BACKGROUND: Induction of general anesthesia with tracheal intubation and skin incision are potent stimuli that can induce increased sympathetic activity, heart rate and blood pressure. We compared the hemodynamic response and catecholamine concentration during general anesthesia with intravenous clonidine pretreatment, a centrally acting -2 adrenoceptor agonist, and without pretreatment. METHODS: Forty ASA I or II patients aged from 20 to 60 years undergoing elective surgery were randomly allocated to two groups. In group I, 5 ml of 0.9% normal saline as control administered intravenously 10 minutes before induction of anesthesia, and anesthesia was induced with thiopental sodium, succinylcholine and maintained with N2O (2.5L/min)-O2 (2.5L/min)-enflurane (1.3~1.8 vol%). In group II, 4 g/kg clonidine diluted in 5ml of normal saline administered intravenously 10 minutes before induction of anesthesia, and anesthesia was induced with thiopental sodium, succinylcholine and maintained with N2O-O2-enflurane (0.5~1.0vol%) and 2 g/kg/hr clonidine was continuously infused. We measured blood pressure, heart rate and plasma catecholamine at preinduction, 1 minute after intubation (T1), 1 (T2) and 30 minutes after skin incision (T3) and compared with group I. RESULTS: There was statistical significance in systolic and diastolic pressure at T1 between two groups. There was statistical significance in heart rate, epinephrine and norepinephrine at T1, T2 and T3 between two groups. CONCLUSION: The elevation of blood pressure, heart rate and plasma catecholamine accompanying tracheal intubation and skin incision may be prevented by administration of intravenous clonidine.
Adult ; Anesthesia ; Anesthesia, General* ; Blood Pressure* ; Brain ; Clonidine* ; Epinephrine ; Heart Rate* ; Heart* ; Hemodynamics ; Hemorrhage ; Hope ; Humans ; Incidence ; Intubation* ; Larynx ; Male ; Norepinephrine ; Plasma* ; Skin ; Spondylitis, Ankylosing ; Succinylcholine ; Thiopental

Thelazia callipaeda is a slender, long, and cylindrical nematode which parasitizes in the conjunctival sac of human and causes conjunctivitis. The animals such as the dog, rabbit, horse, deer, and cow were revealed as its reservoir and some species of the fly suspected as its vector. We experienced a case of T. callipaeda isolated from human conjunctival sac of a 41-year old man who lived in Wanju-gun, Chonbuk province and raised the dogs. He complained of an irritation, itching and foreign body sensation on his right eye and the two worms were picked out of his right eye by forceps from conjunctival sac. General features of the worms were ivory colored and slender. Two worms were 15.2mm and 15.8mm in length and both have less than 1.0mm in maximum width. Microscopically, both of the worms were female. The vulva opening of the worms located anterior to esophago-intestinal junction. The uterus filled with the eggs an6 larvae encysted with oval membrane. The buccal cavity in head portion was tetrazoid and connected with well-developed esophagus. At the tails of the worms, anus and papillae were observed. Characteristic compact cuticular transverse striations were identified on the whole body surface.
Adult ; Anal Canal ; Animals ; Conjunctivitis ; Deer ; Diptera ; Dogs ; Eggs ; Esophagus ; Female ; Foreign Bodies ; Head ; Horses ; Humans* ; Jeollabuk-do ; Larva ; Membranes ; Ovum ; Pruritus ; Sensation ; Surgical Instruments ; Tail ; Thelazioidea* ; Uterus ; Vulva

Hypertrophic cardiomyopathy (HCM) has diverse pathophysiological and clinical features, according to the extent and severity of the hypertrophy development. Hypertrophy mostly involves the left ventricle and sometimes causes a left ventricular outflow tract obstruction. Right ventricular involvement is less frequent, and even the severe form of a right ventricular outflow tract (RVOT) obstruction by concurrent right ventricular hypertrophy in a patient with HCM is rare. We report a case of biventricular HCM with a clinically, morphologically, and hemodynamically significant RVOT obstruction, which had been treated successfully with surgical myectomy.
Cardiomyopathy, Hypertrophic ; Heart Ventricles ; Humans ; Hypertrophy ; Hypertrophy, Right Ventricular

Hypertrophic cardiomyopathy (HCM) has diverse pathophysiological and clinical features, according to the extent and severity of the hypertrophy development. Hypertrophy mostly involves the left ventricle and sometimes causes a left ventricular outflow tract obstruction. Right ventricular involvement is less frequent, and even the severe form of a right ventricular outflow tract (RVOT) obstruction by concurrent right ventricular hypertrophy in a patient with HCM is rare. We report a case of biventricular HCM with a clinically, morphologically, and hemodynamically significant RVOT obstruction, which had been treated successfully with surgical myectomy.

