Severe bradycardia has been associated with a number of medications used for induction of anesthesia. Fentanyl and other potent opioids are well known for their central vagotonic effect, particularly when given rapidly in high doses. Propofol administration has also been associated with bradycardia, and may even exert a central vagotonic or sympatholytic ef- fect, or both. The anesthetic induction with propofol fentanyl may be followed by severe bradycardia in patients who have not received atropine. The bradyeardia may be prevented by premedication with atropine. We report a case in which anesthesia was induced with fentanyl 3 ug/kg and propofol 2. 5mg/kg in 43 year old female patient undergoing oophorectomy. Twenty or thirty seconds after injection of propofol and fentanyl the reduction of blood pressure and severe bradycardia appeared along with premature ventricular contraction and Mobitz type I A-V block. Immediate therapy was initiated with injection of atropine 0.5mg and hyperventilation with 100% oxygen. After about one minute the vital sign of the patient returned to normal. We emphasize that anticholinergic and oxygen before induction with fentanyl propofol should be administered to prevent possible bradycardia and hypoxia.
Adult ; Analgesics, Opioid ; Anesthesia ; Anoxia ; Atropine ; Blood Pressure ; Bradycardia* ; Female ; Fentanyl ; Humans ; Hyperventilation ; Ovariectomy ; Oxygen ; Premedication ; Propofol ; Ventricular Premature Complexes ; Vital Signs

Tuberculosis and lymphoma, these 2 diseases can present with lyphadenopathy in anywhere of the body. Therefor differentiation of tuberculosis from lymphoma is often difficult. CT scans of 17 patients with tuberculosis and 23 patients with lymphoma were retrospectively reviewed to evaluate the efficacy of CT scans in differentating adenopathy between tuberculosis and lymphoma, All the patients underwent abdominal CT scans with contrast enhancement before treatment. The size, internal architecture, distribution of lymph nodes, and associated findings on CT scans were analyzed. As compared with lymphoma, tuberculous lymphadenopathy showed 1) female preponderance (65%), 2) predilection for portocaval lymph nodes (47%), 3) internal low attenuation in lymph nodes (82%), 4) cold abscess formation (24%). Characteristics of lymphoma on CT scans included 1) male prepondrance (78%), 2) conglomeration of lymph nodes (39%), 3) homogenous internal lymph node structure (83%). These results suggest that evaluation of the characteristics of lymphadenopathy on CT scans is helpful for differentiating between tuberculosis and lymphoma.
Abscess ; Female ; Humans ; Lymph Nodes ; Lymphatic Diseases* ; Lymphoma ; Male ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis*

Tuberculosis and lymphoma, these 2 diseases can present with lyphadenopathy in anywhere of the body. Therefor differentiation of tuberculosis from lymphoma is often difficult. CT scans of 17 patients with tuberculosis and 23 patients with lymphoma were retrospectively reviewed to evaluate the efficacy of CT scans in differentating adenopathy between tuberculosis and lymphoma, All the patients underwent abdominal CT scans with contrast enhancement before treatment. The size, internal architecture, distribution of lymph nodes, and associated findings on CT scans were analyzed. As compared with lymphoma, tuberculous lymphadenopathy showed 1) female preponderance (65%), 2) predilection for portocaval lymph nodes (47%), 3) internal low attenuation in lymph nodes (82%), 4) cold abscess formation (24%). Characteristics of lymphoma on CT scans included 1) male prepondrance (78%), 2) conglomeration of lymph nodes (39%), 3) homogenous internal lymph node structure (83%). These results suggest that evaluation of the characteristics of lymphadenopathy on CT scans is helpful for differentiating between tuberculosis and lymphoma.
Abscess ; Female ; Humans ; Lymph Nodes ; Lymphatic Diseases* ; Lymphoma ; Male ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis*

