To darify the cardiotoxic mechanism, the effect of bupivacaine on the cardiac function, especially in coronary flow rate was inveetigated in the isolated working rat heart. When administered into left atrium of the heart, lidocaine(10(-6)-10(-4) M) decreased heart rate in a dose-related fashion, whereae rate of coronary flow and mean coronary resistance tend to decrease and increase transiently, respectively. On the other hand, bupivacaine decreased the coronary flow rate and increased the mean coronary resistanee in a dose(10(-6)-10(-4) M) dependent manner. However, the decrement of heart rate by bupivacaine was not clear, but larger dose(10(-4) M) produced marked bradycardic effect. Bupivaeaine decreased the coronary flow and increased the mean coronary resistance in the isolated working heart, in which the heart rate and aortic pressure were kept constantly by electrical stimulation(3-6 pps, 0.5 mS, 20 V). These effects of bupivacaine were not influenced by 1 uM prazosin and 2 uM atropine pretreatment. But the bupivacaine effeets were completely abolished by 100 mM KC1 pretreatment and were inhibited markedly by 10(-7) M diltiazem, a Ca2+ -antagonist, pretreatment. From these results, it is suggested that the bupivacaine-induced coronary flow decrease is elicited via direct coronary vasoconstriction. And this vasoconstriction is due to the increments of intracellular Ca2+ concentration.
Animals ; Arterial Pressure ; Atropine ; Bupivacaine* ; Diltiazem ; Hand ; Heart Atria ; Heart Rate ; Heart* ; Prazosin ; Rats* ; Vasoconstriction

The t(3;21) (q26;q22) is associated with chronic myelogenous leukemia in blast crisis, leukemia evolving from therapy-related myelodysplasia, and with leukemia following other hematopoietic proliferative diseases. The t(3;21) is rare secondary aberration in blast crisis of Philadelphia(Ph)-positive chronic myeloid leukemia, which may be restricted to patients entering myeloid blast crisis. We report here in one case of chronic myeloid leukemia in blast crisis which reveals both t(9;22) (q34;q11), and t(3;21) (q26 ;q22). A 62-year-old male was diagnosed as chronic myeloid leukemia 5 years ago, received hydroxyurea therapy, and admitted because of gingival bleeding and fever. On examination, splenomegaly and leukocytosis with proliferated blasts(91%) in peripheral blood were noted. Bone marrow aspirate showed hypercellularity with severe blast proliferation(92.5%) which revealed all negative in peroxidase and PAS stain. Cytogenetic study of bone marrow cells showed the karyotype 46, XY, t(3;21) (q26;q22), t(9;22) (q34;q11), which might be suspected as myeloid blast crisis. Above finding was confirmed by the result of immunophenotyping(CD13 43.6%, CD34 68.2%, HLA-DR 91.6%). He received intensive chemotherapy, but still sustained proliferation of blasts was noted . The follow up cytogenetic study was as follows: 46, XY, 4(3;21) (q26:22), t(9;22) (q34;q11)/46, XY, t(3;21)(q26;q22), del(8) (q22), t(9:22) (q34,q11)/46, XY (16/3/1). He died soon from severe pancytopenia and sepsis.
Blast Crisis* ; Bone Marrow ; Bone Marrow Cells ; Cytogenetics ; Drug Therapy ; Fever ; Follow-Up Studies ; Hemorrhage ; HLA-DR Antigens ; Humans ; Hydroxyurea ; Karyotype ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukocytosis ; Male ; Middle Aged ; Pancytopenia ; Peroxidase ; Sepsis ; Splenomegaly

