The intraoperative rupture of an intracranial aneurysm can dramatically interrupt the fine operative procedure and jeopardize the patient's chance for meaningful survival. A sudden increase of the arterial pressure and intracranial pressure during laryngoscopy and intubation is potentially dangerous and may lead to fresh bleeding from an aneurysm in patient with recent subarachnoidal hemorrhage due to aneurysmal rupture. But aneurysmal rupture during induction occurs rarely. Recently we experienced rebleeding due to sudden increased arterial blood pressure during laryngoscopy and intubation in 39 years old female patient who was scheduled for clipping of ruptured intracranial aneurysm on 11th day after ictus. And she died of cerebral death on 6th postoperative day. Here we discuss the incidence, prognosis, diagnosis, management and prophylaxis of the aneurysmal rupture during induction with a brief review of the literature.
Adult ; Anesthesia* ; Aneurysm ; Arterial Pressure ; Diagnosis ; Female ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm* ; Intracranial Pressure ; Intubation ; Laryngoscopy ; Prognosis ; Rupture ; Surgical Procedures, Operative

In order to provide some clues for differential diagnosis of trematode infections in fecal examination, the comparative morphology of eggs of 5 kinds of heterophyid flukes (Metagonimus yokogawai, Heterophyes heterophyes nocens, Heterophyopsis continua, Stellantchasmus falcatus and Pygidiopsis summa) and Clonorchis sinensis was studied. The eggs were obtained from distal portion of uteri of worms which were recovered from men after treatment. The characteristic shape and apperance of each kind of eggs were observed in detail under light microscope, and their length and width measured and compared one another. The results are as follows: Eggs of C. sinensis are elongated ovoidal in shape with attenuated anterior end, 25.3-33.2 (28.3 in average) micrometer long and 14.2-17.4(15.9) micrometer wide with length /width ratio of 1.60-2.00 (1.78). They differ from all heterophyid eggs in that they have prominent wrinkling (muskmelon pattern) at their shell surface. P. summa eggs are ovoid to pyriform in shape and characterized by the smallest size of all kinds examined, 19.8-22.9(21.6) micrometer long and 11.1-13.4 (12.1) micrometer wide and the ratio 1.63-1.99 (1.78). Eggs of S. falcatus are elongated ovoidal and most slender form, 25.3-29.2 (27.2) micrometer long and 11.1-13.4 (12.5) micrometer wide with the ratio of 2.00-2.57 (2.17). Eggs of M. yokogawai are ellipsoid to elliptical in shape with round both ends, 26.9-31.6 (28.5) micrometer long and 14.2-18.2 (16.8) micrometer wide with the ratio of 1.48-2.11(1.70). H. continua eggs are oval in shape, sometimes similar to M. yokogawai or H. h. nocens eggs, however, the relative breadth is broadest among all kinds, with maximum width at posterior half portion. They are 23.7-27.7 (25.0) micrometer long, 15.8-18.9 (16.4) micrometer wide with the ratio of 1.33-1.75 (1.53). Eggs of H. h. nocens are ellipsoid to ovoid in shape but sometimes more slender than M. yokogawai and have slightly pointed both ends. They are 23.7-29.2 (25.7) micrometer long, 14.2-15.8 (15.4) micrometer wide, and the ratio 1.50-2.06 (1.67). From the results, it is concluded that eggs of 5 kinds of heterophyids and C. sinensis can be morphologically differentiated one another, however, careful observation and measurement on sufficient number of eggs are needed.
parasitology-helminth-trematoda ; Clonorchis sinensis ; morphology ; egg ; Metagonimus yokogawai ; Heterophyes heterophyes nocens ; Heterophyopsis continua ; Stellantchasmus falcatus ; Pygidiopsis summa

Subjects should not have any factors affecting neuromuscular transmission. Anestheisa was induced by a sleep dose of 2.5% thiopental sodium, and oxygen, nitrous oxide and lower concentration of enflurane were used for maintenance. When the patients were stabilized, the arm with electrode attached and an indwelling needle inserted into a vein on the back of the wrist, was elevated for 30 seconds to partially drain the blood from it and then pneumatic tourniquet inflated 30 to 40 mmHg above the systolic blood pressure around the upper arm, so that a small dose of relaxants (1/60 or 1/30 of the clinical dose; succinylcholine 1mg/kg, vecuronium 0.08 mg/kg, atracurium 0.2 mg/kg, pancuronium 0.08 mg/kg and alpha-tubocurarine 0.2 mg/kg) could be injected into the arm isolated from the systemic circulation. Thereafter, ischemia was maintained for 4 minutes to allow retrograde spread of some of the drugs into the capillary bed where neuromuscular block was established. At the end of 4 minutes after tourniquet applied, the tourniquet was released. Neuromuscular conduction was recorded using ABM monitor of the Datex Co. for neuromuscular transmssion by 40 mA 2Hz stimulaton to ulnar nerve 20 seconds interval. We confirmed the marked rundown of amplitude of muscle action potensial (MAP) in group injected very small doses throughout the isolated limb but no affect the evoked MAP in group injected into systemic circulation. Conclusively, even there are various factors affecting extent of block by the tournique; ischemic acidosis, concentration volume of drugs, amovnt of exsanguination and the state of vasculare bed, these were not thought to be a source of error for study. Therefore small doses of relaxants required wih this technique exclude the possibility of unwanted systemic side effects and can be reliable and effective for clinical study for neuromuscular transmission.
Acidosis ; Arm* ; Atracurium ; Blood Pressure ; Capillaries ; Electrodes ; Enflurane ; Exsanguination ; Extremities ; Humans ; Ischemia ; Needles ; Neuromuscular Blockade* ; Nitrous Oxide ; Oxygen ; Pancuronium ; Succinylcholine ; Thiopental ; Tourniquets ; Ulnar Nerve ; Vecuronium Bromide ; Veins ; Wrist

