ABSTRACT
The interscalene brachial plexus block is not commonly used in pediatric regional anesthesia. The increasing popularity of ultrasound has allowed more anesthesiologists to perform regional anesthesia with high success rates in pediatric patients with the direct visualization of the target nerve and spread of local anesthetics. We present a case of interscalene brachial plexus block under ultrasound guidance in a 17-month-old child with acute drug-induced hepatitis who required fixation of a fracture of the lateral humeral condyle.
Subject(s)
Child , Humans , Infant , Anesthesia, Conduction , Anesthetics, Local , Brachial Plexus , Chemical and Drug Induced Liver Injury , PediatricsABSTRACT
BACKGROUND: Chronic postoperative pain (CPOP) is defined as pain of at least 2 months duration after a surgical procedure. Until recently, it has been a neglected topic, because it can occur after a wide spectrum of operations; however, little is known regarding its underlying mechanism, prevalence, risk factors, and treatments. We investigated characteristics of CPOP after various operations via a questionnaire. METHODS: Patients were contacted at > 2 months after surgery, irrespective of sex, type of operation or anesthesia method, and a follow-up pain questionnaire was administered by phone. RESULTS: One hundred forty-five of 400 patients (36.3%) described CPOP. The prevalence of CPOP was significantly lower in laparoscopic surgery (29/159, 18.2%) than open surgery (116/241, 48.1%). The prevalence of CPOP was higher with the use of PCA (patient controlled analgesia), (45.3%) than without PCA (24.6%). There were no significant differences regarding sex, anesthetic method, or duration of operation. CONCLUSIONS: Our results indicate that the prevalence of CPOP may be related to use of an endoscope and PCA. However, it is difficult to completely explain the correlation, because this is a complex area of research. More research is needed to improve the quality of pain relief.
Subject(s)
Humans , Anesthesia , Endoscopes , Follow-Up Studies , Laparoscopy , Pain, Postoperative , Passive Cutaneous Anaphylaxis , Prevalence , Risk FactorsABSTRACT
BACKGROUND: To evaluate the accuracy of a portable hemoglobin photometer, the HemoCue, during surgery, hemoglobin concentrations (Hb) of HemoCue were compared with those of the SYSMEX XE-2100, in the situation of bleeding. METHODS: Hemoglobin concentrations were measured with HemoCue and by the SYSMEX XE-2100 at the same time, on 100 blood samples obtained from patients who were bleeding more than 500 ml, during surgery. The limits of agreement between the two methods were calculated from the results according to the method of Bland & Altman. The results of HemoCue were adjusted by adding the mean bias, defining the corrected values, and reevaluated the agreement with the results of the SYSMEX XE-2100. RESULTS: The differences in results between the two methods were 1.12 +/- 0.37 g/dl. The limits of agreement were 0.38-1.86 g/dl, which means disagreement between the two methods. However, the corrected values represented agreement with the values of the SYSMEX XE-2100. The limits of agreement were -0.74-0.74 g/dl. CONCLUSIONS: The corrected Hb values of HemoCue were comparable to the values of SYSMEX XE-2100. It is useful to evaluate the hemoglobin concentration using HemoCue intraoperatively.
Subject(s)
Humans , Anemia , Bias , Hemoglobins , HemorrhageABSTRACT
Kimura's disease is an uncommon chronic inflammatory disorder of unknown etiology. Clinically, it presents as solitary or multiple subcutaneous nodules, predominantly in the head and neck region, and typically in the preauricular region, forehead, and scalp. Other localizations such as lacrimo-orbital involvement and upper extremities have been reported. The soft tissue localization is often associated with regional lymphadenopathy and, occasionally, with enlargement of the major salivary gland. Orbital, eyelid, and lacrimal involvement by Kimura's disease are rare. The etiology of this disease is still unknown. It is essential to differentiate it with malignant tumor through biopsy. When Kimura's disease is confirmed, the combination of surgical excision and oral steroid appears to be effective therapeutic motality. We report Kimura's disease, along with a review of literature, presenting as facial mass and periorbital swelling in a case of a child.
