RESUMO
OBJECTIVE: Our aim was to report an effective procedure of injection of large amount of diluted vasopressin in the treatment of interstitial pregnancy using endoscopic cornuotomy METHODS: This is an uncontrolled retrospective study of 17 patients interstitial pregnancies treated of by endoscopic cornuotomy from June 2001 to June 2004 in our hospital. All cases were applied by the large amount of diluted vasopressin injection. RESULTS: Among 446 ectopic pregnancies, interstitial pregnancies were 17 (3.81%). Fourteen patients (82.4%) were unruptured, three patients (17.6%) were ruptured. Mean (+/-SD) age and parity of patients were 35.6+/-3.9 years (range 30-40 years), 1.5+/-2.1 (range 0-3), respectively. At the time of operation the duration of amenorrhea and mean size of ectopic gestation were 54.5+/-9.6 day and 2.6 x 2.6 cm, respectively. The amount of injected vasopressin was 190.0+/-55.5 cc. For the cornual closure, the endosuture method was applied in 10 patients (59%), and the endoloop method was applied in 7 patients (41%) The mean (+/-SD) blood loss and operation time were 18.2+/-15.9 cc and 28.3+/-7.8 minute, respectively. In fifteen patients (88%), serum beta-hCG level from the preoperative base was declined 90% or more within postoperative day 4 and in 2 patients (12%), it was decreased within postoperative day 60. CONCLUSION: Endoscopic cornuotomy using the large amount of diluted vasopressin injection procedure is a safe and effective in the interstitial pregnancy.
Assuntos
Feminino , Humanos , Gravidez , Amenorreia , Paridade , Gravidez Ectópica , Estudos Retrospectivos , VasopressinasRESUMO
OBJECTIVE: The purpose of this study is to evaluate the application rate and effectiveness of endoscopic operations based on 6,017 cases in the field of gynecology. METHODS: Six-thousand-seventeen cases of endoscopic operations were performed from March 1993 to June 2004 in the department of Obstetrics and Gynecology, Center for Endoscopy, Good Moonhwa Hospital. Endoscopic operations were done on the majority of patients who had benign gynecologic diseases. We applied "two-surgeons system" and simplified methods of operation consisted of endoloop-ligation, endosuture and endotying. RESULTS: Our endoscopic operations were successful in 5,994 cases (99.62%) out of 6,017 attempts. Twenty-three cases (0.38%) were converted to laparotomy due to severe pelvic adhesion, excessive bleeding or difficulty in accessibility. In the first year endoscopic operations were done in 29.0% of the total gynecologic operations, but was increased to 52.9% during the next 4 years. In 2003, 93.0% and in 2004, 99.0% of the total gynecologic operations were done by endoscope. While the simple technique surgeries showed a high application rate, the more complicated technique surgeries, which began at a lower rate, showed a steady increase up to 89.3%. Blood loss and operation time were markedly declined during 3 year period and maintained at a low level thereafter. A 3 years' period of endoscopic operations (about 500 cases) is necessary for a hospital learning curve while, 26.4 cases is necessary an individual surgeon's learning curve. The major complications during the study period was 28 cases (0.47%). CONCLUSION: Endoscopic operations can be applied in almost all benign gynecologic diseases. In particular, "two-surgeons system" is a safe method with few complications and minimal learning period. These results suggest that if appropriate techniques could be learned, endoscopic operation might be preferred to laparotomy for both surgeons and patients.
Assuntos
Feminino , Humanos , Endoscópios , Endoscopia , Doenças dos Genitais Femininos , Ginecologia , Hemorragia , Laparotomia , Aprendizagem , Curva de Aprendizado , ObstetríciaRESUMO
Complications related to a broken stylet during endotracheal intubation have been infrequently reported. In most cases, broken stylets have been recognized by chest radiography. We report a case of unrecognized iatrogenic aspiration of a broken stylet. A 37-year-old man, who underwent explo-laparotomy two days previously, was reintubated with an uncoated stylet in the intensive care unit because of dyspnea and pulmonary congestion. He was on artificial ventilation for one day and was extubated one week later. We could not find the broken stylet on serial chest x-ray films until a metallic substance was expectorated while the patient was coughing 28 days after extubation. During the intervening period the patient did not complain of any chest discomfort and we did not realize that the broken stylet remained. The use of a plastic coated stylet and its careful observation after intubation are recommended to avoid this complication.
