We experienced a case of unilasteral vocal cord paralysis following cuffed endotracheal intubation for abdominal surgery. The patient had have no laryngotracheal symptoms prior to the operation and anesthesia was uneventful. He complained of hoarseness post-operatively but no visible evidence of trauma secondary to the intubation was mainfested on the indirect laryngoscopic examination, except left vocal cord paralysis. There were no obvious causes for the vocal cord paralysis and possible etiologic factors. Therefore, no specific treatment was done except for the bed rest, humidification and gurgling. Vocal cord function returned nearly normal after six months.

This is a case report of pneuothorax which is the most specific complication of the supraclavicular brachial plexus block. This 19 year old patient underwent supraclavicular brachial plexus block with arm in abduction for stump revision of left thumb due to stump pain. When a pneuothorax was noted on the chest X-ray film on 37 hours after the block, closed thoracotomy with water-sealed drainage was done immediately. The pneuothorax dissipated 58 hours post-thoracotomy, therefore, chest tube was removed.
Arm ; Brachial Plexus ; Chest Tubes ; Drainage ; Humans ; Pneumothorax* ; Thoracotomy ; Thorax ; Thumb ; X-Ray Film ; Young Adult

Herpes zoster is characterized by multiple grouped erythematous vesicular eruption on the skin with severe pain. Therefore diagnasis of herpes zoster is clinically easy but effective control of its severe pain is not clear yet. Recently, Behar suggested that morphine which was injected into the epidural space reached subarachnoid space and produced potent analgesic effect by direct action on the specific opiate receptors in the substantia gelatinosa of the posterior horn cell of the spinal cord. On the basis suggestion, we have attempted to treat the severe pain of herpes zoster which was developed on right shoulder, right upper anterior and posterior chest, and posterior auricular area. At the initial block, we inserted the catheter into the 6th cervical intervertebral space and the tip of the catheter was placed in epidural space to 3cm cephalad. Then 3mg of morphine mixed with 10ml of normal saline was adminietered and also right stellate ganglion block with 0. 25% bupivacaine 7ml was combined, therefore effective pain relief was obtained for 11 hours. At second block, additional dose of 2mg of morphine mixed with 10ml of normal saline was administered through the inserted epidural catheter at the initial block without stellate ganglion block, and effective pain relief was obtained for 15 hours. After then, whenever the pain was developed, additional dose of 2mg of morphine was administered as the same procedure of the second block, and the duration of pain relief was extended gradually by the each procedure (for 24 hours after third block and for 49 hours after fourth block). At 5 days after initial block, severe pain was completely subsided. Side effects such as postural hypotension, motor weakness and dizziness was not developed except slightly motor weakness after initial block. This result showed that small dose of morphine injection into the epidural space is effective control of severe pain of herpes zoster.
Bupivacaine ; Catheters ; Dizziness ; Epidural Space ; Herpes Zoster* ; Hypotension, Orthostatic ; Morphine* ; Posterior Horn Cells ; Receptors, Opioid ; Shoulder ; Skin ; Spinal Cord ; Stellate Ganglion ; Subarachnoid Space ; Substantia Gelatinosa ; Thorax

