No abstract available.
Transplants* ; Urinary Incontinence*

BACKGROUND: Controversy exists as to whether or not inhalation anesthetics and intravenous anesthetics impair arterial oxygenation (PaO2) during one lung ventilation (OLV). Accordingly, we examined the effect of enflurane and propofol on PaO2 and pulmonary vascular resistance (PVR) during OLV. METHODS: Forty patients, who had prolonged periods of OLV anesthesia with minimal trauma to the nonventilated lung were studied in a cross over design. Patients were randomized to four groups; Group 1 received 1 MAC of enflurane and oxygen from induction until the first 20 min after complete lung collapse, then were switched to propofol 100 g/kg/min (P100). In group 2, the order of the anesthetics was reversed. Group 3, Group 4 received the same order of the anesthetics as Group 1, Group 2, respectively but received propofol 200 g/kg/min (P200). RESULTS: During OLV, the PaO2 values were lower than those with two lung ventilation (TLV), there were no significant differences among each groups and between propofol and enflurane in PaO2, but in the selected patients (n=10, PaO2<120 mmHg during OLV), PaO2 in propofol group was higher than that of enflurane group (p<0.05). Conversion from TLV to OLV caused a significant increase in PVR, but there were no difference in PVR between propofol and enflurane group. CONCLUSIONS: These results suggest that the usual clinical dose of propofol affords no advantage over 1 MAC of enflurane anesthesia except low PaO2 patients during OLV. Propofol might be of value in risk patients of hypoxemia during thoracic surgery when OLV is planned.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Anoxia ; Cross-Over Studies ; Enflurane* ; Humans ; Lung ; One-Lung Ventilation* ; Oxygen* ; Propofol* ; Pulmonary Atelectasis ; Thoracic Surgery ; Vascular Resistance ; Ventilation

BACKGROUND: The implementation of intraoperative normovolemic hemodilution is a strategy used in an attempt to diminish the need for or obviate allogeneic transfusion and to avert the potential complications. The goal of this study was to evaluate the safety and efficacy of moderate intraoperative normovolemic hemodilution. METHODS: Fifteen patients scheduled for posterolateral spinal fusion underwent intraoperative normovolemic hemodilution with 10% pentastarch to a target hematocrit level of 25% (hemodilution group). All units of blood procured by hemodilution and additional allogeneic blood was transfused in the perioperative period to maintain the hematocrit level of>25%. We investigated the effect of hemodilution on whole blood coagulation as measured by the thromboelastography and, evaluated its efficacy of decreasing the need for allogeneic blood transfusion as compared to the nonhemodilution group, retrospectively. RESULTS: Hemodilution with pentastarch caused a decrease in response and coagulation time (p<0.01) but did not influence on the alpha angle and maximum amplitude on thromboelstogram. Amount of transfusion of allogeneic blood was 4.1 1.7 units for the hemodilution group and 5.0 1.5 units for the nonhemodilution group. Net red blood cell volume ""saved"" from hemodilution was about 120 ml. CONCLUSION: Moderate intraoperative normovolemic hemodilution with pentastarch does not affect the coagulability of whole blood. But its efficacy of decreasing the need for allogeneic blood transfusion is minimal.
Blood Coagulation ; Blood Transfusion ; Erythrocytes ; Hematocrit ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Perioperative Period ; Retrospective Studies ; Spinal Fusion* ; Thrombelastography

No abstract available.
Leiomyoma*

Churg and Strauss established the clinicopathologic features of allergic angiitis and granulomatosis. The condition is rare and is characterized by involvement of vessels of all sizes(including veins and venules), especially the pulmonary vessel. intra- and extravascular granuloma formation, eosinophil infiltration of tissue and an association with asthma and peripheral eosinophilia. Churg Strauss syndrome (CSS) involves the GI tract, the skin, the heart, the lungs etc. We report a case of CSS in 38 year old male patient, who presented acute peritonitis and who had had 4-year history of bronchial asthma. An emergency laparotomy revealed multiple impending perforations in small intestine. A skin lesion and neuropathy developed postoperatively. Microscopic exammination of the appendix and the skin lesion showed thrombs in the lumens of vessels, vasculitis and eosinophilic infiltration to the lesion and the vessel wall.
Adult ; Appendix ; Asthma ; Churg-Strauss Syndrome* ; Emergencies ; Eosinophilia ; Eosinophils ; Gastrointestinal Tract ; Granuloma ; Heart ; Humans ; Intestine, Small ; Laparotomy ; Lung ; Male ; Peritonitis ; Skin ; Vasculitis ; Veins

