Air can be used as a carrier for volatile agent, ether, with a clear airway, normal pulmonary function and normal oxygenation. In 1858 John Snow, the Father of British Anesthesia stated in his book on Chloroform and Other Anesthetics that he believed it to be almost impossible for death to occur from ether administered with ordinary intelligence and attention. Today ether is probably still the safest anesthetic drug we possess. Ether is cheap and easily obtained; with controlled respiration 3% is adequate. Recovery smooth and rapid. Vomiting may be no different from other agents. Most machines depend upon cylinders of oxygen and other gases, and there are difficulties of refilling cylinders and the cost of transporting them. In such circumstances the E.M.O. Inhaler, allowing ether to be vaporized in known concentrations in air, has many advantages as an alternative to the open method administration. From all types of patients chosen at random 22 patients were studied for ether-air anesthesia. Anesthesia was induced with intravenous thiopental and subsequent endotracheal intubation was performed within 30 seconds with the aid of intravenous succinylcholine. SatO2, PaO2, pH, and Base E. were measured 3 times during pre-anesthesia, immediately after the intubation, and post-operatively by Radiometer, using the oxy-hemoglobin dissociation curve and the Siggard-Anderson alignment nomogram. Vital signs were recorded every 5 minutes. It is the purpose of this paper to present this series of 22 anesthetics by the use of the E.M.O. Inhaler with air and to discuss the possibility of hypoxia, advantages and limitations that became apparent. The results obtained may be summarized as follows. 1. It is essential that endotracheal intubation by carried out rapidly and that everything necessary be ready and immediately at hand before starting the anesthetic. 2. In all patients ventilated room air during anesthetic induction, no significant decreases of PaO2 and SatO2 were observed immediately after the endotracheal intubation. 3. The duration of any period of complete apnea inflicted on the patient must be carefully controlled. 4. 100% oxygen prevented the possibility of hypoxia on extubation after all the reflexes had returned. 5. Ether-air anesthesia is recommended without hesitation for use where economy and portability of anesthetic machine are needed.
Anesthesia* ; Anesthetics ; Anoxia ; Apnea ; Chloroform ; Ether ; Fathers ; Gases ; Hand ; Humans ; Hydrogen-Ion Concentration ; Intelligence ; Intubation ; Intubation, Intratracheal ; Nebulizers and Vaporizers ; Nomograms ; Oxygen ; Reflex ; Respiration ; Snow ; Succinylcholine ; Thiopental ; Vital Signs ; Vomiting

Localized enterocolic lymphocytic phlebitis is characterized by selective phlebitis involving the small to medium-sized veins and venules, infiltration exclusively by lymphocytes, and no other systemic vasculitis or inflammatory bowel disease. This vasculitis can be a rare cause of intestinal ischemia. We experienced a case of enterocolic lymphocytic phlebitis in a 72-year-old woman, who presented with abdominal pain and distension. The resected colon and terminal ileum showed striking lymphocytic phlebitis affecting the veins and venules of the bowel and mesentery which resulted in ischemic injury of the bowel. This vasculopathy was the only demonstrable cause of ischemia. Arteritis and arteriolitis was not found. There is no clinical or laboratory evidence or a history of extraintestinal vasculitis. The etiology of this clinicopathological entity has not been elucidated. Herein, we report the clinicopathological findings in this patient who presented with ischemic intestinal necrosis caused by localized intestinal lymphocytic phlebitis associated with thrombosis.
Female ; Humans

No abstract available.

A clear cell islet cell tumor of the pancreas is extremely rare and characterized by extensive clear cell components. Electron microscopic and immunohistochemical findings are essential to prove that the mass with clear cells is an unusual manifestation of an islet cell tumor. Herein, we report a case of clear cell islet cell tumor of a 54-year-old woman with abdominal pain. The tumor was composed of polygonal clear cells arranged in nests, trabeculae, and ribbon pattern with the extensively fibrous stroma. These tumor cells showed strong reactivity for chromogranin and weak reactivity for somatostatin and glucagon. An electron microscope revealed that the important contributing factor of the clear cytoplasmic change was mainly due to an accumulation of lipid droplets, coupled with cytoplasmic swelling in some areas. Some tumor cells showed many endosecretory granules ranging from 111 to 297nm in diameter. In the clinical and immunohistochemical findings these granules were consistent with somatostatin granules in morphology and size.
Abdominal Pain ; Adenoma, Islet Cell* ; Cellular Structures ; Cytoplasm ; Female ; Glucagon ; Humans ; Islets of Langerhans* ; Middle Aged ; Pancreas* ; Somatostatin

