Dynamic cardiomyoplasty is a recently introduced surgical method to improve myocardial performance. It consists of a placement of a skeletal muscle flap around the heart and stimulation of the flap in synchrony with ventricular contraction. We experienced a case of cardiomyoplasty in a 25 year old male patient with congestive heart failure. Anesthesia was induced and maintained with fentanyl, midazolam and isoflurane. The operation was performed for 8hrs without cardiopulmonary bypass and the patient was transferred to the intensive care unit. He was mechanically ventilated electively overnight and extubation was done 18hrs postoperatively. The patient was discharged home on the 40days after operation and improved in exercise tolerance. We report the anesthetic management and hemodynamic changes in a patient who underwent dynamic cardiomyoplasty.
Adult ; Anesthesia ; Cardiomyoplasty* ; Cardiopulmonary Bypass ; Exercise Tolerance ; Fentanyl ; Heart ; Heart Failure ; Hemodynamics ; Humans ; Intensive Care Units ; Isoflurane ; Male ; Midazolam ; Muscle, Skeletal

Leiomyoma is a benign solitary tumor which is originated from a smooth muscle cell and grows slowly. It is most commonly found in the uterus and can develop anywhere that smooth muscle is present, including esophagus, lower extremity, stroma of GI tract, and pleura. However, the occurrence of leiomyoma in the hand is so uncommon. We present one case of solid type leiomyoma found in the right 4th finger of a young woman.
Esophagus ; Female ; Fingers ; Gastrointestinal Tract ; Hand ; Humans ; Leiomyoma ; Lower Extremity ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Pleura ; Uterus

OBJECTIVES: This study was to investigate the fertilization rate after intracytoplasmic sperm injection (ICSI) or partial zona dissection (PZD) of human and hamster sperm into hamster oocyte in in vitro fertilization (IVF). In addition, the possibility of clinical application was evaluated by the comparison of usefulness and difference of these method. MATERIALS AND METHODS: Hamster immature oocytes were obtained from oviducts superovulated by PMSG and hCG, and hamster sperms were obtained from epididymis. The freezed human sperms were thawed before use. Fertilization were confirmed by two pronuclei, one pronucleus, swollen sperm head or/and two polar bodies at 7~8 hour after ICSI or PZD. RESULTS: The fertilization rates after ICSI and PZD of human sperm to hamster oocyte were 3.6%, 64.2%, 73.6%, and 55.6% for negative control, positive control, ICSI, and PZD respectively, suggesting that ICSI only showed improved fertilization rate (p<0.01). The fertilization rates after ICSI and PZD of hamster sperm to hamster oocyte were 11.1%, 51.2%, 39.6%, and 72.7% for negative control, positive control, ICSI, and PZD respectively, suggesting that PZD only showed improved fertilization rate (p<0.01). PZD showed significantly higher fertilization rate than ICSI (p<0.05). CONCLUSIONS: As for the fertilization rate by ICSI and PZD using hamster oocyte in IVF, ICSI technique was considered to be more useful for human sperm and PZD technique for hamster sperm. Therefore, ICSI technique was considered more appropriate for experimental application using human sperm and hamster oocyte.
Humans

OBJECTIVES: This study was carried out to evaluate the effects of embryonic stage, cryoprotectant, and freezing-thawing method on the rates of survival and development of the cryopreserved mouse early embryo and finally to establish the cryopreservation method of surplus embryos obtained during assisted reproductive technology (ART). MATERIALS AND METHODS: Two to eight cell embryos were obtained from oviducts of mated F1 hybrid female mice superovulated by pregnant mare's serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG). Two-step 1,2-propanediol (PROH), dimethylsulfoxide (DMSO) and 4-step PROH, DMSO were used as cryoprotectant and dehydration and rehydration method of embryos, and slow- cooling or rapid-cooling method was used as frozen program. The survival rates of embryos were measured after thawing and rehydration, and the developmental rates of embryos were compared and observed during culturing embryos for 24, 48, 72, 96 hrs. RESULTS: As for the survival and development rates of embryos according to embryonic stage, the survival rate of 2 cell stage in PROH and DMSO was significantly higher than 4-8 cell (64.5% versus 62.1%, 79.7% versus 73.2%) (p<0.01, p<0.01), but the development rates of 4-8 cell embryos in PROH and DMSO were significantly higher than 2 cell embryos for whole culture period (p<0.01) and the development rates of 4-8 cell embryos in PROH were significantly higher than 2 cell embryos in DMSO (p<0.01). As for the survival and development rates of embryos according to cryoprotectant, the survival rate of 2 cell embryo in DMSO was significantly higher than that in PROH (74.4% versus 64.5%) (p<0.01), whereas the development rate of embryos was not differ till 24 hrs. The development rate from morular to hatching blastocyst, however, was significantly higher in PROH than in DMSO during 48 hr (p<0.01). The survival rate of 4-8 cell embryo was 62.1% in PROH and 73.2% in DMSO. The development rates of embryo in PROH were significantly higher for whole culture periods (p<0.01, 0.05). In respect to the effect of freezing and thawing program on the survival and development rates of embryos, method of slow cooling and rapid thawing was more effective than that of rapid cooling and rapid thawing. CONCLUSIONS: The survival rate of embryo in 2 cell stage was higher than in 4-8 cell stage, and PROH appears more effective cryoprotectant than DMSO because PROH showed better development rates of embryos in 2 and 4-8 cell stage. Moreover, slow cooling and rapid thawing method was considered as the best cryopreservation program.
Pregnancy ; Female ; Humans ; Mice ; Animals

