It may be the most important problem to keep the airway during general anesthetic procedure. The authors experienced a case of left segmental bronchial obstruction with foreign body during general anesthesia for right pneumonectomy on the position of left decubitus, which was successfully removed by fiberoptic bronchoscopic aspiration and atelectasis due to segmental bronchial obstrucion was completely cured by active management of I.P.P.B., inhalation of oxygen with humidification, endobronchial suction, and symptomatic medication.
Anesthesia* ; Anesthesia, General ; Foreign Bodies* ; Inhalation ; Oxygen ; Pneumonectomy ; Pulmonary Atelectasis* ; Suction

Nostril stenosis is a rare disease causing cosmetic problem and nasal airway obstruction. Various etiologies including iatrogenic cause the stenosis. Usually the shortage of internal lining of vestibule initiates secondary intention healing where granulation and contracture results in the stenosis. Many surgical techniques have been used to correct the stenosis. The objective of this article is to present a case of iatrogenic unilateral nostril stenosis which was successfully repaired with the use of auricular composite graft.
Constriction, Pathologic* ; Contracture ; Intention ; Nasal Obstruction ; Rare Diseases ; Transplants*

The tourniquet is not only used for facilitation of microaurgery by the bloodless surgical field on the extremities but prepared for the intravenous regional anesthesia and isolation arm test estimated the degree of the neuromuscular transmission in the anesthetic field. On the contrary, there are various complications, such as nerve paralysis and tissue damage from compression, and metabolic and hemodynamic changes from ischemia after application of the tourniquet. Since a sudden increase in PaCO2 immediately following tourniquet deflation is one of the important factors in the hemodynamic changes, we have observed the ehanges of PaCO2 and PCO2, after release of the tourniquet on the upper and the lower extremity under the general anesthesia with enflurane, N2O and respiratory control maintaining PaCO2 level (35 mmHg). The results obtained were as follows; PETCO2, PaCO2 and HCO2- were significantly elevated to peak level within 1 minutue after tourniquet release on the upper and the lawer extremity, except HCO2 on the upper extremity, and there were more severe changes on the lower extremity. pH and base excess were reduced to significantly lowest level 1 minutue and 5 minutes after tourniquet release respectively, and their changes were more reduction on the lower extremity. There were no statistically significant variations in PaO2 on the extremities. In the relationship between tourniquet time and P, it was statistically significant linear on the lower extremity (p<0.05) only. Conlusively, since the sudden changes of PaCO2, pH and base excess after release of tourniquet are closely related with PaCO2, on time and degree, noninvasive monitoring of PaCO2 has rapid interpre- tation to change in PaCO2 after release of tourniquet.
Anesthesia, Conduction ; Anesthesia, General ; Arm ; Enflurane ; Extremities ; Hemodynamics ; Hydrogen-Ion Concentration ; Ischemia ; Lower Extremity ; Paralysis ; Tourniquets* ; Upper Extremity

Trichoblastoma is a benign cutaneous neoplasm that consists of follicular germinative cells. We report a case of trichoblastoma in a 58-year-old man. The tumor was presented as a solitary symmetrical shaped pedunculated 5.0x4.0x2.0cm sized multilobular tumor on right lower leg for 2 years. Histopathologic examination showed well circumscribed dermal tumor composed of multilobular tumor islands of palisaded basaloid epithelial cells. The tumoral lobules were concentrically surrounded by hyalinized collagen bundles with fibroblasts. The overall architecture was reminiscent of hair bulbs. Cytokeratin 14 stain showed positive reaction, but cytokeratin 10 stain showed negative reaction. The tumor was completely excised with clear margin. No sign of recurrence has been noted until 9 months later.
Collagen ; Epithelial Cells ; Fibroblasts ; Hair ; Humans ; Hyalin ; Islands ; Keratin-14 ; Keratins ; Leg ; Middle Aged ; Recurrence

