Abdominal Tuberculosis Combined with Abdominal Trauma

Abdominal tuberculosis is a rare disease, about 5% of extra-pulmonary tuberculosis. However, the diagnosis of abdominal tuberculosis is difficult, because of its atypical symptoms and signs, and ambiguous results upon physical examination. When abdominal tuberculosis is combined with abdominal injury, the diagnosis will be especially complex. We present our experience of abdominal tuberculosis associated with abdominal trauma.

Initial Unmeasured Anions on Emergency Department in Critically ill Patients: Can they Predict the Morbidity?

PURPOSE: To determine whether initial corrected anion gap (C(o)AG), base excess caused by unmeasured anions (BEua), and strong ion gap (SIG) can predict the morbidity of critically ill patients admitted to emergency department (ED). METHODS: 138 patients who visited the critical section of the ED and were admitted to intensive care unit (ICU) were enrolled. We calculated the C(o)AG, BEua, and SIG from the initial blood samples of the patients and initial logistic organ dysfunction score (LODS) also. Then we measured the LODS at the last day of ICU stay again. Comparing with the initial LODS, we divided the patients into two groups based on the changes of the values: favorable group and poor group. RESULTS: There was a significant difference in the mean AGcorr (p=0.007), BEua (p=0.008), SIG (p=0.037) between favorable and poor group. The area under the receiver operating characteristic (AUROC) curves for morbidity prediction were relatively small: 0.66 (95% CI, 0.56-0.77) for C(o)AG, 0.65 (95% CI, 0.54-0.76) for BEua, and 0.59 (95% CI, 0.49-0.70) for SIG. CONCLUSION: We found the initial unmeasured anions at the ED of the patients who eventually showed improved LODS during ICU period are significantly different to those of the other patients. But they failed to show enough capability of discriminating the morbidities between two groups.

The Effect of Lumbar Sympathetic Block in Interstitial Cystitis: A case report / 대한통증학회지

Interstitial cystitis is an extremely painful and distressing condition, characterized by severe suprapubic pain, which increases with bladder filling and is relieved by voiding. The daily frequency of micturition may approach 100 times, but no incontinence is observed. The symptoms persist throughout the night, which consequently affects sleep. The etiology of this condition is still unknown, but includes infection, autoimmune response, allergic reaction, neurogenic inflammation, epithelial dysfunction and inherited susceptibility. Herein, a case of interstitial cystitis, with severe symptoms, which was successfully treated with lumbar sympathetic block, is reported.

The Effect of Vecuronium on Intraocular Pressure / 대한마취과학회지

Thirty healthy patients were studied to evaluate the effect of muscle relaxants on intra-ocular pressure (IOP) during anesthesia. The patients were divided intro three groups-succinrlcholine group(Img/k7,n=10) , pancu-ronium group(0.08mg/kg,n=10), and vecuronium group(0, Img/kg,n=10) according to the muscle relaxants used. All patients were premedicated with robinul 0.2mg and lorazepam 4mg one hour before surgery. Tracheal intubation was fellowed by thiopental sodium 5mg/ kg and muscle relaxant. Anesthesia was maintained with O2-N2O-enflurane and respiration and was controlled by anesthetic ventilator (Dameca). The lOP was measured hy Schotz tonometer, before induction of anesthesia, at 75~100% depression of twitch height on train of-four after injection of muscle relaxant, and at 1,3, 5, 10, minutes after intubation respectively. Heart rate, mean arterial pressure, and end-tidal CO2 tensions were also measured simultaneously. The results were as follows ; 1) At 75~100% depression of twitch height, IOP wart elevated significantly in succinylc-holine group but reduced significantly in both pancuronium and vecuronium groups as Compared With pre induction value. 2) IOP was elevated in all groups after 1 minute of intubation, there were no statistical significance in pancuronium or vecuronium group as compared with pre induction value. After 3 minutes of intubation, IOP was reduced in all groups in proportion to the depth of anesthesia. 3) Cardiovascular changes in vecuronium group were less than those in succinrlcholine or pancuronium group. In conclusion vecuronium, with less cardiovascular changes, may be indicated for anest-hesia of open eye injury compare other muscle relaxants.

