Pneumothorax was recognized as a potential hazard of mechanical ventilation shortly after the introduction of the technique of tracheal intubation in the 19th century. Because the gases used in anesthesia are delivered from cylinders and wall outlets at higher than atmoshperic pressure, the possibility of damage to the lung is ever present. Immediate, prompt and adequate management of bilateral tension Pneumothorax are essentil, otherwise the patient dies rapidly. We had a case of bilateral tension Pneumothorax in a 3 year-old boy who underwent a B-E amputation of a severely crushed hand. We report this case along with a review of the literature on Pneumothorax.
Amputation ; Anesthesia ; Anesthesia, General* ; Child, Preschool ; Gases ; Hand ; Humans ; Intubation ; Lung ; Male ; Pneumothorax* ; Respiration, Artificial

BACKGROUND: Exercise testing is a standard noninvasive method used in the evaluation and management of patients with suspected coronary artery disease. However, patients with lower limb impairment are unable to undergo a standard bicycle or treadmill test. Alternative methods of exercise testing are needed for patients with vascular, orthopedic or neurologic conditions who cannot perform leg exercise. This study was aimed to determine the diagnostic accuracy of arm exercise thallium-201 SPECT for evaluating chest pain in patients unable to perform leg exercise. METHOD: Twenty-five anginal patients performed arm ergometry testing in conjunction with thallium-201 SPECT. Thereafter all underwent coronary angiography. RESULT: Significant coronary artery disease (> or =50% stenosis) in at least one vessel was present in 22 (88%) of the 25 patients. The sensitivity of thallium-201 SPECT for detecting coronary artery disease was 91%, which was significantly higher than the 32% sensitivity found with the electrocardiographic response alone (p <0.001). Thallium-201 SPECT yielded a sensitivity of 88, 86 and 100% for one, two, and three vessel diseases, respectively, and an 84% sensitivity and 81% specificity for detecting individual vessel stenosis. CONCLUSION: Arm exercise thallium-201 SPECT is useful for detecting coronary artery disease in patients unable to perform leg exercise. In addition, it provides an information regarding exercise tolerance. Therefore, this test appears to be reliable and useful and should be considered in the detection of coronary artery disease in nonambulatory patients.
Angina Pectoris ; Arm* ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Electrocardiography ; Exercise Test ; Exercise Tolerance ; Humans ; Leg ; Lower Extremity ; Orthopedics ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

Malignant hyperthermia is defined as a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia, skeletal muscle rigidity, tachycardia, respiratory and metabolic acidosis, cyanosis etx. There is no simple noninvasive test to identify the susceptible individuals. A history of hyperpyrexia and/or muscle rigidity during previous general or a family history of such a condition provides the anesthesiologist with valuable information. Avoidance of potent inhalational anesthetic agents and other triggering agenta, and the selective use of regional anesthesia with either a local anesthetic agent or neuroleptic anesthesia, are the usual acceptable guidelines in the anesthetic management of susceptible individuals. Dentrolene sodium has been shown to be effective in the prevention and treatment of malignant hyperthermia in malignant hyperthermia susceptible swine. We gave Dantrolene sodium orally as a part of the prophylaxia for malignant hyperthermia in a 34yearts-old woman who underwent an emergency bilateral salpingectomy and who had a family history of malignant hyperthermia. We report on this patient with a family history of hyperthermia and reviewed the literature concerning malignant hyperthermia.
Acidosis ; Anesthesia ; Anesthesia, Conduction ; Anesthetics ; Cyanosis ; Dantrolene ; Emergencies ; Female ; Fever ; Humans ; Malignant Hyperthermia* ; Muscle Rigidity ; Muscle, Skeletal ; Salpingectomy ; Sodium ; Swine ; Tachycardia

BACKGROUND/AIMS: In patients with coronary artery stents, the cost of clopidogrel has been cited as a factor in the premature discontinuation of therapy. Thus, the introduction of lower-cost generic clopidogrel may increase patient compliance. However, platelet inhibition by generic clopidogrel has not been compared to the original clopidogrel formulation in patients with coronary artery stents. METHODS: We prospectively enrolled 20 patients receiving chronic therapy with the original clopidogrel bisulfate (Plavix(R)). After assessing patient compliance with Plavix(R), maintenance therapy was switched to generic clopidogrel bisulfate (Plavitor(R)). Platelet reactivity was assessed at baseline and 30-day after the switch using conventional aggregometry and the VerifyNow P2Y12 assay. RESULTS: All patients completed maintenance therapy with Plavitor(R). Before and after switching therapy maximal (36.5 +/- 7.9% vs. 39.8 +/- 16.2%, p = 0.280) and late platelet aggregation (23.5 +/- 10.9% vs. 29.1 +/- 18.3%, p = 0.156) with 5 micromol/L adenosine diphosphate (ADP) stimulus did not differ. Likewise, 20 micromol/L ADP-induced platelet aggregation and P2Y12 reaction unit in patients on Plavitor(R) therapy was comparable to that in patients on Plavix(R) therapy. However, Bland-Altman analysis showed wide limits of agreement between measured platelet reactivity on Plavix(R) vs. Plavitor(R) therapies. CONCLUSIONS: Among patients on Plavix(R) maintenance therapy with coronary stents, replacement with Plavitor(R) shows a comparable inhibition of ADP-induced platelet aggregation. However, due to poor inter-therapy agreement, between two regimens, physicians may be cautious when introducing generic clopidogrel bisulfate.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary ; Combined Modality Therapy ; Coronary Artery Disease/*drug therapy/therapy ; *Drug-Eluting Stents ; Drugs, Generic/*administration & dosage/adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Compliance ; Platelet Aggregation/drug effects ; Platelet Aggregation Inhibitors/*administration & dosage/adverse effects ; Prospective Studies ; Receptors, Purinergic P2/metabolism ; Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives

