Cardiac arrests in placenta accreta patient during emergency cesarean section: A case report

We report the case of a patient who suffered two events of sudden cardiac arrests separately. Sudden onset of dyspnea and cardiac arrests occurred during cesarean section in a 35-year-old woman who delivered premature baby. Instant chest compression and epinephrine 1 mg was administered. She was diagnosed to have a placenta previa totalis with bleeding preoperatively and placenta accreta was noted intraoperatively. Cesarean hysterectomy was performed due to excessive hemorrhage associated with uterine atony. Another cardiac arrests occurred during hysterectomy. After instant successful resuscitation, she recovered her heart rhythm and transferred to tertiary hospital safely. She was discharged about two months later without any major physical or neurocognitive deficits.

Preoperative increased heart rate is related to the blood pressure decrease during spinal anesthesia for cesarean delivery

BACKGROUND: Hypotension is a very common side effect of spinal anesthesia for cesarean delivery. If we can predict the degree of blood pressure decrease after spinal anesthesia, hypotension will be treated better. Tachycardia may reflect the effective circulatory volume deficit. We studied if preoperative heart rate can predict the degree of hypotension after spinal anesthesia. METHODS: Fifty-two parturients for elective cesarean delivery were enrolled and the gestation periods of all parturient were over 37 weeks. In the supine position, noninvasive blood pressure (BP) and heart rate (HR) were measured as baseline values. After change to the right decubitus position, spinal anesthesia was done. Hyperbaric bupivacaine 8 mg and fentanyl 15 microg were injected intrathecally through 26G spinal needle. After return to the wedged supine position, BP and HR were measured every minute until anesthetic level was fixed. If mean BP decreased below 70% value of baseline, ephedrine 5 mg was injected intravenously. The lowest mean BP, hypotension (<80% of baseline) and total ephedrine requirement were recorded. Retrospective analysis was done after grouping by baseline heart rate (below 80 vs. over 80 beats/min). RESULTS: The patients who had more rapid heart rate before anesthesia, tended to have more decrease of mean BP during spinal anesthesia (P < 0.001, R = 0.45). In retrospective group analysis, the incidence of hypotension was lower in low HR group (46% vs. 83%, P = 0.014). CONCLUSIONS: If preoperative heart rate is over 80 beats/min, careful management is required to prevent hypotension during spinal anesthesia for cesarean delivery.

Anaphylactic Shock Caused by the Epidurally-Administered Hyalurinidase

Hyaluronidase is an enzyme that has temporary and reversible enzymatic effects on the matrix of connective tissue. When added to local anesthetics in pain treatments, it enhances their infiltration and dispersal into tissues. It is widely used in anesthesia for ocular, dental, and plastic surgery. Reports of drug hypersensitivity to hyaluronidase are rare and are usually confined to peribulbar or retrobulbar anesthesia during ophthalmic surgery. However, few reports exist on adverse drug reaction after epidural injection. We have observed two patients experiencing anaphylactic shock caused by hyaluronidase following epidural injection. Most of the patients with a hypersensitivity to hyaluronidase had one previous uneventful injection containing hyaluronidase, implying that sensitization had taken place. However, hypersensitivity occurring at the first administration is possible. A positive skin test can help establish the diagnosis. Although rare, the possibility of an allergic reaction to hyaluronidase should be considered even in patients with no known previous exposure.

Evaluating the Nickel Content in Metal Alloys and the Threshold for Nickel-Induced Allergic Contact Dermatitis

Many patients are currently suffering from nickel (Ni)-induced allergic contact dermatitis (ACD). There have been few Korean studies dealing with the threshold of Ni-induced ACD and quantifying the total amount of Ni in the metal alloys. The aim of this study is to evaluate the amount of Ni leached from metal alloys and Ni contents in metal alloys, and to estimate the threshold of Ni-induced ACD. All the earrings we examined leached below 0.5 microgram/cm(2)/week, the upper limit of European Union (EU) regulation, but the other metal alloys leached a much higher amount of Ni than the limit. Likewise, all the earrings we examined contained less than 0.05% Ni (500 microgram/g), the upper limit of EU regulation, but the other metal alloys exceeded this limit. Twenty Ni-sensitive subjects, who were patch-tested with various concentrations of Ni sulphate, showed positive reactions to 5% and 1% Ni sulphate, 10 subjects showed positive reactions to 0.01%, and the most sensitive subject showed reaction even to 0.0001%. The subjects in this study were more sensitive to Ni than those in the previous studies done in Europe. Taken together, strictly regulating the Ni-containing alloys that are made in Korea is needed to lower the occurrence of Ni-induced ACD.

Remifentanil Effect-site Concentration Blunting Cardiovascular Responses to Tracheal Intubation for Different Sex during Propofol Infusion / 대한마취과학회지

