Generalized sterile pustular eruptions occur in various dermatoses including pustular psoriasis, erythema multiforme, Sneddon-Wilkinsan disease and others. Recentlr, acute eruptions of disseminated sterile pustules have been reported. The etiology is not related to a gepetic predisposition to psoriasis but to drug ingestion or viral infections, thus termed toxic pustuloderm; (T. P.). In this report, we present a typical case of T. P. observed iu our department. Our patient, an 18-year-old male, with no personal or family history of psoriasis, was given drug medication including amoxicillin for fever and chilling sensation. Pustilar eruptions first, appeared on his face about two days aft.er the medication and gradually spread to the trunk and limbs. The skin examination revealed numerous small pustules on an erythematous base. Laboratory examination revealed neutrophilic leukocytosis and an elevated sedimentation rate skin biopsy showed subeorneal and spongiform neutrophilic pustules Upon interruption of the amoxicillin, the pustules cleared rapidly in 3 days and there has been ri.o recui rence of any rash over a 7-month follow-up period.
Adolescent ; Amoxicillin ; Biopsy ; Eating ; Erythema Multiforme ; Exanthema ; Extremities ; Fever ; Follow-Up Studies ; Giant Cell Tumors ; Humans ; Leukocytosis ; Male ; Neutrophils ; Psoriasis ; Sensation ; Skin ; Skin Diseases

No abstract available.

The retrograde microorganismal colonization in the pharynx from stomach may cause the nosocomial pneumonia and that may be more likely when the gastric pH is relatively high. We tried to find out the relationships between the gastric pH and the incidence of nosocomial pneumonia with twenty patients intubated for longer than 48 hours at ICU. We achieved following results: 1) The incidence of the nosocomial pneumonia was twenty percent. 2) All the patients developed nosocomial pneumonia showed the gastric pH above 4.0. 3) In the patients intubated for longer than 5 days, the incidence of nosocomial pneumonia was 33.3% in contrast to 9.0% for less than 5 days. 4) With the sputum culture, the incidence of colonization was higher in the patients with gastric pH above 4.0 than that in the patients with gastric pH below 4.0(84.6% vs 58.1%). 5) With regard to the duration of intubation, the incidence of colonization was higher in the patients intubated for longer than 4 days than that in the patients intubated for less than 4 days(90% vs 50%). 6) The most common pathognomic organisms were astreptoccus and Pseudomonas aeroginosa. It is conculded that the nosocmial pneumonia might develop more frequently in the patients with gastric pH above 4.0 than in the patients with gastric pH below establishment of the relationship between the treatment of the stress ulcer and the nosocomial pneumonia.
Colon ; Humans ; Hydrogen-Ion Concentration* ; Incidence ; Intubation ; Pharynx ; Pneumonia* ; Pseudomonas ; Sputum ; Stomach ; Ulcer

Inability to tolerate discontinuation of mechanical ventilation or the need for reintubation has been reported .s much as 20% in mechanically ventilated patients. Many factors may be responsible for the .nsuccessful weaning outcome such as hypoventilation secondary to decreased respiratory c,nter output, respiratory muscle fatigue, impaired pulmonary gas exchange and excessive ventilatory requirements. We experienced a patient who was very difficult to wean from long term mechanical ventilation. The patient was 36 years old male with Guillain Barre syndrome. After 7 days admission, tracheostomy was taken and mechanical ventilation continued to 332 days. There was not any chance of pneumonia during the 11 months ventilation. His respiratory parameter improved to TV of 350 ml and VC of 1300 ml and he was able to breath himself without mechanical ventilator during day time. But he could not sleep without ventilator for fear of dying during sleep. We made him sleep with diazepam injection and carefully observed the patient with pulse oximetry and Sara capnography. We tried this method many times and the patient got the confidence that he cauld alive during sleep without mechanical ventilator. We could wean from long term mechanical ventilation during sleep by carefully observing patients respiratory pattern. Therefore we report here this successful weaning from long term ventilator in anxious and nervous patient.
Adult ; Capnography ; Diazepam ; Fatigue ; Guillain-Barre Syndrome ; Humans ; Hypoventilation ; Male ; Oximetry ; Pneumonia ; Pulmonary Gas Exchange ; Respiration, Artificial* ; Respiratory Muscles ; Tracheostomy ; Ventilation ; Ventilators, Mechanical ; Weaning*

