BACKGROUND: Tracheal extubation causes hypertension and tachycardia. In susceptable patients, even this short period of hypertension and tachycardia can result in myocardial ischemia. The purpose of this study was to evaluate the effect of esmolol and diltiazem in attenuating cardiovascular responses to tracheal extubation. METHODS: Changes in heart rate, systolic and diastolic blood pressure were measured during extubation and emergence from anesthesia in 60 ASA physical status I patients to assess the effect of esmolol and diltiazem. The patients were randomly assigned to one of three groups (n=20 for each group) : saline 5 ml (as a control), 0.2 mg/kg diltiazem and 1.5 mg/kg esmolol. These medications were given 2 min before tracheal extubation. RESULTS: Both groups of diltiazem and esmolol were greater attenuating effect on changes of heart rate, systolic and diastolic blood pressure than control group. The inhibitory effect on changes of heart rate was greater with esmolol than diltiazem, but the attenuating effect on changes of systolic blood pressure was greater with diltiazem than esmolol. CONCLUSIONS: We concluded that a bolus dose of intravenous diltiazem 0.2 mg/kg or esmolol 1.5 mg/kg given at 2 min before extubation was of value in attenuating the cardiovascular changes occuring in association with tracheal extubation and emergence from anesthesia. Esmolol is more effective than diltiazem in attenuating the heart rate changes. Diltiazem is more effective than esmolol in attenuating the systolic blood pressures changes.
Airway Extubation* ; Anesthesia ; Blood Pressure ; Diltiazem* ; Heart Rate ; Humans ; Hypertension ; Myocardial Ischemia ; Tachycardia

Cerebrocostomandibular syndrome is characterized by micrognathia, cleft palate, multiple thorax deformity and frequently, mental deficiency. Respiratory compromise is a common cause of death. We experienced a case of cerebrocostomandibular syndrome with congenital heart disease in a 2 day old female baby with the chief complaint of cyanosis and respiratory difficulty since birth. She was delivered by cesarian section due to delayed labor at IUP 42 weeks. The diagnosis was made on the basis of clinical features, radiologic findings and echocardiogram, which showed micrognathia, deformity of 3rd finger Lt, hemivertebrae of T1-T6 Lt., absence of 1-6th rib Lt., dextrocardia, tetralogy of fallot, atrial septal defect secondum. We reported this case and reviewed related litertures briefly.
Cause of Death ; Cleft Palate ; Congenital Abnormalities ; Cyanosis ; Dextrocardia ; Diagnosis ; Female ; Fingers ; Heart Defects, Congenital* ; Heart Septal Defects, Atrial ; Humans ; Intellectual Disability ; Parturition ; Ribs ; Tetralogy of Fallot ; Thorax

Lovastatin is a potent inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, which catalyzes the conversion of hydroxymethylglutaryl-coenzyme A to mevalonate, anearly and rate-limiting step in the synthesis of cholesterol. We studied the therapeutic effect and safety of lovastatin in 18 patients with nonfamilial primary hypercholesterolemia. Patients received 20mg/day lovastatin therapy as a single evening dose. If the total cholesterol level exceeded 200mg/dl after 2weeks of lovastatin therapy, the dosage of lovastatin was doubled. Mean percent total cholesterol level reductions from baseline were 26.4% and 31.9% after 4, and 8 weeks of lovastatin therapy respectively. Mean percent HDL-cholesterol level increase from baseline were 12% and 13% after 4, and 8 weeks of lovastatin therapy respectively. Adverse effects attributable to lovastatin were mild and temporary and no patient was withdrawn from therapy. We concluded that lovastatin was a well tolerated and effective agent for the treatment of nonfamilial primary hypercholesterolemia. Further studies are needed to establish the long-term safety and effectiveness of this drug.
Cholesterol ; Coenzyme A ; Humans ; Hypercholesterolemia* ; Lovastatin ; Mevalonic Acid ; Oxidoreductases

STUDY DESIGN: Cross-cultural adaptation of the Korean version of the Oswestry Disability Index (KODI). OBJECTIVES: To conduct the cross-cultural adaptation for translating the original version of Oswestry Disability Index (ODI) (English version) SUMMARY OF LITERATURE REVIEW: Society is multicultural populations income. (This makes no sense?) Since languages and cultures are highly related, any cross-cultural assessment must be addressed in the outcome of the measurements. (I have made this into a proper sentence, but the meaning is still unclear, please confirm?) The Oswestry Disability Index (ODI) has not been translated into Korean, but is the most widely used tool in the world for measuring the intensity of back pain. MATERIAL AND METHOD: We used the guideline for the translation and cultural adaptation process, (Where were these guidelines from?) including forward translation, synthesis of translation, backward translation, committee review, pre-testing, test of the pro-final version, and finally, submission of the documentation to the developers. The Korean version of the Oswestry Disability Index (KODI) was tested on 116 patients with chronic low back pain. RESULTS: The reliability for the KODI, as measured by the Cronbach's alpha value, was 0.9168, and the reliability of the testretest was 0.9331. The process results were reported to the developer (Dr. Jeremy Fairbank), who appraised the KODI. CONCLUSIONS: The KODI was found to have satisfactory reliability. Therefore, the KODI can be recommended as a tool for the measurement of lower back pain in Korea.
Back Pain ; Humans ; Korea ; Low Back Pain ; Translating