This study was performed to investigate the stimulating effect on oocyte maturation and cumulus cell expansion in TC199 media by human cord serum (HCS) supplementation. Immature mouse oocyte cumulus complexes (OCCs) were cultured in TC199 media supplemented with bovine serum albumin (BSA), HCS and human chorionic gonadotropin (hCG) instead of luteinizing hormone (LH) respectively, and the expression of cumulus expansion and oocyte maturation were observed. After 4hr and 24hr culture with or without OCCs, media containing 0.4% BSA, 10% HCS and 10 lU hCG respectively were collected and analyzed for changing concentrations of estradiol (E2), progesterone(P4), testosterone(T), and PGF2. There were no elevation of E2, T, and PGF2 by OCCs culture, but minute elevation of P4 level by 24hr OCCs culture in hCG supplementation (p=0.048). The stimulating pattern of cumulus expansion of OCCs by HCS and hCG supplementation was similar to our previously report using Ham's F-10 media, however oocyte maturation rates after 24hr OCCs culture in all media were increased by 20~30% compared to Ham's F-10 media. These results suggest that LH in HCS induce cumulus expansion probably by P4 secretion of OCCs, and TC199 is efficient media for immature mouse oocyte maturation.
Animals ; Chorionic Gonadotropin ; Cumulus Cells* ; Dinoprost ; Estradiol ; Humans* ; Luteinizing Hormone ; Mice ; Oocytes* ; Serum Albumin, Bovine

No abstract available.
Follow-Up Studies* ; Magnetic Resonance Imaging* ; Radiculopathy*

No abstract available.
Biopsy, Fine-Needle* ; Melanoma*

Jehovah,s Witnesses who require operation represent a challenge to the physician because of the patient,s refusal to accept blood transfusion. An orthotopic heart transplantation was succesfully performed in a 40-year old Jehovah,s Witness without use of any blood product. During the operation, cell saver was used for shed blood and aprotinin was administered intravenously. The use of blood conserving methods, meticulous operative technique and brisk postoperative diuresis has added to the efficacy of heart transplantation in this patient. Total postoperative drainage was 860 ml and the lowest hemoglobin level was 11.8 g%. The patient recovered uneventfully and discharged on the 60th postoperative day.
Adult ; Anesthesia* ; Aprotinin ; Blood Transfusion ; Disulfiram ; Diuresis ; Drainage ; Heart Transplantation* ; Heart* ; Humans ; Transplantation

BACKGROUND: Serious pulmonary complications after lung surgery increase morbidity and mortality in perioperative period. Ketamine hydrochloride produces strong analgesic effect in spite of the psychomimetic effects. Intravenous anesthesia with ketamine was performed in lung surgery of patients with decreased pulmonary function and compared with inhalation anesthesia with enflurane. METHODS: Sixty patients, scheduled for elective lung surgery, were randomly assigned to two groups. Patients received either enflurane (Group 1, n=30) or ketamine (Group 2, n=30) as main anesthetic drug. Blood pressure and heart rate were compared in preinduction, postinduction, postintubation, postincision, intraoperative period (30 minutes, 60 minutes) and recovery room between groups, and in each group. Arterial blood gas analysis was compared in preoperative period, intraoperative period and recovery room between groups. Postoperative psychological complications evaluated in group 2. RESULTS: Blood pressure and heart rate were significantly different in postinduction, postintubation and recovery room between groups. PaO2 in group 2 was higher than in group 1 during intraoperative period and recovery room. Postoperative psychological complications occured in 4 patients (13%) in group 2. CONCLUSIONS: Ketamine affords advantage over enflurane anesthesia in terms of PaO2 during intraoperative period and recovery room in lung surgery of patients with decreased pulmonary function.
Anesthesia ; Anesthesia, Inhalation* ; Anesthesia, Intravenous* ; Blood Gas Analysis ; Blood Pressure ; Enflurane* ; Heart Rate ; Humans ; Inhalation* ; Intraoperative Period ; Ketamine* ; Lung* ; Mortality ; Perioperative Period ; Preoperative Period ; Recovery Room

No abstract available.