Malignant hyperthermia is a genetically transmitted, catastrophic, hypermetabolic syndrome that is induced by potent volatile anesthetics and/or depolarizing muscle relaxants. It is now well established that the pathophysiology is related to a malfunction of the intracellular calcium homeostasis in skeletal muscle. Morbidity has been correlated to the duration of symptoms. Dantrolene decreased release of calcium from the sarcoplasmic reticulum. We recently encountered a fulminant case during halothane anesthesia. Anesthesia was induced with thiopental and succinylcholine without jaw tightness or stiffness. After induction, tachycardia, arrhythmias, increased end-tidal CO2, and high body temperature were noted. Arterial blood gas analysis showed a severe, mixed acidosis. Intensive treatment with body cooling was immediately initiated. But dantolene could not be available. The patient died of renal failure and disseminated intravascular coagulation 41 hours after induction of anesthesia.
Acidosis ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Arrhythmias, Cardiac ; Blood Gas Analysis ; Body Temperature ; Calcium ; Dantrolene ; Disseminated Intravascular Coagulation ; Halothane ; Homeostasis ; Humans ; Jaw ; Malignant Hyperthermia* ; Muscle, Skeletal ; Neuromuscular Depolarizing Agents ; Renal Insufficiency ; Sarcoplasmic Reticulum ; Succinylcholine ; Tachycardia ; Thiopental

No abstract available.
6-Cyano-7-nitroquinoxaline-2,3-dione* ; Cycloheximide* ; Dizocilpine Maleate*

Increased and inappropriate production of aldosterone from the adrenal gland is known as primary aldosteronism and leads to sodium retention with hypertension, suppression of plasma renin, and hypokalemia and its manifestations. It is due mainly to a solitary adenoma, bilateral hyperplasia, or rarely an adrenal carcinoms. Primary aldosteronism due to an adenoma is usually treated by surgical excision. Preoper-ative managements include the correction of hypokalemia, volume derangement, and metabolic alkalosis with spironolactone and the trestment of existing hypertension. The authors report a case of unilateral adrenalectomy and anesthetic considerations during perioperative periods.
Adenoma* ; Adrenal Glands ; Adrenalectomy ; Aldosterone ; Alkalosis ; Humans ; Hyperaldosteronism* ; Hyperplasia ; Hypertension ; Hypokalemia ; Perioperative Period ; Plasma ; Renin ; Sodium ; Spironolactone

Serious complications from subelavian vein cannulation have been reported, i.e., pneumothorax, hydrothorax, hemothorax and catheter embolism, etc. A 42 year old female with a diagnosis of septic cholangitis was catheterised in the right subclavian vein by the supraclavicular approach for the measurement of CP and on the 3rd day of admission and developed a hemothorax subsequently. She had a cholecystectomy on the 4th day. Aensthesia was induced with the injection of pentothal and succinylcholine through the CVP line and was maintained with Ethrane. Her vital signs were not stable during the surgery as well as post-operatively. She also was not able to breathe by herself so that her respiration was assisted with a MA-J respirator. On the 2nd post-operative day, blood gases suggested respiratory failure and a chest P-A showed right pleural effusion. A chest tube was then inserted and about 3,200ml of blood was drained. She recovered from the hemothorax and superimposed pneumonia with intensive respiratory care for 20 days.
Adult ; Catheterization* ; Catheters* ; Chest Tubes ; Cholangitis ; Cholecystectomy ; Diagnosis ; Embolism ; Enflurane ; Female ; Gases ; Hemothorax* ; Humans ; Hydrothorax ; Pleural Effusion ; Pneumonia ; Pneumothorax ; Respiration ; Respiratory Insufficiency ; Subclavian Vein ; Succinylcholine ; Thiopental ; Thorax ; Veins* ; Ventilators, Mechanical ; Vital Signs

Central vanous pressure is an extremely useful parameter in the effective monitoring of a patient who is seriously ill. Central venous pressure may be defined as a dynamic measurement of the ability of the right heart and the placement of the catheter in either the right atrium or the superior cava is considered satisfactory. The purpose for this study is to evaluate CVP values according to the placement of the catheter in clinical practice because we have used a short anglocath instead of a long intracath for the measurement of CVP. Ten patients were catheterized with a 20cm in tracathin the right subclavian vein by a supraclavicular approach. AS a control group CVP was measured at 13cm from the puncture site to the tip of catheter which was estimated to be in the right atrium. In the second group, CVP was measured at 8cm which goes the innominate vein and in the fourth group, measured at 5cm which locates in the subclavian vein. Mean values of venous pressures in each location are as follows: The right atrium(13cm from the puncture site): 8.68cm H2O. THe superior vena cava (10cm from the puncture site): 8.69cm H2o/ The innominate vein(8cm from the puncture site): 8.64cm H2O. The subclavian vein (5cm from the puncture site):8.68cm H2O. As a result of this study, we came to the conclusion that the CVP values in all four groups(right atrium, superior vena cava, innominate vein, subclavian vein) are almost the same, so that we can use a short angiocath with no problems for the measurements of CVP which is anchored in the innominate vein or the subclavian vein.
Brachiocephalic Veins ; Catheters* ; Central Venous Pressure ; Heart ; Heart Atria ; Humans ; Punctures ; Subclavian Vein ; Vena Cava, Superior ; Venous Pressure

