Small Cell Carcinoma Manifesting as a Bulky Thoracic Mass in a Pregnant Woman: A Case Report

The classic presentation of small cell carcinoma is hilar or mediastinal lymph node metastases while the primary tumor remains an occult tumor. Grossly enlarged hilar and mediastinal lymph nodes can be frequently seen on the chest radiographs and CT scans. We report here on a case of small cell carcinoma that manifested as a unilateral bulky thoracic mass in a pregnant woman.

Maternal Anxiety related to Medication during Lactation and the Breast Feeding Rate / 대한주산의학회잡지

OBJECTIVE: To determine the type and frequency of medication taken by breast-feeding women and to evaluate the effects of maternal anxiety related to medication during lactation on the breast-feeding rate. METHODS: From April 15 to May 15 2003, we conducted a survey with a prepared questionnaire on ninety-one mothers who visited the obstetric clinics of Samsung Cheil hospital at eight weeks after delivery. The questionnaire contained information about parity, mode of delivery, whether to feed breast-milk, and the type and frequency of medicinal exposure. We also asked the degree of perceived adverse effects on her baby associated with maternal medication using 10cm visual analogue scale. RESULTS: The mean age of respondents was thirty-one years and the mean number of children born to the respondents was 1.3. At the eighth week after delivery the breast-feeding rate was 65.9%. The breast-feeding rate was not related to maternal age or the number of children but rather, the mode of delivery, which was 76.9% in NSVD, 70.0% in vaginal delivery with labor induction and 50% in cesarean delivery(P<0.05). The frequency of maternal medication intake during lactation was 50%. The most frequent type of medicine was herb medicine (36.7%). The average score of perceived adverse effect on a respondent's baby during breast-feeding was about 49% in total, which was 46.5% in NSVD, 48.9% in vaginal delivery with labor induction, and 51.2% in cesarean delivery. CONCLUSION: Most nursing mothers think that their medications during lactation affect adversely their babies, who, in turn, may be associated with the decrease of breast-feeding rate.

Awareness Detection during a Cesarean Section under General Anesthesia Using Bispectral Index Monitoring / 대한마취과학회지

BACKGROUND: A light plane of general anesthesia is chosen for fetal safety during a cesarean section. Therefore an experience of wakefulness and pain perception is not infrequent and can be distressful to patients. The electroencephalogram-derived bispectral index (BIS) is a promising new method to assess anesthetic adequacy. This study was designed to assess the adequacy of general anesthesia and to evaluate the usefulness of the BIS in monitoring the awareness during a cesarean section. METHODS: Twenty one parturients undergoing general anesthesia for an elective caesarean section were examined. Anesthesia was induced with 4 mg/kg thiopental and 1 mg/kg succinylcholine, and then followed with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min. Before administration of succinylcholine, a tourniquet was applied to the free arm and inflated to 250 mmHg. Responsiveness to verbal commands using the Tunstall isolated forearm technique was detected and the BIS was monitored throughout the study period. RESULTS: The incidence of responsiveness to verbal commands were 33% at the time of skin incision and fetal delivery respectively. BIS values of response to commands were significantly higher than that of no respose at both time points (p < 0.05). Fisher's exact test suggested that the BIS value less than 75 was related to unresponsiveness to verbal commands at time of skin incision (p < 0.05) and the BIS less than 85 at fetal delivery (p < 0.05). CONCLSIONS: These results suggest that adequate anesthesia is not provided with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min at the time of skin incision and fetal delivery. In addition BIS could be a predictor of awareness during cesarean section under general anesthesia.

The Effects of Stellate Ganglion Block on the Level of Blood Glucose, Uric Acid, and Catecholamines in the Induced Diabetic Rat / 대한마취과학회지

BACKGROUND: Stellate ganglion block (SGB) has been used to treat over 150 diseases which include diabetes mellitus and gout. This study was planned to investigate whether stellate ganglion block (SGB) could lower the levels of blood glucose, uric acid, epinephrine, and norepinephrine. METHODS: Sixty Sprague-Dawley rats within the weight of 250-350 gm were randomly devided into four groups. CS group was normal group with sham SGB with normal saline, CL group was normal group with SGB with lidocaine, DS group was diabetic group with SGB with normal saline, DL group was diabetic group with SGB with lidocaine. The diabetes was induced by intraperitoneal injection of 40 mg/kg of streptozotocin in citrate buffer (0.01 M, pH 4.5). Nondiabetic groups were given same amount of the citrate buffer. Seven days after the last injection of the streptozotocin blood glucose level was checked and more than 300 mg/dl was considered diabetic. The SGB was performed three times at right superior cervical ganglion two days apart from two days after the conformation of diabetes. Successful SGB was conformed by the ipsilateral ptosis or conjunctival congestion. Blood samplings from tail vein for the check of glucose, uric acid, and catecholamines were done before the injection of streptozotocin, seven days after the last injection of streptozotocin, and two days after the last SGB. RESULTS: The SGB with lidocaine reduced the blood glucose level only in the diabetic rats while SGB with the saline did not. The epinephrine levels were increased in the diabetics and decreased by the SGB with lidocaine without any statistical significance. Norepinephrine and uric acid levels had not been effected by the SGB and both of them had no correlationship with the glucose level. CONCLUSIONS: SGB in the diabetic rats decreases the blood glucose level. But for the effects of the SGB on the level of epinephrine further study would be needed.

Rocuronium Pretreatment for Prevention of Myalgia Following Succinylcholine Administration / 대한마취과학회지

BACKGROUND: The purpose of this study was to assess the effect of rocuronium pretreatment on the succinylcholine induced biochemical changes and fasciculations, myalgia and to compare it with vecuronium pretreatment. METHODS: We have studied 60 patients undergoing minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each were pretreated with saline 0.01 ml/kg (group C), rocuronium 0.05 mg/kg (group R), or vecuronium 0.007 mg/kg (group V). Three minutes after the pretreatment, 1.5 mg/kg succinylcholine was injected. Serum potassium five minutes after succinylcholine and creatine kinase 24 hr after operation were measured. Fasciculations and postoperative myalgia at 24 and 48 h were evaluated. RESULTS: The increase in creatine kinase and incidence of fasciculations were lowest in the rocuronium group (33 IU/L; 15%) and followed by vecuronium group (58 IU/L; 50%) and highest in the control group (101 IU/L; 100%). The increase in serum potassium concentration (0.3 mEq/L) was not attenuated by any regimen. The incidence of postoperative myalgia on day 1 and day 2 was lower in the rocuronium (40%, 30%) and the vecuronium (50%; 35%) group than control group (85%; 75%). CONCLUSIONS: Rocuronium pretreatment is more effective in reducing creatine kinase rise and fasciculations after succinylcholine than vecuronium. However rocuronium and vecuronium are also effective in preventing postoperative myalgia.