A Case of Pregnancy in Essential Thrombocythaemia with Low dose Aspirin Treatment / 대한주산의학회잡지

Essential thrombocythaemia (ET) is a chronic myeloproliferative disorder characterized by markedly elevated platelet count in the peripheral blood due to an excessive proliferation of bone marrow megakaryocytes. The pregnancy outcome among patients with ET is mostly successful but adverse outcome due to thrombotic and bleeding complications is a matter of concern: miscarriage, intrauterine growth retardation, abruptio placenta, intrauterine fetal death and preterm delivery. Various treatments such as acetylsalicylic acid, hydroxyurea, anagrelide, heparin, interferon alpha and plateletpheresis have been proposed to improve the pregnancy outcome. We report a case of pregnant woman in condition of ET who succeeded in normal vaginal delivery without specific obstetric complications after low dose aspirin therapy during pregnancy.

A Case of Ureteral Endometriosis associated with Hydronephrosis / 대한산부인과학회지

Endometriosis affecting the urinary tract is very rare disease. The ureteral endometriosis is mostly asymptomatic for a long time, and associated with nonspecific symptoms such as abdominal or flank pain, renal colic, voiding difficulty and gross hematuria. Radiologic and laboratory findings show nonspecific findings, and the diagnosis is difficult. We report a case of obstructive ureteral endometriosis associated with right hydronephorsis. This case is operated under the impression of direct compression of ureter by uterine myoma. Total abdominal hysterectomy and ureteroureterostomy were performed. Final diagnosis of ureteral endometriosis is documented by pathologic findings.

A Case of Heterotopic Pregnancy in a Natural Cycle / 대한산부인과학회잡지

Heterotopic pregnancy is the coexistency of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy is about 1 to 30,000 pregnancy in a natural cycle. However, the frequency of heterotopic pregnancy has steadily increased because of rising incidence of pelvic inflammatory disease, pelvic surgery and the development of ovulation induction and assisted reproduction. The clinical diagnosis of heterotopic pregnancy is difficult due to low incidence. Many of the cases are diagnosed by rupture of ectopic mass that makes serious complication to mother and fetus. We experienced a case of heterotopic pregnancy in a 32-year old woman who presented with acute abdominal pain in a natural cycle and report this case with a brief review of literature.

Plasma levels of oral methotrexate in children receiving maintenance chemotherapy for acute lymphocytic leukemia

This study was conducted to investigate plasma levels of oral methotrexate in rabbits and children receiving maintenance chemotherapy for acute lymphocytic leukemia. Eight New Zealand white rabbits, weighing 2kg in body weight, were divided into 3 groups and 5mg of methotrexate from 3 different manufactorying company was administered to the each group rabbits via nasogastric tube. Time to peak concentration ranged from 30 minutes to 3 hours (mean 1.2+/-0.9 hour)and the peak plasma concentration ranged from 0.08 micro M to 0.21micron M(mean 0.14+/-0.05 micronM)and area under the plasma concentration-time curve ranged from 0.6micron M.hr to 1.66micron M,hr (mean 1.06+/-0.36micronM,hr). There were no statistically significant difference in AUC of methotrexate in 3 groups, but interindividual variability in plasma levels of methotrexate was noted. Twelve patients with ALL who were receiving maintenance chemotherapy at pediatric department of Yeungnam University Hospital from August, 1988 to August, 1991 were studied. Plasma levels of oral methotrexale were monitored following an oral dose of 3.3 mg~10mg/m2 which was modified from recommended dose of 10 mg/m2 due to hepatotoxicity or myelosuppression. Time to peak concentration ranged from 30 minutes to 2 hours(mean 1.2+/-0.4 hour) and the peak plasma concentration ranged from 0.34 micron M to 0.8 micron M (mean 0.58+/-0.18micron M). The area under the plasma concentration-time curve ranged from 1.25micron M,hr to 3.79 micronM,hr (mean 2.71+/-0.84microM,hr)while standard area under the plasma concentration-time curve ranged from 0.13micronM, hr/mg/m2 to 0.54micronM, hr/mg/m2 (mean0.4+/-0.15micronM hr/mg/m2).Interindividual variability in plasma levels following an oral dose of methotrexate was noted. Peak plasma concentrations of study patients were all less than 1 micronM which is necessary for antileukemic effect of methotrexate in vitro. It seems to be necessary to increase the dose of methotrexate for all study patients, however optimal dose increment of methotrexate avoiding hepatotoxicity and myelosuppression need to be investigated further and measurement of plasma level of methotrexate is recommended when dose modification of methotrexate is made.

