BACKGROUND: Combined spinal epidural anesthesia (CSE) is used for obtaining adventages of both spinal and epidural anesthesia. But it might be suspected that epidural volume load affect spinal sensory blockade level during CSE. METHODS: Eighty patients undergoing lower abdominal and lower extremity operation were involved in our study. Subarachnoid block with 12mg of tetracaine was established in all patients. Four groups were studied. Group 1 (n=20), the control, received only spinal anesthesia. Group 2 (n=20), group 3 (n=20) and group 4 (n=20) received 10, 15 and 20 ml of epidural saline immediately after spinal anesthetic administration. Sensory blockade level was checked by pinprick test at 5, 10, 15, 20, 25, 30, 40, 60 and 90 minutes. Blood pressure, heart rate and incidence of complications such as hypotension, bradycardia, nausea and high block were measured. RESULTS: The sensory blockade level of groups 3 and 4 was higher than group 1 (p<0.05). Blood pressure and heart rate were not different compared with each other. The incidence of complications, except that higher block above T4 in group 4 was more than in group 1 (p<0.05), were not different when compared with each other. CONCLUSIONS: Epidural saline above 15 ml may affect sensory blockade level of spinal anesthesia during CSE.
Anesthesia, Epidural* ; Anesthesia, Spinal ; Blood Pressure ; Bradycardia ; Heart Rate ; Humans ; Hypotension ; Incidence ; Lower Extremity ; Nausea ; Tetracaine

Retroperitoneal tumors are relatively rare, accounting for 0.2% of all cancers; many different histologic types are present, and primitive retroperitoneal germ cell tumors constitute a small miniority of about 3%. Most primary extragonadal germ cell tumors (EGCTs) arise from the mediastinum of retroperitoneum in young males. The authors experienced a case of primary extragonadal mixed germ cell tumor with a 43-year-old woman complaining left lower abdominal pain. With the case report, a brief review was made.
Abdominal Pain ; Adult ; Female ; Germ Cells* ; Humans ; Male ; Mediastinum ; Neoplasms, Germ Cell and Embryonal*

No abstract available.
Melanoma ; Nevus

Amniotic fluid embolism (AFE) is a rare but devasting obstetric emergency. We experienced a case of AFE during dilatation and curettage (D & C) in a 15 2/7 weeks pregnant woman, age 30, who was diagnosed as having a missed abortion. Sudden rapid hypoxemia, low SpO2, hypotension, low PETCO2, high CVP, and tachycardia, right axis deviation and right bundle branch block in 12 leads ECG were developed during D &C under general anesthesia, and signs of disseminated intravascular coagulation (DIC) followed after the operation, which are consistent with the findings of AFE. Even though there was no definite pathologic and radiologic confirmation of AFE, laboratory findings showed 100 times higher level of alpha-fetoprotein in her central venous blood than same weeks of missed abortion woman's blood. Though it is rare, the anesthesiologist should always suspect the possibility of AFE, when the patient shows an unexplained collapse, cyanosis, low PETCO2, high CVP, low SpO2, ECG change and DIC during any kind of obstetric procedure.
Abortion, Missed ; alpha-Fetoproteins ; Amniotic Fluid* ; Anesthesia, General ; Anoxia ; Axis, Cervical Vertebra ; Bundle-Branch Block ; Cyanosis ; Dacarbazine ; Dilatation and Curettage* ; Dilatation* ; Disseminated Intravascular Coagulation ; Electrocardiography ; Embolism, Amniotic Fluid* ; Emergencies ; Female ; Humans ; Hypotension ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnant Women ; Tachycardia

Subcutaneous emphysema is one of the rare complication of tracheal intubation and it's mechanism has been known as airleakage to subcutaneous tissue from the perforated site of larynx, trachea and esophagus by the trauma of laryngoscopic blade, stylet and endotracheal tube. We experienced a case of subcutaneous emphysema during unexpected difficult endotracheal intubation. At the initial laparoscopic examination, the patient's laryngeal view was grade IV of Cormack and Lehane's calssification. After several trial of the intubation, cervical subcutaneous emphysema developed by the trauma of laryngoscopic blade, stylet and endotracheal tube, even though failed to confirm the perforated site at postanesthesia one day.
Esophagus ; Intubation ; Intubation, Intratracheal* ; Larynx ; Subcutaneous Emphysema* ; Subcutaneous Tissue ; Trachea

