Changhua is the centre of a large agricultural area in central Taiwan. The first case of paraquat poisoning was seen in 1977, and, since then, the numbers have increased yearly to a total of more than 600 patients. Some interesting cases are presented, including a series of 9 patients who were pregnant at the time of ingestion. Data from amniotic fluid, fetal and cord blood indicates that paraquat crosses the placenta and is concentrated to levels 4-5 times that of maternal blood. Some controversial new modalities of treatment have been investigated. Low-dose radiotherapy has been tried in 9 patients, with 3 survivors. "Continuous hemoperfusion" has been modified, used clinically in over 100 patients, and supplemented by in vitro experiments related to the adsorptive ability for paraquat of DHP-1 columns of activated charcoal. Hypoxic atmospheres have been used in patients as a routine, and continued during anesthesia in selected cases (pregnant and pediatric patients). These changes have resulted in an increase in our survival blood levels from 0.68μg/ml five years ago to 8.9μg/ml this year.

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The radiographic examinations of 119 cases of operated lumbar disc herniation were reviewd in diagnostic efficacy, particularly of the pain. Myelography represent anatomical changes of lumbar spinal canal almost clearly, but no correlation with clinical score determined by Japan Orthopeadic Association (JOA score) in variance analysis. Recent advanced techniques of diagnostic imaging such as CT and MRI had demonstrated diagnostic superiority in the evaluation of the spinal pathologic condition, but can not yet represent pain exactly. Confirmation of the diagnosis in lumbar disc hernia can be approached by radiculography and discography as the adjunctive diagnositic procedure using block and provocation of isolated pain.

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The extra-corporeal lung assist (ECLA) was used on two cases with respiratory failure in order to decrease the airway pressure and stabilizing the diseased lungs. Case I was suffered from respiratory failure due to broncho pneumonia and case II due to paraquat intoxication.
The ECLA decreased the airway pressure and stabilized the lungs with almost no change in the oxygen and carbon dioxide content in the blood. Unfortunately, both cases died with complications other than lung complications within 1 week (case I: paralystic ileus and circulatory failure in the right leg, and case II: DIC).

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Changes in Ca⁺⁺, Na⁺, K⁺ levels of 84 patients who recieved massive blood transfusion were examined retrospectively. Ca⁺⁺ and pH fell significantly from 1.045+0.074mM/l to 0.934+0.097mM/l, from 7.46+0.075 to 7.43+0.072 respectively. Na⁺ and K⁺ were unchanged. Ca⁺⁺ level had the significant correlation to the volume of blood transfusion. Hyperkalemia in the stored blood did not affect the serum K⁺ level.

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Recently, several reports have appeared on the application of Continuous Arteriovenous Hemofiltration (CAVH) for the management of severe acute renal failure. CAVH makes it possible to remove excessive sodium and water gradually without drastic change in hemodynamics. This technique is especially applicable to critically ill, perioperative renal failure patients with hemodynamic instability.
This paper reports the management of severe postoperative renal insufficiency by CAVH used in conjunction with hemodialysis. The fluid removal rate was quantitated and adjusted by a infusion pump at the ultrafiltrate end of the filter.
Three cases of severe postoperative renal failure were managed. A postoperative patient dependent on hemodialysis as well as patients with pulmonary edema and congestive heart failure markedly improved.

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This paper describes a very rare case that suffered hyperventilation syndrome in sadated or sleeping state under spinal anesthesia. Acute hyperventilation occured in a 15-year-old female patient during orthopedic surgery of hip joint under spinal anesthesia <sensory level of Th-7>. Although no such symptom as pain, metabolic acidosis, hypercapnia, drug intoxication, an no past history of central nervous disorder or psychosomatic disorder, were evidenced to trigger hyperventilation, the patient suffered 13 episodes of hyperventilation which produced profound hypocapnia <PaCO₂ 19.7mmHg> during two and half hours. At the first hyperventilation attack the subject was under intravenous diazepam sedation. To supress each hyperventilation syndrome, diazepam fentanyl and/or thiamylal were injected. The patient showed normal neurologic or psychosomatic function in the post operative period. The cause of hyperventilation attack in this patient was unknown.