A study of cisplatin nephrotoxicity / 영남의대학술지

To evaluate the nephrotoxicity of cisplatin, serum levels of sodium, potassium, chloride, calcium, phosphorous, magnesium, BUN, creatinine and creatinine clearance were measured before and after administration of cisplatin in 18 cases of patients with malignant neoplasm. The results were as follows: 1) Serum calcium, magnesium, potassium and BUN levels were changed after cisplatin administration, but those changes were not statistically significant. 2) The mean value of creatinine clearance was not decreased significantly after treatment with cisplatin. 3) Acute renal failure was developed in one case, and four cases of hypocalcemia, hypomagnesemia were also detected after administration of cisplatin.

A comparative study of therapeutic effect of aspirin alone and intravenous gammaglobulin plus aspirin in Kawasaki disease / 영남의대학술지

We compared the efficacy of each modality of treatment group in reducing the frequency of coronary artery abnormalities and change of clinical courses in children with Kawasaki disease in the children of 81 cases who were admitted in pediatric department of Yeungnam University Hospital from September 1985 to August 1990. Group A (37 cases)-aspirin alone, Group B (44 cases)-intravenous gammaglobulin (400 mmg/kg/day) for 5 consecutive days, plus aspirin. We studied the frequency of echocardiographic abnormalities, the duration of fever, and changes in the total white blood cell counts, platelet counts, ESR and CRP value at 1, 2 and 3 weeks of the illness and compared the results between the two groups. The results were as follows. 1) There was no significant intergroup difference in age and sex ratio. 2)The duration of the febrile period after the initiation of the therapy was significant shorter in group B (2.5±1.2days) than in group A: (5.2±3.5 days) (p<0.01). 3) No significant difference was noticed in the WBC and platelet counts in two groups as measured at admission day, 1 and 2 weeks of the illness, however, at 3weeks of illness significant difference was noted. 4) The CRP values measured at 1,2 and 3 weeks after treatment were significantly lower in group B (2.42±1.8, 2.00±1.2, 1.16±1.0) than in group A (7.22±5.3, 5.25±3.9, 1.85±1.2) respectively (p<0.01). 5) In 2D-Echocardiogram, coronary artery dilatation was more frequent in Group A than in Group B at 6month of illness (p<0.01). In conclusion, intravenous gammaglobulin therapy was effective in the shortening of the duration of fever and in the anti-inflammatory action and somewhat effective in prevention of coronary artery aneurysm.

Clinical Study of the Postperative Pain Management with Silver Spike Point Electro-therapy / 대한마취과학회지

Silver Spike PintElectro-Therapy(SSPET) means passing electric current through the skin surface with the triangle spike silver coated metal electrode. Transcutaneous Electrical Nerve Stimulation(TENS) for chronic pain management was first reported by Shealy in 1972. Since 1975, Vanderark and Mograth reported that TENS has had a analgesic effect for the relief of acute postoperative pain. SSPET was reported by Hyoto and Kitade at Edinburg, Scotland. 3rd World Congress on Pain in 1981; It has a number of advantages over traditional narootic medication in postoperative pain management. It does not depress the cardiovascular, respiratory of metabolic system and has no apparent effect on the sensorium. Furthermore it is noninvasive, nontoxic, simple in its application and can be used continuously or intermittently. This study was undertaken to investigate recent reports concerning the use of Silver Spike Point Electro-therapy for the relief of postoperative pain. Sisyt patients undergoing elective Cesarean section were subjected to a standard perianesthetic proctocol by the Department of Anesthesiology at Hanyang University Hospital from March, 1st to August, 31, 1984. The patients were divided into three groups of twenty, designed control, SSP and sham SSP. Postoperative analgesic requirements for each group were compared. The results are as follows; 1) The age distribution ranged from 21 years to 36 yearts. Mean age was 25 years and the body weight ranged from 45kg to 68kg. The mean body weight was 52kg. 2) The incisional area of the Cesarean section was 23 cases (38.3%) of low midline incision and 37 cases(81.7%) of Pfannenstiel incision. 3) There were no remarkable changes in the blood pressure, pulse rate or respiratory rate during before and after SSP administration. 4) The total number of intramuscular doses of Demerol given to the patients in the ward was: control group 94 doses, SSP group 31 doses and sham SSP group 89 doses. The SSP group was statistical different from the other 3 groups when compared by the Student's T-test. 5) In the subjective assessment of each group, their statements were markedly varied. Nevertherless SSP has shown that the analgesic requirement was considerably less than that of the other group. This result means that SSP can be used for the relief of acute postoperative pain. Despite a number of diffidulties encountered during this study, we were primarily concerned with the action mechanism, subjective measurement of pain and standards in the requirment of Demerol. We considered that further investigation should be done in the use of SSP for postoperative analgesia and pain. SSP for postoperative pain management is a useful method that is simple, non-invasive, non-toxic and obtains safe analgesia.

