Hypouricemic Effect of Ethanol Extract of Aster glehni Leaves in Potassium Oxonate-Induced Hyperuricemic Rats

The prevalence of gout is increasing worldwide, and control of serum uric acid level has been regarded as one of the therapeutic methods for gout. Inhibition of xanthine oxidase (XO) activity which can oxidize hypoxanthine to uric acid has been commonly proposed to decrease serum uric acid level. The aim of this study was to demonstrate the hypouricemic effect of ethanol extract of Aster glehni leaves (EAG) by in vitro and in vivo study in potassium oxonate (PO)-induced hyperuricemic rats. EAG possessed 132.5 ± 6.8 mg QE/g of total flavonoid and showed antioxidant activity. EAG showed in vitro and in vivo inhibitory activity against XO and significantly decreased serum uric acid level in PO-induced hyperuricemic rats without liver toxicity. These results show that EAG significantly attenuates hyperuricemia by inhibiting XO activity, which resulted in the decrease of serum uric acid level. Therefore, EAG might possess a potential therapeutic ability for improving gout.

Effect of intravenous induction agents on emergence delirium after sevoflurane anesthesia in pre-school aged children undergoing adenotonsillectomy

BACKGROUND: In pre-school aged children, the occurrence of emergence delirium (ED) is increased after sevoflurane anesthesia. The purpose of this study was to evaluate if intravenous inducting agents such as propofol, ketamine or thiopental sodium affected the development of ED. METHODS: A total of 62 children between 3 and 6 years of age scheduled for elective tonsillectomy and adenoidectomy were divided into 3 groups in a double-blinded manner. Anesthesia was induced using one of the three drugs intravenously: 5 mg/kg of sodium thiopental, 1 mg/kg of ketamine or 2 mg/kg of propofol. Anesthesia was then maintained with sevoflurane. The development of ED was assessed in the post-anesthetic care unit. RESULTS: The propofol and ketamine group showed a significantly lower pediatric anesthesia emergence agitation (PAEA) score and a lower incidence of ED compared with the thiopental group. CONCLUSIONS: Propofol and ketamine decreased the development of emergence delirium when used as an induction agent.

The influence of age and gender on remifentanil EC(50) for preventing rocuronium induced withdrawal movements / 대한마취과학회지

BACKGROUND: Rocuronium-induced withdrawal movements can be harmful to patients during the induction period. Remifentanil has been reported to reduce these movements effectively. In this study, we determined the EC(50) of remifentanil for the prevention of rocuronium induced withdrawal movements in male, female, old and child group. METHODS: We included patients scheduled for general anesthesia and assigned them into 4 groups depending on their age and gender: male group (20-60 yr), female group (20-60 yr), old group (>65 yr) and child group (6-12 yr). Remifentanil was administered by target controlled infusion. Propofol 2 mg/kg was then administered after equilibration between the effect and plasma concentration of remifentanil was reached. After loss of consciousness, rocuronium 0.6 mg/kg was administered. Patient's response to the rocuronium was graded using a 4 point scale in a blinded manner. The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was determined using Dixon's up-and -down method. RESULTS: The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was 1.8 +/- 0.5 ng/ml [95% confidence interval 1.3-2.2] in the male group, 2.3 +/- 1.0 ng/ml [1.3-3.2] in the female group, 0.5 +/- 0.4 ng/ml [0.2-0.8] in the old group and 2.8 +/- 0.8 ng/ml [2.1-3.5] in the child group. CONCLUSIONS: The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was lowest in the elderly and higher in children than male adult patients. No difference in the EC(50) of remifentanil was seen between male and female adult patients.

The optimal preemptive dose of gabapentin following gynecologic surgery / 대한마취과학회지

BACKGROUND: Gabapentin decreases acute nociceptive pain in animal and human studies when given before surgical incision. Various doses of gabapentin have been used (300-1,200 mg) to measure this preemptive effect. Here, we evaluated the optimal dose of gabapentin for reducing fentanyl consumption and the adverse effects of gabapentin following gynecologic surgery. METHODS: We recruited 100 patients who underwent laparotomy for gynecologic surgery. Patients were randomly divided into 4 groups and received a placebo (control), gabapentin 300 mg (G 300), gabapentin 600 mg (G 600), or gabapentin 1,200 mg (G 1200) 2 h before surgery. Postoperatively, patients received fentanyl via an intravenous patient controlled analgesia device. The cumulative fentanyl doses were recorded 2, 6, 12, 24 h, and 48 h postoperatively, and the sedation scale was recorded in the post anesthetic care unit (PACU). RESULTS: The postoperative fentanyl requirement was lower with gabapentin treatment, but there was no significant differences for the different doses. PACU sedation scores were not different in any group. CONCLUSIONS: Gabapentin has a preemptive effect in gynecologic surgery, but there were no additional fentanyl-sparing benefits at doses above 300 mg. Thus, 300 mg is an optimal dose for decreasing fentanyl consumption following gynecologic surgery.

