Large Duct Pancreatic Ductal Adenocarcinoma:A Morphological Variant of Pancreatic Ductal Adenocarcinoma With Distinct CT and MRI Characteristics

Objective@#To investigate the imaging characteristics of large duct pancreatic ductal adenocarcinoma (LD-PDAC) on computed tomography (CT) and magnetic resonance imaging (MRI). @*Materials and Methods@#Thirty-five patients with LD-PDAC (63.2 ± 9.7 years) were retrospectively evaluated. Tumor morphology on CT and MRI (predominantly solid mass vs. solid mass with prominent cysts vs. predominantly cystic mass) was evaluated.Additionally, the visibility, quantity, shape (oval vs. branching vs. irregular), and MRI signal intensity of neoplastic cysts within the LD-PDAC were investigated. The radiological diagnoses rendered for LD-PDAC in radiology reports were reviewed. @*Results@#LD-PDAC was more commonly observed as a solid mass with prominent cysts (45.7% [16/35] on CT and 37.1% [13/35] on MRI) or a predominantly cystic mass (20.0% [7/35] on CT and 40.0% [14/35] on MRI) and less commonly as a predominantly solid mass on CT (34.3% [12/35]) and MRI (22.9% [8/35]). The tumor morphology on imaging was significantly associated with the size of the cancer gland on histopathological examination (P = 0.020 [CT] and 0.013 [MRI]). Neoplastic cysts were visible in 88.6% (31/35) and 91.4% (32/35) of the LD-PDAC cases on CT and MRI, respectively. The cysts appeared as branching (51.6% [16/35] on CT and 59.4% [19/35] on MRI) or oval shapes (45.2% [14/35] on CT and 31.2% [10/35] on MRI) with fluid-like MRI signal intensity. In the radiology reports, 10 LD-PDAC cases (28.6%) were misinterpreted as diseases other than typical PDAC, particularly intraductal papillary mucinous neoplasms. @*Conclusion@#LD-PDAC frequently appears as a solid mass with prominent cysts or as a predominantly cystic mass on CT and MRI. Radiologists should be familiar with the imaging features of LD-PDAC to avoid misdiagnosis.

Endovascular Treatment of a Fusiform Aneurysm Involving a Premammillary Artery Originating from the Internal Carotid Artery: A Case Report

The premammillary artery (PMA) is a branch of the posterior communicating artery (PCoA). While the PMA is known to originate from the PCoA as demonstrated by most anatomical studies, it originates directly from the internal carotid artery in approximately 1% of patients. Cerebral aneurysms associated with the PMA have rarely been reported. We report an extremely rare case of a ruptured PMA aneurysm that was managed using endovascular treatment.

The Cardiovascular Effect of Risperidone

OBJECTIVES: Risperidone is a new antipsychotic drug developed to overcome the therapeutic limitation of conventional antipsychotics. It responses to negative as well as positive symptoms by blocking both dopaminergic and serotonergic receptors, causing no significant side effects such as agranulocytosis and seizure. It is, however, not known whether it induces any serious cardiovascular side effects as evoked by other conventional antipsychotic drugs. The aims of this study were to evaluate the effect of risperidone on cardiovascular function, and to discuss the factors affecting the cardiovascular function. METHODS: For 42 patients(22 males and 20 females) diagnosed as schizophrenia, schizophreniform disorder or schizoaffective disorder according to the DSM-IV classification, the cardiovascular fuctions such as heart rate, systolic and diastolic blood pressure, PR interval, QRS interval and QT inerval were successively checked before and after 2 weeks and 4 weeks risperidone administration. Furthermore, variables such as body weight, Brief Psychiatric Rating Scale(BPRS), Clinical Global Impression(CGE), Extrapyramidal Symptom Rating Scale(ESRS), Anticholinergic Rating Scale(ARS), serum cholesterol level, serum triglyceride level, serum high-density-lipoprotein level, serum WBC, serum Hb, serum platelet level, prothrombin time and partial thromboplastin time were also analyzed before and after 2 weeks and 4 weeks risperidone administration. RESULTS: 1) Risperidone treatment resulted in a significantly decreased heart rate and increased QT interval after 4 weeks administration(p<0.005 respectively). 2) The scores of BPRS and CGI were significantly decreased after 2 weeks and 4 weeks risperidone adminisration as compared with baseline(p<0.001 respectively). The scores of ESRS and ASRS were significantly increased after 2 weeks and 4 weeks risperidone administration as compared with baseline(p<0.001 respectively). 3) There were positive correlations between heart rate after 4 weeks and total dose(p<0.05). Blood pressure was significantly(p<0.05) correlated with sex(higher in male) and significantly(p<0.05) positive correlated with body weight. QT interval was significantly(p<0.05) correlated with sex(longer in female) and smoking history(shorter in smokers). CONCLUSIONS: Risperidone could induce significant change in heart rate and Q-T interval. Therefore, the cardiovascular safety for risperidone should be reconsidered according to the duration and dosage increase.

