Combined spinal epidural block with use of the needle-through-needle technique has become increasingly more popular during recent years because it provides rapidity and density of spinal block, combined with the ability to extend the block and provide postoperative analgesia by use of the extradural catheter. However, the combined spinal epidural block has some disadvantages. Since the spinal needle makes a hole in the dura, the accidental migration of an extradural catheter into the dural opening made previously by the spinal needle is thought to be theoretical risk. We report a case during combined spinal epidural anesthesia for a total hip replacement in which the clear fluid in the epidural catheter was found and tested to confirm the nature of fluid and migration of catheter by the dextrostix test and the immunoelectrophoresis test(prealbumin test).
Analgesia ; Anesthesia, Epidural* ; Anesthetics, Local* ; Arthroplasty, Replacement, Hip ; Catheters ; Immunoelectrophoresis ; Needles

BACKGROUND AND OBJECTIVES: Whether uric acid is a predictor of cardiovascular events remains controversial. We sought to evaluate the effects of the serum uric acid levels on major adverse cardiovascular events (MACEs) in the patients with coronary artery disease (CAD). SUBJECTS AND METHODS: The study population consisted of 660 consecutive patients with CAD, and they were followed up for a mean of 27 months (maximum: 62 months). The recorded MACEs included acute myocardial infarction (AMI), stroke, coronary artery bypass graft, percutaneous coronary intervention (PCI) due to de novo lesion during follow up, congestive heart failure (CHF) and sudden cardiac death. RESULTS: In the CAD patients with a uric acid level < or =3.88 mg/dL (the lowest quartile), as compared with those CAD patients with uric acid levels >5.74 mg/dL (the highest quartile), the MACE rate increased from 7.2% to 20.1%. On univariate Cox regression analysis, the highest uric acid quartile was a predictor of AMI, CHF and MACE. The absolute serum uric acid level was predictive of PCI, CHF and MACE. Multivariate Cox regression analysis showed that the independent predictors of MACE were presentation with acute coronary syndrome (HR 1.70, 95% CI: 1.04 to 2.78, p=0.033), multi-vessel disease (HR 2.43, 95% CI: 1.44 to 4.12, p=0.001), and the uric acid levels (HR 1.22, 95% CI: 1.05 to 1.43, p=0.010), and the highest uric acid quartile (HR 2.54, 95% CI: 1.58 to 4.10, p<0.001). CONCLUSION: The serum uric acid level and multi-vessel disease are associated with subsequent cardiovascular events in the patients with CAD.
Acute Coronary Syndrome ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Death, Sudden, Cardiac ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Stroke ; Transplants ; Uric Acid*

Electrical injury may lead to a conduction disorder of the heart. We report here on a 36-year-old man, who was treated with a permanent pacemaker, after an electrical injury induced high-degree atrioventricular block and clinical manifestations (dizziness and dyspnea).
Adult ; Atrioventricular Block* ; Electric Injuries ; Heart ; Heart Conduction System ; Humans

BACKGROUND AND OBJECTIVES: Increased carotid intima-media thickness (IMT) is known to be associated with adverse cardiovascular events in the patients with risk factors or established atherosclerosis. However, the prognostic importance of carotid IMT is uncertain in the patients who underwent percutaneous coronary intervention (PCI). We sought to evaluate the association of carotid IMT with major adverse cardiovascular events (MACE) and restenosis in the patients who underwent PCI. SUBJECTS AND METHODS: The study population consisted of 308 consecutive patients who underwent PCI, and they were followed up for mean of 30.6+/-13.3 months. Base on the median values of carotid IMT, which was measured in the right common carotid artery at the time of PCI with using high-resolution ultrasound and a semiautomatic method, the subjects were divided into the thick (n=156, 1.003+/-0.14 mm) and thin IMT (n=152, 0.748+/-0.07 mm) groups, and they were followed up for at least 1 year. RESULTS: Patients with thick carotid IMT were older (61+/-9 years vs. 57+/-10 years, respectively, p=0.001), had a higher body mass index (25.0+/-3.0 vs. 23.9+/-4.0, respectively, p=0.017), a history of previous myocardial infarction (20% vs. 9%, respectively, p=0.008), more multivessel disease and more restenosis (34.6% vs. 23.0%, respectively, p=0.025) than those patients with a thin carotid IMT. However other MACEs such as death, myocardial infarction, stroke, heart failure and target lesion revascularization did not show any significant differences between the two groups. Multivariate Cox regression analysis showed that carotid IMT was an independent predictor of restenosis (odds ratio: 1.754, 95% confidence interval: 1.1296 to 2.726, p=0.012). CONCLUSION: An increased carotid IMT is associated with restenosis, but it does not have clinical prognostic importance for the patients who underwent PCI during a mean follow up period of 31 months.
Angioplasty, Balloon, Coronary ; Atherosclerosis ; Body Mass Index ; Carotid Artery, Common ; Carotid Intima-Media Thickness* ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Prognosis ; Risk Factors ; Stroke ; Ultrasonography