Churg and Strauss established the clinicopathologic features of allergic angiitis and granulomatosis. The condition is rare and is characterized by involvement of vessels of all sizes(including veins and venules), especially the pulmonary vessel. intra- and extravascular granuloma formation, eosinophil infiltration of tissue and an association with asthma and peripheral eosinophilia. Churg Strauss syndrome (CSS) involves the GI tract, the skin, the heart, the lungs etc. We report a case of CSS in 38 year old male patient, who presented acute peritonitis and who had had 4-year history of bronchial asthma. An emergency laparotomy revealed multiple impending perforations in small intestine. A skin lesion and neuropathy developed postoperatively. Microscopic exammination of the appendix and the skin lesion showed thrombs in the lumens of vessels, vasculitis and eosinophilic infiltration to the lesion and the vessel wall.
Adult ; Appendix ; Asthma ; Churg-Strauss Syndrome* ; Emergencies ; Eosinophilia ; Eosinophils ; Gastrointestinal Tract ; Granuloma ; Heart ; Humans ; Intestine, Small ; Laparotomy ; Lung ; Male ; Peritonitis ; Skin ; Vasculitis ; Veins

PURPOSE: The goal of this study was to review the clinicopathologic characteristics of neuroendocrine tumor (NET) of the stomach. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 13 patients who were diagnosed with neuroendocrine tumor from January 1999 to August 2007 at Kosin Medical Center; 4,159 gastric cancer patients were treated surgically during the same time. The average follow up period was 14.3 months. RESULTS: The majority of 13 patients were men (male-female ratio: 11:2) and the average age of patients with NET was 59.4 years (range: 42~72 years). The presenting symptoms were mostly epigastric pain and soreness. The tumor was limited to the mucosa or submucosa in two cases, and the tumor extended beyond the muscle layer in 11 cases. The mean size of the tumor was 7.0 cm, ranging from 0.7 cm to 15 cm. The type of the NEC (according to the WHO classification) was type 3 for eight patients, type 4 for four patients and type 1 for one patient. Regional lymph node metastasis was noted in 11 patients. Four cases showed recurrence of disease and the site of recurrence included liver in two patients, multiple organs (including the peritoneum and lung) in one patient and multiple organs (including liver, pancreas and duodenum) in one patient. The recurrent cases were type 3 and type 4 and the average survival period of the recurrent patients was 12.8 months. CONCLUSION: The majority of neuroendocrine tumors of the stomach were at an advanced stage at the time of diagnosis. These tumors frequently recurred in the liver and they have a poor prognosis.
Follow-Up Studies ; Humans ; Liver ; Lymph Nodes ; Male ; Medical Records ; Mucous Membrane ; Muscles ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Pancreas ; Peritoneum ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach ; Stomach Neoplasms

