Effects of Mivacurium in the Patients with Myasthenia Gravis / 대한마취과학회지

BACKGROUND: Myasthenia gravis is an autoimmune neuromuscular disorder that shows increased sensitivity to nondepolarizing muscle relaxants. Mivacurium chloride is a short acting nondepolarizing neuromuscular blocker and a benzylisoquinolin diester that is hydrolized rapidly to inactive metabolites by plasma pseudocholinesterase. The onset and duration of mivacurium in patients undergoing a thymectomy with myasthenia gravis was studied. METHODS: Fifteen patients undergoing a thymectomy for myasthenia gravis and fifteen patients of ASA class I, II without liver, kidney or neuromuscular disease undergoing orthopedic surgical procedures were included in this study. Anesthesia was induced with thiopental 4 5 mg/kg and maintained with inhalation of N2O:O2 (1:1) and enflurane 1.0 2.0 vol%. Mivacurium 0.2 mg/kg was given as a muscle relaxant and then intubation performed after the twitch response was depressed more than 90%. Neuromuscular relaxation was assessed by TOF (T1) at the adductor pollicis with supramaximal stimulation of the ulnar nerve at 2 Hz every 12 seconds. The onset and duration of 5%, 25%, 50%, 75%, and 95% recovery time of T1 and recovery index were recorded. RESULTS: Onset of block was shortened but recovery time of 5%, 25%, 50%, 75%, 95% and recovery index were prolonged in patients with myasthenia gravis. CONCLUSIONS: In patients with myasthenia gravis, mivacurium induced rapid onset time and prolonged recovery time of 5%, 25%, 50%, 75%, 95% and recovery index.

Analysis of Reported Cases of Malignant Hyperthermia in Korea / 대한마취과학회지

BACKGROUND: Malignant hyperthermia (MH) is a hypermetabolic disorder of skeletal muscle that manifests after exposure to triggering episodes such as halothane or succinylcholine. The first case was reported in Australia on 1960 by Denborough. In Korea the first case report was made by Lim on 1971. The authors retrospectively analysed the reported cases of MH and/or masseter muscle rigidity in Korea for the establishment of appropriate diagnostic criteria and rapid treatment. METHODS: Twenty-one cases of MH and 2 cases of masseter muscle rigidity were analysed retrospectively form 1971 to 1995. These cases were reported in Journal of Korea Society of Anesthesiology and Journal of Research Institute of Medical Science of Korea. The analyzed items were age, department, anesthesia, symptoms and signs, drugs for treatment, history of patient and family and prognosis of MH. RESULTS: The incidence of MH was higher in male patients below the 4th decade of life. The rate was 0.6 per year from 1971 to 1995. In nineteen patients, inhalation anesthetics with succinylcholine were suspected as triggering agents and 4 patients' conditions were related to spinal anesthesia by tetracaine. Only one case of MH occured within 10 min. after induction, but 22 cases occured during operations or the recovery period, and one case in the ward. The most common initial signs were muscle rigidity, high fever with arrhythmia and increased blood pressure. Related laboratory findings were acidosis, elevated end tidal CO2, and hyperkalemia. Six cases had family histories or past histories related to MH. CONCLUSIONS: The incidence of MH is progressively increasing in Korea. But MH will be prevented and treated effctively. So we should prepare a monitoring system for early detection and a supply of dantrolene for treatment. These precautions will spread nationwide and will need the support of the anesthesiology society and the goverment.

Nodular Type of Muscular Sarcoidosis: A Case Report

Muscular involvement of sarcoidosis is rare and occurs in two forms: nodular and myopathic. In the nodular variety, lesions are long and extend along muscle fibers. Axial MR imaging reveals a star-shaped central structure of decreased signal intensity. Sagittal and coronal MR images show three stripes: an inner stripe of decreased signal intensity and outer stripes of increased signal intensity. Longitudinal sonography shows an echogenic inner stripe and hypoechoic outer stripes. We report a case of nodulartype muscular sarcoidosis in a 53-year-old man, describing the findings of MRI and ultrasonography.

CT Findings in Differential Diagnosis of Pelvic Inflammatory Bowel Mass and Tuboovarian Abscess

PURPOSE: To evaluate the CT findings which may help differentiate pelvic inflammatory bowel mass(IBM) fromtubo-ovarian abscess(TOA). MATERIALS AND METHODS: Twenty-five patients with histologically confirmed TOA(n=14),periappendiceal abscess(n=9), an abscess caused by diverticulitis(n=1), and by ulcerative colitis(n=1) wereevaluated. For TOA, age distribution ranged only from the 3rd to the 5th decade, but for IBM, the range was the 2nd to 8th decade with highest frequency during the 3rd-4th decade. CT findings were retrospectively analysed forbilaterality, internal septa, anterior displacement of the mesosalpinx, and perirectal and mesenteric fat. RESULTS: Mesenteric fat infiltration was detected in all 11 cases of pelvic IBM, but in only two of 14 TOA cases(p<0.05).Anterior displacement of the mesosalpinx was observed in two of 11 pelvic IBM cases and in nine of 14 TOAcases(P<0.05). There were no significant difference in bilaterality, internal septa, or perirectal fatinfiltration. CONCLUSION: Mesenteric fat infiltration was the most reliable finding in differentiating pelvic IBMform TOA. Anterior displacement of the mesosalpinx, and age distribution were also helpful in differentiating thetwo disease groups.

Radiologic Findings of Endodermal Sinus Tumor of the Ovary

PURPOSE: To evaluate the radiologic features of endodermal sinus tumor of the ovary. MATERIALS AND METHODS:The radiologic findings of eight patients with pathologically-proven endodermal sinus tumor of the ovary wereretrospectively evaluated for bilaterality, size, margin, architecture, septa, local invasion, distant metastasis,ascites and lymphadenopathy ; serum alpha-FP was also evaluated. RESULTS: All endodermal sinus tumors were unilateralwith irregular septa and ascites ; the longest diameter was 7-18(mean, 12.6)cm. Four of eight tumors had smoothmargins and four, lobulated. Four were predominantly cystic in internal architecture, one was purely cystic, andthree were predominantly solid. There was local invasion or distant metastasis in three patients, andretroperitoneal lymphadenopathy in one ; in seven cases, alpha-FP level was more than 1.000ng/ml. CONCLUSION: Endodermal sinus tumors of the ovary appeared as nonspecific large complex abdominal masses and it was difficultto differentiate them from other malignant ovarian tumors. This tumor should be included in the differentialdiagnosis of a large complex abdominal mass in girls and young women, especially in patients with a predominantlycystic mass and markedly elevated serum alpha-FP.