Single-port access total laparoscopic hysterectomy in women with history of previous abdominal surgery / 대한산부인과내시경학회지

OBJECTIVE: The aim of the present study was to evaluate the impact of previous abdominal surgery on surgical outcomes of single-port access (SPA) total laparoscopic hysterectomy (TLH). METHODS: We reviewed the medical records of 111 women who underwent SPA-TLH at the Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University between January 2010 and December 2010. Women were classified according to their history of previous abdominal surgery. RESULTS: Of 111 women undergoing SPA-TLH, 74 women (66.7%) without history of previous abdominal surgery and 37 women (33.3%) with history of previous abdominal surgery were classified. There was no significant difference in surgical outcomes including operative time, estimated blood loss, change in hemoglobin, uterine weight, perioperative complications, transfusion, and additional port insertion between two groups. CONCLUSION: In our experience, previous abdominal surgery has no significant impact on SPA-TLH.

Single port access laparoscopic myomectomy / 대한산부인과내시경학회지

OBJECTIVE: The aim of this study was to estimate the feasibility, safety and surgical outcomes of single port access laparoscopic myomectomy (SPA-M). METHODS: We reviewed the medical records of 29 patients with uterine leiomyoma who underwent SPA-M in Gumi CHA hospital between March 2010 and August 2010. We performed SPA-M with conventional rigid straight laparoscopic instruments in all cases. RESULTS: In this study, the mean of leiomyoma weight, operating time, and estimated blood loss were 55.43 gm(+/-54.79, range 5~220 gm), 69.68 min (+/-32.99, range 20~120 min.), 100 mL (+/-104.26 range minimal~300 mL), respectively. Transfusion was done in the one case. CONCLUSION: SPA-M using conventional rigid straight laparoscopic instruments was feasible and could be an alternative to conventional multi-port access laparoscopic myomectomy (MPA-M).

Comparison of surgical outcomes after laparoscopy-assisted vaginal hysterectomy and total laparoscopic hysterectomy / 대한산부인과학회지

OBJECTIVE: To compare the surgical outcomes between laparoscopy-assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH). METHODS: The data were collected retrospectively from hospital records. Between September 2006 and August 2007, Patients undergone with LAVH (93 cases) and TLH (142 cases) with pathologic reports of leiomyoma or adenomyosis were enrolled. The characteristics and surgical results were compared according to the operation type. The correlations among the variables were analyzed with multiple linear regression. RESULTS: Between two groups, the characteristics of patients were similar such as age, body mass index, surgical history, and pathologic findings. In the univariate analysis, the differences of operation duration and blood loss between LAVH (129.0+/-34.5 min, 385.5+/-296.1 mL) and TLH (123.6+/-40.8 min, 294.7+/-285.4 mL) were significant (P0.050). In multivariate analysis, blood loss was correlated with operation duration and specimen weight (P=0.000) but not with operation type (P=0.213). CONCLUSIONS: LAVH tends to be selected in larger uteri and results in more blood loss and longer operation duration. Operation type (LAVH or TLH) does not affect blood loss which is related with operation duration and uterine weight.

The value of diagnostic cystoscopy in early detection of ureteral injury at the time of total laparoscopic hysterectomy (TLH) / 대한산부인과학회지

OBJECTIVE: To estimate the effect of diagnostic cystoscopy in early detection of ureteral injury at the time of total laparoscopic hysterectomy. METHODS: Retrospectively 598 women who received total laparoscopic hysterectomy from August 2004 to August 2006 were included. They were divided into two groups : no cystoscopic examination (n=398) group (Group A) and routine intraoperative diagnostic cystoscopic examination after intravenous indigo-carmine injection (n=200) group (Group B). The rates of ureteral injury after total laparoscopic hysterectomy were compared between both groups. RESULTS: Postoperative ureteral injury was observed in 3 case of Group A (3/398 : 0.75%) and in no case of Group B. In 2 cases of group B (2/200 : 1.00%), Intraoperative ureteral injury was detected by cystoscopy. CONCLUSION: Routine intraoperative diagnostic cystoscopy allows for early recognition and treatment of obstructive ureteral injuries, and reduces the rate of late postoperative ureteral complications during advanced laparoscopic procedures.

