Laryngoscopy and intubation cause an adrenergic response manifested by tachycardia and hypertension. Various phamacological agents have been administered prior to induction in an attempt to attenuate the adrenergic response but they all have limitations. The objective of our study was to determine if esmolol would be equally effective when adrninistered in a bolus with and without fentanyl. A double-blind, randomized trial was conducted in sixty ASA physical status 1 patients undergoing elective surgery. All patients were premedicated with 0.2 mg/kg diazepam orally and glycopyrrolate 0.04 mg/kg intramuseularyly 1 hour beforehand. Induction of anesthesia was accomplished with 4 mg/kg thiopental intravenously foUowed immediately by 0.15-0.2 mg/kg vecuronium and study drug (placebo, esmolol 150 mg, esmolol 150 mg and fentanyl 100 mcg). Endotracheal intubation was performed at 2 minutes after study drug adrninistration. Anesthesia was maintained with 1 MAC (+/-10%) isoflurane in 60% nitrous oxide in oxygen at a 5 L/min flow for 6 minutes. Heart rate and blood pressure were measured every minute by an automatic recording device. After laryngoscopy and intubation, maximum increase in stolic blood pressure above awake levels was 33 mmHg (p<0.05) and 14 mmHg (p<0.05) in esmolol 150 mg, esmolol 150 mg with fentanyl 100 mcg respectively, whereas systolic blood pressure increased 62 mmHg after tracheal intubation in patients with placebo. In six patients with esmolol 150 mg, rate-pressure product reached a level considered potentially dangerous to patients with coronary artery disease. However, when used with fentanyl, esmolol provides effectvie protection against the adrenergic response and increase of the rate-pressure product to laryngoscopy and intubation.
Anesthesia ; Blood Pressure* ; Coronary Artery Disease ; Diazepam ; Fentanyl* ; Glycopyrrolate ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal* ; Isoflurane ; Laryngoscopy ; Nitrous Oxide ; Oxygen ; Tachycardia ; Thiopental ; Vecuronium Bromide

No abstract available.
Amniotic Band Syndrome* ; Infant, Newborn

PURPOSE: This study compared the effect of three intraoral repair systems on the bond strength between composite resin and zirconia core. MATERIALS AND METHODS: Thirty zirconia specimens were divided into three groups according to the repair method: Group I- CoJet(TM) Repair System (3M ESPE) [chairside silica coating with 30 microm SiO2 + silanization + adhesive]; Group II- Ceramic Repair System (Ivoclar Vivadent) [etching with 37% phosphoric acid + Zirconia primer + adhesive]; Group III- Signum Zirconia Bond (Heraus) [Signum Zirconia Bond I + Signum Zirconia Bond II]. Composite resin was polymerized on each conditioned specimen. The shear bond strength was tested using a universal testing machine, and fracture sites were examined with FE-SEM. Surface morphology and wettability after surface treatments were examined additionally. The data of bond strengths were statistically analyzed with one-way ANOVA and Tamhane post hoc test (alpha=.05). RESULTS: Increased surface roughness and the highest wettability value were observed in the CoJet sand treated specimens. The specimens treated with 37% phosphoric acid and Signum Zirconia Bond I did not show any improvement of surface irregularity, and the lowest wettability value were found in 37% phosphoric acid treated specimens. There was no significant difference in the bond strengths between Group I (7.80 +/- 0.76 MPa) and III (8.98 +/- 1.39 MPa). Group II (3.21 +/- 0.78 MPa) showed a significant difference from other groups (P<.05). CONCLUSION: The use of Intraoral silica coating system and the application of Signum Zirconia Bond are effective for increasing the bond strength of composite resin to zirconia.
Ceramics ; Collodion ; Phosphoric Acids ; Polymers ; Silicon Dioxide ; Wettability ; Zirconium