Cimetidine, and H2-receptor blocker, is associated with a direct inhibition of liver microsomal enzymes and a decrease in liver blood flow which results in a variety of clinically significant drug interactions, but its effects on the action of muscle relaxants have not been established. Recently, Kambam et al(1987) reported that the duraion of action of succinylcholine was prolonged 2~2.5 times by cimetidine. The effects of cimetidine, ranitidine, and famotidine, on duration of action of succinylcholine and vecuronium were studied. Sixty ASA class 1 or 2 patients scheduled for elective exploratory laprotomies were randomly divided into two groups as follows: Succinylcholine Group(n=40, 1mg/kg) control group(n=10), cimetidine group(n=10): 300mg ph hs & 1 hour before induction, ranitidine group(n=10): 150mg po hs & 1 hour before induction, famotidine group(n=10) : 40mg po hs only. Vecuronimu Group(n=20, 0.08mg/kg) control group(n=10), famotidine group(n=10): 40 mg po hs only. All patients were premedicated with hydroxyzine(1.5mg/kg) and Robinul 0.2mg IM, 1 hour before anesthesia. Anesthesia was induced with thiopental sodium 5~6mg/kg and succinylcholine 1mg/kg or vecuronium 0.08mg/kg. Tracheal intubation was performed at 75~!00% block as monitored by train-of-four stimulation of the ulnar nerve at 2Hz, 20 seconds apart(ABM, Datex). Anesthesis was maintained with 50% nitrous oxide, oxygen, and 2% enflurane. The duration of action of the muscle relaxants was measured from injection of muscle relaxant to the time of 25% recovery of first twitch height on train-of-four stimulation. The results were as follows: 1) The duration of succinylcholine was prolonged significantly by the H2-receptor blockers, 8.3+/-1.49 minutes with cimetidine, 9.8+/-1.98 minutes with ranitidine, and 10.3+/-2.48 minutes in the famotidine group as compared to 6.9+/-1.43 minutes in the control(p<0.05). 2) The duration of action of vecuronium was not affected significantly by the H2-receptor blocker, 26.5+/-4.72 minutes in the famotidine group as compared to 23.6+/-4.52 minutes in the control(p>0.05).
Anesthesia ; Cimetidine ; Drug Interactions ; Enflurane ; Famotidine ; Humans ; Hydrogen-Ion Concentration ; Intubation ; Liver ; Nitrous Oxide ; Oxygen ; Ranitidine ; Succinylcholine* ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide*

BACKGROUND: Catenins are the associated protein with E-cadherin in the formation of adhesion complexes in normal and tumor cells related with epithelial differentiation and development of organ formation as well as in the tumor spread. The present study was aimed to find the distribution of alpha- and gamma-catenins in fetal skin development. OBJECTIVE: The purpose of this study was to observe the distribution of above two adhesion related proteins in the fetal skin during development, and to find its relationship by expression and their distribution pattern. METHODS: Skin was obtained from the scalp, chest, and sole of 21 human fetuses, ranging from 13 to 37 weeks of gestational age. Immunohistochemical staining was performed by the avidin biotin peroxidase complex method on paraffin embedded tissue using the anti-human monoclonal antibody against the human alpha- and gamma-catenins. RESULTS: alpha- and gamma-catenins were expressed strongly in basal cells of the epidermis and germ cells of skin adnexa, such as hair and eccrine glands at 13th week, followed by decreased basal cell expression. Increase in the suprabasal epithelium and differentiated adnexal epithelium, such as outer root sheath cells and eccrine ducts and glands at 18th week, and adult pattern in 23th week of gestation. Both showed similar distribution pattern in skin though gamma-catenin appeared two or three weeks later. alpha- and gamma-catenins are expressed not only in the epithelium of the skin, but also in the mesenchymal cells such as endothelial cells and fibroblasts. Though both catenins are more strongly expressed in the membrane portion, cytoplasmic expression is also noted. CONCLUSION: Both alpha- and gamma-catenin showed basically the same expression distribution pattern in the fetal skin developmental stage, suggesting that both adhesion molecules are highly related to each other in function and development of epidermis and adnexae of the skin in fetal stage.
Adult ; Avidin ; Biotin ; Cadherins ; Catenins ; Cytoplasm ; Eccrine Glands ; Endothelial Cells ; Epidermis ; Epithelium ; Fetus ; Fibroblasts ; gamma Catenin* ; Germ Cells ; Gestational Age ; Hair ; Humans ; Membranes ; Paraffin ; Peroxidase ; Pregnancy ; Scalp ; Skin* ; Thorax

