No abstract available.
Fascia* ; Foot* ; Leg*

No abstract available.
Neuroma*

Pipecuronium bromide (Arduan) is a new steroid base, bisquatemary neuromuscular blocking agent in clinical use in Eastern Europe. The chemical structure, speed of onset and duration of neuromuscular effect of pipecuronium is similar to those of pancuronium. Unlike pancuronium, however, it has no unwanted cardiovascular effects. The neuromuscular and cardiovascular effects of pipecuronium were compared with those of pancuronium in 40 adult patients anesthetized with thiopentone, nitrous oxide with oxygen and intravenous meperidine nad diazepam. Twenty patients received pancuronium 0.02 mg/kg, followed 3 minutes later by pancuronium 0.1 mg/kg intravenously (pancuronium group). The other 20 patients received pipecuronium 0.015 mg/kg and 0.08 mg/kg (pipecuronium gmup). Patient's complaint was asked 2 minutes after administrations af the priming doses. Times to 75% and 100% twitch depression were measured and the conditions of tracheal intubation were evaluated at 100% twitch depression. Heart rate, and systolic and diastolic blood pressures were checked noninvasively on arrival in the operating room (control), before trachal intubation (maximal relaxation), 1, 3, and 5 minutes after tracheal intubation. The results obtained were as follows; 1) Mild complaint of patient, such as unable to open eyes or blurred vision after priming doses was 95% in the pancuronium group and 75% in the pipecuonium group. 2) The times to 75% and 100% twitch depression of the pipecuronium group were 72+/-2.2 sec and 112.8+/-3.3 sec and were shorter than those of the pancuronium group. 3) In the pancuronium group, there was significant increases of heart rate and rate pressure product (RPP) before tracheal intubation, 1, 3, and 5 minutes after tracheal intubation compared with control value. In the pipecuronium group, there was no significant change in heart rate before tracheal intubation and 5 min after tracheal intubation compared with control value, but significant decrease in blood pressure, occured with decrease in RPP. The heart rate and RPP following administration of pipecuronium decreased significantly before tracheal intubation and 5 min after tracheal intubation compared with the pancuronium group. The results from the above study suggest that pipecuronium would have advantages over patients with significant cardiovascular diseases for a prolonged operation.
Adult ; Blood Pressure ; Cardiovascular Diseases ; Depression ; Diazepam ; Europe, Eastern ; Heart Rate ; Humans ; Intubation ; Meperidine ; NAD ; Neuromuscular Agents ; Neuromuscular Blockade ; Nitrous Oxide ; Operating Rooms ; Oxygen ; Pancuronium ; Pipecuronium* ; Thiopental

No abstract available.
Gestational Age* ; Intracranial Hemorrhages*

Postoperative hypertension occurs often in hypertensive patients due to pain, hypercapnia, hypoxemia, or excessive intravascular fluid volume. In addition, tracheal extubation exacerbates hypertension and tachycardia, which leads to left ventricular failure, myocardial infarction, or cerebral hemorrhage. We experienced a case of recurrent intracerebral hemorrhage after extubation in the postanesthetic care unit. The patient was 50-year old female who underwent total abdominal hysterectomy. Three months ago, she suffered a hypertensive cerebral hemorrhage with conservative treatment. Anesthesia induction and intraoperative course were relatively uneventful. In the postanesthetic care unit, she had voluntary movement of all limbs to command and fully awake consciousness. Immediately after tracheal extubation, the blood pressure was increased sharply to 200/110 mmHg. After then, the patient's mental status was deteriorated and the motor weakness of left extremities was developed. Brain CT showed a hypertensive hemorrhage at the right putamen and emergency stereotaxic aspiration was performed. After rehabilitative treatment, the patient was discharged with alert mental status and moderate improvement of motor weakness.
Airway Extubation ; Anesthesia ; Anoxia ; Blood Pressure ; Brain ; Cerebral Hemorrhage* ; Consciousness ; Emergencies ; Extremities ; Female ; Hemorrhage ; Humans ; Hypercapnia ; Hypertension ; Hysterectomy ; Intracranial Hemorrhage, Hypertensive ; Middle Aged ; Myocardial Infarction ; Putamen ; Tachycardia