PURPOSE: Although the reported failure rate of the transobturator tape procedure(TOT) is low, recurrence after this procedure have been reported, and no standard treatment has yet been established for the recurrence. We compared a shortening of the previously implanted tape with a repeat tension-free vaginal tape(TVT) procedure after a failed TOT procedure. MATERIALS AND METHODS: We enrolled eighteen women(mean age: 54.38+/-9.15 years, range: 38-72) who underwent shortening of the previously implanted tape or they underwent a repeated TVT procedure due to persistent or recurrent SUI. Of the 18 women, 10 patients underwent shortening of implanted tape and the others underwent repeat TVT. All the patients were evaluated preoperatively with a detailed history, pelvic examination, urinalysis, voiding diary and urodynamic study that included the Valsalva leak point pressure(VLPP). The postoperative outcomes were assessed by a review of admissions and the medical charts. RESULTS: The mean interval from first surgery to recurrence was 6.88+/-2.61 months for Monarc, 12 months for TVT-O and 4.71+/-2.42 months for T-sling. Of the 10 patients who underwent shortening of the implanted tape, 7(70%) patients were cured and the others failed. Of the 8 patients who underwent repeat TVT, 7(87.5%) patients were cured and one was significantly improved. The success rate is significantly higher in the repeated TVT group(p<0.05). CONCLUSIONS: Both a shortening of the previously implanted tape and a repeated TVT procedure are safe, effective, viable options in the event of initial TOT sling failure. However, the success rate of the repeated TVT group is higher than that of the shortening of implanted tape group, especially for patients with an internal sphincteric deficiency. Therefore, a repeated TVT procedure is a first option in the event of initial TOT sling failure.
Female ; Gynecological Examination ; Humans ; Recurrence ; Suburethral Slings* ; Urethra ; Urinalysis ; Urinary Incontinence* ; Urodynamics

Tsutsugamushi disease is one of the acute febrile diseases caused by Orientia tsutsugamushi that is transmitted to human by the bite of larval-stage trombiculid mite (chigger). The clinical illness is characterized by abrupt onset of fever, headache, rashes, myalgia and eschar. Chest radiologic findings show reticulonodular infiltration, cardiomegaly, lymphadenopathy and in a minority, pleural effusion. About pleural effusion, it is supposed to be caused by tsutsugamushi disease itself in most cases and no case has been reported that the pleural effusion confirmed by pleural biopsy and revealed granulomatous lesions. We experienced a case of tsutsugamushi disease with pleural effusion which was also confirmed to granulomatous lesion by pleural biopsy. So we report this case with a brief review of literatures.
Biopsy ; Cardiomegaly ; Exanthema ; Fever ; Granuloma ; Headache ; Humans ; Lymphatic Diseases ; Myalgia ; Orientia tsutsugamushi ; Pleural Effusion* ; Scrub Typhus* ; Thorax ; Trombiculidae

PURPOSE: We evaluated the changes of storage symptoms after tension-free vaginal tape(TVT) procedures in stress urinary incontinence(SUI) patients, and we investigated the factors predicting the changes of storage symptoms. MATERIALS AND METHODS: From January 2000 to August 2003, 713 patients with SUI were operated on with using suburethral sling procedures(TVT). A follow-up study was conducted for over a one year period with 495 patients. We analyzed the one year outcomes of TVT surgeries and the changes of storage symptoms after TVT. RESULTS: The rates of cure and improvements at one year after TVT were 80.8% and 12.3%, respectively. At one month after TVT, 59 of 180(33%) patients with urgency before TVT were improved, and 60 of 72(83.6%) patients with urgency incontinence before TVT were improved. In 86 of 180(47.8%) patients, the urgency is improved, and in 65 of 72(90.1%) patients, the urgency incontinence disappeared at one year after TVT procedure. Urgency developed in 65 of the 243(26.9%) patients who had no urgency before TVT, but after 1 year, only 28(10.2%, 25/243) these 243 patients had urgency. 102(31.6%) of the patients with frequency before TVT were improved after TVT. Of the 92 patients with nocturia, 22 (23.4%) patients were improved. There were no statically significant factors predicting the changes of the storage symptoms. CONCLUSIONS: The total improvement rate (cure+improvements) of stress urinary incontinence was 93.1% at one year. We can expect the improvement of urgency(47.1%) and urgency incontinence(90.1%) after TVT procedures, but not improvement of the frequency and nocturia.
Follow-Up Studies ; Humans ; Nocturia ; Suburethral Slings* ; Urinary Bladder, Overactive ; Urinary Incontinence* ; Urinary Incontinence, Urge