STUDY DESIGN: This is a retrospective study. OBJECTIVES: This study examined the MRI findings, injury mechanism, clinical findings, and prognosis of a spinal cord injury without radiographic abnormality (SCIWORA) in adults with a normal spinal canal. SUMMARY OF LITERTURE: Most reports on SCIWORA deal with the pediatric age group. However, there are few reports on the MRI findings, clinical features and outcomes in adult patients with cervical SCIWORA. MATERIALS AND METHODS: The hospital records of 753 patients, who were treated for cervical spine injury between February 1, 1994 and July 31, 2004, were reviewed. This study included the 10 subjects with no fractures or dislocation on the plain roentgenograms or cord compression caused by degenerative change or disc herniation on MRI corresponding to the location of the cord lesion. All the patients had at least a 2-year follow-up evaluation. The relationships between the MRI findings, neurological findings and outcomes were evaluated. RESULTS: The MRI findings revealed 7 cases with cord contusion, 3 cases with cord edema, 3 cases with gliosis and 3 cases with syrinx formation at the follow-up. The injury mechanism was hyperextension and hyperflexion in 7 and 3 cases, respectively. The initial motor function scores of ASIA in the edema and contusion groups was 60.7 and 43.9, respectively. At the last follow-up, the motor function scores of ASIA in the edema and contusion groups were 90 and 70.3, respectively. The Frankel grade improved by 1.3 and 1.1 in the edema and contusion groups, respectively. CONCLUSIONS: In patients with SCIWORA, the MRI findings correlated well with the clinical picture and were of prognostic significance. The cord edema group showed better clinical features than the contusion group, and prognosis was relatively good in both groups. A further careful evaluation, such as MRI, is still needed to determine the appropriate treatment for spinal cord injuries without radiographic abnormalities.
Adult* ; Asia ; Contusions ; Dislocations ; Edema ; Follow-Up Studies ; Gliosis ; Hospital Records ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Retrospective Studies ; Spinal Canal ; Spinal Cord Injuries* ; Spinal Cord* ; Spine

BACKGROUND: The purpose of this study was to evaluate the fate of left atrioventricular valve regurgitation(LAVVR) following repair of complete atrioventricular septal defects (AVSDs). MATERIAL AND METHOD: Between July 1984 and March 2002, repair of complete AV defects were performed in 77 patients. Mean age at surgery was 30.23+/-69.11 months (range 1 to 456). Echocardiograms of all survivors after isolated AVSDs correction were reviewed. LAVVR were evaluated with color doppler echocardiography in 64 survival periodically. On each study, LAVVR severity was graded on a 1 to 4 scale, based upon the size of the regurgitated jet. RESULT: Mild deterioration of LAVV function was fairly common. LAVVR severity increased by >1 grade in 19 patients (30.2%) during the course of the study. However, the deterioration in LAVVR function occurred primarily between 12 and 24 months postoperatively. After the initial 24 postoperative months, LAVVR worsened on only 8 occasions and in each instance worsened by only 1 grade. Deterioration more than 3+ LAVVR occurred in only 3 patients. And deterioration to 4+ LAVVR was not observed after the initial 24 postoperative months but one. Survival curve analysis predicted a 88.2% of ten-year freedom rate from development of 4+ LAVVR after initial operation of complete AVSDs. CONCLUSION: Postoperative LAVVR remains fairly stable following AVSDs repair. Serious deterioration is rare after 24 postoperative months, especially after the initial 48 postoperative months. But serial follow-up study with echocariogram was need till 24 postoperative months after repair of complete AVSDs.
Echocardiography ; Echocardiography, Doppler, Color ; Follow-Up Studies ; Freedom ; Heart Defects, Congenital ; Humans ; Survivors

