A Case of Nasal Reconstruction of Fibrous Dysplasia Extensively Involving Middle Turbinate and Nasal Septum / 대한이비인후과학회지

Fibrous dysplasia is a benign pathological condition of bone in which fibrous tissue gradually expands and replaces normal bone. Histologically, it shows various degrees of osseous metaplasia. Fibrous dysplasia frequently affects the maxilla, frontal bone, and mandible. The sign and symptoms of fibrous dysplasia of head and neck vary and are related to the location and extent of bony abnormalities. Facial asymmetry is the most common sign of fibrous dysplasia, while pain and ocular proptosis are the next most frequent symptoms. Fibrous dysplasia is rare in the nasal cavity, especially involving the turbinate and nasal septum. So we report a case of fibrous dysplasia, which extensively involves the middle turbinate and nasal septum, with a review of literature.

A Case of Endoscopic Removal of Nasal Myiasis in Cerebral Infarction Patient

Infestation of tissue by fly larvae is termed myiasis, and it is unusual in humans. Nasal myiasis is common in low socioeconomic status individuals due to poor nasal hygiene. It commonly affects the skin and rarely the nasal and paranasal sinuses. Recently an 82-year-old female was admitted to the emergency department because of discharge of live maggots from the nasal cavity. She had been diagnosed with brain infarction and Alzheimer's disease several years previous. We successfully removed all the maggots from the patient's nasal cavity and sinuses via endoscopic surgery under local anesthesia. Subsequently, the patient's nasal problem resolved completely.

The Surgical Results of Isolated Orbital Blowout Fractures Using Bioresorbable Poly L-/DL-Lactide 70/30 Implant / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to share our clinical experience on the use of bioresorbable poly L-/DL-lactide 70/30 implant to repair blow out fracture. SUBJECTS AND METHOD: The medical records of 130 patients with orbital fractures that were treated surgically from June 2006 to February 2011 were reviewed retrospectively. Patients who had diplopia or limited extraocular motion, significant Enophthalmos (>2 mm), or a large orbital wall fracture on a computed tomographic scan were enrolled for the study. We investigated diplopia, limited extraoacular motion, enophthalmos before and after surgery. RESULTS: The mean postoperative follow-up was 28 months. There was no evidence of sinus infection related to the implant. However, six patients showed dislocation of orbital implant in the nasal cavity. After six postoperative months, diplopia was seen in 1 (2%) patient, and significant enophthalmos was seen 2 (2%) patients. We carried out re-operation on six cases and the main cause was incomplete reduction or over reduction. CONCLUSION: Bioresorbable poly L-/DL-lactide 70/30 implants are safe and reliable for the reduction for blowout fracture.

A Case of Cavernous Lymphangioma Originated in the Middle Ear Cavity / 대한이비인후과학회지

Lymphangioma is a rare benign congenital tumor involving both the head and the neck and causing obstructing symptoms in the upper airways as well as aesthetic anomalies. About 90% of the cases occur within 2 years of age, except for a few cases, which occur in adulthood. The lesions can grow rapidly with infection, truma or bleeding, resulting in disfigurement as well as severe impairment of respiraton, swallowing and speech. The middle ear lymphangioma is very extreme. There have been no previously reported cases of middle ear lymphangioma in Korea. The treatment of choice for lymphangioma located in the middle ear is surgical excision. We present and discuss this rare case with a review of the literature.

A Case of Vogt-Koyanagi-Harada Syndrome with Vertigo and Hearing Loss / 대한이비인후과학회지

Vogt-Koyanagi-Harada (VKH) syndrome is an uncommon multisystem autoimmune disease affecting the melanocytes located in the uvea, inner ear, skin, hair, and meninges. The syndrome is frequently reported by ophthalmologists since the most consistent finding is uveitis. Hearing loss, tinnitus and vertigo are the symptoms of VKH syndrome. The authors report one case of VKH syndrome with hearing loss and vertigo with related literature.

