We have mnanaged the anesthetic and postoperative care in 9 patients with myasthenia gravis who underwent thymectomy and obtained following resultsa : 1) Premedication was glycoprrrolate 0.004mg/kg or atropine 0.01mg/kg and hydroxyzine 1~2mg/kg, I.M. Anesthetic induction was by thiopental 4~5mg/kg with 7he inhalation of halothane 1~2 % or enflurane 4~5%, and followed by endotracheal intubation. Anesthetic maintanance was done by N2O and halothane or enflurane. 2) Mean duration from the end of operation to intubation was 11.83+/-3.37hrs. 5 patients required reintubation. The mean duration from the extubation to reintubation was 33.11+/- 21.06hrs for these 5 patients. Over all this entire group of patients were placed on the respirator for a mean of 5.33+/-1.46dara. 3) Complication occured were 2 cases of cholinergic crisis, 1 cases of lung abscess, 2 cases of dyspnea and 1 case of tension pneumothorax 4) Abstinence of muscle relaxants, adequate respiratory care and the protection from cholinergic crisis were the most important factora for successful management.
Anesthesia* ; Atropine ; Dyspnea ; Enflurane ; Halothane ; Humans ; Hydroxyzine ; Inhalation ; Intubation ; Intubation, Intratracheal ; Lung Abscess ; Myasthenia Gravis* ; Pneumothorax ; Postoperative Care ; Premedication ; Thiopental ; Thymectomy* ; Ventilators, Mechanical

No abstract available.
Meningitis, Bacterial* ; Stapes*

Generally, myasthenic patients are believed to have enhanced sensitivity with variety to the nondepolarizing neuromuscular blockade, even though some authors do not agree with that. Recent1y, the use of the new intermediate-acting nondepolarizing relaxant atracurium has been reported in patient with myasthenia gravis. The unique mode of elimination of atra-curium, which undergoes spontaneous degradation at physiologic body temperature and pH. may offer an advantage over the previously available Bong-acting muscle relaxants. We describe a case report of the anesthetic management of mysthenic patient using atracurium because of its relatilvely rapid rate of recovery. Reduced dosage of atracurium appeared to be a reasonable choice for myasthenic patients requring surgical relaxation when clinically indicated. However, continuous monitoring of neuromuscular function is of course mandatory for the proper and safe use of atracurium.
Atracurium* ; Body Temperature ; Humans ; Hydrogen-Ion Concentration ; Myasthenia Gravis* ; Neuromuscular Blockade ; Relaxation

BACKGROUND: The radial artery pressure is known to differ from central arterial pressure in normal patients (distal pulse amplification) and in the early postcardiopulmonary bypass period. We assumed that there may be a change in the normal relationship between central and peripheral arterial pressure in patients with hepatic failure due to an arterio-venous shunt caused by vasodilation and a complex surgical procedure with major vessel clamping. This study was done to examine the adequacy of the radial artery as a site for blood pressure monitoring in liver transplantation (TPL). METHODS: We investigated when the pressure gradient developed and what mechanism could be responsible by comparing femoral to radial artery pressure in 11 patients undergoing liver transplantation. Radial and femoral artery pressures, systemic vascular resistance, cardiac output and temperature were compared during surgery in all 11 patients. Additionally measurements included pH, PaO2, PaCO2, central venous pressure, pulmonary artery pressure and mixed venous oxygen saturation. RESULTS: The femoral artery systolic pressure was higher than the corresponding radial artery pressures during the operation. Although not statistically significant, the radial mean and diastolic artery pressures were lower than corresponding the femoral artery pressure. CONCLUSIONS: Radial artery systolic pressures underestimate the femoral artery pressure when undergoing a liver TPL. Failure to recognize these effects on pressure recordings can lead to inappropriate patient management decisions.
Adult* ; Arterial Pressure ; Arteries ; Blood Pressure ; Blood Pressure Monitors ; Cardiac Output ; Central Venous Pressure ; Constriction ; Femoral Artery ; Humans ; Hydrogen-Ion Concentration ; Liver Failure ; Liver Transplantation* ; Liver* ; Oxygen ; Pulmonary Artery ; Radial Artery* ; Vascular Resistance ; Vasodilation

