1/8. anaphylaxis due to suxamethonium--manifested at induction of anaesthesia by bradycardia and cardiac arrest.This case report describes an unusual presentation of a severe anaphylactic reaction following induction of anaesthesia in an elderly male patient. Full recovery followed protracted resuscitation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/8. Efficient palliation of haemorrhaging malignant melanoma skin metastases by electrochemotherapy.Electric pulses can cause transient permeabilization of cell membranes (electroporation) and this can be utilized to increase the uptake of chemotherapy (electrochemotherapy). Preclinical studies have shown that in vivo electroporation causes transient shut down of blood flow both in normal and, in particular, malignant tissues. We report the successful palliation of a malignant melanoma patient with bleeding skin metastases using electrochemotherapy. In an on-going study of combined electrochemotherapy and low dose interleukin-2, one patient with bleeding skin metastases was included. Nine skin metastases, of which seven were ulcerated, were treated. After intratumoral bleomycin injection, needle electrodes with two arrays 4 mm apart were inserted into the tumours. Eight square wave electric pulses each 99 micros in duration and with an applied voltage to electrode distance ratio of 1.2 kV/cm were administered. In all the treated lesions, bleeding immediately stopped on administration of the electric pulses and did not recur. The treated metastases developed crusts and the lesions healed in a matter of weeks. Treatments were given under local anaesthesia, lasted a few minutes, and patient discomfort was brief and modest. In conclusion, we propose that electrochemotherapy should be considered for the palliation of haemorrhaging metastases as it is an efficient, tolerable, brief, outpatient, once-only treatment.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
3/8. Post-apopletic trigeminal trophic syndrome.Trigeminal trophic syndrome is an uncommon clinical entity in which cutaneous trophic ulceration develops with continuous manipulation of trigeminal dermatomes. patients spontaneously refer picking, rubbing and/or scratching at the affected areas because of hypo-anaesthesia, paraesthesia and/or pain following damage of the sensory trigeminal fibres or nuclei. We herein describe a patient who developed the syndrome as a sequela of brain stem infarction. diagnosis by scrape cytology in ruling-out basal cell carcinoma and other ulcerative skin diseases is discussed and the importance of neurological examination in disclosing hemi-anaesthesia of trigeminal dermatome(s) is emphasized.- - - - - - - - - - ranking = 0.4keywords = anaesthesia (Clic here for more details about this article) |
4/8. carbon dioxide laser therapy of a widespread epidermal nevus.BACKGROUND AND OBJECTIVE: The treatment of epidermal nevi is difficult and often unsatisfactory. Many therapeutic approaches have been tried, of which the surgical methods including lasers aim to avoid recurrences and hypertrophic scarring. Here we report the case of a widespread, life-impairing epidermal nevus, summarize the available treatment modalities, and discuss CO2 laser therapy with respect to the clinically soft variants of these developmental defects. STUDY DESIGN/patients AND methods: A patient with a widespread, recurrent, biopsy-proven epidermal nevus was treated with a 10,600-nm CO2 laser. After test treatments in local anaesthesia, four sessions were performed under general anaesthesia each with a follow-up time of 4 years to date. RESULTS: CO2 laser vaporization resulted in complete removal of the treated nevus without any obvious scarring. The patient is free of recurrence 4 years postoperatively. CONCLUSION: CO2 laser treatment of epidermal nevi is a useful modality in selected variants.- - - - - - - - - - ranking = 0.4keywords = anaesthesia (Clic here for more details about this article) |
5/8. Q-switched ruby laser treatment of benign pigmented lesions in Chinese skin.The Q-switched ruby laser has been demonstrated as an effective choice of treatment for a range of benign pigmented lesions. Its wavelength of 694 nm enables deep penetration of the skin allowing the treatment of both epidermal and dermal lesions. However, this wavelength is selectively absorbed by melanin thereby enabling efficient targeting of the lesion's melanocytes. By utilising a Q-switched pulsewidth of 25 nanoseconds, thermal conduction into surrounding tissues is minimised. Lesions such as nevus of ota, chloasma, lentigines and cafe au lait have been successfully treated with energy densities ranging from 6 to 12 J/cm2. Four case histories are described in this report. The clinical evidence indicates that pigmented lesions in Chinese skin must be treated with energy densities higher than those used in Caucasian skin to minimise the incidence of hyper-pigmentation. Typically, lesions require a small number of treatments, usually within the range one to six, to effect complete removal. The technique is easy to apply, with no need for anaesthesia, in many cases.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
6/8. Urological aspects of hemicorporectomy.The indications for hemicorporectomy are few. However, with improvements in surgical techniques, anaesthesia and post-operative surgical care, hemicorporectomy may again become a reasonable treatment for certain patients with malignancies of the pelvis. A 2-stage procedure is described which consists of an initial staging celiotomy with urinary and faecal diversions. A non-refluxing colon conduit is the preferred form of urinary diversion. The hemicorporectomy is performed approximately 2 weeks later. No complications were encountered in the post-operative period. Our experience and a review of the literature suggest that hemicorporectomy is a reasonable salvage procedure for certain patients with pelvic malignancies.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
7/8. Combination of an island advancement flap and a composite graft for reconstruction of the nasolabial defect.BACKGROUND: The alar region is one of the most difficult areas of the face to reconstruct. Up until now, various methods have been demonstrated for achieving the best possible results in terms of cosmetic appearance and function. This report deals with a combination of a random pattern flap and a free composite graft, carried out in two stages. OBJECTIVE: In order to reconstruct the alar region, an island advancement flap as well as a composite graft from the contralateral ear were used. methods: The defect in the cheek-upper lip region was closed using an island advancement flap. In a second operation 2 weeks later, the reconstruction of the alar region was attempted using a composite graft from the right ear. RESULTS: The reconstruction of the contour of the wing of the nose succeeded in a satisfactory manner. There are no functional restrictions on nose breathing. CONCLUSIONS: The combination of an island advancement flap with a composite graft from the ear for the reconstruction of the alar region is essentially a less invasive operation that can be carried out under local anaesthesia and that represents an addition to the previously stated methods.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
8/8. Neuropathological alterations in diabetic truncal neuropathy: evaluation by skin biopsy.OBJECTIVES: To describe the neuropathological features in skin biopsies from patients with diabetic truncal neuropathy. methods: Three patients with diabetic truncal neuropathy underwent skin biopsies from both symptomatic and asymptomatic regions of the chest and trunk. After local anaesthesia, biopsies were performed using a 3 mm diameter punch device (Acupunch). Intraepidermal nerve fibres (IENFs), the most distal processes of small myelinated and unmyelinated nerve fibres, were identified after staining with PGP 9.5 as previously described. RESULTS: Diabetes was diagnosed at the time of the neurological presentation in two, and one was a known diabetic patient. All three had associated sensory-motor polyneuropathy. In all, skin biopsies showed a marked reduction of both epidermal and dermal nerve fibres in the symptomatic dermatomes, compared with skin from asymptomatic truncal areas. In one patient, a follow up skin biopsy when symptoms had improved showed a return of IENFs. CONCLUSIONS: In diabetic truncal neuropathy, skin biopsies from symptomatic regions show a loss of IENFs. After clinical recovery, there is a return of the IENF population, suggesting that improvement occurs by nerve regeneration. These findings suggest that sensory nerve fibre injury in diabetic truncal neuropathy is distal to or within the sensory ganglia. Skin biopsy provides a possible tool for understanding the pathophysiology of the disease.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |