The allopurinol hypersensicivity syndrome is a rare, but life thereaning immunologic reaction of allopurinol therapy, characterized by multiple abnormalities such as fever, rash, decreased renal function, hepatocellular injury, leukocytosis, and eosinophila. It may require prolonged hospitalization and occasionally involves residual morbidity. Three patients developed erythematous skin eruption three to five weeks after beginning therapy with allopurinol. The clinical, laboratory, and histologic findings of these patients were compatible with a allopurinol hyperensitivity syndrome.
Abnormalities, Multiple ; Allopurinol* ; Exanthema ; Fever ; Hospitalization ; Humans ; Hypersensitivity* ; Leukocytosis ; Skin

BACKGROUND: While the effect of the flashlamp pumped dye laser in the treatment of telangiectasia and other vascular disease has been reported by many authors, there have been a few reports on the therapeutic effect of the copper vapor laser(CVL) on telangiectasia and other vascular lesions. OBJECTIVE: Our purpose was to assess the clinical results in Korean patients who had cutaneous vascular disorders that were treated with the CVL at 578 nm. METHODS: A total of 23 patients with vascular lesions such as telangiectasia were involved. The effect of the laser treatment was evaluated 3 months after the last treatment. RESULTS: Of the 15 patients with telangiectasia, 12 patients showed good or excellent responses. 2 out of 3 patients with strawberry hemangioma showed good results. As for the other lesions, 2 out of the remaining patients 5 showed excellent results. CONCLUSION: The CVL has a beneficial effect and is a good alternative treatment modality for vascular lesions.
Copper* ; Hemangioma, Cavernous ; Humans ; Lasers, Dye ; Lasers, Gas* ; Telangiectasis ; Vascular Diseases

Primary adenocarcinoma of appendix is a rare clinical entity that is virtually neverdiagnosed preoperatively.The first description was that of Berger in 1882 and this carcinoma was alwayssymptomatic causing a variant of acute appedicitis and palpable right lower quadrant mass. Thefrequency range between 0.08% to 0.5% and these tumors behave aggressively. The possibleroute of metastasize is mainly by peritoneal implantation and right-sided hemicolectomyis the best treatment.We experienced a case of mucinous adenocarcinoma of appendix metastasis to ovaryand we present this case with the brief review of literature.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Appendix* ; Female ; Mucins* ; Neoplasm Metastasis* ; Ovary*

BACKGROUND: Laparoscopic surgery in the Trendelenburg position affects the cardiopulmonary system and may also influence intraocular pressure (IOP). The purpose of this study was to compare the effects of propofol and sevoflurane anesthesias on IOP change during laparoscopic hysterectomy. METHODS: Thirty-one women were randomly allocated to either a propofol (P-group, n = 15) intravenous anesthesia group or a sevoflurane (S-group, n = 16) inhaled anesthesia group with fentanyl-N2O/O2-vecuronium. Heart rate, mean arterial pressure, plateau airway pressure, ETCO2, and IOP were measured before induction (T1), 10 min after induction (T2), 10 min after pneumoperitoneum in the Trendelenburg position (T3), and 5 min after pneumoperitoneum deflation in the horizontal position (T4). RESULTS: IOP was significantly decreased in both groups after induction. IOP was increased in both groups after pneumoperitoneum in the Trendelenburg position, but IOP in the sevoflurane group was significantly higher than that in the propofol group. CONCLUSIONS: Propofol intravenenous anesthesia may be a better choice for IOP control during laparoscopic surgery.
Anesthesia* ; Anesthesia, Intravenous ; Arterial Pressure ; Female ; Head-Down Tilt ; Heart Rate ; Humans ; Hysterectomy* ; Intraocular Pressure* ; Laparoscopy ; Pneumoperitoneum ; Propofol*

Sturge-Weber syndrome is characterized by congenital skin angiomas throughout the facio-trigeminal region, which can cause difficulty in airway management in the case of general anesthesia. The problems with this syndrome include glaucoma, seizures, severe mental retardation, intracranial cavernous hemangioma, etc. We report a case of a patient with Sturge-Weber syndrome with severe facial hemangioma who underwent septoplasty and inferior turbinectomy under general anesthesia. We also review the literature on the anesthetic management for the Sturge-Weber syndrome and discuss methods for avoiding complications.
Airway Management ; Anesthesia* ; Anesthesia, General ; Glaucoma ; Hemangioma* ; Hemangioma, Cavernous ; Humans ; Intellectual Disability ; Seizures ; Skin ; Sturge-Weber Syndrome*