A clinical observation was made on 70 nephrectomized patients during the period from Jan, 1978 to June, 1981. The results were as follows. 1. The total number of inpatients during the period was 1,122 and nephrectomies were performed in 70 of the 744 total urologic operations (9.4%). 2. The age distribution showed the highest in 5th decade with 25.7% and the youngest case was observed at the age of 3, the oldest at 68 and 43 males and 27 females with male to female ratio 1.6:1. 3. The causative diseases of nephrectomy were tuberculosis (25.7%), renal stone (24.3%), renal injury (14.3%), renal tumor (10.0%) and hydronephrosis (8.0%) etc. 4. Percentage of nephrectomy in each disease were 39.1% in tuberculosis, 22.7% in renal stone, 31.3% in renal injury, 77.9 % in renal tumor and 50.0 % in hydronephrosis. 5. Surgical approaches consisted of frank subcostal approach in 38.6%, anterior abdominal extraperitoneal approach in 35.7 % and abdominal transperitoneal approach in 25.7 %. 6. Among the transfused patients who nephrectomized, the average amount of transfused whole bleed were 1757 ml on renal tumor, 1320 ml in renal injury, 700 ml in renal stone and 533 ml in renal tuberculosis. 7. Postoperative complications were postoperative bleeding in 3 cases, wound infection in 2 cases, paralytic ileus in 2 cases, wound disruption in 1 case, uremia in 1 case and upper G-I bleeding in 1 case.
Age Distribution ; Female ; Hemorrhage ; Humans ; Hydronephrosis ; Inpatients ; Intestinal Pseudo-Obstruction ; Male ; Nephrectomy ; Postoperative Complications ; Tuberculosis ; Tuberculosis, Renal ; Uremia ; Wound Infection ; Wounds and Injuries

A clinical observation was made on the 7 cases of ureteropyeloplasty secondary to ureteropelvic junction obstruction during the period from July, 1980 to January, 1982 and brief review of literature was made. 1. Hydronephrosis secondary to obstruction at the ureteropelvic junction was caused by congenital ureteropelvic junction stricture in 4 cases, aberrant vessels in 1 Case and combined cases in 2 cases. 2. The youngest age was 15 year old and the oldest 53 year old. The ratio of male to female and left to right were 3:4 and 2:1. 3. The types of ureteropyeloplasty were Anderson-Hynes pyeloplasty in 5 cases, Sand Cormoily tube-flap pyeloplasty in 1 case and nondismembered pyeloplasty with elimination of aberrant vessels in 1 case. 4. Multiple holed stent was used in all cases. 5. Postoperative complications were developed in2 cases, which were intractable urinary leakage and restricture and were treated by nephrostomy and nephrectomy respectively. 6. Follow up study was performed in 6 cases. Among 7 cases of ureteropyeloplasty, good results included in 4 cases, fair in 1 case and poor in 2 cases.
Adolescent ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Humans ; Hydronephrosis ; Male ; Middle Aged ; Nephrectomy ; Postoperative Complications ; Silicon Dioxide ; Stents

A papillary adeno-carcinoma of the renal pelvis is very rare tumor and mostly diagnosed by histopathologic findings. A 10-years-old female was admitted to Fatima Hospital with Rt. flank pain and intermittent gross hematuria.Herein, we report a case of papillary adeno-carcinoma of the renal pelvis.
Adenocarcinoma ; Female ; Flank Pain ; Humans ; Kidney Pelvis*

No abstract available.
Acute Kidney Injury* ; Nifedipine* ; Plasma* ; Renin*

The advantage of the radiofrequency lesion method are presented, with excellent control of the lesion volume, excellent control of the lesion process using temperature monitoring to quantify the lesion size, prevent boiling, and to produce differential destruction of neural tissue. The presence of afferent fibers in the ventral root which are spared by dorsal rhizotomy suggested an explanation for the failure of this procedure. Nerve fibers with their cells in the ganglion from ventral root will be destructed with streotactic radiofrequency ganglionotomy. Since the dorsal root ganglion cells are more sensitive to than are other structures within the bundle, one is using a differential heat lesion to specifically affect pain pathways while leaving motor pathways. proprioception, and afferent input relatively intact. In the higher thoracic regions, the pleura can be injured when using an traditional approach. Hence in the upper thoracic region(T2-T9), this type of approach requires that a small burr-hole be made at the superior aspect of the corresponding thoracic zygapophyseal joint. Stereotactic thoracic dorsal root ganglionotomy have carried out under local anesthesia on an inpatient basis in 6 patients. A series of 5 patients with metastatic cancer pain and a patient with compression fracture have treated with stereotactic radiofrequency lesioning of the thoracic dorsal root ganglion. Four out of these 6 patients have been relieved of pain without serious complications. I think this should be a good armamentarium to the pain therapists in the management of intractable pain. (Korean J Anesthesiol 1997; 32: 857~862)
Anesthesia, Local ; Efferent Pathways ; Electrodes ; Fractures, Compression ; Ganglia, Spinal ; Ganglion Cysts ; Hot Temperature ; Humans ; Inpatients ; Nerve Fibers ; Pain, Intractable ; Pleura ; Proprioception ; Rhizotomy ; Spinal Nerve Roots ; Zygapophyseal Joint