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We experienced anesthetic management of a 22 days old infant with congenital lung cysts which continued to increase in size following birth and caused marked mediastinal displasement. In this disease there is progressive hyperinflation of one or several cysts of the lung because of air trapping mechanisms and it leads to compression atelectasis, mediastinal shift, impairment of venous return, and cardiopulmonaly dysfunction. Terefore, it is said that positive pressure ventilation is contraindicated before the chest is open and spontanious ventilation should be retained during induction and maintenance of anesthesia. But it is clinically very difficult and may be harmfull. In this case we attempted selective bronchial intubation and unilateral positive ventilation of the opposite lung but failed because of technical problems. We believe this is a usefull method once we are accustomed to the technique. During the operation there were several episodes of hypoxemia and hypercarbia, and pulse oxymeter and transcutaneous oxygen and carbon dioxide tension monitering were very usefull in recognizing these episodes in an early stage.

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When treating geriatric patients the anesthesiologist is faced with a population that is, in general, medically compromised.
Retrospective studies were done on 51 patients 80 years and older who had had operations in Tokyo Women's medical College Daini Hospital from January, 1980 to February 1986.
Many of these older patients had several preoperative medical problems. The most frequent of these, cardiovascular disease was found in 70% of the cases and respiratory disease was present in 39% of the time.
Eight patients suffered post operative mental disturbances. Although in 6 patients these changes were temporary and disappeared by the time they were discharged, in two of the cases the dementia continued to worse. Numerous suspected causes of the disorder are suggested and these need further research.
Three patients died after surgery, corresponding to an operative mortality of 6%. In each of these 3 cases, the operations were performed for emergency reasons. This, of course, is associated with higher surgical risk.
The implications of these factors require the anesthesiologist to perform an extensive preoperative workup that may dictate preoperative medical treatment prior to surgery. Geriatric cases demand very strict management preoperatively to help prevent complications.

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The epidural catheters of 4 patients were broken in the body accidentaly. The end of the broken material under the skin were detected and removed easily with only small skin incision. This complication is relatively uncommon. Then, we observed sections of the catheters with the electron microscope to investigate the cause of the disconnections.
Two patients had spine deformities. And electron microscopic findings suggested that the catheters might have been pinched and sheared off between two vertebral processes.
The other two patients had no spine deformities. And observation with electron microscope gave suggestions that catheters might have been broken with repetition of bending the catheters.
The experience of these four incidents suggested the following precaution; 1) we must take the greatest care of choosing a place and method at the placing epidural catheter for long term. 2) development of epidural catheters with new material bearing bend and force is expected.

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The 9 cases of Malignant Hyperthermia (MH) were observed during the 5 year period from 1982 to 1987 in our institutions. Of these 9 cases, neuroleptics had been administered for shizophrenia in 2 cases. Cautious management of anesthesia is necessary when the patient has been treated with neouroleptics. In 2 cases, MH became apparent after anesthetic procedure. It must be noted that diagnosis of MH is assumed not only in peri -operative but also in post-operative period. Misunderstanding that muscle rigidity was caused by shortage of succinylcholine (SCC), additional administration of SCC was performed in 3 cases. Consequently, administration of SCC should be done cautiously. Tachycardia was observed most frequently (6 cases) in circulatory abnormalities. There is possibility that tachycardia may be recognized to be caused by shortage of anesthetics. Supplementary administration of anesthetics must be avoided in such cases. Dantrolene therapy was terminated according to decline of serum creatine phosphokinase values. As a result of dantrolene therapy in this manner, there was no case who relapsed into MH.

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We evaluated the functional residual capacity and closing volume of aged patients under supine position as preoperative examination.
Patients are forced to under supine position during and post operative course. The airway closure is influenced by posture, age, smoking and the rest. We examined the respiratory functions in nonsmokers and smokers, and in young and aged patients under supine position.
Spirometory measurements (%VC, FEV_1.0%, V₂₅/HT), subdivisions of the lung volume (TLC, FRC/TLC), and closing volume (CV, CV/VC, ΔN₂, CC/TLC) were measured. We have got the results as follows.
1. V₂₅/HT was significantly influenced by aging and smoking factors.
2. Closing volume increased obviously with aging, and ΔN₂ was more reliable parameter in the aged than CV.
3. (FRC-CC)/TLC negatively related with aging.
4. It was suggested that V₂₅/HT was a good parameter for the closing volume.

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An Endoscope system with a 0.9 or 1.4mm flexible fiberscope which contained 1000 or 3000 elements of 8μm glass fiber was developped. The fiberscopes were inserted through the 14G Touhy needle placed in the subarachnoid or epidural space at the level of L_1-2 or L_3-4. The view of ligament and dura in epidural space were obscure. However, dorsal roots and vessels on the surface of spinal cord in subarachnoid space were clearly observed. With minor improvements, our endoscope system could be applicable to the diagnosis and treatment for disorders in subarachnoid and epidural spaces.

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