Accidental subdural block is one of the rare complications of epidural anesthesia and can lead to a life threatening condition. A healthy 40 year old woman underwent cesarean section under the diagnosis of placenta previa. Single epidural puncture was performed at L3-4 interspace without difficulty. A test dose of 3ml of 1.5% lidocaine was injected without adverse effects. However, hypotension(80/40) and loss of pain sensation up to the level of C4 were devloped in 5 min. after injection of 25 ml of 1.5% lidocaine with 50ug fentanyl and 2.5ml of 8.4% sodium bicarbonate. She complained of dyspnea without change of SpO2 and difficulty of phonation about 15min. after injetion. And then, She was lethargic, but was able to open eyes with verbal communication. She was fully recovered in 180 minutes after epidural injection. Such extensive block might be caused by subdural administration of the drugs even if it was not confirmed radiologically.
Adult ; Anesthesia, Epidural* ; Cesarean Section* ; Diagnosis ; Dyspnea ; Female ; Fentanyl ; Humans ; Injections, Epidural ; Lidocaine ; Phonation ; Placenta Previa ; Pregnancy ; Punctures ; Sensation ; Sodium Bicarbonate

Spasticity is common stroke in patients, and its management has been considered as one of the major problems in stroke rehabilitation. The goal of this study was to determine if transcutaneous electrical nerve stimulation(TENS) and acupuncture would reduce the muscle spasticity. To estimate the efficacy of electrical stimulation for the treatment of spasticity TENS(100 Hz, asymmetric bipolar pulse current) was applied to the skin over the extensor muscles of spastic limbs for 20 minutes, once a day in six stroke patients. In addition, acupuncture was also applied to the acupoints of extensor muscles of all extremities and face for 20 minutes twice a day to determine the efficacy of acupuncture for the treatment of spasticity in six stroke patients. As controls subjects, six stroke patients were examined without TENS or acupuncture treatment. In experimental groups, the efficacy of treatment was measured 1, 5, 10, 15 days and 20 days after treatment with either TENS or acupuncture using the spasticity measurement methods (modified Ashworth scale, ankle clonus score, and H/M ratio). Based on the results from the present study, we have concluded that the H/M ratios of affected spastic limbs were significantly higher than those of unaffected limbs (p<0.05). TENS and acupuncture therapies lessened the spasticity of affected limbs of stroke patients when measured with the modified Ashworth scale however not with the H/M ratios nor with the ankle clonus scores.
Acupuncture Points ; Acupuncture* ; Ankle ; Electric Stimulation ; Extremities ; Humans ; Muscle Spasticity ; Muscles ; Rehabilitation ; Skin ; Stroke* ; Transcutaneous Electric Nerve Stimulation*

Mitochondrial dysfunction in dopaminergic neurons of patients with idiopathic and familial Parkinson's disease (PD) is well known although the underlying mechanism is not clear. We established a homogeneous population of human adipose tissue-derived mesenchymal stromal cells (hAD-MSCs) from human adult patients with early-onset hereditary familial Parkin-defect PD as well as late-onset idiopathic PD by immortalizing cells with the hTERT gene to better understand the underlying mechanism of PD. The hAD-MSCs from patients with idiopathic PD were designated as "PD", from patients with Parkin-defect PD as "Parkin" and from patients with pituitary adenomas as "non-PD" in short. The pGRN145 plasmid containing hTERT was introduced to establish telomerase immortalized cells. The established hTERT-immortalized cell lines showed chromosomal aneuploidy sustained stably over two-years. The morphological study of mitochondria in the primary and immortalized hAD-MSCs showed that the mitochondria of the non-PD were normal; however, those of the PD and Parkin were gradually damaged. A striking decrease in mitochondrial complex I, II, and IV activities was observed in the hTERT-immortalized cells from the patients with idiopathic and Parkin-defect PD. Comparative Western blot analyses were performed to investigate the expressions of PD specific marker proteins in the hTERT-immortalized cell lines. This study suggests that the hTERT-immortalized hAD-MSC cell lines established from patients with idiopathic and familial Parkin-defect PD could be good cellular models to evaluate mitochondrial dysfunction to better understand the pathogenesis of PD and to develop early diagnostic markers and effective therapy targets for the treatment of PD.
Adult ; Aneuploidy ; Blotting, Western ; Cell Line ; Diagnosis ; Dopaminergic Neurons ; Humans* ; Mesenchymal Stromal Cells* ; Mitochondria ; Parkinson Disease* ; Pituitary Neoplasms ; Plasmids ; Strikes, Employee ; Telomerase

