No abstract available.
Histiocytosis*

Malignant hyperthermia is a dramatic syndrome that rarely arises during anesthesia and which is still fatal in the majority of cases. It is a hypermetabolic muscle condition characterized by hyperpyrexia and skeletal muscle rigidity. Any potent inhalation anesthetic agent or any skeletal muscle relaxant can trigger this acute catast rophic reaction. A case is presented of a 28 year old femal with a family history of malignant hyperthermia in herrelatives. She sunderwent repair of a retinal detachment under N2O-O2-halothane withcinduction by thiopenthal and succinylcholine. One and half hours after induction, arrhythmia developed and was followed by unstable blood pressure, hyperpyrexia, muscular rigidity. Anesthesia was ended and vigorous emergency treatment was attempted. But she died postoperatively on the 4th day after anesthesia. The etiologic factors, incidence, clinical feature, prevention, treatment and prognosis of malignant hyperthermia are discussed.
Incidence

The degenerative spondylolisthesis is one of the most common causes of the prominent central and recess stenosis which are produced by the hypertrophy of the facet joints and anterior slipping of the posterior arch. The resulting neurogenic symptoms in the legs are the major causes of the surgical treatment in the degenerative spondylolisthesis and the complete decompression is indicated for these types of spinal stenosis. The decompression procedures performed in the degenerative spondylolisthesis makes more unstable and induce the late instability and the post
Clinical Study ; Constriction, Pathologic ; Daegu ; Decompression ; Decompression, Surgical ; Hypertrophy ; Korea ; Leg ; Lumbar Vertebrae ; Nerve Compression Syndromes ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Zygapophyseal Joint

It is well known that the mortality rate is very high in the patients with cerebrovascular disease (CVD). The most common cause of death in the ischemic CVD patients is myocardial infarction. The purpose of this study is to evaluate the diagnostic significance of myocardial perfusion SPECT for coronary artery disease (CAD) in ischemic CVD. We studied in 64 patients with transient ischemic attack and ischemic stroke diagnosed by means of the clinical history and brain CT and MRI. Electrocardiography, myocardial perfusion SPECT and coronary angiography were performed. We checked hypertension, diabetes, smoking, alcohol drinking and hyperlipidemia as the risk factors in ischemic CVD and CAD. The myocardial perfusion SPECT was abnormal in 37 out of 64 patients(57.8%) with ischemic CVD. There was a increasing tendency in the prevalence of myocardial perfusion abnormality in the elderly patients (more than 65 years old). The incidence of abnormal myocardial perfusion SPECT was not significantly different among TIA, lacunar infarction, minor infarction and major infarction. The long standing hypertension and hyperlipidemia were siginificant risk factors in the ischemic CVD and CAD as having the abnormal myocardial perfusion SPECT (p<0.05). There were not significantly different between resting EKG and myocardial perfusion SPECT results. Coronary artery stenosis was identified in 5 out of 7 patients receiving coronary arteriography. The results suggested that ischemic stroke is frequently associated with coronary artery disease. So myocardial perfusion SPECT as an active investigation for CAD in Ischemic CVD should be considered in order to optimal management.
Aged ; Alcohol Drinking ; Angiography ; Brain ; Cause of Death ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis* ; Electrocardiography ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Mortality ; Myocardial Infarction ; Perfusion* ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Stroke ; Stroke, Lacunar ; Tomography, Emission-Computed, Single-Photon*

Hand-foot-mouth disease (HFMD), one of the more distinctive rash syndromes, is most frequently caused by coxsackievirus A16, but can also be caused by enterovirus 71 (EV71) and other coxsackieviruses. Recently, there have been large outbreaks of simple, neurologically complicated and even fatal HFMD caused by EV71 in Western Pacific Area. However, in the Republic of Korea, despite its location in EV71 endemic Western Pacific Area, published reports on HFMD with EV71 are rare and there are no published reports on fatal cases. After the first fatal case of HFMD caused by EV71 announced in May 2009, much more cases of neurologically complicated HFMD have been announced. Even now, physician's increased awareness about the seriousness of HFMD, viral surveillance and early warning system of HFMD, and early detection and proper management of potentially life threatening HFMD caused by EV71 are required in the Republic of Korea, as in the neighboring countries.
Disease Outbreaks ; Enterovirus ; Exanthema ; Republic of Korea