We present a case of recurrent left atrial myxoma which occurred 7 years and 10 months after initial operation despite resection of originaltumor and adjacent atrial septum. This is the first case report of recurrence in Korea. Among the possible causes of recurrence, regrowth from pretumorous focus seems to be the most suggesting one in this case. Histopathologic findings of recurrent myxoma showed increased cellularity with active proliferation and nuclear hyperchromasia. These findings, together with the rapidity of regrowth, suggest that recurrent myxoma may have 'wilder' behavior. Prolonged postoperative observation is important, even if ample resection was done at the initial operation including atrial septum.
Atrial Septum ; Korea ; Myxoma* ; Recurrence*

BACKGROUND: Preoperative screening laboratory tests including forced expiratory spirometry (FES) are performed either to determine the progress of a known disease or to detect unsuspected abnormalities in asymptomatic patients. The former is generally accepted, while there is often dispute about the latter indication. But the routine ordering of preoperative screening tests is currently common practice. Age is used as a criterion to select preoperative tests for asymptomatic elderly patinets. FES and arterial blood gas analysis (ABGA) are used currently as a preoperative screening test. The objective of the present study is to assess the value of FES and ABGA as a preoperative screening test in elderly patients undergonig surgery. METHODS: We have done a retrospective review of the medical records to assess the value of FES and ABGA as a routine preoperative screening tests in 94 asymptomatic elderly patients (> or = 65 years) undergoing surgery within 6 months recently. RESULTS: A retrospective review of the medical records was that the results of FES revealed the stage of early aymptomatic obstructive pulmonary disease and those of ABGA were within lower normal limit. CONCLUSIONS: The present study confirms the forced expiratory spirometry is a valuable preoperative screening test in the elderly patients with clinial assessment during the preanesthetic visit.
Aged* ; Blood Gas Analysis ; Dissent and Disputes ; Humans ; Lung Diseases, Obstructive ; Mass Screening ; Medical Records ; Retrospective Studies ; Spirometry*

BACKGROUND AND OBJECTIVES: A prolonged heart rate-corrected QT interval (QTc) is known to be related to an increased risk of coronary artery disease (CAD) and sudden cardiac death, while the carotid intima-media thickness (IMT) is related to CAD. We sought to evaluate the relationship among the QTc, the carotid IMT and the severity of CAD. SUBJECTS AND METHODS: The QTc and the carotid IMT were measured in 165 consecutive patients who underwent coronary angiography. The measurement of the QTc was done automatically by a digital QT GuardTM system (GE Marquette Medical System, Milwaukee, USA) and the carotid IMT was measured by M'ATH software (METRIS Co., Argenteuil, France). The severity of CAD was divided into minimal disease (90, 54.5%), one-vessel disease (32, 19.4%), and multi-vessel disease (43, 26.1%), according to the number of vessels that were narrowed by more than 50%. RESULTS: The mean values of the QTc were 415.1+/-20.5 msec in the minimal disease group, 411.7+/-17.0 msec in the one-vessel disease group and 434.2+/-46.1 msec in the multi-vessel disease group. The QTc was correlated with age (r=0.236, p=0.002), HDL cholesterol (r=-0.160, p=.043), the right carotid IMT (r=0.17, p=0.026), the left carotid IMT (r=0.178, p=0.022) and the severity of CAD (r=0.243, p=0.002). On the multiple linear regression analysis after adjustment for age and HDL cholesterol, the QTc was an independent factor for the severity of CAD. CONCLUSION: These results suggest that repolarization abnormalities are associated with the severity of CAD and they may reflect the severity of the morphologic atherosclerotic surrogates.
Carotid Arteries ; Carotid Intima-Media Thickness* ; Cholesterol, HDL ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Death, Sudden, Cardiac ; Heart ; Humans ; Linear Models