Thromboembolic complications (TECs) are clinically important sequelae of nephrotic syndrome (NS). The incidence of TECs in children is approximately 2%-5%. The veins are the most commonly affected sites, particularly the deep veins in the legs, the inferior vena cava, the superior vena cava, and the renal veins. Arterial thrombosis, which is less common, typically occurs in the cerebral, pulmonary, and femoral arteries, and is associated with the use of steroids and diuretics. Popliteal artery thrombosis in children has been described in cases of traumatic dissection, osteochondroma, Mycoplasma pneumoniae infection, and fibromuscular dysplasia. We report of a 33-month-old girl with bilateral iliac and popliteal arterial thrombosis associated with steroid-resistant NS due to focal segmental glomerulosclerosis. Her treatment involved thrombectomy and intravenous heparinization, followed by oral warfarin for 8 months. Herein, we report a rare case of spontaneous iliac and popliteal arterial thrombosis in a young child with NS.
Child* ; Child, Preschool ; Diuretics ; Female ; Femoral Artery ; Fibromuscular Dysplasia ; Glomerulosclerosis, Focal Segmental* ; Heparin ; Humans ; Iliac Artery ; Incidence ; Leg ; Mycoplasma pneumoniae ; Nephrotic Syndrome ; Osteochondroma ; Pneumonia, Mycoplasma ; Popliteal Artery ; Renal Veins ; Steroids ; Thrombectomy ; Thrombosis* ; Veins ; Vena Cava, Inferior ; Vena Cava, Superior ; Warfarin

PURPOSE: Serum level of 25-hydroxyvitamin D (25-OHD) is considered as the most appropriate marker of vitamin D status. However, only a few studies have investigated the relationship between 25-OHD and parathyroid hormone (PTH) in children. To this end, this study was aimed at evaluating the lowest 25-OHD level that suppresses the production of parathyroid hormone in children. METHODS: A retrospective record review was performed for children aged 0.2 to 18 years (n=193; 106 boys and 87 girls) who underwent simultaneous measurements of serum 25-OHD and PTH levels between January 2010 and June 2014. RESULTS: The inflection point of serum 25-OHD level for maximal suppression of PTH was at 18.0 ng/mL (95% confidence interval, 14.3–21.7 ng/mL). The median PTH level of the children with 25-OHD levels of <18.0 ng/mL was higher than that of children with 25-OHD levels ≥ 18.0 ng/mL (P<0.0001). The median calcium level of children with 25-OHD levels<18.0 ng/mL was lower than that of children with 25-OHD levels≥18.0 ng/mL (P=0.0001). The frequency of hyperparathyroidism was higher in the children with 25-OHD levels<18.0 ng/mL than in the children with 25-OHD levels≥18.0 ng/mL (P<0.0001). Hypocalcemia was more prevalent in the children with 25-OHD levels<18.0 ng/mL than in the children with 25-OHD levels≥18.0 ng/mL (P<0.0001). CONCLUSION: These data suggest that a vitamin D level of 18.0 ng/mL could be the criterion for 25-OHD deficiency in children at the inflection point of the maximal suppression of PTH.
Calcium ; Child* ; Humans ; Hyperparathyroidism ; Hypocalcemia ; Parathyroid Hormone* ; Retrospective Studies ; Vitamin D ; Vitamin D Deficiency

Congenital aniridia is a rare ocular malformation that presents with severe hypoplasia of the iris and various ocular manifestations. Most cases of congenital aniridia are known to be related to mutations in the paired box gene-6 (PAX6), which is an essential gene in eye development. Herein, we report a familial case of autosomal dominant congenital aniridia with four affected members in 3 consecutive generations and describe the detailed ophthalmologic findings for one of these members. As expected, mutational analysis revealed a nonsense mutation (p.Ser122*) in the PAX6 gene. Thus, our findings reiterate the importance of PAX6 mutations in congenital aniridia.
Aniridia* ; Codon, Nonsense ; Family Characteristics ; Genes, Essential ; Humans ; Iris ; WAGR Syndrome ; Wilms Tumor

For the investigation of the receptive field of the retinal neurons, the spatial and temporal properties of horizontal cells and the center-surround antagonisms of bipolar cells and the third-order neurons were studied using conventional intracellular recording techniques. Horizontal cells were hyperpolarized by the large annulus light stimuli (id: 3.5mm) and required at least 0.2 seconds of dark periods to respond enough. The amplitudes of the response of the ON-bipolar cell were decreased as the diameter of the spot stimuli was increased to 2.6mm and the responses were inverted at 2.6mm of inner diameter of the spreading annulus stimuli with fixed width. ON-sustained cell with spikes generated ON-sustained light responses by small annulus (1400-2100micrometer), but elicited OFF-sustained responses by large annulus (2100-2800micrometer). ON-sustained cell without spikes also showed surround antagonism. The spikes were generated at the spot of 490micrometer diameter and they were disappeared at the spot of 5600micrometer diameter. And, OFF-transient component of the ON-OFF transient cell was enhanced as annulus stimuli spread. The results suggest that the horizontal cells have large and monotonic receptive fields while the bipolar cells and the ON-sustained cells have large biphasic receptive fields in the catfish retina.
Catfishes* ; Neurons* ; Retina ; Retinal Neurons