PURPOSE: Prolonged hepatic ischemia followed by reperfusion in surgery or transplantation results in severe cell death. Apoptosis is one type of cell death and occurs under various conditions. Apoptosis differs from necrosis not only morphologically but also in the mediators and mechanism of injury. It has been recently recognized that oxygen-free radicals are major mediators of apoptosis during ischemia/reperfusion. It was reported that pretreatment with a radical scavenger, such as catalase or superoxide dismutase (SOD) attenuated the apoptotic cell death and that old animals showed a higher catalase, SOD, glutatione peroxidase activity in their livers than young rats. This study was designed to characterize the types of cells within the liver and the extent to which those cells undergo apoptosis during ischemia/reperfusion in rats of different ages and to investigate the effect of dimethylthiourea (DMTU), a scanvenger of reactive hydroxyl radicals, on the induction of apoptosis in old rats. METHODS: Young male Sprague-Dawley rats at 5 weeks of age weighing about 200 gm and old rats at 15 weeks of age weighing about 450 gm were subjected to 30-minute ischemia. Liver ischemia was performed by inflow occlusion. Another group of old rats was injected with DMTU before the clamping. The rats were sacrificed immediately and at 1, 3, and 24 hour(s) after reperfusion. The specimens were prepared using in-situ staining for apoptotic cell and bodies by using terminal deoxytransferase-mediated dUTP- biotin nick-end labelling (TUNEL) methods. RESULTS: The number of apoptotic sinusoidal endothelial cells was larger than the number of hepatocytes during ischemia/reperfusion. The apoptosis of hepatocytes significantly increased at 1 hour and at 3 hours in the young group. Although the number of cells in the old group was lower than that in young rats, an increase of TUNEL positive hepatocytes cells was noted at 1 hour. There was significant increase in the DMTU-pretreated old rats until 24 hours afterreperfusion. The number of apoptotic sinusoidal endothelial cells was noticeably higher in DMTU- pretreated old rats than you only defined two groups previously: old and young in the other group. In young rats, but not old rats, an increase of positive sinusoidal endothelial cells was observed at 1 hours after reperfusion. CONCLUSION: These results suggested that old rats have more resistance to ischemia/reperfusion injury than young rats and that DMTU dose not attenuate apoptosis of sinusoidal endothelial cells after ischemia/reperfusion, but dose attenuate apoptosis of hepatocytes in the liver.
Animals ; Apoptosis* ; Biotin ; Catalase ; Cell Death ; Constriction ; Endothelial Cells ; Hepatocytes ; Humans ; In Situ Nick-End Labeling ; Ischemia* ; Liver* ; Male ; Necrosis ; Peroxidase ; Rats* ; Rats, Sprague-Dawley ; Reperfusion* ; Superoxide Dismutase

PURPOSE: This study was performed to investigate the epidemiology of enterovirus (EV) infections in children at a secondary hospital during recent 5 years. METHODS: We collected the cerebrospinal fluid, stool and throat swab samples from the pediatric patients with suspected EV infections in KEPCO Medical Center, Seoul, Korea from July 2006 to September 2010. EV detection and genotype identification were performed by RT-PCR at Korea Centers for Disease Control and Prevention. RESULTS: A total of 386 samples were collected from 277 patients during study period. Ninety-eight patients (35.4%) were diagnosed with EV infections. The RT-PCR positive rate was the highest in throat swab samples (48.3%). The median age of patient was 4.7 years (range, 0.1-12.5 years). Aseptic meningitis (50, 51.0%) was the most common clinical manifestation; herpangina (22, 22.4%) and hand-foot-mouth disease (18, 18.4%). One hundred EVs were isolated from 98 patients and 20 genotypes of EV were identified; Echovirus 30 (28 cases, 28%), Enterovirus 71 (12 cases, 12%), Echovirus 25 (10 cases, 10%), Echovirus 9 (9 cases, 9%) and Coxsackievirus A6 (8 cases, 8%). Aseptic meningitis caused by Echovirus 30 was the most common manifestation in 2008. There was no complicated case caused by Enterovirus 71. CONCLUSION: This study showed the epidemiology of confirmed EV infection in children from 2006 to 2010. There is a need for continuous surveillance of EV infections and its clinical manifestations.
Centers for Disease Control and Prevention (U.S.) ; Child ; Echovirus 9 ; Enterovirus ; Enterovirus B, Human ; Enterovirus Infections ; Genotype ; Herpangina ; Humans ; Korea ; Meningitis, Aseptic ; Pharynx