Several studies have indicated that the addition of sodium bicarbonate and opioid to soiutions of locl anesthetics shortens the onset time,increases the intensity and prolongs the duration of neural blockade. This study was performed to compare onset times and duration of neural blockade in each groups. Eighty-two parturients scheduled for cesarean section at term under epidural anesthesia were assigned to three groups. Group 1 (n=19) received 1.5% lidocaine hydrochloride (pH 6.32+/-0.01), group 2 (n=26) received 1.5% lidocaine hydrochloride plus fentanyl 50 mcg (pH 6.27+/-0.02) and group 3 (n=37) received l.5% lidocaine hydrochloride plus fentanyl 50 mcg plus 8.4% sodium bicarbonate (sodium bicarbonate l mEq/lidocaine 10 ml)(pH 7.32+/-0.03). All groups were given 22-28 ml of local anesthetic solutions according to their height. Onsei times and duration of sensory blockade were evaluated using pin prick test at two minutes interval after epidural injection at L2, 76, T4 dermatomes. Onset timcs (time between the completion of anesthetic injection and loss of pin prick sensation at each dermatome) of sensory blockade at L2 dermatome were 3.1+/-0.2 minutes in Group 3, which were shorter than 5.0+/-0.3 minutes in Group l and 4.7+/-0.4 minutes in Group 2 (p<0.05). At T6 dermatome, onset times of sensory blockade were 6.9+/-0.6 minutes in Group 3, which were shorter than 15.4+/-1.2 minutes in Group l and 12.9+/-1.0 in Group 2 (p<0.05). At T4 dermatome, onset times of sensory blockade were 10.l+/-0.2 minutes in Group 3, which were shorter than 22.3+/-1.2 minutes in Group 1 and 18.8+/-1.1 in Group 2 (p<0.05). The duration (time between loss of pin prick sensation and complete recovery of pain at each dermatome) of sensory blockade at T4 dermatome in Group 3 were 74.0+/-3.8 min, which were longer than 52.9+/-2.4 minutes in Group 1 and 52.7+/-1.4 minutes in Group 2 (p<0.05). The duration of sensory blockade at L2 dermatome in Group 3 were 119.6+/-4.4 minutes,which were longer than 78.6+/-4.8 minutes in Group 1 and 81.6+/-2.5 minutes in Group 2 (p<0.05). The above results suggested that alkalinization of lidocaine solution is an effective way to shorten the latency and to prolong the duration of epidural block for cesarean section.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local* ; Cesarean Section* ; Female ; Fentanyl ; Injections, Epidural ; Lidocaine ; Pregnancy ; Sensation ; Sodium Bicarbonate

BACKGROUND: Onychomycosis is one of the most common diseases of the nails accounting for up to 50% of all nail problems. There are many literatures on the cure rate and duration for complete cure according to the various factors. However, little information is available regarding duration required for negative conversion of KOH mount. OBJECTIVE: The purpose of this study was to evaluate the duration required for negative conversion of KOH mount in patients with toenail onychomycosis according to the clinical factors and treatment regimens. METHODS: Medical records of 325 patients with onychomycosis between May 2001 and February 2012 were reviewed retrospectively to obtain the following information: age, sex, presence of diabetes mellitus (DM), extent of nail involvement, therapeutic methods, and result of KOH mount at each timepoint. RESULTS: Extent of nail involvement, old age (> or =60) and DM were negatively associated with the duration required for conversion of KOH mount. Extent of nail involvement also negatively affected the rate of conversion of KOH mount at week 48. Positive KOH mount at week 28 was negatively associated with complete cure. CONCLUSIONS: Extent of nail involvement, old age, and DM can prolong the duration required for negative conversion of KOH mount. Also, positive KOH mount at week 28 had negative effect on the cure of onychomycosis.
Accounting ; Diabetes Mellitus ; Humans ; Medical Records ; Nails ; Onychomycosis ; Retrospective Studies