The purpose of this study was to prevent the dilutional effect of excessive absorption of irrigating solution by using furosemide intraoperatively during transurethral resection of the prostate. 30 patients, who belonged to physical status II or III of ASA classification, were selected randomly and divided with two groups as follows: G1 (N=15): Not-administrated furosemide (control group) G2 (N=15): Administrated furosemide (Experimental group) All patients were premedicated with Hydroxyzine (1mg/kg, IM) and were performed continuous epidural anesthesia with 2% lidocaine (1-1.5mg/segment). For irrigating solution, 5% D-sorbitol was used and Hartman's solution were given for maintenance fluid and fixed the height of irrigating container to 60 cm from symphysis pubis. With the starting of operation, 20 mg furosemide was administrated to experimental group. The blood samples for the values of Na⁺, K⁺, Glucose and BUN were performed at the periods of preoperation, 10 min, 20 min, 30 min after the starting of operation and immediate postoperation. Based these date, serum osmolality and effective osmolality were calculated. The results were as follows: 1. The sodium concentration of control group was decreased statistically significantly at 10 min, 20 min, 30 min after the starting of operation and immediate postoperative period as comparing with the preoperation value (p<0.05). But that of experimental Group was not changed significantly. 2. The serum osmolality and effective osmolality were decreased statistically significantly at 30 min after the starting of operation and immediate postoperative period as comparing with the preoperation value (p<0.05). But those of experimental group were not changed significantly. These results show that the dilutional effect of excessive absorption of irrigating solution might be prevented by using furosemide intraoperatively. And so we recommend the use of furosemide during TURP, especially in patients with congestive heart failure or renal failure.
Absorption ; Anesthesia, Epidural ; Classification ; Furosemide* ; Glucose ; Heart Failure ; Humans ; Hydroxyzine ; Lidocaine ; Osmolar Concentration* ; Postoperative Period ; Prostate* ; Pubic Bone ; Renal Insufficiency ; Sodium ; Transurethral Resection of Prostate

Since the epidural catheterization has been widely used for the purpose of anesthesia, diagnosis and pain control, there are various undesirable complications and hazards through the technical procedure or catheterization itself. Authors have experienced several hazards of location of the epidural catheter tip which were detected by epidurography performed the 1st. or 2nd. postoperative day with 50% Angiograffin. Hazards were as follows; 1) Single air bubble in the epidural space. 2) Inappropriate placement of the catheter tip. 3) Kinking of catheter in the epidural space. 4) Intravascular placement of the catheter.
Anesthesia ; Catheterization* ; Catheters* ; Diagnosis ; Epidural Space

The common causes of postoperative liver dysfunction during anesthesia and surgery are due to the decreased cardiac output and/or systemic blood pressure as well as poor regional distribution of hepatic blood flow. It is well known that the surgical manipulation and the kinds of operation, especially around the hepatic area, are more important factors about the hepatic blood flow than anesthetics and anesthesia techniques. We postulated that the activity of sympathetic reflex initiated by surgical manipulation could be abolished by instituting epidural block on the peripheral operative field and consequently hepatic blood flow might be improved. We randomly selected 40 patients for upper abdominal surgery and divided them into 4 groups as follows: Group 1: Halothane anesthesia (10 cases, normal liver function test (LFT); contol) Group 2: Halothane anesthesia with epidural block (10 cases, normal LFT) Group 3: Enflurane anesthesia (10 cases, abnormal LFT; control) Group 4: Enflurane anesthesia with epidural block (10 cases, abnormal LFT) Epidural block was performed just before general anesthesia with 1% lidocaine, 2 ml/segment. Mean arterial pressure (MAP) was measured before anesthesia and at 5, 10, 15, 20, 30 and 60 min during surgery. And serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), alkaline phosphatase, total protein and albumin were measured before anesthesia and on the 1st, 3rd, 5th and 7th postoperative day. The results were as follows: 1) MAP was changed significantly at 20 min in group 2 (p < 0. 01) and at 15 min in group 4(p < 0. 05). 2) The values of postoperative LFT were changed similarly but no statistical difference between group 1 and 2. 3) The values of postoperative LFT were declined significantly (esp. SGOT and SGPT), but no statistical difference between group 3 and 4. 4) Even though the postulation is correct, the effects of epidural block combined with general anesthesia (group 2, 4) on postoperative liver function were not different statistically compared with that of general anesthesia alone (group 1, 3). It might be suggested that the amount of decreased blood flow caused by surgical manipulation would be similar with that by the epidural block. 5) Now we hope that the further evaluation will be expected about the hepatic blood flow such as direct measurement.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Arterial Pressure ; Aspartate Aminotransferases ; Blood Pressure ; Cardiac Output ; Enflurane ; Halothane ; Hope ; Humans ; Lidocaine ; Liver Diseases ; Liver Function Tests ; Liver* ; Reflex

