Pain relief becomes a major concern when treating patients with rib fractures so adequate ventilation must be maintained. Many techniques have been described for the management of frectured ribs, including systemic analgesics, intercostal nerve blockade, intrathecal morphine, epidural bupivacaine and epidural morphine. This case report illustrates the successful use of epidural narcotics in a patient with multiple fractured ribs.
Analgesics ; Bupivacaine ; Humans ; Intercostal Nerves ; Morphine ; Narcotics* ; Rib Fractures ; Ribs* ; Ventilation

The popular term malignant hyperthermia syndrome (MHS) refers to a clinical syndrome classically observed during general anesthesia. It is characterized by a rapidly increasing .temperature and a high mortality rate. A case of MHS was experienced which developed 60 minutes after induction of general anesthesia with thiopental sodium, succinylcholine, halothane, N2O and 02. High fever, muscle rigidity and cyanosis developed and were followed by arrythmia and unstable blood pressure. Anesthesia was terminated and vigorous emergency treatment was attempted. The patient died about 6 hours after induction of anesthesia.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Cyanosis ; Emergency Treatment ; Fever ; Halothane ; Humans ; Malignant Hyperthermia* ; Mortality ; Muscle Rigidity ; Succinylcholine ; Thiopental

Clear cell sarcoma of tendon and aponeuroses is slow growing and painless. It occur chiefIy in young adults, predominates in women and is most common in the region of the foot and knee. It is intimately bound to tendons or aponeuroses and is composed of srnall nest or aggregates of round or fusiform, pale staining cells showing prominent nucleoli. And it is tend to recur and to resuIt in eventual development of metastatic growth after a protracted clinical ccurs. Herein, we report a case of clear cell sarcorna of tendon anu aponeuross of metatarsophalangeal joint area between 2nd and 3rd light of left foot. The patient, 50-year-old female had a slow groving, asymptomatic, slightly eevated, emooth surfaced and normal skin colored mass for 2 years. Histopatholcigic tindings in dermis revealed nests of atypical polygonal or monotonous cells. Each cell had vesicular or hyperchrornatic nucleus with prominent nucleoli, occcasionally mitotic figure and abundant eosinophilic cytoplasm. For. treatment, transmetatarsal amputation was done.
Amputation ; Cytoplasm ; Dermis ; Eosinophils ; Female ; Foot* ; Humans ; Knee ; Metatarsophalangeal Joint ; Middle Aged ; Sarcoma, Clear Cell* ; Skin ; Tendons ; Young Adult

Heart transplantation is an accepted procedure for treatment of end-staged cardiac failure. A return to near-normal quality on life can be expected in many patients with a nonrejecting cardiac allograft, and many of these patients will return to the operating room for noncardiac surgical procedures. Anesthesiologists should be alert to recognizing problems caused by the presence of infection in immunosuppressed patients, modes of presentation of rejection phenomena and how transplanted organs, notably significantly denervated ones, may behave and respond under the pathophysiologic circumstance that arise during surgery, resuscitation and intensive care. The use of regional techniques require adequate preloading to avoid exaggerated hypotension and aseptic technique to avoid infection. Hypobaric spinal anesthesia has some benefit. It does not depress cardiovascular and respiratory system and keep adequate venous return by trendelenberg position. We report herein a case of successfully undergone total hip replacement in a patient who had previously undergone orthotopic heart transplantation under hypobaric spinal anesthesia.
Allografts ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip ; Heart Failure ; Heart Transplantation ; Heart* ; Humans ; Hypotension ; Critical Care ; Operating Rooms ; Respiratory System ; Resuscitation

PURPOSE: Many articles have proposed that osteonecrosis of the femoral head (ONFH) is caused by fat embolism or intravascular coagulation linked to hyperlipidemia. To determine whether hyperlipidemia is an associated factor for ONFH, serum lipid levels were measured. MATERIALS AND METHODS: Nighty-eight patients presenting with ONFH and 110 controls were investigated. We compared the average value of serum lipid levels and the incidence of hyperlipidemia of the two groups. RESULTS: ONFH group showed generalized increase in lipid level and statistically significant difference in the average value of total cholesterol (P=0.0001), HDL-cholesterol (P=0.0261) and phospholipid (P=0.0465) compared with the control. The incidence of hyperlipidemia of the two groups showed statistically significant difference in HDL-cholesterol (P=0.019) and triglyceride (P=0.024). CONCLUSION: Hyperlipidemia seems to be associated with pathogenesis of ONFH. We speculated that hyperlipidemia might be a contributing factor of ONFH. Hyperlipidemia may play a role as a triggering factor in the pathogenetic process that results in osteonecrosis. However, it can not be ruled out that secondary hyperlipidemia might be a finding following ONFH.
Cholesterol ; Embolism, Fat ; Head* ; Humans ; Hyperlipidemias ; Incidence ; Osteonecrosis* ; Triglycerides

