A nineteen year-old boy with progressive enlargement of the joints and distal extremities, clubbing, coarse facial features and hyperhidrosis was investigated. In physical examination, thickening of the scalp with furrowing (cutis verticis gyrata) and greasy thickening of skin (pachyderma) was prominent. His endocrine profile was normal. Radiological studies demonstrated bilateral symmetrical periosteal new bone formation with acroosteolysis and incidental microadenoma of pituitay gland. After extensive investigation to exclude systemic and endocrine causes, the patient was diagnosed as pachydermoperiostosis (PDP). PDP is a rare syndrome manifested clinically by finger clubbing, extremity enlargement, hypertrophic skin changes, and periosteal bone formation. The pathogenesis of the disorder has not been clarified though few endocrine abnormalities were seen. To aware of these clinical phenotype would help to differentiate PDP from acromegaly.
Acro-Osteolysis ; Acromegaly ; Extremities ; Fingers ; Humans ; Hyperhidrosis ; Joints ; Male* ; Osteoarthropathy, Primary Hypertrophic* ; Osteogenesis ; Phenotype ; Physical Examination ; Scalp ; Skin ; Young Adult*

BACKGROUND: This study examined hemodynamic variables, oxygen delivery, extraction, and consumption in response to acute progressive hypoxia and hypercarbia in the setting of apnea. METHODS: Apnea was induced in 9 healthy mongrel dogs by disconnecting animals from mechanical ventilation of 30 minutes with pure oxygen. Hemodynamic variables, oxygen transport, extraction, and consumption were rapidly and repeatedly measured using pulmonary arterial and arterial catheters until cardiac output was undetectable. RESULTS: The baseline PaO2, PaCO2, pH, base excess were 318 +/- 137 mm Hg, 36 +/- 3.5 mm Hg, 7.30 +/- 0.06, 6.81 +/- 2.65 mmol/l respectively. Hypercarbia and hypoxemia (76 +/- 33 mm Hg) was first noted at 1 and 4 minute respectively. Base excess was not changed. Indices of preload (PCWP and CVP) were increased early in the time course (p<0.05). In contrast, indices of afterload (SVR) increased later, just before cardiac decompensation began (p<0.05). No significant reduction of cardiac output, oxygen delivery, extraction, and consumption was detected just until abrupt cardiac decompensation started, 5 minute. CONCLUSIONS: These data suggest that the early increase in preload was primarily due to hypercarbia whereas the late increase in afterload was due to hypoxemia, but the main cause of acute cardiac decompensation was a critical decrease in arterial oxygen tension with some contribution of increased preload and afterload.
Animals ; Anoxia ; Apnea* ; Cardiac Output ; Catheters ; Dogs* ; Hemodynamics* ; Hydrogen-Ion Concentration ; Oxygen* ; Respiration, Artificial

The complications following the use of laryngeal mask(LM) are usually mild and cause clinical problems rarely. However, as the use of LM increases, it seems important to know the common injuries, symptoms, and factors relevant to complications from its use. We investigated prospectively the influence of age, sex, height, weight, duration of LM placement, presence of blood tinged on LM and coughing on LM placement, use of anticholinergics, anticholinesterase, and opioid on the mucosal injuries and patient symptoms in 97 healthy adult patients undergoing elective surgery by the indirect laryngoscopy and questionnaire 8~24 hours after surgery. The upper airway symptoms were throat discomfort(22.7%), and sore throat(10.3%). The findings of mucosal injuries were erythema(27%), edema(5%), and petechial hematoma(2%). The mucosal injuries were centered around the pharynx and the epiglottis(63.6% of total mucosal injuries), and 17 of 21 patients who were observed to have mucosal injuries complained upper airway symptoms. These resuts suggest that the pharynx and epiglottis are most vulnerable to injuries and most common sites causing upper airway symptoms from the LM placement. Vocal cord erythema was found in 8.2% of patients, which was seemed to be due to the grates of the LM aperture. The severity of the mucosal injuries was correlated to the severity of upper airway symptoms(P < 0.05, r=0.464). Male sex, presence of blood on LM, and the longer duration of LM placement were associated with a relatively high incidence of mucosal injuries, and the longer duration of LM placement with that of upper airway symptoms(P < 0.05). After above variables were controlled for, presence of blood on LM was a precipitating factor in mucosal injuries and the longer duration of LM placement was precipitating factor in symptoms(P < 0.05). We failed to find a significant correlation of duration of LM placement with the severity of mucosal injuries or symptoms.
Adult ; Cholinergic Antagonists ; Cough ; Epiglottis ; Erythema ; Humans ; Incidence ; Laryngeal Masks* ; Laryngoscopy ; Male ; Pharynx ; Precipitating Factors ; Prospective Studies ; Surveys and Questionnaires ; Tolnaftate ; Vocal Cords

