Jehovah's Witness patients who require an operation represent a challenge to the physician because of the patients' refusal to accept a blood transfusion. We report 5 years experience with a consecutive series of 12 Jehovah's Witness patients in the Obstetric & Gynecological department who underwent operation. In 12 cases, death ensued in one patient who underwent subtotal hysterectomy for ectopic pregnancy. The cause of death was severe anemia & complicated respiratory problems. We discussed the problem of elective & emergency operations on Jehovah's Witness patients. Anesthesiologists must understand legal aspects, as well as and ethical, if they are to conduct their practice as an art as well as science.
Anemia ; Blood Transfusion* ; Cause of Death ; Disulfiram* ; Emergencies ; Female ; Humans ; Hysterectomy ; Jurisprudence ; Pregnancy ; Pregnancy, Ectopic

It is a well known fact that the major craniofacial operation is a complicated procedure. In this procedure, the operative period is extremely long and blood loss is large, extremely difficult to estimate and continuous into the early postoperative period. The air was should be protected intraoperatively and postoperatively due to frequent airway obstruction. We had experienced of an anesthetic management for correction of hypertelorism. Anesthetic management of this case should focus on reduction intracranial pressure and volume. WE had performed neurolept anesthesia with controlled hyperventilation. The careful monitoring and frequent measuring of blood gas analysis, hematocrit, hourly urine output, electrolytes, body temperature, CVP, ECG, and acid-base balance status are recommended. We report a case of anesthetic management for a patient.
Acid-Base Equilibrium ; Airway Obstruction ; Anesthesia ; Blood Gas Analysis ; Body Temperature ; Electrocardiography ; Electrolytes ; Hematocrit ; Humans ; Hypertelorism* ; Hyperventilation ; Intracranial Pressure ; Postoperative Period

We have experienced the anesthetic management of bilateral adrenalectomy in a 17 years old male, who was diagnosed as Cushing's syndrome. Anesthetic problems in Cushing`s Syndrome are hypertension, tachrcardia, hyperglycemia, hypokalemia and acute adrenal insufficiency. Therefore anesthetic management of this disease should focus on the through understanding of pathophysiology and adequate control of preoperative condition. Careful monitoring of the patient and frequent measurement of electrolytes and acid base balance status during the operation are also needed. We report the case of anesthetic experience of Cushing`s Syndrome and review anesthetic choice and management for better outcome of the patient.
Acid-Base Equilibrium ; Adolescent ; Adrenal Insufficiency ; Adrenalectomy ; Cushing Syndrome ; Electrolytes ; Humans ; Hyperglycemia ; Hypertension ; Hypokalemia ; Male

Anti-coccidial effects of the fruits of Tribulus terrestris (Tribuli fructus) ethanol extract (TTE) were studied with animal experiment following per oral administration with Eimeria (E.) tenella. This experiment was performed on the 3-day-old chicks (n=30). The animals were divided with 3 groups; TFE 15mg per animal+infected (n=10), TTE untreated+infected (n=10) and non-infected control (n=10). Animals were administrated with or without TTE during 1 week, and then inoculated with E. tenella. The anti-coccidial activity were evaluated with oocysts shedding numbers in stools, body weights changes and food intake changes. The TTE-inoclated animals revealed significantly decreased stool oocysts numbers (P < 0.05) when compared to the TTE untreated animals. Also, TTE-treated animals showed more increased body weight gains (P < 0.05) than the TTE untreated animals. These results demonstrate that TTE produce anticoccidial activities against E. tenella. TTE could be a promising treatment for the coccidiosis.
Administration, Oral ; Animal Experimentation ; Animals ; Body Weight ; Coccidiosis ; Eating ; Eimeria tenella* ; Eimeria* ; Ethanol* ; Fruit* ; Oocysts ; Polytetrafluoroethylene ; Tribulus*

