During the past two years, we had 80 cases of intravenous lidocaine anesthesia for upper limb operations. Per kilogram of body weight, we usually used 1.0~3.0mg of 0,5~0.8% lidocaine and a pressure of 200~300 mmHg(about 100 mmHg higher than the patients systolic blood pressure) by means of an Inflato-Matic dual cuff tourniquet which was also connected with an Inflato-Matic 2, 000 Tourniquet Regulator and oxygen tank. Analgesia occurred about 5 10 minutes after injection with relative satisfaction and, fortunately, no kind of serious complications ensued after releasing the tourniquet. It is not only a simple technique and of low cost to give the anesthesia to the patient(in-patient or out-patient), but also it is possible to perform anywhere and at any time without serious complications or complexities of any other method of anesthesia.
Analgesia ; Anesthesia ; Body Weight ; Humans ; Lidocaine* ; Methods ; Oxygen ; Tourniquets ; Upper Extremity*

An anesthetic experience with bilateral adrenalectomy for pheochromocytoma in an 18 year old male has been reported. We chose fluothane as a primary anesthetic agent for the management of anesthesia 'with relative satisfaction. The patient was treated with phenoxybenzamine for a long time (about 40 days) and also with propranolol for a few days intermtteently before induction of anesthesia. During anesthesia and operation, the highest systolic blood pressure was 180 mmHg, the lowest was 80 mmHg and some variable arrhythmias with extrasystoles were present. But these were well controlled immediately after administration of regitine and propranoloL 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 those agents which affect the anesthetic procedures. Conclusively, we prefer to recommend that it is important to manage the patients with alpha & beta adenergic blocking agents for at least several weeks pre-operatively, and to use the anesthetic agents as far as possible which do not have the sensitizing effects to catecholamine on myocardium.
Adolescent ; Adrenalectomy* ; Anesthesia ; Anesthetics ; Arrhythmias, Cardiac ; Blood Pressure ; Cardiac Complexes, Premature ; Halothane ; Humans ; Male ; Myocardium ; Phenoxybenzamine ; Phentolamine ; Pheochromocytoma ; Propranolol

Cardiac arrest is the most serious problem during anesthesia and surgery. Whether the heart is in ventricular fibrillation, in asystole or in EMD, the ABCDS of CPR must always be used. The authors have experience with cardiac arrest obviously due to the complexities of vagovagal reflexs and severe electrolyte imbalance, especially in potassium ions. After the diagnosis of ventricular fibrillation in our case by continuous ECG monitoring, immediate closed chest cardiac massage was carried out and the essential drugs and a DC defibrillator were used. At the first attempt, the normal sinus rhythm was restored immediately after 100 joules of DC countershock were given. We then gave another 200 J. of a second shock for recurrent VF. Thereafter, complete normal sinus rhythm was restored without dysrhythm of any kind. Simultaneously the authors also several times observed changes of arterial blood gases and pH. About ten hours later the patient regaineded consciousness completely without complications. If possible, continuous ECG monitoring during anesthesia is highly recommended because various dysrhythmias can be detected by this system.
Anesthesia ; Cardiopulmonary Resuscitation ; Consciousness ; Defibrillators ; Diagnosis ; Drugs, Essential ; Electrocardiography ; Gases ; Heart ; Heart Arrest ; Heart Massage ; Humans ; Hydrogen-Ion Concentration ; Ions ; Potassium ; Reflex ; Shock ; Thorax ; Ventricular Fibrillation*

It is expected that the stent graft will become an alternative method for treating aortic diseases or reducing the extent of surgery; therefore, thoracic endovascular aortic repair has widened its indications. However, it can have rare but serious complications such as paraplegia and retrograde type A aortic dissection. Here, we report a surgical repair of retrograde type A aortic dissection that was performed after thoracic endovascular aortic repair.
Aortic Diseases ; Blood Vessel Prosthesis ; Paraplegia ; Stents

Aconitine is an anti-inflammatory agent with therapeutic uses in oriental medicine as an analgesic and for treatment of stroke. Because of its sodium channel effect, aconitine can promote undesirable, wide complex tachyarrhythmia. If tachycardia develops during use of aconitine, class Ia and class III anti arrhythmic drugs can be utilized for treatment. However there are no single anti-arrhythmia agents which are uniformly effective. We report a case, characterized by wide complex tachyarrhythmia and severe hypotension, which was successfully treated by simultaneous injections of amiodarone and lidocaine. A 59-year-old woman exhibiting clinical signs of drowsiness as a result of ingesting 6 g of aconitine, was admitted to the emergency department. Initially, wide complex tachyarrhythmia (ventricular tachycardia and pulse rate of 180 beats/min) and severe hypotension (blood pressure of 53/26 mmHg) was observed. After simultaneous injection of amiodarone and lidocaine, the patient's rhythm pattern changed to an accelerated junctional rhythm with ventricular premature complex. Two hours later, the patient's heart pattern became a sinus rhythm. As demonstrated by this case, simultaneous injections of amiodarone and lidocaine can be useful in treating ventricular arrhythmia induced by aconitine.
Aconitine ; Amiodarone ; Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Emergencies ; Female ; Heart ; Heart Rate ; Humans ; Hypotension ; Lidocaine ; Medicine, East Asian Traditional ; Middle Aged ; Sleep Stages ; Sodium Channels ; Stroke ; Tachycardia ; Tachycardia, Ventricular ; Therapeutic Uses ; Ventricular Premature Complexes