Rapid prenatal diagnosis of Down syndrome and Edward syndrome by fluorescence In situ hybridization:Clinical experience with 309 cases

PURPOSE: The purpose of this study was to evaluate the clinical utility of rapid detection of Down syndrome and Edward syndrome by Interphase Fluorescence in Situ Hybridization (FISH) analysis METHODS: A retrospective study in 309 cases of amniotic fluid samples, analysed by interphase FISH with DNA probes specific to chromosome 18 and 21, was performed. All FISH results were compared with conventional cytogenetic karyotypings. RESULTS: The results were considered as informative and they were obtained within 48 hrs. A case of Down syndrome and a case of Edward syndrome were diagnosed by FISH and confirmed by subsequent cytogenetic analysis. In 12 cases with normal FISH results, the cytogenetic analysis showed a case of partial trisomy 22, three cases of sex chromosomal aneuploidy, two cases of mosaicism, two cases of microdeletion, and four cases of structural rearrangement. CONCLUSION: FISH is a rapid and effective diagnostic method, which can be used as an adjunctive test to cytogenetic analysis, for prenatal identification of chromosome aneuploidies. For the more genome- wide screening with variety of probes, the technique of FISH is both expensive and labor-intensive.

Pregnancy outcomes in women aged 35 and older / 대한산부인과학회지

OBJECTIVE: To estimate the effect of maternal age on obstetric outcomes, a retrospective analysis was done. METHODS: Twenty six hundred and forty six women who delivered a singleton baby at our hospital from January 1, to December 31, 2004 were enrolled in this study. Subjects were divided into 3 age groups; 1) less than 35 years, 2) 35-39 years, and 3) 40 years and older. Chi-square test was used to assess the effect of age on obstetrics outcome. Then the odds ratio was calculated to represent clinically meaningful risk. RESULTS: A total of 2646 women with complete data were available; 2245 (84.9%) less than 35 years of age; 350 (13.2%) 35-39 years; and 51 (1.9%) 40 years and older. Increasing age was significantly associated with chromosomal abnormalities (OR 3.9and 8.8 for ages 35-39 years and age 40 years and older, respectively), Preterm premature rupture of membranes (OR 1.3 and 3.2) and cesarean delivery (OR 2.0 and 5.5). Patients aged 35-39 years were at increased risk for placenta previa (OR 1.8) and congenital anomaly (OR 2.8) but these were not statistically significant. The rate of the preterm delivery was increased by age (OR 1.3 and 1.9 for ages 35-39 years and age 40 years and older, respectively) but it was not statistically significant (p=0.121). We did not find advanced maternal age to be associated with a statistically increased risk for preeclampsia, congenital anomaly, gestational diabetes, placenta abruption, low birth weight, macrosomia, neonatal morbidity (NICU admission), and perinatal loss. CONCLUSION: In conclusion, although the likelihood of adverse outcomes increases with maternal age, patients and obstetric care providers can be reassured that overall maternal and fetal outcomes are favorable in this patient population.

The Cardiac Effects of Succinylcholine Single Doses in Children Under Age 10 / 대한마취과학회지

It has already been known that succinylcholine has various cardiac effects such as bradyc adia. tachycardia and, eve cardiac arrest. Among these, bradycardia has most frequently been reported after a single administration of succinylcholine, intravenously in small children. To study the cardiac effects of suecinylcholine in children premedicated with atropine, we intravenously administered thiopental sodium for induction and then a single dose of succinylcholine for endotracheal intubation. The results are as follows: 1) Cardiac rates were significantly decreased for the most part after thiopental sodium administration. However there was no significant change in cardiac rate for the cases in an hypoxic state. 2) Succinylcholine administration produced a significantly increased cardiac rate in more than half the group and a slightly decreased cardiac rate in only a small number. 3) There were neither cardiac arrythmias nor cardiac arrest following succinylcholine administration.

Intrathecal Phenol-glycerine Injection Therapy in Treatment of Intractable Cancer Pain / 대한마취과학회지

To a patient suffering from intractable pain due to the terminal state of cervix cancer, 7% phenol-glycerine solution was injected through the L2-L3 interspace. We obtained a good result of pain relief, but motor paralysis developed.

