Acute Coronary Syndrome ; etiology ; Anaphylaxis ; complications ; Humans

Anaphylaxis ; complications ; Electrocardiography ; Humans ; Myocardial Infarction ; etiology

Aged ; Anaphylaxis ; etiology ; Animals ; Female ; Humans ; Insect Bites and Stings ; complications ; Myocardial Infarction ; etiology ; Wasps

BACKGROUND: Patient-controlled analgesia (PCA) is effectively used for postoperative pain control. Fentanyl has a strong analgesic effect but has some side effects. The purpose of this study was to compare the side effects and analgesic effects of fentanyl alone and combination with nalbuphine in patients using intravenous PCA. METHODS: Forty six ASA class 1 or 2 patients were randomly divided into two groups. Group F (n = 23) received fentanyl 1,200microgram in 100 ml of normal saline. Group NF (n = 23) received nalbupine 60 mg and fentanyl 600microgram in 100 ml of normal saline. All patients used the same background infusion rate (2 ml/hr), bolus dose (2 ml) and lockout interval (15 min) just after emergence from general anesthesia. The analgesic effect was evaluated by using a visual analogue scale (VAS) at 1 hr, 6 hr, 12 hr, 24 hr and 48 hr postoperatively. Side effects and satisfaction degree were also checked. RESULTS: No significant differences were observed between the two groups in terms of pain scores and satisfaction degrees. The side effects were similar in both groups except that sedation was significantly (P<0.05) lower in group NF. CONCLUSIONS: We conclude that nalbuphine with fentanyl in combination is a useful method for intravenous PCA. On comparing the incidence of side effects in the two groups, sedation was found to be lower for the combined regimen.
Analgesia* ; Analgesia, Patient-Controlled ; Anesthesia, General ; Fentanyl* ; Humans ; Incidence ; Nalbuphine ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Complications

We describe a case involving a 69-year-old woman who developed anaphylatic shock caused by a clinical dose of sugammadex (2 mg/kg, 100 mg intravenously) 5 minutes after its administration. She developed redness and welts all over her body, and complained of an oropharyngeal itching sensation with dyspnea and dizziness. Her vital signs were closely monitored. She also experienced a sudden onset of hypotension (from 110/70 to 49/40 mmHg) and tachycardia (from 75 to 120 bpm). We diagnosed anaphylactic shock on the basis of these clinical manifestations. After 20 min of traditional treatment (hydration, ephedrine, cortisol, and phenylephrine), her vital signs returned to normal. No postoperative complications were evident, and the patient was discharged from the hospital. Although the prevalence of anaphylactic reactions to sugammadex is rare, physicians using sugammadex should be aware of the possibility of sugammadex-induced anaphylaxis.
Aged ; Anaphylaxis* ; Dizziness ; Dyspnea ; Ephedrine ; Female ; Humans ; Hydrocortisone ; Hypersensitivity ; Hypotension ; Postoperative Complications ; Prevalence ; Pruritus ; Sensation ; Shock ; Tachycardia ; Vital Signs

OBJECTIVE: This study was to define clinical characteristics and formulate the management strategies of the patients with posterior cerebral artery (PCA) aneurysms. PATIENTS AND METHOD: The authors reviewed the database and imaging studies as sources for identification and analysis. During the past 14 years, 16 consecutive patients with PCA aneurysms were treated either by surgery or neurointervention. RESULTS: Ten patients had ruptured PCA aneurysms: 4 patients were Hunt and Hess Grade I, 1 Grade II, 4 Grade III, and 1 Grade IV. Six patients had unruptured PCA aneurysms: one patient was Grade 1, and the other patient was Grade IV due to ruptured multiple aneurysms. Seven aneurysms were small, 9 (56.2%) were large or giant. Thirteen aneurysms were saccular, 2 were fusiform, and 1 was serpentine. Seven of the 16 patients (43.7%) had multiple aneurysms. Pterional (8) or subtemporal (5) approach was done in 13 patients. The obliteration methods of the aneurysms were neck clipping in 10 patients, and trapping in 3 patients. Endovascular treatment was performed in 3 patients. Five patients showed transient oculomotor nerve palsy and contralateral hemiparesis after the surgery. Persisting oculomotor nerve palsy occurred in one patient. All patients showed favorable outcome (food recovery 14, moderate disability 2). CONCLUSIONS: As a result, PCA aneurysms were characterized by high frequency of non - saccular shape, large or giant size with mass effect, and multiple aneurysms. Surgical treatment was necessary for large or giant aneurysm of the distal PCA to decompress midbrain. Wrapping and clipping technique were useful for treatment of fusiform aneurysms. Although ultimate management outcome of the patients with PCA aneurysms were better than the patients with aneurysms of the other location, intra-aneurysmal treatment with Guglielmi detachable coil would be useful for the proximal PCA aneurysms to avoid surgical injury of the P1 perforator or the oculomotor nerve.
Aneurysm ; Humans ; Intracranial Aneurysm* ; Intraoperative Complications ; Mesencephalon ; Neck ; Oculomotor Nerve ; Oculomotor Nerve Diseases ; Paresis ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery*

