27 autopsy cases died of anaphylactic shock induced by mainline during 1996-2005 were selected and analyzed. The results showed that most anaphylactic shock induced by mainline were rapid type and more easily happened in individual clinique and lawless clinique, and it could be arisen by either antibiotics or non-antibiotics. In some cases, there may be no pathologic findings by autopsy. So, all the materials must be taken into account for determination the anaphylactic shock, such as drugs, clinic symptom, autopsy findings, and so on.
Adolescent ; Adult ; Aged ; Anaphylaxis/pathology* ; Anti-Bacterial Agents/adverse effects* ; Autopsy ; Cause of Death ; Female ; Forensic Pathology ; Humans ; Infusions, Intravenous ; Male ; Middle Aged ; Penicillins/adverse effects* ; Procaine/adverse effects* ; Young Adult

Lidocaine is a commonly used local anesthetic for dental treatment. Urticaria caused by lidocaine has seldom been reported. Generally, urticaria immediately develops after exposure to a causative agent and is considered a manifestation of IgE-mediated hypersensitivity. However, delayed urticaria caused by local anesthetics was reported to be related to cell mediated hypersenstivity. A 3-year old girl visited our allergy clinic due to delayed urticaria after local administration of lidocaine. Both skin prick and intradermal tests with lidocaine revealed negative reactions. However, the provocation test with subcutaneous injection of lidocaine showed urticaria 7 hours after test. In order to identify alternative local anesthetic for the subsequent dental procedure, we performed skin prick, intradermal and provocation tests with procaine, a local anesthetic of the other class, all of which showed negative results. Therefore, we recommended procaine as an alternative local anesthetic, and the patient was successfully treated with procaine. To the best of our knowledge, this is the first case of delayed urticaria caused by lidocaine in Korea.
Anesthetics, Local ; Child* ; Drug-Related Side Effects and Adverse Reactions ; Female ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Injections, Subcutaneous ; Intradermal Tests ; Korea ; Lidocaine* ; Procaine ; Skin ; Urticaria*

OBJECTIVE: To explore the effectiveness and feasibility of dexamethasone combined with oxybuprocaine hydrochloride gel on the prevention of postoperative sore throat after nasal endoscopy. METHODS: In the study, 60 patients with American Society of Anesthesiologist (ASA) physical statuses Ⅰ to Ⅱ, aged 18 to 72 years, scheduled for elective nasal endoscope surgery under general anesthesia requiring endotracheal intubation were randomly divided into dexamethasone combined with oxybuprocaine hydrochloride gel group (G group, n=30) and control group (C group, n=30). The patients in the G group received dexamethasone 0.1 mg/kg before induction and the oxybuprocaine gel was applied to the endotracheal catheter cuff and the front end within 15 cm. The patients in the C group received the same dose of saline and the saline was applied to the endotracheal catheter cuff and the front end within 15 cm. Then, all the patients in the two groups received the same induction and anesthesia maintainance. The operation time, anesthesia time, emergence time, extubation time and departure time were recorded. The intraoperative infusion volume, blood loss volume, propofol, remifentanil, rocuronium dosage were also recorded. The adverse reactions such as intraoperative hypotension, bradycardia and postoperative agitation were recorded. The postoperative sore throat score was recorded at the end of operation and 4 h, 8 h, 12 h, and 24 h after operation. RESULTS: Compared with the C group, the emergence time [(8.4±3.9) min vs. (10.8±4.7) min], extubation time [(8.8±3.7) min vs. (11.9±4.8) min], and departure time [(20.0±5.3) min vs. (23.0±5.8) min] were significantly shorter, and the propofol dosage [(11.8±1.8) mg/kg vs. (15.9±4.6) mg/kg], remifentanil dosage [(10.9±4.7) μg/kg vs. (14.1±3.6) μg/kg] were significantly less in the G group, and there was no difference of rocuronium dosage in the two groups. Compared with the C group the incidence of intraoperative hypotension [10%(3/30) vs. 30%(9/30)], bradycardia [16.7%(5/30) vs. 20%(6/30)] and postoperative agitation [6.7%(2/30) vs. 23.3%(7/30)] were significantly lower in the C group. The postoperative sore throat score at the end of operation, 4 h, 8 h, 12 h and 24 h after operation in the G group were significantly lower than in the C group respectively [0 (0, 1) vs. 1 (1, 2), 0 (0, 0) vs. 1 (1, 2), 0 (0, 0) vs. 1 (1, 2), 0 (0, 0) vs. 1 (0.75, 1), 0 (0, 0) vs. 1 (0, 1)]. CONCLUSION Dexamethasone combined with oxybuprocaine hydrochloride gel was effective and feasible on the prevention of postoperative sore throat after nasal endoscopy.
Adolescent ; Adult ; Aged ; Bradycardia/drug therapy* ; Dexamethasone/therapeutic use* ; Endoscopy/adverse effects* ; Humans ; Hypotension/drug therapy* ; Intubation, Intratracheal/adverse effects* ; Middle Aged ; Pain/drug therapy* ; Pharyngitis/prevention & control* ; Postoperative Complications/prevention & control* ; Procaine/analogs & derivatives* ; Propofol ; Remifentanil ; Rocuronium ; Young Adult

OBJECTIVE: To explore the effect of quadruple fluid aerosol inhalation on oral mucositis induced by radiotherapy in nasopharyngeal carcinoma (NPC) and its mechanism. METHODS: One hundred and twenty NPC patients were divided into a treatment group (n=60) and a control group (n=60). Radiation therapy was administered conventionally over 7 weeks with 2.0 Gy daily fractions for 5 days each week at the 70 Gy. Patients in the control group accepted oral care conventionally, and patients in the treatment group used quadruple fluids aerosol inhalation before the radiotherapy. The saliva volume was measured by a nurse twice a week and the concentration of epidemal growth factor (EGF) was examined by ELISA. RESULTS: The number of patients with mucositis in the treatment group was significantly fewer than that in the control group when the total doses were up to 30 Gy and 60 Gy (P<0.05). The concentration of EGF in the control group significantly decreased when total doses were up to 30 Gy and 60 Gy (P<0.01). The concentration of EGF in the treatment group was not significantly different compared with pre-radiotherapy when the total doses were up to 30 Gy, but when total doses were up to 60 Gy, the concentration of EGF in the treatment group obviously decreased compared with that of pre-radiotherapy. CONCLUSION The quadruple fluid aerosol inhalation is effective to reduce oral mucositis resulted from radiotherapy in NPC patients, which is related to the delay of the EGF decrease in the saliva.
Administration, Inhalation ; Adult ; Aerosols ; administration & dosage ; Aged ; Drug Combinations ; Enzyme-Linked Immunosorbent Assay ; Epidermal Growth Factor ; metabolism ; Female ; Gentamicins ; administration & dosage ; Humans ; Male ; Menthol ; administration & dosage ; Middle Aged ; Nasopharyngeal Neoplasms ; drug therapy ; radiotherapy ; Procaine ; administration & dosage ; Radiotherapy ; adverse effects ; methods ; Saliva ; drug effects ; metabolism ; radiation effects ; Stomatitis ; etiology ; metabolism ; prevention & control ; Treatment Outcome ; Vitamin B 12 ; administration & dosage ; Vitamins ; administration & dosage