BACKGROUND: Rocuronium administration is associated with a severe burning pain during injection in 50-80% patients. The purpose of this study was to evaluate mixtures of saline, lidocaine, sodium bicarbonate (NaHCO3) and lidocaine-NaHCO3 with rocuronium to reduce injection pain and withdrawal movement. METHODS: One hundred and twenty patients were randomly assigned to one of four groups in a double blinded, prospective study; Group S (0.9% normal saline 5 ml mixed with rocuronium 50 mg/5 ml, n = 30), Group L (2% lidocaine 5 ml mixed with rocuronium 50 mg/5 ml, n = 30), Group B (8.4% NaHCO3 5 ml mixed with rocuronium 50 mg/5 ml, n = 30) and Group LB (4% lidocaine 2.5 ml and 8.4% NaHCO3 2.5 ml mixed with rocuronium 50 mg/5 ml, n = 30). After all patients had received an intubating dose (0.6 mg/kg) of premixed rocuronium over 5 seconds, we investigated the incidence and severity of pain and withdrawal movement. We measured the onset and duration of muscle relaxation using train-of-four (TOF) and the pH values and osmolalities of each mixture. RESULTS: The incidence and severity of pain during injection were significantly reduced in Groups B and LB compared with Group S. The withdrawal movement was observed 8 patients (26.7%) in Group S, but in no patient in Groups B or LB. No significant difference in the incidence of pain or withdrawal response was observed between Groups S and L. CONCLUSIONS: We conclude that premixed NaHCO3 with rocuronium is effective at reducing injection pain and withdrawal movement whereas the addition of lidocaine has little effect.
Burns ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Lidocaine* ; Muscle Relaxation ; Osmolar Concentration ; Prospective Studies ; Sodium Bicarbonate

A malignant fibrous histiocytoma of the mesentery is rare, and multifocal involvement as a primary tumor is very rare. In this report, a case of malignant fibrous histiocytoma of the mesentery presenting with two masses and multiple peritoneal seeding in a 48-year-old man is described. A physical examination revealed a large, firm, and non-tender mass in the right lower abdomen of the patient. Computed tomography of the lesion revealed a partially, indistinctly marginated and heterogeneously enhancing mass with irregular peritumoral strands in the mesentery of the right lower abdomen, while sonograms of the lesion revealed an ill-defined low-echoic mass. The final pathology demonstrated the presence of a storiform-pleomorphic malignant fibrous histiocytoma.
Abdomen ; Histiocytoma, Malignant Fibrous* ; Humans ; Mesentery* ; Middle Aged ; Pathology ; Physical Examination ; Ultrasonography

Intracapsular and paraarticular chondroma is a rare benign lesion of the large joints (mostly the knee). We report a case of intracapsular and paraarticular chondroma in the infrapatellar Hoffa's fat pad that presented as a painful palpable mass in 15-yearold woman. A physical examination revealed a firm, movable and tender mass in the infrapatellar area. Magnetic resonance images showed an ovoid, well-defined, soft tissue mass with focal calcification in the infrapatellar fat pad. The final pathology revealed an intracapsular and paraarticular chondroma.
Adipose Tissue ; Chondroma ; Female ; Humans ; Joints ; Knee ; Lower Extremity ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Physical Examination

PURPOSE: This study examined the outcomes of treatment in periprosthetic supracondylar fractures of the femur after total knee arthroplasty with the plates of internal fixation and retrograde intramedullary nailing using clinical and radiological methods. MATERIALS AND METHODS: Between August 1998 to May 2010, 24 cases of periprosthetic supracondylar fractures of the femur around the stem were selected and 18 cases of a stabled fracture without a loosening of the stem were chosen. The mean age was 69.1 (range 55-83) years and the mean follow period was 42.8 (range 14-142) months. In 18 cases, 8 cases who used a plate to gain anatomical alignment were categorized as group A and 10 cases who used retrograde intramedullary nailing were called group B. The union period, range of motion before fracture and last follow up, HSS score and tibiofemoral angle in both groups were compared. RESULTS: Radiographic union was obtained in all cases. The mean union period was 5 and 4.8 month in group A and B, respectively. In group A, the range of motion just before fracture was 120degrees and the last follow up was 93degrees. In group B, the range of motion before fracture was 124.5degrees and the last follow up was 96.8degrees. Although the range of motion in both groups had decreased appreciably (p<0.001), there was no significant difference between them (p>0.05). The HSS score in group A was 87 just before the fracture and decreased to 79.8. The HSS score in group B was 85 before fracture and decreased to 81. The final HSS score at the last follow up decreased in both groups but the decrease and difference between the two groups was not significant (p>0.05). The coronal alignment in group A was 6.2 valgus just before the fracture and 4.4 valgus at the last follow up. The coronal alignment in group B was 6 valgus before the fracture and 5.2 valgus at the last follow up (p>0.05). CONCLUSION: In the treatment of periprosthetic supracondylar fractures of the femur after total knee arthroplasty, both an open reduction with internal fixation of the plates and retrograde intramedullary nailing showed good results in the clinical and radiological fields.
Arthroplasty ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Knee ; Range of Motion, Articular

