MHS is a myopathic disorder transmitted by a dominant autosomal gene. The seriousness of the problem is underscored by the fact that the mortality rate, until recently, has ranked the highest among the complications of modern anesthesia. During halothane anesthesia we experienced a case of MHS with high temperature and rigidity after succinylcholine, observed change of serum electrolytes, and noted CPK and myoglobin in the urine. The patient was managed with surface cooling, bicarbonate, diurectics, mechanical ventilator and corticosteroids. The patient survived without any sequelae and was discharged after 10 days.
Adrenal Cortex Hormones ; Anesthesia ; Electrolytes ; Halothane ; Humans ; Malignant Hyperthermia* ; Mortality ; Myoglobin ; Succinylcholine ; Ventilators, Mechanical

Hemangiopericycic maningioma is clinically and pathologically similar to peripheral Hemangiopericytoma and now tends to be terned as hemangiopericytoma of central nervous system. The authors studied 3 cases of hemangiopericytic meningioma obtained from 3 patients, 1 case of meningotheliomatous meningioma, angioblastic meningioma and transitional meningioma, and 2 cases of peripheral hemangiopericytoma, which had operated from November 1988 to May 1989 at the department of neurosurgery, Pusan Inje University Hospital. The authors analysed and compared the immunohistochemical finding and light microscopic apearance. The results obtained were summarized as follows; 1) Classic maningioma (meningotheliomatous meningioma, transitional meningioma and angioblastic meningioma) shows reactivity to both EMA and vimentin. 2) Hemangiopercicytic meningioma and peripheral hemangiopericytoma are reactive only to vimentin, so the two tumors are suggested as same type of tumor. 3) One of 3 cases of hemangiopericytic meningioma shows whorling and interlacing bundles of spindle cells, the peculiar light microscopic features of transitional meningioma, suggesting transitional or mixed form of hemangiopericytic meningioma and transitional meningioma.
Meningioma

Hemangiopericycic maningioma is clinically and pathologically similar to peripheral Hemangiopericytoma and now tends to be terned as hemangiopericytoma of central nervous system. The authors studied 3 cases of hemangiopericytic meningioma obtained from 3 patients, 1 case of meningotheliomatous meningioma, angioblastic meningioma and transitional meningioma, and 2 cases of peripheral hemangiopericytoma, which had operated from November 1988 to May 1989 at the department of neurosurgery, Pusan Inje University Hospital. The authors analysed and compared the immunohistochemical finding and light microscopic apearance. The results obtained were summarized as follows; 1) Classic maningioma (meningotheliomatous meningioma, transitional meningioma and angioblastic meningioma) shows reactivity to both EMA and vimentin. 2) Hemangiopercicytic meningioma and peripheral hemangiopericytoma are reactive only to vimentin, so the two tumors are suggested as same type of tumor. 3) One of 3 cases of hemangiopericytic meningioma shows whorling and interlacing bundles of spindle cells, the peculiar light microscopic features of transitional meningioma, suggesting transitional or mixed form of hemangiopericytic meningioma and transitional meningioma.
Meningioma

