RESUMO
Miliary tuberculosis is a severe form of tuberculosis resulting from dissemination of Mycobacterium tuberculosis bacilli. Since symptoms appearing in patients due to miliary TB are diverse and atypical, depending on the site of invasion, early diagnosis and treatment are important. A paradoxical response of tuberculosis is a rare phenomenon and it can be a clinical difficulty to treatment especially when involving the central nervous system. We present a case report with a review of related literature about the patient who developed sudden hearing loss due to tuberculosis infection in vestibulocochlear area.
Assuntos
Humanos , Sistema Nervoso Central , Diagnóstico Precoce , Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Mycobacterium tuberculosis , Tuberculose , Tuberculose MiliarRESUMO
Subdural hematoma is a common disease of intracranial hemorrhage that accounts for 11-21% of all head trauma patients. It is defined as a hematoma that develops between dura mater and subarachnoid space. In elder patients, mild trauma may not always be accurately recognized and symptoms may not develop slowly due to the large area of subdural space. Headache is the most common symptom of subdural hematoma and may be associated with hemiplegia, dysarthria, sensation disorder, conscious disorder, and etc. We present, with a literature review, a case of a patient who developed subacute subdural hematoma after performing Brandt-Daroff habituation exercise to treat benign paroxysmal positional vertigo.
Assuntos
Humanos , Vertigem Posicional Paroxística Benigna , Traumatismos Craniocerebrais , Dura-Máter , Disartria , Cefaleia , Hematoma , Hematoma Subdural , Hemiplegia , Hemorragias Intracranianas , Transtornos de Sensação , Espaço Subaracnóideo , Espaço SubduralRESUMO
Fibrous dysplasia (FD) is a rare type of fibro-osseous lesion characterized by progressive replacement of normal bone with immature tissue. The involvement of craniofacial bones is reported in 10% of FD cases, while the involvement of sinonasal cavity is extremely rare. We report a unique case of FD in which the primary complaint was nasal obstruction. As FD cases involving the turbinate bones are very rare, we also reviewed all reported cases of FD involving the inferior or middle turbinates. Based on our experience and a review of the relevant literature, we conclude that inferior and/or middle turbinectomy via endoscopic approach and septoplasty can improve nasal symptoms.
Assuntos
Obstrução Nasal , Conchas NasaisRESUMO
Thermal burns of the larynx after swallowing hot foods or drinks are frequently common in children, but are known to be extremely rare in adults. We report the case of a male adult who, upon swallowing hot food, experienced a burn of the larynx with airway obstruction. Since airway obstruction usually occurs within hours of burn of the larynx, the importance of persistent airway management is emphasized in this case.
Assuntos
Adulto , Criança , Humanos , Masculino , Manuseio das Vias Aéreas , Obstrução das Vias Respiratórias , Queimaduras , Deglutição , Dispneia , LaringeRESUMO
Bullet embolism is a rare complication of non-penetrating gunshot trauma. There are two types of bullet embolisms: arterial and venous. Accurate preoperative localization of the bullet is important for selecting the proper surgical and anesthetic techniques. We report here on a rare case of venous bullet embolus to the right ventricle from the right iliac vein, as was demonstrated by transesophageal echocardiography.
Assuntos
Ecocardiografia Transesofagiana , Embolia , Ventrículos do Coração , Veia IlíacaRESUMO
BACKGROUND: General anesthesia is a balance between hypnosis and analgesia. Remifentanil is often combined with propofol to both induce and maintain total intravenous anesthesia. This study evaluated the effect of remifentanil on the propofol requirements for a loss of consciousness. METHODS: Forty adult patients with ASA 1 or 2 were enrolled in this study. The patients were randomly given either saline or remifentanil before the induction of anesthesia with an infusion of propofol, 15 mg/kg/h. In the remifentanil group, all the patients received a computer controlled infusion of remifentanil with a effect site concentration of 4 ng/ml. The times required for the patient to lose consciousness, the propofol requirements and the bispectral index at the loss of consciousness to verbal commands were recorded. RESULTS: In the remifentanil group, loss of consciousness was attained significantly faster and with lower propofol doses than in the saline group. The bispectral indices were significantly higher at loss of consciousness in the remifentanil group. CONCLUSIONS: A remifentanil infusion before the induction of propofol anesthesia significantly reduces the propofol requirements for the loss of consciousness. Remifentanil enhances the hypnotic effect of propofol.
