Myotonic dystrophy is a muscle disorder characterized by progressive muscle wasting and weakness associated with myotonia. It is a systemic disease transmitted in an autosomal dominant pattern. Myotonia may be precipitated by hypothermia, shivering, and mechanical or electrical stimulation. Furthermore, sensitivity to sedative, anesthetic and neuromusclular blocking agents may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. Therefore, a patient with myotonic dystrophy is at high risk for complications from anesthetic management. We report the successful anesthetic management of such a patient undergoing a total abdominal hysterectomy, in which we used an epidural technique for intraoperative anesthesia and postoperative analgesia.
Analgesia ; Anesthesia ; Electric Stimulation ; Humans ; Hypothermia ; Hysterectomy ; Muscular Diseases ; Myotonia ; Myotonic Dystrophy* ; Shivering

A Bezold-Jarisch reflex (BJR) mediated vasovagal syncope is the most common neurally mediated reflex characterized by the sudden failure of the autonomic nervous system and have been reported in patients undergoing a peripheral nerve block. The concomitant administration of a beta-adrenoreceptor antagonist and calcium channel blocker have a synergistic suppressant effect on the autonomic nervous system and interact with the anesthetics significantly. We report a case of a 57-year-old female patient with essential hypertension controlled with lercanidipine and carvedilol. Cardiac arrest developed with spontaneous respiration 50 min after the brachial plexus block to remove a plate in the humerus. Epinephrine was administered and the pulse immediately returned to a normal sinus rhythm. This event might be vasovagal syncope mediated by BJR, and realted to the antihypertensive medication used.
Anesthetics ; Autonomic Nervous System ; Brachial Plexus* ; Calcium Channels* ; Calcium* ; Epinephrine ; Female ; Heart Arrest* ; Humans ; Humerus ; Hypertension ; Middle Aged ; Peripheral Nerves ; Reflex ; Respiration ; Syncope, Vasovagal

OBJECTIVES: To identify factors associated with cancer screening intention using the Theory of Planned Behavior (TPB). METHODS: Among 55,920 eligible persons for National Cancer Screening Program (NCSP) in J city, 1,100 individuals were contacted. Of these, 797 were interviewed using a structured questionnaire. Thirty-six responses were excluded due to incomplete data. The remaining 761 completed questionnaires were analyzed to find factors associated with cancer screening intention. RESULTS: Cancer screening intention was significantly associated with behavioral attitude (p<0.01) and subjective norm (p<0.01), but not with perceived behavioral control (p=0.29) in the TPB model. These three constructs explained 29.7% of cancer screening intention in multiple linear regression analysis. External factors such as socio-demographic status, health and health behavior variables explained 8.9% of screening intention. Among them, household monthly income, past cancer screening experience, exercise and daily eating habit were significantly associated with screening intention. CONCLUSIONS: Cancer screening intention may be influenced by focusing attitude, subjective norm in TPB model and other external factors. However, further studies are warranted to identify factors influencing cancer screening intention and behavior.

BACKGROUND: Nitrous oxide may cause distension of the intestine. We studied the influence of nitrous oxide on the recovery of bowel function and the incidence of complications of bowel distension. METHODS: Fifty patients scheduled for abdominal hysterectomy were anesthetized with sevoflurane and oxygen and were randomly assigned to be given 50% nitrous oxide (n = 25) or 50% air (n = 25) in two groups. A surgeon assessed the closing condition. Patients reported pain, nausea and vomiting after surgery. The lapse of time before the passing of flatus was recorded. RESULTS: There was no difference between the two groups with respect to body weight, duration of surgery, alfentanil and atracurium requirements, pain score, nausea and vomiting, and closing condition. The time elapsing before the passing of flatus was significantly greater for the patients that received nitrous oxide. CONCLUSIONS: Our results suggest that avoiding nitrous oxide administration during prolonged intraabdominal surgery shortens the time for recovery of bowel function.
Alfentanil ; Atracurium ; Body Weight ; Flatulence ; Humans ; Hysterectomy ; Incidence ; Intestines ; Nausea ; Nitrous Oxide* ; Oxygen ; Recovery of Function* ; Vomiting

Since Inoue et al introduced a specially designed balloon catheter for percutaneous mitral valvuloplasty (PMV) in 1984, the Inoue balloon catheter has been a popular device for the management of mitral stenosis. During the procedure several fatal complications, such as cardiac tamponade, perforation of a cardiac chamber, atrial septal defect, thromboembolism, mitral regurgitation and death have all been reported in the literature. There have also been several international reports regarding deformities of the Inoue balloon, but few reports in Korea. We recently experienced a case of an inflation failure of the distal portion of the Inoue balloon during a percutaneous mitral valvuloplasty in a 34 year old female patient with a tight mitral stenosis. To the best of our knowledge, a similar deformity of an Inoue balloon has never been reported in Korea.
Adult ; Cardiac Tamponade ; Catheters ; Congenital Abnormalities ; Female ; Heart Septal Defects, Atrial ; Humans ; Inflation, Economic* ; Korea ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Thromboembolism