BACKGROUND: Tracheal intubation induces clinically adverse hemodynamic changes. Various pharmacological strategies for controlling these reponses have been suggested with opioids being widely used. The purpose of this study was to determine the effect site concentration of remifentanil in blunting the cardiovascular responses to tracheal intubation according to gender. METHODS: Eighty ASA physical status I or II patients, aged 20-40 years undergoing elective surgery, were classified into a male group (n = 40) and a female group (n = 40). Anesthesia was induced using a propofol target controlled infusion (TCI: Marsh model). A propofol target effect-site concentration of 4microgram/ml was chosen. Rocuronium 0.6 mg/kg was administered after the patients lost consciousness. Remifentanil TCI (Minto model) was started 1 min after the propofol injection. Initially, an effect-site concentration of 3 ng/ml was chosen. The next concentration was chosen using the up-and-down method reported by Dixon. The non-invasive blood pressure and heart rate were recorded before induction (baseline), after the remifentanil injection, immediately after intubation as well as 1 and, 3 minutes after intubation. RESULTS: Probit analysis revealed a remifentanil effect-site EC50 and EC95 in the male group to be 1.94 ng/ml (95% CI, 1.60-2.27 ng/ml ), 3.07 ng/ml (95% CI, 2.65-4.06 ng/ml), respectively. The EC50 and EC95 in the female group were 1.69 ng/ml (95% CI, 1.35-2.01 ng/ml), 2.81 ng/ml (95% CI, 2.39-3.81 ng/ml), respectively. There were no significant differences between the two groups. CONCLUSIONS: The effect-site concentration of remifentanil blunting the cardiovascular responses to tracheal intubation during propofol TCI anesthesia was between 2 and 3 ng/ml. There were no gender differences.

Experience of Administering Oral Prostaglandin E1 for Failed Back Surgery Syndrome: A case report / 대한통증학회지

Oral prostaglandin E1 (PGE1) is a medicine that is clinically applied during a treatment of patients suffering with vascular disease with chronic arterial obstruction because it has vasodilation and anti-platelet effects. The mechanisms of lumbosacral symptoms associated with spinal stenosis probably include vascular insufficiency with hypoxic injury to the cauda equina and the nerve roots. Thus, increasing the blood supply would be beneficial to improve the pathophysiologic condition. Several studies on the improvement of clinical symptoms of spinal stenosis by PGE1 treatment have been reported on. In this case, 47-year old female underwent posterior compression and posterolateral fusion with a cage at L2-4 due to L3 compression fracture, and she did not show improvement of the radiating pain of her right leg after the operation. Therefore, she received repetitive epidural catheterization and adhesiolysis, epidural block and physical therapy, but her symptoms deteriorated after temporary improvement. Finally, she was given PGE1 and the radiculopathy was completely improved, although some muscle weakness still remained.

Development of an angiogenesis-focused cDNA chip and validation of its functionality

DNA chip has been used as a powerful tool to study the genetic reprogramming of cells and its link to cellular phenotype such as angiogenesis. To evaluate the angiogenesis related genetic reprogramming more efficiently, we here developed an angiogenesis- focused cDNA chip containing 153 angiogenesis related genes arrayed in duplicate on a slide glass. In order to validate the functionality of the angiogenesis-focused cDNA chip, we examined gene expression profiles in HT1080 cells treated with either fetal bovine serum, a well known pro-angiogenic factor, or trichostatin A, a known angiogenesis inhibitor, using the cDNA chip. All duplicate data from the analysis are well matched with each other and gene expression profiles are well consistent with previously reported data. These results demonstrate that the angiogenesis-focused cDNA chip developed here can be a useful tool towards angiogenesisrelated researches.

A Comparative Study on Skin Thickness between an Old-Aged Group and a Young Aged Group by 20 MHz-High Frequency Ultrasonography / 대한피부과학회지

BACKGROUND: Skin thickness for parameter of skin aging has been analysed with various methods. Skin thickness variations between the young and the old has been studied with various methods such as biopsies, calipers, micrometers, computer tomography, ultrsonography. But none of these methods evaluates skin thickness exactly. OBJECTIVE: For the evaluation of age-dependent skin thickness changes, we compared the skin thickness of an old-aged group and a young group with 20MHz-ultrasonography. METHODS: In order to identify the skin thickness variation between different age groups, 60 subjects, 30 aged 23-33, and 30 over 60, were studied with 20MHz-high frequency ultrasonogrphy (Dermascan C, Cortex Technology, Hadsund, Denmark) on fourteen skin sites. This machine was designed to measure the thickness from the top of the epidermis to the bottom of the dermis. After storage of cross-sectional skin imaging, skin thickness was calculated with a computer assisted image-analysis program. Skin thickness of the old was analysed by age, sex, height and weight.

A Case of Tuberous Sclerosis

A case of Tuberous Sclerosis, 4 year-old-Korean boy was observed. He had some symptoms about Tuberous Sclerosis which were abenoma sebaceum, seizure, shagreen patch and hypopigmented macule. Diagnosis was confirmed by facial skin biopsy and adenoma sebaceum was noticed.

IntuInfantile Acute Febrile Mucocutaneous Lymph Node Syndrome Report of 4 cases

Mucocutaneous Lymph Node Syndrome(MLNS), a recently recognized entity was first reported by Dr. T. Kawasaki in Japan in 1967 and then about 12,000 cases have been reported since 1967; it is now being found in the United States, but it's etiology is still unknown. The characteristic symptoms is high fever, hypermia of conjunctivae and sclera, reddening of lips and oral cavity, palmer and solar erythema with desqumation and swelling of cervical lymph nodes. Authors insisted that this entity was quite distinct from periarteritis nodosa, Steven-Johnson syndrome, scarlet fever, erythema multiforme and in many ways. We experienced four cases of it and all cases were male and three or them were under the age of two years. All cases had the episodes of high fever, and three of them showed the characteristic symptoms of desquamation, indurtive edema and cervical lymphnodes swelling. In our cases, the fever was continued for about 13 days and desquamation appeared near the end of second weeks of illness. This disease has been treated with various antibiotics and aspirin, but the key point of treatment is how to prevent the complications. From these cases, it may be an interesting disease entity which might be evaluated by careful investigations and follow up study.