BACKGROUND: Combined spinal epidural anesthesia (CSE) is used for obtaining adventages of both spinal and epidural anesthesia. But it might be suspected that epidural volume load affect spinal sensory blockade level during CSE. METHODS: Eighty patients undergoing lower abdominal and lower extremity operation were involved in our study. Subarachnoid block with 12mg of tetracaine was established in all patients. Four groups were studied. Group 1 (n=20), the control, received only spinal anesthesia. Group 2 (n=20), group 3 (n=20) and group 4 (n=20) received 10, 15 and 20 ml of epidural saline immediately after spinal anesthetic administration. Sensory blockade level was checked by pinprick test at 5, 10, 15, 20, 25, 30, 40, 60 and 90 minutes. Blood pressure, heart rate and incidence of complications such as hypotension, bradycardia, nausea and high block were measured. RESULTS: The sensory blockade level of groups 3 and 4 was higher than group 1 (p<0.05). Blood pressure and heart rate were not different compared with each other. The incidence of complications, except that higher block above T4 in group 4 was more than in group 1 (p<0.05), were not different when compared with each other. CONCLUSIONS: Epidural saline above 15 ml may affect sensory blockade level of spinal anesthesia during CSE.
Anesthesia, Epidural* ; Anesthesia, Spinal ; Blood Pressure ; Bradycardia ; Heart Rate ; Humans ; Hypotension ; Incidence ; Lower Extremity ; Nausea ; Tetracaine

BACKGROUND: We postulated that loss of epidural negative pressure might affect on the sensory blockade level of spinal anesthesia. METHODS: Thirty nine patients were involved in our study; group 1, spinal anesthsia with 23G spinal needle (n=20): group 2, spinal anesthesia with 27G spinal needle through the 18G Weiss epidural needle (n=19). Sensory blockade level was checked by pinprick test at 5, 10, 15, 20, 25, 30, 40, 60 and 90 minutes after spinal anesthesia. RESULTS: There was no difference of sensory blockade level between group 1 and 2. CONCLUSION: From above result, there was no evidence of loss of epidural negative pressure affecting on the spinal sensory blockade level.
Anesthesia, Spinal* ; Humans ; Needles

The principle of surgery of the parotid gland is adequate removal of the tumor with functional and anatomical preservation of all blanches of the facial nerve. There are two main surgical approaches to superficial or total conservative parotidectomy. Anterior approach and posterior approach. Preliminary identification of the main trunk of the facial nerve is probably the most favoured techniques, but identification of the peripheral blanches of the facial nerve, with subsequent Proximal dissection to the main trunk, is long established but less popular technique. We have prospectively experienced the low incidence of facial nerve damage in series of 55 conservative parotidectomies performed using the anterior approach. The techniques employed is described with a deport of results obtained in the belief that this approach warrants greater popularity and saute technique.
Facial Nerve ; Incidence ; Parotid Gland ; Prospective Studies

There are two general categories of lateral osteotomy techniques-the external perforating method and the internal continuous method. Regardless of which technique is used, procedural effectiveness is hampered by limited visualization in the surgical field. Considering this point, we devised a new technique that involves using a wide subperiosteal dissection and internal perforation under direct visualization. Using an intranasal approach, whereby the visibility of the intended fracture line was maintained, enabled a greater degree of control, and in turn, results that were more precise, and thus predictable and reproducible. Traditionally, it has been taken as dogma that the periosteum must be preserved, considering the potential for dead space and bony instability; however, under sufficient visualization of the surgical field with an internal perforating method, complete osteotomy with fully preserved intranasal mucosa could be conducted exactly as intended. This intact mucosal lining compensates for the elevated periosteum. Compressive dressing and drainage through a Silastic angio-needle catheter enabled the elimination of dead space. Therefore, precise, reproducible, and predictable osteotomy minimizing the potential for associated complications such as ecchymosis, that is, bruising owing to hemorrhage, could be performed. In this article, we introduce a novel technique for lateral osteotomy with improved visualization.
Bandages ; Catheters ; Drainage ; Ecchymosis ; Hemorrhage ; Mucous Membrane ; Osteotomy* ; Periosteum ; Rhinoplasty

Craniofrontonasal dysplasia(CFND), a rare congenital syndrome, is characterized by varying degrees of frontonasal dysplasia, craniosynostosis, and variable extracranial abnormalities. It was first reported by Cohen in 1979. The inheritance pattern is not straightforward. Although all modes of Mendelian inheritance have been suggested, the most plausible explanation is that this is an X-linked condition with the unusual situation of complete expression in females, and minimal to no expression in males. In our case, CFND was diagnosed in a female neonate who had unilateral coronal craniosynostosis, frontal bossing, orbital hypertelorism, broad nasal root, clefting nasal tip, corpus callosum agenesis and mild extremity abnormalities.
Agenesis of Corpus Callosum ; Craniosynostoses ; Extremities ; Female ; Humans ; Hypertelorism ; Infant, Newborn ; Inheritance Patterns ; Male ; Orbit ; Parturition* ; Wills