BACKGROUND AND OBJECTIVES: It's not clear whether the serum lipid level is associated with the individual carotid arterial wall thickness for patients suffering with coronary atherosclerosis, although hypercholesterolemia is associated with an increased carotid IMT. We sought to evaluate the association between the serum lipid level and the individual carotid arterial wall thickness (intimal thickness (IT) and medial thickness (MT)) as well as the carotid intima-media thickness (IMT) for patients with coronary atherosclerosis. SUBJECTS AND METHODS: The carotid arterial wall thickness was measured using high-resolution B-mode ultrasound in 139 consecutive patients (58+/-11 years old, 75 males) with coronary atherosclerosis by performing coronary angiography. RESULTS: Measurement of the individual arterial wall thickness was possible in 126 patients (90.6%) out of all the study subjects. The carotid IMT was correlated with the total cholesterol (r=0.207, p=0.015) and low-density lipoprotein (LDL) cholesterol (r=0.237, p=0.006). The carotid IT was correlated with the total cholesterol (r=0.210, p=0.020), triglyceride (r=0.212, p=0.018), and LDL-cholesterol (r=0.246, p=0.006), whereas the MT did not show any significant correlation with the serum lipid level. Multivariate analysis disclosed that the serum LDL cholesterol level was associated with the carotid IMT and IT for the patients with coronary atherosclerosis, but it was not correlated with the MT. CONCLUSION: This study suggests that the serum LDL cholesterol level is more closely associated with the carotid IT than the IMT for patients with coronary atherosclerosis, and each carotid arterial wall has a different response to the serum lipid level.
Carotid Arteries* ; Carotid Intima-Media Thickness ; Cholesterol ; Cholesterol, LDL ; Coronary Angiography ; Coronary Artery Disease* ; Humans ; Hypercholesterolemia ; Lipoproteins ; Multivariate Analysis ; Triglycerides ; Ultrasonography

BACKGROUND AND OBJECTIVES: While the clinical significance of descending thoracic aorta intima-media thickness (DTA-IMT) remains unclear, common carotid IMT (CIMT) is known to be associated with major adverse cardiovascular events (MACE) in patients with atherosclerotic disease. SUBJECTS AND METHODS: A total of 104 patients (mean age, 59 yrs; 69 male) with angiographically proven coronary atherosclerosis underwent transesophageal echocardiography (TEE) for DTA-IMT measurement and carotid scanning for CIMT measurement. The patients were divided into two groups based on the median IMT value, and they were followed up for cardiovascular events and all-cause mortality for a period of 50+/-21 months. RESULTS: Patients having a higher DTA-IMT value (n=44, >2.1 mm) had a higher chance of stroke (6.7% vs. 2.8%, p=0.04), peripheral vascular disease (6.7% vs. 1.9%, p=0.02), and death (2.9% vs. 0%, p=0.04) than those who had lower DTA-IMT values (n=60, < or =2.1 mm). The patients who had higher CIMT values (n=49, >0.089 mm) had a higher chance of peripheral vascular disease (16% vs 2%, p=0.009) than those having lower IMT values (n=55, < or =0.089 mm). However, there was no significant difference between the groups in terms of recurrent chest pain, heart failure, syncope, myocardial infarction or chronic kidney disease during the follow-up period. Multivariate Cox regression analysis revealed that increased DTA-IMT was associated with stroke (OR, 4.29; 95% CI, 1.076-17.181; p=0.039) and peripheral vascular disease (OR, 9.37; 95% CI, 1.571-55.499; p=0.014), whereas increased CIMT was associated with peripheral vascular disease (OR, 14.365; 95% CI, 1.050-196.540; p=0.046). CONCLUSION: This study suggests that descending thoracic aorta IMT is more closely associated with prognosis in patients with coronary atherosclerosis than CIMT.
Aorta ; Aorta, Thoracic* ; Atherosclerosis ; Carotid Arteries ; Chest Pain ; Coronary Artery Disease* ; Echocardiography, Transesophageal ; Follow-Up Studies ; Heart Failure ; Humans ; Mortality ; Myocardial Infarction ; Peripheral Vascular Diseases ; Prognosis ; Renal Insufficiency, Chronic ; Stroke ; Syncope

A 57-year-old woman with morbid obesity (BMI: 37.39) was scheduled for ligament reconstruction with tendon interposition of the carpometacarpal joint. A difficult supraclavicular brachial plexus block was performed using a 22-gauge regional block needle with a nerve stimulator and 40 ml of 1% mepivacaine. Approximately 10 minutes after the injection, she complained dyspnea, shortness of breath and right mid-thoracic pain. Her oxygen saturation decreased from 100% to 95%. Diagnostic workup revealed right diaphragmatic elevation caused by phrenic nerve block. General anesthesia was induced because of the unsuccessful brachial plexus block and dyspnea with chest pain. She recovered without any residual complications and was discharged on the third postoperative day. Phrenic nerve block is a common complication in supraclavicular brachial plexus block but it is usually not severe and reassurance is enough to control it. However, pre-operative physical conditions that may lead to decreased respiratory reserves, such as morbid obesity should be considered as a risk factors when conducting supraclavicular brachial plexus block.
Anesthesia, General ; Brachial Plexus ; Carpometacarpal Joints ; Chest Pain ; Dyspnea ; Female ; Humans ; Ligaments ; Mepivacaine ; Middle Aged ; Needles ; Obesity, Morbid ; Oxygen ; Phrenic Nerve ; Risk Factors ; Tendons