Gastric Syphilis and Membranous Glomerulonephritis

Syphilis is a chronic systemic infectious disease caused by the bacterium Treponema pallidum. Gastric involvement and nephrotic syndrome are uncommon but well documented complications of syphilis, but the co-occurrence of these two complications in the same patient is extremely rare. Thus, because of their nonspecific presentation, suspicion of gastric syphilis (GS) and nephrotic syndrome is essential for diagnosis. Patients should be investigated thoroughly and a diagnosis made based on clinical, endoscopic, and histological findings, in order to initiate appropriate therapy. We report of a 34-year-old male patient with a history of epigastric pain and a diagnosis of GS and syphilis-associated membranous glomerulonephritis confirmed by gastroscopy and kidney biopsy, who was treated successfully with penicillin G benzathine. This case report provides information on the typical features of GS that should help raise awareness of this rare disease entity among clinicians, resulting in earlier diagnosis and administration of appropriate therapy.

Anesthesia for Surgical Separation of Thoraco - xiphopagus Conjoined Twins / 대한마취과학회지

Now that open-heart surgery in children has become commonplace, one of the most spectacular operations in the pediatric population is the separation of conjoined twins. Anesthesia for the separation of conjoined twins requires a multidisciplinary team approach. We describe the anesthetic management of a single-stage separation of 2-month-old thoraco- xiphopagus tetrapus conjoined twins as a first case in Korea. The successful 3.25-hour operation was conducted by 6 anesthetists, 6 surgeons and 7 nurses. No any problems were encountered in the perioperative period.

Acute Pulmonary Edema Following Esophagoscopy - A case report / 대한마취과학회지

There are many predisposing factors for acute pulmonary edema, Pulmonary edema in well recognized complication of acute airway obstruction, especially in small children, but rarely seen in adults. We present a case of noncardiogenic pulmonary edema that developed in adult following removal of endotracheal intubation after esophagoscopy, The sequence of events suggest that laryngospasm precipitated the development of the pulmonary edema in this patient.

Anesthetic Management for 12 Patients with Myasthenia Gravis / 대한마취과학회지

Serious complications and death may occur in patients with neuromuscular disorders after administration of muscle relaxants that include prolonged paralysis, hyperkalemia, muscle rigidy and malignant hyperthermia. Myasthenia gravis, neuromuscular junctional lestion, is a postsynaptic autoimmune disease that reduces the acetylcholine receptor population. Those with myasthenia gravis like patients with other neuromuscular disorders respond abnormally to administration of depolarizing and non-depolarizing neuromuscular blocking agents. Therefore, many anesthesiologists avoid the use of muscle relaxants in general anesthesia for these patients, but the use of volatile anesthetics, premedicants, anticholiesterases and other drugs also have drawbacks. Special precautions should be taken with patients with myasthenia gravis to avoid interaction of muscle relaxants and other drugs at the neuromuscular junction in the anesthetic management during surgery and perioperative serious complications.

Muscle Relaxation and Cardiovascular Response in Rabbits by Pancuronium and Verapamil / 대한마취과학회지

Pancuronium is one of the most available nondepolarizing muscle relaxant. It is primarily eliminat-ed unchanged by the kidney, although a small fraction is metabolized by the liver. On the other hand, calcium channel blocking agents are a chemically heterogeneous group of drugs that inhibit the ionic current carried through the calcium slow channel in cardiac and vascular smooth muscle. This action is the basis of their usefulness in the treatment of cardiovascular disorders. Although the role of calcium in skeletal muscle differs from that in cardiac and vascular smooth muscle, various recent studies have shown that verapamil is able to inhibit neuromuscular function in skeletal muscle preparations. However, it is not well known, yet. Increasing number of patients who are taking calcium channel blockers were reported recently. The present study was undertaken to determine if verapamil could potentiate the effects on pancuronium and how does it affect the cardiovacular response. The results were as follows; 1. Verapamil (1.41 mg) significantly enhanced the recovery index of pancuronium as 226.7 sec compared with control recovery index as 162.5 sec (p<0.025). But tetanic stimulation (50Hz, 5 sec) was sustained in the both group. 2. Hypotensive effect was appeared when 1.41 mg of verapamil was given and it was taken 7.7 min. 3. Signs of cardiovascular response was decreasing the blood pressure especially diastolic first then heart rate was decreased.

Muscle Relaxation and Cardiovascular Response in Rabbits by Pancuronium and Verapamil / 대한마취과학회지

Pancuronium is one of the most available nondepolarizing muscle relaxant. It is primarily eliminat-ed unchanged by the kidney, although a small fraction is metabolized by the liver. On the other hand, calcium channel blocking agents are a chemically heterogeneous group of drugs that inhibit the ionic current carried through the calcium slow channel in cardiac and vascular smooth muscle. This action is the basis of their usefulness in the treatment of cardiovascular disorders. Although the role of calcium in skeletal muscle differs from that in cardiac and vascular smooth muscle, various recent studies have shown that verapamil is able to inhibit neuromuscular function in skeletal muscle preparations. However, it is not well known, yet. Increasing number of patients who are taking calcium channel blockers were reported recently. The present study was undertaken to determine if verapamil could potentiate the effects on pancuronium and how does it affect the cardiovacular response. The results were as follows; 1. Verapamil (1.41 mg) significantly enhanced the recovery index of pancuronium as 226.7 sec compared with control recovery index as 162.5 sec (p<0.025). But tetanic stimulation (50Hz, 5 sec) was sustained in the both group. 2. Hypotensive effect was appeared when 1.41 mg of verapamil was given and it was taken 7.7 min. 3. Signs of cardiovascular response was decreasing the blood pressure especially diastolic first then heart rate was decreased.

A Case Report of Airway Obstruction with Armored Endortracheal Tube / 대한마취과학회지

A fifty five year-old male patient was scheduled for a total laryngectomy under general anesthesia. A tracheostomy was performed on the administration day due to respiratory difficulty. All data of the preoperative routine check were within acceptable limits including incomplete RBBB on EKG. Just prior to starting the inhalation anesthesia, an armored tube (RUsch) was inserted instead of a silver cannula. Near the end of operation, signs of hypercapnia appeared as tachycardia and hypertension. Therefore, tracheobronchial suction was attempted but the suction catheter did not go through the armored tube. At that time, we decided there was an obstruction inside the tube. So, the armored tube was changed to a Portex tube. Thereafter, tachycardia and hypertension returned to normal intraoperative levels and we disocvered that the armored tube was obstructed almost completely by a blood clot.