Purpose: To assess the impact of toxoplasma immunoglobulin G (IgG) titers on the diagnosis of active ocular toxoplasmosis. Methods: We retrospectively analyzed the medical records of patients tested for toxoplasma IgG at our uveitis clinic. Active ocular toxoplasmosis was clinically diagnosed based on wide-angle fundus photography and disease progression. Patients with IgG titers ≥ 30 IU/mL were classified as seropositive-high titer, those with IgG titers of 1.6-30 IU/mL as seropositive-low titer, and the remaining patients as seronegative. We compared the proportion of active ocular toxoplasmosis among these groups. Additionally, we evaluated the sensitivity and specificity of each titer and attempted to determine an ideal reference titer for toxoplasma IgG in diagnosing active ocular toxoplasmosis. Results: Out of 824 patients, 86 (10.4%), 88 (10.7%), and 650 (78.9%) were categorized as seropositive-high titer, seropositivelow titer, and seronegative, respectively. Among these patients, 34 in the seropositive-high titer group and 2 in the seropositive- low titer group were clinically diagnosed with active ocular toxoplasmosis. The false-positive rate was significantly different between the groups, being 60.5% in the seropositive-high titer group and 97.7% in the seropositive-low titer group (p < 0.001). The receiver operating characteristic curve indicated that 37.70 IU/mL could be an ideal reference titer for diagnosing ocular toxoplasmosis. Conclusions The false-positive rate was notably lower (60.5%) in patients with IgG titers ≥ 30 IU/mL compared to those with titers of 1.6-30 IU/mL (97.7%). Therefore, not only the presence of IgG but also the level of titer appears to be important in diagnosing ocular toxoplasmosis.

Preoperative fasting is prescribed for a certain period before operations or procedures in which patients are not allowed oral intake to prevent aspiration of gastric content. Fasting recommendations prohibit the consumption of a heavy meal for 8 hours, a light meal or milk for 6 hours, and breast milk for 4 hours, and permit the consumption of clear liquid until 2 hours before an operation. However, sometimes, in an emergency situation such as increased intra-cranial or intraabdominal pressure and other trauma, the recommended fasting time might not be an absolute policy for preventing the aspiration of gastric content because the disease or trauma itself causes changes on the esophageal sphincter pressure, volume of the gastric content, and pH of the gastric fluid. Preparation of a safe anesthetic technique and appropriate preoperative medications can be helpful in preventing aspiration pneumonitis in an emergency situation.
Emergencies* ; Fasting* ; Humans ; Hydrogen-Ion Concentration ; Meals ; Milk ; Milk, Human ; Pneumonia*

The main stream of intraabdominal surgery has changed from laparotomy to laparoscopy, but anesthetic care for laparoscopic surgery is challenging for clinicians, because pneumoperitoneum might aggravate respiratory mechanics and arterial oxygenation. The authors reviewed the literature regarding ventilation strategies that reduce deleterious pulmonary physiologic changes during pneumoperitoneum for laparoscopic surgery under general anesthesia and make appropriate recommendations.
Anesthesia, General ; Laparoscopy* ; Laparotomy ; Oxygen ; Pneumoperitoneum ; Respiratory Mechanics ; Rivers ; Ventilation*

No abstract available.
Bronchial Spasm ; Pulmonary Edema

Even with the rapid development of pediatric postoperative pain management, pediatric patients have remained undertreated for postoperative pain because of difficulty in pain assessment and concerns regarding side effects of opioid analgesics. Although there are no perfect pain assessment techniques and no absolutely safe analgesics, proper monitoring and an individualized analgesic plan after due consideration of age, operative procedures, and underlying illness, using multimodal analgesics may improve the quality of pain control in children.
Analgesics ; Analgesics, Opioid ; Child* ; Humans ; Pain Measurement ; Pain, Postoperative* ; Pediatrics ; Surgical Procedures, Operative