Epidural Analgesia in a Parturient following Splenorenal Shunt Operation for Liver Cirrhosis / 대한마취과학회지

Pregnancy with liver cirrhosis and/or portal hypertension is uncommon. Additionally, pregnancy in young women who previously underwent splenorenal shunt operation for portal hypertension due to liver cirrhosis is extremely rare. Esophageal variceal rupture, fatal hemorrhage and epidural hematoma must be considered during the management of such patients. This is a case of epidural analgesia for labor in a patient who previously underwent splenorenal shunt operation for portal hypertension due to liver cirrhosis.

The Addition of Subarachnoid Fentanyl to Hyperbaric Bupivacaine with Morphine for Cesarean Section / 대한마취과학회지

To investigate the effect of intrathecal fentanyl,36 ASA physieal status 1 or 2 parturients who underwent cesarean section with apinal anesthesis using 0.25% bupivacaine in 5.0% dextroae with 0.25mg morphine were studied. Patients were randomly allocated to receive either saline 0.2ml (group 1, n=17) or fentanyl 10ug(group 2, n=19) in 3.525ml volume mixed with the bupivacaine with morphine. Spinal anesthesia was performed in sitting position using a 25 guage spinal needle. At the completion of injection, patients immediately turned supine with left uterine diaplacement. There was no statistically significant difference in the incidence of the hypotension between groups. The progress of sensory and motor blocks was similar in the two groups. The times from drug injection ta the onset to maximal sensory blockade and complete motor blockade, complete recovery of sensation and motor power were not different between groups. post delivery,the incidence of visceral pain were significantly less in group 2, as 2 of 19 patients(10%) in group 2 compared to 8 of 17 patients(47%) in group 1(p< 0.05). The effective analgesia time was no significant different: 31.7+/-2.5 hour in group 1 compared to 28.6+/-5.6 hour in Group 2. The ineidence of patients not requiring narcotics until discharge was similar in two groups. No patient showed any evidence of respiratory depression. The incidence of other side effects,such as nausea,vomiting and pruritus was not different between groups. No neonate had an Apgar score below 7.

The Addition of Subarachnoid Fentanyl to Hyperbaric Bupivacaine with Morphine for Cesarean Section / 대한마취과학회지

To investigate the effect of intrathecal fentanyl,36 ASA physieal status 1 or 2 parturients who underwent cesarean section with apinal anesthesis using 0.25% bupivacaine in 5.0% dextroae with 0.25mg morphine were studied. Patients were randomly allocated to receive either saline 0.2ml (group 1, n=17) or fentanyl 10ug(group 2, n=19) in 3.525ml volume mixed with the bupivacaine with morphine. Spinal anesthesia was performed in sitting position using a 25 guage spinal needle. At the completion of injection, patients immediately turned supine with left uterine diaplacement. There was no statistically significant difference in the incidence of the hypotension between groups. The progress of sensory and motor blocks was similar in the two groups. The times from drug injection ta the onset to maximal sensory blockade and complete motor blockade, complete recovery of sensation and motor power were not different between groups. post delivery,the incidence of visceral pain were significantly less in group 2, as 2 of 19 patients(10%) in group 2 compared to 8 of 17 patients(47%) in group 1(p< 0.05). The effective analgesia time was no significant different: 31.7+/-2.5 hour in group 1 compared to 28.6+/-5.6 hour in Group 2. The ineidence of patients not requiring narcotics until discharge was similar in two groups. No patient showed any evidence of respiratory depression. The incidence of other side effects,such as nausea,vomiting and pruritus was not different between groups. No neonate had an Apgar score below 7.