A clear cell islet cell tumor of the pancreas is extremely rare and characterized by extensive clear cell components. Electron microscopic and immunohistochemical findings are essential to prove that the mass with clear cells is an unusual manifestation of an islet cell tumor. Herein, we report a case of clear cell islet cell tumor of a 54-year-old woman with abdominal pain. The tumor was composed of polygonal clear cells arranged in nests, trabeculae, and ribbon pattern with the extensively fibrous stroma. These tumor cells showed strong reactivity for chromogranin and weak reactivity for somatostatin and glucagon. An electron microscope revealed that the important contributing factor of the clear cytoplasmic change was mainly due to an accumulation of lipid droplets, coupled with cytoplasmic swelling in some areas. Some tumor cells showed many endosecretory granules ranging from 111 to 297nm in diameter. In the clinical and immunohistochemical findings these granules were consistent with somatostatin granules in morphology and size.
Abdominal Pain ; Adenoma, Islet Cell* ; Cellular Structures ; Cytoplasm ; Female ; Glucagon ; Humans ; Islets of Langerhans* ; Middle Aged ; Pancreas* ; Somatostatin

Purpose: We hereby would like to compare on the basis of the initial 12 hips and latter 18 hips by analyzing the initial results of the minimal incision total hip arthroplasty of 30 hips we experienced. Materials and Methods: For the period of December 2004 through June 2005, we performed the total hip arthroplasty with minimal incision in 10cm or shorter using the posterolateral approach on 25 patients (30 hips) whose BMI(body mass index) is 30 or lower. We compared by analyzing results of the initial 12 cases and 18 latter cases. Results: The average BMI was 23.7. There weren`t statistically meaningful differences the change in the hemoglobin value of pre-op and post-op, necessity of blood transfusion, position of component, and the Harris hip score 6 weeks after operation. But, the average initial operation time of 124 minutes was remarkably reduced to 65 minutes in average in the latter operation and the length of a skin incision was reduced from the average 9.2 cm in the initial operation to an average of 8.1cm in the latter operation. There wasn't the malposition of acetabular cup and femoral stem. Conclusion: Although we need more statistical data through more cases and the analysis of long-term results, we think that, to surgeons with much experience in the conventional total hip arthroplasty, the total hip anthroplasty using minimal incision for patients with BMI of 30 or below would be a useful approach having the advantage in a cosmetic aspect.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Blood Transfusion ; Hip ; Humans ; Learning Curve* ; Learning* ; Skin

Kaposi's sarcoma is one of the important features of acquired immunodeficiency syndrome (AIDS) patients, renal transplanted patients, young African men, and elderly Ashkenazi Jews. It is well recognized as the most common malignancy asssociated with AIDS and there is also an increased incidence among patients with iatrogenic immunosuppression secondary to renal transplantation. However, a few cases of Kaposi's sarcoma in immunosuppressed patients not related to the renal trans-plantation had been reported. In this study, we present a case of Kaposi's sarcoma involving the oropharynx and the skin of a patient who was not associated with AIDS nor treated with special immunosuppressive agents for renal transplantation.
Acquired Immunodeficiency Syndrome ; Aged ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Jews ; Kidney Transplantation ; Male ; Oropharynx* ; Sarcoma, Kaposi* ; Skin*

No abstract available.
Aged ; Carcinoma, Medullary/*diagnosis/surgery/ultrasonography ; Epstein-Barr Virus Infections/diagnosis ; Gastric Mucosa/pathology/surgery ; Gastroscopy ; Humans ; Immunohistochemistry ; Keratins/metabolism ; Male ; Stomach Neoplasms/*diagnosis/surgery/ultrasonography

