No abstract available.
Pregnancy*

BACKGROUND: Esmolol is a short acting sympathetic beta receptor antagonist, and it was successfully applied to induced hypotension. Esmolol lowers blood pressure by decreasing cardiac output, and does not cause vasodilation. This property of esmolol may help to decrease bleeding during induced hypotension. In this study, we tried to elucidate the effect of esmolol on induced hypotension for total hip arthroplasty. METHOD: Twenty patients receiving total hip arthroplasty were randomly divided to two groups. Esmolol group (10 patients) received esmolol as a hypotensive agent, and sodium nitroprusside (SNP) group (10 patients) received SNP as a hypotensive agent. We measured arterial blood gas analysis, vital sign, amounts of bleeding, amounts of transfusion and administered fluid, and various laboratory findings. RESULTS: Induced hypotension was successfully performed in either esmolol and SNP group. Heart rate increased by SNP, and decreased by esmolol. There were no statistically significant differences between the two groups in amounts of bleeding, amounts of transfusion or administered fluid, and laboratory findings. Arterial oxygen tension was relatively constant in esmolol group, but decreased in SNP group. CONCLUSION: Esmolol can be used as a single hypotensive agent during induced hypotension without significant side effects during total hip arthroplasty.
Arthroplasty, Replacement, Hip* ; Blood Gas Analysis ; Blood Pressure ; Cardiac Output ; Heart Rate ; Hemorrhage ; Humans ; Hypotension* ; Nitroprusside* ; Oxygen ; Sodium* ; Vasodilation ; Vital Signs

A 42 year-old male with a history of multidrug-resistant pulmonary tuberculosis suddenly developed massive hemoptysis. Embolization of a bronchial artery branch and the collateral systemic arteries did not resolve the recurrent bleeding. Spiral computerized tomography(spiral CT) of the chest showed contrast enhanced nodules within a large cavity at the left lower lobe in the arterial phase suggesting a Rasmussen aneurysm. A pulmonary angiogram showed abnormal vascular nodules at that site. Coils were deployed at both the proximal and distal vessels of this aneurysmal sac for embolization. Transcatheter arterial embolization is a safe and effective means of controlling bleeding from this pulmonary arterial pseudoaneurysm. Here we report a case of a Rasmussen aneurysm diagnosed by spiral CT, which was successfully treated by pulmonary arterial embolization with a coil.
Aneurysm* ; Aneurysm, False ; Arteries ; Bronchial Arteries ; Embolization, Therapeutic ; Hemoptysis ; Hemorrhage ; Humans ; Male ; Respiratory Insufficiency ; Thorax ; Tomography, Spiral Computed ; Tuberculosis, Pulmonary

The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence. No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature. Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension.
Aortic Aneurysm/*complications/diagnosis ; Aortic Rupture/*complications/diagnosis ; Constriction, Pathologic ; Female ; Hematoma/*complications ; Human ; Hypertension, Pulmonary/*etiology ; Middle Aged ; Pulmonary Artery/pathology/radiography ; Tomography, X-Ray Computed

Aneurysms at the distal branch of the middle cerebral artery may be mycotic or congenital in origin. A 34 year-old male patient was admitted with a seizure and a 7-day history of upper respiratory tract infection. The neurological examination showed no abnormality except for headache and mild dysarthria. There was no intracardiac lesion suggesting infective endocarditis. CT, MRI and cerebral angiograms revealed a partially thrombosed giant aneurysm at the distal branch of the middle cerebral artery. Pathologic examination revealed acute inflammatory cells and focal necrosis in the aneurysmal wall as well as recent thrombus. Here, we are reporting an unusual case with a giant distal middle cerebral artery aneurysm with intramural inflammation, suggesting a congenital giant aneurysm with secondary infectious inflammation.
Adult ; Aneurysm ; Aneurysm, Infected* ; Dysarthria ; Endocarditis ; Headache ; Humans ; Inflammation ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Male ; Middle Cerebral Artery* ; Necrosis ; Neurologic Examination ; Respiratory Tract Infections ; Seizures ; Thrombosis