PURPOSE: Transrectal ultrasonography is known to be an effective tool for the determination of prostatic volume. But the irregularity of shape and the limitation of reliability by intra-observer and inter-observer bias may influence over the results. I would like to represent several factors for the error of transrectal ultrasonographic measurement of prostatic volume. MATERIALS AND METHODS: Errors for transrectal ultrasonographic volume determination of the prostate, based on the principle of HWL(Height x Width x Length x pi/6) are presented. Some artificial prostatic models were made and compared between the real volumes and calculated results. The intra-observer error was determined in 39 cases by repeated measurements. The inter-observer error was also determined in 32 cases by repeated measurements of different observer. RESULTS: There were significant discrepancies between real volumes and calculated results and the range of error by shape was -19?38%. The ranges of intra-observer and inter-observer errors with 95% confidence interval were -7.4?6.1% and 2.7?9.9%. CONCLUSIONS: Errors by several factors should be considered for the clinical application of measured prostatic volume by ultrasonography irrespective of its statistical validity and reliability.
Bias (Epidemiology) ; Prostate ; Reproducibility of Results ; Ultrasonography*

There are many surgical alternatives to medical therapy for trigeminal neuralgia. Among open procedures, Jannetta's procedure for microvascular decompression have widest favor. But there is no justification for exposing patients to such dangers when there are effective and safe alternatives such as percutaneous procedures. Of the percutaneous procedures, the most widely used are thermocoagulation, glycerolization, and microcompression of the gasserian ganglion. Percutaneous microcompression of the gasserian ganglion was introduced by Mullan in 1978 and its description was published in 1983. In the 1950's and 1960's deliberate compression of the gasserian ganglion was performed through an open operation. Mullan carried out this precedure using an inflatable balloon under brief anesthesia. 15 procedures were performed under brief general anesthesia in order to ensure maximum comfort for the patient in the operating room. The instruments consisted of a 14 gauge blunt tip needle, a 4F Fogarty catheter and a tuberculin syringe. The compression was maintained usually for 1 to 1.5 minutes. 14 out of 15 patients were relieved from their pain without serious complications.
Anesthesia ; Anesthesia, General ; Catheters ; Electrocoagulation ; Glycerol ; Humans ; Microvascular Decompression Surgery ; Needles ; Operating Rooms ; Syringes ; Trigeminal Ganglion ; Trigeminal Neuralgia* ; Tuberculin

Clinically, neostigmine is most commonly used as the reversal agent for to the competitive muscle relaxants. Atropine (group 1) and glrcopyrrolate (group 2) were studied in doses of 15ug/kg, 20 ug/kg and 77ug/kg, 10ug/kg given intravenously in a mixture with neostigm-ine 40ug/kg, during operation and at the end of operation 20 ASA class I patients, aged between 15 to 60, were selected in each group. Anesthesia was maintained with enflurane (1-1.5%), N2O (2L/min), O2(2L/min) and pancuronium (50ug/kg) was used as a muscle relaxant. The results were as fellows : 1) Group 1 showed significant increase and decrease in purse rate compared with group 2. 2) Atropine neostigmine mixture significantly showed initial increase and late decrease in pulse rate than glycopyrrolate-neostigmine mixture. 3) In group 2, 20ug/kg dose of atropine, when administered in a mixture with neostigmine, showed significant initial increase in pulse rate, 15ug/kg dose of atropine showed significant late bradycardia. 4) In group 2, 7 ug/kg, 10 ug/kg dose of glycopyrrolate was not associated with initial tachy cardia but late bradycardia was obserred and 10 ug/kg dose of glycopyrrolate was associated with more stable heart rate.
Anesthesia ; Atropine ; Bradycardia ; Cardia ; Enflurane ; Glycopyrrolate ; Heart Rate* ; Heart* ; Humans ; Neostigmine ; Pancuronium