Anesthetic experience of using the intraoperative transesophageal echocardiography in endovascular stent graft placement of descending thoracic aortic aneurysm: A case report

Endovascular stent graft placement is a minimally invasive technique that can be applied to treat many diseases of the descending thoracic aorta. For accurate stent graft placement, clear identification of aortic lesion is important and transesophageal echocardiography (TEE) is an ideal imaging tool for descending thoracic aortic aneurysms. Also TEE is able to detect a perigraft leak that cannot be confirmed by angiography. Unlike angiography, TEE image acquisition capability is not dependent on nephrotoxic contrast dye. The analysis of perioperative cardiac function provided by TEE may be helpful in the perioperative anesthetic management. Furthermore, the tip of the transesophageal echocardiographic probe can be used as a marker to guide stent graft positioning. We report a case of endovascular stent graft placement using TEE in a patient with descending thoracic aortic aneurysm under general anesthesia.

Anesthetic management of the emergency laparotomy for a patient with multiple sclerosis: A case report / 대한마취과학회지

A 33-year-old male patient with multiple sclerosis (MS) received an emergency laparotomy because of perforated appendicitis. He had been suffering from MS for 2 years and the symptoms of MS were paraplegia and urinary incontinence. Anesthesia was induced with propofol and remifentanil and maintained with nitrous oxide, sevoflurane and remifentanil. Rocuronium was used for tracheal intubation. Train of four ratio and bispectral index scale were also monitored for adequate muscle relaxation and anesthetic depth. The patient emerged from general anesthesia smoothly and was extubated without any complication. Postoperative exacerbation of MS symptoms did not appear. However, he was rehospitalized because deep vein thrombosis (DVT) occurred after discharge and he received heparinization immediately. Eventually, he was discharged after a full recovery from DVT. We report a safe anesthetic management of the patient with MS, with the use of sevoflurane and with no the aggravation of MS during postoperative period.

Two Cases of Supernummerary Breast / 대한피부과학회지

Supernummerary breast is a rare developmental anomaly occurring along the course of the embryological milk lines, which run from the anterior axillary folds to the inner thighs. Kajava first described the classification of supernumerary tissue in 1915, and this term is still in use. We herein report two cases of supernumerary breast, classified as Kajava classification type 3 and 6.

Halo Dermatitis Around Junctional Nevus / 대한피부과학회지

Halo dermatitis (Meyerson's nevus) is an inflammatory, eczematous eruption usually encircling a preexisting melanocytic nevus. Spontaneous healing occurs within several weeks or months and is never concurrent with regression of the central nevus, in contrast to halo nevus (Sutton's nevus). Although halo dermatitis is often associated with central melanocytic nevi, pathogenesis leading to the morphological change of this disorder remains obscure. Herein, we report a case of a 23-year-old female who developed an eczematous halo reaction surrounding the junctional nevi.

Long-term Follow-up of Idiopathic Facial Palsy

OBJECTIVE: The purpose of this study was to observe clinical characteristics and electrodiagnostic findings of idiopathic facial palsy and to follow up beyond 1 year after onset. METHOD: From February 2002 to July 2003 the authors analyzed 103 cases that could be followed up after 1 year since diagnosed as idiopathic facial palsy by electrodiagnostic study which was performed at approximately 2 weeks after the onset time. The patients were classified by House- Brackmann (H-B) facial nerve grading system on their first visits and followed up by telephone interview using H-B system. Treatment method, age, sex, medical history and symptoms were noted. In addition, the blink reflex, nerve conduction study and needle electromyography (EMG) were done. RESULTS: When degree of degeneration (% degeneration) was greater than 90% at approximately 2 weeks after the onset or motor unit action potentials were not detected in at least one among the four tested muscles, patients did not gain satisfactory facial function after 1 year. CONCLUSION: Methods related to prognosis of idiopathic facial palsy were compared with side to side evoked potential amplitude and needle EMG. This methods would be helpful to explain its prognosis.

Timing and Causes of Death of Stroke Patients Died in Hospitalization

OBJECTIVE: To evaluate the frequency distribution and causes of death according to number of days after stroke. METHOD: We reviewed in 158 cases of the stroke patients who had died in hospitalization from January 2000 to June 2002 by medical records retrospectively. We evaluated the correlations between the frequency of death and causes of death by frequency analysis. RESULTS: Mean age was 65.8 11.5 years old and average survival days after stroke were 16.2 24.1 days. The proportion of stroke subtypes were infarct (51.3%), intracranial hemorrhage (36.7%), and subarachnoid hemorrhage (12.0%). The frequency of death at 7 days and 30 days after stroke onset were 52.5% and 89.2%, respectively. The most frequent cause of death was respiratory arrest due to transtentorial herniation or brain stem lesion (48.1%), followed in frequency by pneumonia (22.2%), cardiac origin (10.8%), and vasospasm (6.3%). Within the first 30 days, the leading cause of death was respiratory arrest due to transtentorial herniation or brain stem lesion. After the first 30 days, the most frequent cause of death was pneumonia. CONCLUSION: The results of this study are valuable as basic data of mortality and causes of death after stroke during an acute stroke management and early rehabilitation.

