A Case of Recurrent Supratentorial Extraventricular Anaplastic Ependymoma in Adult

Supratentorial extraventricular anaplastic ependymoma (SEAE) in adults is a relatively rare intracranial tumor. Because of the very low prevalence, only a few cases have been reported. According to a recent study, SEAE is associated with a poor prognosis and there is no definite consensus on optimal treatment. We report a case of an adult SEAE patient who had no recurrence until seven years after a gross total resection (GTR) followed by conventional radiotherapy. A 42-year-old male had a persistent mild headache, left facial palsy, dysarthria, and left hemiparesis. Preoperative neuroimaging revealed an anaplastic astrocytoma or supratentorial ependymoma in the right frontal lobe. A GTR was performed, followed by adjuvant radiotherapy. Histologic and immunohistochemical results revealed anaplastic ependymoma. After seven years of initial therapy, a regular follow-up MRI showed a 3-cm-sized partially cystic mass in the same area as the initial tumor. The patient underwent a craniotomy, and a GTR was performed. Histopathologic examination revealed recurrence of the SEAE. External radiotherapy was performed. The patient has been stable without any disease progression or complications for 12 months since the surgery for recurrent SEAE.

The Relationship between Anxiety Level and Serum Potassium Level just before Induction of Anesthesia? / 대한마취과학회지

BACKGROUND: Patients experience preoperative anxiety which stimulates the release of catecholamines. They have influences on serum K+ level by shifting them into the intracellular space. The purpose of this study is to determine whether there is a correlation between anxiety and the serum potassium level immediately before induction of anesthesia. METHODS: Thirty patients were asked about their anxiety levels at 7 : 00 pm of the day before surgery and immediately before induction of anesthesia : 0; nil, 1; slight, 2; moderate, 3; marked. At those times, arterial blood was taken for checking serum K+ level and blood gas analysis. RESULTS: There was no significant correlation between anxiety level and serum potassium level. At 7 : 00 pm of the day before surgery, the anxiety levels of patients had no significant correlation with the changes of serum potassium level ("K1-K2"; K1 = serum potassium level of patient at 7 : 00 pm of the day before surgery, K2 = serum potassium level of patient immediately before induction of anesthesia). Definite correlation between the anxiety level immediately before induction of anesthesia and the changes of serum potassium level has been documented. Immediately before induction of anesthesia, 43% of patients had hypokalemia (K+ < 3.5 mEq/L). CONCLUSIONS: Anxiety level has no correlation with serum potassium level, but the anxiety level immediately before induction of anesthesia has the changes of serum potassium level. If a patient has high anxiety level immediately before induction of anesthesia, the possibility of hypokalemia is increased.

Analysis of Postoperative Liver Function and Complications versus Donor Hepatectomy Type for Living-Related Liver Transplantation / 대한마취과학회지

BACKGROUND: Although living related liver transplantation (LRLT) has several advantages over cadaveric liver transplantation, there still is considerable debate concerning donor safety. We analyzed postoperative liver function and complications versus type of donor hepatectomy for LRLT. METHODS: The charts, anesthetic records and computerized hospital data of 135 consecutive donors registered for LRLT from June 1996 to February 2003 were retrospectively reviewed. Donors were divided into three groups: a left lateral segmentectomy (group LLS; n = 37), a left lobectomy (group LL; n = 8), and a right lobectomy (group RL; n = 90). Volume and weight of the resected liver, volume of blood loss, fluids and blood administered, surgical time and anesthetic time, duration of hospital stay, complications, and perioperative changes in hemoglobin (Hb), aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and prothrombin time (PT) were investigated. RESULTS: No significant differences in donor characteristics, blood loss, and duration of hospital stay were observed. But surgical and anesthetic times in the group RL were longest. The postoperative peak level of AST and ALT in the group LLS were significantly higher than those of the other groups. Postoperative PT and total bilirubin in the group RL were highest. AST, ALT, and PT peaked on the first postoperative day and decreased gradually thereafter. None of the donors experienced a critical complication, including liver failure. CONCLUSIONS: Significant differences in surgical time, postoperative liver function and incidence of hyperbilirubinemia were observed according to the type of hepatectomy. But, serious complication occurred in any donor.

Sudden Cardiac Arrest in the Anhepatic Phase of Living-Related Liver Transplantation: A case report / 대한마취과학회지

We experienced a case of unexpected sudden cardiac arrest, which developed during the anhepatic phase of living-related liver transplantation. The patient was a 56-year old man diagnosed with liver cirrosis. He had stable angina and congestive heart failure. Preoperative EKG, chest x-ray, arterial blood gas analysis and vital signs were all within normal limits. Cardiac echography was normal except for left atrial enlargement and diastolic dysfunction (grade I). Coronary angiography showed no coronary stenosis. About 10 min after the inferior vena cava had been clamped, the sinus rhythm changed suddenly to ventricular tachycardia. Lidocaine was administered and the PA catheter removed immediately but ventricular fibrillation and asystolic cardiac arrest followed. Cardiac rhythm returned about 15 min after the onset of asystole, followed by supraventricular tachycardia (up to 180 beats/min). The EKG suddenly returned to a normal sinus rhythm. He had no further episodes of arrhythmia and recovered without complication.

Gastroduodenal Lesion Accompanied in Obstructive Biliary Disease / 대한소화기내시경학회지

BACKGROUND AND AIMS: Various gastric and duodenal lesions with gastrofiberscopy were observed in patients with obstructive biliary disease. METHODS: A clinical analysis of the endoscopic findings was carried out on 88 patients with obstructive biliary disease, from February 1994 to January 1998, in the department of Internal Medicine, Chungnam National University Hospital. RESULTS: 1) In the 88 patients, sex distribution showed predominance in the males (47/41) and most of the cases involved those in their 60's. 2) The obstructive biliary diseases were included, common bile duct stones (53.4%), common bile duct cancer (18.2%), pancreatic cancer (18.2%), Klatskin tumor (4.5%) and common hepatic duct cancer (3.4%). 3) The gastroduodenal lesions involved in the obstructive biliary diseases were, erosive gastritis (22.7%), duodenal ulcer (8.0%), gastric ulcer (5.7%), and acute duodenitis (3.4%) in orders. CONCLUSIONS: Significant upper gastrointestinal lesions were found in obstructive biliary disease.