Background: A 35-year-old woman was admitted to the emergency room with sudden dyspnea that developed one day prior. The initial Chest X-ray showed multiple bullous changes at the right middle and lower lung field and long standing fibrotic tuberculous changes at the right upper lung field. The left lung field was totally collapesed by an fibrotic old tuberculous lesion. In spite of supportive medical care with oxygen therapy after admission, the radiographic lesions were no significant change but the respiratory distress had worsend. The patient suffered respiratory failure and receive mechanical ventilatory support. The HRCT showed a localized tension pneumothorax mimicking multiple giant bullae at the right lower lung field. Immediately after a closed thoracostomy with a 32 French chest tube and air drainage, her vital signs and dyspnea were gradually improved. The patient was successfully weaned from mechanical ventilation after 5 days of mechanical ventilatory support. The patient had receive talc pleurodesis through a chest tube to prevent the recurrence of the life-threatening localized pneumothorax. The patient was discharged without recurrence of the pneumothorax.
Adult ; Chest Tubes ; Drainage ; Dyspnea ; Emergency Service, Hospital ; Female ; Humans ; Lung ; Oxygen ; Pleurodesis ; Pneumothorax* ; Recurrence ; Respiration, Artificial ; Respiratory Insufficiency ; Talc ; Thoracostomy ; Thorax ; Vital Signs

Calcific constrictive pericarditis is considered to be a nonspecific response to chronic inflammation. This disease has become rare, because the cause of it is usually tuberculosis, which has the tendency to decrease. Other possible causes of it include radiation, rheumatoid disorders, sarcoidosis, and trauma. Whatever the etiology, it can lead to cardiac tamponade by reducing cardiac diastolic filling. We report, herein, the case of a patient with heart failure by a calcific pericardial ring.
Cardiac Tamponade ; Heart Failure* ; Heart* ; Humans ; Inflammation ; Pericarditis, Constrictive ; Sarcoidosis ; Tuberculosis

Laryngoscopy and endotracheal intubation are often associated with hypertension, tachycardia and increase in catecholamines concentrations. The mechanism for these reflex cardiovas-cular changes is unknown, but may be a result of reflex sympathetic activation, involving baroreceptor system, provoked by stimulation of the epipharynx and laryngopharynx. The purpose of the present study was to determine the effect of increasing age on the changes of hemodynamic response to endotracheal intubation. We evaluated in 36 patients aged 20~79 years, ASA class I and II, given atropine sulfate 0.01 mg/kg and hydroxyzine sulfate 0.04 mg/kg I.M as premedication and thiopental sodium 5.0 mg/kg and succinylcholine chloride 1.0 mg/kg I.V. for induction of anesthesia. Patients were studied in three age group's as followings, Group I (n=12):20~39years Group II (n=12): 40~59 years Group III (n=12): 60~79 years Heart rate and blood pressure increased at endotracheal intubation in all age groups to compare with control value, there were no relationship with age in increment of blood pressure but increment of heart rate diminished with advancing age. The reason for above results is that the sensitivity to the vasoconstrictive effect of a-recep- tor stimulation is similar in all age groups, but the sensitivity to B-receptor stimulation altered cardiac chronotropic response is different with advancing age. Additionally, the diminution of sensitivity to a-receptor is not caused by decrease of density of B-receptor, but due to the impairment in the coupling of the B-receptor adenylate cyclase complex in the elderly.
Adenylyl Cyclases ; Aged ; Anesthesia ; Anesthesia, General ; Atropine ; Blood Pressure ; Catecholamines ; Geriatrics ; Heart Rate ; Hemodynamics* ; Humans ; Hydroxyzine ; Hypertension ; Hypopharynx ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy ; Premedication ; Pressoreceptors ; Reflex ; Succinylcholine ; Tachycardia ; Thiopental

