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

Recently, the external cephalic version procedure has attracted attention as an alternative for the operative or vaginal delivery of a breech-presenting fetus. Although this procedure has many benefits, including its comparative safety and economical efficiency, it is not free from complications. We report two cases of external versions attempted under epidural anesthesia. These cases demonstrate that the use of a neuraxial blockade during a version attempt can provide the appropriate conditions necessary for this procedure, as well as the ability to deal with complications in a timely and safe manner.
Anesthesia, Epidural ; Breech Presentation ; Female ; Fetus ; Pregnancy ; Version, Fetal

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*

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*