A case report of actinomycosis in the left TMJ

Actinomycosis is a rare form of disease that is caused by Actinomyces such as A. israelii and A. bovis, which may take the form of chronic, purulent inflammation of deep tissue evolves with necrosis, formation of sinuses and fibrotic mass. This disease arises in the head and neck area mainly in 55% and other places like that chest and the gastrointestinal tract occurs in 45%. Actinomycosis can present in a variety of forms and may mimic other infections or even neoplasms. Our case was 44-year-old man having painful indurated mass in his left TMJ area, otorrhea in his left ear and trismus. He was treated with surgical excision and biopsy confirmed actinomycosis. And after that, he was cured successfully with antibiotic therapy. We report this case of actinomycosis that developed in the left TMJ area with review articles.

Endoscopic Thoracic Sympathetic Ganglion Cauterization for Primary Hyperhidrosis / 대한마취과학회지

BACKGROUND: Palmar and axillary hyperhidrosis causes important consequences to the social and professional life of the affected patient. Endoscopic thoracic sympathectomy is considered the treatment of choice, because it causes minimal morbidity and high initial success rates. Therefore we used a single-site access technique for primary hyperhidrosis patients. METHOD: The operation was done under general anesthesia with the patient in a half-sitting position. Through an incision made along the line between lateral 1/3 portion of the clavicle and ipsilateral nipple, a Verres needle was introduced below the second rib. About 1.5L of CO2 was insufflated into the pleural cavity. The needle was changed to a 5 mm trochar through which the electroresectoscope was introduced. The heads of the upper 2nd-4th ribs were identified and the sympathetic chain could be seen through the pleura riding over the ribs close to the costovertebral junction. The 2nd-4th ganglia were coagulated and divided down to the periosteum. Finally the lung was expanded by limiting flow until the airway pressure reach 30~40 cmH2O. The wound was closed after the removal of electroresectoscope. The procedure was then repeated on the opposite side. RESULT: There were no postoperative mortality and major complications requring surgical reintervention. The preoperatively wet and cold hands had became warm and dry immediately after operation. All patients were very satisfied. CONCLUSION: Endoscopic thoracic sympathetic ganglion cauterization is a minimally invasive and highly successful treatment for the patients with primary hyperhidrosis.

The Effects of the Body Positions and the Durations of CO2 Pneumoperitoneum to the PaCO2 and PETCO2 during Laparoscopy / 대한마취과학회지

During laparoscopic surgery with carbon dioxide (CO2) pneumoperitoneum, PaCO2 (arterial CO2 gas tension) and P(ET)O2 (end-tidal CO2 gas tension) will be affected by the durations of CO2 pneumo-peritoneum and the body positions. PaCO2 and P(ET)CO2 were investigated 5 minutes after induction of general anesthesia(control value), 10 minutes, 30 minutes and 60 minutes after CO2 gas insufflation, and 15 minutes after CO2 gas excretion. Seventy-two patients undergoing laparoscopic surgery under general anesthesia were allocated to two study groups: group I, laparoscopic appendectomy under the Trendelenburg position; group II, laparoscopic cholecystectomy under the reverse Trendelenburg position. In results, PaCO2 and P(ET)CO2 were significantly increased during laparoscopic surgery that associated with times of CO2 pneumoperitoneum. PaCO2 and P(ET)CO2 at 60 minutes after CO2 gas insufflation were increased from P(ET)CO2 control value 35.8+/-4.2 mmHg, P(ET)CO2 . control value 34.0+/-3.6 mmHg to P(ET)CO2 . 39.98.0 mmHg, P(ET)CO2 42.3+/-4.7 mmHg(p<0.05). PaCO2 and PO in group I were more increased compared with group II. PaCO and P(ET)CO2 in group I were increased from PaCO2 control value 35.9+/-4.8 mmHg, P(ET)CO2 control value 34.9+/-3.7 mmHg to PaCO2 45.7+/-2.5 mmHg, P(ET)CO2 48.0+/-3.6 mmHg(p<0.05), in group II from PaCO control value 35.7+/-3.2 mmHg, P(ET)CO2 control value 32.8+/-3.0 mmHg to PaCO2 38.4+/-8.3 mmHg, P(ET)CO2 40.4+/-3.2 mmHg(p<0.05). In conclusion, to minimize the risk of a carbon dioxide retension during laparoscopy especially under the Trendelenburg position, we recommend that ventilation should be adjusted to to the normal range of PaCO2 and P(ET)CO2.