A Case of Tracheobronchopathia Osteochondroplastica Associated with Atrophic Rhinitis / 대한이비인후과학회지

Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease of trachea characterized by numerous osseocartilaginous nodules protruding into the tracheobronchial lumen. The etiology of TO is unknown; however, an association with upper respiratory diseases such as atrophic rhinitis has been suggested. The authors report a case of TO with atrophic rhinitis with related literatures.

Anesthetic Management of Early Ligation of Patent Ductus Arteriosus for Premature Infants in the Neonatal Intensive Care Unit / 대한마취과학회지

BACKGROUND: Left-to-right shunt through patent ductus arteriosus (PDA) produces significant hemodynamic and respiratory derangements in premature infants. Combined diseases in these patients often preclude attempts to close the PDA medically with indomethacin. Recently, the efficacy of early surgical closure performed in neonatal intensive care unit (NICU) rather than in operating room (OR) has been emphasized to reduce the risks of transferring unstable infants. Therefore, we reviewed the anesthetic management and clinical status of premature infants who underwent early surgical closure of PDA in NICU. METHODS: Between 2001 and 2007, we reviewed retrospectively 17 premature infants with extremely low birth weight below 1,500 g and 33 weeks gestational age who underwent early ligation of PDA in NICU with left axillary minithoracotomy. RESULTS: The mean gestational age and weight of infants were 29.4 +/- 1.8 (26(+3) - 32) weeks and 849 +/- 165 (450 - 1,080) g. Most of the infants had complications related to PDA and prematurity. Diastolic blood pressure and pulse oxymetry saturation changed with ligation of PDA from 27.4 +/- 5.3 mmHg and 96.3 +/- 2.9% to 38.1 +/- 10.0 mmHg and 93.8 +/- 2.6%, respectively. The body temperature didn't show significant alterations. There was no direct procedure-related death although threeinfants died from pneumonia and sepsis at 29, 30 and 34 days postoperatively. CONCLUSIONS: Performing early PDA ligation in NICU was demonstrated to be safe and effective, especially in terms of providing continuous care and avoiding the risk of hypothermia.

Anesthetic Management for Liver Segmentectomy and Thrombectomy of Inferior Vena Cava and Right Atrium without Cardiopulmonary Bypass : A case report

The tumor thrombus of hepatocellular carcinoma extending into the right atrium (RA) via the inferior vena cava (IVC) may cause fatal complications such as heart failure and pulmonary embolism. Surgery for removal of thrombus in the RA usually needs aid of cardiopulmonary bypass (CPB). We report a case of successful anesthetic management for simultaneous liver segmentectomy and IVC and RA thrombectomy without CPB.

Cerebral Fat Embolism after External Fixation of Open Ankle Fracture in a Patient with Multiple Fracture: A case report / 대한마취과학회지

Even though cerebral fat embolism develops rarely after long bone fracture, it may be very important complication because it can be fatal and the early detection is not easy. Neurologic symptoms include confusion, restlessness, disorientation, seizure, and stroke with focal deficits. High intensive T2 signal MRI of the brain is most sensitive for diagnosis of cerebral fat embolism. We report a case of cerebral fat embolism diagnosed after external fixation of ankle open fracture in a 46 year old woman patient with multiple fracture.

Unilateral Atelectasis during Total Hip Replacement Surgery under Regional Anesthesia: A case report / 대한마취과학회지

Even though atelectasis develops rare during anesthesia and/or surgical operation, it may be very important complication because it can be fatal. Atelectasis may be due to airway or bronchus obstruction, compression of the lung by position, primary surfactant deficiency, increased pleural pressure due to fluid or air in the pleural space, chest wall restriction due to skeletal deformity and/or muscular weakness. We report a case of acute intraoperative unilateral lobar atelectasis in 87-years-old woman patient undergoing regional anesthetic for total hip replacement surgery.

