Heorrhage and infarct-like necrosis of anterior lobe of the pituitary gland is one of the characteristic pathologic findings of the autopsied cases of Korean Hemorrhagic Fever (KHF) patients, but there has been rare reports of hypopituitarism in patients with KHF. Recently we have experienced a patient with hyponatremia who had recovered from KHF. He was admitted to our hospital due to nausea, vomiting, and epigastric discornfort. To determine the function of the anterior pituitary gland, hormonal levels of target galnds and pituitary gland were measured, and combined pituitary stimulation test was performed. ACTH, GH, and prolactin deficiency were confirmed by combined pituitary stimulation test in this patient. There was no evidence of hypothalamic or other pituitary diseases by brain MRI. Our experience shows that KHF can be a cause of hypopituitarism and these findings should alert physicians the possibility of hypopituitarisrn in patients who had recovered from KHF.
Adrenocorticotropic Hormone ; Brain ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Hyponatremia ; Hypopituitarism* ; Magnetic Resonance Imaging ; Nausea ; Necrosis ; Pituitary Diseases ; Pituitary Gland ; Pituitary Gland, Anterior ; Prolactin ; Vomiting

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

Primary aldosteronism is characterized by hypokalemic metabolic alkalosis, low plasma renin activity, elevated plasma aldosterone level and can be suspected in the patients with hypertension and unexplained hypokalemia. Small adrenal cortical adenomas are responsible for this syndrome in most cases. The incidence of thyrotoxic periodic paralysis ranges from 1.9 to 6.2 % in Japan. Thyrotoxic periodic paralysis usually subsides following treatment of hyperthyroidism and has good prognosis. A 56 year-old man presented with hyperthyroidism, hypertension and recurrent hypokalemia. During the treatment of hyperthyroidism, he repeatedly experienced weakness of both lower extremities. Hormonal evaluation was performed and he was found to have a 2*2*1.5 cm sized right adrenal tumor by abdominal computerized topography(CT). After right adrenalectomy, hypokalemic periodic paralysis was improved. Both thyroid and adrenal function should be comprehensively investigated in periodic paralysis. In conclusion, physicians must be aware of the possibility of primary aldosteronism in hyperthyroid patients with hypokalemic periodic paralysis. We report a case of aldosteronoma complicated with hyperthyroidism and literatures are reviewed.
Adrenalectomy ; Adrenocortical Adenoma ; Aldosterone ; Alkalosis ; Humans ; Hyperaldosteronism ; Hypertension ; Hyperthyroidism* ; Hypokalemia ; Hypokalemic Periodic Paralysis ; Incidence ; Japan ; Lower Extremity ; Middle Aged ; Paralysis ; Plasma ; Prognosis ; Renin ; Thyroid Gland

Mitomycin (MMC) is a naturally ocurring alkylating agent, introduced for clinical use as early as 1958. This drug is useful in the therapy of gastrointestinal carcinomas when used in combination with 5-fluorouracil. Nephrotoxicity among toxicities from MMC is unusual with cumulative doses less than 30 mg/m2. In large studies in which the incidence of MMC nephrotoxicity were assessed, 3-15% of patients developed total dose related renal dysfunction. Three patients in our clinical practice have developed thrombotic microangiopathy clearly related to MMC. We report the clinical and pathologic features of our cases. In view of the probable dose-related and delayed toxicity of MMC, it seems necessary to monitor regularly after initiation of chemotherapy. Early detection of the renal impairment and withdrawal of MMC might halt further progression of renal failure.
Drug Therapy ; Fluorouracil ; Humans ; Incidence ; Mitomycin* ; Renal Insufficiency ; Thrombotic Microangiopathies*

A 53-year-old female admitted for multiple rib fracture, hemoptysis and dyspnea due to traffic accident. High resonance CT of the chest revealed bronchiectasis in left lower lobe. She presented for left lower lobectomy with the consent of her. A day before the operation, right internal jugular vein catheter was placed using anterior approach, and free blood flow was achieved. 2 hours after the procedure, she complained of mild chest pain and dyspnea but it was thought to reflect the rib fracture, and then 2 liters of fluid was administered through internal jugular vein catheter. Conducting anesthesia, thiopental sodium and succinylcholine chloride was administered through this route. But loss of consciousness of the patient didn't occur. The chest x-ray taken in OR showed hydrothorax on right pleural cavity.
Accidents, Traffic ; Anesthesia ; Bronchiectasis ; Catheters* ; Chest Pain ; Dyspnea ; Female ; Hemoptysis ; Humans ; Hydrothorax* ; Jugular Veins* ; Middle Aged ; Pleural Cavity ; Rib Fractures ; Succinylcholine ; Thiopental* ; Thorax ; Unconsciousness