Effects of Fentanyl, Midazolam, and Fentanyl-Midazolam on the Cardiovascular System and Blood Glucose during General anesthetic Induction / 대한마취과학회지

In this study, we evaluated the effects of fentanyl, midazolam, and fentanyl-midazolam on cardiovascular system and blood glucose during endotracheal intubation in forty normotensive patients scheduled for elective surgery under general anesthesia. The patients were randomly classified into four groups; Group I (control) received tracheal intubation with thiopental 5 mg/kg (n=10), group II received tracheal intubation with fentanyl 6 ug/kg followed by thiopental 2 mg/ kg (n=10), group III received tracheal intubation with midazolam 0.3 mg/kg (n=10), group IV received tracheal intubation with fentanyl 4 ug/kg followed by midazolam 1 mg/kg (n=10). The changes of systolic blood pressure, diastolic blood pressure, mean arterial blood pressurie, heart rate, and blood glucose were compared in each group. The results were as follows; 1) In group I, endotracheal intubation caused a significant rise in SBP, HR and blood glucose. 2) In group II, endotracheal intubation caused little changes in SBP, DBP,MAP and blood glucose but HR was rised. 3) In group III, endotracheal intubation caused little changes in SBP, DBP, MAP, HR and blood glucose. 4) In group IV, endotracheal intubation caused little changes in SBP, DBP, MAP, HR and blood glucose.

The Effects of epidural Anesthesia to the Serum Glucose, Lidocaine Concentration and Cardiovascular System / 대한마취과학회지

In the lower abdominal surgery, it is well known that epidural anethesia inhibit endocrine response to surgical stress. We used lidocaine and morphine for epidural anesthesia and investigated the changes of serum lidocane and glucose concentration compared to general anesthesia. Also we estimated the duration of postoperative pain relief. Patients in group I received general anesthesia and patients in group II received 2% lidocaine 20 cc, patients in group III received 2% lidocaine 20 cc with morphine 4 mg. The results were as follows. 1) Blood pressure and pulse rate were increased significantly in group I but were less changed in group II and group III. 2) Blood glucose concentration increased significantly in group I but there was no significant changes in group II, group IIL 3) The duration that plasma lidocaine concentration was reached peak level was prolonged in group III but no significancy was found. 4) In group III that we adminstrated 4 mg morphine epidurally. postoperaive pain relief was sustained for about 15 hours. We conclucled that Epidural anesthesia with Morphine is more convenient during perioperative and postoperative period.

Cardiovascular Effects of Isoflurane in Korean Dogs / 대한마취과학회지

7 Korean dogs were anesthetized with oxygen and isoflurane in different concentrations (1 vo1.%, 2 vo1.%, 3 vo1.%). Cardiovascular effects of isoflurane in different concentrations were investigated. The results were as follow: 1) Heart rate was decreased significantly (p<0.05) following increase of isoflurane concentrations. 2) Mean arterial blood pressure was decreased significantly (p<0.05) following increase of isoflur- ane concentrations. 3) Cardiac index was decreased significantly (p<0.05) following increase of isoflurane concentra- tions. 4) Left ventricular stroke work index was decreased significantly (p<0.05) following increase of isoflurane concentrations. 5) Pumonary artery pressure and pumonary artery wedge pressure were decreased significantly (p<0.05) following increase of isoflurane, but there were no significant changes in central venous pressure, systemic vascular resistance and pulmonary vascular resistance.

The in Vivo Effects of Ethrane Anesthesia and Single Intravenous Injection of Hydrocortisone 250 mg on T-cell Subsets / 대한마취과학회지

The in vivo effects of ethrane and single intravenous injection of hydrocortisone 250 mg on T-cell subsets (T3, T4 and T8), s-cortisol, s-Na+ and K+, polymorphonuclear leukocytes, lymphocytes and HSR (T-helpers to T-suppressors ratio) has been studied. Six healthy volunteers and 16 patients was selected and observed. Sixteen patients has been done surgery under ethrane anesthesia, and single dose of hydrocortisone 250 mg was injected intravenously to eight patients among them. The result is as follows; 1) Serum cortisol level was increased after surgery under ethrane anesthesia and was decreased bellow control value at 24 hours after injection of hydrocortisone 250 mg. 2) After surgery under ethrane anesthesia, PMN's counts and monocyte counts in peripheral blood were increased, but absolute number of lymphocytes and T-cell subsets were decreased. 3) After surgery under ethrane anesthesia with hydrocortisone 250 mg, there was the most elevation of PMN's counts and the most redution of absolute number of T-cell subsets at 5 hours and was somewhat tended to return to control values, but remained changed at 24 hours, and monocyte counts was unchanged. 4) Adding hydrocortisone 250 mg compared with ethrane anesthesia alone, the increasing rate of PMN's counts and the decreasing rate of lymphocytes and absolute number of T-cell subsets were higher at 5 hours, and were lower at 24 hours. 5) Relative percentage of T-cell subsete and HSR were unchanged after surgery under ethrane anesthesia alone and adding hydrocortisone 250 mg.

