Subcutaneous Emphysema and Inflammation of the Neck after Tracheal Puncture by an Intubating Stylet / 영남의대학술지

Laryngo-tracheal perforation caused by the use of a stylet during tracheal intubation is a rare complication. We present a case of subcutaneous emphysema and connective tissue inflammation after tracheal intubation. The patient was a 41-year-old male undergoing general anesthesia for an appendectomy. The intubation was difficult during laryngoscopy (Cormack-Lehane Grade III). An assistant provided an endotracheal tube with a stylet inside while the laryngoscope was in place. During intubation, a short, dull sound was heard with a sudden loss of resistance after the distal tip of the endotracheal tube passed the rima glottis. A sonogram and computerized tomography revealed subcutaneous emphysema from the neck to the upper mediastinum and fluid collection between the trachea and the thyroid. This lesion appeared to have been caused by the protruded, loose stylet. Anesthesiologists should be aware of the damage a loose stylet protruding beyond the tip of the endotracheal tube can cause.

A Case of Synchronous Double Cancer: Klatskin's Tumor and Ampullary Adenocarcinoma / 대한소화기내시경학회지

Multiple cancers in the extrahepatic biliary tree are relatively rare. Many such cases are a double cancer of the common bile duct and the gallbladder. We report a case of a double primary cancer that occurred synchronously at the hilum of the extrahepatic duct and the ampulla of Vater with a review of the relevant literature. A 57-year-old man was admitted to our institution after a 15 day of painless jaundice and a urine color change. Ultrasonography showed a dilation of both intrahepatic ducts. Upper endoscopy revealed a protruding ulcerative mass at the ampulla of Vater and endoscopic retrograde cholangiography showed a dilated common bile duct and a mildly dilatated pancreatic duct, but both intrahepatic bile ducts were not visualized. An upper abdominal CT scan showed a dilation of both intrahepatic bile ducts and an infiltrating mass at the bifurcation area. Magnetic resonance cholangiopanreatography showed narrowing bile duct lumen that was obstructed by the tumor at the hepatic duct bifurcation, which dilated both intrahepatic ducts. A histological examination of the ampulla of Vater revealed a well differentiated adenocarcinoma of the ampulla of Vater. The final diagnosis was a synchronous double cancer of Klatskin's tumor and an adenocarcinoma of the ampulla of Vater.

Acute Postoperative Pulmonary Edema without Reasonable Causes: A Case Report / 영남의대학술지

This report concerns an unusual case of acute postoperative pulmonary edema without any apparent causes in a 45-year-old man. The patient was subjected to the removal of a previously placed device on the left tibia, and the excision of a benign mass on the right forearm. Unexpected acute bilateral pulmonary edema occurred immediately after the completion of the procedures. The etiologies were reviewed in relation to the patient's condition and clinical manifestations. Fluid overloading was excluded as a cause in view of the patient's perioperative state and postoperative chest X-ray results. We could not find any symptoms of upper airway obstruction during emergence from general anesthesia. We had doubts about tourniquet or fentanyl-induced pulmonary edema, but these factors were not sufficient to bring about pulmonary edema in this case. To our knowledge, the cause of acute pulmonary edema in this case is indeterminate.

Clinical Experience of Epidural Adhesiolysis in Patients with Failed Back Surgery Syndrome / 대한마취과학회지

BACKGROUND: Epidural adhesiolysis is advocated in radiculopathy due to epidural adhesion following previous back surgery. Traditionally, a Racz catheter through a R-K needle is used as a standard tool in this procedure. We report our experiences of clinical results and the usage of various catheters for epidural adhesiolysis in patients with failed back surgery syndrome. METHODS: We investigated the medical records of 15 patients with failed back surgery syndrome who received epidural adhesiolysis. An R-K epidural needle was inserted through the sacral hiatus and a Racz catheter was advanced through the needle and repeatedly passed through the adhesion site under fluoroscopic visualization. The authors used Racz catheter in addition to the several kinds of catheter, e.g., the Fogarty balloon, and pulmonary artery or ureteral catheters to improve the epidural adhesion lysis. Bupivacaine, triamcinolone, hypertonic saline and/or hyaluronic acid were injected through the catheter daily for 3 days. Patients were evaluated for pain intensity and side effects 3 days and 2 months after the procedure. RESULTS: Pain scores (numerical rating scale) were significantly lower at 3 days and 2 months (3.1 +/- 1.8, 5.7 +/- 2.0, respectively P <0.01) than pre-procedure values (8.6 +/- 0.9). Complications were 2 mild posterior neck pain during procedure and 1 myoclonus in the recovery room. CONCLUSIONS: We conclude that epidural adhesiolysis is a relatively effective therapeutic means in patients with failed back surgery syndrome. Furthermore, a new balloon catheter with the advantages of Racz and Fogarty catheters, should be made available to improve the quality of lysis.