Impetigo herpetiformis is a rare pustular eruption that may be seen in late pregnancy. It is associated with severe maternal and fetal complications in case of misdiagnosis and delayed treatment. The patient was a 25-years-old multigravida with psoriasis in her past history. At 20weeks gestation, she had been developed erythematous scaly annular patchs with papules and pustules on inner thigh. At 37weeks' gestation, the patient was suffered from a severely pruritic pustular rash with fever and leukocytosis. The skin of the affected areas was biopsied and showed intraepidermal pustular abscess with a neutrophilic infiltrate. Treatment commenced with intravenous fluids, antibiotics, systemic prednisone, steroid creams, and phototherapy(UVB) under the careful fetal well being monitoring. Cesarean section was done due to fetal distress, and a normal healthy male infant was delivered, following which the patient's condition improved rapidly.
Abscess ; Anti-Bacterial Agents ; Cesarean Section ; Diagnostic Errors ; Exanthema ; Female ; Fetal Distress ; Fever ; Humans ; Impetigo* ; Infant ; Leukocytosis ; Male ; Neutrophils ; Prednisone ; Pregnancy* ; Psoriasis ; Skin ; Thigh

No abstract available.
Carcinosarcoma* ; Female ; Ovary*

Retrograde intubation has been often used in the patient who reveal difficulty intubation. But, it is time consuming procedure and the patient may be fall into hypoxemia. We have experienced a successful retrograde nasotracheal intubation without hypoxemia by using the Laryngeal Mask Airway. After induction of inhalation anesthesia, ordinary endotracheal intubation was failed in this 45-year-old male patient who was planned to clip the cerebral aneurysm, because the epiglottis could not be seen under direct laryngoscopy. We decided to perform retrograde nasotracheal intubation. Face mask was replaced with Laryngeal Mask Airway and ventilation was continued during procedure. A 18-gauge Tuohy needle was introduced through the cricothyroid membrane and then the epidural catheter was passed cephalad to larynx, distal hole of Laryngeal Mask Airway, and the end of Laryngeal Mask Airway. A 16-F Levin tube was introduced through right nasal cavity and Laryngeal Mask Airway was removed, the Levin tube was tied with epidural catheter in the oral cavity. The epidural catheter was placed from cricothyroid membrane to right nares. The endotracheal intubation was performed successfully by sliding over the catheter. In the postoperative evaluation, significant complications were not detected. The procedure was performed in about 2 minutes and the apneic time was less than 30 seconds. We believe that this procedure may be useful in the patients who may suffer from hypoxemia.
Anesthesia, Inhalation ; Anoxia ; Catheters ; Epiglottis ; Humans ; Intracranial Aneurysm ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopy ; Larynx ; Male ; Masks ; Membranes ; Middle Aged ; Mouth ; Nasal Cavity ; Needles ; Ventilation

No abstract available.

To define the effect of alkalinization of bupivacaine 0.5% in supraclavicular approch of brachial plexus bock, the onset of sensory and motorblock were determined. Fourty physical status ASA 1 were randomly allocated to two groups.: Group 1 (n=20); bupivacaine 0.5% 20 ml (pH 6.0-6.2). Group 2 (n=20); alkalinized buivacaine 0.5% 20 ml (pH 6.9-7.2). Onest of sensory blockade were determined by pinprick in the C4 - T2 skin dermatome, and extend of sensory block was assessed by the number of dermatomes blocked while motor blockade was assessed by scoring on a scale: Grade 1; inability to flex the elbow against resistance. Grade 2; inability to flex the elbow against gravity. Grade 3; inability to flex the wrist against gavity. The results were as follows. 1) The average time for sensory blockade of five dermatonies was significantly more rapid in group 2 (within 15 min) than those in group 1 (over 25 min). 2) The average time of motor blockade was significantly more rapid in group 2 (Grade 1: 2 min 43 sec, Grade 2: 11 min 36 sec) than those in group 1 (Grade 1: 5 min 4 sec, Grade 2: 18 min 36 sec). 3) There was no pneumothorax, phrenic nerve paralvsis and general seizure or other side effects but Horners syndrome in 10 cases and hematoma in 2 cases were observed. The results indicate that alkainized bupivacaine for supraclavicular approch of rachial plexus block has more rapid onset than plain bupivacaine.
Brachial Plexus* ; Bupivacaine* ; Elbow ; Gravitation ; Hematoma ; Horner Syndrome ; Phrenic Nerve ; Pneumothorax ; Seizures ; Skin ; Wrist

