Bradycardia is recognized as an acute complication of cervical cord injury. The etiology of such a phenomenon is believed to be due to an imbalance in the autonomic nervous system imposed on the heart by a cervical cord injury. The majority of the episodes of bradycardia degrees Ccurred either with tracheal suctioning or with changes in position. We experienced a case of severe bradycardia and hypotension when turning the patient with acute cervical spinal cord injury to the prone position, which was reversed by administration of intravenous atropine and ephedrine.
Anesthesia, General* ; Atropine ; Autonomic Nervous System ; Bradycardia* ; Ephedrine ; Heart ; Humans ; Hypotension* ; Prone Position ; Spinal Cord Injuries* ; Spinal Cord* ; Suction

BACKGOUND: The purpose of this study was to examine the effect of various levels of positive end-expiratory pressure (PEEP) on the intraocular pressure in the patients receiving positive pressure ventilation. METHODS: Twenty, critically ill sedated and hemodynamically stable patients without history of glaucoma were placed on controlled positive pressure ventilation. Measured variables included intraocular pressure (IOP), mean arterial pressure (MAP), central venous pressure (CVP), peak inspiratory pressure (PIP) and arterial blood gas analysis (ABGA), and were recorded at zero end-expiratory pressure (ZEEP), and at 5, 10, 15, 20 cmH2O PEEP, applied in random order. RESULTS: IOP increased significantly from 13+/-3 to 16+/-3 mmHg at 15 cmH2O PEEP and from 14+/-4 to 17+/-6 mmHg at 20 cmH2O PEEP. CVP increased significantly from its corresponding ZEEP measurements at all PEEP levels and from 14+/-4 cmH2O at 5 cmH2O PEEP to 21+/-4 cmH2O at 20 cmH2O PEEP. There was a positive correlation between PEEP levels and PIP or CVP but no relationship between PEEP levels and IOP was observed. CONCLUSIONS: The application of PEEP levels > or = 15 cmH2O resulted in a significant increase in the IOP of patients with normal basal ocular tonometry. This study suggests that further increase in IOP may occur in the mechanically ventilated patients with already increased IOP or normal-tension glaucoma, when higher levels of PEEP are used.
Arterial Pressure ; Blood Gas Analysis ; Central Venous Pressure ; Critical Illness* ; Glaucoma ; Humans ; Intraocular Pressure* ; Positive-Pressure Respiration* ; Tonometry, Ocular ; Veins

It has been reported that keratocytes endocytose foreign particles both in vitro and in vivo, suggesting the active participation of keratocytes in corneal wound healing and host defense mechanism. This study was conducted to investigate the phagocytosis of keratocytes against Candida albicans[C.albicans]and the intracellular response after phagocytosis. C.albicans were fixed with glutaraldehyde and then coated with fibronectin. After exposing these C.albicans to the cultured rabbit keratocytes, the phagocytosis of keratocytes against C.albicans was evaluated by light microscope[LM]and transmission electron microscope[TEM], while the intracellular response was evaluated by changes of acid phosphatase activity. Also the study about latex beads was performed at the same time to know even if keratocytes can phagocytose foreign particles, regardless of wheather or not the particles are biodegradable. After Wright staining, phagocytosed latex beads and C.albicans were observed on LM and these were recognized to be surrounded by limiting membranes inside the cytoplasm of keratocytes on TEM. The phagocytic rates of fibronectin-coated were increased to 1.5 times , as compared with that of non-coated group. Acid phosphatase activities were higher in C.albicans-exposed groups than in control[keratocytes cultured without C.albicans or latex beads]during the culture period of 24 hours and they also increased according to culture duration and reached to the plateau after 12 hours. In comparison with non-coated group, fibronectin-coated groups showed a increasing tendency of acid phosphatase activity. These results suggest that keratocytes can phagocytose not only foreign particles but also C.albicans and that fibronectin may act as effective opsonin on phagocytosis, and that keratocytes phagocytosing C.albicans increase acid phosphatase activity to digest engulfed C.albicans when corneal stroma was wounded or inflammed.
Acid Phosphatase* ; Candida albicans* ; Candida* ; Corneal Stroma ; Cytoplasm ; Fibronectins ; Glutaral ; Latex ; Membranes ; Microspheres ; Phagocytosis* ; Wound Healing ; Wounds and Injuries

