Lidocaline if frequently administered as a component of an anesthetic : for local or regional nerve blocks, to mitigate the autonomic response to laryngoscopy and tracheal intubation, to suppress the cough reflex, and for antiarrythmic therapy. Diazepam dectease the potential central nervous system (CNS) toxicity of local anesthetic agents but -may modify the sitmulant action of lidocaine in addition to their own cardiovascular depressant. The potential cardiovascular toxicity of local anesthetics may be enhanced by the concomitant administration of diazepam. This study was designed to investigate the effects of lidocaine dose and pretreated diazepam to cardiovascular system and plasma concentration of lidocaine. Lidocaine in 100 mcg/kg/min, 200 mcg/kg/min, and 300 mcg/kg/min was given by sequential infusion to dogs anesthetized with halothane-nitrous oxide (Group I). And in group II, after diazepam pretreatment, lidocaine was infused by same way when lidocaine was administered in 100 mcg/kg/min, the low plasma levels (3.97+/-0.22-4.48+/-0.36 mcg/ml) caused a little reduction in cardiovascular hemodynamics. As administered in 200 mcg/kg/min, 300 mcg/kg/min, the higher plasma levels (7.50+/-0.66-11.83+/-0.59 mcg/ml) reduced mean arterial pressure (MAP), cardiac index (CI), stroke index (SI), left ventricular stroke work index (LVSWI), and right ventricular stroke work index (PVSWI) and incresed pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), systemic vascular resistance index (SVRI), but was assciated with little changes of heart rate (HR), mean pulmonary artery pressure (MPAP), and pulmonary vascular resistance index (PVM). When lidocaine with pretreated diazepam was administered in 100 mcg/kg/min, the low plasma level, the lower level than when only lidocaine administered. reduced MAP, but was not changed other cardiovascular hemodynamics. While lidocaine was infused in 200 mcg/kg/min, 300 mcg/kg/min in dogs pretreated diazepam, the higher plasma level (7.64+/-0.79-13.79+/-0.82 mcg/ml) was maintained and was associated with reduced CI, SI, LVSWI and incresed PAWP, CVP, SVRI but was a little changes of HR, MPAP, PVRI. After CaCl2 administeration, CI, SI, SVRI, LVSWI was recovered but PAWP, UP was rather incresed than recovered. The foregoing results demonstrate that pretreated diazepam imposes no additional burden on cardiovascular system when a infusion of large dose of lidocaine is given to dogs anesthetized with halothanenitrous oxide. But caution may be advised if the addition of lidocaine is indicated in subjects who have impared autonomic nervous system and who are in hypercarbic, hypoxic, or acidotic states.
Anesthetics ; Anesthetics, Local ; Animals ; Arterial Pressure ; Autonomic Nervous System ; Cardiovascular System* ; Central Nervous System ; Central Venous Pressure ; Cough ; Diazepam* ; Dogs* ; Heart Rate ; Hemodynamics ; Intubation ; Laryngoscopy ; Lidocaine* ; Nerve Block ; Plasma* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Reflex ; Stroke ; Vascular Resistance