Mastocytosis is a heterogenous group of disorders characterized by abnormal growth and accumulation of mast cells in one or more organ systems. Urticaria pigmentosa represents the most common form of cutaneous mastocytosis in children and adults. We report a case of adult-onset urticaria pigmentosa in a 53-year-old man. The patient had pruritic multiple scattered well-demarcated brownish macules and papules on whole body for 4 years. Histopathologic examination showed diffuse and perivascular infiltration of lymphocytes and cuboidal mast cells in the upper dermis. Any sign or symptom of systemic involvement was not detected.
Adult ; Child ; Dermis ; Humans ; Lymphocytes ; Mast Cells ; Mastocytosis ; Mastocytosis, Cutaneous ; Middle Aged ; Urticaria Pigmentosa* ; Urticaria*

We report a case of alopecia neoplastica in a 54-year-old woman, who presented with a 2 month history of a solitary 2X2 cm sized, erythematous hairless plaque on the vertex. Histological findings showed an extensive infiltration of tumor cells in the dermis, resulting in loss of the pilosebaceous structure. Tumor cells infiltrated in sheets or cords of cells, sometimes demonstrating glandular structures, and tumor cells formed small groups or single rows between thickened collagen bundles; the characteristic features of alopecia neoplastica.
Alopecia* ; Breast Neoplasms* ; Breast* ; Collagen ; Dermis ; Female ; Humans ; Middle Aged

Otolaryngologists are sometimes confronted with various complications. They may be minor or sometimes they can be major, and rarely fatal. Some complications can be prevented, but some are unavoidable. Five cases of major complications, which occurred during or after routine rhinologic surgery, are presented. Two patients died of toxic shock syndrome: one patient after endoscopic sinus surgery (ESS) and the other patient after closed nasal bone reduction. One patient died of acute myocardial infarction during the recovery of anesthesia after uneventful ESS. One patient had a lidocaine shock, which required treatment in the intensive care unit. One patient had a transient unilateral blindness after intranasal steroid injection. Though the 3rd and 4th cases of complications were unavoidable, the others could have been prevented if precautions had taken place. The presumed pathophysiology, possible prevention measures, and their implications in routine otolaryngologic surgery are discussed.
Anesthesia ; Blindness ; Humans ; Intensive Care Units ; Lidocaine ; Myocardial Infarction ; Nasal Bone ; Shock ; Shock, Septic

BACKGROUND AND OBJECTIVES: The success rate of endoscopic endonasal dacryocystorhinostomy (DCR) is not satisfactory enough compared to that of external approach because the newly made ostium is easily obstructed due to granulation tissue formed around the small ostium. The objective of this study is to describe a new technique of an endoscopic DCR which minimizes the stenosis of neo-ostium and to report its success rate. MATERIALS AND METHOD: Twenty patients who had undergone endoscopic DCR with the diagnosis of proximal nasolacrimal duct obstruction were investigated retrospectively. All procedures were done by the same surgeon. The surgical technique includes elevation of mucosal flap, full sac exposure using diamond drill, and design of mucosal flap to cover the denuded bone and approximate with opened sac mucosa. Postoperative symptom improvement and endoscopic finding of the neo-ostium were evaluated. The mean duration of follow-up was 8 months. RESULTS: Ninety percent success rate was noted without any serious complications. Obstruction of the neo-ostium with granulation tissue was observed in two patients. CONCLUSION: Endoscopic DCR using mucosal flap after full sac exposure gives satisfactory success rate without any serious complications.
Constriction, Pathologic ; Dacryocystorhinostomy* ; Diagnosis ; Diamond ; Endoscopy ; Follow-Up Studies ; Granulation Tissue ; Humans ; Mucous Membrane ; Nasal Mucosa ; Nasolacrimal Duct ; Retrospective Studies