Assuntos
Adulto , Humanos , Analgesia , Anestesia , Anestesia Geral , Anestesia Intravenosa , Estado de Consciência , Hipnose , Hipnóticos e Sedativos , Propofol , InconsciênciaRESUMO
BACKGROUND: The computer-assisted continuous infusion (CACI) system was developed to more rapidly attain and to maintain stable effect-site fentanyl concentrations as compared with the intermittent injection method. The CACI system allows the anesthesiologist to control effect-site fentanyl concentrations during various surgical stimuli during cardiac anesthesia. This system can rapidly control the depth of anesthesia and compensate for the disadvantages of IV anesthesia. Early patient recovery also enables early tracheal extubation, which is an important component of the "fast track" cardiac surgery pathway. In this study, the use of a target-controlled infusion of low-dose propofol was combined with the target-controlled infusion of fentanyl for patients undergoing coronary artery bypass graft surgery. The purpose of this study was to evaluate the proper effect-site concentration of fentanyl for the tracheal intubation of patients undergoing coronary artery bypass graft surgery. METHODS: Fifty patients scheduled for elective coronary artery bypass graft surgery were included, and randomly allocated to group L (effect-site fentanyl concentration = 5 ng/ml, n = 25) or group H (effect-site fentanyl concentration = 7.5 ng/ml, n = 25). Anesthesia was induced and maintained by the computer-controlled infusions of propofol and fentanyl. Hemodynamics and other variables were recorded preinduction, and before and 1 minute after intubation. RESULTS: The two groups were compared with regard to demographic and perioperative data. The two groups were similar demographically, and no significant differences was found in any hemodynamic parameter at any time between the two groups. CONCLUSIONS: Both fentanyl regimens provided stable hemodynamics and adequate anesthesia in patients during endotracheal intubation. It is reasonable to say that the lower dose of fentanyl (5 ng/ml) may be the better choice, because it provides the same level of anesthesia during endotracheal intubation during coronary artery bypass graft surgery.
Assuntos
Humanos , Extubação , Anestesia , Ponte de Artéria Coronária , Vasos Coronários , Fentanila , Hemodinâmica , Intubação , Intubação Intratraqueal , Propofol , Cirurgia Torácica , TransplantesRESUMO
Enflurane, and isoflurane potentiated for the vecuronium-induced neuromuscular blokade in a study of 30 patients anesthetized with 1.0 or 1.5 MAC enflurane, and isoflurane or ketaminefentanyl. In the patients anesthetized with 1.0 MAC isoflurane or enflurane, 50% nitous oxide was administrated simultaneously. The median effective dose of vecuronium m the ketamine-fentanyl anesthesia patients(34,0+/-1.2 ug/kg) was higher than that in the 1.0 and 1.5 MAC enflurane or isoflurane patients(2l.2+/-3.2 and 19.4+/-2.7, or 17.8+/-4.5 and 20.0+/-5.3 ug/kg, respectively). There is no significant difference in ED 50 and ED 95 between 1.0 and 1.5 MAC with enflurane or isoflurane. The duration in patients with enflurane was longer than that in the other groups. But, there is no difference in recovery indices among all the groups. The authors conclude that enflurane or isoflurane potentiantes the vecuronium-induced neuromuscular blockade comparing with ketamine-fentanyl anesthesia. Enflurane prolongs the duration of vecuronium in contrast to isoflurane. But, there is no significant difference between 1.0 and 1.5 MAC in same anesthetic considered usually as clinical anesthetic depth.
Assuntos
Humanos , Anestesia , Anestésicos Inalatórios , Interações Medicamentosas , Enflurano , Isoflurano , Fármacos Neuromusculares , Bloqueio Neuromuscular , Brometo de VecurônioRESUMO
The interaction between succinylcholine(SCC) and non-depolarizer; atracurium or vecuronium, was investigated in 36 cats of either sex using the sciatic nerve-anterior tibialis muscle preparation. And also, its relation to the pseudocholinesterase activity was examined. The duration of action of vecuronium(6.5+/-1.3 to 7.3+/-2.2 minutes) in cats pretreated with SCC was greater than those(2.0+/-0.6 minutes) in non-pretreated cats. However, SCC had no influence on the duration of atracurium. The serum pseudocholinesterase activity was decreased after the injection of atracurium or neostigmine in contrast to vecuronium. The authors conclude that the prior administration of SCC prolongs the duration of vecuronium but not that of atracurium, and pseudocholinesterase activity is not related to the prolonging effect of SCC.