No abstract available.
Neuroblastoma*

In an attempt to relieve postoperative pain after lumbar epidural anesthesia, a small dose of morphine with lidocaine was administered into the lumbar epidural space. It is suggested that the morphine reaehed the subarachnoidal space and produced its effect by direct action on the specific opiate receptors in the substantia gelatinosa of the posterior horn of the spinal cord. Epidural anesthesia was done in l25 cases from June 1979 through March 1980. These cases were divided into two groups (Control group and Morphine group). The Control group was 46 cases which were injected with 2% lidocaine, and the Morphine group was 79 cases which west injected with 2% lidocaine and morphine (3. 5~6. 5mg). 0.1% epinephrine 0.1mL was mixed to each 10ml of 2% lidocaine in all of both groups, The results of this study were as follows: 1) The cases complaining pain within 12 hours after epidural anesthesia were 36/46(78.2 %) in the Control group and 11/79(13.9%) in the Morphine group. 2) A variable single dose of morphine did not affect the duration of postoperative pain relief. 3) The time of recovery of spontaneous voiding was similar in Control and Morphine groups. Within 24 hours, spontaneous voiding was recovered in 34/46(73,9%) of the Control group and in 64/79(81.0%) of the Morphine group. 4) Blood pressure changed a little within 30 minutes after epidural anesthesia in both groups(56.5% in the Control group and 54.4% in the Morphine group). 5) Complications were similar in both groups except for nausea and vomiting, which occurred more in the Morphine group(8.9% & 7. 6) than in the control group (4.4% & none).
Anesthesia, Conduction* ; Anesthesia, Epidural ; Animals ; Blood Pressure ; Clinical Study* ; Epidural Space ; Epinephrine ; Horns ; Lidocaine ; Morphine* ; Nausea ; Pain, Postoperative* ; Receptors, Opioid ; Spinal Cord ; Substantia Gelatinosa ; Vomiting

From September 1979 through April 1980, we had carried out continuous lumbar epidural anesthesia(2% lidocaine, 20ml) with small dose of morphine and single dose caudal anesthesia(2% lidocaine, 15-20ml) for 16 cases of lumbar laminectomy,And also we observed the effects of postanesthetic pain relief by administered morphine(2mg) into lumbar epidural space, The results of this study were as follows: 1) Age distribution was from 20 to 60 years, sex distribution was 14 in man and 2 in woman, and physical status was in ASA class I in all cases. 2) The site of herniated intervertebral disc was L4~5 in 15 cases and L3~4 in one, The epidural puncture site was selected 2~3 vertebral segments cephalad from the lesion, 3) The morphine amount administered with lidocaine into lumbar epidural space was 2mg in all cases. 4) The duration of pain relief from the induction of anesthesia was average 17. 5 hours, and from the additional epidural injection of morphine(2mg) in ward was average 13.5 hours. 5) There was no neurological deficit or sequele except nausea in one case postoperatively. Therefore this anesthetic method was not only satisfactory for laminectomy but also safer and simpler in the fixation of spinal anesthetic level by patient's position change than spinal anesthesia, and faster in the postanesthetic ambulation than general anesthesia. Moreover, surgeon's acceptability.
Age Distribution ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, General ; Anesthesia, Spinal ; Epidural Space ; Female ; Humans ; Injections, Epidural ; Intervertebral Disc ; Laminectomy* ; Lidocaine ; Methods ; Morphine* ; Nausea ; Punctures ; Sex Distribution ; Walking

Behar et al reported that small doses of epidurql morphine are effective in the treatment of acute and chronic pain by direct action on the specific receptors in the substantia gelations of the posterior horn of the spinal cord. Brachial plexus blocks were performed in 217 cases in our hospital from Jun. 1979 to Aug. 1981. In an attempt to evaluate the postoperative pain relief, these cases were divided into two groups; the control and the experimental group. The two groups were subdivided into three according to the method of approach-supraclavicular, interscalene, and axillary. The cases complaining of pain within 8 hours after the block were 71/112(63.4%) in the control group, and 26/105(24.8%) in the experimental group: and the cases complaining of pain or noticing no pain after 8 hours following the block were 41/112(36.6%) in the control group and 79/105(75.2%) in the experimental group. The postoperative pain relief was remarkable especially in the interscalene and supraclavicular approach in the experimental group. We thought this was probably due to anatomical variance of the interscalene and supraclavicular approach nearer to the spinal cord and opiate receptors.
Anesthesia, Conduction* ; Animals ; Brachial Plexus ; Chronic Pain ; Horns ; Morphine* ; Pain, Postoperative* ; Receptors, Opioid ; Spinal Cord