Current Epidemiologic Status of Stroke

OBJECTIVE: To evaluate the epidemiological data of stroke patients admitted to Dong-Eui Hospital. METHOD: We performed a prospective study on 1370 cases of stroke consecutively admitted to the hospital from June, 2001 to May, 2002 during hospitalization by medical records and questionaire. RESULT: The highest incidence of the stroke was noted in the group of 60 years of age. The proportion of stroke subtypes were infarct (75.2%), intracranial hemorrhage (21.2%), and subarachnoid hemorrhage (3.6%). Sixteen percents of patients arrived over 24 hours after onset of stroke. The seasonal incidence was in order of frequency of spring, winter, autumn, and summer. The highest occurrence of the stroke was noted in May. The onset time of stroke was highest between 7: 00 am and 8: 00 am. Risk factors in stroke by the order of frequency were hypertension (61.1%), abnormal EKG at admission (45.5%), hyperlipidemia (38.3%), smoking (36.6%), previous stroke history (24.7%), and diabetes mellitus (24.7%). The common complications during hospitalization were pneumonia (7.6%), gastritis (5.6%), depression (4.8%), and hepatitis (4.6%). CONCLUSION: Although the results of this study obtained from one local hospital in Korea, they are valuable as basic epidemiologic data of stroke for the rospective community- based study in the future.

No Response Rates of Sensory Nerve Conduction Studies and Late Responses in Lower Limbs of Heathy Adults

OBJECTIVE: The purpose of this study was to determine no response rates of sensory nerve conduction studies and late responses in the lower limbs of healthy adults. METHOD: The subjects were 50 healthy adults (mean age, 45.6 years) without the clinical signs and symptoms of peripheral neuropathy. All subjects underwent electrodiagnostic evaluation of the following sensory nerves in lower limbs: superficial peroneal, sural, proximal sural, lateral dorsal cutaneous branch of sural nerve (LDSN), and medial plantar. Examined late responses included: tibial F-wave, peroneal F-wave, and H-reflex recorded from the soleus muscle. RESULT: No response rates of sensory nerve conduction studies such as superficial peroneal, sural, proximal sural, LDSN, and medial plantar nerves were 2%, 0%, 0%, 24%, and 18%, respectively. No response rates of late responses such as tibial F-wave, peroneal F-wave, and H-reflex were 0%, 2%, and 8%, respectively. And no response rates were significantly correlated with age (p<0.05). CONCLUSION: No response rate of sensory and late responses of lower limbs are relevant to age increments, the results should be considered for an early diagnosis of peripheral neuropathy in the lower limbs of old population.

Clinical Factors Associated with Functional Status at Discharge in Stroke Patients

OBJECTIVE: To investigate the clinical characteristics, risk factors and complications of stroke patients and their effect on the patient's functional outcomes at discharge. METHOD: We performed a prospective study during hospitalization on 1, 250 consecutive acute stroke patients discharged from Dong-Eui Hospital from June 2001 to May 2002. Glasgow outcome scale, status of upper extremity involved and status of ambulation were used to evaluate functional status. RESULTS: The variables of clinical characteristics identified as significant in functional status at discharge were the presence of occupation, interval between onset and visit to hospital arrival, type of first treatment after stroke, type of caregiver, type of stroke and location of infarction and intracranial hemorrhage. Positive functional outcomes were significantly related to a younger age, male, small amount of hemorrhage and short length of hospital stay. Among risk factors of stroke, abnormal ECG findings at admission and presence of previous stroke were negative prognostic factors. The complications influencing stroke outcome negatively were pneumonia, depression, urinary tract infection, myocardial infarction and recurrence of stroke in hospitalization. CONCLUSION: The results of this study should be considered during acute management and rehabilitation of stroke patients and are valuable as basic data of functional outcome after stroke.