Aneathetic Management in Pregnant Myaethenics for Elective Cesariaa-section / 대한마취과학회지

Myasthenia gravis is relatively common in young women and therefore sometimes associated with pregnancy. Since pregnancy influences the course of the myasthenia gravis, and the drugs used for its treatment may influence gestation, the obstetrical management of myas-thenic patient merits special consideration. In myasthenia gravis, it is generally thought that the anesthesia of chice is regional anesthesia during vaginal delivery and general anesthesia during Cesarian section. But in Cesarina section for a pregnant myasthenic with pulmonary disease, epidural or subarachnoid block may be preferable to avoid postoperative hazards. We performed epidural anesthesia with lidocaine in a 39-year-old elderly primigravida myasthenic with COPD and obtained good intra and postoperative results.

Anesthetic Management in Patient with Myasthenia Gravis / 대한마취과학회지

Myasthenia gravis is a disease characterized by muscle weakness upon exertion of an involved muscle group and partial return of function eithe with rest or the administration of anticholinesterase. It is generally thought that myasthenia gravis is caused by an autoimmune response associated with the thymus gland and thymectomy is considered to be the treatment of choice for countering this autoimmune process. It is a well known fact that perioerative nticholinesterase therapy, muscle relaxant administration during operation and postoperative respiratory management are in dispute. We described a case of a 42 year old male myasthenic patient with mild symptoms who needed 4 days of artificial ventilatory support following thymectomy.

The Clinical Comparative Stndy on Liver Function with Enflurane and Halothane Anesthetics / 대한마취과학회지

Halothane was introduced in 1956. It has been used worldwidely as a relatively safe inhalation anesthetic but it is generally accepted that it can cause decrease of liver function. But the causative factor has not yet been pinpointed. Enflurane also seems to decrease liver function but the exact cause is not yet known. In order to study the effects of enflurane and halothane on liver function, we used 10 cases of spinal anesthesia as a control group, and 20 cases each of enflurane and halothane anesthesia respectively as experimental group. We then checked serum GOT, GPT, total bilirubin, alkaline phosphatase, and eosinophil count in peripheral venous blood before oeration and 6 days after operation and looked for the existence of high fever of more than 39 degrees C 3 days postoperatively. The results are as follows: 1) We found statistical significant change of serum GOT, GPT, total billirubin alkaline phosphatase and eosinophil count in spinal, enflurane, or halothane anesthesia beofre and after operation. There was no statistically significance between the control and experimental groups. 2) No patient developed high fever of more than 39 degrees C until 3 days after anesthesia in any group. 3) No significant change of mean arterial blood pressure was observed before and during anesthesia in each group. In this study no definite conclusion that enflurane and halothane might have affected the liver function.

