Reversible Cerebral Vasoconstriction Syndrome Induced by Blood Transfusion

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headache with reversible vasoconstriction of the cerebral arteries. RCVS has been reported to occur in various clinical settings. However, RCVS triggered by blood transfusion is rare. A 50-year-old woman had severe anemia and received multiple blood transfusions. She developed thunderclap headache after transfusion. Cerebral artery vasoconstrictions were demonstrated by magnetic resonance angiography and transfemoral cerebral angiography. RCVS might be triggered by red blood cell transfusion in patients with severe anemia.

Osmotic Demyelination Syndrome Presenting with Emotional Incontinence

No abstract available.

Comparison of the PANArray HPV Genotyping Chip Test with the Cobas 4800 HPV and Hybrid Capture 2 Tests for Detection of HPV in ASCUS Women

PURPOSE: This study aimed to evaluate the performance of the PANArray human papilloma virus (HPV) test, a PCR-based DNA microarray assay, in detecting HPV from patient samples and its concordance with the cobas 4800 HPV and Hybrid Capture 2 (HC2) tests. MATERIALS AND METHODS: The PANArray HPV, cobas 4800 HPV, and HC2 tests were performed on 504 cervical swab samples from patients with atypical cells of undetermined significance at five hospitals. The samples that were interpreted as ‘HPV-other’ type positive in the PANArray HPV test were confirmed by direct sequencing. RESULTS: The concordance rates were 80.8% between the cobas 4800 HPV and PANArray HPV tests [κ=0.59, 95% confidence interval (CI) 0.52–0.66] and 80.2% (κ=0.6, 95% CI 0.55–0.68) between the HC2 and PANArray HPV tests. Among the 62 patients negative on PANArray HPV (defined as the absence of high risk HPV), but positive on both cobas 4800 HPV and HC2 tests, 42 (67.7%) tested positive for ‘HPV-other’ types on the PANArray HPV test, and 31 (50.0%) had gray zone results [relative light unit/control (RLU/CO), 1.4–9.25] in the HC2 test. Of the patients deemed positive by the PANArray HPV test, 43 tested positive for high-risk (HR) HPV in cobas 4800 HPV and HC 2 tests. Among them, 58.2% showed HR HPV, including HPV 16, by direct sequencing, of which 25% had gray results. CONCLUSION: Results classified as ‘HPV-other’ type by the PANArray HPV test, or gray zone results by HC2 (RLU/CO ratio level 1–10) should be carefully interpreted using comprehensive clinical information.

Metronidazole-Induced Encephalopathy with Thiamine Deficiency

Metronidazole-induced encephalopathy (MIE) can be caused by excessive dose or prolonged metronidazole administration. The signal abnormalities in the cerebellar dentate nuclei, midbrain, dorsal pons and corpus callosum on magnetic resonance imaging are considered as the characteristic feature of MIE. Although the mechanism of MIE remains to be elucidated, various hypothesis have been proposed including the role of metronidazole as a thiamine antagonist. Here we report a 58-year-old woman with MIE who coincidentally presented with thiamine deficiency.

The Incidence Rate of Lymphadenitis after Bacille Calmette-Guérin (BCG) Vaccination

