Chronic eosinophilic pneumonia is a rare diasease characterized by chronic infiltration of the lung with ~eosinophils, usually associated with peripheral eosinophilia. In 65% of cases, the chest rad Ogroaph shows typiical nonsegmental air-space consolidation confined to the outer third of the lung and in 25)/0 of case "photographic negative of pulmonary edema". Typical lung manifestations with 'peripheral eosinophiliSa' tahrcharacteristic of chronic eosinophilic pneumonia. In the remaining cases, radiographic findings are nonspecific and require lung biopsy for confirmation. We repot a case of chronic eosinophilic pneumonia in which chest radiograph and CT scans revealed bilateral patchy or diffuse opacity with nodules scattered throughout the lungs.
Biopsy ; Eosinophilia ; Eosinophils* ; Lung ; Pulmonary Eosinophilia* ; Radiography, Thoracic ; Thorax ; Tomography, X-Ray Computed

Dextran is a macromolecular polymer of dextrose. Dextran is used as a plasma expander with reduction in blood viscosity and disruption of red cell aggregates. It also inhibits platelet aggregation and prothrombin activation. It has been reported that a hemostatic defect characterized by a prolonged bleeding time in subject receiving large amount of dextran. The present study was undertaken to observe the effect of dextran on bleeding time and platelet aggregation by increasing volume. In this study, bleeding time was checked and sampling was done at before infusion, after 5 ml/kg, 10 ml/kg and 15 ml/kg infusion of dextran in 15 patients with spinal or regional anesthesia. The results were as follows: 1) There was prolonged bleeding time by increasing volume of dextran 40, but within nonnal limit. 2) There was no platelet aggregation with 15ml/kg of dextran.
Anesthesia, Conduction ; Bleeding Time ; Blood Platelets* ; Blood Viscosity ; Dextrans* ; Glucose ; Humans ; Plasma ; Platelet Aggregation ; Polymers ; Prothrombin

No abstract available.
Cardiomyopathy, Hypertrophic* ; Humans ; Twins, Monozygotic*

There are many predisposing factors for acute pulmonary edema, namely, left ventricular failure due to cardiac disease or fluid overloading, hypoalbuminemia, pulmonary capillary endothelial damage from bacterial toxins or irritant gases, rare central nervous system injuries pulmonary hyersensitivity reactions, etc. Acute pulmonary edema following operations is a rare complication especially in a patient whose preoperative cardiopulmonary status was within normal limits. We present a case of unilateral pulmonary edema immediately following operation in a 46 year old male patient who had a modified pull-through operation due to tongue cancer and who had no evidence of preoperative cardiopulmonary disorders. The edema was relieved after 9 hours with intensive care of pulmonary edema such as IPPB with Omorphine, diuretics, corticosteroid, asemi-sitting position and frequent tracheal suction.
Bacterial Toxins ; Capillaries ; Causality ; Central Nervous System ; Diuretics ; Edema ; Heart Diseases ; Humans ; Hypoalbuminemia ; Critical Care ; Intermittent Positive-Pressure Breathing ; Male ; Middle Aged ; Noble Gases ; Pulmonary Edema* ; Suction ; Tongue Neoplasms

In the modern practice of general anesthesia, endotracheal intubation is routinely used for controlled ventilation. To facilitating intubation, succinlycholine is the most valuable muscle relaxant. But succinylcholine has many untoward reactions such as elevation of intraocular pressure, increased plasma potassium, increased intragastric pressure, bradycardia and the development of postperative muscle pain, etc. Several attempts have study was intended to determine adequate doses of gallamine triethiodide for endotracheal intubation in patients to avoid the development of bradycardis. The authors measured the heart rate just beofre, immediately after and 5 minutes after intubation. The total number of patients in this study was 67, and the patients were divided into five groups: Group 1: consisting of 10 patients, receiving 1.5 mg/kg of gallamine triethiodide. Group 2: of 10 patients, receiving 2.0 mg/kg of gallamine. Group 3: of 22 patients, receiving 2.5 mg/kg of gallamine. Group 4: of 15 patients, receiving 3.0 mg/kg of gallamine. Group 5: of 10 patients, receiving 3.5 mg/kg of gallamine. The authors tried to choose the least difficult intubation after gallamine triethiodide, the amount administered and the patient's reaction to stimulation. The conclusions are summarized as follows: 1) The adequate dose of gallamine triethiodide for endotracheal intubation is 2.5mg/kg. 2) The duraion of action of gallamine triethiodide is dose dependent. 3) Increase of heart rate in each group is significant after gallamine triethiodide.
Anesthesia, General ; Bradycardia ; Gallamine Triethiodide* ; Heart Rate ; Humans ; Intraocular Pressure ; Intubation ; Intubation, Intratracheal* ; Myalgia ; Plasma ; Potassium ; Succinylcholine ; Ventilation