diopathic facial nerve paralysis after surgery is not common but has clinical significance. We report a case of facial nerve paralysis in the immediate postanesthetic period after cervical spine surgery. A 41-year-old man with cervical herniated disc was scheduled for cervical laminectomy. After uneventful surgery, he suffered from left facial numbness and weakness. Imaging study and audiogram couldn't reveal any anatomic abnormality except Thornwaldt cyst. Conservative treatment with steroids and antivirals resolved his symptoms until 16th day after surgery.
Adult ; Anesthesia, General ; Antiviral Agents ; Facial Nerve ; Facial Paralysis ; Humans ; Hypesthesia ; Intervertebral Disc Displacement ; Laminectomy ; Paralysis ; Spine ; Steroids

Hepatic duct diverticulum is a rare form of choledochal cyst that does not fit into the most widely used Todani classification system. Because of its rarity, it may be difficult for clinicians to diagnose and treat it. Here, we present a case of left hepatic diverticulum in a 57-year-old woman with epigastric pain. At presentation, there were mild elevations in the liver function tests. Computed tomography and magnetic resonance cholangiopancreatography showed diverticulum-like cystic lesion with sludge ball near the confluence portion of both intrahepatic bile duct, but the origin of the lesion could not be identified. The clinical impression was type II choledochal cyst. Surgical excision was planned due to recurrent abdominal pain. The operative findings revealed diverticulum arising from left hepatic duct. Histopathology confirmed the lesion to be diverticulum lined by biliary epithelium. The patient had no postoperative complication and no further symptoms since the operation.
Abdominal Pain ; Bile Ducts ; Bile Ducts, Intrahepatic ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst ; Classification ; Diverticulum ; Epithelium ; Female ; Hepatic Duct, Common ; Humans ; Liver Function Tests ; Middle Aged ; Postoperative Complications ; Sewage

Neurosyphilis is an infection of the brain or spinal cord that is caused by the bacterium Treponema pallidum. Syphilitic myelitis, which involves the spinal cord, is a very rare form of neurosyphilis seen in patients with syphilis. It requires differentiation from other diseases of the spinal cord, including idiopathic transverse myelitis and spinal cord infarction. Herein, we describe the presentation and diagnosis of syphilitic myelitis in a 43-year-old woman, based on a flip-flop sign and candle guttering appearance depicted in magnetic resonance imaging and laboratory tests.
Adult ; Brain ; Diagnosis ; Female ; Humans ; Infarction ; Magnetic Resonance Imaging ; Myelitis ; Myelitis, Transverse ; Neurosyphilis ; Spinal Cord ; Syphilis ; Treponema pallidum

Emphysematous gastritis is an infectious disease in which air is formed in the gastric wall by gas-forming organisms. It is infrequently reported but can be fatal without early diagnosis and treatment. The stomach is rarely infected because of the acidity of the gastric secretions and the rich blood supply. Treatment should be aimed at covering gram-negative organisms and anaerobes using broad-spectrum intravenous antibiotics, and occasional surgical management in order to enhance survival. Risk factors are those that lead to disrupted mucosal integrity, such as corrosive injury, and those that result in an immunosuppressed condition, including diabetes mellitus, chronic kidney disease, immunosuppressive drug use, and subsequent invasion by gas-forming organisms. We experienced a case of emphysematous gastritis that worsened after endoscopy. Aeration during upper endoscopy examination can cause barotrauma to the gastric wall with impairment of the mucosal barrier, resulting in the spread of gastric wall infection to the whole body. Therefore, we report this case and provide relevant literature review to suggest that early endoscopic evaluation can lead to exacerbation of emphysematous gastritis.