Clinical Observation of the Patient who recieved Blood Transfusion / 대한마취과학회지

It is a well known fact that the best method of determinign need ofr transfusion is the accurate measurement of blood loss related to the patient's status and surgical maneuvers during operation. There are many complications of blood transfusion and their pathophysiologic mechanism, and theprevention and management has been discussed. Among the complications of blood transfusion, urticaria is the most common symptom. The pathophysiologic mechanism of urticaria is understood in some degree at the present time but there are many different opinions as to its prevention and management. Furthermore antihistamine has been widely used for the prevention of urticaria but there are many debatable events about the use of antihistamine. This study was undertaken to investigate the recent reports concerning the use of antihistamine for the prevent in and management of urticaria. Two hundred eighty eight transfused patients among the total of six thousand four hundred forty eight surgical cases done at the Hanyang University hospital from January 1st to December 31th 1983. were reviewed. The result are as follows: 1) The incidence of urticaria was 28 cases (9.72%) among the 288 transfused cases and there was no sex difference. 2) The age distribution was 10 cases (12%) in the 2nd decade and 9 cases(11.3%) in the 4th decade. 3) The lowest incidence of urticaria was 5 cases (5.3%) with A blood type and high of incidence with B, O and AB blood type. 4) The physical status of class 3 was seem in 10 cases(43.5%) as the most common occurrence of urticaria. 5) The highest incidence of urticaria was observed in 9(45%) of 20 obstetric cases. 6) There was no significant differnece of urticaria incidence between the groups which did and did not use antihistamine. Also in the group which received histamine 10 minutes before treansfusion there was a significant decreases 6 cases (3.41%) among the 178 transfused cases. 7) There was no significant statistical difference between blood loss and transfused blood volumes. 8) There was no significant statistical change in the mean values of hemoglobin and hematocrit which were measured preoperatively, in recovery room and 24 hours after operation. 9) In the patient's who were tranfused with more than 10 oints of whole blood, urticaria developed in 9 cases (50%) among 18. From the results of this study, I consider the most effective method for the prevention of urticaria to be the administration of histamine 10 minutes before transfusion. Further investigation of this method will be carried out.

Clinical Study of Electrical Stimulation of the Peripheral Nerve / 대한마취과학회지

Recent studies in western countries have reported that the mechanism pf pain are concorded with gate control opiage receptor binding sites and the release of intrinsic morphine like substances, sodium glutamate and also with bradykinin, seroconin, histamine and prostaglandin E. Otherwise the mechanism of the stimulstion producing analgesia has been reported to involve a neurophysiologic and neurohumoral inhibitory effect at the level of spinal cord, brain stem, thalamus and cortex. This has been clarified but further study should improve the chance of understanding the mechanism of pain. From the standpoint of pain management, medications used to manage pain have some unfortunate side effects. nerve blocks cause anesthesia toxicity, major neurosurgical procedures have many complications. Subarachnoidal and epidural analgesics have unknown irritation pneumonia and drug toxicity, and plexus or pituitary gland block with phenol or alcohol has uneventful complication. From January 1980 to December 1982, electrical acupuncture stimulation has been used on 210 cases at HANYANG university hospital in the pain clinic. I found it useful in relieving pain which has not responded to various conventional methods which included medications, nerve blocks, neurosurgical intervantion and neuropolytics. The results are as follows: 1) There are two kinds of treated patients: One is consultation case-12 from internal medicine, 16 from orthopedic surgery, 10 from neurosurgical and 2 from psychiatry. Another 170 cases were patients who directly to the clinic. And the age distribution shows the highset number of patients in the 3rd decade(21%) and in the 4th decade(24.8%). 2) The region of pain was 21% lumbar, 13.8% shoulder, 10% lower leg and head or face with 9.5%. 3) The duration of the pain showed 10 days 25.7%, 1~2 month 18.6%, one year 11.4% and the longest up to 20 years. 4) Patients who were able to walk into the clinic were 19.5%, moderate cases who to be accompanied were 58.6% and bedridden cases were 21.9%. 5) Treatment was conducted mainly on low frequency stimulation with various waves that included the general dynamic activity point plus reactive electro permeable point (REPP) 81.9% and REER plus head in situ needle 18.1%. 6) In 16.7% only one treatment was administered, in 46.1% 2~5 treatments were given, in 28.6% 6~10 treatments were given and in 3 cases more than 100 treatments were administered. 7) Of the 210 cases, 43.3% showed marked improvement, 41.4% were improved, 13.8% showed translent improvement and there were 3 cases of no improvement. The total confidence was 84.7%. 8) There are no serious complications except hypertensive shock case, submucosal hemorrhagic petechia 7 cases and generalized fatigue 18 cases. In conclusion, electrical acupuncture stimulation of the peripheral nervous system can be used to relieve pain replacing such conventional means as medications, nerve blocks, major neurosurgical procedures, neuroytics and physiopsychic therapy which are generally less effective.

