There has long been a controversy on the use of colloids. Many developments have now been made in the theological aspects. The new glycocalyx model and other related studies have shown that the volume expansion effect of colloids is not so superior to crystalloids in many situations. Moreover, the results from several multicenter studies on septic shock patients indicated that hydroxyethyl starch did not improve clinical outcome, but instead, increased the number of serious complications such as death and renal failure. Accordingly, this long debate has been concluded, at least about the use of hydroxyethyl starch colloid on patients with septic shock. Although there is still a lack of studies on perioperative patients, care is also needed when using colloids in their treatment.
Colloids ; Glycocalyx ; Humans ; Renal Insufficiency ; Shock, Septic ; Starch*

Primary malignant lymphoma of the appendix is an unconnnon neoplasm although the gastrointestinal tract is the most common extranodal site of malignant lymphoma. We report a case of primary malignant lymphoma of the appendix in a 54-year-old male, who presented with pain in the right lower abdomen. An appendectomy was performed. The appendix measured 9.5 cm in length and 5.5 cm in diameter. Cut sections showed a solitary circumferential mass in the appendiceal lumen. Light microscopic features were compatible with malignant lymphoma of diffuse large cell type(Working Formulation) and the immunophenotype was B cell type.

There have been cases reported of pneumocephalus, spinal cord and nerve root compression associated with the use of air in the loss of resistance technique during epidural block. However, the manual loss of resistance technique is still widely used by anesthesiologists for identifying the epidural space. A 65-yr-old female requested epidural steroid injection for her low leg radiating pain. A 22-guage Tuohy needle was placed in the L3-4 interspace with the loss of resistance technique using 4 ml air. Aspiration yielded no cerebrospinal fluid. After injection of 1% lidocaine 5 ml as a test dose, 0.25% lidocaine 10 ml with 40 mg triamcinole was infused and she did not show any abnormal signs. After changing to sitting position, however, the patient complained of increasing headache and nausea. After vomiting, she was obtunded. CT scan showed brainstem compression by the air. The patient lost conscioussness for 20 minutes. Four hours later, her neurologic examination was normal except for the headache. She was discharged on the third day after the accident and the headache subsided by the fifth day. As far as we know, this is the first case reported of a brain stem compression by air after epidural technique that induced serious neurologic symptoms.
Brain Stem* ; Cerebrospinal Fluid ; Epidural Space ; Female ; Headache ; Humans ; Leg ; Lidocaine ; Nausea ; Needles ; Neurologic Examination ; Neurologic Manifestations ; Pneumocephalus ; Radiculopathy ; Spinal Cord ; Tomography, X-Ray Computed ; Vomiting

We report a case in which WPW (Wolff-Parkinson-White)-type preexcitation syndrome arose unexpectedly immediately after induction of general anesthesia on a 25-yr-old man who had another rare cardiac arrhythmia, parasystole. His preoperative ECG showed ventricular bigeminy and a delta wave was observed after induction of anesthesia with fentanyl, midazolam and propofol. Anesthesia was maintained with propofol, fentanyl and nitrous oxide. The intraoperative ECG showed varying and temporary responsiveness to drugs such as atropine, lidocaine and ephedrine. After we started to infuse the dobutamine, the delta wave, ventricular bigeminy disappeared on the intraoperative ECG. We should consider the influence of anesthesia-related agents on arrhythmia, and aim to prevent and manage tachyarrhythmias caused by this syndrome.
Anesthesia ; Anesthesia, General* ; Arrhythmias, Cardiac ; Atropine ; Dobutamine ; Electrocardiography ; Ephedrine ; Fentanyl ; Humans ; Lidocaine ; Midazolam ; Nitrous Oxide ; Parasystole* ; Pre-Excitation Syndromes* ; Propofol ; Tachycardia ; Wolff-Parkinson-White Syndrome

BACKGROUND: Cardiac patients undergoing open heart surgery usually require ventilatory support that involves ICU admission in the postoperative period. We tried to find out determinants of postoperative ventilatory support time. METHODS: We reviewed the medical records of 56 open heart surgery patients retrospectively in terms of their disease, preoperative physical status, age, post-bypass arterial oxygen tension/inspired oxygen fraction (PaO2/FIO2) ratio, number of inotropics used and searched the relationship between each factor and postoperative intubation time. RESULTS: None of the factors except the number of inotropics used had an significant influence on the postoperative intubation time. CONCLUSION: In open heart surgical patients their disease, preoperative physical status, age, postbypass PaO2/FIO2 ratio do not affect postoperative intubation time rather than number of inotropics used does.
Heart* ; Humans ; Intubation* ; Medical Records ; Oxygen ; Postoperative Period ; Retrospective Studies ; Thoracic Surgery*