BACKGROUND: Perioperative hypothermia is a common problem during both laparotomy and laparoscopic surgery. Hypothermia during laparoscopic surgery is related to the use of irrigation fluid and the large volume of CO2 for maintaining pneumoperitoneum. The aim of this study is to estimate whether the use of warm irrigation fluid can reduce the incidence of hypothermia and the decrease of body temperature. METHODS: Forty-two female patients undergoing elective laparoscopic surgery were randomly divided into 2 groups. Group 1 (n = 20) was given an ambient temperature irrigation fluid and group 2 (n = 22) a warm irrigation fluid. The core esophageal body temperatures of all the patients were measured every 10 minutes for 70 minutes. Body temperature 10 minutes after induction was a control value. The degree of body temperature decrease was measured, and the incidence of hypothermia was recorded. RESULTS: The incidences of hypothermia in group 2 were decreased significantly 60 and 70 minutes after induction, compared with those of group 1. The degree of body temperature decrease was revealed to be significantly different between the two groups starting 50 minutes after induction. CONCLUSIONS: The use of warm irrigation fluid during laparoscopic surgery can reduce the incidence of hypothermia and degree of body temperature decrease.
Body Temperature* ; Female ; Humans ; Hypothermia ; Incidence ; Laparoscopy* ; Laparotomy ; Pneumoperitoneum

BACKGROUND: Perioperative hypothermia is a common problem during both laparotomy and laparoscopic surgery. Hypothermia during laparoscopic surgery is related to the use of irrigation fluid and the large volume of CO2 for maintaining pneumoperitoneum. The aim of this study is to estimate whether the use of warm irrigation fluid can reduce the incidence of hypothermia and the decrease of body temperature. METHODS: Forty-two female patients undergoing elective laparoscopic surgery were randomly divided into 2 groups. Group 1 (n = 20) was given an ambient temperature irrigation fluid and group 2 (n = 22) a warm irrigation fluid. The core esophageal body temperatures of all the patients were measured every 10 minutes for 70 minutes. Body temperature 10 minutes after induction was a control value. The degree of body temperature decrease was measured, and the incidence of hypothermia was recorded. RESULTS: The incidences of hypothermia in group 2 were decreased significantly 60 and 70 minutes after induction, compared with those of group 1. The degree of body temperature decrease was revealed to be significantly different between the two groups starting 50 minutes after induction. CONCLUSIONS: The use of warm irrigation fluid during laparoscopic surgery can reduce the incidence of hypothermia and degree of body temperature decrease.
Body Temperature* ; Female ; Humans ; Hypothermia ; Incidence ; Laparoscopy* ; Laparotomy ; Pneumoperitoneum

BACKGROUND: Epidural pain control has been used extensively for postoperative pain management, but nausea, vomiting and pruritus associated with morphine and fentanyl administration remain intractable problems. The aim of this study is to find the optimal epidural droperidol dosage for reducing the side effects of epidural morphine and fentanyl. METHODS: 140 patients randomly sampled and undergoing vaginal total hysterectomy were divided into 7 groups. Groups I and IV, and groups II and V, and groups III and VI, received 5 mg, 3.75 mg, 2.5 mg of droperidol by 2-day infusion pump through the indwelling epidural catheter, respectively. Group IV, V, VI patients received 1.25 mg of bolus droperidol through the indwelling epidural catheter at the time of peritoneal closure. As group VII was the control group, these patients received only epidural analgesics (morphine 10 mg, fentanyl citrate 300 microgram and 0.05% bupivacaine 100 ml) by 2-day infusion pump. RESULTS: Droperidol significantly reduced the incidence and severity of postoperative nausea, vomiting and itching sensation compared with the control group but verbal rating scale (VRS) of sedation was increased with the dosage of droperidol. There was no significant difference in the intensity of analgesia between the there groups. CONCLUSIONS: An effective epidural droperidol dosage for reducing postoperative nausea, vomiting and pruritus due to epidural pain control is 2.5 mg by 2-day infusion pump.
Analgesia ; Analgesics ; Bupivacaine ; Catheters ; Droperidol* ; Fentanyl* ; Humans ; Hysterectomy* ; Incidence ; Infusion Pumps ; Morphine* ; Nausea* ; Pain Management* ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Pruritus* ; Sensation ; Vomiting*