Uterine inversion is a rare but a potentially fatal complication of labor, and may occur in the third stage of labor. Because it can lead to shock and hemorrhage, immediate management should be attempted to replace the inverted uterus. We report a case in which uterine inversion was not replaced by manual manipulation, but which was successfully replaced by the induction of general anesthesia.
Anesthesia, General* ; Hemorrhage ; Shock ; Uterine Inversion* ; Uterus

BACKGROUND: The isolated lung model is a very useful model in investigation of hypoxic pulmonary vasoconstriction (HPV), and angiotensin II is extensively used in this model. But the exact role of angiotensin II in HPV is not clear in the isolated rabbit lung. Thus we were concerned about the role of angiotensin II in the blood-perfused rabbit lung. METHODS: New Zealand white rabbits (n = 28) lungs were isolated and perfused with a constant pulmonary perfusate flow; acid-base status and temperature were maintained at constant levels. Deoxyglucose (DOG group, n = 7), angiotension II and deoxyglucose (AG-DOG group, n = 7), calcium (CA group, n = 7), angiotensin II and calcium (AG-CA group, n = 7) were administered, and then hypoxic responses were measured. Three ratios were calculated and compared (P alpha: ratio of hypoxic response to pulmonary arterial pressure at normoxia, P beta: ratio of hypoxic response to baseline hypoxic response, P gamma: ratio of pulmonary arterial pressure at hypoxia to pulmonary arterial pressure at baseline). RESULTS: Angiotensin II increased the pulmonary arterial pressure by 14%, and increased HPV. Baseline pulmonary pressure was increased in the AG-DOG group and in the AG-CA group (P<0.05). P gamma significantly increased in the AG-DOG and AG-CA groups (P<0.05). The first HPV increased but the second HPV decreased in the AG-DOG group (P alpha: P<0.05) and in the AG-CA group. P beta showed no difference between groups. CONCLUSIONS: Angiotensin II resulted in an increase of pulmonary arterial pressure in the isolated rabbit lung. One may misinterpret this as an potentiation of HPV, but HPV was not changed by angiotensin II. Therefore we deny the necessity for angiotensin II in the isolated rabbit lung model.
Angiotensin II* ; Angiotensins* ; Anoxia ; Arterial Pressure ; Calcium ; Deoxyglucose ; Lung* ; Rabbits ; Vasoconstriction*

To determine whether mitomycin-C[MMC]treatment induces apoptosis in cultured keratocytes. Cultured rabbit keratocytes were exposed to MMC[up to 0.4 milligram/milliliter]or phosphate-buffered saline[PBS]for 5 minutes. Light and transmission electron microscopic examination, DNA electrophoresis, and flow cytometric analysis with propidium iodide staining were performed 24 hours after MMC or PBS treatment. A characteristic findings consistent with apoptosis were observed under both light and electron microscopic examination and DNA ladder pattern was shown on electrophoresis. The average percentages of apoptosis measured by flow cytometric analysis were as follows;0.16 +/-0.08%in PBS, 0.23 +/-0.13%in 0.1 milligram/milliliter MMC, 0.50 +/-0.13%in 0.2 milligram/milliliter M M C , and 6.50 +/-1.57%in 0.4 milligram/milliliter MMC. Significant differences were shown in the percentage of apoptosis among the groups based on Kruskal-Wallis test[p=0.005]. Clinically relevant doses of MMC induces apoptosis in cultured keratocytes proportionally. This results suggest that MMC may modulate corneal wound healing process by accelerating the resolution phase of wound healing.
Apoptosis* ; DNA ; Electrophoresis ; Mitomycin* ; Propidium ; Wound Healing

In this study, the effect of surface modification of polymethylmethacry-late[PMMA]by grafting of poly[ethylene glycol][PEG]on cell adhesion was investigated. PMMA surface was treated with ozone and then PEG-acry-late[PEGA]was graft-polymerized. Ozone treatment of the surface was car-ried out at room temperature by applying constant flow of oxygen[4.5liter/min]and 1 bar pressure. After ozone treatment, PMMA was immersed immediately in 20 wt%aq. PEG-acrylate solutions in glass ampoules. After degassing, the ampoule was sealed and kept at 60 degrees C for 24 hours to complete the graft polymerization. PMMA surface grafted with PEG revealed the enhanced oxygen content at ESCA analysis and the decreased dynamic receding contact angles. The adhesion of keratocytes onto modified PMMA was investigated. Keratocytes[4 x105cells/milliliter ]were layered on each PMMA discs which were glued to the bottom of 24-well culture plates, and cultured in a CO2 incubator for 24 hours. The adherent cells onto the surfaces were harvested by trypsinization and counted. The mean numbers of keratocytes on untreated PMMA, PEG-grafted PMMA with 1hour ozone treatment and PEG-grafted PMMA with 2 hour were 72.5 x104 and 6.5 x104 and 7.6 x104cells respectively, and there was a significant statistical difference [p=0.002], irrespective of ozone treatment period. This result suggests that surface modification of PMMA using PEG grafting may reduce etroprosthetic membrane formation of artificial cornea.
Cell Adhesion ; Cornea ; Glass ; Incubators ; Membranes ; Oxygen ; Ozone ; Polymerization* ; Polymers* ; Polymethyl Methacrylate ; Transplants ; Trypsin