BACKGROUND AND OBJECTIVES: Increased QT dispersion (QTD) in patients with acute myocardial infarction (AMI) may be related with such adverse events as sudden cardiac death and ischemic heart failure. SUBJECTS AND METHODS: Two hundred eight patients (age : 62+/-10.4 years, 158 males), underwent diagnostic coronary angiography under the diagnosis of AMI between January and December 2001 at the Heart Center of Chonnam National University Hospital, and these patients were enrolled to evaluate the relationship between the QTD and myocardial injury and the complex coronary arterial lesion. RESULTS: A QTD of over 80 ms was observed in 89 patients (42.7%). There were in 61 patients with ST elevation myocardial infarction (STEMI, 68.5%) and 28 patients with non-ST elevation myocardial infarction (NSTEMI, 31.5%). There was no correlation between the QTD and such risk factors as hypertension, diabetes, gender, smoking, hyperlipidemia and family history. The level of CK-MB on admission was correlated with the QTD (112.5+/-98.1 U/L in the group with a QTD over 80 ms and 72.6+/-73.4 U/L in the group with a QTD under 80 ms, p<0.05). The ejection fraction measured by two dimensional echocardiography on admission showed correlation with the QTD (50.9+/-11.4% in the group with a QTD over 80 ms and 54.7+/-11.2% U/L in the group with a QTD under 80 ms, p<0.05). For the coronary angiographic findings, the lesion type, according to American College of Cardiology/American Heart Association classification, correlated with the QT dispersion (type B2 or C : 64.1% in the group with a QTD over 80 ms, 49.6% in the group with a QTD under 80 ms, p<0.05) CONCLUSION: There was significant correlation between the prolonged QTD and the severity of myocardial injury at admission, and the complex coronary arterial lesion in patients with AMI.
Classification ; Coronary Angiography ; Coronary Vessels* ; Death, Sudden, Cardiac ; Diagnosis ; Echocardiography ; Electrocardiography ; Heart ; Heart Failure ; Humans ; Hyperlipidemias ; Hypertension ; Jeollanam-do ; Myocardial Infarction* ; Risk Factors ; Smoke ; Smoking

BACKGROUND AND OBJECTIVES: Besides the acute coronary syndrome (ACS), the left ventricular failure (LVF) is the next important determinant of morbidity and mortality after acute coronary syndrome (ACS). The prediction of high risk groups for LVF may be in the initial management of patients with unstable angina (UA) or acute non-ST elevation myocardial infarction (NSTEMI). SUBJECTS AND METHODS: 179 patients (60.4+/-11.6 years, 121 male) who underwent diagnostic coronary angiography under the diagnosis of UA/NSTEMI between January and December, 2000, in the Chonnam National University Hospital Heart Center were enrolled for evaluation of relationship between the development LVF and various parameters, including clinical features, initial electrocardiogram, laboratory findings and coronary angiographic findings. RESULTS: Unstable angina was clinically diagnosed in 124 patients, and NSTEMI in 55 patients. During a 12-month follow-up period, less than 40% of the left ventricular ejection fraction (EF), a low amount, was observed in 28 patients (15.7%). In diabetic patients, the incidence of LVF was significantly higher than in non-diabetics (p<0.05). Patients with elevated C-reactive protein (CRP) or positive troponin I had LVF more frequently (p<0.05). On the initial electrocardiogram, the total summation of ST segment change inversely correlated with EF (p<0.05). Patients whose QT dispersion was longer than 80 ms had a higher incidence of LVF (p<0.05). Coronary angiographic findings of total occlusion correlated with the development of LVF (p<0.05), but not with other characteristics. On multiple logistic regression analysis, high CRP level (p=0.024), summation of ST change (p=0.021), total occlusion of the coronary artery (p=0.008) were independent prognostic factors of LVF. CONCLUSION: Elevated CRP, summation of ST change and total coronary artery occlusion are important predictive factors for LVF in UA/NSTEMI.
Acute Coronary Syndrome ; Angina, Unstable* ; C-Reactive Protein ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Follow-Up Studies ; Heart Failure* ; Heart* ; Humans ; Incidence ; Jeollanam-do ; Logistic Models ; Mortality ; Myocardial Infarction* ; Prognosis ; Stroke Volume ; Troponin I

Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complication of controlled ovarian hyperstimulation (COH) and ovulation induction. High serum estradiol concentration can induce the increase of capillary permeability and fluid shift, and it can results in hypovolemia, hemoconcetration, thromboembolism, oliguria, ascites and even death. This physiologic changes of OHSS and/or pregnancy might induce the deterioration of pituitary function in patients with abnormal pituitary conditions such as low pituitary reserve or tumor. However, all this while, panhypopituitarism or pituitary apoplexy in a pregnant woman with OHSS and/or pituitary adenoma has not been reported. We have experienced a case of panhypopituitarism developed in a pregnant woman with severe OHSS and residual pituitary adenoma. She had residual prolactinoma, despite a transsphenoidal adenoidectomy, and had suffered from uncontrolled hyperprolactinemia (HPRL) and chronic anovulation. Therefore, she had taken ovulation induction for getting a pregnancy and conceived, but, in the conception cycle, she was hospitalized for management of severe OHSS and hyperemesis gravidarum. During the period of hospitalization, abrupt panhypopituitarism was developed unexpectedly. Therefore, we present this case with the brief review of literature.
Adenoidectomy ; Anovulation ; Ascites ; Capillary Permeability ; Estradiol ; Female ; Fertilization ; Hospitalization ; Humans ; Hyperemesis Gravidarum ; Hyperprolactinemia ; Hypovolemia ; Oliguria ; Ovarian Hyperstimulation Syndrome* ; Ovulation Induction ; Pituitary Apoplexy ; Pituitary Neoplasms* ; Pregnancy ; Pregnant Women* ; Prolactinoma ; Thromboembolism