BACKGROUND AND OBJECTIVES: Currently, the changes of taste sensation after unilateral injury of chorda tympani nerve during middle ear surgery remains unclear, particularly in objective methods, like threshold to each taste stimulus. This study aims to evaluate the objective changes of taste threshold according to the degrees of injury of chorda tympani nerve. MATERIALS AND METHODS: In 36 patients who underwent middle ear surgery, the degrees of injury were described as "intact", "stretched" and "sacrificed". The taste threshold to citric acid, NaCl, and sucrose were measured preoperatively, and 1 week, 1 month, 3 months after surgery. Subjective changes of taste sensation were questioned together. The amount of changes in threshold according to the degree of injury were statistically analyzed. RESULTS: There were no significant differences of threshold according to the degrees of injury in each taste. Several patients documented subjective taste changes, such as hypogeusia and parageusia. But there were no relationship between subjective and objective findings. CONCLUSION: These results suggest the probability of some compensatory mechanism after unilateral injury of chorda tympani nerve. There might be some discrepancy between taste threshold and real-world taste sensation.
Ageusia ; Chorda Tympani Nerve* ; Citric Acid ; Dysgeusia ; Ear, Middle* ; Humans ; Sensation ; Sucrose ; Taste Threshold

We report a case of 29-year-old, morbidly obese, diabetic primigravida who had undergone previously primary percutaneous coronary intervention with stent placement for an inferior wall myocardial infarction at 10 weeks of gestation. She remained asymptomatic with medication during the remainder of her pregnancy, but preoperative echocardiography revealed left ventricular dilation and a restrictive diastolic dysfunction with a preserved ejection fraction (46%). She developed acute pulmonary edema associated with hypertension after an elective Cesarean delivery under continuous epidural anesthesia despite the meticulous restriction of fluid.
Adult ; Anesthesia, Epidural ; Cesarean Section ; Echocardiography ; Female ; Humans ; Hypertension ; Inferior Wall Myocardial Infarction ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Pregnancy ; Pulmonary Edema ; Stents

BACKGROUND: Although heart rate variability (HRV) and blood pressure variability (BPV) arise from many different influences, probably the most consistent external modulator is respiration. At rest, the heart rate increases on inspiration and decreases on expiration, a phenomenon called respiratory sinus arrhythmia (RSA). Spectral analysis of heart rate offers good and reproducible estimate of RSA and BPV. Many studies have been conducted on the effects of respiration on HRV and BPV during awake subject breathing spontaneously. However, little is known as to whether respiratory rate modulates HRV and BPV during general anesthesia with mechanical ventilation. Here, we studied effects of respiratory rate on HRV and BPV during general anesthesia. METHODS: We studied 40 patients undergoing general anesthesia with mechanical ventilation. Maintaining anesthesia with isoflurane, we recorded R-R interval and systolic blood pressure at respiratory rate of 15, 10 and 6 breaths/minute. Data was analyzed by the power spectral analyses of HRV and BPV, which were divided into low frequency (LF) and high frequency (HF) band. RESULTS: Respiratory rate did not affect RR interval, systolic blood pressure, and total spectral power HRV and BPV. Compared with its value at 15 breaths/minute, HF-HRV was significantly increased at 6 breaths/minute. HF-and LF-BPV at 6 breaths/minute were significantly increased versus 15 breaths/minute. CONCLUSIONS: Respiratory rate modulates HRV and BPV during general anesthesia with mechanical ventilation. We suggest that respiratory rate should be considered and controlled in studies of cardiovascular variability during general anesthesia.
Anesthesia ; Anesthesia, General* ; Arrhythmia, Sinus ; Blood Pressure ; Heart Rate ; Humans ; Isoflurane ; Respiration ; Respiration, Artificial* ; Respiratory Rate*