Hydatid disease is a parasitic infestation caused by the larval form of Echinocococcus. In human, the most commonly affected organs are liver and lung. Most cysts remain clinically silent and are diagnosed incidentally or when complications occur. In Korea, hydatid disease is rare and surgically treated cases have been reported in the Korean literature. However, it is expected to confront this disease sooner or later, because of recent increase in traveling to the endemic area and industrial workers originating from those areas. With this trend, we experienced a case of hydatid cyst of the liver in a male patient from Uzbekistan. This patient was presented with anaphylactic shock combined with hydatid cyst. We successfully treated using ultrasound-guided transhepatic percutaneous drainage [termed puncture, aspiration, injection, and re-aspiration (PAIR)] of the hydatid cyst and concomitant albendazole instead of surgery. In this clinical case report, we describe all the course of the patient and recommend the PAIR as a first choice method for treatment of hepatic hydatid cyst.
Adult ; Albendazole/therapeutic use ; Anaphylaxis/*complications ; Animals ; Anticestodal Agents/therapeutic use ; Drainage ; Echinococcosis, Hepatic/complications/drug therapy/radiography/*therapy ; Echinococcus/isolation & purification ; Humans ; Korea ; Male ; Uzbekistan

Acute Coronary Syndrome ; complications ; Aged ; Anaphylaxis ; chemically induced ; Angina, Unstable ; etiology ; therapy ; Contrast Media ; adverse effects ; Dextrans ; adverse effects ; Drug Hypersensitivity ; complications ; Humans ; Male

STUDY DESIGN: This is a prospective study. OBJECTIVES: To evaluate the effects and complications of patient controlled analgesia(PCA) after spinal fusion. SUMMARY OF LITERATURE REVIEW: Spinal fusion was associated with highest pain and dosage of analgesics among the orthopedic procedures due to the nature of its procedure. Higher requirement of analgesics might cause several postoperative complications including severe respiratory depression and death. It is well known that PCA provides better pain relief and lower complications than as needed intramuscular analgesia. MATERIALS AND METHODS: We compaired the efficacy and possible side effects of intravenous PCA(n = 24) with control(n = 13) in patients undergone spinal fusion. The degree of resting pain, movement pain, and side effects were marked by the patients with 100mm visual analog scales. RESULTS: Postoperative pain control with intravenous PCA showed more effective analgesia and higher patient's satisfaction without causing significant side effects. CONCLUSIONS: Intravenous PCA in patients undergone spinal fusion was effective therapeutic modality in the aspect of pain relief, complications, and satisfaction rate. PCA will be a good alternative for as needed intramuscular analgesia after spinal fusion.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics ; Humans ; Orthopedic Procedures ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Complications ; Prospective Studies ; Respiratory Insufficiency ; Spinal Fusion* ; Visual Analog Scale

Aneurysms of the posterior circulation are regarded as difficulty in their surgical management because of their infrequency and confined space in front of the brain stem and cerebellum and perforators around brain stem. From Januarym 1983 to August 1990, we are reporting a review of 21 cases of surgically treated posterior circulation aneurysms among 334 cases of surgically treated all intracranial aneurysms. They represent 6.3% of all intracranial aneurysms, the average age of these patients was 45 years with range of 28 to 63 years. Of the 21 patients, 12 had aneurysms of basilar artery bifurcation, 4 had aneurysms of the PCA, and two had aneurysms of the SCA, and two had aneurysms of the PICA and one had aneurysm of the AICA. Five patients had multiple aneurysms and one patient associated with moya-moya disease. There were postoperative complications including nine transient or permanent cranial nerve deficit, three disturbance of consciousness, two aseptic meningitis and one osteomyelitis. Two motor weakness, one intraparenchymal hemorrhage, one epidural hemorrhage, one thalamic infartion. The aneurysms varied on size and included 17 small(<12 mm), 2 large(12 to 25 m), and 2 giant(> or =25 mm). Overall surgical outcome was evaluated "excellent" in 7 cases, "good" in 9 cases, "fair" in 2 cases, "poor" in 2 cases, and one patient expired.
Aneurysm* ; Basilar Artery ; Brain Stem ; Cerebellum ; Confined Spaces ; Consciousness ; Cranial Nerves ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Meningitis, Aseptic ; Moyamoya Disease ; Osteomyelitis ; Passive Cutaneous Anaphylaxis ; Pica ; Postoperative Complications