Quadriplegia is a serious or complete loss of motor function of all four limbs that is commonly caused by spinal cord injuries secondary to damage to the cervical spine. In this situation, there is a higher risk of pneumonia due to paralysis of the respiratory muscles. Tracheostomy is preferred over endotracheal intubation for the effective elimination of sticky bronchial secretion. The safest technique for a tracheostomy is to carry it out under general anesthesia with endotracheal intubation. However, endotracheal intubation may be difficult and cause other complications in patients with laryngotracheal stenosis caused by repeated tracheostomy and a limitation of neck movement as a result of the fixation of the cervical vertebral bodies due to the cervical spine fracture. We report a case of a tracheostomy performed sucessfully under intravenous anesthesia using a laryngeal mask airway without muscle relaxants in a patient with quadriplegia caused by a cervical spine injury.
Anesthesia, General ; Anesthesia, Intravenous ; Constriction, Pathologic ; Extremities ; Humans ; Intubation, Intratracheal ; Laryngeal Masks ; Muscles ; Neck ; Paralysis ; Pneumonia ; Quadriplegia ; Respiratory Muscles ; Spinal Cord Injuries ; Spine ; Tracheostomy

OBJECTIVE: The objective of this study was to analyze the clinical course of mild head injury patients and to investigate the risk and prognostic factors of delayed deterioration. METHODS: We retrospectively studied 366 consecutive patients with Glasgow Coma Scale scores ranging from 13 to 15 who were admitted to the neurosugery department from January 1995 to December 1997. RESULTS: Among 51(13.9%) patients with delayed deterioration, 13(25.5%) died and 36(70.6%) patients had favorable outcomes. Statistically correlated risk factors of delayed deterioration were: old age, drowsiness or speech disturbance, a low GCS score, abnormal laboratory findings including coagulopathy, electrolyte imbalance, hyperglycemia, and presence of subdural hematoma in initial brain CT. Twentyeight(54.9%) patients with delayed deterioration underwent neurosurgical intervention and 229(72.1%) patients without delayed deterioration were treated conservatively. Only sex, age and the GCS score on admission or deterioration were statistically correlated with prognosis of delayed deteriorated patients. CONCLUSION: Delayed deterioration following mild head injury may need an urgent operation, or lead to serious complication or disability. Therefore, physicians treating these patients must aware of the risk factors and prognostic factors of delayed deterioration to prevent more serious sequelae or to make an early diagnosis allowing for proper treatment. We also recommend special caution in patients with the abovementioned risk factors to ensure a even better prognosis for patients with mild head injury.
Brain ; Craniocerebral Trauma* ; Early Diagnosis ; Glasgow Coma Scale ; Head* ; Hematoma, Subdural ; Humans ; Hyperglycemia ; Prognosis ; Retrospective Studies ; Risk Factors* ; Sleep Stages

Rerupture of intracranial aneurysms during cerebral angiography is a rare complication and it usually occurs with in 24 hours after initial bleeding. We experienced three cases of aneurysmal rerupture during cerebral angiography, and in each case, angiography was performed after 24 hours from the initial attack. We have noticed extravasation of contrast medium to subarachnoid space or intraventricular space during angiography. In result, two patients died and one patient was disabled moderately.
Aneurysm ; Angiography* ; Cerebral Angiography ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Subarachnoid Space

Purpose: The purpose of this case was to report the inhibition of toxoplasma retinitis reactivation with long-term, low-dose antibiotics.Case summary: A 76-year-old woman complained of poor vision and floaters in her right eye. The corrected visual acuity (LogMAR) of the right eye was 0.5, and there was an area of yellow infiltration and dye leakage on the retinal fluorescein angiography images. Toxoplasma IgG were detected in the serum, the patient was diagnosed with toxoplasma retinitis, and the patient was advised oral trimethoprim-sulfamethoxazole, clindamycin, and steroids. Her visual acuity improved and the inflammation resolved. However, she again had decreased visual activity and retinal inflammation in her right eye after 5 months. The inflammation improved with oral steroids, but she was shifted to intravitreal dexamethasone because of the side effects of systemic steroids. Although the inflammation improved initially, there was worsening of inflammation (evidenced by vitreous opacity) after 2 months, which was treated with oral antibiotics. After vitrectomy for the removal of residual vitreous opacity, antibiotics were stopped because of the stable disease course. After discontinuation of the antibiotics, inflammation was noted again, and low-dose trimethoprim-sulfamethoxazole was administered. Low-dose antibiotics were continued for 5 months and the disease remained stable without any retinal inflammation. Conclusions Long-term, low-dose oral antibiotics may prevent reactivation of recurrent toxoplasma retinitis.

