Acute Inflammatory Facial Nerve Paralysis / 대한이비인후과학회지

Bell's palsy is the most common form of acute facial nerve disorder, which presents as an acute peripheral unilateral facial palsy of unknown cause. Ramsay-Hunt syndrome is the second most common cause of acute facial palsy, and is known to be caused by reactivation of latent varicella zoster virus. The main goal of treatment for acute inflammatory facial nerve paralysis is to speed up recovery, to facilitate the recovery more completely and to prevent other sequelae. However, some patients may have a poor recovery with permanent, disfiguring facial asymmetry despite of many kinds of treatments. Regarding the diagnostic and therapeutic issues of the two common disorders, there still exist some controversies. This article reviewed recent evidences on several important issues in evaluation and management of acute inflammatory facial nerve paralysis, and intended to provide an evidence-based framework for decision-making in the clinic.

A Case of Primary Choriocarcinoma of The Fallopian Tube / 대한부인종양콜포스코피학회잡지

Choriocarcinoma is a relatively rare malignancy of which characteristic is rapid metastasis to the other organs. It is related to the previous gestation or originated from the teratoma. Choriocarcinoma is mostly originated from the intrauterine chorionic villi, but it is rarely originated from the utreine cervix, fallopian tube, ovary, vagina and pelvic cavity. Primary choriocarcinoma of the fallopian tube is exceedingly rare and it is originated from ectopic tubal pregnancy, tubal migration from the intrauterine pregnancy or intratubal teratoma. 9 Symptoms and signs of the choriocarcinoma originated from the ectopic pregnancy are abdominal pain, vaginal bleeding, palpable adnexal mass, positive pregnancy test and amenorrhea. Thus it is difficult to distinguish choriocarcinoma from ectopic pregnancy on the basis of symptoms before the microscopic diagnosis presented.20 Effective treatment of choriocarcinoma is chemotherapy. Additional operation is possible. B-HCG is a useful measure for the follow up. We experienced a 36-year-old multigravida Korean woman who was diagnosed as the rupture of ectopic pregnancy after left salpingectomy in our hospital and then confirmed primary choriocarcinoma of the fallopian tube without metastasis on microscopic finding. Postoperative chemotherapy was performed with methotrexate. The follow up of disease is still on going at two month intervals and she has remained healthy, We report this case with review of literatures.

Cushing's Syndrome due to Adrenocortical Carcinoma: Anesthetic Experience with Two Cases / 대한마취과학회지

Anesthetic experience with unilateral adrenalectomy for two patients (ll-year-old and 19- year-old female) with Cushings syndrome due to adrenocortical carcinoma has been reported. Anesthesia was induced with intravenous thiopental followed by nitrous oxide-oxygen-halothane and Pancuronium (Mioblock) for muscular relaxation. An endotracheal semi-closed circle absorption techniqne with controlled respiration was employed. The Patient tolerated well the anesthesia and surgery with appropriate cardiovascular control using hydrocortisone, whole blood and fluid replacement under continuous monitoring of B.P., E.C.G., C.V.P., and urine output. Importance of optimal preparation of the patient with Cushings syndrome, sufficient sedation, smooth induction, complete analgesia, good mucular relaxation, adequate alveolar ventilation and of proper cardiovascular control has been stressed and discussed together with the hazards of postoperative adrenal insufficiency.

A Clinical Study of Anesthesia for Cesarean Section / 대한마취과학회지

Anesthesia for cesarean section involves consideration of Loth maternal and fetal welfare. The choice of anesthesia for cesarean section is controversial. Regional analgesic techniques may be least harmful to the fetus, but suffer definite drawbacks; they are time-consuming, and therefore not always applicable when urgent surgery is indicated; are associated with a definite failure rate even in skilled hands, and require considerable technical ability and practice. Recently there has been progressive increase in the use of balanced anesthesia for cesarean section, it produces little or no hemodynamic and acid-base disturbance in the mother and infant if administered skillfully. The value of muscle relaxants to facilitate endotracheal intubation and pulmonary ventilation and to permit the use of light general anesthesia. From November, 1971 to October, 1973 there were 1,432 deliveries, of which 1,284 were delivered vaginally and 148 (10.3%) by cesarean section. Of the cesarean section group, 139 were performed under general anesthesia and 9 were performed under regional anesthesia. The characteristic difference for our series was that most of all cases were emergency cesarean section (71.6%). The major indication for surgery was that of a previous cesarean section (45.3%), the second most common cause was dystocia (42.9%), and the others are as following order; Hemorrhage (5.4%), toxemia (3.4%), and others (3.4%). In our study, we adopted two different general anesthetic techniques for cesarean section. Patients were randomly assigned to two groups: Group I: 112 patients, thiopental-succinylcholine-nitrous oxide-oxygen (67:33) anesthesia. Group II: 25 patients, thiopental-succinylcholine-nitrous oxide-oxygen (50:50) supplemented with 0.5~1.0% of halothane anesthesia. All patients were pre-oxygenated for 3 5 minutes and anesthesia was then induced with thiopental sodium 125~250mg, followed by succinylcholine 40~50 mg to facilitate intubation. Pressure was maintained on the cricoid cartilage to prevent regurgitation following loss of consciousness. After the affects of succinylcholine showed signs of wearing off, relaxation was maintained with 0.1% succinylcholine drip or 40~80 mg of gallamine. Anesthesia was maintained with nitrous oxide 4 l/min. and oxygen 2 l/min. and/or nitrous oxide 2 l/min. and oxygen 2 l/min. supplemented with 0.5~1.0% of halothane. Respiration was carefully controlled by manually so as not to producing hyperventilation. The clinical condition of newbron infant in general anesthesia series of 135 cases, mean minute apgar score were good (7~10) in 91.8 percent, fair (4~6) in 6.7 per cent, and poor (1~3) in 1.5 per cent. And 90.4 per cent of babies born within 10 minutes of induction to delivery time interval (IDI) had mean apgar score of 8. 8, 5.8 per cent were delivered after 11 to 15 minutes of IDI with decreased mean apgar score of 7.6, and 3.7 per cent were delivered after over 15 minutes of IDI had mean apgar score of 7. 6. A short IDI appears to be advantageous from the standpoint of the newborn. Of the 144 infants, 6. 9 per cent of newbron infants(10) received intermittent positive pressure breathing by face mask and 3.5 per cent(5) received oxygen through an endotracheal tube for the resuscitation. Neonatal death occurred only 1(0.69%) case out of 144 infants, which caused by severe fetal. distres associated with toxemia of pregnancy. There were no maternal death or anesthetic complication.. At the conclusion, the technique of general anesthesia with thiopental-succinylcholine-nitrous oxide-oxygen and/or supplemented with 0.5~1.0% of halothane was proved to be safe for mother and child, and showing a wide acceptance of general anesthesia for cesarean section(94%) at the Kyung Hee University Hospital.