Peripartum cardiomyopathy (PPCM) is a rare form of cardiomyopathy associated with a significant morbidity and mortality. The anesthetic management of a Cesarean section in patients with PPCM has not been well defined. Herein, our experience of a 31-year-old multipara, with recurrent PPCM and congestive heart failure, who presented for an elective cesarean section, is reported. Combined spinal-epidural anesthesia was successfully employed as the anesthetic technique for the procedure. The intra-arterial blood pressure and central venous pressure were monitored throughout the procedure. In addition, the patient's postoperative pain was markedly reduced with the use of epidural PCA. Combined spinal-epidural anesthesia is suggested to be a reliable technique, which provides minimal hemodynamic changes, and a lower failure rate than epidural anesthesia only, and is also highly effective with a low dose of local anesthetic drug.
Adult ; Anesthesia* ; Anesthesia, Epidural ; Blood Pressure ; Cardiomyopathies* ; Central Venous Pressure ; Cesarean Section* ; Female ; Heart Failure ; Hemodynamics ; Humans ; Mortality ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peripartum Period* ; Pregnancy

BACKGROUND: Systemic inflammatory response after open heart surgery has an adverse effect on the postoperative course of patient, and results from the release of cytokines by leukocytes activated by cardiopulmonary bypass (CPB). TNF-alpha has an important role in inflammatory response-it has clinical effects such as fever, tachycardia, and hypotension, and also induces other cytokines. However studies about the change of blood concentration of TNF-alpha after CPB show differing results, and so have been up to now inconclusive, we have therefore endeavored to investigate the change of TNF-alpha level after CPB and its relationship with the postoperative course of patients. METHODS: We studied 20 children undergoing open heart surgery. Serum TNF-alpha was detected after induction (control), 5 minutes after onset of CPB (T1), 5 minutes after release of aortic cross clamp (T2), and 30 minutes after CPB (T3) by enzyme-linked immunosorbent assay. We compared the concentration of TNF-alpha and the duration that patients stayed in intensive care unit (ICU) and were supported by mechanical ventilator in group I (CPB time 60 minutes, n = 10). RESULTS: TNF-alpha levels of S2 and S3 were significantly lower than those of S1 and S4 (P = 0.001), but no difference was detected between group I and II. No statistical relationship was found linking TNF-alpha levels with the duration in ICU, or time supported by mechanical ventilator. Three children with postoperative complications showed higher level of TNF-alpha than others (P = 0.002). CONCLUSIONS: We concluded that TNF-alpha levels decreased during CPB, did not increased after CPB, and had no relationship to such postoperative courses as postoperative ICU time and intubation time, but there was a correlation with postoperative complications.
Cardiopulmonary Bypass* ; Child ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Fever ; Humans ; Hypotension ; Intensive Care Units ; Intubation ; Leukocytes ; Postoperative Complications ; Tachycardia ; Thoracic Surgery ; Tumor Necrosis Factor-alpha* ; Ventilators, Mechanical

BACKGROUND: Postoperative pain control is provided for humanitarian reasons and to alleviate nociception-induced responses, such as endocrine metabolic responses, autonomic reflexes, which have adverse effects on organ function, and other undesirable results. Of the various methods of treatment, patient-controlled analgesia (PCA) is considered the gold standard for the of control postoperative pain. PCA can be administered via intraveous, epidural, or subcutaneous routes. Although patient-controlled epidural analgesia (PCEA) has been compared to IV-PCA, there is no optimal administrative route for the treatment of postoperative pain. This randomized study compared the effectiveness of PCEA and IV-PCA on postoperative pain and the side-effects after gynecologic surgery. METHODS: Ninety-seven patients undergoing gynecologic surgery were randomly assigned to receive either IV-PCA using a mixture of morphine and ketorolac or PCEA using 0.1% bupivacaine and morphine. Pain intensity was tested using a visual analog scale (VAS) until postoperative day 2. Nausea, vomiting, sedation, and pruritus were also measured. RESULTS: Among the 97 patients, 12 patients were excluded during study. Pain relief was better at rest and after coughing in the PCEA group during the 2 postoperative days, except at the first visit. Additional analgesics were used significantly less in the PCEA group, whilst the incidence of other complications was comparable in the IV-PCA and PCEA groups. CONCLUSIONS: After gynecologic surgery, PCEA using bupivacaine and morphine provides better pain relief than IV-PCA using morphine and ketorolac.
Analgesia, Epidural ; Analgesia, Patient-Controlled* ; Analgesics ; Bupivacaine ; Cough ; Female ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Ketorolac ; Morphine ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pruritus ; Reflex ; Visual Analog Scale ; Vomiting