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome which may be related to lethal condition. Although several modalities including medical therapy have been suggested, agreement on optimal treatment has not yet been determined. We describe a case of SCAD which was presented as ST-segment elevation myocardial infarction, and treated successfully with medical treatment. Coronary angiography, intravascular ultrasound and multi-detector computed tomography showed the serial changes of this disease entity.
Acute Coronary Syndrome ; Angiography ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Myocardial Infarction ; Tomography, Spiral Computed ; Ultrasonography, Interventional

PURPOSE: Single scrotal incision orchiopexy is emerging as an alternative to the traditional inguinal approach. The purpose of this study was to compare the operative time, success rates, and complications of single scrotal incision orchiopexy with the traditional inguinal approach. MATERIALS AND METHODS: We reviewed the charts of patients with palpable undescended testes treated with a single scrotal incision or inguinal orchiopexy from April 2004 to April 2008. The position of the testis was confirmed under general anesthesia before any incision. Retractile and ectopic testes were excluded. We compared preoperative and postoperative testicular position, operative time, prevalence of patent processus vaginalis, and complications between the two groups. RESULTS: There were 43 patients who had palpable undescended testes below the external inguinal ring. A total of 57 orchiopexies were performed in 43 patients by either the single scrotal approach (group 1; n=25, mean age 3.12+/-1.99 years) or the inguinal approach (group 2; n=32, mean age 2.56+/-1.92 years). The average operative times for groups 1 and 2 were 39.76+/-7.66 and 53.31+/-6.33 minutes, respectively (p<0.05). Only 1 patient required conversion to an inguinal incision because of inappropriate mobilization. The complication rates were similar between the two groups. Testicular atrophy, hernia, or hydrocele formation did not occur during the follow-up period (4-41 months). CONCLUSIONS: Single scrotal incision orchiopexy is an effective procedure in selected patients regardless of patency of the processus vaginalis. It has the advantages of a shorter operative time and a more cosmetically appealing result compared with the inguinal two-incision approach.
Anesthesia, General ; Atrophy ; Cryptorchidism ; Follow-Up Studies ; Hernia ; Humans ; Inguinal Canal ; Male ; Operative Time ; Orchiopexy ; Prevalence ; Testis

OBJECTIVES: Recently,tinea pedis has been reported to be a type of occupational dermatoses because of its high prevalence in specific working conditions.Although there is no doubt that the environment surrounding work places, the usual habits of workers etc are intimately related to this skin conditions, there is some controversy as to whether or not this condition is a real occupational illness and what is the exact cause of the high prevalence of this illness is. In this study, the prevalence of tinea pedis in workers from the shipbuilding industry was investigated andthe risk factors of this disease were evaluated. This study also aimed to verify whether or not tinea pedis is one of the occupational diseases. METHODS: The results of interviews, questionnaires and clinical findings from 1,419 workers who visited the occupational health center for an annual routine check for their health state were analyzed. RESULTS: Among the 1,419 workers, 778 workers (54.8%)had tinea pedis. By simple logistic regression analysis,the prevalence of tinea pedis was found to be affected by some variables, including the job category, the types of work,the kinds of footwear, whether or not they were using communal baths in the work places, and a family history of tinea pedis.In contrast, by multiple logistic regression analysis,only utilization of the communal baths in the work places and a family history of tinea pedis turned out to be statistically significant risk factors. CONCLUSIONS: In this study, the major factors contributing to the high prevalence of tinea pedis are the use of communal baths in the workplace and a positive family history. However, the wearing of safety shoes was not statistically significant. Therefore, tinea pedis could not be confirmed to be an occupational disease. On the basis of these results, a solution to the environmental hygiene of communal baths and the personal hygiene of individuals needs to be improved in order to prevent tinea pedis.
Baths ; Humans ; Hygiene ; Logistic Models ; Occupational Diseases ; Occupational Health ; Prevalence* ; Questionnaires ; Risk Factors* ; Shoes ; Skin ; Skin Diseases ; Tinea Pedis* ; Tinea* ; Workplace