Occurrence of Intestinal Pseudo-obstruction in a Brainstem Hemorrhage Patient

Intestinal pseudo-obstruction is a massive colonic dilation with signs and symptoms of colonic obstruction, but without a mechanical cause. A 49-year-old female patient complained of nausea, vomiting, and abdominal distension 1 month after a massive brainstem hemorrhage. No improvement was seen with conservative treatments. An extended-length rectal tube was inserted to perform glycerin enema. In addition, bethanechol (35 mg per day) was administered to stimulate colonic motility. The patient's condition gradually improved over a 2-month period without any surgical intervention. Extended length rectal tube enema and bethanechol can be used to improve intestinal pseudo-obstruction in stroke patients.

Subcutaneous Emphysema following Laparoscopic Cholecystectomy / 대한마취과학회지

Subcutaneous emphysema is one of the complications of the pneumoperitoneum necessary to perform laparoscopy. We experienced a case of extensive subcutaneous emphysema which was manifested by severe hypercarbia with respiratory acidosis and tachycardia during laparoscopic cholecystectomy in 65 years old female patient. Hypercarbia was reversed rapidly by hyperventilation and subcutaneous emphysema was resolved spontaneously on postoperative 3rd day almostly. The possible cause of subcutaneous emphysema in this case is dissection of the insufflated carbon dioxide from the peritoneal cavity via a trocar site to a tract along subcutaneous tissue planes. Immediate recognition, evaluation, and treatment is necessary since this can be a life threatening complication. And tension peu-mothorax should be ruled out. It is safe to monitor end tidal carbon dioxide tension or arterial carbon dioxide tension during the laparoscopic cholecystectomy.

Transcranial Doppler Measurement of Intracraial Arterial Flow Velocity in Subarachnoid Hemorrhage

The velocity of blood flow through the middle cerebral arteries was measured by transcranial Doppler sonography in 18 patients with aneurysmal subarachnoid hemorrhage. The velocity became greater from 4th day after the hemorrhage, reached a plateau on 6th-11th day and declined thereafter. 2) In the cases of laterally localized aneurysms, the velocity through the arteries ipsilateral to the aneurysm was significantly greater than that through the arteries contralateral to the aneurysm. 3) The velocity through the arteries of the patients who showed thick subarachnoid clots on CT scan within 3 days after the hemorrhage was significantly greater than that of the patients who showed thin subarachnoid clots. 4) The maximum mean velocity in the patients with delayed ischemic deficits(DID) was greater than that in the patients without DID. The results suggest that the transcranial Doppler monitering is helpful to detect early vasospasm.