The Clinical Investigation of Geriatric Anesthesia / 대한마취과학회지

In contrast to younger patients, old peoples frequently mainfest more than one pathologic process, mainly degenerative diseases and neoplasia. Nearly all have some degree of arteriosclerosis, even if this is not clinically diagnosed, and many have associated chronic cardiac, renal, hepatic, or pulmonary disease. The surgeon and the anesthesiologist must see theat their clinical decisions are tied to a physiologic understanding based on exact quantification of the specific hemodynamic, respiratiory, renal, and metabolic factors which may play a decisive role in influencing the final outcome to a major operative procedure. From May 1972 to Dec 1980, the Department of Anesthesiology, Hanyang University, College of Medicine had 517 geriatric patients(above 65 years) who received anesthesia and these were analyzed clinically according to age, sex, department, physical status, anesthetic technique and agent, anesthesia time, length of admission, laboratory studies(chest X-ray, EKG, arterial blood gas), and postoperative complications(mortality and causes of deathe). The results are as follows. 1) Out of 25,857 anesthetized patients 517(2.0%) were over 64 years of age and 290 were males(56.1%) and 227 females(43.9%). 2) In the surgical group, 246 cases (47.6%) were from general sugery: 81 cases(15.7%), orthopedic surgery: 78 cases (15.1%), urology: and 67 cases (12.9%), neurosurgery respectively. 3) In the classification of physical status, 33 cases(6.4%) were class 1, 269 cases(52.0%) class 2, 181 cases (35.0%) class 3, 28 cases (5.4%) class 4, and 6 cases (1.2%) class 5. Emergency cases were 137 cases(26.5%) and 380 cases (73.5%) were elective. 4) Concerning premedication-150cases(29.0%) were premedicated with atropine sulfate plus valium and 93 cases had no premedication. 5) There were 425 cases of general anesthesia (82.2%) and 92 cases of regional anesthesia (17.8%). The major anesthetic was halothane, 362 cases (70.0%). The technic in 419 cases( 81.0%) was circle type with endotracheal intubation. Anesthesia duration was within 1hour for 70 cases(13.5%), within 2 hours for 158 cases(30.0%), and within 3hours in 144 cases(27.9%). 6) Preoperative laboratory findings were as follows: The chest X-ray suggested that 199 cases (45.9%) were within normal limits, 56 cases (12.9%) had hypertensive heart disease, 56 cases (12.9%) had pulmonary tuberculosis, and 38 cases (5.1%) had senile lung fibrosis. The EKG which was done on 85% of the patients, ravealed that 193 cases (44.0%) were within normal limits, 61 cases(13.9%) showed left ventricular hypertrophy, and 38 cases(8.7%) had myocardial ischemia. In the preoperative arterial blood gas studies of 56 cases the results were almost all within normal limits. 7) Postoperative complications were as follows: 52 cases showed wound infection or bleeding, 20 cases had pneumonia, and 18 cases atelectasis. There were a number of miscellaneous complications. 8) The overall mortality rate was 5.8%. The difference of mortality rate related to the age was not statistically significant,(p>0.1) and the mortality rate related to physical status was statistically significant(p<0.005). 9) As the cause of death-11 cases (36.7%) had transtentorial herniation, 2 cases (6.7%) sepsis, 2 cases (6.7%) hypovolemia, and 1 case (3.3%) had pulmonary edema.