The Effect of Continuous Infusion of Vecuronium on Muscle Relaxation / 대한마취과학회지

In order to obtaine the constant, stable muscle relaxation, vecuronium was infused con-tinuously at fixed rate(0.06 mg/kg/hour) in 30 ASA class l & ll adult female Patients und-ergoing explorative laparatomy. All patients were premedlcated with Robinul 0.2 mg and hydroxyzine 1.5mg/kg IM 1 hour Prior to anesthesia. Starting infusion of vecuronium, anesthesia was induced with thiopental 5-6 mg/kg and vecuronium 0.08 mg/kg. Endotrach-eal intubatioo was Pperformed at 77~100% depresaion of twitch height monitored by train-of-four stimulation(2Hz) of the ulnar Nerve. Anesthesia was maintained with O2-N2O-enflurane. The patients were divided into three group: 1) Group l(n=10) : spontaneous recovery of neuromuscular block. 2) Group ll(n= 10) : reversed with neostigmine(0.02 mg/kg) at 25% twitch recovery after infusion stop. 3) Group lll(n= 10) : Reversed with same dose of neostigmine immediately after infus-ion Stop. The results were as follows ; 1) The onset times of 50% and 75-l00% twitch depression were average 122+/-23.72 sec. and 162+/-32.08 sec. respectively. 2) The neuromuscular response during infusion was well maintained less than 17% of control twitch height in all cases, and objeotive muscle relaxation was satisfactory. 3) The times of twice recovery from 25% to 75%(recovery index) were 27.9+/-13.02 min. in Group l, 8.6+/-4.44min. in Group ll, and 10.0+/-3.81min. in Group lll. Recovery index was shortened significantly in Group ll&lll compaired to Group I (p7.05) . 5) Tidal volume and end-tidal CO2 tension before extuhation were within normal range in three group. 6) Abilities of open-eyes, tongue Protrusion, and head-lift for 5 seconds at recovery room were confirmed In all cartes. In conolusion, this technique is not definite in routine use. It would, however, be possible to adapt this infusion ramie to apply in male Patient, in patient with liver or kidney disease, or in long-term respiratorr care at intesive care unit.

Anesthesia for Pheochromoeytoma Removal / 대한마취과학회지

We recently had a patient(46 year-old) who was to undergo resection of a pheochromocytoma. The patient was treated with phenoxybenzamine for about 2 weeks preoperatively. Thiopental was used for induction followed by N2O-O2-halothane. An endotracheal semiclosed circle absorption technique with controlled ventillatian was employed. The course of anesthesia was rather stormy, reflectedby hypertension, arrhythmia and hypotension, but the patient talerated the anesthesia and surgery well with appropriate cardiovascular control using regitine, levophed, lidocaineand intravenous fluids. Importance of preoparative preparation, sufficient sedation, smooth induction, complete analgesia, good muscuar relaxation, adequate alveolar ventillation and proper cardiovascular control has been discussed. Recently some reviews of the literature on the anesthetic management of pheochromocytoma suggest that the selection of an anesthetic agent is not as important as the adequate management of the characteristics of these agents which affect the anesthetic procedures.

A Clinical Comparison of Pancuronium and Succinylcho! ine for Cesarean Section Anesthesia / 대한마취과학회지

In this study, we adopted two different general anesthetic techniques for Cesarean section. Patients were randomly assigned to two groups; Group I ; 51 patients, thiopental-succinylcholine-nitrous oxide-oxygen supplemented with ether or halothans anesthesia. Group II 67 patients, pancuronium-thiopental-nitrous oxide-oxygen supplemented with ether or halothane anesthesia. Group I (Succinylcholine group): 51cases were induced for anesthesia with 150~250mg of thiopental and intubated with 1mg/ kg of succinylcholine followed by 100% oxygen with controlled ventilation. After delivering the fetus, anesthesia was maintained with nitrous oxide-oxygen-ether or halothane throughout- the procedure. Group III (Pancuronium group); Anesthesia was performed with150~250mg of thiopental, 0. 08mg/kg of pancuronium with endotracheal intubation for 67 patients. After delivery, nitrous oxide with oxygen and supplemental ether or halothane were given, if necessary. It was concluded that incidence of hypotension was less in the pancuronium group, and no evidence of fetal effects was seen. And there is no clinical evidence of significant placental transfer of pancuronium and that this is a safe and efficacious agent for incorporation into the nitrous oxide-relaxant anesthetic technique for Cesarean section. No clear superiority of succinylcholine over pancuronium was demonstrated in this study.

Thiopental Anaphylaxis: A Case Report / 대한마취과학회지

Millions of injection of sodium thiopental have been clinically used since it was introduced by Lundy in 1934. As with other barbiturates, cutaneous allergic manifestation are rather frequently seen, but reports of anaphlyactic reactions are rare. Probably many cases have not been recognized or have been misdiagnosed. It is believed that some cases of unexplained collapse or even death after thiopental inductions are very possibly due to an unrecognized anaphylactic action. This report presents a case of anaphylactic action due to injection of sodium thiopental and the references were reviewed.