We have experienced an anesthetic management of a 34 year old female patient with pheochromocytoma of left adrenal gland. The anesthetic management of patients presents many difficult problems, such as hypertension, arrhythmia and hypotension. The patient had been treated with phenoxybenzamine for 2 weeks preoperatively. Following induction of anesthesia with intravenous fentanyl, thiopental sodium and vecuronium, endotracheal intubation was performed. Anesthesia was maintained with nitrous oxide, oxygen and isoflurane administration. Blood pressure and pulse were controlled well with nitroprusside and isoflurane. After removal of tumor, blood pressure was controlled by Hartman's solution, packed red cell and dopamine administration. The patient tolerated well despite the episodic hemodynamic changes. Importance of preoperative preparation, sufficient sedation, smooth induction, complete analgesia, good muscle relaxation and stable cardiovascular control has been discussed.
Adrenal Glands ; Adult ; Analgesia ; Anesthesia ; Anesthesia, Inhalation* ; Arrhythmias, Cardiac ; Blood Pressure ; Dopamine ; Female ; Fentanyl ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Inhalation* ; Intubation, Intratracheal ; Isoflurane* ; Muscle Relaxation ; Nitroprusside ; Nitrous Oxide ; Oxygen ; Phenoxybenzamine ; Pheochromocytoma* ; Thiopental ; Vecuronium Bromide

Local or general anesthesia is essential for safe operation. Patients in good preoperative condition are relatively to tolerable to the operation, but the patients in poor preoperative condition have the high mortality and morbidity during and after the operation. Therefore, we should choose the anesthetic agents and methods, which cause little effect to the patient's life. Among the intraventricular blocks, bundle branch is the most common type, and left bundle branch block may progress to a more serious condition of complete heart block. Optimal anesthetic management of patients with cardiovascular disease requires a thorough knowledge of normal cardiac physiology, the circulatory effects of the various anesthetic agents, and the pathophysiology and treatment of these diseases. The authors successfully performed balanced anesthesia in operation of a 63 year old female patient who showed complete left bundle branch block pattern in a preoperative electrocardiographic tracing without any subjective symptoms.
Anesthesia, General ; Anesthetics ; Balanced Anesthesia* ; Bundle-Branch Block* ; Cardiovascular Diseases ; Electrocardiography ; Female ; Heart Block ; Humans ; Middle Aged ; Mortality ; Physiology

Local or general anesthesia is essential for safe operation. Patients in good preoperative condition are relatively to tolerable to the operation, but the patients in poor preoperative condition have the high mortality and morbidity during and after the operation. Therefore, we should choose the anesthetic agents and methods, which cause little effect to the patient's life. Among the intraventricular blocks, bundle branch is the most common type, and left bundle branch block may progress to a more serious condition of complete heart block. Optimal anesthetic management of patients with cardiovascular disease requires a thorough knowledge of normal cardiac physiology, the circulatory effects of the various anesthetic agents, and the pathophysiology and treatment of these diseases. The authors successfully performed balanced anesthesia in operation of a 63 year old female patient who showed complete left bundle branch block pattern in a preoperative electrocardiographic tracing without any subjective symptoms.
Anesthesia, General ; Anesthetics ; Balanced Anesthesia* ; Bundle-Branch Block* ; Cardiovascular Diseases ; Electrocardiography ; Female ; Heart Block ; Humans ; Middle Aged ; Mortality ; Physiology

A clinical observation on the nephrectomized 114 patients in the department of Urology, Han Gang Sung Sim Hospital, during the period from January, 1972 to December, 1979 was presented with brief review of the literature. The result were as follows: 1. The total number of in-patients during above period was estimated to 1492. and nephrectomies were performed in the 114 of the 913 urologic operations. (12.4%) 2. The age distribution ranged from 1 year to 66 years with the most common age groups in the 4 th decades. (22.8%) 3. The ratio of male to female was 1.2 to 1. 4. Among the symptoms on admission, hematuria was in 82 cases (71.9%), flank pain in 74 cases (64.9%), and urinary frequency in 46 cases. (40.4%) 5. The causative diseases of the operated kidney showed the highest in renal tuberculosis (30.7%), renal tumor (18.4%), calculous disease (17.5%). renal injury (14.9%) and hydronephrosis (10.5%) by sequence. 6. Flank approach with 1 rib resection was the most frequently used in 52 of 114 cases. 7. Postoperative complications were seen with 3 cases of wound infection, 2 cases of wound dehiscence, 2 cases of atelectasis, 1 case of pneumonia, and 1 case of paralytic ileus. 8. 110 cases (96%) were discharged within 2 weeks after surgery.
Age Distribution ; Female ; Flank Pain ; Hematuria ; Humans ; Hydronephrosis ; Intestinal Pseudo-Obstruction ; Kidney ; Male ; Nephrectomy ; Pneumonia ; Postoperative Complications ; Pulmonary Atelectasis ; Ribs ; Tuberculosis ; Tuberculosis, Renal ; Urology ; Wound Infection ; Wounds and Injuries