Influence of Midazolam on Serum Potassium and Creatine Phosphokinase Levels / 대한마취과학회지

Succinylcholine is used most widely for tracheal intubation during induction for general anesthesia. However adverse effects following the administration of succinylcholine which include an increase of serum potassium, creatine phosphokinase, abdominal pressure and the presence of fasciculation are well known to anesthesiologists. Many investigators have studied the influence of pretreatment with d-tuhocurarine and diazepam to prevent the adverse effects following administration of succinylcholine. We studied the effects of serum potassium and creatine phophokinase with midazolam(0.25 mg/kg) the most newly introduced benzodiazepine derivatives and thiopental sodium(4-5mg/kg) the most widely used induction agent for anesthesia in 33 adult healthy surgical patients. We also observed the onset of loss of eyelash reflex and fasciculation, the degree of fasciculation and the adequacy of relaxation for intubation comparing the two agents. The results are as follows: 1) There were no significant increases in serum potassium and creatine phosphokinase levels before succinylcholine and after 10 minutes administration in both agents groups. 2) Loss of eyelash reflex occurred immediately with thiopental and at 63+/-43 seconds with midazolam one minute after administration. 3) Fasciculation appeared at 14.4+/-4.9 seconds with thiopental and at 21.3+/-11.9 seconds with midazolam and continued 66.3+/-20.1 seconds with thiopental and 43.5+/-l8.5 seconds with midazolam. 4) The adequacies of relaxation for intubation were good enough in both agents groups but midazolam seems to be better. Midazolam seems to be a good induction agent for general anesthesia and prevents an increase of serum potassium level after administration of succinylcholine without pretreatment of non-depolarizing muscle relaxants or diazepam.

Clinical Evaluation of the Patients who Received Blood Transfusion During Operation / 대한마취과학회지

This study chose 530 patients among the total of 5214 operative cases except open heart and pediatric surgery who received more than 2 pints of blood who were performed general, spinal and epidural anesthesia. This study lated for a year in an operating room. We measured and compared the value of hemoglobin and hematocrit, preoperatively, in recovery room and 24 hours after operation. We also compared the volume of blood transfused with the volume of blood loss during the operation. The results are as follows. 1) According to the operative Department of the transfusion cases, the distributions were 129 cases(Obstetic & Cynecology), 114 cases(Orthopedic Surgery). 2) The mean values of hemoglobin measured preoperatively, in recovery room and 24 hours after operation were 11.9gm/dl, 11.5gm/dl and 11.6gm/dl, respectively. 3) In the comparison and observation about the difference of the hemoglobin value and hematocrit value preoperatively and in recovery room the cases which showed the difference of 10% were 229 cases which was the most frequent cases. The cases which showed the differences of 40% were 24 cases and it was the less frequent cases. 4) In the volume of blood loss on the operative department, maximum volum of blood loss was 4,130ml in hepatic primary closure. 5) In the comparison and observation of the volume of the blood transfusion, the cases whose volume of transfusion was 2~5pint were 430 cases. The cases in which more than 10 pints transfused were 25 cases. 6) In the operation where the patients transfused more than 10 pints of whole blood, vertebral interbody fusion was the most cases. 7) In the patients who transfused more than 10 point of whole blood, urticarias was whon 16 cases among 25 cases. 8) Recording the values of hemoglobin and hematocrit, preoperatively, in recovery room and 24 hours after operation on the blood trasfusion makes anesthesiologist precise to determine the volume of blood transfusion and blood loss. The results from all the cases were considered satisfactory except one case which showed the complication of pulmonary edema.

Influence of Flunitrazepam on the Adverse Effects of Succinylcholine Chloride / 대한마취과학회지