Isolated and severe left main coronary ostial stenosis is a rare case. In the majority of these patients ostial stenosis was associated with any of the conditions known to involve the coronary ostia. These conditions include syphilitic aortitis, Takayasu's aortitis, familial hypercholesterolemia, and aortic valve disease. A 34-year young female patient was presented with exertional and stabbing anterior chest pain. There was no history of syphilis, diabetes mellitus, hypertension, hyperlipidemia and smoking. Coronary angiogram showed isolated left main coronary ostial stenosis. Transesophageal echocardiography(TEE) showed acute angle takeoff of the left main coronary artery. She underwent surgical angioplasty of coronary ostia with a patch of autologous pericardium. After angioplasty, TEE showed dilatation of left main coronary ostium and her clinical symptom improved.
Angioplasty ; Aortic Valve ; Aortitis ; Chest Pain ; Constriction, Pathologic* ; Coronary Vessels ; Diabetes Mellitus ; Dilatation ; Female ; Humans ; Hyperlipidemias ; Hyperlipoproteinemia Type II ; Hypertension ; Pericardium ; Smoke ; Smoking ; Syphilis ; Syphilis, Cardiovascular

BACKGROUND: We evaluated the performance of the Rapidlab 860 (Chiron Diagnostics, Medfield, MA, USA), the newly introduced automated blood gas&electrolytes analyzer, according to the guidelines of the National Committee for Clinical Laboratory Standards. METHODS: The tested analytes were pH (hydrogen ion activity), PCO(2) (carbon dioxide pressure or tension), PO(2) (oxygen pressure or tension), Na(+) (sodium), K(+) (potassium), Ca(++) (ionized calcium), Cl(-)(chloride), HCO(3)(-)(bicarbonate), ctCO(2) (concentration of total carbon dioxide). Within-day precision, between-day precision, and sample-related carryover were analyzed using quality control materials at three different concentration levels for each analyte. Correlation was compared with the routinely used NOVA-Stat Profile 5 (Nova Biomedical, Waltham, MA, USA) with patient's whole blood samples. RESULTS: The within-day coefficients of variations (CVs) for pH, PCO(2), Na(+), K(+), Ca(++), HCO(3)(-), and ctCO(2) were less than 5.0%. The within-day CVs for PO(2) and Cl(-) at low concentration levels were 7.128% and 5.065%, respectively. The between-day CVs for each group were less than 5.0% in all analytes. Sample-related carryover was less than 5.0% in all items. Coefficients of correlation exceeded 0.950 except for PCO(2) and HCO(3)(-). CONCLUSIONS: Rapidlab 860 showed good precision, close correlation with NOVA-Stat Profile 5 and sample-related carryover was barely present for pH, PCO(2), PO(2), Na(+), K(+), Ca(++), Cl(-), HCO(3)()-ctCO(2).
Carbon ; Electrolytes* ; Hydrogen-Ion Concentration ; Quality Control

A thirty nine year-old male patient was scheduled for emergent craniotomy and epidural hematoma evacuation under general anesthesia. All data of the preoperative check lists for emergent operation were within normal limits and vital signs of the patient were stable. During the induction of anesthesia an armored tube was inserted into the trachea for this operation. Approximately 110 minutes after the induction of anesthesia, signs of complete airway obstruction developed abruptly. At that time we deflated the cuff balloon to exchange the tube. Then, the signs of airway obstruction disappeared completely. Therefore the deflation of cuff balloon is recommended in order to exclude the obstruction by the displaced cuff.
Airway Obstruction* ; Anesthesia ; Anesthesia, General ; Craniotomy ; Hematoma ; Humans ; Intubation ; Male ; Trachea ; Vital Signs