A 61-year-old man was admitted to the emergency room complaining of a severe left exophthalmos caused by frontal and ethmoid sinus mucoceles that were visualized on a brain computerized tomogram. In addition, he had coexisting ankylosing spondylitis with a 20 year duration that resulted in total fixation of the cervical spine and progressive thoracic kyphosis. An unruptured anterior communicating artery aneurysm was found incidentally on the cerebral angiogram. We report that the anesthetic management for endoscopic sinus surgery of a frontal sinus mucocele in a patient with coexisting severe cervical spine ankylosing spondylitis and an unruptured cerebral aneurysm requires a detailed preoperative assessment of the airway, cardiac, pulmonary, and neurologic system. This case highlights the need for careful measures to avoid rupturing the cerebral aneurysm by the increased blood pressure induced by endotracheal intubation and the infiltration of an epinephrine-containing local anesthetic.
Blood Pressure ; Brain ; Emergencies ; Ethmoid Sinus ; Exophthalmos ; Frontal Sinus ; Humans ; Intracranial Aneurysm ; Intubation, Intratracheal ; Kyphosis ; Middle Aged ; Mucocele ; Spine ; Spondylitis, Ankylosing

Central venous catheter-related venous thrombosis is one of the most important complications occurred after central venous catheterization. Forty six year old man had end-stage renal failure due to diabetes mellitus. Temporary hemodialysis catheter was inserted via right subclavian vein. Thirty days after hemodialysis catheter insertion, the patient presented with right neck swelling and difficulty to aspirate blood from hemodialysis catheter. Venography showed right internal jugular vein thrombosis. We report a case in which a patient developed right internal jugular vein thrombosis after long-term placement of temporary hemodialysis catheter.
Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Diabetes Mellitus ; Humans ; Jugular Veins ; Kidney Failure, Chronic ; Neck ; Phlebography ; Renal Dialysis* ; Subclavian Vein* ; Thrombosis ; Venous Thrombosis*

PURPOSE: The purpose of this study is to illustrate MR patterns of signal intensity of proximal femur in normal subjects according to the age distribution. METHOD AND MATERIAL: Tl-weighted MR images of the proximal femur in 125 subjects, aged 13 days to 25 years, were retrospectively analyzed. Age distribution was classified to 4 groups;below 4 months, 5 months to 4 years, 5 years to 14 years, and 15 years to 25 years. RESULTS: By the age of 4 months, the non-ossified femoral epiphysis was seen as intermediate-signal-intensity cartilage. At 5 months-4 years, the ossified fernoral capital epiphysis was seen within intermediate-signal-intensity cartilage and appeared as decreased or increased signal-intensity red or yellow marrow surrounded by a rim of low-signal-intensity cortical bone. At 5-14 years, the ossified femoral capital and greater trochanteric epiphysis were seen within the intermediate-signal-intensity cartilage and appeared as decreased or increased signal-intensity red or yellow marrow. At 15-25 years, the proximal metaphyseal marrow showed increased signal intensity. Four patterns of the metaphyseal marrow were recognized by Ricci et al. The frequency of pattern la progressively decreased with age. Pattern 2 and 3 were visible in the 15-25 years age group. CONCLUSION: An understanding of the spectrum of normal age-related change of the proximal femoral cartilage and marrow patterns serves as the foundation for interpretation of proximal femur pathologies.
Age Distribution ; Bone Marrow ; Cartilage ; Epiphyses ; Femur* ; Humans ; Magnetic Resonance Imaging* ; Pathology ; Retrospective Studies

A 28-year-old primigravida at 33 weeks gestation was referred to our hospital because of aggravation of seizures which occurred intermittently for the past 2 years. A brain magnetic resonance imaging scan taken at 33 weeks gestation showed a large brain tumor (7X5X4 cm) in the left high frontal lobe. She had a cesarean section under general anesthesia at 38 weeks and 1 day gestation. General anesthesia was induced with thiopental 250 mg, succinylcholine 75 mg and lidocaine 60 mg after a vecuronium 0.8 mg intravenous injection. The hyperventilation and mannitol used to reduce increased intracranial pressure (ICP) in this patient may be harmful and detrimental to the fetus before delivery. Achieving both ICP control and fetal well being at the same time during a cesarean section can be challenging to anesthesiologists. We report the anesthetic management of a cesarean section in a patient with a large brain tumor.
Adult ; Anesthesia, General* ; Brain Neoplasms* ; Brain* ; Cesarean Section* ; Female ; Fetus ; Frontal Lobe ; Humans ; Hyperventilation ; Injections, Intravenous ; Intracranial Pressure ; Lidocaine ; Magnetic Resonance Imaging ; Mannitol ; Pregnancy ; Seizures ; Succinylcholine ; Thiopental ; Vecuronium Bromide

