Spinal Extradural Meningeal Cyst in Klippel-Trenaunay Syndrome

A case of a symptomatic spinal extradural meningeal cyst (SEMC) in Klippel-Trenaunay syndrome (KTS) is introduced. A 38-year-old woman presented with right L2 radiculopathy. She underwent operations for varicose veins in both her lower extremities. She had port-wine nevi on her trunk and extremities. The edematous change in both legs had waxed and waned. Magnetic resonance imaging showed an 11.8x13 mm extradural meningeal cyst growing through the intervertebral foramen in L2-3. Multiple meningeal cysts were located in the dorsal aspect of the spinal cord from T3 to T10. A 5.8x6.2 mm cyst was also found in left pleural cavity. The extradural meningeal cyst was completely excised and the preoperative symptom was improved. KTS is a congenital disorder due to a mesodermal abnormality, which may predispose the dura to weakness. The SEMC may occur through the dural defect or weakened point.

The Effect of Continuous Remifentanil Infusion on the Airway Reactivity during Desflurane Inhalation / 대한마취과학회지

BACKGROUND: Because desflurane can cause airway reactivity, the use of opioids are aimed at its reduction. This study was designed to evaluate the effect of continuous remifentanil infusion on the airway reactivity during desflurane inhalation. METHODS: 108 adult ASA physical status class I patients were enrolled in this study. The patients were divided into four groups.The breathing circuit was primed with 8 vol% desflurane in 3 L/min each of N2O and O2. Anesthesia was induced with 0.2 mg/kg of intravenous etomidate. After 2 minutes, either 20 ml/hr saline, or 0.15, 0.25 or 0.35g/kg/min remifentanil, groups S, R1, R2 and R3, respectively, was infused. Each patient inhaled the gas mixture through a tight fitting facemask. During this period, the coughing, secretions, breathing hold, laryngospasms, excitatory movements and hemodynamics were measured. RESULTS: The coughing, spasms, secretions and excitatory movements were significantly lower in the remifentanil than the saline infusion group (P 0.05). However, the breathing hold was significantly higher in group R3 (P 0.001). The mean arterial pressure and heart rate were more stable in groups R1 and R2. CONCLUSIONS: These results demonstrate that groups R1 and R2 had significantly reduced airway reactivity, with stabilize hemodynamics, during desflurane inhalation.

A Case of a Traumatic Vertebro-Jugular Arteriovenous Fistula

The vertebral artery is infrequently injured because it lies deep in the neck, surrounded for the most part by bony foramina. Vertebral artery injuries are caused by penetrating traumas, blunt traumas and iatrogenic injuries. Sequela of vertebral artery injury include arteriovenous (AV) fistulae, and pseudoaneurysms may appear months after injury. Angiography is currently the gold standard for evaluating vascular injuries, such as vertebral artery injuries, and can be therapeutic. A vertebral artery fistula can also be treated by operative ligation. We experienced a rare case of a vertebro-jugular AV fistula secondary to a cervical stab wound. In this case, the patient was successfully treated by coil embolization and glue injection during angiography, which was confirmed by a postangiograpy operation.

Evaluation of Fingerstick Blood Glucose in Hypotensive Patients

PURPOSE: Due to its rapidity and easy accessibility, the fingerstick blood glucometer has been used in almost all hospitals and private clinics, and even by patients themselves. We also have used it even in shock patient care, but shock shows global tissue hypoperfusion, especially in peripheral tissue. The changes of peripheral circulation have an influence on the results for fingerstick glucose. To evaluate the accuracy of the glucometer for patients with poor peripheral perfusion, we designed this study. METHODS: A prospective, nonrandomized comparison group study was done. A hypotensive group and a normotensive group were compared. We obtained three data from each patient: venous blood glucose level (clinicopathologic laboratory), venous blood glucose level (by glucometer) and fingerstick glucose level (by glucometer). RESULTS: We saw a significant difference between the fingerstick glucometer results and the laboratory glucose levels in hypotensive patients: 131.67+/-55.33 mg/dl vs. 1 4 7 . 2 3+/-62.06 mg/dl (paired t-test, p0.05). There was no significant difference between the results of venous glucometer and laboratory test in either group: 142.37+/-61.27 mg/dl vs. 147.23+/-62.06 mg/dl (paired t-test, p>0.05) and 102.98+/-17.02 mg/dl vs. 105.60+/-21.95 mg/dl (paired t-test, p>0.05). Although some statistical differences existed between the results, all of the error rates were in an acceptable range (within 15%, accepted by American Diabetes Association consensus). CONCLUSION: These results suggest that the blood glucose level of the glucometer with venous blood is more accurate than that with peripheral blood in patients with poor peripheral circulation.

A CASE OF SURVIVOR WHO SHOWED ALPHA COMA APTER AN ATTEMPTED SUICIDE BY HANGING

A case of survivor who showed alpha coma after an attempted suicide by hanging was reported. A 44 years old women was admitted to the hospital because of respiratory arrest following a hanging attempt on July 3, 1996. She was found pendant completely. On admission she was comatose and the pupils were not reactive to light. The systolic pressure was 100 mmHg, and diastolic pressure was 80mmHg and she had no self respiration and immediately an endotracheal intubation was instituted. After three hours from the onset, the weak spontaneous respiration was restored and the pupils reacted briskly to light. On the 1st day the brain computed tomography (CT) revealed no abnormal findings. An electroencephalogram (EEG) showed widespread alpha activity without occipital dominance a moderate amount of regular, 8 approximately 10 Hz, 10 approximately 30 microvolt potentials. This alpha rhythm had persisted until 24 hours from the onset. At 36 hours later she was still comatose, presenting flaccid quadriplegia with no responses to stimulations. On the 2nd hospital day she was drowsy and on the 3rd day she had become conscious. She showed gradual progress towards complete nerologic recovery. This is the first presentation of a survivor from alpha coma caused by anoxic encephalopathy following a hanging attempt in Korea.