Succinylcholine-induced prolonged neuromuscular blockade may occur in patients with either a low level of plasma cholinesterase activity or genotypically abnormal form of that enzyme. We experienced a case of succinylcholine-induced prolonged apnea due to a low level of plasma cholinesterase activity. A 31-year-old woman, full term primigravida, underwent cesarean section for breech presentation under general anesthesia. Familial and past medical history were nonspecific and preoperative physical and laboratory findings were within normal range. After operation, delayed apnea was detected and lasted for about one hour. We performed controlled and assisted ventilation for two and half hours. Plasma cholinesterase activity measured 30.00 IU/L (colorimetric method, normal value: 1130~1960 IU/L) at the first postoperative day. She was discharged on 7th postoperative day without any sequelae. From follow-up study after six months, it measured 1.02 U/ml (EIA, normal value: 7~9 U/ml).
Adult ; Anesthesia, General ; Apnea* ; Breech Presentation ; Cesarean Section* ; Cholinesterases* ; Female ; Follow-Up Studies ; Humans ; Neuromuscular Blockade ; Plasma* ; Pregnancy ; Reference Values ; Ventilation

The pulmonary thromboembolism (PTE) developes occasionally in trauma, surgery and pregnancy. It presents dyspnea, tachycardia, syncope, hypotension and may be fatal by right heart failure. Severe intraoperative PTE is rare. But an intraoperative PTE occurs, it is difficult to diagnose with classic diagnostic measures such as ventilation-perfusion scan, pulmonary angiography, so appropriate management may be delayed. We experienced a case of severe PTE during Ceaserian section of placenta previa totalis. The patient survived and showed complete resolution after 1-year follw-up.
Angiography ; Dyspnea ; Heart Failure ; Humans ; Hypotension ; Placenta Previa* ; Placenta* ; Pregnancy ; Pulmonary Embolism* ; Syncope ; Tachycardia

BACKGROUND: Osteoradionecrosis is a delayed complication from radiation therapy which causes chronic pain, infection and constant deformity after necrosis. Most of the osteoradionecrosis occurs spontaneously or after the primary oncologic surgery, dental extraction or by trauma of prosthesis. The treatment of osteoradionecrosis relies on both conservative measures and surgical measures. The fibular osteocutaneous free flap has become more popular choice for reconstruction of maxillofacial defects as a treatment of osteoradionecrosis. METHODS: We presented our experiences from 7 patients with osteoradionecrosis who have had reconstruction surgery with fibular osteocutaneous free flap at National Cancer Center during the recent 5 years. We performed segmental mandibular resection with fibular osteocutaneous free flap for all 7 patients of advanced osteoradionecrosis who were not controlled by conservative treatment such as wound irrigation, debridement, and antibiotics. RESULTS: A wide range of techniques were available for the reconstruction of composite defects resulted from the treatment of advanced mandibular osteoradionecrosis. Significant improvement was noted in relieving pain and treating trismus after the surgery however difficulty in swallowing and xerostomia showed less improvement. CONCLUSIONS: We concluded that fibular osteocutaneous free flap can be performed safely in patients with osteoradionecrosis and yields positive outcomes with significantly increased success rate. The fibular osteocutaneous free flap was our preferred choice for the mandibular reconstruction due to its versatility and predictability.
Anti-Bacterial Agents ; Chronic Pain ; Congenital Abnormalities ; Debridement ; Deglutition ; Free Tissue Flaps* ; Humans ; Mandible ; Mandibular Reconstruction ; Necrosis ; Osteoradionecrosis* ; Prostheses and Implants ; Trismus ; Wounds and Injuries ; Xerostomia

