We describe here a case of difficult intubation due to pseudoankylosis of the temporo-mandibular joint after a pterional craniotomy. A 50-year-old female was admitted to our hospital presenting with severe headache. According to her angiogram, a ruptured aneurysm in left posterior communicating artery (PCoA) and an unruptured right PCoA aneurysm were detected. We the operation in two-steps; the first operation for the left PCoA proceeded without any problem, and the tracheal intubation also was not difficult. Four weeks later, while inducing the general anesthesia for her second operation, severe trismus was detected after the infusion of propofol 120 mg. While ventilating the patient with a well-fitted mask, we performed several attempts of conventional tracheal intubation, and the patient was finally managed using a ProSealTM laryngeal mask airway with controlled ventilation. According to patient's history, trismus has also occurred after her first operation. We think that the reason for her trismus was a result of contracture of the temporalis muscle after her first pterional craniotomy.
Anesthesia, General ; Aneurysm ; Aneurysm, Ruptured ; Arteries ; Contracture ; Craniotomy* ; Female ; Headache ; Humans ; Intubation* ; Joints* ; Laryngeal Masks ; Masks ; Middle Aged ; Propofol ; Trismus ; Ventilation

Granular cell tumor is mostly benign and thought to be of Schwann cell origin. The head and neck, particularly tongue, breast, and upper respiratory tract are frequently involved. Recently, we have experienced a case of granular cell tumor of the right thigh in a 30-year old male, diagnosed by fine needle aspiration cytology which revealed distinct cytologic features. The smear revealed cellular aspirates with clear background. The tumor cells showed uniform small nuclei and abundant eosinophilic, granular cytoplasm with hazy cell border. Mitoses were not found.
Adult ; Biopsy, Fine-Needle ; Breast ; Child* ; Cytoplasm ; Eosinophils ; Granular Cell Tumor ; Head ; Humans ; Lupus Nephritis* ; Male ; Mitosis ; Neck ; Paraganglioma ; Respiratory System ; Statistics as Topic* ; Thigh ; Tongue

Splenic infarction is a rare disease and usually detected as a complication of SBE, atrial fibrillation, hemoglobinopathy, or myeloproliperative disorders. Although thrombotic event, such as deep vein, cerebral or renal thrombosis, is a frequent complication of SLE, there have been only a couple of cases documenting splenic infarction complicated in SLE. This is, to our knowledge, the first case report describing isolated splenic infarction in pediatric SLE. The splenic infarction was diagnosed on abdominal CT, 99mTc-RBC splenic scan, and abdominal USG, and resolved with anticoagulant therapy. And we discussed about the possibility of antiphospholipid syndrome as a cause of the infarction in this case.
Antiphospholipid Syndrome ; Atrial Fibrillation ; Cerebral Veins ; Female* ; Hemoglobinopathies ; Humans ; Infarction ; Lupus Erythematosus, Systemic* ; Rare Diseases ; Splenic Infarction* ; Thrombosis ; Tomography, X-Ray Computed

INTRODUCTION: The use of rabbits as a cardiopulmonary bypass(CPB) animal model is extremely difficult mainly due to technical problems. On the other hand, deep hypothermic circulatory arrest(CA) is used to facilitate surgical repair in a variety of cardiac diseases. Although steroids are generally known to be effective in the treatment of cerebral edema, the protective effects of steroids on the brain during CA are not conclusively established. Objectives of this study are twofold: the establishment of CPB technique in rabbits and the evaluation of preventive effect of steroid on the development of brain edema during CA. MATERIAL AND METHODS: Fifteen New Zealand white rabbits(average body weight 3.5kg) were divided into three experimental groups; control CA group(n=5), CA with Trendelenberg position group(n=5), and CA with Trendelenberg position + steroid(methylprednisolone 30 mg/kg) administration group(n=5). After anesthetic induction and tracheostomy, a median sternotomy was performed. An aortic cannula(3.3mm) and a venous ncannula(14 Fr) were inserted, respectively in the ascending aorta and the right atrium. The CPB circuit consisted of a roller pump and a bubble oxygenator. Priming volume of the circuit was approximately 450ml with 120~150ml of blood. CPB was initiated at a flow rate of 80~85ml/kg/min. Ten min after the start of CPB, CA was established with duration of 40min at 20 degrees C of rectal temperature. After CA, CPB was restarted with 20min period of rewarming. Ten min after weaning, the animal was sacrificed. One-to-2g portions of the following tissues were rapidly dissected and water contents were examined and compared among groups: brain, cervical spinal cord, kidney, duodenum, lung, heart, liver, spleen, pancreas, stomach. Statistical significances were analyzed by Kruskal-Wallis nonparametric test. RESULTS: CPB with CA was successfully performed in all cases. Flow rate of 60-100 ml/kg/min was able to be maintained throughout CPB. During CPB, no significant metabolic acidosis was detected and aortic pressure ranged between 35-55 mmHg. After weaning from CPB, all hearts resumed normal beating spontaneously. There were no statistically significant differences in the water contents of tissues including brain among the three experimental groups. CONCLUSION: These results indicate (1) CPB can be reliably administered in rabbits if proper technique is used, (2) the effect of steroid on the protection of brain edema related to Trendelenburg position during CA is not established within the scope of this experiment.
Acidosis ; Animals ; Aorta ; Arterial Pressure ; Body Weight ; Brain Edema ; Brain* ; Cardiopulmonary Bypass* ; Duodenum ; Hand ; Head-Down Tilt ; Heart Atria ; Heart Diseases ; Heart* ; Hypothermia ; Kidney ; Liver ; Lung ; Models, Animal ; New Zealand ; Oxygen ; Oxygenators ; Pancreas ; Rabbits ; Rewarming ; Spinal Cord ; Spleen ; Sternotomy ; Steroids ; Stomach ; Thoracic Surgery* ; Tracheostomy ; Weaning

A diversity of synthetic cathinones has flooded the recreational drug marketplace worldwide. This variety is often a response to legal control actions for one specific compound (e.g. methcathinone) which has resulted in the emergence of closely related replacement. Based on recent trends, the nitrogen atom is one of the sites in the cathinone molecule being explored by designer type modifications. In this study, we designed and synthesized two new synthetic cathinones, (1) α-piperidinopropiophenone (PIPP) and (2) α-piperidinopentiothiophenone (PIVT), which have piperidine ring substituent on their nitrogen atom. Thereafter, we evaluated whether these two compounds have an abuse potential through the conditioned place preference (CPP) in mice and self-administration (SA) in rats. We also investigated whether the substances can induce locomotor sensitization in mice following 7 days daily injection and challenge. qRT-PCR analyses were conducted to determine their effects on dopamine-related genes in the striatum. PIPP (10 and 30 mg/kg) induced CPP in mice, but not PIVT. However, both synthetic cathinones were not self-administered by the rats and did not induce locomotor sensitization in mice. qRT-PCR analyses showed that PIPP, but not PIVT, reduced dopamine transporter gene expression in the striatum. These data indicate that PIPP, but not PIVT, has rewarding effects, which may be attributed to its ability to affect dopamine transporter gene expression. Altogether, this study suggests that PIPP may have abuse potential. Careful monitoring of this type of cathinone and related drugs are advocated.
Animals ; Dopamine Plasma Membrane Transport Proteins ; Gene Expression ; Mice ; Nitrogen ; Rats ; Reward