A Case of Mediastinal Cystic Parathyroid Adenoma Presenting as Acute Pancreatitis / 대한내분비학회지

Hypercalcemia due to hyperparathyroidism is rarely associated with acute pancreatitis. But, the relationship between hypercalcemia and pancreatitis still remains controvesial. Ectopic parathyroid adenoma with cystic change is one of the rare causes of hyperparathyroidism, and is usually located in neck and mediastinum. We report a case of mediastinal parathyroid adenoma with cystic change associated with acute pancreatitis. A 54-year-old male presented with epigastric pain for 3 days. The serum calcium, phosphate, elastase were 16.8mg/dL, 1.1 mg/dL, 2772.0 ng/mL respectively and his parathyroid hormone level in serum was 651.84 pg/mL. Chest CT showed a mediastinal mass with well defined inhomogenously enhanced density located between SVC and aorta. The patient was diagnosed to hyperparathyroidism with acute pancreatitis due to mediastinal parathyroid adenoma with cystic change, and was surgically removed. The surgical biopsy showed parathyroid adenoma with cystic change. After operation his general condition was improved and serum calcium, phosphate, amylase, lipase level were normalized.

A Clinical Observasion of Pediatric Caudal Anesthesia / 대한마취과학회지

Pediatric caudal anesthesia was done in 50 infants and children under 15 years of age, who were to undergo surgery of the inguinal region, urethra, perineum and lower extremity. All cases were given 1mg/kg body weight of 1% lidocaine solution with adrenaline 1: 200,000. The results were as follows: 1) Pediatric caudal anesthesia was simple, easy and reliable in technique and the success rate was high (94%). 2) There was one case of convulsion following lidocaine injection and it was treated immediately with thiopental, diazepam and ventilation with 100% oxygen. 3) As additional measure to provide a more cooperative state was need ed i.e. intravenous administration of 5mg/kg body weight of thiopental. 4) Anesthetic effect was judged satisfactory in 47 cases (84%). There was 2 poor anesthesia results and 1 failure. All 3 cases needed inhalation anesthesia. One failure was accidental intravenous injection of lidocaine solution. 5) The onset time of analgesia ranged from 1 to 5 minutes(average 2.5min.) after injection of lidocaine solution into sacral canal. 6) Complete analgesia was established 8~25 minutes(average 15.6min.) after injection of lidocain solution. Highest dermatome level of analgesia was T11-T4. 7) The duraion of analgesia, which was measured from maiximum analgesia to regression of analgesia of 2 dermatomes, ranged from 70 to 130 minutes(average 98.5 min.). 8) The average operation time was 70 minutes, so that pediatric caudal anesthesia is desirable in an operation lasting about 1 hour. 9) Cardiovascular and respiratory changes were minimal. 10) Theis anesthetic method was especially helpful in postoperative management because of continuous anal esic effect. From the above results, it my be concluded that caudal anesthesia in pediatric surgery is useful for the patients, anesthetists, surgeons, nurses and parents.

Clinical Study of Postintubation Sore Throat / 대한마취과학회지

Sore throat is undoubtedly the commonest complication noted after endotracheal intubation. We studied the incidence and factors affecting sore throat in 120 patients requiring orotracheal intubation for surgery from November, 1975 to June, 1976 at Seoul Red Cross Hospital. The following conclusions were obtained: 1) The incidence of sore throat was 36% 2) There was no correlation between sore throat and patient age. 3) No correlation between sore throat and sex was observed. 4) The incidence was low in poor general condition among patients. 5) It was more common after prolonged intubation. 6) It was least common in major operations such as abdominal surgery and most common in minor operations such as for extremities. 7) Less than 8 ml of air in the cuff did not affect significantly incidence of sore throat. 8ml Mild and moderate sore throat were more common (86%) than severe one. 9) Sore throat disappeared within 48 hours without any specific therapy(97.7%).

Modified Neuroleptanesthesia using Diazepam-Pentazocine with N2O / 대한마취과학회지

From April 1974, we have performed modified neurcleptanesthesia with diazepam-pentazocine N2O in 60 cases. These patients were given diazepam, 0.3 mg/kg, and pentazocine, 1 0 mg/kg, intravenously. Endotracheal intubation was performed in all cases after a sleep dose of thiopental or N2O by mask, with an adequate dose of succinylcholine. Anesthesia was maintained with N2O-O2, suplemented with muscle relaxants. During the operation, we gave an additional dose of diazepam or pentazocine, if needed. The results were as follows: Respiratory depression was observed after the administration of diazepam and pentazocine, but this depression disappeared in the early postoperative recovery period. 2. Recovery from anesthesia was rapid and smocth. Almost all patients awakened within 5 minutes after discontinuance of N2O admir.istration. 3. Analgesia and sedation extended well into the postoperative period, minimizing the need for narcotics. 4 Postoperative nausea and vomiting appeared in only 7% of cases. 5 Circulagory stability was marked during and after operation, being particulary valuable in the elderly and poor risk patients.

Ketamine Induction in Poor-Risk Patients / 대한마취과학회지

The induction period in the course of a general anesthetic has its own attendant hazards and is especially problematical for the anesthetist in managing the patient for whom the risk is high. The purpose of this study is to determine if ketamine used as an induction agent in poor-risk patients would induce sudden changes in the cardiovascular or respiratory system. Forty poor-risk patients, falling into class 3 or 4 of the A.S.A. physical status classification, were studied for ketamine induction and rangedoin age from 4 months to 62 years. Anesthesia was induced with intravenous or intramuscular ketamine and subsequent endotracheal intubation was performed with the aid of succinylcholine. Vital signs were recorded every 5 minutes. According to blood pressure and pulse rate measured 5 minutes after giving ketamine, patients were classified into fcur grougs to emphasize the four typical cardiovascular responses to ketamine induction. By observation of vital signs, ketamine induction in 40 poor-risk-patients did not produce any untoward cardiovascular and respiratory effects, and the postanesthetic psychic disturbances were absent. Specifically, in accordance with our observation of vital signs, blood pressure and pulse rate were increased or unchanged by ketamine induction. In conclusion, ketamine as an induction agent is recommended for poor-risk patients, especially those with unstable cardiovascular systems.