Intravenous succinylcholine is often associated with adverse effects, including muscle fasciculation, postoperative myalgia, increased intraocular and intragastric pressure, along with potassium and creatinine phosphokinase, myoglobinuria, and disturbances in cardiac rate and rhythm. Several methods have been used to modify these side effects, the most popular of which has been the of subparalyzing doses of nondepolarizining relaxants prior to injection of succinylcholine. With such pretreatment however satisfactory muscular relaxation is often not achieve, necessitaing use of larger doses of succinylcholine becauses pretreatment renders the endplateless sensitive to succinylcholine; hence large doses of succinylcholine are necessary to ensure adquate degress of relaxation. The present investigation was undertaken to determine the effects of flunitrazepam on the adverse effects of succinylcholine. This paper covers the period from March, 1981 to March, 1982 in the Department of Anesthesiology, Hanyang University Hospital. The 45 subjects were divided into 3 groups: 1) propanidid (8mg/kg) with succinylcholine 2) flunitrazepam(0.03mg/kg) with succinylcholine 3) flunitrazepam(0.06mg/kg) with succinylcholine. None had existing neuromuscular disease nor were any patients receiving diazepam or any drug known to influence myoneural blocking agent. Patients with burns, muscle injury of muscle atrophy were excluded. In each group, the plasma concentration of potassium and creatinie phosphokinase was observed before and 10 minutes after use of succinylcholine. Also succinylcholine in duced myalgia, fasciculation, onset of loss of eyelid reflex and relaxation were observed and compared. The conclusions are as follows: 1) There were no significant changes of plasma concentration of potassium and creatinine phosphokinase in presuccinylcholine and 10 minutes postsuccinylcholine. Also any statistically significant changes were not observed in the comparison of the propanidid group and the flunitrazepam groups. 2) Flunitrazepam significantly diminished the incidence of postoperative muscle pain and it was shown that the degree of fasciculation has no relationship with succinylcholine induced muscle pain. 3) In the propanidid group, the onset of loss of eyelid reflex was most rapid(22+/-13 second). In the flunitrasepam 0.03mg/kg group, the onset of loss of eyelid reflex was statistically significant (p<0.05), as compared with the 0.06mg/kg group(42+/-27 second). 4) In all groups, excellent conditions of intubation were observed. Propanidid and flunitrazepam did not affect the magnitude nor duration of the succinylcholine neuromuscular block.

Clinical Statistical Analysis of Pediatric Anesthesia / 대한마취과학회지

Within the past decade it has been said that progress it pediatric anesthesia is especially the result of clinical application of developments in baic medicine, added to the anesthetist's technical improvements and experience in the use of apparatus and the knowledge of respiratory control. And so anesthetists sholud perform good pediatric anesthesia after understanding pediatric anatomy, physiology and the phamacology of all the drugs used in pediatric anesthesia. 803 cases (under 15years) of pediatric anesthesia were analyzed statistically according to sex, age, disease, department, physical status, premedication, anesthetic technic, anesthetic agents, length of anesthesia duration of Hospitalization, re-operation incidence, complications and mortality in the Department of Anesthesiology, Hanyang University, College of Medicine from August of 1979 to December 1980. The conclusions are as follows: 1) Sex and Age: 91 cases(11.33%) under 1year and 95 cases(11.83%) under 7years are of interest. The comparison of male (542 cases) to female (261 cases) is 2:1. 2) Departmente: 257 cases(32.00%) from ENT, and 217 cases(27.02% from general surgery were noted ont of the total. 3) Disease: It divided into two groups. 204 cases(25.40%) were congenital disease which comprised mainly of 70 cases of inguinal hernia and 45 cases of eleft lip and palate. 599 cases (74.60%) were acquired disease comprised mainly of 237 cases of tonsillitis and 43 cases of appendicitis. 4) Physical status: The time of operation divided into two groups. One group contained 657 cases of elective surgery and the other 146 cases of emergency surgery. According to the ASA classification of physical status, 741 cases(92.28%) were class 1 and 2, and 52 cases (64.8%) were class 3, and 10 cases(1.24%) were in class 4. 5) Premedication: 400 cases(49.81%) were premedicated with atropine sulfate and valium 161 cases(20.05%) were not premedicated because the patients had fever, dehydration, or tachycadia. 6) Anesthetic method and agents: they were divided into three groups. In the frist group using general inhalation, 206 cases(2565%) ont of 761, had non-rebreathing anesthesia and 555 cases(69.12%) had semiclosed circle technique anesthesia. In the second group 41 cases(5.10%) had intramuscular and intravenous anesthesia. Thirty 1 case(0.12%) was given spinal anesthesia. 711 cases(88.54%) received halothane + nitrone oxide _ oxygen. 7) Incidence of reoperation: 32 cases(3.98%) were reoperated and included colostomy repari, abdominal flap detachment, pin removal, skin graft, post operative bleeding control, remove of laryngeal papilloms, and urethral dilatation. 8) Complications: 20 cases which were made up of 8 cases of pneumonia, 5 cases of wound infection, 3 cases of post operative bleeding control, 2 cases of fistula formation, 1 case of gastroenteritis, 1 case of intestinal obstruction. The relationship between length of anesthesia and complications is statistically in significant(p<0.01). 9) Motality: 10 cases died 3 from respiratory insufficiency, 3 cases of sepsis, 1 case of intestinal obstruction and 3 cases of high intracranial pressure. There is statistical significance in the relationship between the anesthetic time, physical status, and mortality.(p<0.01).