BACKGROUND: This study was designed to determine the optimal sedative dose of propofol to start brain magnetic resonance imaging (MRI) in children with cerebral palsy (CP). METHODS: Twenty children, aged 0.5-5 years, were administered propofol to achieve a University of Michigan Sedation Scale (UMSS) score > or = 3 in the MRI room. The proper dose of propofol was determined using the up-and-down method. RESULTS: The ED50 and ED95 for successful sedation with a UMSS > or = 3 were 2.07 mg/kg (95% CI 1.69-2.56) and 2.69 mg/kg (95% CI 2.35-5.59). Respiratory events occurred in 5 patients and were resolved with neck extension, chin lift, or transient respiratory assistance with successful sedation. CONCLUSIONS: Low dose propofol can safely facilitate the initiation of MRI in children with CP.
Aged ; Brain ; Cerebral Palsy ; Child ; Chin ; Humans ; Magnetic Resonance Imaging ; Michigan ; Neck ; Propofol

Intradermal injections of indigo carmine for sentinel node mapping are considered safe and no report of an adverse reaction has been published. The authors described two cases of profound hypotension in women that underwent breast-conserving surgery after an intradermal injection of indigo carmine into the periareolar area for sentinel node mapping.
Breast Neoplasms ; Female ; Humans ; Hypotension ; Indigo Carmine ; Indoles ; Injections, Intradermal ; Mastectomy, Segmental ; Nitriles ; Pyrethrins ; Sentinel Lymph Node Biopsy

BACKGROUND: Hemodynamic derangement during off-pump coronary artery bypass surgery (OPCAB) is mainly attributed to impaired filling and diastolic dysfunction. An elevated ratio of the mitral velocity to the early-diastolic velocity of the mitral annulus (E/e' > 15) is a relatively new indicator of diastolic function, and this was reported to be associated with impaired hemodynamics during OPCAB. We investigated the efficacy of milrinone on the perioperative hemodynamics and short term outcomes of patients with an E/e' > 15 and who underwent OPCAB. METHODS: The patients were randomly allocated into either group C (control, n = 31) or group M (n = 31) and they were treated with the same amount of either normal saline or milrinone (0.5 microg/kg/min) without bolus loading after completion of internal mammary artery harvest until the end of operation. Hemodynamic measurements were recorded after the induction of anesthesia (T1), 5 min after starting each distal anastomosis of the left anterior descending artery (T2), left circumflex artery (T3) and right coronary artery (T4), and 5 min after sternum closure (T5). RESULTS: The mixed venous oxygen saturation (SvO2) was lower through T2-T4 compared to the baseline value in both groups, while the degree of the decrease was significantly less in group M than that in group C. The other hemodynamic variables, the operative data and the postoperative outcomes were similar between the two groups. CONCLUSIONS: Intraoperative infusion of milrinone did not significantly improve the perioperative hemodynamics and the subsequent short term outcomes for the patients with preexisting diastolic dysfunction as represented by an elevated E/e' value, although it reduced the degree of decrease of the SvO2 during OPCAB.
Anesthesia ; Arteries ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels ; Hemodynamics ; Humans ; Mammary Arteries ; Milrinone ; Oxygen ; Sternum

Excess absorption of fluid distention media remains an unpredictable complication of operative hysteroscopy and may lead to lethal conditions. We report an extreme hyponatremia, caused by using an electrolyte-free 5 : 1 sorbitol/mannitol solution as distention/irrigation fluid for hysteroscopic myomectomy. A 34-year-old female developed severe pulmonary edema and extreme hyponatremia (83 mmol/L) during transcervical endoscopic myomectomy. A brain computed tomography showed mild brain swelling without pontine myelinolysis. The patient almost fully recovered in two days. Meticulous attention should be paid to intraoperative massive absorption of fluid distention media, even during a simple hysteroscopic procedure.
Absorption ; Acidosis ; Adult ; Brain ; Brain Edema ; Female ; Humans ; Hyponatremia ; Hysteroscopy ; Pulmonary Edema

Kartagener's syndrome (KGS) is an autosomal recessive disorder which possible to link the occurrence of abnormal ciliary movement and abnormal position of the body organs. Considering the fact that airway ciliary function plays an important role in the primary pulmonary defense mechanism, prevent the ciliodepressant actions are also important for anesthetic management. We described successful anesthetic management of a 44-year-old male scheduled for endoscopic sinus surgery who had a history of frequent epistaxis, anosmia and situs inversus totalis. Anesthesia was induced and maintained with propofol and remifentanil using a target controlled infusion device.
Adult ; Aluminum Hydroxide ; Anesthesia ; Anesthesia, Intravenous ; Carbonates ; Epistaxis ; Humans ; Kartagener Syndrome ; Male ; Olfaction Disorders ; Piperidines ; Propofol ; Situs Inversus