Laryngoscopy and endotracheal intubation are often associated with hypertension, tachycardia and increase in catecholamines concentrations. The mechanism for these reflex cardiovas-cular changes is unknown, but may be a result of reflex sympathetic activation, involving baroreceptor system, provoked by stimulation of the epipharynx and laryngopharynx. The purpose of the present study was to determine the effect of increasing age on the changes of hemodynamic response to endotracheal intubation. We evaluated in 36 patients aged 20~79 years, ASA class I and II, given atropine sulfate 0.01 mg/kg and hydroxyzine sulfate 0.04 mg/kg I.M as premedication and thiopental sodium 5.0 mg/kg and succinylcholine chloride 1.0 mg/kg I.V. for induction of anesthesia. Patients were studied in three age group's as followings, Group I (n=12):20~39years Group II (n=12): 40~59 years Group III (n=12): 60~79 years Heart rate and blood pressure increased at endotracheal intubation in all age groups to compare with control value, there were no relationship with age in increment of blood pressure but increment of heart rate diminished with advancing age. The reason for above results is that the sensitivity to the vasoconstrictive effect of a-recep- tor stimulation is similar in all age groups, but the sensitivity to B-receptor stimulation altered cardiac chronotropic response is different with advancing age. Additionally, the diminution of sensitivity to a-receptor is not caused by decrease of density of B-receptor, but due to the impairment in the coupling of the B-receptor adenylate cyclase complex in the elderly.
Adenylyl Cyclases ; Aged ; Anesthesia ; Anesthesia, General ; Atropine ; Blood Pressure ; Catecholamines ; Geriatrics ; Heart Rate ; Hemodynamics* ; Humans ; Hydroxyzine ; Hypertension ; Hypopharynx ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy ; Premedication ; Pressoreceptors ; Reflex ; Succinylcholine ; Tachycardia ; Thiopental

Kidney transplantation is the treatment of choice for the vast majority of patients with end-stage renal disease. A total of 350 living donor renal transplantations were performed by renal transplantation team of Dongsan medical center, Keimyung University between November 1982 and October 1996. In order to evaluate the results of renal transplantation using multiple renal arteries, we reviewed our recipients about their post-transplant renal function, blood pressure, rejection episode and complications according to their arterial anastomosing types. The recipients were divided into 4 groups: Group 1- one donor renal artery anastomosed to one recipient renal artery(n=288), Group 2- two donor renal arteries anastomosed to recipient renal artery as a single lumen(n=38) (2a; smaller renal artery anastomosed to larger renal artery as end to side fashion(n=23), 2b; double barrel type anastomosis after wedge shape excision of each renal artery(n=15)), Group 3-more than one donor renal arteries anastomosed to multiple sites of recipient arteries(n=9), Group 4-small polar artery was ligated(n=15). The BUN, serum creatinine, systolic and diastolic pressure all showed no statistical differences between each group at 1, 6 months and 1, 3, 5 years after transplantation. But the incidence of acute tubular necrosis was frequent in Group 4 compare with Group 1 (14.3% vs 1.4%) and their onset time is delayed than Group 1 (18.5 months vs 8.2 months). Acute rejection episode in Group 4 was also higher than other groups (80.0% vs 34.5%, 24%, 11.1% in group 1, 2, 3). Post-transplant surgical complication including urological complications, however, seems not correlated with type or number of renal artery anastomosis. These results suggest that number of renal artery of donor and renal arterial anastomosis in recipient didn't affect the post-transplant renal function and their clinical courses only if arterial anastomosis be done meticulously, but polar artery ligation must be avoided to reduce the incidence of acute tubular necrosis and acute rejection episode.
Arteries ; Blood Pressure ; Creatinine ; Humans ; Incidence ; Kidney Failure, Chronic ; Kidney Transplantation ; Ligation ; Living Donors ; Necrosis ; Renal Artery* ; Tissue Donors