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*

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

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.

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

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: 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*

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

BACKGROUND: Mediastinoscopy is generally performed to confirm mediastinal lymph node metastasis in lung cancer patients. It still remains controversial whether mediastinoscopy should be performed in all patients with resectable non-small cell lung cancer (NSCLC). We studied the clinical value of mediastinoscopy in preoperative staging in NSCLC. MATERIAL AND METHOD: We retrospectively studied 90 NSCLC patients who underwent radiological evaluation and mediastinoscopy followed by surgical resection from March 2002 to December 2004. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each evaluation method were assessed and compared. RESULT: Specificity, PPV, NPV, and accuracy of mediastinoscopy were superior to those of radiological evaluation, but there was no significant difference in sensitivity. The sensitivity of mediastinoscopy was 28.6% in 62 patients with radiological N0/1 disease and 72.7% in 28 patients with radiological N2/3 disease. Seven of eight patients in whom positive nodes were not detected by the mediastinoscopy had subcarinal lymph node metastasis. CONCLUSION: Considering its invasiveness, the difficulty to reach certain node stations, and its low sensitivity in radiological N0/1 disease, mediastinoscopy should be selectively performed in radiological N2/3 disease rather than in all radiological cancer stages.
Carcinoma, Non-Small-Cell Lung* ; Humans ; Lung Neoplasms ; Lymph Nodes ; Mediastinoscopy* ; Neoplasm Metastasis ; Retrospective Studies ; Sensitivity and Specificity

A spontaneous spinal epidural hematoma (SSEH) is a rare disease that accompanies severe axial pain in the spine with various levels of paralysis depending on the location of the hematoma. A SSEH is mainly caused by a coagulating disorder or anticoagulants medication, while certain cases relate this disease with spinal inflammatory conditions. The early diagnosis of a SSEH is important for its treatment. Most cases with neurologic symptoms can be treated with an immediate laminectomy and decompression. If the neurologic symptom improves within 12 hours, a conservative treatment is effective; however few cases have been reported. We report this case with a review of the relevant literature.
Anticoagulants ; Decompression ; Early Diagnosis ; Hematoma ; Hematoma, Epidural, Spinal ; Laminectomy ; Neurologic Manifestations ; Paralysis ; Polymethacrylic Acids ; Rare Diseases ; Spine

Dentigerous cysts are common odontogenic cysts that are associated with the crown of the tooth and typically develop from single lesions. Bilateral and multiple dentigerous cysts are very rare and occur in patients with syndromic conditions. This paper presents a case report of a 15-year-old male patient that experienced non-syndromic bilateral dentigerous cysts that simultaneously occurred in all four dental quadrants around the unerupted third molars. Clinicians should confirm the extent of cystic lesions using a panoramic view and computed tomography, and should keep the possibility of bilateral dentigerous cysts in mind as a potential diagnosis, even in a non-syndromic patient.
Adolescent ; Crowns ; Dentigerous Cyst* ; Diagnosis ; Humans ; Male ; Molar, Third ; Odontogenic Cysts ; Tooth