We report two cases of post-extubation negative pressure pulmonary edema in otherwise healthy patients. The patients underwent laparoscopic appendectomy under general anesthesia and developed negative pressure pulmonary edema immediately after extubation. All cases fully resolved within 24 hours with supplementary oxygen. The literature suggests that post-extubation pulmonary edema occurs more frequently than is generally thought, with a frequency of 0.05-0.1% in all anesthesia, and is often unrecognized or misdiagnosed. Most cases occur in the early post-operative period, and this is potentially life-threatening condition. Therefore, anesthesiologist and surgeon are well placed to witness, investigate and manage this condition.
Anesthesia ; Anesthesia, General ; Appendectomy ; Humans ; Oxygen ; Pulmonary Edema ; Wit and Humor as Topic

In this prospective study, 208 cases of ptosis were repaired using dried preserved fascia lata as suspension material for frontalis sling procedure during 1990 to 1996. The average age at operation was 9.2 years with the range of 2 months to 56 years. One hundred forty one patients (91.0%) of the 155 patients with follow-up of more than 3 months and 99 (90.8%) of the 109 patients with follow-up of more than 6 months showed satisfactory results respectively. Among 12 unsatisfactory cases six patients underwent reoperation and achieved satisfactory results. Exposure keratitis was the most common complication (39.4%)but most of them were transient. The authors report frontalis sling operation using preserved fascia lata with 96.3% of success rate with few complications.
Blepharoptosis ; Fascia Lata* ; Fascia* ; Follow-Up Studies ; Humans ; Keratitis ; Prospective Studies ; Reoperation

OBJECTIVE: We investigated the association between lactate clearance or serum lactate levels and neurologic outcomes or in-hospital mortality in cardiac arrest survivors who were treated with targeted temperature management (TTM). METHODS: A retrospective analysis of data from cardiac arrest survivors treated with TTM between 2012 and 2015 was conducted. Serum lactate levels were measured on admission and at 12, 24, and 48 hours following admission. Lactate clearance at 12, 24, and 48 hours was also calculated. The primary outcome was neurologic outcome at discharge. The secondary outcome was in-hospital mortality. RESULTS: The study included 282 patients; 184 (65.2%) were discharged with a poor neurologic outcome, and 62 (22.0%) died. Higher serum lactate levels at 12 hours (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.006 to 1.331), 24 hours (OR, 1.320; 95% CI, 1.084 to 1.607), and 48 hours (OR, 2.474; 95% CI, 1.459 to 4.195) after admission were associated with a poor neurologic outcome. Furthermore, a higher serum lactate level at 48 hours (OR, 1.459; 95% CI, 1.181 to 1.803) following admission was associated with in-hospital mortality. Lactate clearance was not associated with neurologic outcome or in-hospital mortality at any time point after adjusting for confounders. CONCLUSION: Increased serum lactate levels after admission are associated with a poor neurologic outcome at discharge and in-hospital mortality in cardiac arrest survivors treated with TTM. Conversely, lactate clearance is not a robust surrogate marker of neurologic outcome or in-hospital mortality.
Biomarkers ; Heart Arrest* ; Hospital Mortality ; Humans ; Hypothermia, Induced ; Lactic Acid* ; Prognosis ; Retrospective Studies ; Survivors*

PURPOSE: There has been debate on the use of peritoneal irrigation and drainage following gastric cancer surgery. This study was conducted to evaluate the usefulness of routine peritoneal irrigation and drainage following gastric cancer surgery, especially with regard to the perioperative leukocyte count. METHODS: Of 298 patients, 153 were enrolled in the test group (without peritoneal irrigation & drainage), between October 2001 and August 2002, and 145 in the control group (with peritoneal irrigation and drainage), between January 2001 and September 2001. The demographics, range of dissection, pathological staging, operation times, anesthesia times, fever, perioperative leukocyte counts and operative complications were retrospectively analyzed in these consecutive patients. RESULTS: It was found that there was no difference in the demographics, range of dissection, pathological staging and operative complications between the two groups. However, the operation times, anesthesia times, and mean length of hospitalization in the test group were significantly shorter than those in the control group. No significance differences were found between the two groups with regard to the perioperative leukocyte counts. CONCLUSION: The routine usage of peritoneal irrigation and drainage was found to be neither safe nor effective in gastric cancer surgery patients.
Anesthesia ; Demography ; Drainage* ; Fever ; Hospitalization ; Humans ; Leukocyte Count* ; Leukocytes* ; Peritoneal Lavage* ; Retrospective Studies ; Stomach Neoplasms*