No abstract available.
Classification* ; Humans ; Spinal Cord* ; Urodynamics*

BACKGROUND: This study was designed to estabilish serum LDL cholesterol(LDL-C) and HDL cholestrol(HDL-C) levels in the Korean adult population and to identify the difference in sex, age, and living place and the incidence of high risk group and the affecting factors on the serum lipid levels. METHODS: The serum LDL-C and HDL-C distribution in the normal Korean abult population were studied in 5,278 cases(males 2,802 and females 2,476) in the age groups of 3rd to 8th decade. Data were collected from 33 institutes and hospitals throughout the country during the period of June 1989 to December 1990. The serum Lipid levels were examined in the state of fasting of at least 12 hours. Total cholesterol and triglyceride levels were measured by enzymatic assays and HDL-C levels were determined by precipitation methods. The level of LDL-C was determined indirectly using the formula by Friedwald [LDL-C=total cholesterol-(HDL-C+triglyceride/5)]. RESULTS: The mean level of LDL-C was 112.1mg/dl. Males had 110.0mg/dl and females had 114.5mg/dl without statistical significance between gender, but levels were significantly higher in the 4th decade in males and in the 6th, 7th and 8th decade in females. The LDL-C levels rose gradually with the increase of age. The peak level of LDL-C for the males was in the 7th decade and that for the females was in the 8th decade. The mean level of serum HDL-C was 45.1mg/dl. Males had 43.8mg/dl and females had 46.6mg/dl without statistical significance between gender, but levels were significantly higher in the 3rd, 4th, 5th and 6th decade in females. The incidence LDL-C level of > or = 160mg/dl was 10.0%. Males had 8.2% and females had 12.1% with significantly higher incidence in females, especially in 6th decade females. The incidence of LDL-C level of > or = 160mg/dl of big cities was 10.7% and that of smaller cities & towns was 8.8% with significantly higher incidence in big cities. But, there was no significant difference in gender between big cities and smaller cities & towns. The incidence of LDL-C level of > or = 160mg/dl was significantly higher in 7th decade males in big cities and that of big cities and smaller cities and smaller cities & towns was 15.9% and 5.2%, respectively. The incidence of HDL-C level of <35mg/dl was 17.4% Males had 20.0% and females had 14.5% with significantly higher incidence in males, especially in 4th decade males. The incidence of HDL-C level of <35mg/dl of smaller cities & towns was 19.8% and that of big cities was 16.2% with significantly higher incidence in smaller cities & towms. Males in smaller cities & towns had 23.1% and males in big cities had 18.1% with statistical higher in smaller cities & towns. But, there was no significant difference in females between big cities and smaller cities & towns. The incidence of HDL-C level of <35mg/dl was significantly higher in 4th and 6th decade males in smaller cities & towns and that of smaller cities & towns and big cities was 26.8%, 25.6% and 16.2%, 17.7%, repectively. The significantly positively related factors for serum LDL-C level were age, BMI, systolic blood pressure(SBP), location and occupation. And those for serum HDL-C level were SBP and family history and negatively related factor for HDL-C level were BMI, smoking, and exercise. CONCLUSION: This study can provide the basic date base for prevention and management of coronary heart disease among Korean population.
Academies and Institutes ; Adult* ; Cholesterol ; Cholesterol, HDL* ; Cholesterol, LDL* ; Coronary Disease ; Enzyme Assays ; Fasting ; Female ; Humans ; Incidence ; Korea ; Male ; Occupations ; Smoke ; Smoking ; Triglycerides

Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) is a rare condition that is severe and may be fatal. Adverse reactions to drugs increasingly are reported as probable causes of TTP-HUS. Many chemotherapeutic agents have also been implicated in causing TTP-HUS. We reported a woman with metastatic renal cell carcinoma who presented with TTP- HUS associated with sunitinib. She had gross hematuria and generalized edema. The hemoglobin concentration was 8.9 g/dl and the platelet count was 46,000/mm3. Her reticulocyte count was increased to 4.1% and the peripheral blood smear revealed red blood cell fragmentation and spherocytes. The patient completely recovered after discontinuing the use of sunitinib and undergoing plasmapheresis. Because of the increasing use of sunitinib in the treatment of cancer patients, oncologists should be aware of the possibility of TTP-HUS related to sunitinib, as early recognition and prompt therapeutic intervention can be beneficial.
Carcinoma, Renal Cell ; Edema ; Erythrocytes ; Female ; Hematuria ; Hemoglobins ; Hemolytic-Uremic Syndrome ; Humans ; Indoles ; Plasmapheresis ; Platelet Count ; Purpura ; Pyrroles ; Reticulocyte Count ; Spherocytes

Massage is generally accepted as a safe and a widely used modality for various conditions, such as pain, lymphedema, and facial palsy. However, several complications, some with devastating results, have been reported. We introduce a case of a 43-year-old man who suffered from tetraplegia after a neck massage. Imaging studies revealed compressive myelopathy at the C6 level, ossification of the posterior longitudinal ligament (OPLL), and a herniated nucleus pulposus (HNP) at the C5-6 level. After 3 years of rehabilitation, his motor power improved, and he is able to walk and drive with adaptation. OPLL is a well-known predisposing factor for myelopathy in minor trauma, and it increases the risk of HNP, when it is associated with the degenerative disc. Our case emphasizes the need for additional caution in applying manipulation, including massage, in patients with OPLL; patients who are relatively young (i.e., in the fifth decade of life) are not immune to minor trauma.
Adult ; Facial Paralysis ; Humans ; Longitudinal Ligaments ; Lymphedema ; Massage ; Neck ; Ossification of Posterior Longitudinal Ligament ; Quadriplegia ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases ; Spinal Cord Injuries

