No abstract available.
Wilms Tumor*

This study was designed to compare the efficacy of an ephedrine intramuscular injection with crystalloidadministration for the prevention of hypotension during spinal anesthesia in geriatric patients undergoing hip fracture surgery. Twenty-seven ASA II patients scheduled for the .arthroplasty of femoral neck fracture under spinal anesthesia were randomly allocated to receive either 15 ml/kg of Ringer's lactated solution (crystalloid group) or an ephedrine intramuscular injection (ephedrine group). Spinal anesthesia was performed in a lateral decubitus position. According to the patient's height, 10-12 mg of hyperbaric 0,5% tetracaine was injected through a 23-25 gauge spinal needle at the L3-4 or L4-5 interspace. Patients in crystalloid group received Ringer's lactated solution 15 mVkg, over 20 minutes before spinal anesthesia. Patients in the ephedrine group were injectede 30 mg of ephedrine I.M immediately after spinal anesthesia. The incidence of hypotension was 8/12 (66%) in the crystalloid group and 6/15 (40%) in the ephedrine group (p<0.01). There was no significant difference between the groups in the level of anesthesia or heart rate, and hypertension did not occur in either group. The result of this study suggests that the intramuscular injection of ephedrine may be more effective than crystalloid infusion for the prophylaxis of hypotension associated with spinal anesthesia in geriatric patients.
Anesthesia ; Anesthesia, Spinal* ; Arthroplasty ; Blood Pressure ; Ephedrine* ; Femoral Neck Fractures ; Heart Rate ; Hip ; Humans ; Hypertension ; Hypotension* ; Incidence ; Injections, Intramuscular ; Needles ; Tetracaine

This study was designed to compare the efficacy of an ephedrine intramuscular injection with crystalloidadministration for the prevention of hypotension during spinal anesthesia in geriatric patients undergoing hip fracture surgery. Twenty-seven ASA II patients scheduled for the .arthroplasty of femoral neck fracture under spinal anesthesia were randomly allocated to receive either 15 ml/kg of Ringer's lactated solution (crystalloid group) or an ephedrine intramuscular injection (ephedrine group). Spinal anesthesia was performed in a lateral decubitus position. According to the patient's height, 10-12 mg of hyperbaric 0,5% tetracaine was injected through a 23-25 gauge spinal needle at the L3-4 or L4-5 interspace. Patients in crystalloid group received Ringer's lactated solution 15 mVkg, over 20 minutes before spinal anesthesia. Patients in the ephedrine group were injectede 30 mg of ephedrine I.M immediately after spinal anesthesia. The incidence of hypotension was 8/12 (66%) in the crystalloid group and 6/15 (40%) in the ephedrine group (p<0.01). There was no significant difference between the groups in the level of anesthesia or heart rate, and hypertension did not occur in either group. The result of this study suggests that the intramuscular injection of ephedrine may be more effective than crystalloid infusion for the prophylaxis of hypotension associated with spinal anesthesia in geriatric patients.
Anesthesia ; Anesthesia, Spinal* ; Arthroplasty ; Blood Pressure ; Ephedrine* ; Femoral Neck Fractures ; Heart Rate ; Hip ; Humans ; Hypertension ; Hypotension* ; Incidence ; Injections, Intramuscular ; Needles ; Tetracaine

Murine typhus is a flea-borne infectious disease caused by Rickettsia typhi, of which myocarditis is a rare complication in the acute disseminating phase. A 62-year-old female presented with a fever and was diagnosed with murine typhus. She was treated with doxycycline and discharged after complete resolution of the fever. However, recurrent presyncope and exertional dyspnea developed 6-8 weeks later. Complete atrioventricular (AV) block with a wide QRS escape rhythm and a left bundle branch block configuration was documented. Subacute myocarditis was diagnosed based on persistent cardiac troponin-I elevation and typical cardiac magnetic resonance imaging findings. A permanent pacemaker was implanted for symptomatic complete AV block. Few reports of myocarditis in murine typhus have been published. We report a case of murine typhus myocarditis complicated by complete AV block in the late convalescence phase.
Atrioventricular Block ; Bundle-Branch Block ; Communicable Diseases ; Convalescence ; Doxycycline ; Dyspnea ; Female ; Fever ; Humans ; Magnetic Resonance Imaging ; Myocarditis ; Rickettsia typhi ; Syncope ; Troponin I ; Typhus, Endemic Flea-Borne ; United Nations