STUDY DESIGN: This is a retrospective study. OBJECTIVES: The purpose of this study is to decrease the frequency of the postoperative complications and to improve the postoperative clinical outcomes for the elderly patients with lumbar spinal stenosis. Summery of Literature REVIEW: Many controversies exist about postoperative complication and its influencing factors in the elderly patients suffering with lumbar spinal stenosis. MATERIALS AND METHODS: We reviewed the hospital records of 213 patients who underwent decompression and posterolateral fusion between February 1, 1998 and December 31, 2003 to treat their degenerative lumbar spinal stenosis. This study was performed, to assess and compare the postoperative complications and clinical outcomes of surgical management for the patients over 65 years (Group A) and the patients between 50-64 years (Group B). All the patients had at least a 1-year follow-up evaluation. The factors that could have influenced the complications that resulted within 12 weeks after the operation were evaluated and statistically analyzed. RESULTS: Postoperative complications occurred in 62 patients of Group A and in 40 patients of Group B, of which the major complications occurred in 10 patients of Group A and in 1 patient of Group B and minor complications occurred in 52 patients of Group A and in 39 patients of Group B. A statistical relationship between diabetes and major complications was observed in Group A (p=0.005). While any relationship between age and the frequency of complication in each group was not found, Group A had a higher frequency of major complication than did Group B (p=0.004). CONCLUSIONS: Surgeon should be vigilant about postoperative complications in elderly patients suffering with diabetic mellitus.Elderly patients with diabetic mellitus should be made aware that they are at an increased risk for postoperative complications because of their fragility.
Aged ; Decompression ; Follow-Up Studies ; Hospital Records ; Humans ; Postoperative Complications* ; Retrospective Studies ; Spinal Stenosis*

In patients with pupil-involving isolated oculomotor nerve palsy (IOP), compressive lesions, meningitis, and midbrain infarction can usually be excluded if the responsible lesions are not verified on a brain MRI, catheter angiography, and cerebrospinal fluid examination. However, we experienced a 11-year-old boy with pupil-involving IOP whose initial investigations had been normal and whose symptoms had been stationary over 3 months but was eventually confirmed to have germinoma. This case suggests that a patient with IOP without improvement for a prolonged period needs re-evaluation regardless of normal initial investigations. (J Korean Neurol Assoc 19(4):423~426, 2001)
Angiography ; Brain ; Catheters ; Cerebrospinal Fluid ; Child ; Germinoma* ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Meningitis ; Mesencephalon ; Oculomotor Nerve Diseases* ; Oculomotor Nerve*

Verapamil overdose results in cardiac arrhythmia including the complete A-V block, and hypotension due to decreased peripheral resistance and decreased myocardial contractility. However, sustained-release verapamil overdose frequently has atypical presentations, such as delayed and prolonged course of toxic signs and symptoms. Although several cases of sustained-release verapamil overdose have been reported worldwidely, the specific treatment modalities and prognostic indicators for verapamil overdose have not been well-defined. Recently, we experienced a case of sustained-release verapamil overdose in 30-year-old female. 10 hours after verapamil ingestion she presented in severe bradycardia and hypotensive shock state. Initial EKG showed the complete AV block and her systolic blood pressure was below 60 mmHg. Temporary cardiac pacemaker was performed and she was treated with activated charcoal, glucagon, amrinone, and several sympathomimetics, and 48 hours after admission, she was fully recovered.
Adult ; Amrinone ; Arrhythmias, Cardiac ; Atrioventricular Block ; Blood Pressure ; Bradycardia ; Charcoal ; Eating ; Electrocardiography ; Female ; Glucagon ; Humans ; Hypotension ; Shock ; Sympathomimetics ; Vascular Resistance ; Verapamil*

Hashimoto's encephalopathy (HE) is a steroid-responsive disorder of persistent or relapsing neurological or neu-ropsychological deficits associated with elevated serum concentrations of antithyroid antibody that frequently presents with myoclonus, seizures, and stroke-like episodes. We report a 55-year-old woman who presented with an altered men-tality associated with generalized tonic-clonic seizure. She was diagnosed with Hashimoto's thyroiditis 3 years prior. Serum antithyroglobulin antibody and antimicrosomal antibody were elevated. Electroencephalography (EEG) showed generalized slowing. Brain magnetic resonance imaging (MRI) with T2-weighted sequence and fluid-attenuated inver-sion- recovery (FLAIR) image revealed a high signal intensity in both mesial temporal areas. Single photon emission computed tomography (SPECT) demonstrated decreased perfusion in multiple areas. With the impression of HE, she was placed on high dose steroid and thyroid hormone replacement therapy which ameliorated her neurological symp-toms. We suggest that HE should be included in the differential diagnosis of decreased mentality, especially when patients with Hashimoto's thyroiditis show altered consciousness, seizure disorder, or cognitive decline.
Brain ; Consciousness ; Diagnosis, Differential ; Electroencephalography ; Epilepsy ; Female ; Hormone Replacement Therapy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Myoclonus ; Perfusion ; Seizures ; Thyroid Gland ; Thyroiditis ; Tomography, Emission-Computed, Single-Photon