Previous studies have shown that the cancer cell lines secrete multiple cytokines, such as macrophage colony-stimulating factor(M-CSF), granulocyte-macrophage colony stimulating factor(GM-CSF), interleukin-l(IL-1), interleukin-2(IL-2), interleukin-6(IL-6), and tumor necrosis factor-alpha(TNF-alpha). We evaluated the levels of IL-2, IL-6, and TNF-alpha in the ascites of 23 patients with ovarian cancer. These levels were then compared with cytokine concentration found in 10 patients who had benign ascites and also studied the relation between levels of cytokines and clinical parameters. Enzyme-linked immunosorbent assay(ELISA) was used to determine the levels of cytokines in ascitic fluids. The median age of the group was 56, and the median follow-up time was 24 months. The levels of IL-2 was not elevated in ascites of ovarian cancer(30.5 vs 37.2 pg/ml, p=0.083), 1 he levels of TNF-alpha in the ascites with ovarian cancer were higher when compared with ascites of benign disease and was nearly approached statistically significant(91.0+/-20.7 vs 440.2+/-117.9pg/ml, p=0.058). Significantly higher IL-6 levels were detected in patients ascites compared with ascites with benign disease(354.3+/-42.9 vs 5,605+/-1,137pg/ml, p=0.006). IL-6 and TNF-a levels in ascites did not correlate statistically with tumor volume, histologic type or with survival time. IL-6 levels did not correlated statistically with volume of ascites. IL-6 and TNF-a levels did not correlated either. Circulating platelet counts in patients with ovarian cancer were significantly higher than in patients with benign conditions (282.6+/-5 vs 388.4+/-21.2x-10(9)/l, p=0.003). Thrombocytosis(platelet counts>400x10(9)/l) occured in 35%(8/23) of the cases with ovarian cancer. IL-6 levels in ascites correlated signi-ficantly with circulating platelet counts(R=0.427, p=0.042). This study showed that the patients with ovarian cancer have elevated levels of IL-6 in ascites. IL-6 levels were not correlate with disease status in patients with ovarian cancer. However, the correlation was found between IL-6 levels and thrombocytosis. This observation suggest a role for IL-6 in the development of tumor-associated thrombocytosis. A larger study would help in evaluating the potential biological roles and use of cytokines as tumor markers in ovarian cancer.
Ascites* ; Ascitic Fluid ; Blood Platelets ; Cell Line ; Cytokines ; Follow-Up Studies ; Humans ; Interleukin-2 ; Interleukin-6 ; Macrophages ; Necrosis* ; Ovarian Neoplasms* ; Platelet Count ; Thrombocytosis ; Tumor Burden ; Biomarkers, Tumor ; Tumor Necrosis Factor-alpha

PURPOSE: To evaluate error of corneal thickness measurement in different gazes in Orbscan topography. METHODS: Sixty eyes of 30 normal subjects were investigated using the Orbscan topography system. The central corneal thickness (Kc) and the thinnest corneal thickness (Kt) on topography map were obtained in 5 different gazes. Gaze directions were classified into center (C), nasal I (NI), nasal II (NII), temporal I (TI), and temporal II (TII), in which I means 13 degree deviation from visual axis and II means 22 degree deviation. RESULTS: Kc in right eye was 540.4+/-37.7 micro meter(mean+/-standard deviation) at central gaze (C) and 550+/-36.9 micro meter at NI ; there was no significant change, but there were in Kc at NII (563.0+/-40.5 micro meter), TI (566.5+/-32.8 micro meter), TII (595.2+/-54.5 micro meter). In addition, the same patterns were seen in left eye in Kc analysis. In contrast, Kt did not change even in 5 gaze changes. In comparison between Kc and Kt at the same gazes, there were significant differences except in central gaze (C). CONCLUSIONS: Though the gaze direction changed, the most reliable measurement for evaluation and follow up of corneal thickness is the thinnest corneal thickness (Kc) in Orbscan topography system. In case that the central corneal refractive power and thickness were needed, it is important that Orbscan topography is performed in exact central fixation.
Axis, Cervical Vertebra ; Corneal Pachymetry