In order to obtaine the constant, stable muscle relaxation, vecuronium was infused con-tinuously at fixed rate(0.06 mg/kg/hour) in 30 ASA class l & ll adult female Patients und-ergoing explorative laparatomy. All patients were premedlcated with Robinul 0.2 mg and hydroxyzine 1.5mg/kg IM 1 hour Prior to anesthesia. Starting infusion of vecuronium, anesthesia was induced with thiopental 5-6 mg/kg and vecuronium 0.08 mg/kg. Endotrach-eal intubatioo was Pperformed at 77~100% depresaion of twitch height monitored by train-of-four stimulation(2Hz) of the ulnar Nerve. Anesthesia was maintained with O2-N2O-enflurane. The patients were divided into three group: 1) Group l(n=10) : spontaneous recovery of neuromuscular block. 2) Group ll(n= 10) : reversed with neostigmine(0.02 mg/kg) at 25% twitch recovery after infusion stop. 3) Group lll(n= 10) : Reversed with same dose of neostigmine immediately after infus-ion Stop. The results were as follows ; 1) The onset times of 50% and 75-l00% twitch depression were average 122+/-23.72 sec. and 162+/-32.08 sec. respectively. 2) The neuromuscular response during infusion was well maintained less than 17% of control twitch height in all cases, and objeotive muscle relaxation was satisfactory. 3) The times of twice recovery from 25% to 75%(recovery index) were 27.9+/-13.02 min. in Group l, 8.6+/-4.44min. in Group ll, and 10.0+/-3.81min. in Group lll. Recovery index was shortened significantly in Group ll&lll compaired to Group I (p<0.05), there was noStatistical Significantly between Group ll&lll. 4) There was no statistical significance between total dose of vecuronium used and reco-very inde% (P>7.05) . 5) Tidal volume and end-tidal CO2 tension before extuhation were within normal range in three group. 6) Abilities of open-eyes, tongue Protrusion, and head-lift for 5 seconds at recovery room were confirmed In all cartes. In conolusion, this technique is not definite in routine use. It would, however, be possible to adapt this infusion ramie to apply in male Patient, in patient with liver or kidney disease, or in long-term respiratorr care at intesive care unit.
Adult ; Anesthesia ; Boehmeria ; Depression ; Female ; Humans ; Hydroxyzine ; Kidney Diseases ; Liver ; Male ; Muscle Relaxation* ; Neostigmine ; Neuromuscular Blockade ; Recovery Room ; Reference Values ; Thiopental ; Tidal Volume ; Tongue ; Ulnar Nerve ; Vecuronium Bromide*

The present study was firstly undertaken in an attempt to compare simultaneously EMG(electromyography) and two new ACC(accelerography) reponses in the both hand following vecuronium administration in 26 ASA 1 or 2 adult patients undergoing general anesthesia. In the three NMT monitors, stimulating electrodes are applied similarly over the ulnar nerve on the volar side of the wrist, but the evoked EMG(Relaxograph, Datex Co.) responses obtained from the hypothenar muscles, TOFGUARD(Biometer Co.) responses from adductor pollicis and ParaGraph(Utah Med. Prod. Co.) responses from both muscles of hypothenar and thenar muscle of the hand respectively. Following induction of anesthesia with thiopental sodium(5 mg/kg) and vecuronium(0.08 mg/kg) intravenously, endotracheal intubation was facilitated and anesthesia was maintained with a mixture of enflurane(1~2%) and N2O(50%) . After loss of consciousness, the assessment of the neuromuscular blockade was started. We compared simultaneously TR(train-of-four ratio) responses of EMG at the one hand, and two new ACC named TOF-GUARD and ParaGraph at the other hand respectively during evoked recovery from vecuronium induced neuromuscular blockade. The result was the greater depression of TR response in TOF-GUARD and the lesser depression of TR response in ParaGraph than those in EMG. But test for parallelism did not show a statistically significant difference between the slope of these regression lines. Conclusively, the regression line for TR seems to be tend to give an impression that two new ACC named TOF-GUARD and ParaGraph would be suitable in the assessment of neuromuscular blockade in clinical anesthesia.
Adult ; Anesthesia ; Anesthesia, General ; Cytochrome P-450 CYP2B1 ; Depression ; Electrodes ; Hand ; Humans ; Intubation, Intratracheal ; Muscles ; Neuromuscular Blockade ; Thiopental ; Ulnar Nerve ; Unconsciousness ; Vecuronium Bromide* ; Wrist