BACKGROUND: Flow interruption technique has been used to measure respiratory system mechanics, and its prominent advantage is to partitionate the respiratory system resistance into airway and tissue component. In this study, we investigated the effects of varing concentrations of enflurane on respiratory system mechanics using flow interruption technique. METHODS: Six cats, weighing 3.0~3.6 kg were used. Pentobarbital sodium was injected intraperitonially and endotracheal intubation was followed. Intermittent mandatory ventilation was applied with Siemens Servo 900C ventilator. The inspiratory flow rate, tidal volume, and respiratory rate were fixed, and normocarbia (PaCO2; 30~35 mmHg) was maintained throughout the experiment. The changes in the pressure and volume were recorded with Bicore CP100 pulmonary monitor at control, 0.5, 1, 1.5, and 2 MAC of enflurane. The data were transfered to a PC and analyzed by Anadat processing software. Respiratory system, airway and tissue viscoelastic resistances, and dynamic and static compliances were calculated. RESULTS: Respiratory system resistances decreased up to 1 MAC of enflurane compared to the control value (p<0.05), but there were no significant differences in the values of resistance among 1, 1.5, 2 MAC of enflurane. There were no significant differences in tissue viscoelastic resistances, and dynamic and static compliances with varying concentrations of enflurane. CONCLUSIONS: Enflurane significantly reduces the respiratory system resistance mainly by decreasing airway resistance. Tissue viscoelastic resistance and respiratory system compliances are not influenced by changes in concentration of enflurane.
Airway Resistance ; Animals ; Cats* ; Enflurane* ; Intubation, Intratracheal ; Mechanics* ; Pentobarbital ; Respiratory Rate ; Respiratory System* ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

BACKGROUND: The physical results after a pylorus-preserving gastrectomy (PPG) for early gastric cancer were evluated. METHODS: From August 1996 to March 1998, sixteen (16) patients underwent a PPG, and 17 patients underwent a conventional distal gastrectomy with Billroth I anastomosis (DG). The patients undergoing the PPG and theDG procedures were assessed for 1 year following their surgical procedure. Changes in body weight, food intake volume, and abdominal symptoms, which were determined from questionaires, gastric-emptying tests using the acetaminophen method, and gastroscopic findings, were compared between the two groups. RESULTS: There were no significant differences in the body weight ratio and the amount of food taken in a meal between the two groups. Patients who had a PPG had fewer postoperative abdominal symptoms than those who underwent a DG. After a DG, emptying was much more rapid. Gastroscopy revealed that the mucosa of the stomach remnant after a PPG was less abnormal than it was after a DG, but food stasis was more frequent after a PPG. CONCLUSION: A PPG is a more physiological operation than a conventional DG and should be used in carefully selected patient with early gastric cancer to improve their quality of life.
Acetaminophen ; Body Weight ; Eating ; Gastrectomy* ; Gastroenterostomy ; Gastroscopy ; Humans ; Meals ; Mucous Membrane ; Quality of Life ; Stomach ; Stomach Neoplasms*

BACKGROUND : Prophylactic nasogastric decompression is used routinely after elective gastric surgery in spite of many disadvantages and complications - discomfort, pain, especially postoperative atelectasis. The aim of this study was to determine whether routine nasogastric decompression benefitted patients undergoing elective stomach operations. METHODS : Two hundreds forty patients were studied prospectively. All patients underwent elective gastric surgery from January 1994 to March 1996 by one surgeon at Gospel Hospital. In the intubated group, 120 consecutive patients were treated with a nasogastric tube (silastic, 16 French) just before or during the operation, it being removed on the 1st or the 2nd postoperative day. In the tubeless group, a nasogastric tube was not inserted at all in 120 consecutive patients. We compared the differences between two groups with respect to the mean duration of flatus passing, the incidence of postoperative pulmonary complication, leakage, reoperation, wound dehiscence, and operation mortality. RESULTS : The two groups showed no significant differences in age, sex and operation methods. Flatus passed earlier in the tubeless group, but the difference was statistically insignificant. The patients suffering from atelectasis were much larger in number in the intubated group (p<0.03). There were no significant differences in the incidence of anastomotic leakage, wound dehiscence, reoperation and operation mortality. CONCLUSIONS : The routine omission of nasogastric intubation was not associated with increased risks, such as leakage, wound dehiscence, reoperation, postoperative pulmonary complication, delayed flatus passing or diet intake, operative morbidity and motality. Conversely, the incidence of postoperative atelectasis was twice as high in the intubated group. We conclud that routine nasogastric intubation should be used only in specific cases and routine use of nasogastric intubation is not justified.
Anastomotic Leak ; Decompression* ; Diet ; Flatulence ; Humans ; Incidence ; Intubation, Gastrointestinal ; Mortality ; Prospective Studies ; Pulmonary Atelectasis ; Reoperation ; Stomach ; Wounds and Injuries