Concomitant Glomus Tumor with CRPS in the Hand

Glomus tumors are benign tumors that account for 1% to 5% of all soft tissue tumors of the hand and are characterized by a triad of sensitivity to cold, localized tenderness and severe paroxysmal pain. Paroxysmal pain is a symptom common not only in glomus tumors but also in CRPS, and the hand is one of the commonly affected sites in patients with both glomus tumors and CRPS. Therefore, it is not easy to clinically diagnose glomus tumors superimposed on already affected region of CRPS patients. We report a case of glomus tumor concomitantly originating with CRPS at the hand.

Effects of Epidural Fentanyl on Speed and Quality of Block for Emergency Cesarean Section in Extending Continuous Epidural Labor Analgesia Using Ropivacaine and Fentanyl

We performed a prospective, randomized, and double-blind study comparing the top-up effects of 2% lidocaine/100 microgram fentanyl/epinephrine (n=31) and 2% lidocaine/saline/epinephrine (n=30) when extending an epidural labor analgesia using low-dose ropivacaine and fentanyl. Survival analysis for the sensory blocks to the T4 level showed no statistically significant differences in onset time to T4 between the 2 groups. Onset times (min) to T4-sensory blocks for cold and pinprick were not different between the two groups. However, median maximum sensory level in the lidocaine-fentanyl group (T1 for cold and T2 for pinprick) was significantly higher than that in the lidocaine-saline group (T3 and T4, respectively). The lidocaine-fentanyl group exhibited less visceral pain (6.5% vs. 36.7%), less supplementation of lidocaine (6.5% vs. 43.3%), and less nausea (6.5% vs. 26.7%) compared with the lidocaine-saline group during the intraoperative period. It is concluded that adding fentanyl to 2% lidocaine does not speed up the onset of the block when the onset is tested with cold or sharp pinprick but improves the quality of analgesia with fewer side effects in emergency top-up for cesarean section.

Use of Intraaortic Balloon Pump in a Patient with Right Ventricular Failure after Cardiac Surgery: A case report / 대한마취과학회지

The intraaortic balloon pump (IABP) is the most effective and widely used device for temporary mechanical assistance of left heart. Considering left and right ventricular (RV) interdependence, IABP may also alleviate predominantly RV dysfunction following cardiac surgery. This is the case of a 61-year-old female patient who had experienced RV failure after cardiac surgery. After tricuspid valve replacement, preexisting RV failure was progressively aggravated and systemic blood pressure could not be maintained in spite of aggressive pharmacological support on second postoperative day. Thus, mechanical support with IABP was considered to increase coronary perfusion pressure in this case. IABP dramatically improved hemodynamics and cardiac function. It was removed on fifth postoperative day and she has remained well. In conclusion, IABP could play a role in RV failure following cardiac surgery and timely treatment of the heart failure with mechanical circulatory assistance would prevent further complications.