A Case Report of Temporal Arteritis / 대한마취과학회지

Temporal arteritis, also referred to as giant cell arteritis, is defined as a granulomatous vasculitis in people age 50 years or older. We are going to report a case of temporal arteritis. A 67-year-old woman had a headache in the right posterior auricular area. The pain character was pulsatile, paroxysmal and lancinating. On examination her body temperature was 36.6degrees C and allodynia existed in the C2 dermatome. No other positive signs were found. The laboratory results were as follows: white blood cells 7,000/mm3, hemoglobin 9.6 g/dl, erythrocyte sedimentation rate 120 mm/hr, C-reactive protein 11.0 mg/dl and SGPT 33 IU/L. Radiographs of a brain CT, cervical MRI and cervical MRA appeared normal. A cervical epidural block and C2 ganglion block were done but effects were transcent. Temporal arteritis was suspected due to an elevated erythrocyte sedimentation rate and C-reactive protein, anemia and old age. Prednisolone 60 mg/day was given and the patient recovered within 10 days. As a result, the diagnosis was made by a combination of clinical features, laboratory findings and response to steroids. The patient was sucessfully treated with a steroid.

A Reduction of Plasma Antidiuretic Hormone (ADH) during Mastoidectomy with General Anesthesia: Preliminary Study / 대한마취과학회지

BACKGROUND: It has been said that anesthesia and surgery tend to increse 'stress hormone' followed by reduction of GFR and urine flow. We have been noticed a polyuria during mastoidectomy with anesthesia. We hypothesized that a reduction of ADH secretion related to operative procedure might be a cause of a transient polyuria. METHODS: In 41 patients who were in ASA class I, mean arterial pressure (MAP), heart rates (HR), temperature, central venous pressure (CVP) were measured at before induction, just before drilling with irrigation, 30 minutes and 60 minutes after drilling with irrigation, and on arrival in recovery room by groups (room temperatured irrigating fluid and warm fluid were used in group 1 and group 2) during procedures. In 7 of 41, blood samples for antidiuretic hormone (ADH) and plasma osmolalities (Posm) were withdrawn at the same time points. In all patients, fluid were administered with 4 ml/kg/hour throughout the procedures. RESULTS: In group 1, mean urine volume were 5.0 and 6.4 ml/min during anesthesia and drilling with irrigation that was significantly more than in group 2 (3.6 and 4.2 ml/min). In 7 patients, ADH concentration was decreased during surgery compared to pre-induction level, while the Posm were in normal ranges. None of the MAP, HR and CVP showed significant changes. ADH concentrations were not significantly correlated to Posm. CONCLUSIONS: We suggest that a reduction of ADH secretion may have a major role in transient polyuria during mastoidectomy, which might be related to the mechanism that; 1) lowered temperature of hypothalamo-pituitary system by cold irrigating fluid may induce a transient ischemic changes of pituitary gland, 2) absorption of hypoosmolar irrigating fluid to central circulation may reduce central osmotic pressure.