Pulmonary function test is one of the most important tools in the management of patients with respiratory tract diseases and allergic diseases. As with the difficulties in performing the test, it has been seldom used in pediatric field. But with the advent of simple, computerized tools, pediatric pulmonologist and allergist try to manage the patients using PFT. Still the normal predicted values are variable among the reports. So it is important to have normal predicted value in Korean children. From April to July 1992, pulmonary function test was performed in 965(male: 490, female: 475) primary school-aged children except <3 or >97 percentile of Korean-children Physical developemental standards with history of allergic diseases and respiratory tract diseases ay SungNam, KyongKiDo. We evaluated the predicted normal values of the FEV1.0, FVC and PEFR and logarithmic regression equation setting the predicted values by using the microspirometer of Micromedical Ltd. England that could that could be easily applied to children. 1) Predicted values of pulmonary function test items were generally higher in boys than those of girls. 2) Correlation coefficient to the parameters examined was the highest in height 0.78, then age 0.75, weight 0.70 and chest circumference 0.61.
Child* ; England ; Female ; Gyeonggi-do ; Humans ; Peak Expiratory Flow Rate ; Reference Values ; Respiratory Function Tests* ; Respiratory Tract Diseases ; Thorax

BACKGROUND: Oropharyngeal manipulation is problematic when patients have a gag reflex. Sedation can suppress gag reflex, but can cause serious airway problems. We compared remifentanil (Group R) and propofol (Group P) in terms of cooperation and loss of gag reflex, while drugs were administered incrementally using target controlled infusion (TCI). METHODS: Fifty seven patients who required awake fiberoptic intubation were randomized to Group R or Group P. After measurement of baseline gag trigger point index (GTPI), TCI was set to effect-site concentration (Ce) of 1 ng/ml (Group R) or 1 microg/ml (Group P), then titrated by 0.5 increment until GTPI score reached 0. The incidence of drop-out and decreased cooperation, Ramsay sedation scale (RSS) and Ce at loss of GR, and complications were assessed. RESULTS: Seven patients were dropped out in Group P due to deep sedation and disobedient behavior, but none in Group R (P = 0.015). Gag reflex suppressed as RSS increased in both groups (P < 0.001), however, the incidence of elimination of gag reflex clustered at RSS 2 in Group R (P < 0.001), whereas it was evenly distributed in Group P (P = 0.20). The incidence of patients who were spontaneously roused (gag reflex elimination at RSS 1 and 2) were higher in Group R than in Group P (P = 0.002). CONCLUSIONS: Deep sedation and impaired cooperation were observed only in Group P and spontaneously roused patients were higher in Group R, suggesting that remifentanil is more suitable for cooperative elimination of GR.
Conscious Sedation ; Deep Sedation ; Humans ; Incidence ; Intubation ; Piperidines ; Propofol ; Reflex ; Trigger Points

Two-thirds of ependymomas arise in the infratentorial or intraventricles, whereas one-third are located supratentorially. But supratentorial "cortical" ependymomas are very rare. We report a case of a cortical ependymoma in a 21-month-old boy. The patient presented with simple partial seizures. This tumor was located in the postcentral gyrus and he had gross total excision. Microscopy and immunohistochemistry showed grade II differentiation ependymoma.
Ependymoma* ; Epilepsies, Partial ; Humans ; Immunohistochemistry ; Infant* ; Male ; Microscopy ; Pediatrics ; Supratentorial Neoplasms

No abstract available.