Changes of Arterial Oxygen Saturation after Pediatric Anesthesia / 대한마취과학회지

In postanesthetic period, infants and children have a risk of hypoxemia due to decreased functional residual capacity(FRC) and increased alveolar-arterial O2 tension gradient(A-a DO2). We measured arterial oxygen saturation(SaO2) with a pulse oximeter in 60 ASA class 1 infants and children. Group 1 was breathing with supplemental oxygen(4L/min) by mask and Group 2 was breathing with room air in recovery room after general anesthesia. SaO2 was measured on arrival in the recovery room, 2,4,6, 8,10,15, and 20 minute after arrival The results were as follows: 1) Postanesthetic SaO2 measured on arrival in the recovery room had decreased significantly(p<0.05) to preanesthetic SaO2 2) SaO2 measured in room air had decreased significantly compared with SaO measured in supplemental oxygen. As a result of the study, it is thought to be safe that supplemental oxygen is administered to patient on transfer and in recovery room.

Effect of Labetalol on Cardiovascular Responses to Laryngoscopy and Endotracheal Intubation / 대한마취과학회지

Arterial blood pressure, pulse rate and rate pressure product changes following tracheal intubation were studied in 50 patients undergoing elective surgical procedures who received a thiopental-succinylcholine anesthetic intubation sequence. Three treatment groups and a control group were observed. Intravenous labetalol doses of 0.25 mg/kg, 0.5 mg/kg and 1.0 mg/kg, injected prior to anesthesia, were compared with respect to their effect on the cardiovascular sequences to direct laryngoscopy followed by the passage of an endotraeheal tube. The increases in heart rate and rate-pressure product associated with tracheal intubation were significantly prevented in labetalol treated patients, significantly. The increase in arterial pressure was prevented, insignificantly. However, it was dose-dependent. From the above result, a pre-induction dose of labetalol was effective in attenuating the pressure response to laryngoscopy and intubation.

A Case of Dry Gangrenous Extremity in Septic Shock Patient / 대한마취과학회지

Progressive ischemia can result in gangrenous changes of the tissues. Most commonly the digits are affected initially, but progression to the hand is not unusual. Small amounts of infection superimposed on a severe chronic ischemic state can progress very rapidly to gangrene. Clinically, dry and wet gangrene should be differentiated. Dry gangrene represents mummification of tissue, and active purulent tissue and cellulitis are absent. Wet gangrene is characterized by active infection with cellulitis and purulent tissue planes and is an indication for urgent amputation to prevent ascending infection. We experienced a case of dry gangrenous extremity due to septic shock after anethesia.

Changes of Cardiovascular System and Blood Sugar to Endotracheal Intubation with Fentanyl - Diazepam / 대한마취과학회지

We selected at random 30 normotensive patients who had received operation under the general anesthesia with intubation at Chungnam national university hospital. They were divided into 3 groups. group I (Control) had received tracheal intubation with thiopental 5mgkg-1. (n=10), group II had received tracheal intubation with fentanyl 15 ugkg-1. (n=10), group III had received tracheal intubation with fentanyl 15ugkg-1 and diazepam 0.05mgkg-1 (n=10). The changes of systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial blood pressure (MAP), heart rate (HR), and blood sugar were compared in each group. The results were as follows: 1) In group I, endotracheal intubation caused a significant riae in SBP(p<0.01) and blood glucose (p<0.01). 2) In group Il, endotracheal intubation caused a significant rise in SBP (p<0.05) and blood glucose (p<0.01). 3) In group III, endotracheal intubation cauaed little changes in SBP, DBP, MAP, HR and blood glucose.

The Effects of Fentanyl Anesthesia on the Changes of Blood Sugar , Electrolyte and ABGA During Cariopulmonay Bypass / 대한마취과학회지

The effects of fentanyl anesthesia on the changes of hemodynamic(HR, BP), blood suger, electrolytes and ABGA during induction of anesthesia and cardiopumonary bypass under fentanyl anesthesia were studied in three groups of 30 patients. The results were as follows: 1) The changes of HR & BP were significatly decreased under fentanyl anesthesia compaired to morphine anesthesia. 2) The level of blood sugar was increased during whole procedures in all groups and it was the least in large dose fentanyl group. 3) The changes of electrolyte and arterial blood gas value during CPB were not remakable.