BACKGROUND: Tracheal intubation is usually carried out under a combination of general anesthesia and muscle relaxation. Recent sutdies have found satisfactory conditions for intubation of the trachea without using muscle relaxants. However, these studies have used large amounts of propofol or expensive opioids like alfentanil and remifentanil. In this study, we evaluated intubation conditions and success rate with midazolam, fentanyl, propofol and either 10% lidocaine applied topically into the larynx and trachea or not. METHODS: Forty patients of ASA class I or II were randomly allocated to one of two groups. All patients received glycopyrrolate 0.2 mg, midazolam 0.03 mg/kg and fentanyl 2 mcg/kg IV before induction of anesthesia and propofol 2 mg/kg IV for induction of anesthesia. Group I patients (n = 20) received 10% lidocaine into the larynx and trachea topically, and group II patients (n = 20) did not. After loss of the eyelid reflex, laryngoscopy and endotracheal intubation were attempted and airway conditions were graded. The success rate of intubation was evaluated. RESULTS: Intubation without a muscle relaxant was possible in 19 of 20 (95%) patients in group I and 8 of 20 (40%) patients in group II. There were no significant differences in scoring criteria for various airway conditions such as jaw tone, vocal cord exposure and cord position. CONCLUSIONS: Induction of anesthesia with midazolam 0.03 mg/kg, fentanyl 2 mcg/kg and propofol 2 mg/kg combined with 2 ml of 10% lidocaine spray into the larynx and trachea offered a satisfactory success rate of intubation without muscle relaxants.
Alfentanil ; Analgesics, Opioid ; Anesthesia ; Anesthesia, General ; Eyelids ; Fentanyl ; Glycopyrrolate ; Humans ; Intubation ; Intubation, Intratracheal* ; Jaw ; Laryngoscopy ; Larynx ; Lidocaine* ; Midazolam ; Muscle Relaxation ; Propofol ; Reflex ; Trachea ; Vocal Cords

The use of radiopharmaceuticals in evaluation of pulmonary tuberculosis may help to resolve difficult diagnostic problems such as discordance between sputum examinations and chest roentgenographic findings. We investigated the usefulness of 99mTc-methoxyisobutylisonitrile(MIBI) scintigraphy in the detection of active pulmonary tuberculosis. Forty-six patients with suspected active pulmonary tuberculosis were studied with sputum smear of AFB, sputum AFB culture, chest X-ray and MIBI scan. MIBI image was obtained 15 and 60 min after intravenous injection of 370MBq(10mCi) 99mTc-MIBI. In 16 patients of them Ga scans were performed in addition to MIBI scan. Repeated MIBI scans were done in 7 patients with active pulmonary tuberculosis after 4~6 months of antituberculous chemotherapy. Thirty-two patients were confirmed as active tuberculosis by sputum culture. Sensitivity of MIBI scan to active tuberculosis was 87.5%(28/32) and MIBI findings were negative in all of 14 patients with inactive disease. Focal uptake of MIBI was dense in the area that was strongly suggested active tuberculous lesions by chest roentgenogram. There was no discordance between MIBI and Ga image in 16 patients. But the uptake areas of Ga images were broader than that of MIBI images. After 4~6 months of antituberculous treatment all repeated MIBI scans revealed negative findings except 1 patient with persistent active pulmonary tuberculosis due to drug resistance. MIBI scan could be used in the detection of active pulmonary tuberculosis as a useful noninvasive diagnostic tool.
Drug Resistance ; Drug Therapy ; Humans ; Injections, Intravenous ; Radionuclide Imaging ; Radiopharmaceuticals ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

We examined the hepatitis G virus infections among 227 Koreans who were healthy or were suspected of hepatitis and determined the phylogenetic relationship based on a part of the NS-5 region of 5 positive samples. Viral RNA was extracted from sera and cDNA was synthesized and subsequently amplified by RT-PCR (reverse transcription-polymerase chain reaction) or RT-nested PCR using random hexamer and NS-5 specific primers (470-20-1-77F, 470-20-1-211R, HGVNESTFO, HGVNESTRE). Five positives were found to belong to samples of patients showing symptoms of viral hepatitis. Primers used for PCR or nested PCR were derived from the NS-5 region. On the other hand, no amplification was detected using primers derived from the 5'-NCR (G-146F, G-401R). We performed TA cloning and sequencing of 5 amplified fragments, and their sequences were compared with those of foreign isolates of HGV. The phylogenetic analysis using MegAlign programme of DNAstar has shown that the Korean isolates are clustered on the phylogenetic tree. In summary, we confirmed the hepatitis G virus infection in 5 cases out of 12 patients showing the symptoms of viral hepatitis. The phylogenetic analysis of sequences of 5 amplified fragments showed that their relations to each other were closer than those to the foreign HGV isolates reported.
Clone Cells ; Cloning, Organism ; DNA, Complementary ; GB virus C* ; Hand ; Hepatitis* ; Humans ; Korea* ; Polymerase Chain Reaction ; RNA, Viral