Epidural nerve block is the most widely practiced procedure in the pain clinic. Accidental dural puncture during epidural nerve block also has been associated with postdural puncture headache and total spinal anesthesia. Especially, total spinal anesthesia is the most serious complication of epidural nerve block and can lead to a life threatening conditions. We have experienced two cases in whom total spinal anesthesia occurred during epidural nerve block for neck and lower back pain control. Immediately after epidural nerve block, the patients became unresponsive and apneic with loss of muscle tone in all extremity. We performed resuscitations and about 3 hours later the patients recovered completely without any complication.
Anesthesia, Spinal* ; Extremities ; Humans ; Low Back Pain ; Neck ; Nerve Block* ; Pain Clinics ; Post-Dural Puncture Headache ; Punctures ; Resuscitation

No abstract available.
Trichomonas*

No abstract available.
Trichomonas*

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway(LMA), but the results of those studies were much different much different from one another. The aim of this study was to compare the incidence of gastroesophageal reflux and regurgitation of gastric contents between the LMA and the endotracheal tube(ETT). METHOD: Ninety patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were randomly allocated to receive either a LMA(n-49) or a ETT(n=41) for airway management. The esophageal manometry was carried out for the exclusion of esophageal motility disorders and the 24-hour ambulatory pH metry was done from one day before the operation. A methylene blue(50mg) capsule was swallowed just before the induction and the simultaneous recordings of pH were maintained during anesthesia. At the end of anesthesia, the episodes of regurgitation of gastric contents above hypopharynx were analyzed by the pharyngeal blue staining and the pH metric data were analyzed for the detection of gastroesophageal relux episodes during anesthesia. RESULTS: There was no significant difference in the incidence of gastroesophageal relux(pH< or =4) between two groups; only two patients in LMA and three patients in ETT had reflux episodes during the removal or arousal phase. There was no episode of the pharyngeal blue staining in both group. All of the gastroesophageal reflux patients in both group developed a cough or straining during those phases. There was no clinical evidence of aspiration of gastric contents in both group. CONCLUSION: In comparison with ETT, use of LMA does not appear to increase the incidence of gastroesophageal reflux and regurgitation above hypophryngeal level in positive pressure ventilating patients during long surgical procedures. Therefore, the risk of aspiration in LMA will not be much more than ETT.
Airway Management ; Anesthesia ; Arousal ; Cough ; Esophageal Motility Disorders ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Hypopharynx ; Incidence ; Laryngeal Masks* ; Manometry ; Masks* ; Orthopedics

Semantic dementia is a rare, distinct form of frontotemporal lobar degeneration, characterized by a deficit in semantic memory with relative preservation of attention and executive functions. We report a case of semantic dementia that pre-sented with a 3-year history of progressive word-finding difficulty and prosopagnosia. Brain MRI showed prominent atrophic changes in the left temporal region and neuropsychological tests demonstrated semantic memory deficits.
Brain ; Executive Function ; Frontotemporal Dementia* ; Frontotemporal Lobar Degeneration ; Magnetic Resonance Imaging ; Memory ; Memory Disorders ; Neuropsychological Tests ; Prosopagnosia ; Semantics*

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway (LMA), but the results of those studies were much different from one another. This conflicting results may be due to the time of the removal of LMA, which has been usually after the arousal (when the patient can open the mouth on command). So, the authors investigated the incidence of the gastroesophageal reflux and the regurgitation of gastric contents above the upper esophageal sphincter associated with the difference of the time of the removal of LMA. METHODS: Sixty three patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were allocated randomly to Group A (n=34, LMA was removed when the rejection signs such as struggle, restlessness, swallowing and cough came out.) or Group B (n=29, LMA was removed after arousal). For the detection of reflux and regurgitation episodes during anesthesia, a pH monitoring probe was positioned in the lower esophagus and a methylene blue (50 mg) gelatine capsule was swallowed just before induction. At the end of anesthesia, the episodes of reflux and regurgitation of gastric contents were analyzed according to the pharyngeal blue staining or pH< or = 4. RESULTS: The incidence of reflux (pH< or = 4) from the time of the rejection signs to the removal of LMA and the total incidence of reflux in Group B were significantly higher than that of Group A. No patient in both group showed pharyngeal staining of methylene blue. There was no clinical evidence of aspiration of gastric contents in either group. CONCLUSION: Maintenance of LMA until the patient can open the mouth on command seems to increase the incidence of the gastroesophageal reflux.
Anesthesia ; Arousal ; Cough ; Deglutition ; Esophageal Sphincter, Upper ; Esophagus ; Gastroesophageal Reflux ; Gelatin ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Laryngeal Masks* ; Methylene Blue ; Mouth ; Orthopedics ; Psychomotor Agitation

BACKGROUND: Abnormal platelet activation has been identified in several disorders characterizedby vascular patholo-gy including coronary artery disease, Alzheimer disease, myeloproliferative disorders, diabetes, preeclampsia, inflam-matory bowel disease and glomerular disease. Antiplatelet therapy has been valuable in the management of some of these conditions. The aim of this study is to verify usefulness of mean platelet component (MPC) concentration as a marker of thrombotic process in patients with cerebral infarction. Our hypothesis is that MPC as measured by the ADVIA(R) 120 hematology system is used to detect and monitor platelet activation associated with thrombotic process of ischemic stroke. METHODS: To study the existence of platelet activation at the onset of cerebral infarction, mean platelet concentration of platelets were measured daily during post-stroke 10 days. Thirty-four acute thrombotic cerebral infarction and seventeen age-matched healthy persons were selected for this study. To investigate the time course of the platelet MPC changes observed in stroke patients, the blood samplings for MPC measuring were done and analyzed on the ADVIA 120(R) system. RESULTS: There was a statistically significant decrease in MPC concentration of the platelets at post-stroke 3rd to 7th day compared to the control group ( p < 0.05). CONCLUSIONS: We conclude that a reduction of MPC as measured by the ADVIA 120(R) hematology system may be used to detect and monitor thrombotic process associated with platelet activation in ischemic stroke.
Alzheimer Disease ; Blood Platelets* ; Cerebral Infarction ; Coronary Artery Disease ; Hematology ; Humans ; Myeloproliferative Disorders ; Platelet Activation* ; Pre-Eclampsia ; Stroke*