Chest Pain due to an Aortic Pseudoaneurysm during Trans-Urethral Resection of the Prostate: A case report / 대한마취과학회지

Aortic pseudoaneurysms are rare. When aortic pseudoaneurysms are detected, they demand timely surgical intervention because they trend to increase in size and cause complications. We experienced a rare case of a chronic traumatic pseudoaneurysm located at the distal descending aorta associated with chest pain during trans-urethral resection of the prostate under spinal anesthesia. Diagnostic testing led to appropriate management.

Pharmacodynamic Changes of Mivacurium in Liver Cirrhosis Model in Rabbits Using Carbon Tetrachloride Intoxication / 대한마취과학회지

BACKGROUND: A reproducible animal model of liver cirrhosis by administering multiple doses of carbon tetrachloride (CCl4) is highly desirable for appropriate metabolic and therapeutic studies. The current study was undertaken to evaluate the neuromuscular blockade of mivacurium in CCl4 induced liver cirrhosis in rabbits. METHODS: Cirrhosis was induced in rabbits by CCl4 treatment for 11 weeks. Rabbits were randomly assigned to two groups; control group: corn oil 0.5 ml/kg/2 days IM for 11 weeks; study group: CCl4 0.5 ml/kg/2 days mixed 1:1 with corn oil IM for 11 weeks. In the first study, the dose-response relations of mivacurium were studied in twenty rabbits during thiopental anesthesia. They received mivacurium 10, 20, and 30 microgram/kg in control group, and mivacurium 20, 30, and 40 microgram/kg in study group, respectively. In the second study, time course of mivacurium 0.18 mg/kg in twenty rabbits was evaluated in each groups. Three fragments of each liver lobe at the end of the experimental period were performed for the histological examination. RESULTS: Eleven-weeks CCL4 treatment resulted in liver cirrhosis, decreased pseudocholinesterase to 1/6 of control level, and increased AST and ALT compared with controls. In the first study, There were significant differences between two groups. In the second study, There were significant differences between two groups. CONCLUSIONS: It is suggested that mivacurium should be used with caution in patients with hepatic insufficiency and that, in such patients, monitoring of neuromuscular function is desirable.

Modified Submental Orotracheal Intubation Using the Blue Cap on the End of the Thoracic Catheter

The technique of submental intubation in patients with multiple facial fractures and skull base fracture was originally described by Altemir. This technique provides a secure airway and allows intermaxillary fixation while avoiding the complications of nasotracheal intubation or tracheostomy. However, when the endotracheal pilot balloon and endotracheal tube are pulled through the submental incision site using this technique, soft tissues or blood may enter the endotracheal tube and trauma may result in the surrounding tissues. To overcome these problems, we carried out a modification of submental orotracheal intubation using the blue cap on the end of the thoracic catheter in a patient with mandibular fractures and injury to the skull base and found that this modification resulted in a safer and less traumatic intubation.

The Effect of Skull Pin Fixation on Cerebrospinal Fluid Pressure and Cerebral Perfusion Pressure: Influence of Lidocaine and Fentanyl / 대한마취과학회지