A 50-year-old man with bladder cancer had spinal anesthesia for transurethral resection of bladder. After he had spinal block at the T8 level, he developed a persistent penile erection, making it impossible to introduce the 24 French cystoscope. To treat a persistent penile erection, intravenous glycopyrrolate was incrementally given for a total of 0.4 mg. A persistent penile erection was markedly subsided 5 minutes after last 0.2 mg glycopyrrolate was given. Then corpus cavernosum blood was aspirated. The cystoscope was easily introduced, and transurethral resection of bladder proceeded without further complication.
Anesthesia, Spinal* ; Cystoscopes ; Glycopyrrolate ; Humans ; Male ; Middle Aged ; Penile Erection* ; Urinary Bladder ; Urinary Bladder Neoplasms

PURPOSE: To compare the diagnostic accuracy between fine needle and large cutting needle biopies. METHODS & MATERIALS: Chest lesion was biopsied consecutively by 19 G or 22 G fine needle and 14 G large cutting needle with interval of 10-20 min. 119 patients confirmed by operation or clinical follow-up were evaluated. RESULTS: There were 65 patient confirmed as malignant lesion and 54 confirmed as benign lesions. Diagnostic accuracy was 87.7%(57/65) for malignancy and 85.2%(46/54) for benign lesion with fine needle. With large cutting needle, it was 90.8%(59/65) for malignancy and 88.9%(48/54) for benign lesion. In the benign lesion, specific diagnostic accuray was 48.1%(26/54) with fine needle, and 64.8%(35/54) with large cutting needle biopsy, respectively. Complications were hemoptysis(n=13, 10.9%), pneumothorax(n=7, 5.9%) and mild to moderate chest pain. Although, it is impossible to compare the complications by the two types of biopsy on same lesion, 10 cases of immediate hemopytsis and more severe chest pain occurred when large cutting needle biopsy was done. CONCLUSION: No significant difference in diagnostic accuracy between fine needle and large cutting needle biopsies was observed in malignant lesion. In benign lesions, larger sample volume may increase the chance of obtaining a specific diagnosis but has no influence on overall diagnostic accuracy of benignity. Thus, we believe that fine needle aspiration biopsy is an accurate, safe, and more tolerable means to be performed as first step for diagnosis of chest lesions.
Biopsy* ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Chest Pain ; Diagnosis ; Follow-Up Studies ; Humans ; Needles* ; Thorax

BACKGROUND: A small change in venous capacitance significantly alters venous return and thus cardiac output. It is therefore important to know the effects of intravenous anesthetics on venous capacitance, particularly in a hypovolemic state. As ketamine does not suppress sympathetic activity, it has been suggested that ketamine may be the drug of choice for anesthesia during hypovolemia. The purpose of this study was to examine the effects of ketamine or sodium thiopental on venous capacitance and total vascular compliance in dogs. METHODS: Twenty mongrel dogs, weighing 10~15 Kg, were divided into two group (ketamine group: 10, sodium thiopental group: 10) of 10 each. Venous capacitance was assessed before and after drug (ketamine 1 mg/kg or sodium thiopental 5 mg/kg) injection by measuring mean circulatory filling pressure (MCFP) in the normovolemia and hypovolemia. MCFP was measured after arresting the circulation by tightening of superior vena cava and inferior vena cava snares simultaneously. RESULTS: As compared with MCFP in the normovolemia and hypovolemia, MCFP was significantly increased by ketamine in the normovolemia and hypovolemia. As compared with MCFP in the hypovolemia, MCFP was significantly decreased by sodium thiopental in the hypovolemia. The slope of the regression line relating MCFP and blood volume was not significantly altered by ketamine or sodium thiopental, which suggests that ketamine or sodium thiopental did not alter total vascular compliance. CONCLUSIONS: These results suggest that ketamine decreases venous capacitance in the normovolemia and hypovolemia but sodium thiopental increases venous capacitance in the hypovolemia.
Anesthesia ; Anesthetics, Intravenous ; Animals ; Blood Volume ; Cardiac Output ; Compliance ; Dogs* ; Hypovolemia ; Ketamine* ; SNARE Proteins ; Sodium* ; Thiopental* ; Vena Cava, Inferior ; Vena Cava, Superior