Paraneoplastic pemphigus is a distinct and rare autoimmune disease characterized by extensive and painful mucosal ulcerations and polymorphic desquamated skin lesions in the setting of an underlying neoplasm, typically of lymphoreticular origin. Thus difficulties in the management of anesthesia can be expected. A 66-years-old man was scheduled for removal of intraabdominal sarcoma associated with paraneoplastic pemphigus. Physical examination showed multiple erythematous bullae, crusts, plaques and target-like lesions on the whole body and desquamated erythematous skin lesions on the back and extremities. In the operating room, his right femoral artery was cannulated with a 20 G, 12.7 cm CVP catheter and left femoral and subclavian veins with 14 G, 20 cm CVP catheters, respectively. After application of 4 % lidocaine spray, his oropharynx and supraglottic area were evaluated under direct laryngoscopy and revealed multiple ulcerations on oral mucosa, but no distinct lesion on supraglottic area. Anesthesia was induced by rapid-sequence method with fentanyl, thiopental sodium and succinylcholine followed by endotracheal intubation. The endotracheal tube was held by a roll gauze around the neck and its cuff was minimally inflated to avoid overpressure against his tracheal wall. After the end of surgery, his oral cavity was suctioned with no remarkable bleeding, and tracheal wall including cuff-contacted area was evaluated under fiberoptic bronchoscopy, revealed intact wall without any bulla or ulceration. The patient was transferred to intensive care unit for proper postoperative management after extubation of endotracheal tube.
Anesthesia ; Autoimmune Diseases ; Bronchoscopy ; Catheters ; Extremities ; Femoral Artery ; Fentanyl ; Hemorrhage ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Laryngoscopy ; Lidocaine ; Mouth ; Mouth Mucosa ; Neck ; Operating Rooms ; Oropharynx ; Pemphigus* ; Physical Examination ; Sarcoma ; Skin ; Subclavian Vein ; Succinylcholine ; Suction ; Thiopental ; Ulcer

No abstract available.

No abstract available.
Knee Joint* ; Knee*

No abstract available.
Spinal Cord* ; Urinary Bladder, Neurogenic*

BACKGROUND: The purpose of this study is to define the risk factors of S. epidermidis acquisition and the epidemiology of strain variation in acute leukemia patients. METHODS: The participants were 155 patients of acute leukemia admitted in a University hospital for 11 months. 83 patients are the isolated group who had isolated S. epidermidis from body sites (blood, oral cavity, nares, rectum) and 72 patients are the not isolated group who had not isolated S. epidermidis. Isolates were analysed by CHEF and cluster analysis with dendrogram. Differences In proportions were tested with the Chi-square and Fisher's exact test. RESULTS: Ninety-one S. epidermidis were obtained from blood, oral cavity, nares, and rectum. The major proportion of positive culture was 81.3% from nares. Eight-nine S. epidermidis were isolated from healthcare workers. There were significant development of bacteremia in patients with S. epidermidis from nares. Resistance rate of S. epidermidis was 75.8% to methicillin, 86.3% to erythromycin, 81.l% to gentamicin, 68.9% to ciprofloxacin, 0% on vancomycin. There was significant difference on resistance rate between patients and healthcare workers' group. There was no relation between the strain of patients and those of healthcare workers. Sex age, diagnosis, length of stay, type of chemotherapy, duration of chemotherapy, Type of central venous catheter. duration of central venous catheter, prior antibiotic therapy, number of antibiotics, site of nosocomial infection, neutropenic period were not significantly different between S. epidermidis isolated group and not isolated group. Significant risk factors included duration of central venous catheter. hyper-alimentation, and folliculitis. CONCLUSION: Our result suggests that S. epidermidis in nares can be a risk factor of bacteremia. This research would be helpful for decreasing the S. epidermidis of immunocompromised patients.
Anti-Bacterial Agents ; Bacteremia ; Central Venous Catheters ; Ciprofloxacin ; Cross Infection ; Delivery of Health Care ; Diagnosis ; Drug Therapy ; Epidemiology ; Erythromycin ; Folliculitis ; Gentamicins ; Humans ; Immunocompromised Host ; Length of Stay ; Leukemia* ; Methicillin ; Molecular Epidemiology* ; Mouth ; Rectum ; Risk Factors* ; Staphylococcus epidermidis* ; Staphylococcus* ; Vancomycin