Purpose: Patients with respiratory failure associated with neurological dysfunction often require mechanical ventilator support, which poses increased economic burden and ventilator-associated complications. A diaphragm pacing system (DPS) is an implanted device that provides respiratory support for such patients. In this systematic review, we reviewed the literature to assess the safety and efficacy of DPS for patients with respiratory failure resulting from amyotrophic lateral sclerosis (ALS) or cervical spinal cord injuries. Materials and Methods: The following databases were searched from July 10 to July 30, 2018: MEDLINE, EMBASE, Cochran library, KoreaMed, Research Information Sharing Service, Korean studies Information Service System, Korea Institute of Science and Technology Information, and Korean Medical database. The abstracts and full texts of the searched articles were reviewed by two reviewers. Results: The search keywords generated 197 articles: two randomized controlled trials, two case-control studies, and one case report involving patients with ALS; one cohort study, one case-control study, and two case reports involving patients with cervical spine injury; and one case report involving patients with both conditions were included. The primary outcome was safety profile (complications and adverse event) and efficacy (overall survival and sleep improvement). Complications and adverse events were more common in patients with ALS and spinal cord injury receiving DPS than in controls. Efficacy outcomes were inconsistent across ALS studies. Conclusion Based on safety and efficacy results, we do not support using DPS to manage respiratory failure in patients with ALS or cervical spine injury.

BACKGROUND: Continuous interscalene block has been known to improve postoperative analgesia after arthroscopic shoulder surgery. This was a prospective study investigating the ultrasound-guided posterior approach for placement of an interscalene catheter, clinical efficacy and complications after placement of the catheter. METHODS: Forty-two patients undergoing elective arthroscopic shoulder surgery were included in this study and an interscalene catheter was inserted under the guidance of ultrasound with posterior approach. With the inplane approach, the 17 G Tuohy needle was advanced until the tip was placed between the C5 and C6 nerve roots. After a bolus injection of 20 ml of 0.2% ropivacaine, a catheter was threaded and secured. A continuous infusion of ropivacaine 0.2% 4 ml/hr with patient-controlled 5 ml boluses every hour was used over 2 days. Difficulties in placement of the catheter, clinical efficacy of analgesia and complications were recorded. All patients were monitored for 48 hours and examined by the surgeon for complications within 2 weeks of hospital discharge. RESULTS: Easy placement of the catheter was achieved in 100% of the patients and the success rate of catheter placement during the 48 hr period was 92.9%. Postoperative analgesia was effective in 88.1% of the patients in the post anesthetic care unit. The major complications included nausea (7.1%), vomiting (4.8%), dyspnea (4.8%) and unintended vascular punctures (2.4%). Other complications such as neurologic deficits and local infection around the puncture site did not occur. CONCLUSIONS: The ultrasound-guided interscalene block with a posterior approach is associated with a success high rate in placement of the interscalene catheter and a low rate of complications. However, the small sample size limits us to draw definite conclusions. Therefore, a well-designed randomized controlled trial is required to confirm our preliminary study.
Amides ; Analgesia ; Catheters ; Dyspnea ; Humans ; Nausea ; Needles ; Neurologic Manifestations ; Prospective Studies ; Punctures ; Sample Size ; Shoulder ; Vomiting