Oxidative stress was evaluated for anthracene (Ant) and alkyl-Ants (9-methylanthracene [9-MA] and 9,10-dimethylanthracene [9,10-DMA]) in Caenorhabditis elegans to compare changes in toxicity due to the degree of alkylation. Worms were exposed at 1) the same external exposure concentration and 2) the maximum water-soluble concentration. Formation of reactive oxygen species, superoxide dismutase activity, total glutathione concentration, and lipid peroxidation were determined under constant exposure conditions using passive dosing. The expression of oxidative stress-related genes (daf-2, sir-2.1, daf-16, sod-1, sod-2, sod-3 and cytochrome 35A/C family genes) was also investigated to identify and compare changes in the genetic responses of C. elegans exposed to Ant and alkyl-Ant. At the same external concentration, 9,10-DMA induced the greatest oxidative stress, as evidenced by all indicators, except for lipid peroxidation, followed by 9-MA and Ant. Interestingly, 9,10-DMA led to greater oxidative stress than 9-MA and Ant when worms were exposed to the maximum water-soluble concentration, although the maximum water-soluble concentration of 9,10-DMA is the lowest. Increased oxidative stress by alkyl-Ants would be attributed to higher lipid-water partition coefficient and the π electron density in aromatic rings by alkyl substitution, although this supposition requires further confirmation.
Alkylation ; Ants ; Caenorhabditis elegans* ; Caenorhabditis* ; Cytochromes ; Gene Expression ; Glutathione ; Humans ; Lipid Peroxidation ; Oxidative Stress* ; Polycyclic Hydrocarbons, Aromatic ; Reactive Oxygen Species ; Superoxide Dismutase

Oxidative stress was evaluated for anthracene (Ant) and alkyl-Ants (9-methylanthracene [9-MA] and 9,10-dimethylanthracene [9,10-DMA]) in Caenorhabditis elegans to compare changes in toxicity due to the degree of alkylation. Worms were exposed at 1) the same external exposure concentration and 2) the maximum water-soluble concentration. Formation of reactive oxygen species, superoxide dismutase activity, total glutathione concentration, and lipid peroxidation were determined under constant exposure conditions using passive dosing. The expression of oxidative stress-related genes (daf-2, sir-2.1, daf-16, sod-1, sod-2, sod-3 and cytochrome 35A/C family genes) was also investigated to identify and compare changes in the genetic responses of C. elegans exposed to Ant and alkyl-Ant. At the same external concentration, 9,10-DMA induced the greatest oxidative stress, as evidenced by all indicators, except for lipid peroxidation, followed by 9-MA and Ant. Interestingly, 9,10-DMA led to greater oxidative stress than 9-MA and Ant when worms were exposed to the maximum water-soluble concentration, although the maximum water-soluble concentration of 9,10-DMA is the lowest. Increased oxidative stress by alkyl-Ants would be attributed to higher lipid-water partition coefficient and the π electron density in aromatic rings by alkyl substitution, although this supposition requires further confirmation.
Alkylation ; Ants ; Caenorhabditis elegans ; Caenorhabditis ; Cytochromes ; Gene Expression ; Glutathione ; Humans ; Lipid Peroxidation ; Oxidative Stress ; Polycyclic Hydrocarbons, Aromatic ; Reactive Oxygen Species ; Superoxide Dismutase

Complications from use of the light wand have been reported rarely. We present a case of arytenoid cartilage dislocation incurred by using this technique for intubation of a patient. A 35-year-old healthy woman was admitted for microsurgical cervical diskectomy. Anesthesia was induced and a 7.0 mm cuffed endotracheal tube with a light wand was inserted during blind orotracheal intubation. The trachea was extubated without any difficulty in the operating room after the surgery. In the third postoperative day, the patient complained sore throat and mild hoarseness. In the eighth postoperative day, the patient was discharged for follow-up of Department of neurosurgery. In the second day after the discharge, she was consulted to otolaryngology service in our hospital because she suffered from persistent hoarseness. Flexible nasopharyngolaryngoscopy revealed anterior and inferior dislocation of left arytenoid cartilage. The patient was taken to the operating room for reduction of the dislocated cartilage by the otolaryngologists. Despite the delayed reduction, which was performed tenth day after her initial injury, the patient,s hoarseness had resolved completely without further treatment.
Adult ; Anesthesia ; Arytenoid Cartilage* ; Cartilage ; Diskectomy ; Dislocations* ; Female ; Follow-Up Studies ; Hoarseness ; Humans ; Intubation ; Intubation, Intratracheal* ; Neurosurgery ; Operating Rooms ; Otolaryngology ; Pharyngitis ; Trachea