The incidence of cardiac arrhythmias during anesthesia in a total 5,845 surgical patients who were admitted to Hanyang university hospital from Janury 1 to December 31, 1988 was investigated using on-line continuous EKG monitoring. The results were as follows: 1) Among study patients, 111 patients (1.9%) had pre-existing cardiac arrhythmias before anesthesia and showed significantly higher incidence of arrhythmias (49.5%) than that of patients without pre-existisng arrhythmias before anesthesia (2.9%). 2) Among arrhythmias found during anesthesia, most types of arrhythmias were ventricular premature contractions (77.4% in the patients with pre-existing cardiac arrhythmias and 43.6% in the patients without pre-existing cardiac arrhythmias) except sinus bradycardia and tachycardia. 3) Although the incidence of arrhythmias during the induction of anesthesia was similar to that during anesthesia maintenance, it was somewhat greater on the basis of incidence per unit time. 4) The incidence of arrhythmias was increased with age. 5) The incidence of arrhythmias when anesthesia was induced with halothane (3.7%) was greater than that when anesthesia was induced with enflurane (2.1%). 6) Most of the arrhythmias were controlled with sufficient ventilation and oxygen supply, adjusting concentration of inhaled anesthetics or changing anesthetics, and occasionally, intravenous admininstration of 1% lidocaine (1.0-1.5 mg/kg). Considering the above results, it may be an appropriate conclusion that the continuous on-line EKG monitoring during the induction and maintenance of anesthesia is a noninvasive and simple method for detecting early signs of cardiac arrhythmias and hemodynamic changes during anesthesia, and consequently, improving the overall efficiency of patient care. Therefore, we are impressed with an idea that the continuous EKG monitoring should be mandatory for all surgical patients to be anesthetized.
Anesthesia* ; Anesthetics ; Arrhythmias, Cardiac* ; Bradycardia ; Electrocardiography ; Enflurane ; Halothane ; Hemodynamics ; Humans ; Incidence* ; Lidocaine ; Oxygen ; Patient Care ; Tachycardia ; Ventilation

After the hemodynamic comparison of venous air volume in 32 rabbits, the following conclusions were derived. 1) The precordial doppler ultrasonography was most sensitive and end titdal CO2 pressure was statistically decreased at 0.1 ml/kg of air. 2) The mean arterial pressure was suddenly decreased at 1 minute after injection of more than 0.25 ml/kg of air, and was furether reduced according to the time. 3) The arterial PCO2 was continuously increased and statistically different from 0.25 ml/kg of air, and the arterial PO2 was suddenly decreased to about 1/3 of the control data. 4) The pulse rate was statistically decreased at more than 0.5 ml/kg of air and shown peaked p wave, arrhythmias, ST depression and premature ventricular contraction on the EKG. There 4 dead rabbits at 1.0 ml/kg of air, so we could conclucle that the fatal dose of rabbits was more decreased than that of the dogs in venous air embolism.
Animals ; Arrhythmias, Cardiac ; Arterial Pressure ; Depression ; Dogs ; Electrocardiography* ; Embolism, Air* ; Heart Rate ; Hemodynamics ; Rabbits* ; Ultrasonography, Doppler ; Ventricular Premature Complexes

Now that open-heart surgery in children has become commonplace, one of the most spectacular operations in the pediatric population is the separation of conjoined twins. Anesthesia for the separation of conjoined twins requires a multidisciplinary team approach. We describe the anesthetic management of a single-stage separation of 2-month-old thoraco- xiphopagus tetrapus conjoined twins as a first case in Korea. The successful 3.25-hour operation was conducted by 6 anesthetists, 6 surgeons and 7 nurses. No any problems were encountered in the perioperative period.
Anesthesia* ; Child ; Humans ; Infant ; Korea ; Perioperative Period ; Twins, Conjoined*