PURPOSE: Bacille Calmette-Guérin (BCG) lymphadenitis is a relatively frequent local adverse reactions after BCG vaccination. Its incidence rate is usually <1%. However, this rate may be different according to BCG strain, vaccination method or skill, etc. In the Republic of Korea, two BCG strains are used: intradermal Danish-1331 or percutaneous Tokyo-172. We surveyed the incidence rates of BCG lymphadenitis. METHODS: This survey was performed in total 25 centers (5 general hospitals, 20 private pediatric clinics). Immunized type of BCG strain in study subjects was verified by directly observing the scar. The occurrence of BCG lymphadenitis was asked to their parent. In cases of BCG lymphadenitis, location, diameter size, progression of suppuration, and treatment method were investigated, as well. RESULTS: The total number of study subjects was 3,342. Among these, the subjects suitable for enrollment criteria (total 3,222; Tokyo strain 2,501, Danish strain 721) were analyzed. BCG lymphadenitis regardless of its size developed in each five of subjects per strains, therefore, its incidence rate was 0.20% in Tokyo and 0.69% in Danish strain, respectively (P=0.086). However, when applying the WHO criteria - the development of lymph node swelling with diameter 1.5 cm or more, the incidence rate of BCG lymphadenitis was 0.16% (4 cases) in Tokyo and 0.42% (3 cases) in Danish strain, respectively. CONCLUSIONS: The incidence rate of lymphadenitis in two BCG types, percutaneous Tokyo and intradermal Danish strain BCG, is 0.20% and 0.69%, respectively. Both rates are acceptable.

Cardiac arrest following reversal of muscle relaxation by pyridostigmine: A case report

The anticholinesterase pyridostigmine is usually used as a reversal agent of non-depolarizing muscle relaxants in general anesthesia. Most adverse muscarinic effects of anticholinesterases are controlled by anticholinergics; however, there is still a potential for fatal cardiac complications. We report a case of cardiac arrest associated with coronary vasospasm that developed during emergence from general anesthesia in a 61-year-old male patient undergoing uvulopalatopharyngoplasty with preoperatively undiagnosed coronary vasospastic angina. Anticholinesterases should be administered with caution for neuromuscular blockade reversal, especially in patients with coronary vasospastic angina.

Bilateral recurrent laryngeal nerve palsy in a patient undergoing consecutive thyroid operations / 대한마취과학회지

No abstract available.

Regulation of paclitaxel-induced programmed cell death by autophagic induction: A model for cervical cancer

OBJECTIVE: Autophagy plays a vital role in homeostasis by combining organelles and cellular proteins with lysosome under starvation conditions. In addition, autophagy provides tumor cells with a source of energy. Continued autophagy will induce cells death. Here we aim to see if autophagic induction has an effect on conventional chemotherapeutic agents. METHODS: Rapamycin, or mammalian target of rapamycin and paclitaxel, apoptosis-inducing agents were used autophagy in HeLa cervical cancer cells. RESULTS: Growth inhibition of cells was not observed after the application of 0, 10, 20 nM of paclitaxel with or without rapamycin. Using a 5 nM concentration of paclitaxel, rapamycin administration inhibited cell growth significantly compared to no treatment. This implies the synergic antitumor effect of paclitaxel and rapamycin. Paclitaxel itself did not show any autophagic effect on cells but did show cell apoptosis by flow cytometry. Light chain 3, a microtubule-associated protein, which reflect autophagy, was increased with 5 nM of paclitaxel after pretreatment with 10 nM of rapamycin. CONCLUSION: These findings suggest that the autophagic inducer, rapamycin, can potentiate autophagic cell death when added as an apoptosis-inducing chemotherapeutic agent. In conclusion, the control of autophagy may be a future target for chemotherapy.

Efficacy and Safety of Propiverine in Children with Overactive Bladder

PURPOSE: Antimuscarinic therapy remains one of the most common forms of therapy for overactive bladder (OAB) in children. However, few clinical studies on the outcomes of antimuscarinics in children with OAB have been published. Therefore, we evaluated the efficacy and safety of propiverine, which is frequently prescribed for the treatment of pediatric OAB. MATERIALS AND METHODS: We retrospectively reviewed children with OAB treated with propiverine within the past 5 years. The response rates were compared between the non-urge incontinence (non-UI) and urge incontinence (UI groups). The cumulative response rate by treatment duration was also compared between the two groups. RESULTS: Among a total of 68 children, 50 children (73.5%) experienced UI. The overall response rate was 86.8%. Functional bladder capacity after treatment was 150 ml, which represented an increase compared with the value (140 ml) before treatment. The voiding frequency per day decreased from 14.0 to 8.5 times. The overall response rate (88.0%) in the non-UI group was not significantly different from that seen in the UI group (83.3%; p>0.05). In non-UI children, the cumulative response rates were 36.0%, 54.0%, 68.0%, 74.0%, 76.0%, and 78.0% at 4, 8, 12, 16, 20, and 24 weeks, respectively. The cumulative response rates in the UI children were 11.1%, 33.3%, 44.4%, 50.0%, 50.0%, and 55.6%, respectively during the same respective time periods. Adverse effects were identified in only two (2.9%) patients, and neither case was severe. CONCLUSIONS: Propiverine is effective and well tolerated as a treatment for children suffering from OAB with or without UI.