BACKGROUND: Nerve conduction study (NCS) is an objective and quantitative test in evaluating peripheral nerve disorders. Several physiological and technical factors are well known to influence the results of NCS, which can be controlled and regulated by standardization of environment and through the process to make range of normality. However, most electromyographers do not pay much attentions about inter- and intra-examiner variabilities, and there are only a few and incomplete reports on these topics. We examined the intra-examiner variability of NCS on the basis of periods of practice. METHODS: Twenty-eight electromyographers were divided into two groups: residents and neurologist-technicians. All, having variable NCS training periods, have performed NCS on one of other 27 electromyographers ten times within two weeks where each study was made once a day. RESULTS: Coefficient of variation and external quotient increased according to the following order - nerve conduction velocities (NCV), terminal latencies (TL), and amplitudes of compound action potentials (AMP). There were significant differences between the two groups in NCV and TL, but no statistical difference in AMP. CONCLUSIONS: Our results suggest that errors from intra-examiner variability should be considered when interpreting NCS and that those electromyographers who have enough training should perform NCS.
Action Potentials ; Attention ; Humans ; Neural Conduction* ; Peripheral Nerves

Atypical antipsychotics have replaced conventional antipsychotics in the treatment of schizophrenia because they have less of a propensity to cause undesirable neurologic adverse events including extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome (NMS). However, atypical antipsychotics have been known to result in various metabolic complications such as impaired glucose tolerance, diabetes and even diabetic ketoacidosis (DKA). In addition, a number of NMS cases have been reported in patients treated with atypical antipsychotics, although the absolute incidence of neurologic side effects is currently significantly low. Here, we report a patient who simultaneously developed DKA, acute renal failure and NMS with rhabdomyolysis after olanzapine treatment. Olanzapine-induced metabolic complications and NMS were dramatically improved with cessation of the olanzapine treatment and initiation of supportive management including fluid therapy, hemodialysis, and intensive glycemic control using insulin. At short-term follow-up, insulin secretion was markedly recovered as evidenced by a restoration of serum C-peptide level, and the patient no longer required any hypoglycemic medications. Despite the dramatic increase in the use of atypical antipsychotics treatment, individualized treatments along with careful monitoring may be prudent for high risk or vulnerable patients in order to avoid the development of metabolic side effects.
Acute Kidney Injury ; Antipsychotic Agents ; Benzodiazepines ; C-Peptide ; Diabetic Ketoacidosis ; Fluid Therapy ; Follow-Up Studies ; Glucose ; Humans ; Incidence ; Insulin ; Movement Disorders ; Neuroleptic Malignant Syndrome ; Renal Dialysis ; Rhabdomyolysis ; Schizophrenia

Purpose: Targeted next-generation sequencing (NGS) panels for solid tumors have been useful in clinical framework for accurate tumor diagnosis and identifying essential molecular aberrations. However, most cancer panels have been designed to address a wide spectrum of pan-cancer models, lacking integral prognostic markers that are highly specific to gliomas. Materials and Methods: To address such challenges, we have developed a glioma-specific NGS panel, termed “GliomaSCAN,” that is capable of capturing single nucleotide variations and insertion/deletion, copy number variation, and selected promoter mutations and structural variations that cover a subset of intron regions in 232 essential glioma-associated genes. We confirmed clinical concordance rate using pairwise comparison of the identified variants from whole exome sequencing (WES), immunohistochemical analysis, and fluorescence in situ hybridization. Results: Our panel demonstrated high sensitivity in detecting potential genomic variants that were present in the standard materials. To ensure the accuracy of our targeted sequencing panel, we compared our targeted panel to WES. The comparison results demonstrated a high correlation. Furthermore, we evaluated clinical utility of our panel in 46 glioma patients to assess the detection capacity of potential actionable mutations. Thirty-two patients harbored at least one recurrent somatic mutation in clinically actionable gene. Conclusion We have established a glioma-specific cancer panel. GliomaSCAN highly excelled in capturing somatic variations in terms of both sensitivity and specificity and provided potential clinical implication in facilitating genome-based clinical trials. Our results could provide conceptual advance towards improving the response of genomically guided molecularly targeted therapy in glioma patients.