Sensitivity of Electrodiagnostic Parameters in Patients with Asymptomatic Diabetic Neuropathy

OBJECTIVE: To determine the sensitivity of electrodiagnostic parameters in the patients with asymptomatic diabetic neuropahty. METHOD: The subjects were 26 patients with asymptomatic diabetic neuropathy and 40 healthy adults as control group. All subjects underwent electrodiagnostic evaluation of the following motor nerves: median, ulnar, tibial, and peroneal. Sensory nerves included: median, ulnar, radial, superficial peroneal, sural, lateral dorsal cutaneous branch of the sural nerve (LDSN) and medial plantar. And other studies were the sural/radial amplitude ratio, LDSN/sural amplitude ratio, peroneal and tibial F-responses, and H-reflex recorded from the soleus muscle. The frequency of abnormal parameters in the patients with asymptomatic diabetic neuropathy was obtained by comparison with the normative limits obtained from the control group. RESULTS: The most frequent abnormal electrodiagnostic parameters were the LDSN onset latency and the amplitude ratio of LDSN/sural (84.6%, respectively) followed by the LDSN peak latency, LDSN amplitude, and medial plantar onset and peak latency (80.8%, respectively). CONCLUSION: We concluded that the LDSN and medial plantar nerve conduction studies are useful for early detection of neuropathy in diabetes mellitus.

Measurement of Distance from Skin to Pleural Cavity in Interscapular Intercostal Space

OBJECTIVE: The purpose of this study is to measure the skin-pleura distance (SPD) of interscapular intercostal space and to correlated SPD with the individual constitutional data such as body-weight, height, obesity and body mass index (BMI; kg/m2). METHOD: We examined 50 patients (36 men and 14 women) who had no pathological abnormality in interscapular intercostal space. We measured the SPD in chest CT (GE sytec 3000i) study and also measured individual constitutional data of patients. RESULTS: The average age of the subjects was 47.0+/-15.3 years, average weight was 59.0+/-9.7 kg, average height was 167.0+/-8.7 cm, average obesity was 98.4+/-14.9%, average BMI was 21.1+/-3.2 kg/m2 and average SPD was 3.7+/-0.7 cm. There was no correlation of statistical significance between SPD, height and age. But there were statistically significant correlations between SPD, weight, obesity and BMI (p<0.01). Linear regression analysis of these data showed significant correlations between SPD and weight (p<0.01, y=0.109x-2.744), obesity (p<0.01, y=0.092x-5.367) and BMI (p<0.01, y=0.380x-4.301). CONCLUSION: We conclude that the approach considering the correlations between SPD and obesity or BMI will be helpful in reducing pleural puncture during any injection on interscapular intercostal space.

Carbamazepine-induced Acute Interstitial Lung Disease

Seven days after starting carbamazepine therapy because of a central pain, a 67-year old man with the occlusion of left middle cerebral artery developed acute interstitial lung disease with severe dyspnea and decreased consciousness. Initial therapy included mechanical ventilation, discontinuation of carbamazepine, and injection with epinephrine and steroid. Five days after developing the acute interstitial lung disease, his clinical status and the finding of simple chest X-ray were markedly improved. Several days later, there was the removal of the ventilator and resolution of pulmonary symptoms. Acute interstitial lung disease is a rare fatal adverse reaction to carbamazepine therapy. However, awareness of carbamazepine-induced lung disease may reduce delays in both diagnosis and withdrawal of the drug.

Polyethylene Failure Following TKRA

PURPOSE: We purpose to analyze the factors related to the polyethylene failure through the 7 exchanged polyethylene. MATERIALS AND METHODS: We experienced 7 cases of polyethylene failure from Apr. 1988 to Jan. 2000. The average duration of reoperation is 5 year 2 months(1 year 8 months-8 year 11 months), age at primary operation is 62 years old(55-64 years old), weight is 65kg(56-78kg) and height is 155cm(150-162cm). The used prostheses were AGC(Biomet, Warsaw, U.S.A) in 2 patients, AMK(Depuy, Warsaw, U.S.A) in 1 patient, ,MG II(Zimmer, Warsaw, U.S.A) in 1 patient, PFC(Johnson and Johnson, Warsaw U.S.A) in 2 patients and Series 7000(Osteonics, New Jersey, U.S.A.) in 1 patient. RESULTS: The thickness of polyethylene is Smm in 6 patients and 9mm in 1 patient. All of prostheses are cruciate retaining type with relatively flat surface geometry and low-height intercondylar eminence, and the minimal thickness of each system. CONCLUSION: We consider that the thicker polyethylene should be used when feasible in order to avoid reoperation which is caused by accelerated wear of polyethylene, and early detection of polyethylene wear is important. This can be got through knee standing AP, fluroscopic evaluation with varus and valgus stress.

Disc excision and anterior lumber interbody fusion for internal disc derangement at the lumbar and lumbosacral intervertebral space / 대한정형외과학회잡지

No abstract available.

A cases of velamentous insertion of umbilical cord / 대한산부인과학회잡지

No abstract available.