Survey of malignant hyperthermia in Korea: Report for the necessity of establishing the center for caffeine and halothane contracture test in Korea: a questionnaire

BACKGROUND: Malignant hyperthermia (MH) has a high mortality rate and a family history. Then, caffeine and halothane contracture test (CHCT), generally used to detect MH susceptibility, is needed for early detection. The aim of this survey is to collect the opinion about establishment of the center for CHCT in Korea. METHODS: A people who were anesthesiologists working in the training hospital of Korea participated the survey between January and March 2011. Usual anesthetic drug during general anesthesia including volatile agents, opioids, muscle relaxants, incidence, diagnoses and treatments of MH, and opinion about establishment of the center for CHCT, were investigated. RESULTS: A total of 105 people who were anesthesiologists working in Korea were registered, they answered that 33 anesthesiologists (32%) met MH patient, and MH occurred once in a decade. If there is a diagnostic method such as CHCT in Korea, 89 anesthesiologists (89%) will recommend the test for the patients and their family. CONCLUSIONS: Many anesthesiologists want to recommend the CHCT for patients and their family. But, in Korea, it is impossible because there is no laboratory available for CHCT. Now, we considered carefully to establish the laboratory available for CHCT.

Anesthetic care for electroconvulsive therapy during pregnancy: A case report / 대한마취과학회지

Electroconvulsive therapy (ECT) is recommended for patients with psychotic disorders that do not respond to medication. Usually, many psychotropic medications have teratogenic effects on the fetus. ECT seems to be a relatively safe and effective treatment during pregnancy. We report here on a 33-year-old primigravida patient in her third trimester receiving ECT.

A case of life-threatening post-operative diffuse alveolar hemorrhage in patient with recent chemotherapy: A case report / 대한마취과학회지

A 53-year-old woman who had undergone total gastrectomy and received adjuvant chemotherapy two months ago underwent adhesiolysis of the small bowel. She presented with sudden desaturation and dyspnea of unknown etiology at postanesthetic care unit. Following ET intubation, the endotracheal tube suction revealed massive hemoptysis. Bilateral lung infiltrated on her chest radiograph and bronchofibroscopic examination disclosed a diffuse hemorrhage on both lung fields without bleeding focus. These findings were consistent with diffuse alveolar hemorrhage (DAH) syndrome. As per our knowledge and search, this is the first reported case of DAH that occurred during the recovery period immediately after general anesthesia. DAH is known to have a high mortality rate and an early detection followed by adequate treatment is essential.

Anesthetic efficacy of etomidate, propofol and thiopental sodium during electroconvulsive therapy

BACKGROUND: Electroconvulsive therapy (ECT) is effective for major psychosis and affective disorder. The ideal anesthetics for ECT provide rapid induction and recovery, and they attenuate the adverse effects of ECT. We compared the effects of etomidate, propofol and thiopental sodium during ECT. METHODS: Nine patients were enrolled in this double blinded cross over design study. The ECT was done 3 times per week for two weeks. We monitored the patients with electrocardiography, pulse oximetry, the bispectral index score and the blood pressure. We recorded the data at the time of arrival to the therapy room, just before ECT and at 1, 2, 3, 4, 5, 7 and 10 minutes after ECT. Hypnosis was induced with 3 mg/kg of thiopental sodium (group T), 1.5 mg/kg of propofol (group P) or 0.15 mg/kg of etomidate (group E). The ECT was done after administering 1 mg/kg of succinylcholine. The duration of seizure were measured after ECT. RESULTS: There were significantly different durations of motor seizure among the three groups. The duration of EEG seizure in group E was longer than that of group P and group T. The blood pressure and the heart rate of group P were significantly lower than that of the other groups (P < 0.05). CONCLUSIONS: Compared to thiopental sodium and etomidate, propofol was not associated with clinically significant changes in the duration of seizure and hemodynamic stability. It has a good hypnotic effect and it did not affect the therapeutic efficacy of ECT. Etomidate is effective for patients for achieving a short duration of seizure after ECT is applied.