BACKGROUND: There has been a general feeling among surgeons that recurrence or metastasis following a curative gastric resection is a hopeless surgical proposition. This study was conducted to evaluate the clinical features and significance of relaparotomy following a gastrectomy for gastric cancer. METHODS: Fifty-six cases of relaparotomies following resection for 53 gastric cancer patients, which were performed over a nine-year period, were investigated retrospectively. On preoperative diagnosis, there were 17 cases of remnant and anastomotic recurrence, 15 cases of intestinal obstruction, 7 cases of cholecystitis, 7 cases of rectosigmoid obstruction, 5 cases of E-loop obstruction and 5 cases of other diseases. RESULTS: Of all the laparotomies eleven cases (19%) were non-recurrence, benign diseases and forty-six (81%) were recurrence. In the 17 cases of remnant and anastomotic recurrence, re-resection was possible in 13 (76%) and major postoperative complications developed in 4 cases with 2 cases of death within one month. Also 6 of 7 re-resected cases which was stage I at first operation were still alive well. In 15 cases of mechanical obstruction, 5 cases were non-recurrence and 10 cases involved recurrence, of which 6 had a bypass or enterostomy and 4 an exploration only. All cholecystitis cases had a cholecystectomy; metastasis was found in 2 cases. Rectal obstruction and E-loop obstruction all involved recurrence and a palliative resection was possible in only one case of each type of obstruction. CONCLUSIONS: In a relaparotomy of remnant and anastomotic recurrence, most of the survival-improving re-resection cases were in stage I at the first operation. In late-onset cholecystitis tumor recurrence should be suspected and a relaparotomy of the malignant obstruction, with bypass and ostomy procedure, can be justified for symptomatic relief.
Cholecystectomy ; Cholecystitis ; Diagnosis ; Enterostomy ; Gastrectomy ; Humans ; Intestinal Obstruction ; Laparotomy ; Neoplasm Metastasis ; Ostomy ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Stomach Neoplasms*

The cardiovaseular response evoked by tracheal intubation was observed in 69 patients undergoing elective surgery in whom anesthesia was induced with group A, B and C induction agents. Sixty nine ASA class 1 or 2 surgical patients were divided into three groups. Group A: thiopental 5 mg/kg (control) Group B: thiopental 2 mg/kg with midazolam 0.1 mg/kg Group C: midazolam 0.2 mg/kg Systolic and diastolic blood pressure, mean arterial pressure, heart rate and loss of eyelid reflex were measured in each group. There was a little difference in the cardiovascular changes between group A and C. But there was not a significant difference between group A and B and also between group B and C. The measured time until loss of eyelid reflex of the group C (55+/-30 sec) was considerably longer than other groups (Group A: 10+/-3 sec, Group B: 37+/-13 sec). The incidence of venous complication in three groups was low. Pain on injection and posto- perative nausea and vomiting was noted in one patient of the group A and B respectively, but no patient in the group C. There was no significant difference in the incidence of the postoperative local venous complication. On the whole, these results suggest that the difference between midazolam and thiopental had no apparent hemodynamic change. From the above results, both midazolam alone and midazolam combined with thiopental may be useful agents for induction of anesthesia.
Anesthesia* ; Arterial Pressure ; Blood Pressure ; Eyelids ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Intubation ; Midazolam* ; Nausea ; Reflex ; Thiopental ; Vomiting

While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems. These reactions most often occur after initiation of therapy, but can also develop before treatment. We report a case of leprosy type 1 reaction as the first manifestation of borderline tuberculoid leposy. The patient was a 71-year-old woman who had never received treatment for leprosy. She developed multiple erythematous, swollen lesions on has face, extremities and trunk within a few weeks and suffered from paresthesia, numbness and tenderness on those sites. General symptoms were accompanied by fever, malaise, fatigue and loss of appetite. Histological examination revealed multiple tuberculoid granulomas along with neurovascular bundles. A few acid-fast bacilli were detected on AFB stain. The disease was classified as borderline tuberculoid leprosy. The acute neuritis followed by skin lesions represented leprosy with type 1 reaction.
Aged ; Appetite ; Chronic Disease ; Extremities ; Fatigue ; Female ; Fever ; Granuloma ; Humans ; Hypesthesia ; Leprosy* ; Leprosy, Paucibacillary* ; Neuritis ; Paresthesia ; Skin