Comparison of alfentanil and remifentanil for the use of patient controlled sedation under local anesthesia during ear, nose and throat surgery / 대한마취과학회지

BACKGROUND: This study was conducted to compare the effects of alfentanil and remifentanil on patient controlled sedation (PCS). METHODS: 60 patients scheduled for ear, nose and throat surgery under local anesthesia were randomly allocated to Group P (n = 20, propofol 10 mg/ml), Group A (n = 20, propofol 10 mg/ml with alfentanil 500 microg/ml) and Group R (n = 20, propofol 10 mg/ml with remifentanil 10 microg/ml). Without a basal rate, bolus was set to 2 ml with one minute of lockout time. RESULTS: A total of 57 patients were included in this study. Group A was found to have a lower blood pressure and pulse rate than group R. Group R showed a lower PCS dose upto an OAA/S (Observer's Assessment of Alertness/Sedation Scale) value of 4 and a higher OAA/S prior to surgery than group P. Group P was found to have a higher blood pressure and respiration rate than Group A. During PCS, patient anxiety was significantly decreased in all groups. In addition, there was no differences among groups in the level of pain during the perioperative period, delivery/attempt ratio, satisfaction of the patient and surgeon, and number of patients required to undergo the same PCS technique again. The frequency of side effects of PCS, which included pain on injection, transient hypertension, hypotension, desaturation and oversedation, were similar among groups. CONCLUSIONS: Evaluation of patients who underwent ear, nose and throat surgery under local anesthesia using PCS with propofol alone or alfentanil or remifentanil revealed no differences in safety, effectiveness, complications or satisfaction of the patients and surgeons.

Airway management in a patient with Treacher Collins syndrome: A case report / 대한마취과학회지

Treacher Collins Syndrome (TCS) is an autosomal dominant genetic disorder which is resulted from the mutation that affect the Treacher Collins-Franceschetti syndrome 1 (TCOF1) gene on chromosome 5. The features of patients affected by this syndrome are characterized by depression of the malar bones, an antimongoloid slant of the palpebral fissures, coloboma of the lower lids, mandibular hypoplasia with retrognathia and deformities of the ear structures. The airway obstruction is frequently caused by mandibular hypoplasia. This may necessitate the placement of a tracheostomy for airway patency after the birth. We experienced a tracheostomy for an infant with respiratory difficulty associated airway obstruction.

Regional Anesthesia for Cesarean Delivery

During the last 2 decades, there has been an increasing impetus to avoid general anesthesia in women undergoing cesarean delivery because of the increased of failed endotracheal intubation in pregnant women compared with nongravid patients. The past decade has seen major changes in the practice of obstetric anesthesiology, as evidenced by an improved understanding by anesthesiologists of many disease entities seen in obstetric patients, as well as by the enhancements of new techniques and drugs. Recent advances in the practice of this specialty include the refinement of the combined spinal-epidural technique for both labor analgesia and cesarean delivery, the use of continuous infusions of dilute solution of local anesthetics combined with opioids, the development of multiorifice epidural catheters, the dramatic increase in the use of subarachnoid anesthesia for elective cesarean delivery, and the introduction of new amide local anesthetics. Because of the tremendous increase in the application of neuraxial techniques, the administration of general anesthesia for cesarean delivery has dramatically decreased. Also the number of deaths associated with regional anesthesia declined markedly with the withdrawal of 0.75% bupivacaine and probably due to increasing awareness of local anesthetic toxicity and increased use of test dosing. The discussion includes new methods and drugs associated with regional anesthesia for cesarean delivery and highlight their benefits and risks.