OBJECTIVE: To investigate the changes of the intramuscular temperature on buttock according to the application methods of cold jet-stream and to find the more effective method which reduces the intramuscular temperature. METHOD: Twenty eight healthy volunteers were examined. Cold-jet stream (CS) was applied on buttock (5 cm below of iliac crest, surface of gluteus medius muscle). We measured the time that skin temperature fall from room temperature to 10 degrees C (first period), the time rewarmed from 10 degrees C to 20 degrees C (second period), the time fall again to 10 degrees C (third period) and the time rewarmed again to 20 degrees C (fourth period). Cold-jet stream with infrared combination (CSIC) therapy was performed with the same method. RESULTS: At the first and third cooling periods, It took longer in CSIC group than CS group to decrease skin temperature. At fourth period, It took longer in CSIC group than CS group to rewarm skin. In CS and CSIC groups, fourth period is longer than second period. CONCLUSION: It took longer in CSIC method than CS only to decrease skin temperature to 10degrees C. Rewarming speed of skin temperature was slower twice cold-jet stream applies than once. Rewarming speed of skin temperature was slower at old-jet stream and infrared combination therapy than cold-jet only.
Buttocks* ; Healthy Volunteers ; Rewarming ; Rivers* ; Skin Temperature* ; Skin*

BACKGROUND: Propofol has been used for the induction and maintenance of obstetric anesthesia for its potential benefit of rapid recovery and less post-anesthetic complications. In order to determine the safe application of target-controlled infusion of propofol and fentanyl during Cesarean section under general anesthesia, we have investigated the adequate target concentrations of each drug using the bispectral index and hemodynamic parameters. METHODS: Ninety-two pregnant women who received Cesarean section under general anesthesia were enrolled in this study. After preoxygenation, anesthesia was induced with thiopental 4 mg/kg and succinylcholine 1 mg/kg, and intubation was done. Vecuronium 0.1mg/kg I.V. was applied for muscle relaxation, and mechanical ventilation was maintained with N2O/O2 (2 L/2 L)-enflurane. EtCO2 was maintained between 30 35 mmHg. After delivery of the fetus, propofol and fentanyl was infused by a computer-assisted continuous infusion system with air/O2 (2 L/2 L). The bispectral index was monitored perioperatively. This study proceeded in three stages. In the first stage, thirty women were studied for titration of the target effect-site concentration of propofol that could maintain a bispectral index between 40 60 while maintaining the target concentration of fentanyl at 1.5 ng/ml. In the second stage, forty-two women were randomly assigned into the four different groups (F25, F50, F75, F100) at target fentanyl concentrations of fentanyl of 0.25, 0.50, 0.75 and 1.0 ng/ml for each group respectively. The adequate target concentration of fentanyl was titrated. In the third stage, twenty women were studied for assessment of the adequacy of target concentrations of propofol and fentanyl prospectively. RESULTS: The target effect-site concentrations (Ce, 95% confidence interval) that could maintain 50% and 95% of patients hemodynamically stable with the bispectral index within 40-60 were 2.41 (2.27-2.55) microgram/ml and 3.15 (2.95-3.50) microgram/ml for propofol, 0.32 (0.13-0.46) ng/ml and 0.84 (0.66-1.29) ng/ml for fentanyl. The pre-anesthetic bispectral index was 97.1+/-1.2 and it decreased maximally to 39.5+/-6.47 after thiopental injection and increased maximally to 83.6+/-6.3 before delivery and it was 80.6+/-6.9 for eye-open to verbal command during recovery. CONCLUSIONS: The adequate target effect-site concentrations of propofol and fentanyl for the maintenance of total intravenous anesthesia during Cesarean section were determined and these concentrations were validated prospectively.
Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous* ; Anesthesia, Obstetrical ; Cesarean Section* ; Female ; Fentanyl* ; Fetus ; Hemodynamics ; Humans ; Intubation ; Muscle Relaxation ; Pregnancy ; Pregnant Women ; Propofol* ; Prospective Studies ; Respiration, Artificial ; Succinylcholine ; Thiopental ; Vecuronium Bromide