Cardiac Arrest in the Hyperkalemic Patient - A case report / 대한마취과학회지

A 69 year-old male patient was admitted for lumboperitoneal shunt operation due to normotensive hydrocephalus. There was not significant laboratory findings except slightly increased serum potassium(5.0 mEq/1). But we ignored this hyperkalemia probably due to hemolysis because ECG at word and operation room did not reveal any evidence of hyperkalemia. Following induction of an anesthesia with fentanyl 100 ug thiopental(2.5%) 100 mg injection, succinylcholine 60 mg was administered intravenously, and endotracheal intubation was performed. Vecuronium 5 mg was administered intravenously for neuromscular blook. Anesthesia was maintained with nitrous oxide, oxygen and enflurane. During the course of operative procedure, his vital signs were stable(blood pressure 120/70 mmHg, pulse 60/min). After lumboperitoneal shunt was completed without problem, neostigmine 5 mg and glycopyrrolate 0.2 mg was administered for reversal of vecuronium. About 10 minutes after arrival in recovery room, his general condition deteriorated suddenly and radial arterial pulse could not be palpated. Radial arteiial blood pressure wave did not appear and ECG showed asystole and stand-still. Cardiopulmonary resuscitation(CPR) was started with Ambu-bagging, sodium bicarbonate and epinephrine injection with external cardiac massage, but the immediate response was not so good. We re-examined the patients chart and found the past history of chronic renal function impairment. CPR was directed for hyperkalemia including calcium chloride, sodium bicar-bonate and 10% dextrose with insulin. At 5 minutes after CPR, ECG showed regular sinus rhythm with stable vital signs. But ECG still showed hyperkalemic pattern(high tented T wave and prolonged P-R interval). After vigorous and continous treatment for hyperkalemia in recovery room, he regained consciousness and he was transfered to the neurosurgical intensive care unit for further evaluation and treatment. Postoperative course was relatively good and he was discharged on 25th postoperative day without any sequale of cardiac arrest.

Cardiac Arrest in the Hyperkalemic Patient - A case report / 대한마취과학회지

A 69 year-old male patient was admitted for lumboperitoneal shunt operation due to normotensive hydrocephalus. There was not significant laboratory findings except slightly increased serum potassium(5.0 mEq/1). But we ignored this hyperkalemia probably due to hemolysis because ECG at word and operation room did not reveal any evidence of hyperkalemia. Following induction of an anesthesia with fentanyl 100 ug thiopental(2.5%) 100 mg injection, succinylcholine 60 mg was administered intravenously, and endotracheal intubation was performed. Vecuronium 5 mg was administered intravenously for neuromscular blook. Anesthesia was maintained with nitrous oxide, oxygen and enflurane. During the course of operative procedure, his vital signs were stable(blood pressure 120/70 mmHg, pulse 60/min). After lumboperitoneal shunt was completed without problem, neostigmine 5 mg and glycopyrrolate 0.2 mg was administered for reversal of vecuronium. About 10 minutes after arrival in recovery room, his general condition deteriorated suddenly and radial arterial pulse could not be palpated. Radial arteiial blood pressure wave did not appear and ECG showed asystole and stand-still. Cardiopulmonary resuscitation(CPR) was started with Ambu-bagging, sodium bicarbonate and epinephrine injection with external cardiac massage, but the immediate response was not so good. We re-examined the patients chart and found the past history of chronic renal function impairment. CPR was directed for hyperkalemia including calcium chloride, sodium bicar-bonate and 10% dextrose with insulin. At 5 minutes after CPR, ECG showed regular sinus rhythm with stable vital signs. But ECG still showed hyperkalemic pattern(high tented T wave and prolonged P-R interval). After vigorous and continous treatment for hyperkalemia in recovery room, he regained consciousness and he was transfered to the neurosurgical intensive care unit for further evaluation and treatment. Postoperative course was relatively good and he was discharged on 25th postoperative day without any sequale of cardiac arrest.