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Paraneoplastic pemphigus is a distinct and rare autoimmune disease characterized by extensive and painful mucosal ulcerations and polymorphic desquamated skin lesions in the setting of an underlying neoplasm, typically of lymphoreticular origin. Thus difficulties in the management of anesthesia can be expected. A 66-years-old man was scheduled for removal of intraabdominal sarcoma associated with paraneoplastic pemphigus. Physical examination showed multiple erythematous bullae, crusts, plaques and target-like lesions on the whole body and desquamated erythematous skin lesions on the back and extremities. In the operating room, his right femoral artery was cannulated with a 20 G, 12.7 cm CVP catheter and left femoral and subclavian veins with 14 G, 20 cm CVP catheters, respectively. After application of 4 % lidocaine spray, his oropharynx and supraglottic area were evaluated under direct laryngoscopy and revealed multiple ulcerations on oral mucosa, but no distinct lesion on supraglottic area. Anesthesia was induced by rapid-sequence method with fentanyl, thiopental sodium and succinylcholine followed by endotracheal intubation. The endotracheal tube was held by a roll gauze around the neck and its cuff was minimally inflated to avoid overpressure against his tracheal wall. After the end of surgery, his oral cavity was suctioned with no remarkable bleeding, and tracheal wall including cuff-contacted area was evaluated under fiberoptic bronchoscopy, revealed intact wall without any bulla or ulceration. The patient was transferred to intensive care unit for proper postoperative management after extubation of endotracheal tube.
Anesthesia ; Autoimmune Diseases ; Bronchoscopy ; Catheters ; Extremities ; Femoral Artery ; Fentanyl ; Hemorrhage ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Laryngoscopy ; Lidocaine ; Mouth ; Mouth Mucosa ; Neck ; Operating Rooms ; Oropharynx ; Pemphigus* ; Physical Examination ; Sarcoma ; Skin ; Subclavian Vein ; Succinylcholine ; Suction ; Thiopental ; Ulcer

4.Immunohistochemical Study on Cytokeratin Expression in Epidermis of Human Fetus.

Sung Sik PARK ; Dong Ho YANG ; Kwang Il NAM ; Shin Kon KIM

Korean Journal of Physical Anthropology 1995;8(1):39-52

To identify the developmental characteristics of intermediate filaments, the expressions of various cytokeratines (CK), desmin and vimentin in fetal (14032 weeks of gestations) and adult epidermis were studied immunohistochemically. The primary antibodies used were CK7, 8, 10, 14, 18, AE8, 5D3, and MNFl16 for cytokeratins, D33 for desmin, and V9 for vimentin. At 14 weeks of gestation, the epidermis consisted of basal cells and periderm. The periderm exhibited positive staining for CK8 and AE8, and weak staining for MNF116 and D33. The basal cells showed positive staining for MNF116 and D33. The epidermis did not reacted for CK7, 10, 14, 18, 5D3, and V9 at this period. At 16-20 weeks of gestation, the epidermis was composed of basal, intermediate, and periderm layers. The periderm was positive for CK8, 18, AE8, MNF116, and D33. The intermediate cells were positive for CK10 and the basal cells CK14, MNF116, and D33. Few cells were stained positively with V9 among the basal cells. At 24-32 weeks of gestation, the epidermis exhibited no longer positive reactions for CK8, 18, AE8 and D33. The intermediate cells were positive for CK10. Immunoreactivity for MNF116 was noted in intermediate layer just above the basal layer. CKl4, MNFl16, D33, and often V9 were expressed in basal cells. The expressions of CK7 and 5D3 were not observed at any period of gestation. In adult epidermis, basal cells exhibited positive staining for CKl4, MNFl16, and D33. The intermediate cells were strongly positive for CK10, and weakly positive for CK7, 8, and MNFl16. The cells positive for V9 were often present among the basal cells. These results indicate that CK8 and 18 may serve as useful markers for periderm, CK10 for intermediate cells, CKl4 for basal cell, and suggest that the vimentin immunoreactive cells in basal cell layer are Langerhans cells.
Adult ; Antibodies ; Desmin ; Epidermis* ; Fetus* ; Humans* ; Immunohistochemistry ; Intermediate Filaments ; Keratins* ; Langerhans Cells ; Pregnancy ; Vimentin