The general anesthesia combined with epidural anesthesia have many advantages, which are including early recovery, postoperative analgesia, and less requirement of inhalation anesthetic. But the complications of epidural anesthesia such as total spinal anesthesia, respiratory depression, myocardial ischemia, and local anesthetic toxicity can lead to cardiac arrest. We report a case of acute myocardial infarction in a 74-year-old female patient receiving general anesthesia combined with epidural anesthesia. The profound hypotension without bradycardia and ST-segment elevation in lead II occurred 1 hour after local anesthetic injection and cardiac arrest followed. After the injection of atropine, epinephrine and dopamine, and external cardiac massage, sinus rhythm was restored. Postoperative serial examinations of ECG showed ST-segment elevation in leads II, III, aVF and serum enzymes such as CPK, CK-MB, and Troponin T were elevated. Emergency percutaneous transluminal coronary angioplasty was performed and the patient recovered uneventfully.
Aged ; Analgesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Angioplasty, Balloon, Coronary ; Atropine ; Bradycardia ; Dopamine ; Electrocardiography ; Emergencies ; Epinephrine ; Female ; Heart Arrest ; Heart Massage ; Humans ; Hypotension ; Inhalation ; Myocardial Infarction ; Myocardial Ischemia ; Respiratory Insufficiency ; Troponin T

OBJECTIVE: Elective surgical approaches and trauma cause changes in the production of different cytokines. The aim of this study was to evaluate the effects of laparoscopic surgery on the immune system of patients with gynecologic diseases. METHODS: We recruited the open surgery group (n=20) and laparoscopic surgery group (n=33). In a prospective study we examined the C-reactive protein (CRP) level, the production of the cytokines Interleukin-1beta (IL-1beta), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10 (IL-10) and TNF-alpha concentrations by ELISA. In addition the fibrinogen, transferrin, albumin, hemoglobin and hematocrit were measured. Statistical analysis was made by Mann-Whitney U test and Kruskal-Wallis test. RESULTS: There were significant statistical differences in the CRP, IL-6 and IL-8 between the open surgery group and laparoscopic surgery group after surgery. The CRP and IL-8 showed a more distinct increase in open surgery group 24 hours after surgery, the differences between the two surgical approaches were significant (p<0.05). CONCLUSION: Elective surgical approaches cause changes in the immune system, which can be evaluated by the reaction of cytokines. Laparoscopic surgery cause less activation of the CRP and IL-8 than open surgery.
C-Reactive Protein ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibrinogen ; Genital Diseases, Female* ; Hematocrit ; Humans ; Immune System* ; Interleukin-10 ; Interleukin-1beta ; Interleukin-6 ; Interleukin-8 ; Laparoscopy* ; Prospective Studies ; Transferrin ; Tumor Necrosis Factor-alpha

The incidence of all transverse vaginal septum is 1:2,100 - 1:72,000. The transverse vaginal septum is a developmental defect of vagina which may be fused incompletely between the Mullerian duct component and the urogenital sinus component of vagina. Serious complications may be hematocolpos, hematometra and hematosalpinx. Simple surgical excision or simple incision have been developed to treat congenital transverse vaginal septa, but also caused common complications such as secondary tissue contracture. Garcia technique using eight vaginal mucosa flaps was developed to avoid common complication of secondary vaginal stenosis. Here, we present a case of contracted transverse vaginal septum who has been performed a simple incision 13 years ago, successfully performed the modified Garcia technique without serious postoperative complication.
Constriction, Pathologic ; Contracture ; Female ; Hematocolpos ; Hematometra ; Incidence ; Mucous Membrane ; Postoperative Complications ; Vagina

A 6-year-old-man with a severe pectus excavatum and marfanoid feature was admitted for the correction of pectus excavatum. Nuss procedure was recently introduced, because of its excellent effect from the cosmetic point of view. This method is that convex steel bar is inserted under the sternum through small bilateral thoracic incisions, and when it is in position, the bar is turn over, thereby correction the deformity. We experienced a case of the cardiac arrest during the rotation of a stainless steel bar. After the injection of atropine, epinephrine and the closed cardiac massage, sinus rhythm was restored. A vasovagal reflex due to the operation could be considered the possible etiology.
Atropine ; Congenital Abnormalities ; Epinephrine ; Funnel Chest* ; Heart Arrest* ; Heart Massage ; Humans ; Reflex ; Stainless Steel* ; Steel ; Sternum

Nuss procedure was recently introduced, because of its excellent effect from the cosmetic point of view and improvement of the pulmonary function, but the complications such as heart injury, bar displacement, hemothorax, pneumothorax and tension pneumothorax sometimes occur. We experienced a 12 year-old female, who showed profound hypotension with a bradycardia and severe reduction in oxygen saturation followed by the tension pneumothorax after the operation by the Nuss method. The patient was treated with the immediate thoracostomy and recovered without any other problem. In anesthetic management of the pectus excavatum repair by the Nuss method, we should always pay attention to the possible occurrence of tension pneumothorax.
Bradycardia ; Child ; Female ; Funnel Chest* ; Heart Injuries ; Hemothorax ; Humans ; Hypotension ; Oxygen ; Pneumothorax* ; Stainless Steel* ; Thoracostomy