BACKGROUND: Remifentanil is a novel, ultra-short acting opioid. This study was performed to compare the hemodynamic responses of remifentanil and nitrous oxide under propofol-based anesthesia during the intraoperative period. METHODS: Forty patients undergoing gynecologic surgery were randomly allocated to either remifentanil (R group) or N2O group (N group). In the R group, remfentanil was continuously infused from the induction of anesthesia (0.5 microgram/kg/min) to the end of surgery (0.1-0.5 microgram/kg/min). In the N group, fentanyl (2 microgram/kg) was injected intravenously and N2O was used thereafter. In both groups, target-concentration infusion of propofol was applied. We compared mean arterial pressure (MAP) and heart rate (HR) before and after tracheal intubation and during the rest of anesthetic time between the two groups. Postoperative parameters such as nausea/vomiting, consciousness level and pain at 2 and 24 hours were also compared. RESULTS: The magnitude of MAP and HR after tracheal intubation were significantly smaller and more stable in the R group than in the N group. Hypertensive (systolic blood pressure > 140 mmHg) episodes were significantly less frequent in the R group (3.0%) than in the N group (12.4%) during the operation. R group showed less MAP (76+/-12 mmHg) and HR (61+/-10 bpm) compared with those of N group (86+/-17 mmHg, 63+/-8 bpm, P < 0.05 respectively). Other postoperative measures were comparable between the two groups. CONCLUSIONS: We conclude that the continuous infusion of remifentanil can provide more stable hemodynamic status than N2O without significant adverse effects, in propofol-based general anesthesia.
Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Blood Pressure ; Consciousness ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics ; Humans ; Intraoperative Period ; Intubation ; Nitrous Oxide ; Propofol

BACKGROUND: Diabetic patients have more chance of requiring surgery than non-diabetic population. Glycemic and metabolic controls are key points in the perioperative diabetic management. A variety of methods have been proposed for the management of diabetics perioperatively, but their effectiveness is still controversial. This study was done to investigate whether diabetic patients are managed appropriately in perioperative period. METHODS: Among diabetic patients referred to anesthesiologic outpatient clinic from August 1997 to September 2002, 85 patients were randomly selected Diabetic duration, medication for diabetic control, concurrent illness and referral surgical department was recorded. In preoperative routine laboratory findings, HbA1c, fasting glucose and postprandial glucose were checked Perioperative glucose control protocols applied to patients were investigated RESULTS: Patients received 1.32 operation per person. Diabetic duration was 12.2 +/- 7.2 years, thirty nine patients had take oral hypoglycemic agent and thirty one patients had received insulin. Mean HbA1c was 8.0 +/- 1.6%, thirty four patients showed above 8.0%. Alberti's regimen was used in fifty five patients and insulin was omitted in fifty six patients. Two patients received insulin of half of usual dose in the morning. Alberti's regimen in major surgery and no insulin in minor surgery were preferred. The composition of Alberti's regimen and target blood glucose level varied. During operation, blood glucose was checked only in fourty four cases. Five of seven postoperative hypoglycemic patients were not checked glucose level during operation. Mortality rate was 7% and major cause of death was sepsis. All of the mortality cases had diabetic cardiovascular and nephrologic complications. CONCLUSIONS: We concluded there is a pitfall in managing diabetic patients requiring surgery. There must be a consensus between surgeon and anesthesiologist about perioperative management of diabetics. Perioperative glucose level should be checked as often as feasible, and insulin supply be continued during operation.
Ambulatory Care Facilities ; Blood Glucose ; Cause of Death ; Consensus ; Diabetes Mellitus ; Fasting ; Glucose ; Humans ; Insulin ; Mortality ; Perioperative Period ; Referral and Consultation ; Retrospective Studies* ; Sepsis ; Surgical Procedures, Minor

BACKGROUND: Controlled hypotension improves surgical field and decreases transfusion requirement in surgical patients and can be induced with various kinds of drugs including esmolol and hydralazine. METHODS: This study examined the effect of a combination of esmolol and hydralazine as hypotensive agents in spine surgery. In the esmolol group (n = 15), after boluses of esmolol (0.5 mg/kg) injection, esmolol was infused to maintain the mean arterial pressure of 55-65 mmHg. In the hydralazine-esmolol group (n = 15), hydralazine (0.3 mg/kg) was administered 15 minutes before esmolol injection which was done in the same way as that of the esmolol group. RESULTS: The mean arterial pressure decreased to the target range more rapidly in the hydralazine-esmolol group. The heart rate was increased by hydralazine, but reduced by esmolol. The cardiac output remained elevated after hydralazine injection in the hydralazine-esmolol group, and decreased significantly by esmolol in the esmolol group. The administered dose of esmolol was much less in the hydralazine-esmolol group than in the esmolol group. CONCLUSIONS: Our data suggest that hydralazine can enhance the efficacy of esmolol-induced controlled hypotension. It can reduce the requirement of esmolol and maintain a higher cardiac output during hypotension.
Arterial Pressure ; Cardiac Output ; Heart Rate ; Humans ; Hydralazine* ; Hypotension ; Hypotension, Controlled* ; Spine*