A Case of Status Asthmaticus during Spinal Anesthesia for Cerarian Section of Chronic Asthma Patient / 대한마취과학회지

Asthma involves intermittent episodes of bronchospasm associated with wheezing and dyspnes and asymptomatic period. Many drugs and anesthetic agents can affect bronchomotor tone and asthmatic patients requiring anesthesia are at higher risk than nonasthmatics. The anesthetic management of the asthmatic patient continues to present a challenge to the clinical anesthesiologis, despite increased knowledge and better understanding of the pathogenesis of bronchial asthma and the availability of safer and more effective anesthetic agents and methods. We have experienced status asthmaticus during spinal anesthesia for Cesarian section of a chronic asthma patient. We report the case and review the relevant literature.

The Study of the Liver Function Test after Halothane Anesthesis - for Biliary System Surgery / 대한마취과학회지

Since it's introduction in 1956 as a general anesthetic agent, halothane has enjoyed worldwide acceptance as a relatively safe and useful inhalational anesthetic. It is described as a universal anesthetic agent by Johnstone, but the question of its potential hepatotoxicity has not been definitely established. At our hospital, the patient whose liver function was in normal limit and had no history of the hepatitis, jaundice, exposing to hepatotoxic drug or alcoholism, and have received general anesthesia with halothane for biliary surgery as first operation from June 1979 to August 1980 were studied to evaluate the change of the liver function before and after kalothane anesthesia. The results were as follows; 1) In two cases, the liver funtion test showed the evidence of the hepatic damage. 2) The change of SGOT and bilirubin was statistically significant, but there was no significant change of SGOT, alkaline phosphatase and T.T.T. 3) We thought that the changes of liver function test were due not only to halothane but also to the other factors. So, it may be good that repeated exposure to halothane is avoided.

Pulmonary Edema during General Anesthesia for Cesarean Seetion of Pre-eclampsia Patient / 대한마취과학회지

Our hospital has been experienced pulmonary edema during general anesthesia for cesarean section of pre-eclampsia. But, the patient recovered rapidly without complication. Therefore, we think that before anesthesia, accurate laboratory data and careful attention are needed for general anesthesia of pre-eclamsia.

The Effect of General Anesthesia on Oxygen Consumption / 대한마취과학회지

Oxyen consumption of surgical patients was measured by McKesson Metabolar (Model 185) on the Recording Metabolar Chart (M-147) in four groups: group A, at resting state immediately before preanesthetic medication; group B, immediately following induction of anesthesia with thiopental (10 mg./kg.); group C. 30 minutes after surgical ether anesthesia; and group D, when conciousness returned during the stay in the recovery room. The results are as follows: (1) Thiopental reduced oxygen consumtion by 25 per cent. (2) Ether anesthesia reduced, oxygen consumption by 59 per cent. (3) During recovery from anesthesia, oxygen consumption was 28 per cent below the control. (4) Comparing with other data, ether anesthesia reduced oxygen consumption significantly more than fluothane or nitrous oxide did.

A case of sirenomelia in a FDIU at 28 week / 대한산부인과학회잡지

No abstract available.

Anesthetic Management for the Palient with Insuliaoma / 대한마취과학회지

Hyperinsullinism and the resultant hypoglycemia are hallmarks of functioning beta islet cell tumors of the pancreas. The management of one case of insulinoma during surgery for the removal of the tumor is described and the available literature on the subject reviewed. The outline of the anesthetic management for the insulinoma is as follows: 1) Anesthetists should understand the signs and the symptoms of hypoglycemia and hyperglycemia. 2) Preoprative management: a) infusion of glucose for avoiding hypoglycemia due to NPO after midnight. b) glucocorticosteroid administration with premedications. 3) Operative management: a) continuous determination of blood glucose level may be helpful. b) Maintenance of the glucose level about 50mg% above symptomatic CNS level have the advantage that exicision of the infulinoma can be immediately judged. c) The use of an agent that decreases CMRO2 and does not affect the insulin-glucose ratio is rational choice when concern about hypoglycemia exists. Thiopental-enflurane anesthesia with controlled ventilation maintaining normocarbia is recommended. d) beta-adrenergic blocker. These drugs must be avoided in the hypoglycemic state.

Residual Epidual and Subural Hematoma in the Occipital Area / 대한마취과학회지

In a 8 year-old boy who had epidural hematoma in the occipital area, had an episode of dislodgement of the endotracheal tube due to improper position. After operation, there were drowsy consciousness, irregular respiration, apnea, absence of cough reflex and swallowing reflex. Then these was no improvement in spite of treatment, and because of this hypoxic encephalopathy was diagnosed. WE suspected there might be some pathologic lesion volving the respiratory center and lower cranial nerves. CT scanning was performed and the result was diagnosed with epidural hematoma and subdural hematoma in the posterior fossa. The patient was reoperated.