Acute Respiratory Distress Syndrome with Chemical Pneumonitis after Aspiration of Activated Charcoal: A Case Report / 대한구급학회지

Charcoal has been commonly used for enteral detoxication although it causes few adverse effects. The major causes of morbidity and mortality secondary to activated charcoal therapy are pulmonary aspiration, gastrointestinal complication, and fluid and electrolyte abnormalities. Aspiration of charcoal is associated with pulmonary compromise due to increased microvascular permeability with concomitant lung edema, surfactant depletion, atelectasis, and obliterative bronchiolitis. Herein we report the case of a patient with acute respiratory distress syndrome with chemical pneumonitis after aspiration of activated charcoal in sorbitol with a review of the related literatures.

Effects of waglerin-1 in mice hindlimb muscle during immobilization

BACKGROUND: Three isoforms of the neuronal acetylcholine receptors (AChRs) have been described in muscle epsilonAChRs, gammaAChRs and alpha7AChRs. The adult neuromuscular junctions are composed of epsilonAChRs. During immobilization, new AChRs with subunit compositions of gammaAChRs and alpha7AChRs appear in the perijunctional and extrajunctional area. This study evaluated the contribution of these isoforms to neurotransmission during immobilization, by using waglerin-1 which selectively blocks the epsilonAChRs. METHODS: Male mice (n = 20) were used and each group was divided into sham operated or immobilized. A leg was immobilized in mice for 14 days by pinning, after which nerve-evoked twitch tension was examined under anesthesia in tibialis muscle of both legs, with the contralateral leg serving as control. Neuromuscular transmission was monitored by using a peripheral nerve stimulator with the tibialis muscle and sciatic nerve. Electrical stimuli of 0.2 msec duration were applied to sciatic nerve 2 Hz for 2 sec every 30 sec. After administration of waglerin-1, the evoked twitch was recorded. The percent depression of T1 relative to baseline was transformed to probit scale to determine the effective dose of waglerin-1 for 5%, 50%, and 95% twitch depression. RESULTS: The twitch tension in the control group was higher than immobilized group, confirming the efficacy of immobilization. Waglerin-1 produced 99% twitch suppression on the control group. But on the immobilized group, waglerin-1 produced only 70% twitch suppression even at 37 pg. CONCLUSIONS: The functional role of epsilonAChRs in neurotransmission decreases during immobilization while that of gammaAChRs and alpha7AChRs increases.

Anesthetic management of renal cell carcinoma that extended into the right atrium through the inferior vena cava: A case report

Renal cell carcinoma (RCC) rarely extends to the cardiac chambers, and the presence of an extension of tumor thrombus to the inferior vena cava or the right atrium has not been shown to determine the survival of patients with RCC.Although an aggressive surgical approach remains the primary treatment for RCC, the anesthetic management remains a difficult intraoperative challenge.We report here on a case of performing cavoatrial tumor thrombectomy and radical nephrectomy in a patient with RCC with an intracardiac extension, and we used cardiopulmonary bypass and intraoperative trans-esophageal echocardiography to assess and treat this tumor.