Urinary voiding disorders owing to anticonvulsants medications have been reported rarely. I have recently seen 2 patients in whom carbamazepine (Tegretol) therapy was associated with nocturnal enuresis. The first patient was a 7-year-old boy in whom carbamazepine 150 mg twice a day (15 mg/kg, early morning plasma level 10 microgram/mL before the morning dose) was prescribed for control of complex partial seizure. Approximately 5 months after starting to take the drug he developed frequency of micturition and urgency. Soon followed by nocturnal enuresis. His development was normal. Sphincter control was complete at 3 years of age. Urinalysis was negative. Carbamazepine discontinued and within 1 week all urinary symptoms disappeared. Second patient was a 6-year-old girl in whom carbamazepine 100 mg twice a day (15 mg/kg, early morning plasma level 7.06 microgram/mL before the morning dose) was prescribed for control of simple partial seizure. Approximately 10 weeks after starting to take the drug he developed urgency, and then after 2 weeks followed by daily nocturnal enuresis. Her development was normal. Urinalysis was negative. Carbamazepine was changed to oxcarbazepine, and the patient's urinary symptoms abated within 2 weeks disappeared and did not recur. The nocturnal enuresis in both patients can be attributed to carbamazepine;it appeared after 3-4 months of the start of treatment;during seizure-free period and disappeared on discontinuation of carbamazepine. The drug should be discontinued before any other invasive investigations are undertaken to clarify the cause of the urinary symptoms.
Anticonvulsants ; Carbamazepine* ; Child ; Female ; Humans ; Male ; Nocturnal Enuresis* ; Plasma ; Seizures ; Urinalysis ; Urination

Reconstruction of the soft tissue defects on the plantar foot continues to be a difficult challenges because of the unique anatomical features. It should endure constant weight loading or alternate stimulus of shoes while standing or walking. The methods used for reconstruction of the soft tissue defects on the plantar foot are skin graft, local flap, cross leg flap, myocutaneous flap, neurovascular island and free flap. However, it is verb difficult to find a proper method to reconstruct the soft tissue defect of the first toe plantar area. The ideal reconstruction should provide tissue as durable yet sensitive, provide tissue components similar to the original lost tissue, be reliable, result in a donor site that is well tolerated, and entail one operative procedure with minimal morbidity Although the medial plantar flap was initially described to surface heel defects, many surgeons haute used this flap as a cross leg flap or a free flap to recover the first toe plantar area. Its use has always required a secondary surgical procedure or a difficult technique. In order to overcome this inconvenience, we used the flap based on the principle of reversing the direction of blood flow in a distal vascular pedicle to restore a defect of the anteromedial aspect of the foot. We haute experienced 3 cases of reverse medial plantar flap for the reconstruction of the great toe plantar area. Good functional and aesthetic results were obtained.
Foot ; Free Tissue Flaps ; Heel ; Humans ; Leg ; Myocutaneous Flap ; Shoes ; Skin ; Surgical Procedures, Operative ; Tissue Donors ; Toes* ; Transplants ; Walking

Amniotic fluid embolism (AFE) is a rare but devasting obstetric emergency. We experienced a case of AFE during dilatation and curettage (D & C) in a 15 2/7 weeks pregnant woman, age 30, who was diagnosed as having a missed abortion. Sudden rapid hypoxemia, low SpO2, hypotension, low PETCO2, high CVP, and tachycardia, right axis deviation and right bundle branch block in 12 leads ECG were developed during D &C under general anesthesia, and signs of disseminated intravascular coagulation (DIC) followed after the operation, which are consistent with the findings of AFE. Even though there was no definite pathologic and radiologic confirmation of AFE, laboratory findings showed 100 times higher level of alpha-fetoprotein in her central venous blood than same weeks of missed abortion woman's blood. Though it is rare, the anesthesiologist should always suspect the possibility of AFE, when the patient shows an unexplained collapse, cyanosis, low PETCO2, high CVP, low SpO2, ECG change and DIC during any kind of obstetric procedure.
Abortion, Missed ; alpha-Fetoproteins ; Amniotic Fluid* ; Anesthesia, General ; Anoxia ; Axis, Cervical Vertebra ; Bundle-Branch Block ; Cyanosis ; Dacarbazine ; Dilatation and Curettage* ; Dilatation* ; Disseminated Intravascular Coagulation ; Electrocardiography ; Embolism, Amniotic Fluid* ; Emergencies ; Female ; Humans ; Hypotension ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnant Women ; Tachycardia

Subcutaneous emphysema is one of the rare complication of tracheal intubation and it's mechanism has been known as airleakage to subcutaneous tissue from the perforated site of larynx, trachea and esophagus by the trauma of laryngoscopic blade, stylet and endotracheal tube. We experienced a case of subcutaneous emphysema during unexpected difficult endotracheal intubation. At the initial laparoscopic examination, the patient's laryngeal view was grade IV of Cormack and Lehane's calssification. After several trial of the intubation, cervical subcutaneous emphysema developed by the trauma of laryngoscopic blade, stylet and endotracheal tube, even though failed to confirm the perforated site at postanesthesia one day.
Esophagus ; Intubation ; Intubation, Intratracheal* ; Larynx ; Subcutaneous Emphysema* ; Subcutaneous Tissue ; Trachea

BACKGROUND: Filler injection into the soft tissue of the nose is a useful technique for rhinoplasty. The individual characteristics of fillers determine which is best suited for a patient's specific circumstances. The objective of this study was to identify the characteristics of various fillers and to determine which fillers should be used for primary rhinoplasty in order to yield optimal long-term results. METHODS: Excluding patients treated with hyaluronic acid fillers, we reviewed 17 patients who underwent surgical rhinoplasty due to dissatisfaction with an injection using a different filler. After removing the previously injected filler, rhinoplasty was performed as part of the same procedure using a silicone or Surgiform® prosthesis. RESULTS: Various previous fillers were used in the cohort. During the process of filler removal, skin perforation occurred in 2 cases and infection was observed in 1 case. In the other cases, rhinoplasty using a prosthesis was performed at the time of filler removal and no complications were observed. CONCLUSIONS: We found that if surrounding tissue had been maintained stably, a simultaneous secondary operation using implants produced ideal results in most cases without any complications, despite the presence of residual remnant filler material.
Cohort Studies ; Humans ; Hyaluronic Acid ; Nose ; Prostheses and Implants ; Rhinoplasty* ; Silicon ; Silicones ; Skin