Plasma Concentrations of Lidocaine Associated with Epidural Anesthesia and Axillary Nerve Block / 대한마취과학회지

Forty adult patients who received lumbar epidural anesthesia and axillary nerve block were assigned to four groups. Of these, 15 patients in group 1 (lumbar epidural anesthesia group) were given 1.5% lidocaine 400 mg (27 ml) and 15 patients in group 2 (lumbar epidural anesthesia group) were given lidocaine with epinephrine (200,000:1) in the same volume and concentration as in group l. 5 patients in group 3 (axillary nerve block group) were given lidocaine in the same volume and concentration and 5 patients in group 4 (axillary nerve block group) were given lidocaine with epinephrine (200,000:1). The plasma concentration of lidocaine were measured by immunofluorescence assay and the peak concentration were achieved 15 and 30 min, after injection in group 1, 2, respectively. Similar results were observed in group 3 and 4. The peak plasma concentration in group 1, 2,3 and 4 were 2.85+/-1.17, 1.81+/-0.60, 2.35+/-0.97 and 1.62+/- 0.67 ug/ml (Mean+/-SD), respectively. and the time course of plasma levels of lidocaine in group 2 and 4 lower than those in group 1 and 2. These results indicate the mixed injection of 1.5% lidocaine 400 mg with epinephrine is considered safe when there is no contraindication because plasma concentration is reduced significantly.

Intrathecal Block with 15 % Phenol in Glycerine for Pain of Rectal Cancer / 대한마취과학회지

This patient who was a 42-year-old female had suffered from bearing down sensation and pain on anal region due to metastatic rectal cancer. She was done intrathecal block with 15% phenol in glycerine. The result was exellent to bearing down sensation and pain on anal area. Because lower back pain, pain on lower extremity and generalized painful sensation was not improved, we has done pharmacologic assistance. Urination difficulty became slightly aggrevated but was improved at post-block day 4th. This pain clinic report that intrathecal block with 15% phenol in glycerine was effective to treatment of cancer pain without major complications.

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

Of a total of 11690 operative cases, 2111 patients who received a transfusion during operation were analyzed statistically at the Department of Anesthesiology, Chung-Nam University Hospital from January 1985 to December 1987 according to department, sex, preoperative hemoglobin, blood type, operation time and blood component therapy. The results as follows: 1) The percentage of transfused patients among all operative cases was 18.05 percent. 2) Of all the transfused patients, 477 cases(22.95%) were general surgery cases. 3) Of all the transfused patients, 1187 cases(56.2%) were male. 4) The mean value of hemoglobin measured preoperatively was 10~15g/dl (72.19%). 5) The most frequent cases of transfusion were done in operations requiring 2~3 hours. 6) Blood component therapy was preformed 11 percent in 1985, 26.73 percent in 1986, and 80.72 percent in 1987. The number of cases receiving blood component therapy has tended to increase year by year.

The Effect of Component Transfusion on Perioperative Change of Hemoglobin , Hematocrit and Platelet Count / 대한마취과학회지

In order to study the changes of blood sugar and electrolyte during cardiopulmonary bypass(CPB) in open heart surgery, 28 patients were selected and observed. The results are as follows: 1) The levels of blood sugar were increased significantly(p<0.01) in all patients compared to the controls as the operation advanced to the end of the CPB. But there was no significant correlation the with the CPB. 2) The increase in blood sugar level was greater in the TOF group and it was at significantly increased(p<0.01) after the CPB and was maintained higher at the end of the CPB. 3) The changes of electrolyte and arterial blood gas values during CPB were not remarkable.

Heart Rate, Arterial Pressure and Arterial Blood Gas Tension Change Caused by Enflurane and Halothane Anesthesia / 대한마취과학회지

Change in heart rate, mean arterial pressure, PaO2 and PaCO2 Caused by enflurane and halothane anesthesia were investigated in patients premedicated with diazepam and glycop-yrrolate. Enflurane caused a slightly(10.1%) increase in heart rate and not change in mean arter-ial pressure(0.1%), Halothane depressed heart slightly(10.16%) and arterial pressure was also (12.2%). The authors conclude that enflurane possesses a positive chronotropic effect.