The Effect of Regional Sympathetic Block in the Treatment of Herpes Zoster / 대한마취과학회지

We must be assured that sympathetic ganglion block interrupts a vicious cycle of nerve impulses. Therefore, it prevents vasospasm and improves local circulation. The sympathetic ganglion block is effective in acute stage of herpes zoster and reduces the incidence of post-herpetic neuralgia. Herpes zoster is more often involved in an immunosuppressive imbalance. Three cases of herpes zoster were treated by repeated sympathetic ganglion block with 1% proved. Duration from onset of pain was 1 week, 1 month and 2 months, respectively. The block decreased the degree of pain markedly and dried up the vesicle in the early stage. Two of these three cases had suffering from diabetes melitus.

Two cases of pruritic urticarial papules and plaques of pregnancy / 대한주산의학회잡지

No abstract available.

Six Cases of Congenital Absence of the Vagina Managed by McIndoe Operation / 대한산부인과학회잡지

Mullerian agenesis or dysgenesis, rare developmental anomaly presenting as primary amenorrhea, is characterized by absence of vagina and absence or rudimentary development of the uterus. Anatomic anomalies of the axial skeleton and kindney often accompany this psychologically devatating condition. There are various methods of surgical treatment for congenital absence of the vagina. The six cases reviewed in this paper were all treated with McIndoe technique. All of 6 women experienced satisfactory sexual activity and were satisfied with vaginal depth following vaginal creation using a split thickness skin graft technique. Despite the existence of several alternative methods, the McIndoe technique is a relatively simple and highly successful procedure and hence is still prefered by many surgeons.

Comparison of Right Internal Jugular or Subclavian Pressure and Central Venous Pressure during Anethesia / 대한마취과학회지

The internal jugular and subclavian veins are considered as satisfactory intravenous routes for rapid blood and fluid replacement. To determine whether these venous pressures can be used as reliable guides for central venous pressure monitoring, simultaneous measurements of the Rt. internal jugular venous pressure and central venous pressure (CVP), or Rt. subclavian venous pressure and CVP using long 14 gauge catheter were made in 20 patients undergoing cardiac anesthesia. The results were as follows: l. Each mean value of the Rt. internal jugular venous pressure and CVP was 10.64+/-5.43 cm H2O and 10.05+/-5.55cm H2O (Mean+/-SD) respectively in first 10 patients. Pressure difference was 0.59+/-0.39cm H2O (p<0.005). 2. Each mean value of the Rt. subclavian venous pressure and VP was 7.77+/-3.37 cm H 0 and 7.05+/-3.49cm H2O (Mean+/-SD) respectively in second 10 patients. Pressure difference was 0.73+/-0.59cm H2O (p<0.005). 3. There were significant correlations between Rt. internal jugular venous pressure and CVP (r=0. 99, p<0.005) as well as between Rt. subclavian venous pressure and CVP (r=0.98, p<0.005). The results suggest that Rt. internal jugular or subclavian vein catheterized with short intravenous catheter during Anesthesia can be used as effective and reliable guides for CVP monitoring because pressure differences with CVP were small and consistant.

Intentional prolongation of pregnancy and survival of twin B after loss of twin A at 16 weeks' of gestation: A case report / 대한산부인과학회잡지

Intentional delay of aftercoming siblings in multiple gestation is an infrequent occurrence in obstetrics. After delivery of an immature twin, conventional treatment calls for induction and delivery of the aftercoming sibling. However, several case reports have documented the feasibility of an expectant management. And also, as in our case, an aggressive treatment consisting of cerclage, tocolysis, and broad-spectrum antibiotics has been shown to prolong pregnancy. We experienced an unavoidable delivery of a nonviable first twin after premature rupture of membranes at 16 weeks' of gestation. The placenta was left undisturbed. Twin B was confirmed to be alive within the intact second sac. Tocolysis was started and cervical cerclage was done directly after delivery of twin A. Pregnancy was successfully prolonged, which enabled the second fetus to remain in utero and grow for another 145 days. To our knowledge, this was the longest interval between deliveries in a twin pregnancy reported in the literature. A healthy 3,050 gm male was delivered by cesarean section at 37 weeks' of gestation. Below we present this case in detail and discussed with respect to the aggressive approach undertaken to prolong gestation.