Epidural Granulocytic Sarcoma presenting as Thoracic Spinal Cord Compression: Case Report

STUDY DESIGN: A case report OBJECTIVES: This case report presents a patient with thoracic spinal cord compression, who had been on regular follow-up after being diagnosed with myelodysplastic syndrome. SUMMARY OF LITERATURE REVIEW: A granulocytic sarcoma is a rare tumor that occurs in the extramedullary sites, forming a localized lesion with a predilection in the orbit, sinus and periosteum. It rarely involves the central nervous system, particularly spinal cord. MATERIAL AND METHODS: For myelodysplastic syndrome, the patient underwent a bone marrow transplant for the condition. He was placed on conservative treatment until he developed sudden abdominal pain. He was admitted to our hospital through the emergency department. On the 2nd hospital day he complained of increasing weakness in his lower extremities. He underwent an emergency decompression of the spinal cord and his motor weakness completely disappeared. RESULTS: No signs of recurrence were found on the follow up performed at 2 years and 6 months. CONCLUSION: Epidural granulocytic sarcoma is rare but can be treated successfully.

Delayed activation-induced T lymphocytes death in aplastic anemia: related with abnormal Fas system

OBJECTIVES: To quantitate apoptosis and Fas antigen expression of T lymphocytes by activation in aplastic anemia (AA) and compare with that of normal controls and completely-recovered AA, and to investigate the apoptotic sensitivity to anti-fas antibody of activated T lymphocytes in AA. METHODS: We studied the expression of Fas antigen on fresh T lymphocytes of twenty patients with AA [13 newly diagnosed, 7 recorvered AA after immunosuppressive therapy (IST)], and investigated the activation-induced cell death (AICD) and Fas expression by activation [interleukin-2 (200 U/ml) and phytohemagglutinin (50 micrograms/ml)] in 5 newly-diagnosed AA, 5 normal controls and 5 AA in complete response (CR). Apoptotic sensitivity to anti-Fas antibody was assessed by the time-course kinetics of induction of cell death by anti-Fas antibody (500 ng/ml). RESULTS: There was no significant difference of Fas antigen expression on freshly-isolated T lymphocytes among newly-diagnosed severe AA, normal control s and patients with AA in CR after IST. In normal controls, T lymphocytes death was greatly increased at 3 days of activation, and Fas antigen expression on T lymphocytes was increased above baseline at day 1 of activation. In contrast, in newly-diagnosed AA, T lymphocytes showed delayed cell death, which correlated with a slowed increase of Fas antigen expression by activation. Also, anti-Fa s antibody sensitivity of activated T lymphocytes was decreased in newly-diagnosed AA. In completely recovered AA, these abnormal AICD and Fas antigen expressions by activation were recovered to normal range. CONCLUSIONS: Abnormal AICD plays a role in the immune pathophysiology of AA, and defective Fas system is involved in this process.

Erythrocyte Band 7 Integral Protein Defect in Congenital Hemolytic Anemia: Hereditary Stomatocytosis

Hereditary stomatocytosis is a rare congenital hemolytic anemia, named after mouth shaped or stomatocytic erythrocyte morphology. In this report, we present a case of a hereditary stomatocytosis in a 1 month old boy. During the initial identification process, we overlooked the morphology of the RBC in peripheral blood smear and tentatively diagnosed it to be a hereditary spherocytosis case. In order to study further, we isolated RBC membranes from the patient, separated membrane proteins by SDS polyacrylamide gel electrophoresis, and found that a protein band, band 7, was missing in the patient. We suggest that erythrocyte morphology as well as erythrocyte membrane protein analysis is an important criterion in the diagnosis of hereditary hemolytic anemia.