It is clinically important to know the size of normal trachea for airway management and respiratory care. The knowledge is useful for avoiding many possible complications due to tracheal intubation by appropriate choice of endotracheal tube size. Therefore, we investigated antero-posterior(A-P) diameter, transverse diameter and cross- sectional area(CSA) of trachea at various level with MRI(magnetic resonance imaging) in 70 males and 79 females who were divided into three age groups(group 1: 16-39 year of age, group 2: 40-59 year of age, group 3: 60-83 year of age), and they had no abnormalities in cardiopulmonary system. The results were as follows; 1. A-P 2. Transverse 3. Narrowing portion 4. CSA 1. A-P diameter of trachea was 17.1+/-1.4 mm in male and 13.9+/-1.3 mm in female. Transverse diameter of trachea was 15.1+/-1.6 mm in male and 13.3+/-1.5 mm in female(Table 1). A-P and Transverse diameters were greater in male than in female (P<0.05). 2. C-7 was the narrowest portion of A-P diameter in both sex (P<0,05). C-5 was the narro- west portion of transverse diameter in both sex (P<0.05). 3. A-P diameters of trachea among male patients were 17.1+/-1.2 mm, 17.41.6 mm, and 16.6+/- 1.3 mm in group 1, 2 and 3 (Table 3, Fig. 4). A-P diameters of trachea in female age group 1, group 2 and group 3 were 13.7+/-1.2 mm, 14.3+/-1.3 mm, and 13.6+/-1.5 mm(Table 3, Fig. 4). Transverse diameters of trachea in male age group 1, group 2 and group 3 were 14.8+/-1.4 mm, 15.1+/-1.7 mm, and 15.4+/-1.6 mm(Table 3, Fig. 4). Transverse diameters of trachea in female age group 1, group 2 and group 3 were 13.0+/- 1.2 mm, 13.6+/-1.9 mm and 13.5+/-1.4 mm(Table 3, Fig. 4). 4. CSA(cross sectional area) of trachea were 201.1+/-31.3 mm(2) in male and 145.4+/-27.7(2) mm in female(Table 4). 5. CSA at C5, C6, C7 and Tl in male were 175.9+/-61.1 mm(2), 201.1+/-43.8 mm(2), 196.2+/-36.2 mm(2) and 230.9+/-463 mm(2) (Table 4, Fig. 5). CSA at C5, C6, C7 and Tl in female were 127.0+/- 33.4 mm(2), 138.434.6 mm(2), 140.734.7 mm(2) and 171.7+/-42.0 mm(2) (Table 4, Fig. 5). 6. CSA of trachea among male patients were 198.1+/-28,5 mm(2), 206.2+/-33.0 mm(2) and 198.3+/-33.1 mm(2) in group 1, 2 and 3 (Table 5, Fig. 6). CSA of trachea in female age group 1, group 2 and group. 3 were 140.2+/-25.0 mm(2), 152.8+/-32.4 mm(2) and 145.6+/-25.1 mm(2) (Table 5, Fig. 6). But there was no significant difference between groups according to the sex. 7. CSA of trachea in age groups were stastically insignificant for both sex.
Adult* ; Airway Management ; Female ; Humans ; Intubation ; Magnetic Resonance Imaging* ; Male ; Trachea*

As higher mortality rate and frequent incidence of morbidity, early surgical treatment is generally recommended for the multivalvular endocarditis. A 46-year-old female presented with high fever. Echocardiography showed the vegetation on pulmonic valve, tricuspid valve and mitral valve with a ventricular septal defect. Emergency operation was conducted due to uncontrolled infection. We present a clinical success of this rare case with review of the medical literature.
Echocardiography ; Emergencies ; Endocarditis ; Female ; Fever ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Middle Aged ; Mitral Valve ; Tricuspid Valve