A 28-year old woman in DM (Ed note: Define DM) and chronic renal failure underwent an uneventful open reduction and internal fixation for an ankle fracture under spinal anesthesia. PCA with fentanyl and tramadol was started in the operating room with a background infusion of 2 ml/hr (10 μg/h of fentanyl and 6 mg/h of tramadol), a bolus dose of 2 ml and a lockout interval of fifteen minutes. Approximately eight hours after initiating PCA the patient was found unresponsive in the ward with respiratory failure. Resuscitation was started with endotracheal intubation and cardiac massage with an injection of epinephrine and atropine. The patient made a full and immediate recovery two hours later.
서 론 척추주위차단은 횡돌기, 추체, 추간공, 늑횡돌기인대(costotransverse ligament)와 흉막으로 둘러싸인 공간인 척추주위 공간(paravertebral space)에 국소마취제를 주입하여 흉부와 복부에 분포하는 신경을 편측 혹은 양측으로 차단하는 술 기이며, 현재 개흉술, 담낭절제술, 유방 수술, 서혜부 탈장 등의 수술시 마취 또는 수술 후 통증관리 등에 광범위하게 쓰이고 있다.그 외에 척추주위차단은 술기가 쉽고 비교적 안전하며 편측 차단이 가능하며, 늑막강내차단술과 달리 흉 관을 통한 국소마취제 소실이 없다는 장점이 있다. 1) 최근 수부와 액와부 다한증의 치료 방법으로 많이 사용 되는 비디오 흉강경을 이용한 흉부교감신경 절제술은 상후 부 교감신경 사슬(upper dorsal sympathetic
Hysteroscopy is a procedure that may appear minimally invasive, but may result in potentially disastrous complications.A hysteroscopy requires the insertion of a hysteroscope into the uterine cavity and the installation of a suitable distention medium for the visualization of the endometrium.Fluid overload due to the absorption of distention media during hysteroscopy can cause mild to severe complications, including hyponatremia, hypoosmolarity, nausea, vomiting, headache, arrhythmia, blindness, confusion, seizure, cerebral edema, brain herniation, and death.We report a case of a 41 year-old female patient who underwent elective hysteroscopic myomectomy under general anesthesia.Approximately 4 hours after the beginning of the surgery, the patient's serum sodium concentration dropped to 109 mM.She was treated with furosemide and recovered without sequelae.(Korean J Anesthesiol 2009; 57: 535∼9)
The chrysanthemum cultivar Field Green (Chrysanthemum x morifolium) was developed at the National Institute of Horticultural and Herbal Science, Rural Development Administration (RDA) in 2012. The cultivar Field Green was derived from the artificial crossing in 2008 between two spray chrysanthemum cultivars, Laque Roicks, a maternal p arent with y ellow single t ype flower, and F rill Green, a paternal parent with a green single type and white rust disease resistance. The vigorous plants with green petals and stable flower shapes were selected in 2009. After an evaluation of the characteristics, including shading culture in summer and retarding culture in spring and consecutive selections from 2010 to 2012, the final selection was made. The flowering time of Field Green was October 26 in a natural day length, and year-round production was possible by day-length treatment. This cultivar has single-type flowers with bright green ray florets and green disc florets. The number of ray florets is 18.8, and the flower diameter is 7.1 cm. The growth of the plant is vigorous, with a plant height of 130 cm. Field Green is highly resistant to white rust disease, and vase life is about 20 days in autumn. Number 2013-153 was applied to Field Green on February 20, 2013 for variety protection; its plant variety protection rights were then registered (No. 4839) on April 2, 2014 at the Korea Seed and Variety Service.
Retrobulbar hematoma can arise from orbital trauma and periorbital or intraorbital procedures, and it can result in several morbidities including vision loss. Making the immediate diagnosis and performing decompression of the retrobulbar hematoma are crucial for preventing serious morbidities such as permanent vision loss. We present here a case of temporary vision loss that was due to iatrogenic retrobulbar hematoma in a patient who received infraorbital nerve block for the treatment of trigeminal neuralgia. A 70-year-old woman with trigeminal neuralgia was treated with infraorbital nerve block. Just after the procedure she experienced acute periorbital swelling, proptosis and worsening visual acuity. Immediate orbital computed tomography was done, and this revealed a retrobulbar hematoma. The patient underwent lateral canthotomy with cantholysis and administration of dexamethasone and mannitol. Improvement of visual acuity began 3 hours after these procedures. Her visual acuity was greatly improved 12 days after admission.
