Laryngeal granuloma is a localized inframmatory response to mucosal loss caused by endolaryngeal trauma. Endotracheal intubation is the most common cause of laryngeal granuloma. Mucosal loss is followed by ulceration and infection and then by an overproduction of reactive granuloma tissue. Granuloma formation is most frequent on the posterior one third of the vocal cord. The authors experienced two cases of laryngeal granuloma after endotracheal intubation for general anesthesia.

A 6-year-old boy was anesthetized with halothane-N2O-O2 for anal fistulectomy. During induction of anesthesia, trismus developed soon after intravenous injection of S.C,C. and persisted for several minutes, associated with increased serum creatinine phosphokinase (C.P.K.) levels and elevated body temperature only up to 37. 8C (without hyperkalemia & myoglobinuria). The operation was postponed and uneventfully performed 4 days later with a normal limit of serum C.P.K. levels, under premedication by intramuscular injection of Valium(diazepam) and induction of anesthesia with halothane-Oplus intravenous injection of Valium for intubation, without any muscular rigidity or increased serum C.P.K. levels. Therefore the authors think there is a difference between this case and malignant hyperpyrexia following anesthesia, and also that the boy had a hyposensitivity predisposition to S.C.C. rather than halothane. Without accurate investigation for predisposition of muscular rigidity, We recommended Valium injection for premedication and induction of anesthesia for prevention of the muscular rigidity.
Anesthesia ; Body Temperature ; Child ; Creatinine ; Diazepam ; Halothane ; Humans ; Hyperkalemia ; Injections, Intramuscular ; Injections, Intravenous ; Intubation ; Male ; Malignant Hyperthermia ; Muscle Rigidity ; Premedication ; Succinylcholine* ; Trismus*

To determine the effects of hydrcxyethyl starch upon liver, kidney, serm electrolytes and particularly upon blood coagulation, 500 ml of 6% HES in saline solution was administered intravenously to 15 patients during elective minor surgery. In all cases weighted blood loss was less than 600 ml without replacement. The following laboratory tests were performed immediately before infusion and again 1 hour, 24 hours, 48 hours, and 1 week after the infusion: RBC, WBC, hemoglobin, hematocrit, ESR, platelet, bleeding time, coagulation time, prothrombin time, total protein, albumin, total bilirubin, direct bilirubin, SGOT, SGPT, alkaline phosphatase, BUN, sodium, potassium, and chloride. The results are as follows: 1) No anaphylactic shock or bleeding tendency characteristic of colloids was encountered. 2) No functional disturbance of liver or kidney directly attributable to HES was identified. 3) All laboratory parameters except WBC and ESR decreased after infusion. The decrease was, however, within the normal range and believed secondary to dilational effect of infusion. WBC increased somewhat, but returned to the preinfusion level in a week. 4) Exceptionally erythrocyte sedimentation rate increased notably during the 24 hour period following infusion. As with dextran, this was interpreted not due to direct effect of HES, but due to increased adsorption of fibrinogen, alpha-beta-gamma-glcbulin to red cell surface with changes in electric charge between red cells. 5) Clinical applicability, metabolic aspect, degree of subtitution of hydroxyethyl group and safety with multiple infusion of HES must be carefully determined.
Adsorption ; Alanine Transaminase ; Alkaline Phosphatase ; Anaphylaxis ; Aspartate Aminotransferases ; Bilirubin ; Bleeding Time ; Blood Coagulation ; Blood Platelets ; Blood Sedimentation ; Colloids ; Dextrans ; Electrolytes ; Fibrinogen ; Hematocrit ; Hemorrhage ; Humans ; Kidney ; Liver ; Potassium ; Prothrombin Time ; Reference Values ; Selective Estrogen Receptor Modulators ; Sodium ; Sodium Chloride ; Starch* ; Surgical Procedures, Minor

Melorheostosis is a rare entity while causes pain and stiffness in a limb and has an unknown etiology. It is characterized by roentgenographic appearance of melting wax dripping down one side of a candle along the major axis of long bone. The present case represents a melorheostosis of the left tibia accompanied by synovial chondromatosis in the left knee. Good result was obtained by arthrotomy of the left knee and removal of the bony masses in the joint.
Chondromatosis, Synovial ; Extremities ; Freezing ; Joints ; Knee ; Melorheostosis ; Tibia

It has been emphasized that continuous monitorings of arterial pressure, central venous pressure, electrocardiogram, blood gas analysis, serum electrolytes, body temperature, hematacrit and urinary output are mandatory for the anesthetic management of pheochromocytoma. In addition, it is necessary for the anesthetists to understand pharmacologic effects of drugs which influence the peripheral vascular tone and cardiac excitability. We experienced recently anesthetic management of two cases of pheochromocytoma; one raised problems of ventricular arrhythmias and hypertension that aggravated nature of arrhythrmias by increasing blood pressure and responded favorably to treatment with propranolol and trimetaphan. Tumor of this case originated from abdominal aortic wall. The other was managed by injection of d-tubocurarine which induced narrowing of pulse pressure by depletion of increasing systolic pressure and accompanied tachycardia without cardiac decompensation. We have reported proper anesthetic managements of two cases of pheochromocytoma with N2O O2-halothane anesthesia and reviewed literatures in discussion.
Anesthesia ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Gas Analysis ; Blood Pressure ; Body Temperature ; Central Venous Pressure ; Electrocardiography ; Electrolytes ; Hypertension ; Pheochromocytoma* ; Propranolol ; Tachycardia ; Trimethaphan ; Tubocurarine