Brachial plexus block may cause many complications such as pneumothorax, inadvertent subarachnoid or epidural blockade, permanent neurologic damage to the motor outflow of the brachial plexus, hoarseness, Homer's syndrome, carotid bruit, convulsions, phrenic nerve palsy, etc. Since Winnie (1970) introduced interscalene approach for brachial plexus block, this has been one of the most popular methods in recent years because of infrequent complications and the technique is still considered safe. We experienced a rare, unusual complication after interscalene approach in a thirty eight year old woman. She was scheduled for left index finger amputation because of crushing injury. A 20 ml of 2% lidocaine and 20 ml of 0.5% bupivacaine was injected through interscalene groove after paresthesia was elicited on the patient's left thumb. Fifteen minutes after injection, she complained of respiratory difficulty and became apneic after five minutes later, and finally she did not respond to stimulation. Endotracheal intubation was proceded for respiratory support. Although neuromuscular blocking drug was not injected, vocal cord was paralysied on laryngoscopy. Pupillary light reflex and eye lash reflex were abscent. Blood pressure and heart rate decreased slightly. Ninety minutes after conservative treatment, self respiration was restored and pupillary light reflex and consciousness were recovered. She was discharged from recovery room to general ward after 4 hours without any events. We suspected that local anesthetics might be injected through epidural space or subarachnoid space in this patient.
Amputation ; Anesthetics, Local ; Apnea* ; Blood Pressure ; Brachial Plexus* ; Bupivacaine ; Consciousness ; Epidural Space ; Female ; Fingers ; Heart Rate ; Hoarseness ; Humans ; Intubation, Intratracheal ; Laryngoscopy ; Lidocaine ; Neuromuscular Blockade ; Paralysis ; Paresthesia ; Patients' Rooms ; Phrenic Nerve ; Pneumothorax ; Recovery Room ; Reflex ; Respiration ; Seizures ; Subarachnoid Space ; Thumb ; Vocal Cords

BACKGROUND: Methylmethacrylate monomer (MMA) bone cement has been associated with sudden systemic hypotension. The present study was aimed to explore the mechanism of direct myocardial depressant actions of MMA. METHODS: The isometric contraction of isolated guinea pig's right ventricular papillary muscle was measured. Normal and slow action potentials were evaluated by a conventional micro-electrode technique. The effects of MMA on sarcoplasmic reticulum (SR) function were evaluated by its effect on: rapid cooling contractures, rested state contraction of rat papillary muscle in normal Tyrode's solution and of guinea pig's papillary muscle in low Na+ Tyrode's solution. To measure the inward calcium currents (ICa), whole cell patch clamp techniques were applied. RESULTS: MMA caused a dose-dependent depression of the peak force (PF) and maximal rate of peak force (dF/dt-max). About a 30% depression of PF was shown at rested state (RS) contraction in rat myocardium and under low Na+ Tyrode's solution in guinea pig myocardium, respectively. In the 26 mM K+ Tyrode's solution, MMA caused dose-dependent depression of late force development without alteration in early force development. MMA depressed rapid cooling contracture accompanied by prolongation of time to peak contracture. MMA did not alter the amplitude or maximum depolarization rate of normal and slow action potentials. Action potential durations were significantly reduced. In patch clamp studies, MMA reduced ICa in a dose-dependent manner. CONCLUSIONS: MMA depressed cardiac contractility in a dose-dependent manner and may be partly related to the depression of Ca2+ influx through the cardiac membrane. SR Ca2+ release seems to be mildly inhibited by MMA. Based on common clinical concentrations, the direct myocardial depressant effect of MMA may not be a main cause of hypotension during an operation.
Action Potentials ; Animals ; Calcium ; Contracture ; Depression ; Guinea ; Guinea Pigs ; Hypotension ; Isometric Contraction ; Membranes ; Methylmethacrylate* ; Myocardium ; Papillary Muscles ; Patch-Clamp Techniques ; Rats ; Sarcoplasmic Reticulum

The purpose of this study is to obtain information of simple and effective methods for the pos-tlaminectomy pain control, and to reduce the consumption of supplemental analgesic drugs and side effects. In a double blind study, 75 patients scheduled for lumbar laminectomy were randomly divided into five groups according to the epidurally instilled drugs, such as, morphine 2mg,Group M2; morphine 3mg,Group M3; methylprednisolone 80 mg, Group D; morphine 2mg plus methylprednisolone 80mg, Group M2D; normal saline as a control Group C. All of the drugs were prepared in 2ml normal saline solution. The following items were recorded in the postoperative period: Pain score using visual analogue scale(VAS) at 6, 12, 24, 48 hours after the operation; the episode of supplemental systemic analgesic; the need for postoperative urethral catheterization; any evidence of respiratory depression; pruritus; nausea and vomiting. The results were as follows. I) VAS score were not significantly different between control group and group M2(p>0.05), but usually less in the group M2 and supplemental analgesic consumption was significantly less in the group M2 than in the control group. 2) VAS score were less in the group M3 than in the group M2 and significantly less than in the control group at 6 hour after operation and also supplemental analgesic consumption was significantly less in the group M3. 3) Group D revealed similar VAS score with group M2 at 6 and 12 hour but significantly lower VAS score at 24 and 48 hour after operation than group M2. 4) VAS score were the most significantly less in the group M2D at 6,12,24,48 hour after operation than in the control group and supplemental analgesic consumption was significantly less in the group M2D. 5) Side effects were not significantly different among all groups. These findings suggest that epidurally instilled morphine 3mg, or methylprednisolone 80mg or both before the closure of the laminectomy wound is effective, simple and safe method for the post-laminectomy pain control and reducing supplemental intramuscular analgesics without specific complication.
Analgesics ; Double-Blind Method ; Humans ; Laminectomy* ; Methylprednisolone* ; Morphine* ; Nausea ; Pain, Postoperative* ; Postoperative Period ; Pruritus ; Respiratory Insufficiency ; Sodium Chloride ; Urinary Catheterization ; Urinary Catheters ; Vomiting ; Wounds and Injuries