The management of pineal region tumors remains controversial. Advocates of a conservative approach emphasize the excellent results of radiotherapy, particularly with germinoma, while a number of recent reports have demonstrated the safety of direct surgery. We analyzed 8 cases of pineal region tumors which had been treated at our institution over the past 7 years. Tissue diagnosis was obtained in 3 patients before irradiation and 5 patients underwent irradiation without histological diagnosis. Among 5 irradiated patients initially, four patients had been achieved complete remission by radiotherapy thus they were presumptively germinoma, but other one patient had no response, so she had been underwent surgery. Among 3 biopsy proven cases, 2 were teratoma and other one was embryonal carcinoma. Complete gross microsurgical excision of well encapsulated tumor was possible in two teratoma cases. MRI and other neuroradiological studies have ben found to be useful in indicating the biological nature and histological type of pineal tumor. So, consideration of MRI scans together with tumor markers and response to small dose irradiation will generally allow a specific diagnosis with a high degree of probability. In this way, germinomas may be selected for radiotherapy and the tumor less likely to response may be subject to primary surgery to obtain complete tumor extirpation or tissue diagnosis.
Biopsy ; Carcinoma, Embryonal ; Diagnosis ; Germinoma ; Humans ; Magnetic Resonance Imaging ; Pinealoma ; Radiotherapy ; Teratoma ; Biomarkers, Tumor

BACKGROUND AND OBJECTIVES: With the wide use of cochlear implants, there have been many published studies which report that cochlear implants have a suppressive effect on tinnitus in profoundly deaf patients. The aim of this study was to understand the clinical and audiologic characteristics of the tinnitus in patients with cochlear implantation and to observe changes of their tinnitus after cochlear implantation. SUBJECTS AND METHOD: A total 23 patients who had undergone cochlear implants in our hospital from August 2003 to December 2006, were included in this study. The patients were divided into tinnitus (n=11) and non-tinnitus groups (n=12) according to the presence of tinnitus at the time of surgery. We compared clinical and audiologic features between the two groups. We also studied changes in tinnitus after surgery in the tinnitus group using validated self-report measures [tinnitus handicap inventory (THI), tinnitus handicap score (THS), and visual analogue scale]. RESULTS: There were significant differences between the two groups with respect to the age of cochlear implant recipients, whether or not the subjects had impaired hearing or were wearing hearing aids. Tinnitus was rarely observed in patients under 20 years of age with cochlear implantation (11.1%) in contrast to the higher rates in the patients of 20 years old and over (71.4%). Marked reduction of THI, THS and visual analogue scale of tinnitus were observed in all patients. CONCLUSION: For the adult patients who had undergone cochlear implant surgery and had tinnitus preoperatively, cochlear implants had shown suppressive effect on their tinnitus. Considering the significant prevalence of tinnitus in profoundly deaf patients, tinnitus of these patients should not be overlooked and further studies should be made to define relationship between cochlear implant and tinnitus.
Adult ; Cochlear Implantation ; Cochlear Implants ; Hearing ; Hearing Aids ; Humans ; Prevalence ; Tinnitus

BACKGROUND AND OBJECTIVES: For patients with sudden hearing loss or retina arterial spasm, stellate ganglion block (SGB) has been used as a treatment method to increase the blood flow to the interested area. The aim of this study is to prospectively investigate the efficacy of SGB in patients with olfactory dysfunction following upper respiratory tract infection (URI). MATERIALS AND METHOD: Fifty one patients with anosmia or hyposmia following URI were included. The average duration of olfactory dysfunction was 3.5+/-8.4 years. Thirty eight patients were treated with SGB and compared with the untreated 13 patients. Buthanol threshold test and odor identification test with 16 natural fragrances were used to determine anosmia/hyposmia in these patients and to quantify the improvement of olfactory perception after SGB treatment or follow-up without treatment. RESULTS: Olfactory perception was improved significantly in the treated patients as shown by the buthanol threshold test (p<0.001) and by odor identification test (p<0.001). Subjective olfactory perception was improved in 27 of the 38 treated patients (p<0.001). No complications were observed after SGB and no one reported any worsening in olfactory perception during or after treatment. On the other hand, none of the untreated patients showed any improvement in neither of the tests or the subjective assessment. CONCLUSION: These results suggest that SGB may be a new treatment modality for olfactory dysfunction following URI.
Follow-Up Studies ; Hand ; Hearing Loss, Sudden ; Humans ; Odors ; Olfaction Disorders ; Olfactory Perception ; Prospective Studies ; Respiratory System* ; Respiratory Tract Infections* ; Retina ; Smell ; Spasm ; Stellate Ganglion*

