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.

Spinal Myoclonus on Lower Extremities Following Spinal Anesthesia or Subdural Administration of Intended Epidural Steroid Injection: Three cases reports / 대한마취과학회지

Clonic movement is an extremely rare complication that occurs after neuroaxial blockade. We have experienced three patients showing intermittent clonic movement on both lower extremities following spinal anesthesia or subdural administration of intended epidural steroid injection.The first and the second patients, 13-year-old boy and 51-year-old man, experienced clonic movement following standard spinal anesthesia with hyperbaric tetracaine with epinephrine for operation on lower extremities. The third one, 24-year-old man, was an outpatient for the treatment of intractable radiculopathy, previously had an L4 laminectomy. His clonic movement may have resulted from the accidental subdural administration of an intended epidural injection of 0.5% lidocaine 6 ml containing triamcinolone 40 mg. Clonic movement has appeared as the occurrence of intermittent, short-timed (about 2~5 seconds), severe annoying, bilateral involuntary muscle contraction on lower extremities at the stage of recovery. It sustained for about 4~19 hours. The treatment was mainly sedation with sedatives and inhalation anesthetics, and partially muscle relaxants or anticholinesterase. They recovered without any sequelae.

Brachial Plexus Injury Following Axillary Brachial Plexus Block Using a Transarterial Approach: A case report / 대한마취과학회지

A 25-year-old male patient was received emergency operation, open reduction and tenorrhaphy owing to degloving injury on the dorsum of his left hand, under axillary brachial plexus block using a transarterial approach. Following operation, he revealed the signs and symptoms of brachial plexus injury such as weakness, sensory deficit and tingling sensation on his left forearm and hand. The finding on electromyography (EMG), performed on the 16th postoperative day (POD), was indicative of left incomplete brachial plexus injury, mainly in medial cord and ulnar nerve, and partially median and radial nerve at/above the axillary level. The signs and symptoms were improved slightly on POD 8 and a lot on POD 23. The complete recovery of symptoms and regeneration of injured nerve on EMG were confirmed 3 months following operation. In this case, the causative factors of brachial plexus injury were suggested in stretching of the brachial plexus due to improper positioning of injured arm during or after operation, combined with or without injury due to nerve block or tourniquet compression.

The Roles of IgG and Albumin as a Predictor of Frequent Relapse in Nephrotic Syndrome

The etiology of nephrotic syndrome in unknown. The characterization were proteinuria, hypoalbuminemia, generalized edema and hyperlipidemia. To assess the recurrence factors in the nephrotic syncrome, we measured serum immunoglobulin (IgG, IgA, IgM), albumin, complement, cholesterol and the 24-hour total urine protein at the initial relapse of nephrotic syndrome. Each data of frequent and infrequent relapsed nephrotic syndrome were compared. In total 67 cases, 18 cases were frequent relapsers and 26 cases were infrequent relapsers and 23 cases were normal control without renal disease. The levels of IgG and albumin in frequent relapser were 304 mg/dl and 1.59 g/dl as compared with 440 mg/dl and 2.06 g/dl in infrequent relapsers. The levels of IgG and albumin were signifecantly lower in frequent relapser than infrequent relapsers (p<0.05). This study might be useful to predict that very low levels of IgG and albumin at the first relapse might be related to high risk chances of frequent relapse in children with nephorotic syncrome.

Clinical Study of Febrile convulsion and Factors Related to Recurrence

We have reserched the relationship of their clinical pictures and factors related to the risk of recurrence of 75 patients with simple or complex febrile convulsions, who were admitted to the Departmenrt of Pediatrics, Chungnam National University Hospital from January 1987 to July 199. The 75patient were followed up and consisted of the 55 patients with initial or non-recurrent febrile convulsions and the othere 20 patients with recurrent febrile convulsions. The results were of follows; 1) The age of first episodes was under the 6 years in 94.6% and the first episode under the 12 months was 14.6% in initial cases and 55% in recurrent cases. 2) There were family history of convulsive disorder in 40% of recurrent cases, compared to 10.9% of initial cases. 3) In gestational age, there was no significant difference between initial and recurrent cases. 4) In sex distribution, the boys (66.7%) outnumbered the girls(33.7%) and the ratios was 2:1. Among the recurrent cases of 20 patients, the boys(90%) were much more than the girls(10%). 5) The patients of low birth weight had more febrile convulsions than large birth weight in both initial and recurrent cases. 6) There was no significant difference between initial and recurrent cases in the causes of febrile convulsion. 7) In abnormal EEG findings, recurrent cases were 30% more than 7.3% of initial cases. 8) There was no significant difference of number of seizure during a day in both initial and recurrent cases 9) In episodes of duration over 15 minutes, recurrent cases were 40% more than 23.7% of initial cases. 10) The resident of urban was 78.6% and of rural was 21.4%. 11) The types of convulsion were generalized in 92% of total cases and focalized in 8%. In the focal types, recurrent cases (15%) were much more than initial cases (5.5%). 12) In occurrence of seizures in body temperature above 40 degrees C, it was 5.5% in initial cases, whereas it was 20% in recurrent cases. 13) 13) There was no significant difference between initial and recurrent cases on fever duration before seizure.