BACKGROUND: As an antihypertensive drug, Nifedipine, a calcium channel blocker was introduced recently, which also has antianginal effect. But due to the relatively short duration of action, another antihypertensive agents having longer duration of action and stronger hypertensive effect were under investigation. Nilvadipine, a new calcium channel blocker, was introduced to have more prologned duration of action and to act more specifically on vascular smooth muscle. So the efficacy and safety of oral Nilvadipine on essestial hypertension was investigated and represented by our institute. METHODS: In order to investigate the efficacy and safety of oral Nilvadipine, daily doses of 4mg twice a day were administered in 30 hypertensive patients whose states were compatible to the criteria : 1) severity of hypertension rated in Stage I and Stage II according to the classification by WHO, 2) ages ranging from 30 to 74 years regardless of sex, 3) blood pressure with 95mmHg or higher but less than 115mmHg in diastolic pressure which was the mean in a sitting position at the last two out of not less three consultations in the 2 week observation period, 4) outpatients with informed consent for 6 weeks. Blood pressure and heart rate were measured every 2 weeks. The complete with blood count with platelet, uronalysis and the electrocardiography were performed at the beginning period and the 6th weeks of therapy. And kinds of side effects were questioned by examining physicians. RESULTS: The following results were obtained : 1) Blood pressure fell significantly in 6 weeks of treatment with Nilvadipine(Mean pressure+/-S.D., 6.00mmHg vs 108.90+/-9.68mmHg p<0.05), 2) There was no significant change in EKG in 6 weeks of treatment with Nilvadipine, 3) Pulse rate was decreased in 6 weeks of treatment with Nilvadipine(80.14+/-11.90/min vs 75.39+/-6.47/min, p<0.05). 4) No significant chsange in body weight was observed(64.50+/-8.7kg vs 63.50+/-10.25kg, p<0.05). 5) There were no significant changes in blood chemistry including blood sugar, cholesterol, electrolytes, serum creatinine and alkaline phosphatase values, 6) Hematologic findings and urinalysis findings reamained unchanged, 7) Total 10 patients(33.30%) had various side effects;facial flushing 30.00%, palpitation 23.33%, headache 20.00%, nausea 10.00%, drowsiness 3.33%, heaviness 3.33% and indigestion 3.33%. But there was no serious side effect that requires to discontinue the medication of the test drug. And there was no need to reduce the dosage due to the side effect, 8) The antihypertensive effect was judged to decrease markedly in 76.70%, decrease 20.00%, unchange 3.30% and increase 0.00%, 9) The utility which was assessed with the data from the overall safety and antihypertensive effect, the drug was judged to be very useful in 60.00%, useful 33.30%, useless 6.67% and inhibited 0.00%. CONCLUSION: From the above results, Nilvadipine in doses of 4mg twice a day was effective and useful in most cases without severe side effects in essential hypertensive patients with diastolic blood pressure of 95 to 115mmHg.
Alkaline Phosphatase ; Antihypertensive Agents ; Blood Glucose ; Blood Platelets ; Blood Pressure ; Body Weight ; Calcium Channels ; Chemistry ; Cholesterol ; Classification ; Creatinine ; Dyspepsia ; Electrocardiography ; Electrolytes ; Flushing ; Headache ; Heart Rate ; Humans ; Hypertension* ; Informed Consent ; Muscle, Smooth, Vascular ; Nausea ; Nifedipine ; Outpatients ; Referral and Consultation ; Sleep Stages ; Urinalysis

In correction of ptosis, symmetry of lid contour, lash position and lid height must be matched. Most of blepharoptosis patients want to perform both the double eyelid operation and ptosis repair at the same time to achieve the best cosmetic and functional result. Using a surgical technique directed at the levator aponeurosis or the frontalis muscle with double eyelid operation, we corrected 13 cases of unilateral and 10 cases of bilateral congenital blepharoptosis. In unilateral ptosis with good or fair levator function, levator resection was performed and the position of the lid margin was adjusted at 1~2 mm below the superior limbus. The height of the lid crease of the ptotic eye is determined 1~3 mm lower than that of normal side. The position of the lid margin is adjusted at the level of the superior limbus and the height of the lid crease of the ptotic eye is determined 2~4 mm lower than that of nonptotic side. The advantages of this approach are normal anatomic planes of the eyelid are maintained, to obtain symmetry of both eyelids relatively easily, entropion may be prevented, and to achieve aesthetically pleasing results.
Blepharoptosis* ; Entropion ; Eyelids* ; Humans