The influence of GABAAgamma2 genetic polymorphism on the emergence agitation induced by sevoflurane / 대한마취과학회지

BACKGROUND: Sevoflurane is one of the most popular anesthetics, used in pediatric anesthesia, but emergence agitation is more common with using sevoflurane as compared to that with using the other inhalation anesthetics. Sevoflurane exerts its effect on gamma-aminobutyric acid (GABA) ergic transmission. This study aimed to investigate if genetic variations at the GABRgamma2 (single nucleotide polymorphism [SNP] 211037 C/T, nucleotide position 3145 in intron A/G) on the 5q33 chromosome were associated with the development of emergence agitation when sevoflurane is used. METHODS: One hundred fourteen, pre-school aged patients who were to undergo tonsillectomy and adenoidectomy were included in this study. Anesthesia was induced with 5 mg/kg of thiopental sodium, 0.02 mg/kg of atropine and 0.1 mg/kg of vecuronium, and this was maintained with 3% sevoflurane and 50% N2O in oxygen. The incidence of emergence agitation and the emergence agitation scores were assessed at 0 min, 10 min, 20 min and 30 min after arriving at the post anesthetic care unit (PACU). Genomic DNA from peripheral leukocytes was isolated using the QIAamp Blood Minikits and the GABRgamma2 genetic polymorphisms were analyzed by performing polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: There were no significant differences of the emergence agitation scores among the genotypes in the GABRgamma2- SNP211037 C/T and GABRgamma2-nucleotide position 3145 in intron A/G. There was a trend in which the AA group in the GABRgamma2- nucleotide position 3145 in intron A/G has a lower incidence of emergence agitation compared with the non-AA group, but this was without statistical significance (P = 0.07). CONCLUSIONS: There is a possibility that the GABR2 genetic polymorphism may affect the development of emergence agitation when sevoflurane is used in pediatric anesthesia.

Comparison of Postoperative Pain after Abdominal and Laparoscopic Assisted Vaginal Hysterectomy by using IV-PCA / 대한마취과학회지

BACKGROUND: It is known that laparoscopic surgery is associated with less pain than open surgery in many studies. We wanted to evaluate the postoperative pain by using intravenous patient-controlled analgesia (IV-PCA) in patients undergoing laparoscopic assisted vaginal hysterectomy (LAVH) or abdominal total hysterectomy (ATH). METHODS: Ninety one women with uterine myoma were prospectively assigned to undergo either LAVH (n = 49) or ATH (n = 42). IV-PCA was used for postoperative pain control in both groups. Pain scores were assessed using a visual analogue scale (VAS) and cumulative PCA-drug consumption and incidences of nausea and vomiting were recorded in 1, 2, 4, 24, 48 hours after surgery. RESULTS: There were no differences in terms of patient's age, BMI and total operation time between the both groups. Pain scores and the demand of analgesics of the IV-PCA in 1, 2, 4, 24, and 48 hours after surgery were not significantly different in both groups. Incidences of nausea and vomiting after surgery were more common in LAVH than ATH especially within 4 hours. CONCLUSIONS: The present study demonstrates that LAVH requires adequate postoperative pain control as ATH during the first 48 hours after surgery, and the effective prevention of PONV is required in LAVH compared with ATH.

Comparison of Propofol ED50 and Insertion Conditions of LMA between Fentanyl and Alfentanil Adjuvant Group / 대한마취과학회지

BACKGROUND: Recent studies suggest that additional use of alfentanil could provide the best condition for the laryngeal mask airway (LMA) insertion. The aim of this study is to compare the median effective dose (ED50) of propofol for the classic LMA insertion and the insertion condition following between fentanyl and alfentanil adjuvant. METHODS: We enrolled 53 patients scheduled for minor surgery under general anesthesia. Patients were randomly allocated to the fentanyl group (n = 24) and the alfentanil group (n = 29) in double blind manner. For fentanyl group, 1microgram/kg of fentanyl was injected intravenously 90 sec before propofol. The afentanil group received 4microgram/kg of alfentanil and propofol coincidently. The insertion of LMA was attempted 90 sec after propofol administration. In accordance with Dixon's up-and-down method, the dose of propofol for consecutive patients in each group was varied with increments or decrements of 0.5 mg/kg based on the previous insertion results of patients. RESULTS: In the fentanyl and alfentanil group, the ED50 of propofol for LMA insertion according to Dixon's method was 2.0 +/- 0.3 mg/kg and 1.8 +/- 0.3 mg/kg, respectively. In addition, the ED50 of propofol of the fentanyl and alfentanil group according to probit regression model, 1.7 mg/kg (95% confidence interval, 1.2-2.2) and 1.7 mg/kg (1.3-2.0) were calculated respectively. There is no significant difference between the two groups. CONCLUSIONS: There was no significant difference in propofol ED50 for insertion of LMA and insertion condition between the alfentanil and the fentanyl group.