Solid and papillary neoplasms of the pancreas, a rare tumor usually found in young female patients, seldom presents with metastasis since it is a tumor with low potential for malignancy. The prognosis for this lesion is much more favorable than that for other pancreatic neoplasms. In an attempt to understand the characteristics and prognosis of this lesion, we reviewed twenty cases treated at the Department of Surgery, Severance Hospital, Yonsei University from 1985 to 1994. The mean age of the patients was 25.6 years (range: 13 to 39 years), and 19 (95%) were women. Chief complaints were palpable mass (50%), pain (45%), and indigestion(5%). In laboratory studies, tumor markers, including CEA, CA125, CA19-9, and aFP were studied in eight patients, and found negative. Other laboratory findings were also nonspecific. These tumors may occur anywhere in the pancreas. In our studies, the tumor was most often located in the tail (45%), and the head (40%) of the pancreas. These were treated by distal pancreatectomy and splenectomy (55%), Whipple's operation (20%), pylorus preserving pancreatoduodenectomy (10%), enucleation (10%) or excision (5%). Significant morbidity or mortality was not observed during hospitalization, and no recurrence or malignant degeneration occurred during the mean follow-up period of 4 years (range: 1 month to 9 years). In conclusion, this study has suggested that the patients with a solid and papillary neoplasm of the pancreas have a good prognosis for successful treatment, if the disease is diagnosed early and the tumor is completely resected. A higher index of suspicion, and more aggressive diagnostic workups are needed in dealing with this disease entity.
Adolescent ; Adult ; Carcinoma, Papillary/diagnosis/*pathology/surgery ; Female ; Follow-Up Studies ; Human ; Male ; Pancreatic Neoplasms/diagnosis/*pathology/surgery

Though non-tumoral stenosis of the aqueduct has long been described as a common cause of hydrocephalus in infants and young children, its occurrence in adults has been recorded infrequently. In adults, the general picture of the clinical features is of chronic hydrocephalus such as impaired memory, epilepsy, unsteady gait, headache and other features of increased intracranial tension and endocrine disorders and features indicative of hypothalamic involvement. Plain skull X-rays show the signs of increased intracranial tension. The diagnosis if confirmed by ventriculography with or without lumbar encephalography. Recently cerebral angiography is stressed in diagnosis of aqueductal stenosis. We have seen two cases of aqueductal stenosis which can be regarded as non-tumoral origin. They were females and 29 and 34 years old respectively. Their symptoms were similar. It was headache for several months' duration which were aggrevated as time progress and combined with convulsions. Bilateral papilledema was the only finding in neurological examination. In conray ventriculography, the third ventricles were markedly enlarged and involved the salla tursica, and conray was not filled the caudal part of the aqueduct in two cases. The first case, following Torkildsens ventriculocisternal shunt did well for several days, however, patient died in spite of massive antibiotic therapy and ventriculostomy after removal of shunt tube which was regarded as infective. Autopsy showed periaqueductal gliosis without neoplasmic infiltration. Second case was improved with anterior third ventriculostomy.
Adult* ; Autopsy ; Cerebral Angiography ; Child ; Constriction, Pathologic ; Diagnosis ; Epilepsy ; Female ; Gait Disorders, Neurologic ; Gliosis ; Headache ; Humans ; Hydrocephalus* ; Infant ; Memory ; Neurologic Examination ; Papilledema ; Seizures ; Skull ; Third Ventricle ; Ventriculostomy

Though non-tumoral stenosis of the aqueduct has long been described as a common cause of hydrocephalus in infants and young children, its occurrence in adults has been recorded infrequently. In adults, the general picture of the clinical features is of chronic hydrocephalus such as impaired memory, epilepsy, unsteady gait, headache and other features of increased intracranial tension and endocrine disorders and features indicative of hypothalamic involvement. Plain skull X-rays show the signs of increased intracranial tension. The diagnosis if confirmed by ventriculography with or without lumbar encephalography. Recently cerebral angiography is stressed in diagnosis of aqueductal stenosis. We have seen two cases of aqueductal stenosis which can be regarded as non-tumoral origin. They were females and 29 and 34 years old respectively. Their symptoms were similar. It was headache for several months' duration which were aggrevated as time progress and combined with convulsions. Bilateral papilledema was the only finding in neurological examination. In conray ventriculography, the third ventricles were markedly enlarged and involved the salla tursica, and conray was not filled the caudal part of the aqueduct in two cases. The first case, following Torkildsens ventriculocisternal shunt did well for several days, however, patient died in spite of massive antibiotic therapy and ventriculostomy after removal of shunt tube which was regarded as infective. Autopsy showed periaqueductal gliosis without neoplasmic infiltration. Second case was improved with anterior third ventriculostomy.
Adult* ; Autopsy ; Cerebral Angiography ; Child ; Constriction, Pathologic ; Diagnosis ; Epilepsy ; Female ; Gait Disorders, Neurologic ; Gliosis ; Headache ; Humans ; Hydrocephalus* ; Infant ; Memory ; Neurologic Examination ; Papilledema ; Seizures ; Skull ; Third Ventricle ; Ventriculostomy