Osmotic diuretics are used in neurosurgical patient to decrease intracranial pressure. Mannitol produces diuresis because it is filtered by the glomeruli and not reabsorbed from the renal tubule, leading to increased osmolarity of renal tubular fluid and associated excretion of water. There are some controversies about the effect of mannitol induced diuresis on the change of serum electrolytes. But these controversies are related to the mannitol dosage and infusion speed. We studied the effect of mannitol on serum and urine e1ectrolyte change in 10 patients undergoing operation of cerebral tumor or aneurysm. Every patient was free from cardiac and renal disease. We started infusion of 20% mannitol of which dosage is 0.6-0.9gm/kg for 5 to 10 min after cranium was opened and then injected furosemide O.l mg/kg for acceleration of diuresis. We measured serum electrolyte, urine volume and urine electrolyte before and after 30, 60 and 120 min of mannitol infusion. The results were as follows. 1) Seurm sodium and chloride level decreased significantly from 133 and 102 to l30 and 100 mEq/1 respectively after 30 min, but there was no statistic significance after 60 and 120 min of mannitol infusion. 2) Serum potassium level increased slightly from 4.2 to 4.5 mEq/1 after mannitol infusion but there was no statistic significance. 3) Urine volume increased abruptly from 57 to 477 ml/hr as soon as infusion of mannitol but the degree decreased slowly following times. 4) Urine electrolytes concentration increased abruptly as soon as infusion of mannitol but the degree decrease slowly following times. With the above results, we can conclude that intraoperative mannitol and furosemide infusion in healthy patient can cause only transient change in serum electrolyte and the magnitude of change was too small to have significant clinical effect.
Acceleration ; Aneurysm ; Diuresis ; Diuretics, Osmotic ; Electrolytes ; Furosemide ; Humans ; Intracranial Pressure ; Mannitol* ; Neurosurgery ; Osmolar Concentration ; Potassium ; Skull ; Sodium

No abstract available.
Membranes* ; Pregnancy* ; Rupture*

Intrathecal morphine can provide goad analgesia for the first stage of labor. However, a long latency, high incidence of side effects, and lack of perineal anesthesia limit its usefulness. We wished to make a short the latency and reduce the dose of morphine, administered morphine 0.2 mg, 0.3 mg, combined with fentanyl 25 micrograms intrathecally. Forty-five laboring patients were studied and randomly divided into two groups' group I (n=24) received intrathecal morphine 0.2 mg with fentanyl 25 ug; group II (n=21) received intrathecal morphine 0.3 mg with fentanyl 25 ug; We compared the analgesia and side effects of group I to those of group II. Analgesia was assessed using the 100 mm visual linear analog(VLA) as the time elapsed from the drug administration to the delivery. The onset of analgesia was rapid(within 5 minutes) in both groups and VLA scores did not differ at any observation point between the groups. The effect of analgesia was lasted until the perineum was distended by the fetus. The incidence of nausea or vomiting was 41.7%(10/24) in group I, and 33.3%(7/21) in group II. Pruritus occured 87.5%(21/24)) in group I and 90.5%(19/21) in group II. The majority of pruritus occured soon after administration of study drug. There were more instances of urinary retention in group II (61.9%) than in group I(37.5%). No patient developed postdural puncture headache, vital sign alteration or respiratory depression. Most of all the patients in this study said that they were satisfied with this analgesic technique and would like to receive intrathecal narcotic analgesia for future labor. With the above results we conclude that intrathecal morphine 0.2 mg with fentanyl 25 ug for labor pain provides rapid and effective analgesia as 0.3 mg intrathecal morphine with fentanyl 25 ug.
Analgesia ; Anesthesia ; Female ; Fentanyl* ; Fetus ; Humans ; Incidence ; Injections, Spinal* ; Labor Pain ; Morphine* ; Nausea ; Perineum ; Post-Dural Puncture Headache ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Urinary Retention ; Vital Signs ; Vomiting