2.7% sorbitol-0.54% mannitol has been selected as an alternative irrigating fluid during endoscopic surgery for its theoretical advantages. We compared the influence of 2.7% sorbitol-0.54% mannitol (Urosol™, CJ Pharma, Seoul, Korea) and 5% glucose as an irrigating solution for hysteroscopic myomectomy & polypectomy in the occurrence of associated complications.Thirty patients scheduled for a hysteroscopic operation were included in a prospective randomized trial comparing 2.7% sorbitol-0.54% mannitol solution (Group S, n = 15) and 5% glucose (Group G, n = 15) as an irrigating fluid. We recorded the amount of the irrigating fluids, the amount of fluid intake, and the duration of the procedure. Serum sodium, chloride, potassium, glucose values, and serum osmolality were measured before (just after the induction, T1), during (when 2 L of irrigation fluid was infused, T2), and after (1 h after the end of the operation, T3) the hysteroscopic procedure.The mean volume of absorbed irrigating fluid was 185.0 ± 73.5 ml in Group G and 175.4 ± 50.5 ml in Group S. Transient hyperglycemia occurred in one patient of Group G. No differences were found in the intraoperative and postoperative levels of serum sodium, potassium, chloride, glucose and osmolality in both groups.There was no clinical evidence of hyponatremic hypoosmolality in any of the patients. We found no difference between 2.7% sorbitol-0.54% mannitol and 5% glucose as an irrigating fluid for hysteroscopic procedures with mild to moderate irrigant absorption.
Epidural block is achieved either by single injection of local anesthetic through an epidural needle or as a continuous block by infusion pump through an epidural catheter.Complications associated with epidural catheters include breakage, entrapment, and knotting.Knotting of epidural catheters is very rare, but knotting in lumbar epidural catheters has been reported in a number of studies, and most of these cases involved removal difficulty.We report a case in which we inserted a cervical epidural catheter in a patient who was experiencing severe post-herpetic neuralgia and then removed the knotted catheter without complications.
Background: Orthostatic intolerance is a debilitating problem that can occur after prolonged bed-rest, exposure to microgravity, and in the elderly.This study examined the integrated cardiovascular response to baroreceptor activation in a hind-limb unweighing (HLU) mouse model of microgravity to test the hypothesis that both the pressor and contractility response are attenuated in HLU mice.Methods: C57BL/6 mice (25-30 g body wt, 8-10 wk old) were exposed to HLU for 2 weeks.A bilateral carotid artery occlusion and open-loop baroreceptor stimulus was performed to measure the myocardial contractile responses using a left ventricular micromanometer-conductance catheter in the mice.In isolated myocytes simultaneous sarcomere shortening and calcium transient were measured in response to increasing concentrations of the β-agonist isoproterenol.Results: In the controls, bilateral carotid artery occlusion increased the heart rate and mean arterial pressure.These responses were markedly attenuated in the HLU mice.A bilateral carotid artery occlusion also increased the slope of the end-systolic pressure volume relationship (Ees) by 70 ± 11% and the slope was markedly attenuated to 10 ± 8% in the HLU mice.Isoproterenol increased the sarcomere shortening in both control and HLU mice in a dose-dependent manner.However the contractile response to isoproterenol was significantly attenuated in the HLU mice than the controls.Conclusions: Both the pressor and myocardial contractile responses appear to be impaired in a mouse model of microgravity.(
Influence of the Exposed Length of Rootstock on Vegetative Growth and Productivity of ‘Sansa’ Apple Trees Grafted on M.7 or M.9-Accumulated yield,Biennial bearing,Fire blight,Vegetative growth,Yield efficiency
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