Hypoglycemic effects of exo-biopolymers (EBP) produced by submerged mycelial cultures of Coriolus versicolor, Cordyceps sinensis, Paecilomyces japonica, Armillariella mellea, and Fomes fomentarius were investigated in streptozotocin (STZ)-induced diabetic rats. The rats from each experimental group were orally administered with EBPs (100 mg/kg BW) daily for 2 weeks. Though the hypoglycemic effect was achieved in all the cases, however, C. versicolor EBP proved as the most potent one. The administration of the C. versicolor EBP substantially reduced (29.9%) the plasma glucose level as compared to the saline administered group (control). It also reduced the plasma total cholesterol (TC), triglyceride (TG), aspartate aminotransferase (AST) and, alanine aminotransferase (ALT) levels by 9.22, 23.83, 16.93, and 27.31%, respectively. The sugar and amino acid compositions of this EBP were also analyzed in detail.
Agaricales ; Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Cholesterol ; Cordyceps ; Coriolaceae ; Glucose ; Hypoglycemic Agents ; Paecilomyces ; Plasma ; Rats ; Streptozocin

PURPOSE: Hypothermia has been demonstrated to protect the brain from reperfusion injury in patients suffering from cardiac arrest. We hypothesized that infusion of normal saline at 4 degrees C into the carotid artery (hypothermic carotid arterial flush, HCAF) during cardiac arrest would achieve selective cerebral hypothermia during cardiac arrest and cardiopulmonary resuscitation (CPR), without a detrimental effect on the rate of return of spontaneous circulation (ROSC) or significant impairment of cardiopulmonary function after ROSC. METHODS: Ventricular fibrillation was induced in 18 dogs weighing 12~18 kg, and circulatory arrest was maintained for 9 minutes. The subjects were then resuscitated using open cardiac massage. Group I (n=6) received no normal saline, while the dogs of group II (n=6) and group III (n=6) received infusions of 15 ml/kg and 30 ml/kg of normal saline solution, respectively, at 4 degrees C into both carotid arteries (cephalad) via 18 gauge catheters. RESULTS: Tympanic temperature decreased from 37.7 (37.5~37.7) degrees C to 34 degrees C within 1.2 (1~2) min and 1.0 (1~2) min from the start of HCAF in groups II and III, respectively. Thereafter, tympanic temperatures were maintained below 34 degrees C to 7.7 (1.5~14.5) min and 21.2 (12~37) min, respectively, from the start of HCAF in groups II and III. There were no significant differences in CPR-related variables or post-ROSC hemodynamic and laboratory variables between the two groups. CONCLUSION: HCAF rapidly induces selective cerebral hypothermia without detrimental effects on the rate of ROSC or significant impairment of cardiopulmonary function after ROSC.
Animals ; Brain ; Cardiopulmonary Resuscitation ; Carotid Arteries ; Catheters ; Dogs ; Heart Arrest* ; Heart Massage ; Hemodynamics ; Humans ; Hypothermia* ; Reperfusion Injury ; Sodium Chloride ; Ventricular Fibrillation

OBJECTIVE: To evaluate the relationship between the presence of apolipoprotein E (Apo E) 4 allele and bone mineral density (BMD) and severity of joint destruction in postmenopausal women with rheumatoid arthritis (RA). METHODS: Apo E genotypes were analyzed in 113 postmenopausal women who were first diagnosed with RA and had not receiving antiresorptive therapy for osteoporosis at the time of enrollment. BMD was measured using dual-energy X-ray absorptiometry (DEXA), and joint destruction was evaluated on plain radiographs according to 'Larsen score'. The differences in BMD and severity of joint destruction in groups with and without an Apo E4 allele were analyzed in 94 patients with clinical information available. RESULTS: BMD (g/cm2) of the lumbar spine in the Apo E4 (-) group was 0.94+/-0.16 (n=67), whereas that in the Apo E4 (+) group was 0.87+/-0.14 (n=27; p=0.049). BMD of the femoral neck and great trochanter in the Apo E4 (-) group was 0.74+/-0.12 and 0.63+/-0.11, while that in the Apo E4 (+) group was 0.68+/-0.11 (p=0.039) and 0.57+/-0.11 (p=0.008). However, there were no significant differences in Larsen scores and erosive disease (%) between the Apo E4 (+) and Apo E4 (-) groups. CONCLUSION: The Apo E4 allele is associated with a reduced bone mass in postmenopausal RA patients. Therefore, Apo E4 allele is considered to be an independent risk factor for generalized osteoporosis in postmenopausal RA patients.
Absorptiometry, Photon ; Alleles ; Apolipoprotein E4 ; Apolipoproteins E ; Apolipoproteins* ; Arthritis, Rheumatoid* ; Bone Density* ; Female ; Femur ; Femur Neck ; Genotype ; Humans ; Joints ; Osteoporosis ; Polymorphism, Genetic* ; Risk Factors ; Spine