PURPOSE: To evaluate the clinical usefulness of a home-made histographic analysis system using a lung volume controller. MATERIALS AND METHODS:Our study involved ten healthy volunteers, ten emphysema patients, and two idio-pathic pulmonary fibrosis (IPF) patients. Using a home-made lung volume controller, images were obtained in the upper, middle, and lower lung zones at 70%, 50%, and 20% of vital capacity. Electron beam tomography was used and scanning parameters were single slice mode, 10-mm slice thickness, 0.4-second scan time, and 35 -cm field of view. Using a home-made semi-automated program, pulmonary parenchyma was isolated and a histogram then obtained. Seven histographic parameters, namely mean density (MD), density at maximal frequency (DMF), maximal ascending gradient (MAG), maximal ascending gradient density (MAGD), maxi-mal descending gradient (MDG), maximal descending gradient density (MDGD), and full width at half maxi-mum (FWHM) were derived from the histogram. We compared normal controls with abnormal groups includ-ing emphysema and IPF patients at the same respiration levels. RESULTS: A normal histographic zone with +/-1 standard deviation was obtained. Histographic curves of normal controls shifted toward the high density level, and the width of the normal zone increased as the level of inspi-ration decreased. In ten normal controls, MD, DMF, MAG, MAGD, MDG, MDGD, and FWHM readings at a 70% inspiration level were lower than those at 20% (p<0.05). At the same level of inspiration, histograms of emphysema patients were located at a lower density area than those of normal controls. As inspiration status decreased, histograms of emphysema patients showed diminished shift compared with those of normal con-trols. At 50% and 20% inspiration levels, the MD, DMF, and MAGD readings of emphysema patients were significantly lower than those of normal controls (p<0.05). Compared with those of normal controls, his-tograms of the two IPF patients obtained at three inspiration levels were located in an area of higher density. CONCLUSION: Using a home-made histographic analysis system which included a lung volume controller, pa-tients with diffuse parenchymal lung disease could be distinguished from normal controls. The method may be useful for the diagnosis and follow up of diffuse parenchymal lung diseases.
Diagnosis ; Emphysema ; Healthy Volunteers ; Humans ; Lung Diseases* ; Lung Diseases, Interstitial ; Lung* ; Pilot Projects* ; Pulmonary Emphysema ; Pulmonary Fibrosis ; Reading ; Respiration ; Tomography, X-Ray Computed ; Vital Capacity

A hyperglycemic hyperosmolar state is usually associated with type 2 diabetes. It has significant mortality and morbidity and is rare in the pediatric population. We describe a rare case of a 15-year-old boy with type 2 diabetes who presented to the emergency department with a mixed hyperglycemic hyperosmolar state and diabetic ketoacidosis. Excessive consumption of high-sugar carbonated drinks may have worsening the initial presentation. The patient recovered without any complications. We highlight the fact that gradual correction of osmolarity and sodium is important to avoid cerebral edema despite severe dehydration.
Adolescent* ; Brain Edema ; Carbonated Beverages ; Dehydration ; Diabetes Mellitus, Type 2* ; Diabetic Ketoacidosis* ; Emergency Service, Hospital ; Humans ; Hyperglycemic Hyperosmolar Nonketotic Coma ; Male* ; Mortality ; Osmolar Concentration ; Sodium

Triceps tendon avulsion from the olecranon is a rare injury. Missed or delayed diagnosis may result in a weakness of strength or a decreased range of motion of the elbow. This injury is usually caused by a fall on the outstretched hand or a direct blow to the posterior arm. In addition, the rupture of the triceps tendon is implicated by a sudden eccentric contraction of the triceps muscle. To determine whether the rupture is complete or incomplete is critical to guide the treatment method. A small avulsed fragment from the olecranon may be detected on lateral radiographs of the elbow. We report three cases of the triceps tendon avulsion with a bony flake from the olecranon, which were surgically treated, along with a brief review of the literature.
Arm ; Contracts ; Delayed Diagnosis ; Elbow ; Hand ; Muscles ; Olecranon Process ; Range of Motion, Articular ; Rupture ; Tendons

Subclavian steal syndrome caused by an acute thrombus is very rare. We present a case of cerebellar infarction with proximal subclavian artery thrombosis. A 56-year-old woman was admitted for sudden vertigo. One day prior to admission, she received a shoulder massage comprised of chiropractic manipulation. On examination, her left hand was pale and radial pulses were absent. Blood pressure was weak in the left arm. Downbeat nystagmus and a right falling tendency were observed. Brain MRI showed multiple acute infarctions in the left cerebellum. The findings of Doppler ultrasonography in the left vertebral artery were compatible with a partial subclavian artery steal phenomenon. Digital subtraction angiography demonstrated a large thrombus in the left subclavian artery. After heparin infusion, thrombus size markedly decreased. Cerebellar infarction caused by acute subclavian thrombosis following minor trauma is rare, but the thrombus can be successfully resolved with anticoagulation.
Brain Infarction/*diagnosis/etiology/pathology ; Cerebellar Diseases/diagnosis/etiology ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Thrombosis/*complications

The effect of anesthetic volume on the spread of hypobaric tetracaine were sutdied after intrathecal injection in thirty patients with prone jackknife and 15 degree Trendelenburg position for perinal surgery. The patients were assigned randomly into the one of three groups divided by the 3, 4, or 5 ml of volume of anesthetic solution. The results show that the volume of tetracaine in distilled water with hypobaric spinal anesthesia in prone jackknife and l5 degree Trendelenburg position had a important effect on the anesthetic dermatomal levels in spite of slightly rapid onset with large. volume. Therefore, we concluded that for the perianal surgery in prone jackknife position, as the volume of the anes- thetic solution with hypobaric spinal anesthesia, 3 or 4 ml of the volume are sufficient to get the adequate anesthetic levels.
Anesthesia, Spinal* ; Head-Down Tilt ; Humans ; Injections, Spinal ; Tetracaine ; Water