Hemodynamic and Arterial Blood Gas Changes following Tourniquet Use under General Anesthesia with Sevoflurane or Propofol for Total Knee Replacement (TKR) in Geriatric Patients

BACKGROUND: Tourniquets are widely used to provide a clean surgical field but can induce variable hemodynamic and metabolic changes. Sevoflurane is one of anesthetic agents used for unstable or elderly patients, and propofol can be used for smooth induction and early recovery with few side effects. This study evaluated the differences in the hemodynamic and metabolic changes after the application of a tourniquet under general anesthesia with sevoflurane or propofol for total knee replacement (TKR). METHODS: Thirty elderly female patients scheduled to undergo TKR were allocated into two groups, the general anesthesia with sevoflurane group (S group, n = 15) or the propofol group (P group, n = 15). The hemodynamic parameters such as the mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), cardiac index (CI), stroke volume (SV), systemic vascular resistance (SVR), and arterial blood analysis were checked immediately before (control, T1), at 5 (T2), 30 (T3) and 60 minute (T4) after inflation, and at 5 (T5) and 30 minutes after (T6) deflation. RESULTS: Compared with T1, the MAP increased significantly at T2, T3, and T4 in both groups. The increase in the SVR after inflating the tourniquet and the decrease in the SVR after deflation were lower in the P group than in the S group. The metabolic changes after deflating the tourniquet were similar in both groups. CONCLUSIONS: Compared with sevoflurane, propofol did not significantly decrease the hemodynamic and metabolic changes after placing a tourniquet during TKR for elderly patients. therefore, both sevoflurane and propofol are acceptable anesthetics for TKR in geriatric patients.

Comparison of Thiopental Sodium and Ketamine Induction on Emergence Agitation after Desflurane Anesthesia in Children undergoing a Tonsillectomy / 대한마취과학회지

BACKGROUNDs: It is widely known that desflurane provides fast emergence but with a high incidence of emergence agitation. This study was designed to investigate the emergence agitation resulting from thiopental or ketamine induction with desflurane anesthesia for pediatric patients. METHODS: Forty patients, aged 3-8 years, scheduled for a tonsillectomy or a tonsillectomy and adenoidectomy were randomly allocated into two groups. Anesthesia was induced using 5 mg/kg thiopental sodium (Group T patients) or 2 mg/kg ketamine (Group K patients), and was maintained using O2-N2O-desflurane. The recovery time and incidence of emergence agitation were assessed. RESULTS: The incidence of emergence agitation was less in patients in the ketamine induction group. There were no differences in the recovery time and reported side effects. CONCLUSIONS: We conclude that ketamine induction provides less emergence agitation when compared to thiopental induction for desflurane anesthesia for a pediatric tonsillectomy or a tonsillectomy and adenoidectomy without delayed recovery.

Total Atelectasis after Intubation of a Double Lumen Tube: A case report / 대한마취과학회지

The intubation of a double lumen endotracheal tube (DLT) has become the technique of choice for most procedures requiring one lung ventilation (OLV). The potential complications of the use of DLT are airway ruptures and malpositions of the DLT which can induce an increase of airway pressure, hypercapnia, severe hypoxemia, and other effects during the induction of general anesthesia. The intractable hypoxia due to total lung atelectasis is one of the very rare complications during and after intubation of the DLT. We experienced a 16 year-old male patient with severe hypoxia scheduled for thoracoscopy after a position change from supine to lateral decubitus. The hypoxia was unable to be easily corrected by endobronchial suction, rechecking of DLT position with fiberoptic bronchoscope, and manual positive ventilation, even after a position change to supine. An emergent chest X-ray revealed total atelectasis of the right lung that was relieved gradually by general supportive care at the intensive care unit.

Comparison of the Effects of Intrathecal Fentanyl and Meperidine on Shivering after Cesarean Delivery under Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Meperidine has proved a far more effective treatment for shivering after spinal anesthesia than equianalgesic doses of opioid agonist. We performed this prospective, double-blinded, randomized study to compare the antishivering effect of fentanyl and meperidine when added to intrathecal hyperbaric bupivacaine during Cesarean delivery under spinal anesthesia. METHODS: Sixty ASA I or II patients undergoing Cesarean delivery under spinal anesthesia were randomly assigned into three groups. Fentanyl 12.5 ug (group F) or meperidine 12.5 mg (group M) or normal saline 2.5 ml (group C) were added to 0.5% hyperbaric bupivacaine 8.5 mg for spinal anesthesia. Data including mean arterial pressure, heart rate, sensory block level, core temperature, shivering incidence and intensity were collected every 2 min for 10 min and then every 5 min until the end of surgery. RESULTS: There were no significant statistical differences in patient characteristics, the mean arterial pressure, heart rate and core temperature among the groups. The incidences of shivering in fentanyl and meperidine group were significantly lower than in the control group, but there were no significant differences between fentanyl and meperidine group. Shivering intensity was significantly lower in fentanyl and meperidine group than in the control group. CONCLUSIONS: Intrathecal fentanyl and meperidine added to 0.5% hyperbaric bupivacaine are effective in reducing the incidence and intensity of shivering associated with spinal anesthesia.