Ventilatory management of tracheal reconstruction surgery may require sophisticated anesthetic techniques. Most airway problems that occurred during the tracheal surgery can be prevented by passing an endotracheal tube of small size through the tracheal narrowing or locating a normal endotracheal tube just above the stenotic lesion. However, in case of high tracheal stenosis sited near the vocal cord, it is difficult to manage airway using a cuffed endotracheal tube because of high possibility of injury of the vocal cord, shallow placement of the tube and inability to apply positive pressure ventilation. The laryngeal mask airway has been used as an efficient ventilatory device in this situation. We report one case of high tracheal stenosis requiring end to end anastomosis, where airway management was successful without any complications using the proseal laryngeal mask airway (PLMA).
Airway Management ; Laryngeal Masks* ; Positive-Pressure Respiration ; Tracheal Stenosis ; Vocal Cords

BACKGROUND:Epidural anesthesia has been shown to have a direct sedative effect, and to markedly reduce the hypnotic requirement of intravenous anesthetics. The purpose of this study was to investigate whether the level of sensory block by epidural anesthesia is related with the degree of sedation, and to the hypnotic requirement of propofol. In addition, we tested whether bispectral index (BIS) monitoring can quantify the sedative effects of epidural anesthesia. METHODS: Thirty two patients scheduled for elective upper abdominal or lower extremity surgery were allocated into two groups. 2% lidocaine 15 ml was administered through an epidural catheter at the T9 T10 level (group T, n = 16) or at the L3-L4 level (group L, n = 16). Observer's assessment of alertness/sedation (OAA/S) and BIS were evaluated 20 min after the epidural injection. Hypnotic doses of propofol were then determined by evaluating the loss of open eyes in response to a verbal command as an end point while propofol was administered by target controlled infusion (target effect concentration 5microgram/ml, induction time 3 min). At the time of induction of hypnosis, the target effect concentration and BIS were recorded. RESULTS: The average level of sensory block was up to T3 in group T, and up to T11 in group L. Compared with the group L, more decreases were noticed in group T in terms of the hypnotic dose of propofol (1.13+/-0.31 mg/kg vs. 1.67+/-0.36 mg/kg; P = 0.03). A decrease in the OAA/S scale from 5 to 4 was more frequently noticed in group T than in group L (93.7% vs. 12.5%, P < 0.05). BIS recorded at the time of induction of hypnosis was higher in group T than in group L (94.8+/-2.8 vs. 82.6+/-2.2; P < 0.001). CONCLUSIONS: A higher sensory block observed in group T than in group L induced a more profound sedative effect and hypnotic induction with a lesser dose of propofol. These results support the condition that the level of sensory block by epidural anesthesia affects the degree of sedation. Moreover, BIS monitoring could not quantify the sedative effect induced by epidural anesthesia.
Anesthesia ; Anesthesia, Epidural* ; Anesthetics, Intravenous ; Catheters ; Humans ; Hypnosis ; Hypnotics and Sedatives ; Injections, Epidural ; Lidocaine ; Lower Extremity ; Propofol

To evaluate the relationship between arterial and ent tidal carbon dioxide teneion, we use ETCO2cuffed tracheal tude. Twenty five patients were selected for the study. The anesthesia was induced by pentothal sodium 4-5mg/kg, succinylcholine 1-1.5mg/kg After intubation, anesthesia was maintained by halothane, nitrous oxide and oxygen. The patients were ventilated mechanically with tidal bolume 10 ml/kg and respiration rate 12/min When anesthesia was stabilized, end tidal cardon dioxide tension were measured at proximal and distal site of ETO2cuffed tracheal tube. The arterial blood sample were taken for arterial carbon dioxide tension from radial artery simultaneously. The results were as follows: 1) Both the end tidal carbon dioxide tension at proximal and distal sites of the tube showed close correlationship with arterial carbon dioxide tension 2) There was no statistical significant difference in carbon dioxide tension between proximal and distal site of ETCO2cuffed tracheal tube.
Anesthesia ; Carbon Dioxide ; Halothane ; Humans ; Intubation ; Nitrous Oxide ; Oxygen ; Radial Artery ; Respiratory Rate ; Sodium ; Succinylcholine ; Thiopental