BACKGROUND: A hypertensive response is seen when a skull pin is inserted for a craniotomy. The risk of morbidity and mortality is high in patients with intracranial pathology. Many methods have been introduced to overcome the problem. We compared the hemodynamic effects and changes of intracranial pressure when we used lidocaine or fentanyl for blunting the hypertensive response. METHODS: Thirty-two patients scheduled for a craniectomy were divided into two groups: an IV (intravenous) bolus of fentanyl (2micro gram/kg) group or lidocaine (1.5 mg/kg) group. An anesthesia was induced with fentanyl (2micro gram/kg), thiopental (5-7 mg/kg), lidocaine (1.5 mg/kg) and vecuronium (0.1 mg/kg), and was maintained with isoflurane 1 MAC (minimum alveolar anesthetic concentration) in nitrous oxide 50% and oxygen. After induction of anesthesia, a lumbar subarachnoid catheter was inserted for CSFP (cerebrospinal fluid pressure) measurement. An IV bolus of either fentanyl (2micro gram/kg) or lidocaine (1.5 mg/kg) was administered prior to insertion of the skull pin by a randomized method. CSFP, MAP (mean arterial pressure), and HR (heart rate) were measured before and 5 min after induction of anesthesia, immediately before and each mininute for five measurements after skull pin insertion. RESULTS: There were no intergroup differences in the values of CSFP and HR. The MAP increased 9+/-14 (mean+/-SD) mmHg and 4+/-12 (mean+/-SD) mmHg 1 min after the skull pin insertion compared with immediately before skull pin insertion in the fentanyl group and lidocaine group respectively. The MAP recovered 2 min after the skull pin insertion in both groups. CPP (cerebral perfusion pressure) recovered 3 min and 2 min after the skull pin insertion in the fentanyl group and lidocaine group respectively. CONCLUSIONS: An IV bolus of either fentanyl or lidocaine before skull pin insertion resulted in a stable value of CSFP, CPP and HR.

Effects of Capsaicin Application to Peripheral Nerves in a Rat Model for Human Postoperative Pain / 대한마취과학회지

BACKGROUND: The interest in management of postoperative pain has increased with the development of medicine. The mechanism of postoperative pain should be understood first. Capsaicin has been proven to be a powerful agent acting selectively on nociceptive afferent fibers. This study was focused on how the perineural treatment of capsaicin affects pain after an incision in the rat model. METHODS: Capsaicin was applied directly to sciatic nerve branches, on the are tibial, sural, and saphenous nerves. Pain behaviors to von Frey filaments, blunt probe stimulation, resting pain, and heat were evaluated on the incised feet. The grade of wound healing was assessed according to clinical findings of the wound 3 days postoperatively. RESULTS: Capsaicin applied directly onto nerves elevated withdrawal latency to heat during the study. There were statistically significant increases of withdrawal latencies in the capsaicin group compared with the vehicle group. Capsaicin produced agreater increase of the withdrawal threshold to von Frey than the vehicle 2 days after the incision. Resting pain scores were lower in capsaicin - treated rats than in the vehicle group for 2 days. The grade of wound healing was poor in capsaicin - treated rats. CONCLUSIONS: The perineural application of capsaicin appears to affect the pathway of transmission of postoperative pain. Current results suggest that capsaicin has a strong analgesic effect on thermal hyperalgesia and attenuates mechanical hyperalgesia by an incision. Capsaicin sensitive nerves could be involved in wound healing.

Effect of Continuous Epidural Block on the Duration of Intensive Care after Cardiac Surgery / 대한구급학회지

BACKGROUND: Continuous epidural block after surgery has been able to get better postoperative analgesic effect than intermittent intravenous (IV) opioids and to decrease the duration of mechanical ventilatory support, endotracheal intubation and ICU stay. The purpose of this study is to observe these effects of continuous epidural block after cardiac surgery. METHODS: 30 patients, undergoing cardiac surgery, were divided into 2 groups. Postoperative analgesia were performed by intermittent IV meperidine 25 mg in group 1 and by continuous epidural block with 1% mepivacaine 100 ml and morphine 4 mg in group 2. Both groups were supplemented, at the patient's request, by IV meperidine 25 mg as needed. Quality of pain relief, total number of IV meperidine and duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay were compared between 2 groups. RESULTS: Quality of pain relief and total number of IV meperidine were significantly lower in group 2 than group 1, each time interval. Duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay and time interval between consciousness return & mechanical ventilatory support were significantly shorter in group 2 than group 1. CONCLUSIONS: Continuous epidural block, with 1% mepivacaine 100 ml and morphine 4 mg, for postoperative analgesia decreases the duration of intensive care compaered with intermittent IV meperidine 25 mg, after cardiac surgery.