Developed Extrapotine Myelinolysis after Hysteroscopic Myomectomy: A case report / 대한마취과학회지

Transcervical resection of endometrium is under-utilized in the treatment of dysfunctional uterine bleeding, uterine myoma and menorrhagia. The procedure is similar to transurethral resection of prostate in men with a possibility of substantial absorption of irrigation fluid. Absorption of a large volume of fluid can cause excessive intravascular volume, hyponatremia, cerebral edema and death. Severe hyponatremia leading to extrapontine myelinolysis is an extremely rare complication of this procedure. So, We report a case of developed extrapontine myelinolysis after hysteroscopic myomectomy which, however, showed complete recovery.

Delayed Recovery after Continuous Infusion of Midazolam in Hepatic Dysfunction: A case report / 대한마취과학회지

Benzodiazepines are frequently administered for sedation to surgical intensive care unit patients who require postoperative intubation and mechanical ventilation. Midazolam is the most commonly used drug, which is water soluble, short-acting benzodiazepine and rapidly metabolized by the liver. Continuous intravenous infusion of midazolam was administered to the man who was 40 years old for mechanical ventilation in the intensive care unit for 58 hours. After discontinued midazolam, patient who had acute hepatic dysfunction had been sedated with endotracheal intubation for 5 days. Even flumazenil was tried twice to reverse the effect of midazolam, the response was limited by the time. Finally he awaked as recovery of his hepatic function.

Hydrohemothorax and Subclavian Artery Laceration during Internal Jugular Vein Cannulation: A case report / 대한마취과학회지

Central venous cannulation via an internal jugular vein has become a common procedure in the management and monitoring of severely ill patients. Although complications such as carotid artery puncture or pneumothorax have been reported, hemothorax is relatively uncommon. We describe a case of hydrohemothorax and subclavian artery laceration which occurred during right internal jugular vein cannulation. A 44-year-old female patient was admitted for laparoscopic adrenalectomy under general anesthesia. For central venous pressure monitoring, central venous cannulation performed. However, dilator overinsertion injured the right subclavian artery. This led to a massive ipsilateral hydrohemothorax requiring thoracotomy for subclavian artery repair. This case suggests that central venous cannulation should be done carefully and improves awareness of the potential for dilator induced injury.

Effects of Neostigmine and Pyridostigmine on the Cardiovascular Responses in Inhalation Anesthesia / 대한마취과학회지

At the end of the operation, residual neuromusular blookade may be antagonized by anticholines-terase (edrophonium, neostigmine and pyridostigmine). Neostigmine is probably commonly used antagonist of nondepolarizing neuromuscular blocking agents. But, because of an apparent longer duration of action and lesser muscarinic effects, pyridos- tigmine has been suggested as possibly superior to neostigmine as an antagonist of nondepolarizing neuromuscular blockade. Accordingly, present study observed the heart rate, systolic and diastolic blood pressure changes following equipotent doses of pyridostigmine and neostigmine given with glycopyrrolate in inhalation anesthesia (halothane and enflurane). Eighty patients were randomly divided in four groups as follows: Group I: halothane, glycopyrrolate + neostigmine Group II: halothane, glycopyrrolate + pyridostigmine Group IIl: enflurane, glycopyrrolate + neostigmine Group IV: enflurane, glycopyrrolate +pyridostigmine The results were as follows: 1) In halothane and enflurane anesthesia, the changes in heart rate were significant in each group after 4 minutes and especially, the group I, III showed more decrease than the group II, IV. 2) Tachycardia were observd until 6 minutes after administration of anticholinesterase in each group. Bradycardia were appeared at 6 minutes in the group I, IIl and at 14 minutes in the group II, IV and, each group showed bradycardia which continued over 20 mintes. 3) Even though the decrease of systolic and diastolic blood pressure showed transiently with time, there were no significant difference in the changes in ach group. 4) When the same anticholinesterase was administered, the cardiovascular responses were no significant difference between the halothane and enfurane anesthesia. In conclusion, pyridostigmine with glycopyrrolate seems to produce minimal changes in the cadiovascular responses in halothane and enflurane anesthesia.