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

Antiphospholipid syndrome is defined as the presence of lupus anticoagulant antibodies or anticardiolipin antibodies with vascular thrombosis or specific pregnancy complications. Antiphospholipid syndrome can be associated with autoimmune, malignant or infectious diseases. Cutaneous manifestations of antiphospholipid syndrome are variable and can be a first clue to the syndrome or other associated diseases. We report a case of systemic lupus erythematosus and secondary antiphospholipid syndrome presenting as livedo reticularis on both legs of a patient. We recommend that patients with livedo reticularis should be examined for systemic lupus erythematosus or antiphospholipid syndrome.
Antibodies ; Antibodies, Anticardiolipin ; Antiphospholipid Syndrome ; Communicable Diseases ; Humans ; Leg ; Livedo Reticularis* ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic* ; Pregnancy Complications ; Thrombosis

Plexiform schwannoma is a rare benign peripheral nerve sheath tumor characterized by a plexiform growth pattern. Only 5% of schwannomas develop into the plexiform type and these are usually seen as solitary or multiple lesions affecting young adults. They are usually found on the trunk, head and neck or the extremities as slowly growing, asymptomatic, well circumscribed lesions. We present the case of a 32-year-old man who had an asymptomatic subcutaneous nodule on the left fourth finger tip. Histological examination revealed typical features of plexifom schwannoma, that composed of Antoni A type cellular tissue with frequent nuclear palisades and Verocay bodies. The skin lesion was totally excised and recurrence has not been found.
Adult ; Extremities ; Fingers ; Head ; Humans ; Neck ; Neurilemmoma ; Peripheral Nerves ; Recurrence ; Skin ; Young Adult

Proliferating trichilemmal cyst is a rare benign tumor of external root sheath origin that usually occurs on the scalp of elderly women. It is rarely found on the face, neck, trunk and back. A 17 year-old man presented with a skin-colored, subcutaneous, tender nodule on the elbow with a history of bee sting. A histological examination revealed a well demarcated multilobular cystic mass characterized by trichilemmal keratinization in the dermis. The skin lesion was totally excised and recurrence has not been found. We present a case of proliferating trichilemmal cyst of unusual predilection site.
Aged ; Bees ; Bites and Stings ; Dermis ; Elbow ; Female ; Humans ; Keratins ; Neck ; Quaternary Ammonium Compounds ; Recurrence ; Scalp ; Skin

BACKGROUND: To elucidate the mechanism of interaction between depolarizing and nondepolarizing muscle relaxants, train-of-four (TOF) fade during onset of neuromuscular blockade of d-tubocurarine (dTC) with or without decamethonium (C10) was evaluated in a rat phrenic nerve hemidiaphragm preparation. METHODS: Phrenic nerve hemidiaphragm preparations from 250~300 g Sprague Dawley rats (n=20) were suspended in a Krebs solution bubbled with 5% CO2 in O2 at 32oC. Phrenic nerves were stimulated with supramaximal stimuli of 0.2 ms duration at 0.15 Hz single twitch and 2 Hz TOF by a Grass S88 stimulator and the contractions of the hemidiaphragm were detected by a Grass FT03 force transducer then recorded. Estimation of ED50 for the dose response data were performed by a linear regression. The statistical significance of the results was determined by Wilcoxon Rank Sum test. p<0.05 was considered significant. RESULTS: Mean ED50 values of dTC and C10 calculated from the dose response relations were 7.76 microgram/ml and 0.65 microgram/ml respectively. Compared to adminstration of 2xED50 of dTC alone, TOF ratios at 75% and 50% of twitch height were markedly decreased by combination of ED50 of C10 and ED50 of dTC with statistic significance (67 +/- 1.9% vs. 46 +/- 3.1% and 36 +/- 2.5% vs. 7 +/- 2.5%). Conclusion: If fade in response to TOF stimulation represents a prejunctional effect, the results from this study suggests that the presynaptic action of C10 has some role in the mechanism of the interaction between dTC and C10 in the rat.
Animals ; Linear Models ; Neuromuscular Blockade* ; Phrenic Nerve* ; Poaceae ; Rats* ; Rats, Sprague-Dawley ; Transducers ; Tubocurarine*