Intracranial epidermoid cysts usually show homogeneous hypodensity on CT scans, hypointensity on T1-weighted MR images and hyperintensity on T2-weighted MR images. Most of them arise in the cerebellopontine angle and parasellar areas. We report a case of middle cranial fossa epidermoid tumor with unusual image findings. The entire tumor mass showed inhomogeneous low density, without any enhancing solid portion on the CT scans. The lateral portion of the tumor showed homogeneous T1 low signal intensity and T2 high signal intensity. The medial portion of the tumor showed heterogeneous T1 and T2 intermediate to high signal intensity. On the gadolinium enhanced MR images, enhancement of the thickened dura was observed behind the tumor. Surgery and pathologic examination revealed the presence of an extradural epidermoid cyst.
Cerebellopontine Angle ; Cranial Fossa, Middle* ; Epidermal Cyst* ; Gadolinium ; Tomography, X-Ray Computed

PURPOSE: To assess the efficacy and toxicity of the preoperative radiotherapy with or without chemotherapy in locally advanced rectal cancer. METHODS: Forty three Patients (clinically diagnosed stages above or equal to Astler-Coller stage B2 without distant metastasis) were assigned to preoperative radiotherapy alone arm (n=16) or combined preoperative radiotherapy and chemotherapy arm (n=27). Preoperative radiotherapy of 4500 cGy to whole pelvis +/- 540 cGy boost to primary site and concurrent chemotherapy of 2 cycles of 5-FU (500 mg/m2) and leucovorin (20 mg/m2) were used. Fifteen patients of preoperative radiotherapy alone arm and 19 of combined arm received surgical resection after preoperative treatment. RESULTS: During the preoperative treatment, no significant complication was developed in both groups. Pathologic results were as follows; complete remission 1, B1 1, B2 6, C1 2, C2 5 in preoperative radiotherapy alone arm and complete remission 2, B1 8, B2 4, C2 3 D2 in combined arm. Postoperative complications were delayed perineal would healing in three patients, intestinal obstruction in three patients (one managed by conservative medical treatment, two by surgical treatment). CONCLUSION: The combined preoperative radiotherapy and chemotherapy arm was more effective in pathological response and lymph node negativity rate that the preoperative radiotherapy alone arm. Both the preoperative radiotherapy alone arm and the combined arm were generally well tolerated and did not result in an increased postoperative morbidity.
Arm ; Drug Therapy* ; Fluorouracil ; Humans ; Intestinal Obstruction ; Leucovorin ; Lymph Nodes ; Pelvis ; Postoperative Complications ; Radiotherapy* ; Rectal Neoplasms*

Diabetic muscle infarction (DMI) is a rare complication of long-standing diabetes mellitus. The typical feature of DMI is abrupt onset of thigh pain, tenderness, and swelling and then spontaneous resolution over several months and frequent recurrence. Until 2004, a case of DMI has been reported among end-stage renal disease patients on dialysis in korea. Under-recognition or misdiagnosis (cellulitis, myositis, abscess, hemorrhage, and tumor) by physicians may contribute to the relative rarity of the diagnosis. We report a case of recurrent diabetic muscle infarction in a hemodialysis patient.
Abscess ; Diabetes Mellitus ; Diagnosis ; Diagnostic Errors ; Dialysis ; Hemorrhage ; Humans ; Infarction* ; Kidney Failure, Chronic ; Korea ; Myositis ; Recurrence ; Renal Dialysis* ; Thigh

We report a case of coronary fistula between the left anterior descending and main pulmonary artery complicating acute non-Q wave myocardial infarction. A 27-year-old man visited emergency department because of severe chest pain lasting two hours. The electrocardiogram showed ST segment elevation in precordial leads V3~6. Cardiac enzymes were as follows;CK-MB:36.44 IU/L T-T:0.489 ng/mL, CPK:542 IU/L, and LDH:475 IU/L. The thallium-201 dipyridamole stress perfusion scan showed perfusion defect and reversed redistribution in the anteroseptal wall. The coronary angiogram revealed coronary artery fistula between the proximal left anterior descending artery and main pulmonary artery without significant stenoses of coronary arteries. The result of ergonovine test was negative. After micro-coil embolization to the coronary fistula, symptoms were improved. Follow-up thallium-201 scan showed normalized blood flow in the left anteroseptal wall.
Adult* ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Dipyridamole ; Electrocardiography ; Emergency Service, Hospital ; Ergonovine ; Fistula* ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Perfusion ; Pulmonary Artery*