PURPOSE: We analysed perioperative and postoperative complications in a series of patients who had a pertrochanteric fracture which had been treated by using a Gamma Asia-Pacific Locking Nail. MATERIALS AND METHODS: A retrospective analysis was done on 44 patients who were available for follow-up over one year period. The Clinical analysis included their walking ability, buttock pain, thigh pain, and their leg length discrepancy. The correlation between radiological parameters and the incidence of complications was analysed. RESULTS: The average follow-up period was 26 months. The presence of buttock pain, thigh pain, a diminution of walking ability and a limb shortening were common findings. The amount of typical complications from a classic gamma nail in the pertrochanteric fractures of the femur were very low, but complications such as avascular necrosis of the femoral head or a refracture after removal of the nail occurred in patients who had been treated by a Gamma Asia-Pacific Locking Nail. The radiological parameters did not statistically correlate with the incidence of complications. CONCLUSION: There was mismatch of Gamma Asia-Pacific Locking Nail with Korean femorae. We recommend that a precise operative technique is essential and a modification of the nail must be made.
Buttocks ; Extremities ; Femur ; Follow-Up Studies ; Head ; Humans ; Incidence ; Leg ; Necrosis ; Postoperative Complications ; Retrospective Studies ; Thigh ; Walking

OBJECTIVES: The purpose of this study was to evaluated the difference of depressive symptoms and attention between estrogen user and non-user in postmenopausal women. METHODS: 30 Estrogen users and 30 non-users were participated in this study. They were all menopausal for at least 1 year and have 12 or more education years. We used BDI(Beck Depression Inventory), digit span and digit symbol to evaluate depressive symptoms and attention in both groups. We also measured the plasma estradiol level and identified the correlation between estradiol level and BDI, digit span and digit symbol. RESULTS: The demographic data was not different between both groups. Estrogen users scored higher than non-users in digit span(forward) and lower than non-users in BDI. The correlation between estradiol level BDI, digit span and digit symbol was not significant. CONCLUSION: Estrogen replacement therapy was effective in alleviation depressive symptoms but ineffective in improving attention in postmenopausal women.
Depression* ; Education ; Estradiol ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Humans ; Plasma

The diagnosis of dilated cardiomyopathy associated with pheochromocytoma was made in a 24 year old male on the basis of symptoms and signs, measurements of metabolites of catecholamine,echocardiography and radionuclide ventriculography were preformed and demonstrated. The presence of a tumor on both adrenal glands without definite distant metastasis was demonstrated by abdominal ultrasonography, CT scanning and 131I-MIBC scintigraphy. Surgical removal was performed after proper preoperative preparation with a-adrenergic blocker. During the surgery, neither significant arrhythmia nor severe change of blood pressure was observed. After surgery, cardiac function of the patient improved slowly and progressively.
Adrenal Glands ; Arrhythmias, Cardiac ; Blood Pressure ; Cardiomyopathy, Dilated* ; Diagnosis ; Humans ; Male ; Neoplasm Metastasis ; Pheochromocytoma* ; Radionuclide Imaging ; Radionuclide Ventriculography ; Thoracic Surgery ; Tomography, X-Ray Computed ; Ultrasonography ; Young Adult

Myopathy due to hypothyroidism can be detected in its early stage, but as the symptom is mild, complications such as rhabdomyolysis are rare. Thrombotic thrombocytopenic purpura in hypothyroidism is not yet clearly defined, and rare cases of it are reported. Reported herein is a case of thrombotic thrombocytopenic purpura and rhabdomyolysis associated with acute renal failure in hypothyroidism. A 70-year-old male was admitted to the hospital due to general weakness and muscle pain. Later, based on the laboratory findings, he was diagnosed with rhabdomyolysis associated with acute renal failure and thrombotic thrombocytopenic purpura combined with hypothyroidism. Initially, he was treated with fluid resuscitation due to rhabdomyolysis combined with acute renal failure but eventually, the levothyroxine supplement lowered the thyrotropin-stimulating hormone level. As a result, the patient recovered from rhabdomyolysis and thrombotic thrombocytopenic purpura without receiving plasmapheresis treatment.
Acute Kidney Injury* ; Aged ; Humans ; Hypothyroidism* ; Male ; Muscular Diseases ; Myalgia ; Plasmapheresis ; Purpura, Thrombotic Thrombocytopenic* ; Resuscitation ; Rhabdomyolysis* ; Thyroxine

Primary ureteral tumor accounts for an estimated about 1 percent of all tumors of the urinary tracts. We observed one case of the ureteral tumor in 65 years old male patient and he was treated by complete nephroureterectomy with an excision of a cuff bladder wall around ureteral orifice. A case of primary ureteral tumor was reported with a brief review of the literatures.
Aged ; Humans ; Male ; Ureter* ; Urinary Bladder ; Urinary Tract