OBJECTIVE: To evaluate the types and severity of subcortical aphasia after stroke and to determine the predictors of the degree of aphasic impairment. METHODS: Medical records of 38 patients with post-stroke subcortical aphasia (19 males; mean age, 61.7±13.8 years) were reviewed retrospectively with respect to the following tests: the Korean version of the Western Aphasia Battery (K-WAB), the Korean version of the Modified Barthel Index (K-MBI), and the Fugl-Meyer Index (FMI). The severity of aphasia was evaluated by the aphasia quotient (AQ) and the language quotient (LQ). RESULTS: Anomic aphasia was the most frequent type of aphasia (n=15, 39.5%), and the lesion most frequently observed in subcortical aphasia was located in the basal ganglia (n=19, 50.0%). Patients with lesions in the basal ganglia exhibited the lowest scores on the FMI for the upper extremities (p=0.04). Severity of aphasia was significantly correlated with the K-MBI (Pearson correlation coefficient: γ=0.45, p=0.01 for AQ and γ=0.53, p=0.01 for LQ) and FMI scores for the lower extremities (γ=0.43, p=0.03 for AQ and γ=0.49, p=0.05 for LQ). In a multivariate logistic regression analysis, K-MBI remained the only explanatory variable closely associated with aphasia severity. CONCLUSION: This study showed the general characteristics of post-stroke subcortical aphasia, and it revealed that K-MBI was an associated and explanatory factor for aphasia severity.
Anomia ; Aphasia* ; Basal Ganglia ; Cerebrovascular Disorders ; Humans ; Language Tests ; Logistic Models ; Lower Extremity ; Male ; Medical Records ; Retrospective Studies ; Stroke* ; Upper Extremity

This study was conducted to investigate osteopenia and osteoporosis prevalence of radius and tibia using Quantitative Ultrasound (QUS) and to identify affecting factors of osteoporosis. A total of 4,340 women aged 40 - 69 years, living in Ansung (rural) and Ansan (mid-sized) area, and free of illnesses affecting bone metabolism participated in the community-based cohort study. Among them 4,059 subjects measured radius bone density and 4,089 measured tibia. The T-score threshold, defined as < -1.0 and < or = -2.5, was used to identify subjects with osteopenia and osteoporosis by WHO criteria. The crude prevalence of osteoporosis in radius and tibia was 8.4% and 23.3% respectively; after adjustment for age, it changed 6.3% and 18.8%. In simple logistic regression analysis, the prevalence of osteoporosis increased by aging, non-marital status, low education, low income. Otherwise, high intakes of Ca/P, thiamin, riboflavin, vitamin B6, and vitamin E were decreased osteoporosis prevalence. Compared to the normal BMI (body mass index) group (18.5 < or = BMI < 23), the odds ratio (ORs) of the low BMI group (BMI < 18.5), and high BMI groups (BMI 25 - 30, BMI > or = 30) were significantly increased. The OR of osteoporosis decreased across increasing quartiles of intakes of Ca, P and Ca/P. Therefore, maintaining normal BMI and increasing Ca intake and Ca/P ratio may have a beneficial effect on bone health of Korean women.
Aging ; Bone Density ; Bone Diseases, Metabolic ; Cohort Studies* ; Education ; Female ; Genome* ; Gyeonggi-do ; Humans ; Logistic Models ; Metabolism ; Odds Ratio ; Osteoporosis* ; Prevalence* ; Radius* ; Riboflavin ; Tibia* ; Ultrasonography* ; Vitamin B 6 ; Vitamin E ; Vitamins

Disseminated intravascular coagulation (DIC) is one of the most serious acquired coagulopathies. The clinical manifestations of this condition as well as the laboratory data considerably, depending on the patients compensatory mechanism. The primary treatment of DIC is that of the underlying disease and it`s complications. Gram-negative septicemia and metastatic prostatic cancer are frequent causes of DIC in urologic patients. We report a case of DIC after operation for vesicocervical fistula developed in a 34 year old woman and the relevant literature bas been reviewed.
Adult ; Dacarbazine ; Disseminated Intravascular Coagulation ; Female ; Fistula* ; Humans ; Prostatic Neoplasms ; Sepsis