We report two cases of toxic methemoglobinemia caused by an inert ingredient in pesticide product after intentional ingestion of pesticide. First, 51-year-old male visited to the emergency department (ED) after the ingestion of pesticide in a suicide attempt. Initial methemoglobin (MetHb) level was 25.6%. We did not know the cause of methemoglobinemia at that time. Second, 56-year-old female visited to the ED after the ingestion of the same pesticide in a suicide attempt. MetHb level after 30 minutes was 16.1%. The patients were treated with methylene blue. We contacted to the Korean Rural Development Administration and estimated that magnesium nitrate was more likely to cause methemoglobinemia. This report highlights the importance of considering the possibility of methemoglobinemia caused by inert ingredient in pesticide and early antidotal therapy.
Eating* ; Emergency Service, Hospital ; Female ; Humans ; Magnesium ; Male ; Methemoglobin ; Methemoglobinemia* ; Methylene Blue ; Middle Aged ; Pesticides ; Social Planning ; Suicide

Mucoepidermoid carcinoma is an uncommon lesion that accounts for approximately 1% of primary malignant bronchial gland tumors and less than 0.2% of all lung neoplasm. This tumor presents with symptoms of bronchial irritation or obstruction. Distant metastasis is uncommon, therefore complete surgical resection is the treatment of choice. The prognosis of tumor correlates with on the histologic grade of tumor. We experienced mucoepidermoid carcinoma in a 15 year-old girl with symptoms of cough and blood tinged sputum. The patient underwent successful removal of tumor by bilobectomy via explorothoracotomy after chest CT and bronchoscopic biopsy.
Adolescent ; Biopsy ; Bronchi* ; Carcinoma, Mucoepidermoid* ; Cough ; Female ; Humans ; Lung Neoplasms ; Neoplasm Metastasis ; Prognosis ; Sputum ; Tolnaftate ; Tomography, X-Ray Computed

PURPOSE: Ingestion of puffer fish can be poisonous due to the presence of potent neurotoxins such as tetrodotoxin (TTX) found in its tissues. There are few clinical reports related to TTX. We performed this study to evaluate the clinical characteristics of TTX poisoning. METHODS: We conducted a retrospective study of the 41 patients diagnosed with TTX poisoning who visited the Seoul Asan medical center from July 2004 and December 2010. A review of patients'electronic medical records and patient telephone interviews were conducted. Diagnosis of TTX poisoning was confirmed by observing the casual link between puffer fish consumption and the development of typical TTX intoxication symptoms. RESULTS: The mean age of the patients included in the study was 46.6 years. The highest incidence of intoxication was observed in patients in their 50s (10 patients). Seasonal distribution of intoxication events included 10 in spring, 7 in summer, 10 in fall, and 14 in winter. In most cases, symptoms occurred within 1 hour of ingestion. A wide range of symptoms were associated with puffer fish ingestion affecting multiple body systems including neuromuscular (27 patients), gastrointestinal (19 patients), and cardiopulmonary/vascular (19 patients). All patients were treated with symptomatic and supportive therapy and recovered completely, without sequelae, within 48 hours. In three cases, ventilator support was required. CONCLUSION: TTX poisoning is not seasonally related, and patients admitted to the emergency room were observed with a wide range of symptoms. Where TTX poisoning is diagnosed, supportive therapy should be performed. Early intubation and ventilation is important, especially is cases of respiratory failure.
Aluminum Hydroxide ; Carbonates ; Eating ; Emergencies ; Humans ; Incidence ; Interviews as Topic ; Intubation ; Medical Records ; Neurotoxins ; Respiratory Insufficiency ; Retrospective Studies ; Seasons ; Tetraodontiformes ; Tetrodotoxin ; Ventilation ; Ventilators, Mechanical

Objective: The purpose of this study was to identify if there was a perception of difficulty in using emergency department (ED) services during the coronavirus disease 2019 (COVID-19) pandemic and the contributing factors to this situation through a cross-sectional public survey in a metropolitan city. Methods: In November 2020, face-to-face interviews based on a structured questionnaire were conducted with 1,000 citizens. A multivariable logistic regression analysis was performed to identify the factors affecting the perception of difficulty in using the ED. Results: Of the respondents, 65.2% (58.9% male and 71.3% female) perceived difficulty in using ED services during the pandemic. By age, 69.8% of those who had this perception were under the age of 40 years ; 63.2% were 40-64 years old, and 61.1% were over the age of 65. Of the total number of respondents, 24.8% and 13.8% said they would hesitate to visit ED for chest pain and neurological symptoms, respectively. As a result of multivariate analysis, the significant contributing factors were age under 40 years old, female gender, fear of in-hospital COVID-19 contagion, emergency medical technician (EMT) referral to the ED, and prior experience with the emergency medical service (EMS) dispatch center. Conclusion A significant percentage of respondents perceived that it was difficult to use ED services during the COVID19 pandemic, even when experiencing chest pain and neurological symptoms, which require urgent treatment. Younger age, women, and fear of nosocomial COVID-19 contagion appear to have aggravated this situation. Conversely, prior experience with the EMS dispatch center and visits to the EMT-recommended ED facilitated ED utilization.

Low grade fibromyxoid sarcoma (LGFM) is a rare, deep soft-tissue malignant tumor. Although its histologic features are benign, the clinical course is malignant. The usual tumor locations are the lower extremity and chest wall. LGFM originating from the visceral pleura is extremely rare. We report here on a 37 year old man with a LGFM of the visceral pleura. Thirty three months after surgery, the patient is alive without any sign of local recurrence or distant metastasis.
Humans ; Lower Extremity ; Pleura ; Pleural Neoplasms ; Recurrence ; Sarcoma ; Thoracic Wall