Percutaneous radial artery cannulation is a very useful method of invasive monitoring in critically ill patients. Although the method is generally safe and simple, it can infrequently lead to tissue necrosis. Recently we experienced this complication in two patients. The first patient was a 52-year-old male who received a craniotomy for removal of a subdural hematoma. Right radial artery cannulation was carried out after a modified Allen's test appeared to be positive. After removal of the cannula on the 9th hour after operation because it was obstructed, his right hand was cool and cyanotic. Despite stellate ganglion block and other supportive therapy, the ischemic changes increasingly worsened. On the 10th day after removal of the cannula, the necrotic change was extended in all fingers of the right hand and he underwent disarticulation of the right wrist. The second patient was a 63-year-old female who received a craniotomy for clipping of a cerebral aneurysm. Left radial artery cannulation was performed without a modified Allen's test. On the 2nd hour after operation, the cannula was removed because the left hand was cyanotic. On Doppler examination, the radial and ulnar arteries were not identified with blood flow. On angiographic finding, the radial artery was occluded almost totally and the ulnar artery was not visualized below the antecubital fossa. After the left stellate ganglion block, thrombectomy and anticoagulant therapy, the ischemia in the left hand was transiently improved, but then became more aggravated and eventually the level of tissue necrosis advanced to the left elbow, therefore amputation above the left elbow joint was performed. Presumptive causes of these tissue necroses were peripheral embolization in the first patient, and inadequate collateral circuation of the ulnar arterial malformation in the second case.
Amputation* ; Catheterization* ; Catheters ; Craniotomy* ; Critical Illness ; Disarticulation ; Elbow ; Elbow Joint ; Extremities* ; Female ; Fingers ; Hand ; Hematoma, Subdural ; Humans ; Intracranial Aneurysm ; Ischemia ; Male ; Middle Aged ; Necrosis ; Radial Artery* ; Stellate Ganglion ; Thrombectomy ; Ulnar Artery ; Wrist

Primary squamous cell carcinoma of the colon is very rare and its incidence is 0.025% to 0.05% among all colon cancers. We report a case of primary squamous cell carcinoma of the sigmoid colon in a 65year-old man. He had bowel habit change and hematochezia for 3 months. Colonoscopy with biopsy and left inguinal lymph node biopsy revealed squamous cell carcinoma. We confirmed the diagnosis of primary squamous cell carcinoma of the sigmoid colon with lymph node metastasis by diagnostic criteria. The patient was discharged against advice and expired.
Biopsy ; Carcinoma, Squamous Cell* ; Colon ; Colon, Sigmoid* ; Colonic Neoplasms ; Colonoscopy ; Diagnosis ; Gastrointestinal Hemorrhage ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis

Hematoma of gastric wall is very rare, and occasionally associated with coagulopathy, trauma, peptic ulcer disease, and therapeutic endoscopy. Ischemic gastric necrosis is also rare because of the abundant anastomotic supply to the stomach, and it is usually associated with surgery and disruption of the major vessels. Endoscopic submucosal injection of hypertonic saline-epinephrine (HS-E) is a safe, cost-effective, and widely used therapy for hemostasis but it may cause tissue necrosis and perforation. We describe a case of gastric wall hematoma with oozing bleeding after endoscopic gastric mucosa biopsy in 71-year old woman with chronic renal failure and angina pectoris undergoing anti-platelet medication. We injected a small dose of HS-E (7ml) for controlling oozing bleeding. Two days later, endoscopy showed huge ulcer with necrotic tissue at the site of previously hematoma. Therefore we should pay particular attention for hematoma and mucosal necrosis when performing endoscopic procedure in a patients with high bleeding and atherosclerotic risk.
Angina Pectoris ; Biopsy ; Endoscopy ; Female ; Gastric Mucosa ; Hematoma ; Hemorrhage ; Hemostasis ; Humans ; Kidney Failure, Chronic ; Necrosis ; Peptic Ulcer ; Stomach ; Ulcer

Fiberoptic bronchoscope guided tracheal intubation is more popular in patient with expected difficult intubation by conventional laryngoscopy. We report a case of smooth fiberoptic bronchoscope guided tracheal intubation under local anesthesia. A 10% lidocaine spray 2-3 puffs of pharyngolaryngeal topical anesthesia and 2% lidocaine injection through a 19 gauge epidural catheter (ARROW(R)) placed over the fiberoptic bronchoscope suction channel for laryngeal and tracheal anesthesia were sufficient to prevent pain, coughing and nausea.
Anesthesia* ; Anesthesia, Local ; Bronchoscopes* ; Catheters* ; Cough ; Humans ; Intubation* ; Laryngoscopy ; Larynx* ; Lidocaine ; Nausea ; Suction ; Trachea*

Fiberoptic bronchoscope guided tracheal intubation is more popular in patient with expected difficult intubation by conventional laryngoscopy. We report a case of smooth fiberoptic bronchoscope guided tracheal intubation under local anesthesia. A 10% lidocaine spray 2-3 puffs of pharyngolaryngeal topical anesthesia and 2% lidocaine injection through a 19 gauge epidural catheter (ARROW(R)) placed over the fiberoptic bronchoscope suction channel for laryngeal and tracheal anesthesia were sufficient to prevent pain, coughing and nausea.
Anesthesia* ; Anesthesia, Local ; Bronchoscopes* ; Catheters* ; Cough ; Humans ; Intubation* ; Laryngoscopy ; Larynx* ; Lidocaine ; Nausea ; Suction ; Trachea*

BACKGROUND: Sevoflurane, a newly developed halogenated inhalation anesthetic agent shows myocardial protective effects against global ischemia like other inhalation agents. We investigated differences between pharmacologic preconditioning effects at various concentrations of sevoflurane. METHODS: Forty male Sprague-Dawley rats were subdivided into 4 groups (each n = 10). All groups underwent the same procedure (Langendorff preparation, 30 minutes ischemia and 60 minutes reperfusion) except for the concentrations of sevoflurane. The control group received no sevoflurane treatment. The sevo 1.6% group was given 1.6% sevoflurane before ischemia, the sevo 205% group was given 2.05% sevoflurane before ischemia, and the sevo 2.5% group was given 2.5% sevoflurane before ischemia. Hemodynamic parameters of all groups were recorded through a thin, saline-filled latex balloon and a transducer. Coronary flows were also measured. All hearts were stained by triphenyl tetrazolium to measure infarct size. RESULTS: The sevoflurane administered groups showed higher left ventricular end systolic pressures and lower left ventricular end diastolic pressures than the control group after ischemia and reperfusion. The dP/dtMAX of the sevoflurane administration groups showed a more rapid recovery pattern after ischemia than the control. But no differences were found between the sevoflurane administered groups. Infarct sizes in the sevoflurane administered groups were smaller than those in the control group, and there were no significant differences between the sevoflurane administered groups. CONCLUSIONS: Sevoflurane (even below one MAC) administration before myocardial ischemia has a superb cardioprotective effects, i.e., rapid recovery of left ventricular fuctions, less stiffness development, and a reduced infarct size. There were no significant differences between the sevoflurane administered groups.
Animals ; Heart* ; Hemodynamics ; Humans ; Inhalation ; Ischemia* ; Latex ; Male ; Myocardial Ischemia ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Transducers ; Ventricular Function, Left