PURPOSE: We analyzed the oncological outcome and prognostic factor of the chondrosarcoma arising from benign bone tumor due to malignant transformation. MATERIALS AND METHODS: From April 1986 to April 2009, 18 cases were considered eligible. We analyzed retrospectively the patient's characteristics and prognostic factors that affect to the local recurrence and distant metastasis. RESULTS: As classified by primary benign bone tumor, 4 cases were solitary osteochondroma, 11 cases were multiple osteochondromatosis and 3 cases were multiple enchondromatosis. The mean follow-up period was 85 months. The 5-year disease free survival rate of 18 patients was 85.9%. Their overall MSTS score was 25.2 (84%). There were local recurrence in 3 cases and no distant metastasis. We found that tumor location and surgical margin affected to the prognosis significantly. CONCLUSION: In secondary chondrosarcoma patients, the prognosis was good relatively and tumor location and surgical margin are important prognosis factor.
Chondrosarcoma ; Disease-Free Survival ; Enchondromatosis ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Osteochondroma ; Osteochondromatosis ; Prognosis ; Recurrence ; Retrospective Studies

Background: Although an ambulatory surgical practice continues to increase, there is a few data exist about patient discharge criteria. This study was undertaken to evaluate the usefulness and safety of Aldrete PAR (postanesthetic recovery) score and modified PADSS (modified postaneathesia discharge scoring system) on ambulatory surgery patients for recovery in Korea. Methods: Demographic, anesthetic data, Aldrete PAR score and modified PADSS on 279 patients were recorded. The time to dicharge, from recovery room and postoperative complications were evaluated, also. Results: PAR score and modified PADSS are correlated to length of stay in ambulatory surgery center. 24hr after discharge, 16% patients complained postoperative complications. Pain was most frequent postoperative complication. The PAR score was correlated with the occurrence of the complication. Conclusion: PAR score and modified PADSS are useful scoring systems to evaluate patients and make a decision to discharge the patients from ambulatory surgery center in safe.
Ambulatory Surgical Procedures* ; Humans ; Korea ; Length of Stay ; Patient Discharge* ; Postoperative Complications ; Recovery Room

Anaphylaxis is an acute, potentially lethal, multisystem syndrome resulting from the sudden release of mast-cell- and basophile-derived mediators into the circulation. Common manifestations of anaphylactic reactions include urticaria, angioedema, nausea, vomiting, hypotension and cardiovascular collapse. Cardiovascular collapse is the first detected manifestation in up to 50% of cases in perioperative anaphylaxis, because patients are anesthetized and unable to report symptoms. A 25-year-old male presented with severe hypotension and erythema after intravenous atropine administration during general anesthesia. Postoperative laboratory findings demonstrated elevated serum tryptase and total immunoglobulin E. An intradermal test showed atropine sensitivity. Although atropine is used widely as a perioperative anticholinergic agent, it is a potential risk factor for a severe anaphylactic reaction. Therefore, prompt recognition and adequate therapeutic measures are necessary to avoid fatal consequences.
Adult ; Anaphylaxis* ; Anesthesia, General* ; Angioedema ; Atropine* ; Erythema ; Humans ; Hypotension ; Immunoglobulin E ; Immunoglobulins ; Intradermal Tests ; Male ; Nausea ; Risk Factors ; Tryptases ; Urticaria ; Vomiting

Here, we report a case of newly diagnosed diabetes, with concurrent pancreatic cancer manifested as hyperglycemic crisis, and aggravated by urinary tract infection. We summarize the initial clinical manifestations and pertinent laboratory, radiologic, and clinical findings in an elderly patient with hyperglycemic emergency. A review of the documents involving pancreatic tumors and hyperglycemic hyperosmolar state, which is an acute complication of diabetes mellitus, is presented. In the absence of other identifiable conditions, it is reasonable to speculate that some factor (or factors) produced by the tumor had a role in the metabolic decompensation. In addition, this discussion should be more carefully considered in the aged people group.
Aged ; Diabetes Mellitus ; Emergencies ; Humans ; Pancreatic Neoplasms ; Urinary Tract Infections

BACKGROUND: Straight raising of the legs in the supine position or Trendelenburg positioning has been used to treat hypotension or shock, but the advantages of these positions are not clear and under debate. We performed a crossover study to evaluate the circulatory effect of full flexion of the hips and knees in the supine position (exaggerated lithotomy), and compare it with straight leg raising. METHODS: This study was a prospective randomized crossover study from the tertiary care unit at our university hospital. Twenty-two patients scheduled for off-pump coronary artery bypass surgery were enrolled. Induction and maintenance of anesthesia were standardized. Exaggerated lithotomy position or straight leg raising were randomly selected in the supine position. Hemodynamic variables were measured in the following sequence: 10 min after induction, 1, 5, and 10 min following the designated position, and 1 and 5 min after returning to the supine position. Ten min later, the other position was applied to measure the same hemodynamic variables. RESULTS: During the exaggerated lithotomy position, cerebral and coronary perfusion pressure increased significantly (P < 0.01) without a change in cardiac output. During straight leg raising, cardiac output increased at 5 min (P < 0.05) and cerebral and coronary perfusion pressures did not increase except for cerebral perfusion pressure at 1 min. However, the difference between the two groups at each time point in terms of cerebral perfusion pressure was clinically insignificant. CONCLUSIONS: Full flexion of the hips and knees in the supine position did not increase cardiac output but may be more beneficial than straight leg raising in terms of coronary perfusion pressure.
Anesthesia ; Cardiac Output ; Coronary Artery Bypass, Off-Pump ; Cross-Over Studies ; Hemodynamics ; Hip ; Humans ; Hypotension ; Knee ; Leg ; Perfusion ; Prospective Studies ; Shock ; Supine Position ; Tertiary Healthcare