No abstract available.
Anoxia* ; Neurons*

Atrial natriuretic factor(ANF) is a diuretic natriuretic peptide hormone produced by both the heart and brain. It has been postulated to play a role in the hemodynamic and sodium instability that frequently follows subaracthnoid hemorrhage(SAH). Electrocardiographic(EKG) abnormalities is known to occur frenquently after cerebrovascular accident, especially subarachnoid hemorrhage. A prospective study was undertaken to evaluate the relation between the changes of ANF and EKG findings and clinical findings. Thirty-five nonselected patients with SAH were followed with serial measurements of plasma ANF, plasma antidiuretic hormone(ADH), serum sodium, serum osmolarity, and electrocardiography(EKG) at 2nd, 5th, and 7th day after hemorrhage. Mean plasma ANF values at 2nd, 5th, and 7th day of hemorrhage were 202.3+/-109.6 pg/ml, 134.6+/-83.5 pg/ml, and 123.3+/-69.9 pg/ml, respectively. Mean plasma ADH values were within normal limits(3.2-4.4 pg/ml). At a later stage, 9 patients showed hyponatremia and hypoosmolarity, among whom 8 patients had elevated ANF and 1 patient elevated ADH. The delayed and persistent rise of plasma ANF was correlated with the development of hyponatremia. One or more EKG abnormalities were found in 13 patients. Mean ANF values of patients with normal EKG(131.8+/-48.7 pg/ml) were significantly different from those with abnormal EKG(272.2+/-107.5 pg/ml). The changes of plasma ANF appeared unrelated to age, sex, clinical grade, CT grade, and bleeding site. The results of this study indicate that elevated plasma ANF is closely related with electrophysiological changes of myocardium and that the transitory myocardial ischemia might be the source of plasma ANF sfter SAH.
Atrial Natriuretic Factor* ; Brain ; Electrocardiography* ; Heart ; Hemodynamics ; Hemorrhage ; Humans ; Hyponatremia ; Myocardial Ischemia ; Myocardium ; Osmolar Concentration ; Plasma ; Prospective Studies ; Sodium ; Stroke ; Subarachnoid Hemorrhage*

In recent years there has been a tendency to abandon repeat cerebral angiography in patients with subarachnoid hemorrhage(SAH) if the initial angiogram is normal because prognosis is said to be excellent. Our experiences does not support such a conclusion. In 291 cases with subarachnoid hemorrhage(SAH), four vessel cerebral angiography was performed to investigate a source of the hemorrhage. The first four vessel study on admission revealed 234 cases(80.4%) of ruptured cerebral aneurysms. Fifty-five of 291 patients with primary subarachnoid hemorrhage(SAH) did not show vascular lesion in initial pan-angiography studies. In order to define the benefit of control angiography these patients were reviewed. Among 41 patients who underwent repeat angiography, a second angiography showed an aneurysm in 24(58.5%). Twelve of the twenty-four cases had aneurysms in the anterior communicating artery. But the age, sex, initial clinical grade and CT grade of patients with aneurysm in repeat angiography were indistinguishable from thoses of patients without aneurysm. Even in the patients who showed angiographic vasospasm in intial angiography, probability of revealing an aneurysm was not different from those without spasm. We conclude that repeat angiography is necessary in the cases of SAH with normal initial angiogram regardless of the CT findings and the presence of vasospasm.
Aneurysm ; Angiography* ; Arteries ; Cerebral Angiography ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Prognosis ; Spasm ; Subarachnoid Hemorrhage*

The patient was a 51 year-old woman suffering fraen dysphagia due to upper esoyhageal lye stricutue whieh had developed as a result of a suicide attempt 21 years ago. Shortly after that, she underwent feeding gastrostomy and has lived in the gastrostomy state for 2l years. After admission, she underwent a barium esophagoram which revealed a near total obstruction at the cricoid cartilage level. Bougie dilatation with American Dilation System was tried on day 3. But the spring tip marked guide wire which was to be used with the American Dilation System could not be passed through the stricuture. Therefore, we performed a bougie dilatation using angiographic guide wire M(H-AG-35in-150 cm) with success. On day 14, she underwent a barium esophagogram which revealed her improved condition, and she was discharged on day 16.
Barium ; Constriction, Pathologic* ; Cricoid Cartilage ; Deglutition Disorders ; Dilatation* ; Female ; Gastrostomy* ; Humans ; Lye* ; Middle Aged ; Suicide

No abstract available.
Conus Snail* ; Hemangioblastoma*