Clinical factors affecting the pain on injection of propofol / 대한마취과학회지

BACKGROUND: Pain on propofol injection is a well-known adverse effect. We evaluated the clinical factors that affect the pain on injection of propofol to develop a strategy to prevent or reduce pain. METHODS: We conducted a prospective, observational study of 207 adult patients (ASA I-II), and the patients were classified according to gender, age, the body mass index (BMI), the IV site and the side of the IV site. During the 10 seconds after propofol injection, pain intensity was measured on an 11-point numerical rating scale (0 = no pain and 10 = worst possible pain). Pain in excess of 3 on the numerical scale was regarded as moderate to severe pain. RESULTS: The subgroups of gender (female: 55.6% vs. male: 25.0%; P < 0.01) and the IV site (dorsum of hand: 61.2% vs. wrist: 40.0% vs. antecubital fossa: 22.5%; P < 0.01) had significantly different frequencies for the incidence of pain on injection on the univariate and multivariate analyses. For the subgroup of females, the incidence of pain was statistically different according to the age group (20-40 yr: 71.0% vs. 41-60: 54.8% vs. 61-80: 38.5%; P = 0.014). CONCLUSIONS: Our results showed that the younger age patients, the patients with a peripheral IV site and female patients are more sensitive to pain on the injection of propofol.

Development of an Adequate Propofol Sedation Model in Elderly Patients for Elective Surgery under Regional Anesthesia

BACKGROUND: Propofol, an ultrashort-acting anesthetic agent, is being increasingly used for sedation during regional anesthesia. The goal of this study was to characterize the pharmacodynamic relation between the effect site concentration of propofol and the occurrence of loss of consciousness (LOC) and apnea in elderly patients undergoing regional anesthesia. METHODS: Twenty patients aged 65 years or older presenting for elective surgery requiring regional anesthesia were enrolled. After performing spinal anesthesia, the target effect site concentration of propofol was set at 1.0 microg/mL. Effect site concentration was increased by 0.2 or 0.3 microg/mL until LOC and apnea were observed. LOC was determined by the loss of response to verbal command ("open your eyes") and apnea as the loss of spontaneous breathing for 20 seconds. The pharmacodynamic relation between effect site concentrations of propofol and LOC or apnea was characterized by population analysis using nonlinear mixed effects model. Approximate entropy (ApEn) as a surrogate measure of central nervous effect of propofol was calculated from raw electroencephalogram, retrospectively. The correlation between effect site concentration of propofol and ApEn was tested. RESULTS: The estimates (standard error) of Ce50 for LOC and apnea (the effect site concentration of propofol associated with 50% probability of LOC and apnea) were 1.74 (0.09) and 2.35 (0.11) microg/mL, respectively. The Spearman correlation coefficient between effect site concentration of propofol and ApEn was -0.8164 (p<0.0001). CONCLUSION: These results provide an adequate guidance for sedation in elderly patients for elective surgery under regional anesthesia.

Two Cases of Hydrothorax Associated with Pleuroperitoneal Communications Proved by CT Peritoneography and Peritoneoscintigraphy / 대한신장학회잡지

With the increasing use of PD as a replacement therapy in chronic renal failure, the number of complications related to PD also has increased. One of these is hydrothorax associated with pleuroperitoneal communications. Diagnosis is based upon confirming that the fluid in pleural space is dialysate. The chemical characteristics of the pleural fluid can help diagnose dialysate in pleural space. One can use dialysate mixed with dye (methylene blue, indigo). Peritoneographies with contrast and radionucleotides are safe, accurate, and reliable methods of diagnosing peritoneal defects. While these substances do not damage the peritoneum, their diffusion is low. We report 2 cases of hydrothorax associated with pleuroperitoneal communications in CAPD patients. We employed CT peritoneography and peritoneoscintigraphy to diagnose the hydrothorax associated with pleuroperitoneal leak.

A Case of Systemic Lupus Erythematosus Presented with Streptococcal Myositis / 대한류마티스학회지

Streptococcal myositis is an extremely uncommon infectious disease caused by Group A streptococcus (GAS). GAS infection spreads rapidly and diffusely through the muscle, resulting in edema and necrosis. Consequently, it results in streptococcal toxic shock syndrome having extremely high mortality. We report a 42 year-old female patient with systemic lupus erythematosus accompanying with streptococcal myositis who initially presented with fever, severe pain, and tenderness on the calf. Her systemic toxic symptoms were aggravated and finally she died of the disease in spite of aggressive management.