The effects of subarachnoid administration of 0.5% bupivacaine in 5% and 10% glucosesolution were investigated in a randomized 30 cases undergoing a low limb and low abdominal surgery in the Department of Anesthesiology at the Hanyang University Hospital from October 1st, 1984 to March 31st, 1985. The results are as follows: 1) These were no significant differences between the patients of the three groups in relation to sex, age, weight, height and operation time. 2) The oneset time of the maximum segmental spread of analygesia in the control group was 5 to 10 minutes and 10 to 15 minutes in the experimental groups. 3) The spread of sensory blockade in the experimental groups was lowered 2~3 segment compared with control group. 4) The onset time of complete motor blockade in the control group was 5 minutes and 5~10 minutes in the experimental group. 5) Duration of complete motor blockade in experimental groups was shorter than the control group. 6) The cardiovascular changes were investigated with no significant differences between the patients of the three groups. 7) The minimal complications such as mild hypotension in three cases, micturition difficulty in one case, mild translent headache in one case were investigated in the three groups. According to our investigation of subarachnoid blockade with 0.5% bupivacain 2ml in 5% and 10% glocose solution, it considered that the spread was limited and produced intense sensory and motor block of long duration which was suitable of the low limbs and low abdominal surgery.
Anesthesiology ; Bupivacaine ; Extremities ; Headache ; Humans ; Hypotension ; Urination

PURPOSE: Mitochondrial disorders are a clinical entity characterized by diverse symptoms and signs of involvement of various systems. Furthermore, the disorders are known to show ophthalmologic manifestations as well as neurological findings. Visually evoked potential is a sensitive measure to check the integrity of the visual pathway. In this study, we have investigated the value of visually evoked potential in mitochondrial disorders with respiratory chain defects. METHODS: Nineteen patients diagnosed with mitochondrial respiratory chain complex I defect as confirmed by spectrophotometric enzyme assay in muscle samples were enrolled for this study. The patients underwent a visually evoked potential study. We classified the results into four groups and compared these with clinical ophthalmologic findings. RESULTS: Among the 19 patients, 14 showed abnormal visually evoked potential findings. Seven patients showed abnormal clinical ophthalmologic findings. All patients with abnormal ophthalmologic findings showed abnormal visually evoked potential findings. Among the 12 patients with normal ophthalmologic findings, seven showed abnormal results in visually evoked potential. CONCLUSION: Visually evoked potential study could be used as an effective screening tool for mitochondrial disorders to detect ophthalmologic and neurological abnormalities.
Child ; Electron Transport ; Enzyme Assays ; Evoked Potentials ; Eye ; Humans ; Mass Screening ; Mitochondria ; Mitochondrial Diseases ; Muscles ; Visual Pathways

Intraoperative pulmonary thromboembolism (PTE) is rare, but is nevertheless one of the important causes of morbidity and mortality in patient undergoing surgery. However, The detection of PTE is difficult because it's clinical symptoms and signs are nonspecific during surgery, and specialized diagnostic tools are not readily available in the operating room. We report a case of PTE due to cancer emboli with thrombi encountered during a nephrectomy in patient with renal cell cancer, and demonstrate that one-lung ventilation can aid in the diagnosis of massive PTE when the evaluation is suspected.
Carcinoma, Renal Cell ; Diagnosis ; Humans ; Mortality ; Nephrectomy ; One-Lung Ventilation* ; Operating Rooms ; Pulmonary Embolism*