Primary aortoenteric fistula (PAEF) is a rare disease with a high mortality rate due to massive hemorrhaging and diagnostic difficulties. Although hemorrhagic regions can be identified by endoscopy, it is difficult to diagnose PAEF by this method. If PAEF is suspected, endoscopic procedure should be terminated and abdominal CT should be performed. Overlooking the herald bleeding of PAEF can lead to massive bleeding and death. An 85-year-old previously healthy male presented with a complaint of melena. Gastrointestinal endoscopy identified a hemorrhagic site in the third portion of the duodenum and endoscopic hemostasis was performed. However, during the procedure, it became apparent that the hemorrhage was probably not the result of a simple duodenal ulceration and abdominal CT was performed immediately. An aortic aneurysm connected to the duodenum was identified, confirming the diagnosis of PAEF. However, the patient died of massive hemorrhaging before an operation could be performed.
Aged, 80 and over ; Aortic Aneurysm, Abdominal/*diagnosis/pathology ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Fibrin Tissue Adhesive/therapeutic use ; Fistula/*diagnosis/pathology ; Gastrointestinal Hemorrhage/diagnosis/therapy ; Humans ; Male ; Tomography, X-Ray Computed

BACKGROUND: Rocuronium administration after the induction of general anesthesia is associated with localized withdrawal of limbs or generalized movements in children and adolescents. The purpose of this study was to evaluate the effect of normal saline, lidocaine, sodium bicarbonate (NaHCO3), and lidocaine-NaHCO3 mixed with rocuronium reduces withdrawal response. METHODS: Eighty-five pediatric patients (aged 5-15 years) were randomly assigned to one of four groups in a double blinded, prospective study; Group S (0.9% normal saline 5 ml mixed with rocuronium 50 mg/5 ml, n = 21), Group L (2% lidocaine 5 ml mixed with rocuronium 50 mg/5 ml, n = 22), group B (8.4% NaHCO3 5 ml mixed with rocuronium 50 mg/5 ml, n = 22) and Group LB (4% lidocaine 2.5 ml and 8.4% NaHCO3 2.5 ml mixed with rocuronium 50 mg/5 ml, n = 20). After loss of consciousness by sevoflurane inhalation, all patients received 0.6 mg/kg premixed rocuronium over 5 seconds. We investigated the incidence and severity of withdrawal movement using 4-point scales. We also measured pH values and the osmolalities of each mixture. RESULTS: The incidence and degree of withdrawal reaction in response to rocuronium injection were significantly reduced in Groups B (18.1%) and LB (15.0%) versus Group S (57.1%). The addition of lidocaine failed to reduce withdrawal response compared with saline. CONCLUSIONS: NaHCO3 mixed with rocuronium is more effective than lidocaine addition with suspect to preventing withdrawal movement in pediatric patients.
Adolescent ; Anesthesia, General ; Child ; Extremities ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Inhalation ; Lidocaine* ; Osmolar Concentration ; Prospective Studies ; Sodium Bicarbonate* ; Sodium* ; Unconsciousness ; Weights and Measures

BACKGROUND: The majority of patients undergoing stem cell transplantation (SCT) require a blood transfusion until the complete engraftment. Because blood transfusion rules for patients with ABO-incompatible SCT are complicated, we developed an ABO-incompatible transfusion management system (ABO-ITMS) for accurate blood transfusion and improved manageability. METHODS: A committee composed of medical doctors, technicians, and a programmer developed ABO-ITMS during the eight months from July 2013 to February 2014. The program has been linked with other databases, including clinical and laboratory databases and resulted in a new subsystem of the health information system. Server computer's operating system was Window Server 2008, and the database manager program was Oracle 11g. Programming language was ASP.Net (VBScript, C #), and the server and client computer were used to connect to the web server using a web browser. RESULTS: ABO-ITMS was designed to follow three main steps by hematologic oncology clinic, laboratory physician, and blood bank. In the first step, a hematologic-oncology clinic doctor inputs SCT recipients' data and appropriate ABO group for each phase of post-transplantation. Laboratory physician enters the isoagglutinin titer and ABO group at the second step. Finally, blood bank workers enter the results of type, screening, and antibody identification. The patient's SCT information and the previous immunohematologic test results are shown on the screen. CONCLUSION: ABO-ITMS can replace the existing complicated system and workflow. ABO-ITMS will contribute to reducing medical error and improving quality of SCT recipient care.
Blood Banks ; Blood Transfusion* ; Health Information Systems ; Humans ; Mass Screening ; Medical Errors ; Programming Languages ; Stem Cell Transplantation* ; Web Browser