Lesch-Nyhan syndrome (LNS) is a rare, X-linked recessive inherited disorder caused by a deficiency of the enzyme hypoxanthine-guanine-phophoribosyltransferase, leading to excessive purine production and elevation of uric acid. Clinical manifestations include mental retardation, spasticity, choreathetosis, compulsive self-mutilation, renal calculi followed by obstructive nephropathy, and arthritis. Patient with LNS may have increased risk of aspiration pneumonia, acute renal failure and unexpected sudden death. We accomplished successful general anesthesia in a case of LNS requiring percutaneous nephrolithotomy due to renal calculi.
Acute Kidney Injury ; Anesthesia, General ; Arthritis ; Death, Sudden ; Humans ; Intellectual Disability ; Kidney Calculi* ; Lesch-Nyhan Syndrome* ; Muscle Spasticity ; Nephrostomy, Percutaneous* ; Pneumonia, Aspiration ; Uric Acid

The transurethral resection of the prostate (TURP) syndrome is caused by intravascular absorption of an electrolyte-free irrigating fluid during TURP for benign prostatic hypertrophy or prostatic carcinoma. The clinical symptoms and signs include hypertension, bradycardia, respiratory distress, hypotension, nausea, vomiting, confusion, blindness, seizure, coma, hyponatremina, and hypoosmolality. In this case, we incidentally detected very severe dilutional hyponatremia (99 mmol/L) without any symptoms during TURP and immediately took measures to treat TURP syndrome. On the third postoperative day, the hyponatremia had resolved within the normal range.
Absorption ; Blindness ; Bradycardia ; Coma ; Hypertension ; Hyponatremia* ; Hypotension ; Nausea ; Prostate* ; Prostatic Hyperplasia ; Reference Values ; Seizures ; Transurethral Resection of Prostate ; Vomiting

Wernicke's encephalopathy is a fatal neurological disease caused by thiamine deficiency. Many reports indicate that Wernicke's encephalopathy is caused by malnutrition. We report the case of a 79-year-old female patient who had a left masticator space and parapharyngeal space abscess who was diagnosed with Wernicke's encephalopathy. She reported problems while eating due to the presence of the abscess, but the true quantities of food she was ingesting were never assessed. Clinicians have a responsibility to provide adequate nutritional support by ensuring that patients receive adequate nutrition. Clinicians should also keep in mind that Wernicke's encephalopathy may occur in patients who experienced prolonged periods of malnutrition.
Abscess* ; Aged ; Eating ; Female ; Humans ; Malnutrition ; Nutritional Support ; Parenteral Nutrition ; Thiamine Deficiency ; Wernicke Encephalopathy*

Clinical features of masticator-space abscess (MSA) are very similar to those of parotitis or temporomandibular disorder (TMD), making early differential diagnosis difficult. Local causes of MSA include nerve block anesthesia, infection after tooth extraction, and trauma to the temporomandibular joint (TMJ); the systemic cause is immunodeficiency. Odontogenic causes account for most etiologies, but there are also unusual causes of MSA. A 66-year-old male patient visited the emergency room (ER) presenting with left-side TMJ pain three days after receiving an acupressure massage. He was tentatively diagnosed with conventional post-trauma TMD and discharged with medication. However, the patient returned to the ER with increased pain. At this time, his TMD diagnosis was confirmed. He made a third visit to the ER during which facial computed tomographic (CT) images were taken. CT readings identified an abscess or hematoma in the left masticator space. After hospitalizing the patient, needle aspiration confirmed pus in the infratemporal and temporal fossa. Antibiotics were administered, and the abscess was drained through an incision made by the attending physician. The patient's symptoms decreased, and he was discharged.
Abscess* ; Acupressure* ; Aged ; Anesthesia ; Anti-Bacterial Agents ; Diagnosis ; Diagnosis, Differential ; Emergency Service, Hospital ; Hematoma ; Humans ; Male ; Massage* ; Needles ; Nerve Block ; Parotitis ; Reading ; Suppuration ; Temporomandibular Joint ; Temporomandibular Joint Disorders ; Tooth Extraction

Obturator nerve block is occasionally performed during transurethral resection of lateral bladder wall tumors to prevent the violent contraction of the adductor muscle of the thigh. Rare complications including intravascular injection of the local anesthetics and hematoma formation may occur during the obturator nerve block. We report a case of the unintentional breakage of the spinal needle during the obturator nerve block with successful removal of the broken spinal needle by an orthopedic surgeon.
Anesthetics, Local ; Hematoma ; Needles* ; Obturator Nerve* ; Orthopedics ; Thigh ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Intraoperative pulmonary embolism can result in severe hemodynamic instability, including cardiac arrest. Therefore, immediate diagnosis and proper treatment are required. We report a case of the acute cardiac and pulmonary embolisms during radical nephrectomy and inferior vena cava (IVC) thrombectomy in a patient with renal cell carcinoma with thrombus in the IVC. We diagnosed the cardiac embolism intraoperatively using the transesophageal echocardiogram, and performed emergent cardiac and pulmonary embolectomies immediately. After the surgery, the patient was discharged without any complication.
Carcinoma, Renal Cell ; Diagnosis ; Embolectomy ; Embolism ; Heart Arrest ; Hemodynamics ; Humans ; Nephrectomy* ; Pulmonary Embolism* ; Thrombectomy* ; Thrombosis ; Vena Cava, Inferior*

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure