BACKGROUND: One of the main disadvantages of caudal block is the long latent period before a satisfactory blockade is obtained. Many investigators have used various preparations of local anesthetic solutions to improve the speed of onset. This study was performed to evaluate the effectiveness of prewarming of lidocaine HCl for caudal block. METHODS: Fifty healthy young patients (ASA I) were allocated into two groups, A and B. In group A, the local anesthetic solution were injected at room temperature (25 degrees C), while in group B, they were injected at 37oC. All the caudal block were performed using 2% lidocaine HCl 20 ml with fentanyl 100ug and epinephrine 1:200,000. The onset time was defined as the period from completion of injection until the patient first noticed loss of sensation to pin-prick on perianal region. Assessment of sensory loss was made at 15 seconds interval. We have compared the onset of sensory blockade between groups. The duration of analgesia and any significant side effects were also recorded. RESULTS: The onset of sensory blockade was significantly faster in group B (3.5 +/- 0.5 minutes) than group A (6.2 +/- 0.9 minutes). The duration of analgesia were not significantly changed between groups. Side effects of urinary retention, pruritus and nausea were noted between both groups but the difference was not significant. CONCLUSIONS: We have found that the onset time was 44% faster with warm lidocaine-fentanyl mixture (37 degrees C) than with the room temperature (25 degrees C). The improved clinical usefulness was achieved with no increase in side effects. The technique is a safe and effective method to reduce the latency of onset.
Analgesia ; Epinephrine ; Fentanyl ; Humans ; Lidocaine ; Nausea ; Pruritus ; Research Personnel ; Sensation ; Urinary Retention

We have presented three cases of Ritter's disease appearing on 11, 14, and 14 days old boys respectively. Staphyloccccus albus was cultured from bullar contents of case 1 and 2, and coaguIase positive staphylococcus from case 3. These patients were successfully treated with systemic and topical antimicrobials.
Humans ; Staphylococcal Scalded Skin Syndrome* ; Staphylococcus

We report a case of morphea profunda in a 21-year-old male who had diffuse brown sclerotic plaques on his extremities. Laboratory findings showed peripheral eosinophilia and an increased titers for anti-DNA and anti-nuclear antibodies. Histopathologic findings showed diffuse fibrosis and a thickening of the lower dermis and subcutaneous tissue. He has been treated with hydroxychloroquine 400mg per day and the sclerosis of the skin improved.
Antibodies ; Dermis ; Eosinophilia ; Extremities ; Fibrosis ; Humans ; Hydroxychloroquine ; Male ; Scleroderma, Localized* ; Sclerosis ; Skin ; Subcutaneous Tissue ; Young Adult

A case of acne conglobata associated with hidradenitis suppurativa, dissecting cellulitis and disseminated superficial actinic porokeratosis in 44 year-old man is presented with brief review of literature. The patient had acne vulgaris for a few years during his highschool days, about 5 years prior to the development of such a typical lesions of acne conglobata as multiple comedones, papules, pustules, abscesses, cysts and draining sinnses and subsquent hypertrophic scars and keloids. We are ps,rticularly interested in association of hidradenitis suppurativa and dissecting cellulitis with ance conglobata that comprise follicular occlusion triad in tbis teint. The pstient was treztei with systemic antibiotics and corticosteroids injections and surgical interventions with considerable improvement.
Abscess ; Acne Vulgaris* ; Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Cellulitis ; Cicatrix, Hypertrophic ; Hidradenitis Suppurativa ; Humans ; Keloid ; Porokeratosis

A 28-year-old male patient is described who developed multiple erythematous nodules and papules on the face, upper chest, back, upper and lower extrimities, leading to extensive ia.filtration of the skin and lymph nodes. Histology from the involved lymph node and skin nodule revealed widely scattered patchy infiltration of abnormal. hyperchromatic polymorphous histiocytes in the dermis. The patient died at about 8 months after onset of the disease, in spite of antineoplastic treatment.
Adult ; Dermis ; Histiocytes ; Humans ; Lymph Nodes ; Lymphoma* ; Male ; Skin ; Thorax

No abstract available.
Cholecystectomy* ; Common Bile Duct* ; Humans

Two cases of tuberous sclerosis are reported. Case 1: A 13 years-old girl had a triad of adenoma sebaceum, mental deficiency and epileptic seizures associated with ichthyosis vulgaris, but family history revealed no evidences of the disease except ichthyosis in her mother. Case 2 : A 21 year-old woman had a adenoma sebaceum, shagreen patch, periungual fibroma and fihromatous plaque, showing intracranial calcificatins on roentgenographic examination, but has not demonstrated any neurological manifestations as yet. Family history also revealed adenoma sebaceum in her father and two younger sisters. We feel this case is a "forme fruste" of tuberous sclerosis.
Adolescent ; Epilepsy ; Fathers ; Female ; Fibroma ; Humans ; Ichthyosis ; Ichthyosis Vulgaris ; Intellectual Disability ; Korea* ; Mothers ; Neurologic Manifestations ; Siblings ; Tuberous Sclerosis* ; Young Adult

A case of dermatitis herpetiformis assaciated with erythema annulare centrifugum is reported. The patient was a 21 year-old male, who had papulovesieles, erythematous lesions, pigmentation, and erythema annulare centrifugum lesions on the trunk, shoulders, buttocks and extensor surfaces of the extremities, and severe itching sensation of 9 months' duration. The skin biopsy from the vesicular and erythema annulare centrifugum lesion showed subepidermal bulla and vesicles with neutrophil and eosinophil infiltrations.
Biopsy ; Buttocks ; Dermatitis Herpetiformis* ; Dermatitis* ; Eosinophils ; Erythema* ; Extremities ; Humans ; Male ; Neutrophils ; Pigmentation ; Pruritus ; Sensation ; Shoulder ; Skin ; Young Adult

We evaluated the scapular shape, dispiacement and rotation in 10 cases of Sprengel deformity using three-dimensional computed tomography in order to investigate its clinical usefulness. Standard views, including trunk posterior view, scapular true posterior view and medial view, were taken, and the 3-D image was rotated in three axes to visualize the omovertebral bony connection. In the trunk posterior view, the amount of superior displacement of the affected scapula was measured using the glenoid level as reference, and the rotational deformity by the tilting of the base of scapular spine. Scapular dysplasia was evaluated in the scapular true posterior and medial views. The presence, size, and anchoring points of omovertebral bone were assessed in various view points. There was a tendency of inverse correlation hetween superior displacement and rotational deformity of scapula. In most cases, the affected scapulae were convex at their medial borders and concave at their lateral borders, with increased width/height ratio. The anchoring point of omovertebral connection appeared to determine the scapular shape, level, and amount of rotation. Three-dimensional CT was helpful in preoperative planning.
Congenital Abnormalities* ; Imaging, Three-Dimensional ; Scapula ; Spine

The fiberscope is no longer an experimental instrument, and it is a state-of-the-art technique for airway management in the operating room, recovery room, and intensive care unit. Changing the oral tube to a nasal one is often necessary if the trachea is to be intubated for a long period. A nasal tube is better tolerated by the patient, is easier to secure when the patient is moved, and is easier to attach to the respiratory care equipment. We describe three cases report changing the oral tube to a nasal one in neurosurgical pa- tient post operatively under flexible fiberoptic laryngoscope, while the interruption of venti- lation is minimized.
Airway Management ; Humans ; Intensive Care Units ; Laryngoscopes* ; Operating Rooms ; Recovery Room ; Trachea