Drug-induced acute interstitial nephritis is characterized by renal interstitial inflammatory cell infiltration and commonly presents as acute renal failure. This is caused mainly by methicillin, non-steroidal antiinflammatory drugs, sulfonamide diuretics such as thiazide, but cases induced by furosemide are rare. We report a patient with acute interstitial nephritis causing reversible acute renal failure and dermatitis while she was taking furosemide. A 37-year old woman was referred to our hospital because of generalized skin rash and non-oliguric acute renal failure. She had peripheral eosinophilia (1,577/mm3) and serum creatinine level of 6.8mg/dL. Skin biopsy showed leukoclastic vasculitis and percutaneous renal biopsy showed severe interstitial infiltration of lymph ocyte and mild interstitial fibrosis with focal tubular atrophy. After withdrawal of furosemide, renal function and skin lesions were completely recovered.
Acute Kidney Injury ; Adult ; Atrophy ; Biopsy ; Creatinine ; Dermatitis ; Diuretics ; Eosinophilia ; Exanthema ; Female ; Fibrosis ; Furosemide* ; Humans ; Methicillin ; Nephritis, Interstitial* ; Skin ; Vasculitis

BACKGROUND: The pattern of left ventricular filling as depicted by Doppler echocardiographic transmitrial flow velocities has been used to left ventricular diastolic properties. Especially, altered transmitral flow by abnormal myocardial wall motion and left ventricular function in ischemic heart disease, was predicted during exercise test. METHODS: To determine the effects of exercise on Doppler echocardiographic measures of left ventricular diastolic filling, we studied 15 angina pectoris patients and 20 normal control subjects. Transmitral flow measurements comprised peak and integrated early passive(E) and late atrial(A) filling velocities and diastolic filling period. RESULTS: Heart rate in negative exercise treadmill test group was 70/min at rest, 111/min just after exercise, and 86/min at 5 minutes after exercise. Positive exercise treadmill test group was 69/min, 109/min and 82/min, respectively. DFP and E duration were also significantly decreased after exercise in group with negative treadmill exercise test. In positive treadmill exercise group, peak A was significantly increased from 0.57+/-0.15m/sec to 0.75+/-0.20m/sec at just after exercise(p<0.01), 0.67+/-0.12m/sec at 5 minuties after exercise. DFP and E duration were also significantly decreased after exercise. CONCLUSION: Doppler echocardiographic transmitral flow was altered by abnormal regional wall motion and left ventricular dysfunction in ischemic heart disease during exercise test. The use of Doppler echocardiography for this purpose is limited, however, because a number of variables may influence transmitral flow patterns, including age, preload, afterload and systolic function.
Angina Pectoris ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis* ; Echocardiography ; Echocardiography, Doppler* ; Exercise Test ; Heart Rate ; Humans ; Isoflurophate ; Myocardial Ischemia ; Ventricular Dysfunction, Left ; Ventricular Function, Left

OBJECTIVE: The objectives were to estimate the rate of the injury in the elderly over the past year and to identify factors related to injury in the elderly in South Korea. METHOD: Using data from the 2008 Community Health Survey, 43,049 elderly persons, aged 65 years and older, were selected as study subjects. Their experience of injury during the past year and other variables, including socio-demographic factors, health-related factors, and diagnosed chronic diseases, were used. The chi-squared test and multiple logistic regression analysis with weighted analysis were conducted and statistical significance was set at p<0.05. RESULT: The rate of injury in the elderly during the past year was 5.1%. The most common types of the injury were falling/slipping down and traffic accidents. Factors related to injury in the elderly were living alone, current drinking, depression, poor self-rated health, stroke, and osteoporosis. Living alone (odds ratio 1.23, 95% CI: 1.05-1.45), current drinkers (OR 1.19, 95% CI: 1.05-1.35), poor self-rated health (OR 1.72, 95% CI: 1.43-2.08), depression (OR 1.23, 95% CI: 1.17-1.68), and history of stroke (OR 1.40, 95% CI: 1.17-1.68), and history of osteoporosis (OR 1.45, 95% CI: 1.26-1.66) were related to an increased risk of injury. CONCLUSIONS: Intervention programs that consider the risk factors related to injury should be developed and implemented to decrease and prevent injuries in the elderly.