We studied the effect of 1% apraclonidine (Iopidine(R)) on the ocular hypotensive action and its ocular side effects following laser surgery for glaucoma. One hundred twenty patients with primary angle closure glaucoma underwent argon laser peripheral iridotomy and 40 patients with primary open angle glaucoma were treated with laser trabeculoplasty. Mean lOP of eyes instilled with 1% apraclonidine fell by 16% 3 hours after instillation in laser iridotomy cases and by 28% 3 hours after instillation in trabeculoplasty cases. lOP elevation greater than lO mmHg was found in 18 eyes (30%) of the control group in iridotomy cases and 4 eyes (40%) in trabeculoplasty cases, but none in the apraclonidine group in both treated cases for the first three hours. Apraclonidine reduced the incidence and magnitude of potentially harmful lOP elevations after laser irdotomy and trabeculoplasty.
Argon* ; Glaucoma ; Glaucoma, Angle-Closure ; Glaucoma, Open-Angle ; Humans ; Incidence ; Intraocular Pressure* ; Laser Therapy ; Trabeculectomy*

Conjunctival tuberculosis has become a rare disease in these days along with decreased incidence of systemic tuberculosis. We experienced a 43-year-old patient with large pinguecula-like protruding mass on the medial bulbar surface which was later diagnosed as conjuctival tuberculoma histopathologically. Evidence of systemic tuberculosis could not be found from any other organs of the body. This case raises the possibility that conjunctival tuberculoma may be misdiagnosed as a simple pingueculum unless histopathologic examination is performed. Brief history and clinical findings will be presented with pictures of the pathology findings, and some literatures will be reviewed.
Adult ; Humans ; Incidence ; Pathology ; Rare Diseases ; Tuberculoma ; Tuberculosis*

Changes of body temperature were observed in the esophagus and rectum by telethermometer during extracorporeal circulation in 40 cases of open heart for detection of significant differences in survivals and non-survivals. The following results were obtained; 1) Esophageal and rectal temperature(just prior to extracorporeal circulation) were 36.4+/-0.69 degrees C, 36.8+/-0.8 degrees C respectively in non-survivals and 36.0+/-0.73 degrees C, 36.4+/-0.8 degrees C in survivals after open heart surgery 2) Normal differences between rectal and esophageal temperature came to disappear after 30 minutes of extracorporeal circulation in two groups. 3) Esophageal temperatures were higher than rectal temperatures after extracorporeal circulation for open heart surgery in both groups. 4) Changes of temperature differences between rectum and esophagus have no correlation with mortality because of the variation in two areas in both groups.
Body Temperature* ; Clinical Study* ; Esophagus ; Extracorporeal Circulation* ; Heart* ; Mortality ; Rectum ; Thoracic Surgery*

Sine 1961, Dr. Safar postulated the new form of patient, so called "progressive patient care", the hospital service in all countries are fashioned with intensive therapy unit. Particulary the- World Federation Society of Anesthesiologists who have discusincerly at several International congress. we were interested from the literature and visited England, Denmark, United States. and Japan. Of course in Korea, the intensive therapy unit developed from the recovery room and is thus intimately oonnected with anesthesiologists. Here we reviewed with literature and introduced the activities af the intensive therapy unit of Hanyang University Hospital from May 1972 to October 1973, from the point view of the definition, building design, location, capacity, equipment, staff organization and charge of patient, several problems and regulations. Furthermore we recommended with the following new ideas for establishment in hospital of an intensive therapy. unit. a. The design should be arranged on the same floor (OR-RR-Anes.-1TU) and in central part of building. b. Several isolation rooms should be made in 1-T-U. c. One central monitoring system will serve each units. d. The 1-T-U equipment should be used with wall trolly system. e. The regulations of 1-T-U should be noted and advocated by all hospital members. f. The beds in 1-T-U should be arranged with open system.
Denmark ; England ; Humans ; Japan ; Korea ; Recovery Room ; Social Control, Formal ; United States

Benzodiazepine derivatives, chlordiazepoxide(Librium), diazepam(Valium), nitrazepam(Mogadon) and oxazepam(Serenid-D) are mainly used as hypnotics at present. Diazepam has been used mainly for premedication in anesthesia and as an intravenous anesthetic agent. The pharmacological actions of these drugs are tranquilizing effects for central nervous system, slight depression on the cardiovascular and respiratory system, anticonvulsant, anxiolytic and antidepressant effects. A new benzodiazepine derivative, Flunitrazepam(Ro 5-4200) has strong hypnotic action, is anticonvulsant and antidepressant in spite of slight depression of the cardiovascular and respiratory systems. Furthermore the onset and duration of this drug are shorter than the others. In our clinical study, flunitrazepam in the dosage of 0.005mg/kg was administered intravenously, as an intravenous anesthetic induction agent, for 22 surgical adult patients. In each patient, the blood pressure, pulse rate, respiratory rate, minutes volume and arterial gas study were done, before and after administration of the Ro 5-4200. The results are as follows; 1. Dosage of this flunitrazepam is not constant as other benzodiazepines. 2. The effects of flunitrazepam on the cardiovascular system showed slight depression but no effect by one hour post-operation. 3. In respiratory system, the minute volume was depressed slightly and the respiratory rate was increased but negligibly. 4. Undesirable side effects attributed to this drug were not found, except the developing of cough (one case).
Adult ; Anesthesia ; Benzodiazepines ; Blood Pressure ; Cardiovascular System ; Central Nervous System ; Clinical Study* ; Cough ; Depression ; Diazepam ; Flunitrazepam ; Heart Rate ; Humans ; Hypnotics and Sedatives ; Premedication ; Respiratory Rate ; Respiratory System ; Tranquilizing Agents