BACKGROUND: The role of aging in damage to DNA have been of increasing in recent years. DNA damage correlated with biochemical and physiologic changes that are characteristic of cellular impairment in aging and disease. Reduction of oxygen in tissue produces a number of oxygen free radicals which may induce cellular damage and even cell death. Glutathione, its function in reductive processes that are essential for the synthesis (and the degradation) of proteins, formation of deoxyribonucleotide precursors of DNA, regulation of enzymes, and protection of the cell against reactive oxygen compounds and free radicals. The aim of this study was, 1) to measure the glutathione concentration and glutathione proxidase activity of erythroyte, plasma, human gastric mucosa in elderly and liver cirrhosis patient 2) to investigate a role of glutathione mediated cellular defense mechanism against oxidative stress between in liver cirrhosis patient and in elderly. METHODS: We measured glutathione concentration and glutathione peroxidase activity in the plasma, erythrocytes, gastric mucosa of human in 4 group (Group A: 10 patients of liver cirrhosis and portal hypertensive gastropathy in age 40~55 years, Group B: same number and disease of patients in age over 65 years, group C: healthy person of age over 65 years, Group D: control). Glutathione concentration of erythocyte, plasma and human gastric mucosa was measured by spectrophotometer using Bioxytech GSH-400. Glutathione peroxidase activity of plasma was measured by Paglia & Valentine method using Bioxytech pl. Gpx and of erythocyte and human gastric mucosa was measured by using Bioxytech Gpx.340. Statistical significance of the different group was determined by ANOVA. A p<0.05 was considered significant. RESULT: Glutathione concentration of erythrocytes and gastric mucosa was decreased in Group A, B, C compared to group D. plasma concentration of glutathione was decreased in group A, B compared to group C, D. Activity of glutathione peroxidase was not different in any group (ANOVA, p<0.005). CONCLUSION: Even though glutathione concentration of erythrocyte and human gastric mucosa was decreased in elderly and in liver cirrhosis patient, our study shows decreased glutathione related defense mechanism against oxidative stress is different in view of plasma concentration of glutathione.
Aged ; Aging ; Cell Death ; DNA ; DNA Damage ; Erythrocytes* ; Free Radicals ; Gastric Mucosa* ; Glutathione Peroxidase* ; Glutathione* ; Humans* ; Liver Cirrhosis* ; Liver* ; Oxidative Stress ; Oxygen ; Oxygen Compounds ; Plasma*

BACKGROUND: The aim of this study was to compare the difference in hemodynamic change and in sensory or motor block between hyperbaric tetracaine and bupivacaine in spinal anesthesia. METHODS: The sixty-three patients, belonged to ASA class 1 and 2, were divided into tetracaine group and bupivacaine group. The patients were administered 0.5% hyperbaric tetracaine(Pantocaine ) in tetracaine group and 0.5% hyperbaric bupivacaine(Marcaine ) in bupivacaine group, intrathecally. After intrathecal injection of the agents, we measured the change of sensory block level according to pinprick test, the motor block by the modified Bromage score until fixations was achieved, and the blood pressure and heart rate. RESULTS: The two groups did not differ significantly with loss of sensory level and onset time. Bupivacaine group was revealed a slower fixations of motor block than tetracaine group(p<0.05). Changes of systolic blood pressure and mean arterial blood pressure of bupivacaine group were less than tetracaine group(p<0.05) in 2~25 minutes and 6~15 minutes, respectively. Diastolic blood pressure and heart rate were not different statistically in two groups. CONCLUSION: Spinal anesthesia with hyperbaric bupivacaine was revealed less changes of systolic blood pressure and mean arterial blood pressure than hyperbaric tetracaine, although fixation of motor block was delayed onset. Therefore, we thought that spinal anesthesia with hyperbaric bupivacaine may be used more safe than hyperbaric tetracaine in hemodynamical troublesome case.
Anesthesia, Spinal* ; Arterial Pressure ; Blood Pressure ; Bupivacaine* ; Heart Rate ; Hemodynamics ; Humans ; Injections, Spinal ; Tetracaine*

Intussusception is defined as the telescoping of one segment of the gastrointestinal tract into an adjacent one. The incidence of the adult intussusception is low. It constitutes approximately 5% of all intussusception and accounts for 5% of all cases of intestinal obstruction in adult. The clinical feature in adults is not typical. General symptoms and signs of intestinal obstruction dominate the clinical feature of intussusception in adult. The classic appearance of intussusception on barium studies is the coil spring appearance as contrast is trapped between the intussusceptum and intussuscipiens. Ultrasound and CT scan shows a target-like lesion. Colonofiberscopy shows a round invaginated mass with congested mucosa and by air inflation, round mass is decreased in size and is changed in shape. Differential diagnosis can be made by colonofiberscopy because the most common cause of colonic intussusception in adult is a primary colon cancer. A case of diverticulitis associated with intussusception diagnosed by colonofiberscopy in a 72 years old man was presented with brief review of the literature.
Adult ; Aged ; Barium ; Colon ; Colonic Neoplasms ; Diagnosis, Differential ; Diverticulitis* ; Estrogens, Conjugated (USP) ; Gastrointestinal Tract ; Humans ; Incidence ; Inflation, Economic ; Intestinal Obstruction ; Intussusception ; Mucous Membrane ; Tomography, X-Ray Computed ; Ultrasonography