Percutaneous transhepatic cholangiography: analysis of 120 cases

Percutaneous transhepatic cholangiography(PTC) is of value in differential diagnosis of cholestatic diseases. Authors had performed PTC in 120 patients with flexible needle of 23 gauge at the Department of Radiology, KangNam St, Mary's Hospital and Myung Dong St. Mary's Hospital during the period from Jan. 1976 to April 1980. PTC was accomplished successfully in 112 of 120 patients. Diagnoses included cholangiocarcinomas (27 cases), arcinomas ofpancreas head (21 cases), ampullary carcinomas (4 cases), metastatic carcinomas(4 cases), metastatic carcinomas (5cases), bile duct stones(27 cases), sclerosing cholangitis(6 cases), hepatitis(6 cases), liver cirrhosis(6 cases), post operative adhesions(5 cases), chronic pancreatitis(3 cases), stomach carcinomas(3 cases), clonorchiasis(2cases), blood clot (1 case), and remaining normal 4 cases. Some characteristic PTC findings were (1) segmentalannular narrowing and abrupt complete obstruction and polypoid filling defects of the bile duct incholangiocarcinoma, (2) typical nipple or rat-tail appearance of the distal commmon bile duct in pancreatic headcarcinoma, (3) single or multiple sharply and smoothly outlined filling defects whthin bile duct in all cases ofstones, (4) complete obstruction with shallow concavity in ampullary carcinoma, (5) diffuse or segmental narrowingof the intrahepatic bile duct and common bile duct in sclerosing cholangitis, (6) multiple tiny polypoid fillingdefects of gallbladder, common hepatic duct, and common bile duct in clonorchiasis, (7) normal appearance inhepatitis. The overall diagnostic accuracy of PTC in 66 operated cases was 89.4%, and complications following the examination were signficantly reduced by using a fine flexible needle(23 gauge). From the present study it is concluded as follows; 1. To evaluate obstructed or stenosed site accurately, aspiration of bile juice must bepreceded by a 23 gauge needle connected to either 10mo or 5ml syringe. 2. To diagose carcinoma of hte ampullaryportion, serial spot filmings were indispensible ot demonstrated modified appearance of obstructive lesions due tocontraction of Oddi sphincter. 3. In contrast to other reports, the most common site of cholangiocarcinomas wasthe common hepatic duct (12 of 27 cases) in our series. Rat-tail appearance was seen in both pancreatic headcarcinoma and carcinoma involving the distal end of the common bile duct. 4. PTC was a more valuable method for diagnosis of clonorchiasis.

The appendicolith in acute appendicitis: a radiological study

The diagnostic importance of finding an appendicolith in the plain x-ray of the abdomen has been well documented. However, most of the papers so far published have stressed x-ray findings of the preoperative abdomenin acute appendicitis. In the present study we have attempted to correlate incidences of appendicoliths insurgical specimen and plain x-ray of the abdomen. The materials were 37 surgical specimens of the appendix removed for acute appendicits at St. Mary's Hospital, St. Paul's Hospital, Kang Nam Hospital, Holy Family Hospital and Our Lady of Mercy Hospital of Catholic Medical College during the period of 6 months from August 1980. Each surgical specimen was subjected to soft tissue radiography to detect calcified appendicolith. Then the preoperative x-raysof abdomen were retrospectroscopically analysed for the presence of radiographically demonstrable appendicoliths.Our study revealed that in as many as 32% of 37 surgical specimens one or more calcified appendicoliths were demonstrated radiographically whereas only one of these was identified as such in the preoperative x-ray film ofthe abdomen. Such a great discrepancy between the incidences of appendicoliths in the surgical specimen andpreoperative x-ray films of the abdomen are ascribed to (1) relative smallness of appendicoliths (87% of the stones measured less than 1cm in diameter in radiographs of surgical specimen in our series), (2) overlapping of these small stones on the right iliac bone and (3) underpenetrating of the iliac bone area in x-ray films of theabdomen. For improving detctability of appendicoliths therefore it is recommended that the technique of radiography of plain abdomen should be such that a small appendicolity overlying the iliac bone can be brought outof trabecular shadows.