PURPOSE: Is there any relationship between penile size and physical stature? This study was performed to answer this question and provide guidelines of penile size to assist in counseling patients for penile augmentation. MATERIALS AND METHOD: Penile size, body weight and height were measured in 150 young healthy men, and the body mass index(BMI) was calculated in weight(kg)/height(m)2. The penile length and circumference were measured with tape in flaccid and erect states. The 'lengthening ratio' was calculated by 'erect length/flaccid length', and 'tumescent ratio' was calculated by 'erect circumference/flaccid circumference'. All the data was statistically evaluated and the following results were obtained. Result : The average length and circumference were 8.26+/-1.07cm and 8.34+/-1.03cm respectively in the flaccid state, and 13.42+/-1.38cm and 11.17+/-1.05cm in the erect state. The average lengthening and tumescent ratios were 1.64+/-0.22 and 1.35+/-0.08, and were negatively correlated to the flaccid penile length and circumference. Height was positively correlated to erect penile length and lengthening ratio. There was a relationship between body weight and erect penile length in a positive direction, but with other penile parameters there were none. There was no relationship between BMI and any parameters of penile size. However, the erect penile length of the normal BMI group was longer than that of the lower BMI group. CONCLUSIONS: The results show that the flaccid penile size is related to the erect penile size and there is some relation between penile size and physical stature. We believe these results will be applicable to the penile augmentation.
Body Size ; Body Weight* ; Counseling ; Humans ; Male

PURPOSE: This study is for the evaluation of low tesla(0.064T) MR imaging diagnostic accuracy in the internal derangement of the knee. MATERIALS AND METHODS: We retrospectively analysed the MR images of 36 injured knees of 35 patients. The presence of tear was determined by arthroscopy or surgery in all cases. RESULTS: The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of low tesla MRI for the diagnosis of anterior cruciate ligament injury were 83%, 88%, 86%, 77%, 91%, for the posterior cruciate ligament 75%, 95%, 86%, 92%, 83%, for the medial collateral ligament 83%, 96%, 92%, 91%, 92%, for the lateral collateral ligament 67%, 97%, 94%, 67%, 97%, for the menisci 75%, 93%, 89%, 75%, 93%. CONCLUSION: The low tesla MRI is an accurate method in detection and evaluation of the internal derangement of the knee.
Anterior Cruciate Ligament ; Arthroscopy ; Collateral Ligaments ; Diagnosis ; Humans ; Knee* ; Lateral Ligament, Ankle ; Magnetic Resonance Imaging* ; Posterior Cruciate Ligament ; Retrospective Studies ; Sensitivity and Specificity

In this report we describe twenty-two cases of intracranial tumors studied with an MR imager operating at a field strength of 0.064 T for evaluation of the clinical utility of low tesla MRI. The comfirmed diagnoses were meningioma(9 cases), astrocytoma(4 cases), glioblastoma multiforme(1 case), craniopharyngioma(2 cases), intracranial metastasis(1 case). pituitary microadenoma (1 case), hemangioblastoma (1 case), and trigerminal neurilemmoma(1 case). Meningiomas appeared as well-marginated, homogenous signal intensity masses(67%) in most cases. Most meningiomas showed iso-signal intensity(78%) on T1-weighted images, and high signal intensity on T2-weighted images. After Gd-DTPA enhancement, diffuse homogeneous contrast enhancement(75%) was well see. The multiple hemorrhagic foci within the glioblastoma multiforme were identified, which shoed high signal intensity on T1-weighted images and low signal intensity on T2-weighted images(intracellular methemoglobin), or high signal intensity on both T1 and T2-weighted images(extracellular methemoglobin). One case of cerebellar hemangioblastoma was a well-defined cystic mass with contrast enhanced mural nodule but no identification of characteristic signal void vessels. The remianing tumors showed low signal intensity on T1-weighted images, and high signal intensity on T2-weighted images. Gd-DTPA enhancement was helpful in separating the lesion from the surrounding edema or normal tissue, but had limited diagnostic value in characterizing the nature of the mass. The advantages of low tesla MRI are as follows on requirement of cooling water or electricity, open design, shorter T1 relaxation time compared with high tesla unit that increases the difference of T1-relaxation time between tissues, ease of installation, and cost effectiveness. In conclusion, the low tesla MRI is useful for the detection and evaluation of the brain tumors.
Brain Neoplasms ; Cost-Benefit Analysis ; Diagnosis ; Edema ; Electricity ; Gadolinium DTPA ; Glioblastoma ; Hemangioblastoma ; Magnetic Resonance Imaging ; Meningioma ; Relaxation ; Water