I.V. Fluid Administration for Prevention of Hypotension during Cesarean Section Performed under Spinal Anesthesia / 대한마취과학회지

Rheomacrodex-D 10% W/V in dextrose(550ml) was prophylactically infused before anesthesia over 15 to 20 minutes to prevent hypotension during spinal anesthesia in 20 patients undergoing elective Cesarean section. Apgar scores and the incidence and severity of hypotension were compared to results obtained in 20 patients who were given 500 ml of Hartmann's solution. The results were as follows: 1) Mean arterial pressure decreased up to 20 torr from control values in patients hydrated with Hartman's solution and also changed significantly in patients given Rheomacrodex-D(p<0.05). 2) The incidence and severity of hypotension at 10 minutes, and 15 minutes, and 15 minutes after spinal anesthesia(p<0.05) was significantly less in patients given Rheomacrodex-D than in patients hydrated with Harmann's solution. 3) The Apgar scores, both at 1 minute and 5 minutes, were significantly higher(p<0.05, p<0.005) in infants born of mothers given Rheomacrodex-D than in infants whose mothers were given Hartmann's solution. 4) The cases of hypotension defined as a decrease in systolic arterial pressure lower than 100 torr or a decrease in mean arterial pressure to 25% from control values were 12 cases in 20 patients hydrated with Hartmann's solution and 6 cases in 20 patients given Rheomacrodex-D.

A Study on the Cell-Mediated Immunity of Patients with Vitiligo / 대한피부과학회지

The pathogenesis of vitiligo has not been fully elucidated, but three different hypothese have been advanced to explain the cause of vitiligo. One is related to autoimmunity, another concerns neurohumoral factors and the third involves self-destruction of melanocytes. The autoimmune theory of vitiligo is further strengthened by the increased association of vitiligo with a nurnber of autoimmune disorders and by the increased prevalence of organ-specific autoantibodies in vitiligo. Also decreased T lymphocytes in vitiligo patients were reported. The present study was undertaken to evaluate the cell mediated immune status of patients with vitiligo using several in vitro and in vivo immune parameters. Thirty patients between the ages of 12 and 65 were observed at the Department of Dermatology of Ewha Womans University Hospital from Apri11981 through October 1981. Age matched 30 healthy persons comprised the control group. The results were summarized as follow: 1) The mean percentage of T lymphocytes in 30 vitiligo subjects and 30 control subjects were 55.3% and 67.4% respectively. There was a significant decrease of T lymphocytes in patients with vitiligo(p<0.05). 2) The percentage of subjects showing positive delayed hypersensitivity reactions to candidin, trichophytin and PPD were 33.3%, 43%, 50% respectively in 30 vitiligo patients and 60%, 75%, 80% respectively in 20 controls. A slight depression in delayed cutaneous hypersensitivity in gatients with vitiligo. (p<0.1). 3) The percentage of subjects showing positive sensitization with DNCB was 53% in 30 vitiligo patienta and 85% in 20 controls. A slight depression in DNCB sensitization was evident in vitiligo patients(p<0.1).

A Case of Pityriasis Lichenoide Chronica Associated with Pseudoacanthosis Nigricans / 대한피부과학회지

Pityriasis lichenoides chronica is considered to be a benign disease. Erythematous yelIowieh scaly maeulea appear insidiously, chiefly on the sides of trunk, thighs and upper arms. Acanthosis nigricans is a rare cutaneous disorder with peak incidence in puberty characterized by hyperkeratosis and, dark pigmentation. We report a case of pityriasis lichenoides chronica assaciated with pseudoacanthosis nigricans in a 14 year-old obeae male patient who has bean sized erythematoua scaly papules on the trunk and extremities, velvety black brownish colored patchea on the neck and both axillary regions.