BACKGROUND AND PURPOSE: Discrepancies between objectively measured sleep and subjective sleep perception in patients with insomnia have been reported. However, few studies have investigated sleep-state misperception in patients with obstructive sleep apnea (OSA). We designed this study to 1) delineate the factors that could affect this discrepancy and 2) infer an underlying mechanism in patients with OSA. METHODS: We recruited patients who visited our sleep clinic for the evaluation of their snoring and/or observed OSA. Participants completed a structured questionnaire and underwent overnight polysomnography. On the following day, five sessions of the multiple sleep latency test (MSLT) were applied. We divided the patients into two groups: normal sleep perception and abnormal perception. The abnormal-perception group included patients whose perceived total sleep time was less than 80% of that measured in polysomnography. RESULTS: Fifty OSA patients were enrolled from a university hospital sleep clinic. Excessive daytime sleepiness, periodic limb movement index (PLMI), and the presence of dreaming were positively associated with poor sleep perception. REM sleep near the sleep termination exerted important effects. Respiratory disturbance parameters were not related to sleep perception. There was a prolongation in the sleep latency in the first session of the MSLT and we suspected that a delayed sleep phase occurred in poor-sleep perceivers. CONCLUSIONS: As an objectively good sleep does not match the subjective good-sleep perception in OSA, physicians should keep in mind that OSA patients who perceive that they have slept well does not mean that their OSA is less severe.
Dreams ; Extremities ; Humans ; Polysomnography* ; Sleep Apnea, Obstructive* ; Sleep Initiation and Maintenance Disorders ; Sleep, REM ; Snoring

This report concerns an unusual case of acute postoperative pulmonary edema without any apparent causes in a 45-year-old man. The patient was subjected to the removal of a previously placed device on the left tibia, and the excision of a benign mass on the right forearm. Unexpected acute bilateral pulmonary edema occurred immediately after the completion of the procedures. The etiologies were reviewed in relation to the patient's condition and clinical manifestations. Fluid overloading was excluded as a cause in view of the patient's perioperative state and postoperative chest X-ray results. We could not find any symptoms of upper airway obstruction during emergence from general anesthesia. We had doubts about tourniquet or fentanyl-induced pulmonary edema, but these factors were not sufficient to bring about pulmonary edema in this case. To our knowledge, the cause of acute pulmonary edema in this case is indeterminate.
Airway Obstruction ; Anesthesia, General ; Forearm ; Humans ; Middle Aged ; Pulmonary Edema* ; Thorax ; Tibia ; Tourniquets

BACKGROUND AND OBJECTIVES: Tonsillectomy is one of the most common operations in otolaryngology and is performed with various surgical techniques. It seems that there is no superior technique regarding post-tonsillectomy pain. We attempted to identify preferable methods of tonsillectomy in clinical practice by comparing the levels of postoperative pain. MATERIALS AND METHODS: Between June 2009 and Jan 2010, 80 cases of tonsillectomy were performed. In Group A (age : 10-15 years, 40 cases), 20 cases involved tonsillectomy via snare. The other 20 underwent tonsillectomy using electrocautery. The same surgical division was applied in Group B (25-40 ages, 40 cases). All tonsillectomies were performed under general anesthesia by the same surgeon. RESULT: The mean duration of postoperative pain after tonsillectomy by snare and tonsillectomy by electrocautery in Group A was 5.2+/-2.1 and 6.7+/-3.7, respectively. The mean duration of postoperative pain after tonsillectomy by snare and tonsillectomy by electrocautery in Group B was 7.4+/-1.4 and 10.8+/-3.2, respectively. The results indicate that electrocautery is the more painful method of the two tested methods. The difference in post-tonsillectomy pain was statistically significant between the surgical methods. CONCLUSION: It seems that snare tonsillectomy is a useful method for reducing post-tonsillectomy pain compared with that after electrocautery tonsillectomy.
Anesthesia, General ; Cold Temperature ; Electrocoagulation ; Otolaryngology ; Pain, Postoperative ; SNARE Proteins ; Tonsillectomy