Pulmonary tuberculosis is still endemic in Korea, but esophageal tuberculosis, especially primary esophageal tuberculosis, is very rarely seen. A 76-year-old male is presented dysphagia. The clinical presentation, barium swallow study, and chest CT were suggestive of carcinoma of the esophagus. Findings that can suggest the diagnosis are enlarged lymph nodes, ulceration, and luminal narrowing. The major differential diagnosis was primary esophageal tuberculosis. This was not excluded on biopsy obtained at endoscopy. Operation was done for severe dysphagia and exclusion of malignancy. The patient was finally diagnosed as primary esophageal tuberculosis.
Aged ; Barium ; Biopsy ; Deglutition Disorders ; Diagnosis ; Diagnosis, Differential ; Endoscopy ; Esophagus ; Humans ; Korea ; Lymph Nodes ; Male ; Phenobarbital ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

BACKGROUND: To evaluate the clinical characteristics of patients with non-amnestic mild cognitive impairment (naMCI) in a memory disorder clinic at a single center. METHODS: A retrospective study was conducted involving 312 patients with naMCI from May 2011 to July 2018. Brain magnetic resonance imaging and detailed neuropsychological tests were performed in all patients. We used the proposed criteria for naMCI to classify the patients into single- and multiple-domain groups. We compared the baseline clinical characteristics, neuroimaging findings, and the rate of progression to dementia between these two groups. RESULTS: The 312 patients comprised 210 in the single-domain group (67.3%) and 102 in the multiple-domain group (32.7%). The mean age was significantly higher in the multiple-domain group than in the single-domain group. The years of education, mean Mini Mental State Examination score, and mean Clinical Dementia Rating Scale Sum of Boxes score were significantly lower in the multiple-domain group than in the single-domain group. The Z-scores of neuropsychological tests in most cognitive domains were significantly lower in the multiple-domain group than in the single-domain group. Compared to the single-domain group, the multiple-domain group showed more-severe medial temporal atrophy and contained a higher proportion of patients with moderate white-matter hyperintensities. Thirteen (8.4%) patients with naMCI progressed to dementia, most of who were diagnosed with Alzheimer's disease. CONCLUSIONS: We present a single-center experience of clinical characteristics in patients with naMCI. Close observation of the clinical profiles of patients with naMCI may help identify individuals at the greatest risk of dementia.
Alzheimer Disease ; Atrophy ; Brain ; Dementia ; Education ; Humans ; Magnetic Resonance Imaging ; Memory Disorders ; Mild Cognitive Impairment ; Neuroimaging ; Neuropsychological Tests ; Retrospective Studies

Methyl salicylate is widely used in various topical products, including sports creams, ointments, patches, and oral hygiene products. These products are mainly used for localized treatment of musculoskeletal pain. Given their intended topical application, their ingestion can result in salicylic acid poisoning due to their high concentrations of methyl salicylate. Symptoms of salicylic acid poisoning may include dizziness, vomiting, hallucinations, seizures, and, in severe cases, unconsciousness, respiratory failure, and circulatory disorders. We report a case of a 71-year-old male who ingested Mensolatum Lotion to commit suicide and died.

Idiopathic segmental ileal dilatation is a rare congenital condition in which the caliber of the bowel lumen increases locally without distal luminal obstruction or thickening of the muscle coats in involved lumen. Congenital abnormalities such as exomphalos, malrotation of the midgut, and Meckel's diverticulum are found frequently in the patients with segmental dilatation of the small bowel. Intermittent abdominal pain or anemia may be the symptoms of segmental dilatation of the small bowel in infants, children and occasionally adults. The radiologic finding in barium studies of the small bowel is characteristic axial segmental dilatation. The pathologic finding is nonspecific ulcer and mild congestion, but it has normal nervous system and smooth muscle bundle. There are no evidence of ischemic changes, inflammatory changes or neoplastic changes. The condition can be cured with surgical excision of the dilated segment. A case of idiopathic segmental ileal dilatation associated with melena and recurrent abdominal pain diagnosed by enteroclysis in a 47 years old man was presented with brief review of the literature.
Abdominal Pain ; Adult ; Anemia ; Barium ; Child ; Congenital Abnormalities ; Dilatation* ; Estrogens, Conjugated (USP) ; Hemorrhage* ; Hernia, Umbilical ; Humans ; Infant ; Meckel Diverticulum ; Melena ; Middle Aged ; Muscle, Smooth ; Nervous System ; Phenobarbital ; Ulcer