BACKGROUND: Angiotensin II (Ang II) appears to play important roles in the pathogenesis of hypertension. However, the mechanism by which Ang II induces vascular smooth muscle contraction is not fully understood. The phosphorylation of myosin light chain (MLC) is an essential trigger of the cascade that initiates of smooth muscle contraction. In this study, we investigated the role of MLC phosphorylation on Ang II-induced vascular smooth muscle contraction. METHODS: Rat thoracic aortas were used as an experimental substrates. We measured isometric tension, myosin light chain phosphorylation, intracellular Ca2+ concentration, mitogen-activated protein kinase phosphorylation, and tyrosine phosphorylation. RESULTS: 100 nM Ang II increased smooth muscle contraction transiently in rat thoracic aorta. Ang II also increased intracellular Ca2+ and 20 kDa MLC phosphorylation. Pretreatment with 10microM verapamil and 30microM La3+ abolished the contraction developed at 30 seconds by Ang II, whereas pretreatment with 10microM verapamil and 30microM La3+ abolished the contraction and the intracellular Ca2+ increase induced at 2 minutes by Ang II. Moreover, pretreatment of 10microM verapamil, 30microM La3+ and 1microM thapsigargin abolished the contraction as well as intracellular Ca2+ increase developed at 30 seconds and 2 minutes by Ang II. However, MLC phosphorylation was not affected. GF109203X attenuated Ang II-induced contraction more so than ML-7. 100 nM Ang II increased tyrosine phosphorylation of mitogen-activated protein kinase, 68 and 125 kDa proteins. The 125 kDa protein was confirmed as paxillin in primary vascular smooth muscle cell culture. CONCLUSIONS: Ang II-induced contraction involves Ca2+-dependent and independent components, and Ca2+-dependent contraction by Ang II is mediated by voltage-dependent Ca2+ channel. Moreover, protein kinase C and the mitogen-activated protein kinase activation pathway are involved in Ang II-induced contraction.
Angiotensin II ; Animals ; Aorta, Thoracic ; Calcium ; Cell Culture Techniques ; Hypertension ; Muscle, Smooth* ; Muscle, Smooth, Vascular ; Myosin Light Chains ; Paxillin ; Phosphorylation ; Protein Kinase C ; Protein Kinases ; Rats* ; Thapsigargin ; Tyrosine ; Verapamil

The Iinvolvement of subaortic structures in the aortic valve endocarditis appears more commonly than previously recognized. These subaortic complications are most commonly located in the mitral-aortic intervalvular fibrosa and may be presented as abscess, or as pseudoaneurysm with or without perforation. Perforated pseudoaneurysm can lead to the development of communication between the left ventricular outflow tract and various cardiac chambers, most commonly the left atrium. These complications are related with poor prognosis. Early and precise recognition of these complications is important for optimal treatment. At present, transesophageal echocardiography (TEE) has been validated as the technique of choice. We describe a case of infectious pseudoaneurysm of mitral-aortic intervalvular fibrosa featuring the connection of the fistulous simultaneously to the left atrium and aorta. In our case, accurate interpretation of TEE imaging revealing the subaortic structures was not so easy due to interference of both aortic and mitral prosthetic valves. We expect the further development of (Ed-confirming that here you don't intend, "We expect to further develop") TEE and other imaging modalities to substantially improve the future diagnosis of these undesirable complications.
Abscess ; Aneurysm, False* ; Aorta ; Aortic Valve* ; Diagnosis ; Echocardiography, Transesophageal ; Endocarditis* ; Fistula* ; Heart Atria ; Prognosis

Propofol is a rapidly acting intravenous anesthetic agent used for the induction of anesthesia, with a low incidence of side effects. But pain on injection of propofol has limited its use. The additional effect of lidocaine on painful injection of propofol was studied, during induction of general anesthesia in 75 patients in a prospective, randomized method. They were allocated randomly to three groups to receive propofol 2.0 mg/kg(group A), propofol 2.0 mg/kg with lidocaine 0.2 mg/kg(group B), propofol 2.0 mg/kg with lidocaine 0.3 mg/kg(group C). Pain score was assessed on a simple scale graded from 0 (no pain) to 3 (severe pain). Mean arterial blood pressure and heart rate were monitored at 1, 3, 5, 7 minutes after endotracheal intubation. In group B and C, significantly smaller pain score was observed. On the other hand, changes of mean arterial blood pressure and heart rate after endotracheal intubation was not significant. It is concluded that the addition of small amount of lidocaine can significantly reduce the severity of pain on injection of propofol.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Hand ; Heart Rate ; Humans ; Incidence ; Injections, Intravenous ; Intubation, Intratracheal ; Lidocaine* ; Propofol ; Prospective Studies