Nuss procedure offers excellent outcome effect in the cosmetic point of view, but the complications such as cardiac perforation, pericardial effusion, constrictive pericarditis, hemothorax, pneumothorax and bar displacement sometimes occur. We experienced a 13-year-old-male, who showed the profound hypotension with bradycardia due to the cardiac perforation and the lung laceration during the pericardiectomy and the removal of pectus bar. Emergent partial cardiopulmonary bypass was initiated and then, ruptured right atrium and lung laceration were repaired without the remarkable complications. In anesthetic management of the pectus excavatum. This case reveals that special attention should be paid to those with cardiac perforation and lung laceration.
Bradycardia ; Cardiopulmonary Bypass ; Funnel Chest* ; Heart Atria ; Hemothorax* ; Humans ; Hypotension ; Lacerations ; Lung ; Pericardial Effusion ; Pericardiectomy* ; Pericarditis, Constrictive* ; Pneumothorax

Uterine leiomyomas are the most common uterine tumors. They are estimated to be present in approximately 20% of all women of reproductive age. They may be present in subserosal, intramural, or submucosal in location within the uterus, or located in the cervix, in the broad ligaments, or on a pedicle. Many studies report that the malignant potential of a preexisting uterine leiomyoma is extremely rare, occuring in less than 0.5%. Uterine leiomyomas may cause a range of syptoms, for example, severe anemia from abnormal uterine bleeding, dysmenorrhea, constipation from rectosigmoid compression, dysuria, frequency, residual sensation due to bladder compression. Patients with those symptoms or "cancer phobia" should be treated. Rare but severe symptoms associated with uterine leiomyomas are rectosigmoid compression, with intestinal obstruction, thrombophlebitis of lower extremities from venous stasis, polycythemia, ascites, severe pain from torsion and infection of prolapsed pedunculated submucosal myoma and uterine inversion from prolase of pedunculated submucosal leiomyoma. Now we report a rare case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma, which caused hypovolemic shock due to massive uterine bleeding.
Anemia ; Ascites ; Broad Ligament ; Cervix Uteri ; Constipation ; Dysmenorrhea ; Dysuria ; Female ; Humans ; Intestinal Obstruction ; Leiomyoma* ; Lower Extremity ; Myoma ; Polycythemia ; Prolapse* ; Sensation ; Shock ; Thrombophlebitis ; Urinary Bladder ; Uterine Hemorrhage ; Uterine Inversion* ; Uterus

Sertoli-Leydig cell tumors are rare sex cord-stromal tumors. These tumors account for less than 0.5% of all ovarian tumors. Because these tumors appear predominantly in young women (between the age of 30 and 40) and are bilateral in less than 1% of cases, conservative removal of the tumor and adjacent fallopian tube is justifiable. Recently, we experienced a case of successful laparoscopic surgical staging in patient of Sertoli-Leydig cell tumor which was previously incompletely evaluated in local OBGY clinic. There are no solid data to suggest that usefulness and risk of laparoscopic surgical staging and adjuvant therapy with stage I disease of these tumors until now. So we present it with a brief review of literature.
Fallopian Tubes ; Female ; Humans ; Sertoli-Leydig Cell Tumor* ; Sex Cord-Gonadal Stromal Tumors

The incidence of all malignant tumor in pregnancy is 0.07-0.1%. The most frequent tumors in pregnancy are breast cancer, gynecologic tumors (cervical cancer, ovarian cancer), melanoma and lymphomas. Any malignant tumor in pregnancy has a diagnostic and therapeutic problem. Melanoma is 8% of all malignancies in pregnancy. Surgery is a definitive therapy for early-stage disease. Melanoma in pregnancy metastasize early and rapidly. So we have difficulty in making therapeutic plan. Most frequent metastatic lesions are liver and lung. We experienced melanoma of liver in pregnancy. This report represents melanoma in pregnancy with a review of literature.
Breast Neoplasms ; Incidence ; Liver* ; Lung ; Lymphoma ; Melanoma* ; Ovarian Neoplasms ; Pregnancy* ; Rupture, Spontaneous*

Goldenhar syndrome is a rare congenital disorder of hemicraniofacial and vertebral defects related to the abnormal development of the first and second branchial arches. In some infants, congenital heart disease, and pulmonary and renal defects are also present. Goldenhar syndrome commonly involves an airway which is difficult to manage. Tracheal intubation may be difficult due to a combination of retrognathia, micrognathia, mandibular hypoplasia, palatal defects and vertebral abnormities. We experienced the anesthetic management of an 8-month-old boy with Goldenhar syndrome who received excision and biopsy for conjunctival dermoid and ureteral reimplantation for vesicoureteral reflux under general anesthesia. Airway management, with thiopental, rocuronium and sevoflurane, and tracheal intubation were accomplished successfully in the patient. Surgery was performed uneventfully and the patient was discharged without complication.
Airway Management ; Anesthesia, General ; Biopsy ; Branchial Region ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Dermoid Cyst ; Goldenhar Syndrome* ; Heart Defects, Congenital ; Humans ; Infant ; Intubation ; Male ; Replantation ; Retrognathia ; Thiopental ; Ureter ; Vesico-Ureteral Reflux