BACKGROUND: Coronary artery bypass graft (CABG) surgery has been a main treatment modality of ischemic heart disease since Sabiston reported the first CABG operation using a saphenous vein graft in 1963. However, graft stenosis that happens after CABG surgery is one of the main limitations of the procedure. We investigated risk factors that are related to graft stenosis and occlusion in patients that needed a coronary angiogram after CABG surgery. METHODS: From May 1995 to April 2004, we performed 348 CABG surgeries. Among them, we performed follow up coronary angiogram for 45 patients because of clinical indications, corresponding to 146 graft vessels. According to the angiography findings, patients with 27 graft vessels that showed stenosis or occlusion were defined as group S and patients with 119 graft vessels that showed no stenosis or occlusion were defined as group P. RESULTS: The mean patient age of group S is 59.44 (+/-8.549) years and the mean patient age of group P is 57.99 (+/-8.676) years. Group P patients had more stenotic native coronary arteries than group S patients, which is statistically significant (80.0+/-7.2% vs. 68.0+/-11.9%, p=0.005). Group S patients had a statistically significant lower postoperative HDL level than the level of the group P patients (40.4+/-15.9 mg/dL vs. 50.5+/-4.4 mg/dL, p=0.002). CONCLUSIONS: When performing CABG surgery and postoperative patient management, the severity of native coronary artery stenosis and the postoperative HDL level should be considered for better patient outcome.
Angiography ; Cholesterol, HDL ; Constriction, Pathologic* ; Coronary Artery Bypass* ; Coronary Stenosis ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Myocardial Ischemia ; Risk Factors* ; Saphenous Vein ; Transplants*

BACKGROUND: Duchenne muscular dystrophy is an X-linked recessive disorder leading to death in the late teens or early twenties. There is no effective pharmacological therapy for now. L-carnitine (LCAR), a naturally occurring compound facilitating the transport of fatty acid into mitochondria for -oxidation, has been getting an attention for its antiapoptotic and osmoprotective effect. The aim of this study is to evaluate if LCAR administration reduces dystrophic progression and enhances exercise tolerance in dystrophin deficient (mdx) mice. METHODS: Mdx mice (n=5) and wild type mice (n=5), aged 3 weeks were treated with oral LCAR (75mg/kg/day) for 6 weeks. Five each mdx and wild type mice were recruited for their counter-control. The animals underwent a 30-minute run on a horizontal treadmill for evaluating their exercise endurance. After 6-week training, baseline and post exercise serum CK of each group were analyzed. We examined sarcolemma integrity and muscle histology after exercise. Immunofluorescent stain and Western blot analysis for dystrophin-dystroglycan complex were also performed. RESULTS: LCAR-treated mdx mice showed higher exercise tolerance and lower serum CK value compared with those of control mice. The area of Evans blue dye uptake in LCAR-treated mdx mice was much smaller than that of control mdx mice. There was no remarkable difference in dystrophin-dystroglycan complex expression between treated and control mdx mice. CONCLUSIONS: LCAR seems to enhance exercise tolerance and decrease the breakdown of sarcolemma during strenuous exercise. Our study suggests the possibility of adjunctive therapeutic use of L-carnitine to the patients with Duchenne muscular dystrophy.
Adolescent ; Animals ; Blotting, Western ; Carnitine* ; Dystrophin ; Evans Blue ; Exercise Tolerance* ; Humans ; Mice* ; Mice, Inbred mdx ; Mitochondria ; Muscular Dystrophies* ; Muscular Dystrophy, Duchenne ; Sarcolemma

OBJECTIVES: Vitamin D deficiency, which causes secondary hyperparathyroidism, is considered to be a major contributor to osteoporosis. Because the serum 25-hydroxyvitamin D (25-OHD) level depend on sun exposure and, varies by season, the level of serum 25-OHD in each season at which vitamin D status can lead to changes in bone mineral density (BMD) is not known. METHODS: A total of 2,878 women who underwent periodic health examinations at Ajou University Hospital were included in this study. We measured the serum 25-OHD concentrations using radioimmunoassay and BMDs using dual energy x-ray absorptiometry (DXA). The differences in serum 25-OHD levels among groups as a function of age, season, and BMD were tested by one-way ANOVA. RESULTS: The serum 25-OHD level was not different based on age, but by season, with higher levels in the summer and autumn than in the winter and spring. However, the 25-OHD level did not have a significant relationship with BMD in any season. CONCLUSION: The serum 25-OHD level represents vitamin D status at the time of testing, which is not associated with long-term changes in BMD. When the 25-OHD levels are used to make clinical decisions related to the treatment of osteoporosis, careful interpretation is required.
Absorptiometry, Photon ; Bone Density ; Female ; Humans ; Hyperparathyroidism, Secondary ; Osteoporosis ; Radioimmunoassay ; Seasons ; Solar System ; Vitamin D ; Vitamin D Deficiency ; Vitamins