A malignant rhabdoid tumor of the kidney, an uncommon renal tumor of children, is one of the most lethal neoplasms in early life. It was considered to be a sarcomatous variant of Wilms' tumor; however, further studies of its histological and clinical characteristics have proven it to be a distinct entity. We report a case of malignant rhabdoid tumor of the kidney in a 3-month-old girl, with a left abdominal palpable mass that had developed over the previous month. A left radical nephrectomy, with a regional lymph node biopsy, and 4 cycles of adjuvant chemotherapy, was performed. On the 45th postoperative day, multiple metastasises in liver, contralateral kidney and left upper lobe of lung were found. The patient expired 2 months after the operation.
Biopsy ; Chemotherapy, Adjuvant ; Child ; Female ; Humans ; Infant* ; Kidney* ; Liver ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Nephrectomy ; Rhabdoid Tumor* ; Wilms Tumor

Eosinophilic granuloma of the cervical spine is an uncommon disease. A 20-year old male patient noticed cervical pain, restricted range of movement, torticollis and tenderness. On computed tomographic scan, myelographic imaging and plain radiographic imaging demonstated a bony destruction in the left side of the third cervical vertebral body and a part of the pedicle. Preoperative radioisotope bone scan demonstrated an hot uptake in the third cervical vertebral body. Gross total removal of the lesion and radiation therapy were performed. Postoperative course was favorable. The lesion is readily curable and should be considered in the diferential diagnosis of pain or neurological deficit in association with a lytic defect in the cervical spine. Occasionally, a solitary lesion characteristic of eosinophillic granuloma in found in cases of otherwise classic Hand-Schuller-Christian. So, close chinical and radiologic follow-up sholuld be obtained.
Diagnosis ; Eosinophilic Granuloma* ; Eosinophils* ; Follow-Up Studies ; Granuloma ; Humans ; Male ; Neck Pain ; Spine* ; Torticollis ; Young Adult

The posterolateral approaches to the spine is an effective method for the neural decompression and the spinal stabilization. This procedure has an advantages of an one-stage posterolateral decompression-stabilization. We have experienced 8 patients with burst fracture in the thoracolumbar junction. A three-quater prone position was used for patient positioning. No patient showed neurologic deterioration after surgery. Patient positioning and the operative approach are described and illustrated.
Decompression* ; Humans ; Patient Positioning ; Prone Position ; Spine*

To report the association of a unilateral serous macular detachment with severe postoperative pain. A 71-year-old woman presented with a sudden decrease in vision in the right eye, seven days after a total knee replacement arthroplasty. The patient's history was unremarkable except for a severe pain greater than the visual analog scale of 8 points for about 2 days after surgery. Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located in the macular area. Fluorecein angiography and indocyanine green angiography showed delayed perfusion of the choriocapillaris without leakage points in the early phase and persistent hypofluorescence with pooling of dye in the subretinal space in the late phase. There was a spontaneous resolution of the serous detachment and the choroidal changes with residual pigment epithelial changes. Severe postoperative pain may influence the sympathetic activity and introduce an ischemic injury with a focal, choroidal vascular compromise and secondary dysfunction of overlying RPE cells in select patients.
Aged ; *Arthroplasty, Replacement, Knee ; Choroid/*blood supply ; Coloring Agents/diagnostic use ; Female ; Fluorescein Angiography ; Humans ; Indocyanine Green/diagnostic use ; Ischemia/diagnosis/*etiology ; Pain Measurement ; *Pain, Postoperative ; Retinal Detachment/diagnosis/*etiology ; Serum ; Vision Disorders/etiology