BACKGROUND: Low values of lung compliance have been reported in patients with increased pulmonary blood flow due to intracardiac left to right(L-R) shunt. The compliance had returned to within normal limits 4 to 6 weeks after surgical correction of the shunt. We investigated whether lung compliance was improved immediately after surgical correction of the shunt. METHODS: Fifty four pediatric patients who were undergoing repair of intracardiac L-R shunt were evaluated. Lung compliance, arterial oxygen tension(PaO2) and arterial to end-tidal carbon dioxide tension difference(Pa-ETCO2) were measured after induction of anesthesia and at the completion of surgery. Left atrial pressure(LAP) was monitored. Lung compliance and end-tidal carbon dioxide tension were measured by monitoring system built in Cato anesthetic ventilator system. RESULTS: Lung compliance was significantly lower after surgery(6.57+/-6.46 ml/mbar) than after induction of anesthesia(7.71+/-7.18 ml/mbar). After surgery, PaO2 was significantly decreased and Pa-ETCO2 significantly increased than after induction of anesthesia. The decrease in lung compliance after surgery significantly correlated with a decrease in PaO2(r=0.43) and an increase in Pa-ETCO2 (r=0.47) but not correlated with LAP. CONCLUSIONS: Although surgical correction of intracardiac L-R shunt reduces pulmonary blood flow, the lung compliance decreases in immediate postoperative period. Therefore a deterioration of postoperative lung compliance may need judicious management for pulmonary and hemodynamic instability.
Anesthesia ; Carbon Dioxide ; Compliance ; Hemodynamics ; Humans ; Lung Compliance* ; Lung* ; Oxygen ; Postoperative Period ; Ventilators, Mechanical

BACKGROUND: Post-operative shivering is one of the potential complications for any surgical patient. Its incidence varies from 5% to 65%, and many preventive and treatment modalities have been reported. For the effective prevention of post-anesthetic shivering by using intravenous clonidine or meperidine, randomized controlled studies were reviewed. The overall incidence of shivering after clonidine or meperidine administration, and the anti-shivering effect of clonidine and meperidine were evaluated. METHODS: DATA SOURCES: Medline search from 1978 to March 1998. DATA SELECTION: We selected studies that had investigated the preventive anti-shivering effect of intravenous clonidine or meperidine by randomized controlled trials. Ten clinical trials were evaluated. RESULTS: The pooled odd ratio of the patients who received clonidine was 0.32 (95% confidence interval, 0.22~0.47) and it seemed to be effective. But these studies showed little evidence of significant homogeneity (P=0.01). In the subgroup analysis, the pooled odd ratio of group A (early administration or intra-operative infusion group) was 0.47 (95% CI 0.31~0.72) evidenced effectiveness but failed to prove homogeneity (P=0.047). But group B (the late intra-operative administration group) had a pooled odd ratio of 0.10 (95% CI 0.05~0.22) and showed homogeneity (P=0.98). In meperidine trials, the pooled odd ratio was 0.20 (95% CI 0.07~0.55). CONCLUSION: We present quantitative evidence based on a meta-analysis of pooled effect size from randomized trials that clonidine is more beneficial for the prevention of post-anesthetic shivering and more effective than meperidine when it is administrated during later period of surgery.
Clonidine* ; Information Storage and Retrieval ; Humans ; Incidence ; Meperidine* ; Shivering*

The purpose of this study was to estimate mean pressure thresholds over several skeletal muscles, grip and pinch strengths in female telephone operators. Pressure thresholds on muscles of neck and shoulder were measured with a pressure algometer, and grip and pinch strength were measured with a Jamar dynamometer and a Jamar pinch gauge in 904 female telephone operators. The pressure threshold was highest in the supraspinatus and lowest in the cervical paraspinals. There was no statistically significant difference between right and left corresponding muscles. The mean grip strength was 22.29 kg in the right hand, 21.97 kg in the left hand. The mean tip pinch strength was 0.56 kg in the right, 0.51 kg in the left. The mean lateral pinch strength was 2.21 kg in the right, 2.12 kg in the left. The mean palmar pinch strength was 1.82 kg in the right, 1.66 kg in the left. There was no significant correlation between grip, pinch strength and age(p>0.05). There were positive correlations between height, weight and grip strength. There were positive correlations between exposure duration to visual display terminal and pinch strength.
Cumulative Trauma Disorders ; Female* ; Hand ; Hand Strength* ; Humans ; Muscle, Skeletal ; Muscles ; Neck ; Pinch Strength* ; Shoulder ; Telephone*