Recently we experienced 10 cases of posterior urethral injury associated with pelvic fracture. Of these patients 5 underwent primary realignment with perineal traction on the prostate (Selikowitz method), and the other 5 underwent immediate cystostomy and delayed urethroplasty (Johanson method). Comparison of the post-operative complications didn`t appear to show significant differences in the 2 groups, although the numbers were small. But patients who performed immediate cystostomy and delayed urethroplasty showed some disadvantages of the long period of treatment, high charges, often multiple hard procedures and the long time of operation. Therefore in the initial management of posterior urethral injury, we think it better to take primary realignment in Korean socioeconomic circumstances, if the patient is not in the high risk.
Cystostomy ; Humans ; Prostate ; Traction

BACKGROUND: Intraarticular opioids and local anesthetics may provide effective analgesia following knee arthroscopic surgery. However, there are conflicting results about the analgesic effects of a combination of morphine, bupivacaine and clonidine injected intraarticularly following knee arthroscopic surgery. The goal of this study was to determine whether clonidine added to an intraarticular morphine- bupivacaine combination provide an analgesic benefit. METHODS: Thirty patients scheduled for knee arthroscopic surgery under epidural anesthesia were selected and divided to two groups randomly. The patients in Group 1 received a combination of morphine 3 mg 0.25% bupivacaine 30 ml and patients in Group 2 received a combination of clonidine 3microgram/kg and morphine 3 mg in 30 ml of 0.25% bupivacaine intraarticularly following knee arthroscopic surgery. Postoperative pain was assessed using the visual analogue scale (VAS) and changes of arterial blood pressure, heart rate, requirement of additional analgesics, adverse effects and sedation scale were observed at 1, 2, 4, 8 and 24 hours after intraarticular injection. RESULTS: The VAS observed at 4, 8 and 24 hours after intraarticular injection were significantly lower in group 2 than group 1. Blood pressure and heart rate were not significantly changed between group 1 and group 2. The incidence of side effects, injection of additional analgesics and sedation were similar between the groups. There were no significant differences in hemodynamic changes, analgesic requirements, sedation scale or the increase of side effects between group 1 and group 2. CONCLUSIONS: The results suggest that the combination of intraarticular morphine 3 mg in 30 ml 0.25% bupivacaine plus clonidine provides significantly better analgesia than morphine 3 mg in 30 ml 0.25% bupivacaine alone following knee arthroscopy.
Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthesia, Epidural ; Anesthetics, Local ; Arterial Pressure ; Arthroscopy* ; Blood Pressure ; Bupivacaine ; Clonidine ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Injections, Intra-Articular ; Knee* ; Morphine ; Pain, Postoperative

No abstract available.
Congenital Abnormalities* ; Osteotomy*

Background: Close reading is used in medical education to improve doctors’ listening, empathy and relationship-building ability, but no method for close reading has been suggested yet. In order to efficiently use close reading in medical education, it is essential to present concrete methods of close reading. Methods: The development of the Close Reading methods is based on the basic principles of text interpretation, resources of knowledge in the evaluation process and the theory of variation analysis presented by Lucius-Hoene and Deppermann. Results: The basic principles of text interpretation include data-orientedness, reconstructive attitude, prerequisites for meaningfulness, multilevel consideration, sequence analysis and contextuality, circularity and coherence, explicativity and argumentativity. As knowledge resources there is everyday knowledge, ethographic-historical knowledge, knowledge about linguistic-communicative phenomena, theoretical knowledge. Variation analysis includes substitution, deletion, permutation, insertion. Conclusion The basic principle of text interpretation is worth using as guidelines for text interpretation that readers of close reading should pay attention to. Knowledge resources can be used as the resources and argument for text interpretation. And the Variation analysis can be used to verify the validity of the close reading results. All of these can also be used for teachers in assessing and providing feedback to learners.

PURPOSE: This study aimed to examine the effects of interpersonal relationship ability, job stress, and stress coping type on the turnover intention of nurses in the early stage of their careers. METHODS: Data were collected from 136 early stage nurses from two general hospitals and one tertiary hospital in Chungbuk province. An early stage nurse was defined as the nurse with a work experience of 3 to 36 months. The collected data were analyzed using independent t-test, one-way ANOVA, Mann-Whitney U test, Person's correlation coefficient, and stepwise multiple regression. RESULTS: It was seen that turnover intention had a negative correlation with interpersonal competency (r=-.20, p=.020) and a positive correlation with job stress (r=.56, p < .001). Job stress due to work over load, inadequate compensation and working environment, interpersonal relationship ability, and length of clinical career were significant factors influencing turnover intention (p < .05). These variables explained for 50.4% of the variance in turnover intention. CONCLUSION It is necessary to develop an interpersonal relationship ability improvement program to decrease turnover intention among early stage nurses by helping them to successfully adapt to their job. Moreover, it is important to bring about continuous improvements in terms of provision of adequate workload and appropriate rewards, and creation of a suitable work environment to reduce the job stress of early stage nurses.

No abstract available.