BACKGROUND: Propofol offers the advantages of rapid onset of action and recovery. However, the pharmacokinetics of propofol in children is different from that of adults. Therefore, infusion of propofol by target-controlled infusion (TCI) has same difficulties in use. Also, bispectral index has shown a close relationship with plasma concentration of propofol. In this study, we measured the effect site concentration comparable to Bispectral index (BIS) 50 during induction and the awakening concentration. Furthermore, we tried to demonstrate age-related differences. METHODS: Forty five premedicated (atropine 0.02 mg/kg) children (ASA class I) scheduled for elective surgery were assigned to one of three groups (Group 1: 1-5 years, Group 2: 6-10 years, Group 3: 11-15 years). After intravenous injection of lidocaine 0.5 mg/kg, a propofol infusion was started at a target concentration of 6 microgram/ml by using a Stelpump. Anesthesia was maintained with propofol 4-6 microgram/ml and 67% nitrous oxide in oxygen. During anesthesia induction, we checked the effect site concentration comparable to BIS 50 and plasma/effect concentration for awakening during an emergence period. RESULTS: The effect site concentrations comparable to BIS 50 were 5.7 +/- 0.5 microgram/ml (group 1), 4.9 +/- 0.8 microgram/ml (group 2) and 3.8 +/- 1.1 microgram/ml (group 3), so there are significant differences among the groups (P < 0.05)(Table 2). At the moment of awakening, the current/effect site concentration in group 1 (2.0 +/- 0.1 microgram/ml, 2.6 +/- 0.2 microgram/ml) was significantly higher than those of group 3 (1.6 +/- 0.2 microgram/ml, 2.0 +/- 0.30 microgram/ml). CONCLSIONS: The effect site concentration comparable to BIS 50 showed significantly age-related differences and was higher in younger children. The current/effect site concentration at awakening was highest in group 1.
Adult ; Anesthesia ; Child ; Humans ; Injections, Intravenous ; Lidocaine ; Nitrous Oxide ; Oxygen ; Pharmacokinetics ; Plasma ; Propofol*

Embolization of the uterine arteries is a valuable method for controlling postpartum hemorrhage. There have been recent attempts to apply this tool as a means of controlling bleeding during Cesarean section, especially in patients with placenta previa. However, the benefits are controversial due to lack of randomized controlled studies, no evidence of significant improved outcomes, and potential harm including radiation exposure. This paper includes two case reports of intraoperative uterine artery embolization without fetal radiation exposure in patients with placenta previa totalis.
Cesarean Section ; Female ; Hemorrhage ; Humans ; Placenta ; Placenta Previa ; Postpartum Hemorrhage ; Pregnancy ; Uterine Artery ; Uterine Artery Embolization

OBJECTIVE: To investigate the relations among pain, emotional factors and cognitive-behavioral factors in chronic musculoskeletal pain patients. METHOD: This study was designed as a questionnaire survey. 73 patients who visited our outpatient clinics due to chronic musculoskeletal pain were evaluated. They checked visual analogue scale (VAS), pain site and frequency. Beck depression inventory (BDI) and state-trait anxiety index (STAI) were checked for evaluation of emotional factors. Somatization scale of symptom checklist-revised (SCL-R- 90) and pain catastrophizing scale (PCS) were checked for cognitive-behavioral factors. Correlations among each variable were evaluated by statistical analysis. RESULTS: VAS was correlated with pain frequency (r=0.538, p<0.01), somatization and catastrophizing thought. Rumination thought was correlated with VAS (r=0.443, p<0.01), pain frequency (r=0.446, p<0.01) and static anxiety (r= 0.449, p<0.01). Magnification thought was correlated with depression (r=0.403, p<0.01) and static anxiety (r=0.447, p<0.01). Helpless thought was correlated with VAS (r= 0.442, p<0.01), pain frequency (r=0.429, p<0.01), depression (r=0.510, p<0.01), static anxiety (r=0.640, p<0.01) and somatization (r=0.504, p<0.01). Duration was not correlated with VAS, depression, anxiety, somatization and catastrophizing thought in chronic musculoskeletal pain patients (p>0.05). CONCLUSION: Cognitive-behavioral factors such as catastrophizing thought are strongly correlated with both pain aspects and emotional factors. Consideration of cognitive- behavioral factors as well as emotional factors may be important for management of chronic musculoskeletal pain.
Ambulatory Care Facilities ; Anxiety ; Catastrophization ; Depression ; Humans ; Musculoskeletal Pain ; Surveys and Questionnaires