A survey of postoperative residual neuromuscular block and neuromuscular monitoring

BACKGROUND: To aware of postoperative residual neuromuscular block (PRNB) is important in that it can cause apnea, delay of awakening and recovery and dissatisfaction of patient.This study aimed to evaluate the PRNB at recovery room and it's course during postoperative periods. METHODS: A questionnaire designed to provide information concerning PRNB, monitoring and reversal on neuromuscular block was sent to all members of the Korean Society of Anesthesiologists by e-mail.The contents of survey were about the incidence of PRNB, the monitoring methods of the muscle relaxation.We also investigated the usual type of neuromuscular blocker and reversal agents. RESULTS: Most responders (85.9%) concerned about the PRNB of which causing a serious problem.More people answered that clinical evaluation was more reliable (83.3%) than tetanic stimulation (46.2%) and neuromuscular monitoring might reduce PRNB. Some responders (11.5%) sometimes omitted the reversal of neuromuscular block.Quantitative neuromuscular monitoring devices were not enough to use in all patients at all hospitals. CONCLUSIONS: The responders had great interest to PRNB but neuromuscular monitoring and reversal of neuromuscular blockade were underused.

Ultrasound-guided evaluation of the bifurcation of the femoral artery and vein in pediatric patients / 대한마취과학회지

BACKGROUND: The femoral arteries (FA) and femoral veins (FV) are useful access sites for diagnostic and interventional procedures. In adults, the usual puncture sites are 1-3 cm distal from the inguinal crease. In children, however, the optimal puncture site vessels are not known. The aim of our study was to assess the number of branches and bifurcation sites of the femoral vessels in children by using ultrasonography. METHODS: Color Doppler ultrasonography was used to determine bifurcation sites of the FA and FV, relative to the inguinal crease, in 48 children (median age, 4 yr; median weight, 18.7 kg) with American Society of Anesthesiologists (ASA) Physical Status (PS) score 1-2 and who were scheduled for general anesthesia. RESULTS: The numbers of FAs and FVs at the inguinal crease were 1.83 +/- 0.39 and 1.08 +/- 0.29, respectively, in infants, and 1.83 +/- 0.58 and 1.0 +/- 0.0, respectively, in 10-year-old children. The bifurcation site of the FA in infants and those aged 10 years was 0.78 +/- 0.30 cm and 1.47 +/- 0.27 cm proximal to the inguinal crease, respectively (P < 0.05), whereas the bifurcation site of the FV in these two age groups was -0.96 +/- 0.27 cm and -2.29 +/- 1.09 cm distal to the inguinal crease, respectively (P < 0.05). CONCLUSIONS: In children, the FA frequently bifurcates proximal to the inguinal crease, whereas the FV bifurcates distal to the inguinal crease. However, there are anatomical differences among age groups, so care should be taken to avoid complications during femoral vessel cannulation.

Clinical survey of sedation and analgesia procedures in intensive care units / 대한마취과학회지

BACKGROUND: The proper use of sedation and analgesia in the intensive care unit (ICU) minimizes its physical and psychological impact. Otherwise, patients can suffer from recall, nightmares, and depression after discharge. We investigated the sedatives, analgesics, and muscle relaxants used in the ICU. METHODS: We visited 79 ICUs in 52 training hospitals and noted the use of sedatives, analgesics, and muscle relaxants from July, 2007, to December, 2007, using a 5-item questionnaire with 57 sub-questions. The survey evaluated the ICU system administration of analgesics and muscle relaxants. RESULTS: Most ICU management is done by the anesthesiology department (55%). Most have resident doctors (63.3%) and an ICU committee (60.8%) in charge of the ICU, as well as a special ICU chart (88.6%) and scoring system (65.8%). Most hospitals have a consulting system (94.9%). The standard ICU analgesics are fentanyl (65.8%), NSAIDs (53.2%), and morphine (48.1%). CONCLUSIONS: Adequate sedation is difficult to achieve in the ICU, but is important for patient comfort and to reduce ICU stay duration. Awareness of patient status and appropriate drug/protocol use are therefore important.

Venovenous bypass using central venous catheter during liver transplantation / 대한마취과학회지

No abstract available.