A Case of Transcatheter Alcohol Ablation of the Septum in a Patient of Hypertrophic Obstructive Cardiomyopathy

Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by inappropriate myocardial hypertrophy that occurred in the absence of an obvious cause for the hypertrophy and dynamic left ventricular outflow tract obstruction, caused by asymmetrical septal hypertrophy and systolic anterior motion of the anterior mitral leaflet. The pathophysiological abnormality in HOCM is diastolic dysfunction, abnormal stiffness of the left ventricle with resultant impaired ventricular filling and impaired vasodilator reserve (perhaps related to the thickened and narrowed small intramural coronary arteries found in HOCM). During the early course of this progressive disease, treatment consists of negative inotropic drugs. Surgery has been the only therapeutic option in patients with hypertrophic cardiomyopathy who are resistant to drug treatment and sequential pacemaker therapy. We describe a novel catheter-based technique that may replace surgical myocardial reduction. The technique is interventional infarction of a portion of the interventricular septum by the infusion of alcohol into a selectively catheterized septal artery.

A case of primary malignant mesothelioma of tunica vaginalis testis / 대한비뇨기과학회지

Mesothelioma is a neoplasm arising from the mesothelial cells lining the serous membrane such as pleura, peritoneum. and tunica vaginalis of testis. Primary malignant mesothelioma of tunica vaginalis is rare and there was no report in Korean literature yet. We report a case of a 43-year-old man with a painless palpable growing mass and histopathologically demonstrated to a malignant mesothelioma arising from the tunica vaginalis of testis.

Analgesic Effect of Demerol Administered in Caudal Space in Anal Surgery / 대한마취과학회지

Epidural and intrathecal injection of narcotics for postoperative pain relief have been well reported. In an attempt to assess the postoperative analgesic effect of demerol in anal surgery, caudal block was carried out with 1.5% lidocaine mixed with demerol 5 mg(Group II) in 15 patients and demerol 1 0 mg(Group II) in 15 patients. As a control group(Group I), 16 patients were injected with 1.5% lidocaine alone in the epidural space for caudal anesthesia. The incidence of postoperative injection of demerol as needed by the patients for pain control were recorded and compared. As a result of this study, the 3rd group in which 10 mg of demerol were used, appeared to have a significantly prolonged analgesic effect and there were no serious complications observed in our experience such as nausea, vomiting or respiratory depression.

Flail Chest Resulting from Cardiopulmonary Resuscitation / 대한마취과학회지

The term flail chest is used to describe the condition in which a portion of the chest wall moves in a direction opposite to the rest of the thorax. This condition generally results from multiple rib fractures caused by external thoracic compression. Most characteristically, this occurs as a result of bilateral rib fractures after a steering-wheel injury or a crushing chest injury. In this article, 3 cases of flail chest developed following cardiopulmonary resuscitation showing a typical paradoxical respiration. The first case, a 69 year old male, had cardiac arrest during direct laryngoscopy in the operating room and was successfully resuscitated with external heart compression. He was then found to have separation of all costochondral junctions with paradoxical respirations. He was intubated and his respirations were controlled with a volume controlled respirator. Two days later, surgical traction was applied to his sternum, and was maintained for three weeks. He went home in good health after removal of the traction. The second case, a 48 year old male in hypovolemic shock, had a cardiac arrest postoperatively. He was resuscitated and then found to have paradoxical respiration which was controlled by a volume controlled respirator. He died of brain damage resulting from insufficient C.P.R. on the third day after the incident. The third case, a 57 year old male, was admitted to this institution from a local clinic with a flail chest as a result of costochondral separation after C.P.R. had been performed. He was intubated and his respirations were controlled by a volume setting respirator. On the second day following admission, traction was applied surgically to his sternum, thereafter he had normal respirations. However, his consciousness never returned and he died fo suspected brain damage fifteen days following admission. Cardiopulmonary resuscitation is vitally important to maintain artificial circulation and respiration. Cardiac compression must be sufficient to force blood out of the ventricles between the sternum and the spin(Fig.3). Even though the most common complication of C.P.R. is rib fractures, a sufficient heart compression is still the most important factor. However, rib fractures may be avoided by proper placement of the hands over the sternum during manual heart compression(Fig. 2). Once flail chest occurs, it should be actively treated by a volume controlled respirator and traction.