BACKGROUND: The aim of this study was to investigate the effect of butorphanol on the Bispectral Index (BIS) during the administration of intravenous anesthesia with propofol and remifentanil. METHODS: Forty adult patients, ASA I-II, scheduled for an emergency laparoscopic appendectomy were studied. The doses for the anesthetics were adjusted to keep the BIS value between 40 and 50. After 20 minutes of stable anesthesia, the subjects were randomly allocated to receive intravenous saline (control group) or 0.02 mg/kg butorphanol (butorphanol group). The BIS values, mean arterial pressure, and heart ratewere recorded every five minutes for a period of 20 minutes. RESULTS: The mean BIS values after butorphanol administration were not significantly different from the values following the administration of saline, throughout the observation period. No patients were able to recall explicitly any events under anesthesia. No significant changes in mean arterial pressure and heart rate were noted after butorphanol administration. CONCLUSIONS: Butorphanol given to prevent postoperative pain does not modify the BIS value during anesthesia maintained with remifentanil and propofol.
Adult ; Anesthesia ; Anesthesia, Intravenous* ; Anesthetics ; Appendectomy ; Arterial Pressure ; Butorphanol* ; Emergencies ; Heart ; Heart Rate ; Humans ; Pain, Postoperative ; Propofol*

BACKGROUND: The relationship between the injection speed of a local anesthetic and the success rate of unilateral spinal anesthesia has been a controversial issue. The aim of this thesis was to identify any significant effects of the drug injection speed on the success rate of unilateral spinal anesthesia. METHODS: Forty patients were randomly allocated into 2 groups, group R and S. The injection speed was 4 ml/min in group R (n = 20) and 1 ml/min in group S (n = 20). Hyperbaric 0.5% bupivacaine 10 mg was injected via a syringe pump. The drug was administered at the L3-4 intervertebral space with the patient in the lateral decubitus position, which was maintained for 20 minutes after the injection. A spinal sensory block was assessed by examining the temperature sensation using an alcohol-sponge. The motor block was evaluated using the modified Bromage scale and the dependent and non-dependent sides were compared. RESULTS: Significant differences (P<0.05) were observed in the success rate of unilateral motor paralysis (45% in group R vs 90% in group S). There were no significant blood pressure differences between the two groups 5, 10, 15, 30 and 60 minutes after injecting the hyperbaric 0.5% bupivacaine. CONCLUSIONS: The injection speed of local anesthetics is one of the crucial factors for achieving a unilateral spinal anesthesia. Therefore, it is important to maintain a slow injection speed of a local anesthetic in unilateral spinal anesthesia.
Anesthesia, Spinal* ; Anesthetics, Local ; Blood Pressure ; Bupivacaine ; Humans ; Paralysis ; Sensation ; Syringes

A tracheoesophageal fistula (TEF) was detected in a woman who received chemotherapy for acute lymphoblastic leukemia. The fistula biopsy confirmed the aspergillus infection. A large fistula was located at the lateral wall of the carina involving the proximal left main bronchus, and the orifice of left main bronchus was almost completely obstructed by white mass-like plaque. Primary repair was planned using the right thoracotomy approach. We originally planned to selectively intubate the left lung with the aid of fiberoptic bronchoscope without success. Therefore, we selectively intubated the right lung. Hypoxemia developed during surgery and the level of oxygenation was improved by selectively intubating the left bronchus from the surgical field once the defect had been exposed. We review the ventilation technique and anesthetic problems encountered in patients with a large distal TEF.
Anoxia ; Aspergillus ; Biopsy ; Bronchi ; Bronchoscopes ; Drug Therapy ; Female ; Fistula ; Humans ; Lung ; Oxygen ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Thoracotomy ; Tracheoesophageal Fistula* ; Ventilation

Herpes zoster in childhood is uncommon, but it is more common in association with immunosuppression. Maternal varicella infection during pregnancy and varicella occurring in the newborn represent risk for childhood herpes zoster. However, some controversies persist on risk factors, diagnosis, and the natural history of childhood disease. We report a 10-year-old healthy boy with shingles and review the risk factors, prognosis, and treatment of pediatric zoster.
Chickenpox ; Child ; Herpes Zoster ; Humans ; Immunosuppression ; Infant, Newborn ; Natural History ; Pregnancy ; Prognosis ; Risk Factors

Cauda equina syndrome is a well-known but rare complication of spinal anesthesia. An 80-year-old man was scheduled for both herniorrhaphy. Spinal anesthesia was performed at the L3-4 interspinous space with 0.5% hyperbaric bupivacaine 12 mg. Eight hours after anesthesia, the patient complained bilateral sensorimotor deficits of the lower extremities and peroneal region. Urinary and fecal incontinence were also observed. MRI and myelography showed severe central spinal stenosis at L3-4 and L4-5. EMG showed cauda equina syndrome. Seven weeks after the procedure, left decompressive subtotal laminectomy L2-L5 was done. The patient still complains the neuropathic pain in the both lower extremities and ambulates using a walker. The local anesthetic was injected into thecal sac between maximum stenoses, and it is likely that there was poor upward spread leading to maldistribution of local anesthetic and resultant local anesthetic toxicity.
Aged, 80 and over ; Anesthesia ; Anesthesia, Spinal ; Bupivacaine ; Cauda Equina ; Constriction, Pathologic ; Fecal Incontinence ; Herniorrhaphy ; Humans ; Laminectomy ; Lower Extremity ; Myelography ; Neuralgia ; Polyradiculopathy ; Spinal Stenosis ; Walkers