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

Cryoneurolysis to peripheral neuralgia has been tried in selected postoperative pain and chronic pain patient; post-thoracotomy pain, post-herniorrhapy pain and trigeminal neuralgia. Here we report first two cases those were effectively controlled by percutaneous cryoneurolysis. Intercostal neuralgia was confirmed by intercostal nerve block with 1% mepivacaine and then we applied cryoneurolysis. Those pains could be relieved for more than two or three months. We suggest that cryoneurolysis can be an useful, simple and safe neurolytic method to intercostal neuralgia in outpatient pain clinic.
Chronic Pain ; Humans ; Intercostal Nerves ; Mepivacaine ; Neuralgia* ; Outpatients ; Pain Clinics ; Pain, Postoperative ; Trigeminal Neuralgia

Autonomic dysreflexia is a syndrome of uninhibited sympathetic spinal reflexes in response to stimuli below the level of injury in the patients with high spinal lesions. During labor, it can cause uteroplacental vasoconstriction resulting in fetal distress or devastating maternal complications including retinal hemorrhage, cerebrovascular accident and hypertensive encephalopathy. Neuraxial blockade has proven to be an effective method to attenuate or prevent it. We present a case detailing the use of epidural analgesia in managing the delivery of a quadriplegic parturient with a history of autonomic dysreflexia.
Analgesia, Epidural* ; Autonomic Dysreflexia ; Fetal Distress ; Humans ; Hypertensive Encephalopathy ; Reflex ; Retinal Hemorrhage ; Spinal Cord Injuries* ; Spinal Cord* ; Stroke ; Vasoconstriction

A 33-yr old female patient with coagulation factor VII deficiency was scheduled for laparoscopic oophorectomy under the diagnosis of ovarian teratoma. Plasma concentration of factor VII of this patient was 9 IU/dl (normal range; 60-140 IU/dl) and the prothrombin time INR (International Normalization Ratio) was 1.79 (normal range; 0.8-1.2) on the day before the operation. Total 1,200microgram (30microgram/kg) of recombinant activated factor VII (rFVIIa) was administered just before the start of the laparoscopic procedure, which was accomplished safely without severe hemorrhage or other complications. Postoperative course was uneventful. In addition, this article provides the clinical implication of rFVIIa in terms of hemostasis management in hemophiliacs and surgical patients.
Blood Coagulation ; Blood Coagulation Factors* ; Diagnosis ; Factor VII* ; Factor VIIa* ; Female ; Hemorrhage ; Hemostasis ; Humans ; International Normalized Ratio ; Ovariectomy ; Plasma ; Prothrombin Time ; Teratoma

BACKGROUND: In this randomized, double-blinded study, we evaluated the efficacy of ramosetron and ondansetron for preventing postoperative nausea and vomiting (PONV) in gynecologic patients. METHODS: Sixty patients undergoing total abdominal hysterectomy or myomectomy, ASA physical status I or II, aged 30-65 yr, received IV ramosetron 0.3 mg (group R) or ondansetron 4 mg (group O) at the end of surgery (n = 30 each). A standard general inhalational anesthesia and postoperative IV patient-controlled analgesia were used. At postoperative 3, 24 and 48 hours, we assessed pain score (VAS), incidence of PONV, rescue drug consumption, adverse events associated with study medications and overall satisfaction scores. RESULTS: The incidence of PONV showed no difference between groups at each time points after surgery (overall incidence; 59% in group R, 69% in group O). There was no difference in the severity of nausea, pain score and analgesic drug usage. However, the consumption of rescue drug in the ramosetron group was markedly less than that of ondansetron group at postoperative 3 hrs (none vs. 8 patients). No clinically serious adverse events were observed in either of the groups. Overall satisfaction scores were also comparable in both groups (6.5 +/- 3.0 vs. 6.2 +/- 2.7). CONCLUSIONS: Prophylactic therapy with ramosetron is as effective and safe as conventional prophylactic therapy with ondansetron for preventing PONV in women undergoing general anesthesia for gynecologic surgery. Severity of PONV seems significantly less with ramosetron than with ondansetron in the early postoperative period.
Analgesia, Patient-Controlled ; Anesthesia ; Anesthesia, General ; Female ; Gynecologic Surgical Procedures* ; Humans ; Hysterectomy ; Incidence ; Nausea* ; Ondansetron* ; Postoperative Nausea and Vomiting ; Postoperative Period ; Vomiting*

BACKGREOUND: When a double-lumen endotracheal tube (DLT) is used for one-lung ventilation, its position should be accurate. But only a few studies has been performed about how to predict the depth of insertion for DLT preoperatively. The purpose of this study is to investigate which physical measurements are correlated with the depth of insertion for left-sided DLT and how the depth of insertion for DLT can be explained with these physical measurements. METHODS: After placing a 5 cm-high pillow under the patient's head, we intubated left-sided disposable DLT (BronchocathTM, Mallinckrodt medical Ltd, USA) in 65 adults. We tape-measured sternocleidomastoid muscle (SCM) length and sternal length. We positioned the proximal margin of the bronchial cuff of DLT just below carinal bifurcation through fiberoptic bronchoscope, and recorded the depth of insertion for DLT at the upper incisor level. RESULTS: The depth of insertion for DLT was correlated with both height (y=3.96+0.15x, r2=0.51, p=0.0001) and SCM length (y=16.73+0.82x, r2=0.49, p=0.0001). Sternal length (r2=0.11, p=0.0081) was weakly correlated with the depth of insertion for DLT. The best regression model was depth of insertion for DLT (cm)=6.88+0.09 height (cm)x0.46 SCM length (cm). CONCLUSIONS: The depth of insertion for DLT is correlated with SCM length as well as height. So we may use them in predicting the depth of insertion for DLT.
Adult ; Bronchoscopes ; Head ; Humans ; Incisor ; One-Lung Ventilation