Purpose: To investigate the MRI features associated with neural foraminal stenosis (NFS) in patients older than 60 years with lumbar (L) radiculopathy. Materials and Methods: This study included 133 retrospectively selected patients older than 60 years with lumbar radiculopathy who had undergone a lumbar spine MRI (from January 2018 to April 2018). For L4/L5 and L5/sacral (S)1 levels, NFS was reviewed blindly by two radiologists. Spondylolisthesis, retrolisthesis, disc height loss, disc bulging/herniation/central canal stenosis, ligamentum flavum thickening, and facet hypertrophy were evaluated separately for the NFS and non-NFS groups, and they were compared using univariate and multivariate analyses. Results: The univariate analysis revealed that disc height loss (p = 0.006) was associated with NFS for L4/L5. For L5/S1, both spondylolisthesis (p = 0.005) and facet hypertrophy (p = 0.006) were associated with NFS. The multivariate logistic analysis revealed that disc height loss was associated with NFS for L4/L5 [odds ratio (OR) = 4.272; 95% confidence interval (CI) 1.736– 10.514]. For L5/S1, spondylolisthesis (OR = 3.696; 95% CI 1.297–10.530) and facet hypertrophy (OR = 6.468; 95% CI 1.283–32.617) were associated with NFS. Conclusion Disc height loss was associated with NFS for L4/L5 and spondylolisthesis and facet hypertrophy were associated with NFS for L5/S1.

Purpose: To investigate the MRI features associated with neural foraminal stenosis (NFS) in patients older than 60 years with lumbar (L) radiculopathy. Materials and Methods: This study included 133 retrospectively selected patients older than 60 years with lumbar radiculopathy who had undergone a lumbar spine MRI (from January 2018 to April 2018). For L4/L5 and L5/sacral (S)1 levels, NFS was reviewed blindly by two radiologists. Spondylolisthesis, retrolisthesis, disc height loss, disc bulging/herniation/central canal stenosis, ligamentum flavum thickening, and facet hypertrophy were evaluated separately for the NFS and non-NFS groups, and they were compared using univariate and multivariate analyses. Results: The univariate analysis revealed that disc height loss (p = 0.006) was associated with NFS for L4/L5. For L5/S1, both spondylolisthesis (p = 0.005) and facet hypertrophy (p = 0.006) were associated with NFS. The multivariate logistic analysis revealed that disc height loss was associated with NFS for L4/L5 [odds ratio (OR) = 4.272; 95% confidence interval (CI) 1.736– 10.514]. For L5/S1, spondylolisthesis (OR = 3.696; 95% CI 1.297–10.530) and facet hypertrophy (OR = 6.468; 95% CI 1.283–32.617) were associated with NFS. Conclusion Disc height loss was associated with NFS for L4/L5 and spondylolisthesis and facet hypertrophy were associated with NFS for L5/S1.

Gastric tuberculosis accounts for approximately 2% of all cases of gastrointestinal tuberculosis. Diagnosis of gastric tuberculosis is challenging because it can present with various clinical, endoscopic, and radiologic features. Tuberculosis manifesting as a gastric subepithelial tumor is exceedingly rare; only several dozen cases have been reported. A 30-year-old male visited emergency room of our hospital with hematemesis and melena. Abdominal CT revealed a 2.5 cm mass in the gastric antrum, and endoscopy revealed a subepithelial mass with a visible vessel at its center on gastric antrum. Primary gastric tuberculosis was diagnosed by surgical wedge resection. We report a rare case of gastric tuberculosis mimicking a subepithelial tumor with acute gastric ulcer bleeding.
Adult ; Diagnosis ; Emergency Service, Hospital ; Endoscopy ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage* ; Humans ; Male ; Melena ; Pyloric Antrum ; Stomach Ulcer ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Gastrointestinal