Assuntos
Adulto , Humanos , Tosse , Dispneia , Estrogênios Conjugados (USP) , Unidades de Terapia Intensiva , Intubação , Intubação Intratraqueal , Plásticos , Radiografia , Tórax , Ventilação , Filme para Raios XRESUMO
BACKGROUND: Transient cardiovascular responses are frequently associated with direct laryngoscopy and tracheal intubation. The aim of this study was to investigate the change of hemodynamic response in laryngoscopy and intubation after injection of diltiazem and lidocaine. METHODS: We studied eighty adult patients (ASA 1-3). After intravenous injection of thiopental sodium, each patient received saline (Control), 1 mg/kg lidocaine (Group L), 0.3 mg/kg diltiazem (Group D), or 0.3 mg/kg diltiazem + 1 mg/kg lidocaine (Group DL) 90 seconds before a laryngoscopy. Heart rate and arterial blood pressure were obtained at baseline, just before the laryngoscopy, immediately after intubation, 1, 2, 3 and 4 minutes after intubation. RESULTS: There were no significant differences in the changes of heart rate among all groups. Patients who received saline and lidocaine showed a significant increase in mean arterial pressure associated with tracheal intubation, and these responses were attenuated in diltiazem and diltiazem + lidocaine treated patients. However, there was no significant difference between the diltiazem group and diltiazem + lidocaine group. CONCLUSIONS: This data suggests that 0.3 mg/kg diltiazem or 0.3 mg/kg diltiazem + 1 mg/kg lidocaine treatment are effective methods to attenuate the hypertensive response to laryngoscopy and tracheal intubation. However, injection of diltiazem + a low dose of lidocaine was not more effective than the diltiazem alone group.
Assuntos
Adulto , Humanos , Pressão Arterial , Diltiazem , Frequência Cardíaca , Hemodinâmica , Injeções Intravenosas , Intubação , Laringoscopia , Lidocaína , TiopentalRESUMO
PURPOSE: Cataract and refractive surgical procedures are now among the most common and successful surgeries in medicine. Since 1995, we have annually surveyed the members of the Korean Society of Cataract and Refractive Surgery(KSCRS) on cataract surgery technique, anesthesia, intraocular lens and refractive surgery to understand the current situation and future trends in these fields. METHODS: Fifth annual survey forms consisted of 80 multiple-choice questions mailed in January 2000 to 234 ophthalmologists of the KSCRS. Approximately 47% of the questionnaires mailed were returned by the February cutoff date. Current data were compared with previous annual survey and data from Japan and USA. RESULTS: Hospitalized period is decreased annually and use of topical anesthesia(38%) increased steady. Self sealing wound construction was the main wound closure technique in phacoemulsification accounted for 41%. Most preferred intraocular lenses for small incision cataract surgery are silicone(60%), acrylic (33%), and PMMA(7%). Especially, acrylic intraocular lens had been used highly. Viscoelastics(38%) produced by Korean medical company becomes widely used compared with previous year. 61% of the respondents were performing excimer laser keratomy for refractive surgery. Its complications are the regression of visual acuity(39%), halo or glare(36%), and irregular astigmatism(15%). 52% of the respon-dents performing LASIK had the experience of thin or perforated flap formation, and 48% had free cap formation. Also, legal problems on excimer laser and LASIK have been increased highly. CONCLUSION: From this survey, we found current trend and change in cataract and refractive surgery in Korea are similar to those of Japan and USA.