Clinical Evaluation of Alkalinized Lidocaine for Epidural Anesthesia / 대한마취과학회지

Epidural anesthesia is often preferred over spinal anesthesia because of it's more gradual onset of action and less precipitous hypotension. But, there may be a delay in onset and incomplete blockade at I and S1 segments due to the large size of these nerve roots. Increasing the pH of local anesthetic solution toward the physiologic range has been reported to improve the quality of neural blockade in vitro. Local anesthetic solution applied to a nerve membrane exits in two forms, nonionized free base and charged ionized cation. An increase in the nonionized fraction of local anesthetics associated with an increase in pH results in improved nerve penetration and more rapid onset time of nerve blockade. This study was undertaken to determine the effect of increase in the pH of the lidocaine solutions used for epidural administration on time of onset of sensory blockade and quality of motor blockade. One hundred ten patients having epidural anesthesia for lower extremity orthopedic procedures, perineal and lower abdominal procedures were randomly assigned to two groups and the following local anesthetic solutions were epidurally injected. Group 1 received 2 % lidocaine solution with 1; 200,000 epinephrine and group 2 received 2% lidocaine solution with 1; 200,000 epinephrine plus l mEq of NaHCO added per 10 ml of lidocaine solution. The onset of sensory blockade was measured by pin prick test, and onset time of analgesia was defined as the time between the completion of anesthetic injection and loss of pinprick sensation. Motor blockade was assessed by modified Bromage scale every 5 minutes for 30 min. Blood pressure and pulse rate were measured before epidural injection and every 5 min after injection for 30 min. Results were as follows; 1) Time to onset of anaIgesia at L1, T10, T5 S1 dermatome were significantly more rapid in group that received the alkalinized Iidocaine solution. 2) Degree of motor blockade were significantly more intense in alkalinized lidocaine group from 5 min to 25 min. 3) The decrease in systolic pressure in alkalinized group were more rapid than control group. In conclusion, when lidocaine plus epinephrine alkalinized with bicarbonate was used during epidural bloekade, quality of neural blockade was improved and onset of anesthesia and development of systolic hypotension were more rapid.

Postoperative Airway Obstruction in a Patient With Huge Mediastinal Hemangioam / 대한마취과학회지

Anesthesia for the patients with mediastinal mass may be associated with significant respiratory and cardiovaacular complications due to compression of traeheobronchial trees, the pulmonary artery, heart and superior vena cava The authors present a case of a 6-year-old girl with a large mediastinal tumor located in anterior and superior mediaetinum. Preoperatively, the patient was asymptomatic and anesthesia was induced and maintained uneventfully. Operative finding was that 8 X 14 cm sized hemangioma was extended superiorly over thoracic outlet, posteriorly aorta and SVC, medially pericardium and right hilum and inferiorly right upper lung and pleura. Because difficulties in removal of the hemangioma were expected, exploratory thoracotomy was discontinued. On emergence, as soon as the patient was extubated due to irritability, the patient became cyanotic and was noticed bulging mass on right supraclavicular area, Intubation was attempted and during direct laryngoscopy, anesthesiologist also noticed a bulging mass in right oral cavity. Postoperatively, the patients airway was kept with endotracheal tube, but cyanosis appeared on the face and skin over the chest, but not below the abdomen. Bulging mass on right supraclavicular area, distension of neck vein and conjunctival edema were noticed only when the patient was crying or suctioned. Symptoms improved by deep sedation. We assumed that enlargement of hemangioma due to increased central blood volume occasionally compressed tracheobronchial tree and sup. vena cava when patient was irritable, crying and coughing. On 11th postoperative day, patient was transferred to the another hospital for the better treatment with endotracheal intubation.

A study on the behavioral trend and personality of the alcoholics' wives / 신경정신의학

No abstract available.

Sudden Extreme Bradycardia and Hypotension in a Patient with Total Hip Replacement during Epidural Anesthesia / 대한마취과학회지

Epidural anesthesia is a popular regional anesthetic technique for total hip replacement (THR). It s benefits are reduced blood loss, less need for transfusion, and decreased chance of deep vein thrombosis, and if necessary, it provides longstanding postoperative analgesia with small dose of epidural narcotics through indwelling epidural catheter. The wellknown cardiovascular effects are bradycardia and hypotension according to the degree of sympathetic blockade. These occur usually early in the anesthetic period and the course is benign and are easily treated. We report a case of sudden extreme bradycardia and hypotension during THR under epidural anesthesia that was not associated with hypoxemia, obvious respiratory depression, or systemic toxic reaction. It is concluded that the most likely cause would be a sudden large increase in vagal activity which results from marked reduction in venous return and inadequate oxygenation of myocardium with the assumption of prolonged iatrogenic hemodilution and undercorrected hypovolemia. The patient who receives epidural anesthesia should require constant monitoring and vigilance throughout all procedure.