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

For the evaluation of the 51Cr labelled in-vivo crossmatching test as a transfusion safety test, We examined the viability of the thransfused autologous and heterologous 51Cr labelled red cell at 1 hour and 24 hour in 6 normal volunteers and 4 patients whose RBC had been stored in CPDA-1 media from 1 day to 30 day. In both autologous transfusion control group(n=3) and allogeneic transfusion control group(n=3), the in-vivo RBC survival rate were more than 70% at 1 hour and 24 hour compared to that of basal 3 minute result(percent counted as 100%), and the eluted free radioisotope activity was less than 5% compared to that of whole blood. The crossmatch incompatible patient group also satisfied the safe transfusion criteria. The mean labelling efficiency which was tested in three patients was more than 95% and also satisfactory to reliable test. We concluded that in-vivo crossmatching test using 51Cr radioisotope would give us valuable informations about transfusion safety, especially in serologically incompatible patients.
Healthy Volunteers ; Humans ; Survival Rate

No abstract available.
Barium* ; Intussusception*

No abstract available.
Anemia, Aplastic* ; Child* ; Humans ; Immunomodulation*

No abstract available.
Dermatitis, Atopic ; Pyroglyphidae

No abstract available.
Leukemia*

No abstract available.
Dyskeratosis Congenita*

OBJECTIVE: To evaluate the effects of strengthening exercise for isolated lumbar extensor muscles on chronic low back pain patients. METHOD: 28 patients with chronic low back pain in back school program participated in this study. Initially, isometric lumbar extensor strength, 10 point of Visual analog scale (VAS) and questionnaires related to self-experienced symptoms and daily activity (ADL) were checked. Isometric lumbar extensor strength test and strengthening exercise were performed with MedXTM lumbar extensor machine, which was designed to stabilize the pelvis. After 8 weeks of training program, isometric lumbar extensor strength & other pain related variables were checked again in the same way. RESULTS: The results were as follows: 1) After 8 weeks of lumbar extensor strengthening program, isometric lumbar extensor strength was increased at all the measured points significantly (p<0.01). 2) VAS and ADL were improved from 6.7 to 3.7, and from 6.9 to 9.1 respectively (p<0.05). CONCLUSION: 8 weeks of lumbar extensor strengthening program with pelvic stabilization was effective therapeutic tools for patients with chronic low back pain.
Activities of Daily Living ; Education ; Humans ; Low Back Pain* ; Muscles ; Pelvis ; Surveys and Questionnaires ; Visual Analog Scale

BACKGROUND: An aggressive skin cancer on the nose, tends to have poorly defined clinical margins, and has a higher recurrence rate. A small tumor on the nose is usually easily treated by any of the standard methods. However, removal and reconstruction with preserved cosmesis is more laborous in a basal cell carcinoma larger than 10 mm in diameter. This is because the nose has complex contoures, unique skin color and texture, and the limited availability of mobile adjacent skin. When available Mohs micrographic surgery is the preferred treatment for these large tumors. OBJECTIVE: Our purpose was to investigate the preferred reconstruction method(especially, local flap reconstruction) by the cosmetic unit of the nose after Mohs micrographic surgery. METHODS: From March 1991 to February 1997, twenty-one patients were diagnosed with basal cell carcinoma on the nose at our department. All the tumors were removed with Mohs micrographic surgery, and then the defects were reconstructed with a primary closure, skin graft, and local flap.
Carcinoma, Basal Cell* ; Humans ; Mohs Surgery* ; Nose* ; Recurrence ; Skin ; Skin Neoplasms ; Transplants

In this study, we designed the expert system for the diagnosis of stroke. The causes of stroke in central nervous systems are very diverse, so a doctor who treats the patients with stroke must have the expert knowledge for the quick and correct diagnosis and for the adequate medical management. But the primary physician who engaged in the primary care of the patient with stroke does not have the expert knowledge for the stroke. So, we need to develop the expert system for assisting the diagnosis of stroke. Also the diagnosis system can be used as simulator for the medical students who study the neurology. In this study, we developed the diagnosis expert system that offer a pathological name provided by artificial neural networks. And we designed the inference engine and GUIs(graphical user interfaces). The artificial neural network is a system that provide a possible diagnosis of stroke. We implemented the system using Visual Basic 6.0 of Microsoft Co.
Central Nervous System ; Diagnosis* ; Expert Systems* ; Humans ; Neurology ; Primary Health Care ; Stroke* ; Students, Medical