Subject(s)
Child , Humans , Angiolymphoid Hyperplasia with Eosinophilia , Biopsy , Eyelids , Forehead , Head , Lymphatic Diseases , Neck , Orbit , Salivary Glands , Scalp , Upper ExtremityABSTRACT
BACKGROUND AND OBJECTIVES: Multiple Endocrine Neoplasia type 2A (MEN 2A) is a syndrome that encompasses medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism. Since MEN 2A is inherited as autosomal dominant, early detection and treatment is crucial. A genetic analysis of RET proto-oncogene of the family members of an index patient diagnosed as MEN 2A is reported. SUBJECTS AND METHOD: A patient diagnosed as MEN 2A and his 13 family members across two generations were studied. Initially, DNA was extracted from the peripheral blood leukocyte of family members and PCR amplification of exons 10, 11, 13, 14, 15, and 16 was performed, followed by investigation of point mutation on the RET proto-oncogene using a DNA sequence analyzer. Cervical ultrasonography was carried out in the 3 nephews who were revealed to have RET proto-oncogene point mutation. RESULTS: Point mutations of TGC (cys) to TGG (Trp) at codon 634 of exon 11 at RET proto-oncogene was detected by using automatic DNA sequence analyzing method in the index patient. The same point mutation was identified in 7 of the 13 family members. Cervical ultrasonography revealed bilateral thyroid nodules in all 3 nephews who had point mutations of RET proto-oncogene. CONCLUSION: With the genetic analysis of RET proto-oncogene, limitations of the conventional calcitonin stimulation test may be overcome, and a more complete approach can be achieved through early diagnosis by carrying out this screening test for point mutations in family members of the patient with MEN 2A.
Subject(s)
Humans , Base Sequence , Calcitonin , Codon , DNA , Early Diagnosis , Exons , Family Characteristics , Hyperparathyroidism , Leukocytes , Mass Screening , Multiple Endocrine Neoplasia Type 2a , Multiple Endocrine Neoplasia , Pheochromocytoma , Point Mutation , Polymerase Chain Reaction , Proto-Oncogenes , Thyroid Neoplasms , Thyroid Nodule , UltrasonographyABSTRACT
BACKGROUND AND OBJECTIVES: Salvage surgery for recurrent glottic cancer after radiation failure has been reported in the literature as a treatment for total laryngectomy and partial laryngectomy (vertical partial laryngectomy, supracriocoid partial laryngectomy) in selected cases. Also, CO2 laser cordectomy has also been reported as a successful primary treatment for early glottic cancer. However, salvage laser surgery for recurrent glottic cancer has been rarely reported. Our experience of transoral laser cordectomy on recurrent glottic cancer after radiotherapy is reported. SUBJECTS AND METHOD: Twelve patients with early recurrent glottic cancer after full-course radiotherapy (rT1a, n=4 ; rT1b, n=1 ; rT2, n=7) underwent laser cordectomy between October, 2002 and January, 2005. According to the European Laryngological Society Classification, they were found to have two type III, one type IV, and eight type V performed. One patient underwent type II at one side and type III at the other. Surgery in all the cases were performed at one stage with curative intent. RESULTS: The mean follow-up interval was 30 months (range 17-44 months) with five out of 12 cases (42%) having local recurrence. Four of the five cases with local recurrence underwent total laryngectomy. Three cases were salvaged while one had additional recurrence. The other one was under palliative treatment. The local control rate was 58%, overall survival and disease specific survival rate was 100%. The mean hospitalized period was 6.4 days (range 2-26 days) after surgery, and tracheotomy was performed in four cases (duration : 3-20 days). There was no postoperative aspiration pneumonia and nasogastric tube was not performed in any of the cases. CONCLUSION: Transoral laser microsurgery may be a feasible salvage method for recurrent glottic cancer to gain oncologic and functional results, and could be used as an organpreserving procedure with curative intent in selected cases.