A Case of Severe Asthma Complicated with Pneumoperitoneum and Pneumomediastinum During AMBU Ventilation / 결핵

Pneumoperitoneum, Pneumomediastinum, subcutaneous emphysema and a pneumothorax are some of the mechanical complications of bronchial asthma. The incidence of pneumoperitoneum during an attack of acute asthma is rare. The pathogenesis is free gas track from the overdistended alveoli, through the bronchovascular sheaths to the mediastinum. If the high pressure is maintained, air can escape retroperitoneally into the abdomen and burst into the peritoneal cavity. A 43-year-old woman was admitted due to a severe asthma attack. She was required endotracheal intubation and AMBU(air mask bag unit) ventilation. Immediately after these procedures, pneumoperiotneum, pneumomediastinum, and subcutaneous emphysema daveloped. She was treated with mechanical ventilation and medical therapy. The pneumoperitoneum was resolved after 27 days. Here, we report this case with the review of the relevant literature.

A Case of Epidermolysis Bullosa (Weber-Cockayne Type) / 대한피부과학회지

We report herein a case of epidermolysis bullosa (Weber-Cockaynetype) in a 22-year-old male soldier. He had tense egg sized bulla on the both feet for about 10 years. The lesions were exacerbated during hot weather but were mild. After entering military service, lesions became severe by mecanical trauma such as prolonged walking or marching. Histopathological findings showed subepidermal bulla and a few inflammatory infiltration in the dermis.

Hereditary Palpulotranslucent Acrokeratoderma: Report of a Case / 대한피부과학회지

A case of hereditary papulotranslucent acrokeratoderma, a variant of familiaI punctate keratoderma, is presented. A 20-year-old female patient had a five-year history of persistent, asymptomatic, yellowish-white translucent papules and plaques on the thenar and hypothenar eminences and knuckles of both hands, and on the dorsa of proximal interphalangeal joints of both feet. She also had a vitiligo lesion on the left side of the face of 1.5 years duration. Her elder brother also had similar papular skin lesions on both hands and feet. Histologic section of a papule from the right thenar eminence showed marked hyperkeratosis, hypergranulosis, and acanthosis of the epidermis.

Trichorrhexis Nodosa: report of a case and Scanning Electron Microscopic Findings / 대한피부과학회지

Trichorrhexis nodosa is a distinctive response of the hair shaft to physical or chemical trauma, characterized by the development of node-like swelling, through which the shaft readily fractures. We have described here a case of trichorrhexis nodosa with scanning electron microscopic findings. Nodular swelling of the affected hair showed longitudinal fissures and fractures in the cortex with loss of cuticular scales. At the site of fracture, a paintbrush-like effect was seen.

Juvenile Plantar Dermatosis / 대한피부과학회지

A characteristic dermatosis of infancy and childhood has recently been reported as many names, called juvenile plsntar dermatoais, recurrent juvenile eezema of hands and feet, and atopic winter feet in children. However, the clinicsl and epidemiological features of the published cases are strikingly the same The etiology of the diseaee remains unclear. The role of atopy appears to be highly controversial. We have observed 11 patients with juvenile plantar dermatosis and sumrnarized the results as followa: 1. The disease was found mainly in female children (3 boys, 8 girls) between 1 and 18 years old. Duration of the disease ranged from 1 month to 10 years. 2. The lesions occured or were exacerbated dunng the winter in 9 of them. 3. The disease affected symmetrically on the pressure areas of the feet, mainly the forefeet and toes, the lateral margins of the soles, and the heels. Five of our patients also showed the lesions on the hands simultaneously. 4. We have found a high incidence of atopy among the patients or close relative. Nine patients had a personal history of atopy and 5 gatients also had a history of atopy in the first degree relatives. 5. The serum IgE value increased in one of 6 patients determined. From the above clinical findinge, it is evident that juvenile plantar dermatosis is a true localized atopic dermatitis but also a primary irritant contact derrnatitis to which atopics are prone but which may occur in susceptible non-atopics.

Hyperkeratosis of the Nipple and Areola: report of a case and review of literature / 대한피부과학회지

We described here a case of hyperkeratosis of the nipple and areola. A 23-year- old woman had a verrucous thickening and brownish discoloration on her right nipple and areola that had been present for 4 yeare. The only symptom was an intermittent mild itching sensation. The patient had no other additioa.al hyperkeratotic conditians. She was not married and had never had a pregnancy. Riopsy spccimen showed papillomatous elongation of the epidermis and edema, of the underlying papillary eonnective tissue. The epidermis was parakeratotic and hyperpigmented, and showed focal intercellular and intracellular edema. The present case seems to be the nevoid form by the Levy-Franckel classification. The world literature was briefly reviewed.