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the correlation between clinical results and sagittal vertical axis, clinical results and total lumbar lordosis in degenerative lumbar scoliosis with spinal stenosis. SUMMARY OF LITERATURE REVIEW: There has been no report about the relation between sagittal spinal alignment and surgical outcome of degenerative lumbar scoliosis. MATERIALS AND METHODS: We reviewed 38 surgical cases of degenerative lumbar scoliosis from February 1997 to February 2001 with an average follow-up of 35 months. In whole spine standing AP and lateral radiographs, scoliotic angle(Cobb method), total lumbar lordosis(L1-S1) and the sagittal vertical axis(C7 plumb line) were measured. In lumbar flexion-extension and standing side bending views, the lateral translation was measured and instability was determined. Clinical results were evaluated based on the Kirkaldy-Willis criteria. RESULTS: The scoliotic angles at preoperative, postoperative and follow-up were 15.0+/-4.9, 5.3+/-3.1 and 7.1+/-3.7 degrees retro-spectively. Total lumbar lordosis were 28.7+/-6.1, 40.6+/-7.3 and 35.1+/-10.2 degrees retrospectively. Sagittal vertical axis at preoperative and the last follow-up were 3.3+/-3.2 and 0.1 +/-3.3 cm retrospectively. According to Kirkaldy-Willis criteria, 6 cases were excellent, 24 cases good, 7 cases fair and 1 case poor. There was no statistical correlation between total lumbar lordosis and the clinical results (r=-0.061, p=0.717). Sagittal vertical axis was significantly correlated with the clinical results (r=0.519, p=0.001). CONCLUSIONS: For improvement of surgical outcome of degenerative lumbar scoliosis, the sagittal vertical axis should be used as a parameter of sagittal alignment rather than the total lumbar lordosis.
Animals ; Axis, Cervical Vertebra ; Follow-Up Studies ; Lordosis ; Retrospective Studies ; Scoliosis* ; Spinal Stenosis* ; Spine

A 21-year-old woman with a 4 cm enhancing cystic renal mass in the left moiety of a horseshoe kidney was treated through a retroperitoneal laparoscopic approach. The tumor was excised completely with cold scissors, and renal parenchyma suturing with a surgical bolster was done with Vicryl 2-0 sutures. Choosing the proper approach according to the location of the lesion and the surgeon's experience with both approaches are of importance in laparoscopic surgery in horseshoe kidney cases. A preoperative kidney computed tomography angiography was helpful for understanding the complex renal vasculature.
Angiography ; Cold Temperature ; Female ; Humans ; Kidney ; Laparoscopy ; Nephrectomy ; Polyglactin 910 ; Sutures ; Young Adult

We report here on the multiple genital tract neoplasms in a 41-yr-old Korean woman with Peutz-Jeghers Syndrome (PJS). The patient presented with lower abdominal pain. Her previous medical history was PJS and breast cancer. Pelvic ultrasound showed a multilocular cyst at the right adnexal region, diagnosed as bilateral ovarian mucinous borderline tumors. An ovarian sex cord tumor with annular tubules was incidentally diagnosed together with a minimal deviation adenocarcinoma of the uterine cervix and mucinous metaplasia of both the Fallopian tubal mucosa and the endometrium. Although the cases of multiple genital tract tumors with PJS has rarely been reported, the present case appears to be the first in Korea in which the PJS syndrome was complicated by multiple genital tract tumors and infiltrating carcinoma of the breast. The clinical significance of the multiple genital tract tumors and breast cancer associated with PJS is reviewed.
Uterine Cervical Neoplasms/complications/*pathology ; Sex Cord-Gonadal Stromal Tumors/complications/pathology ; Peutz-Jeghers Syndrome/complications/*pathology ; Ovarian Neoplasms/complications/*pathology ; Metaplasia ; Korea ; Humans ; Female ; Fallopian Tubes/pathology ; Endometrium/pathology ; Carcinoma, Ductal, Breast/complications/pathology ; Breast Neoplasms/complications/*pathology ; Adult ; Adenocarcinoma/complications/pathology