Propofol is a short acting, rapidly metabolized intravenous anesthetic agent. It cause a decrease in arterial pressure after induction of anesthesia and a decrease in heart rate. Hypertension, tachycardia during induction of anesthesia or in response to tracheal intubation is undesirable in high-risk patients, Propofol might attenuate the pressor to tracheal intubation than thiopental. In this study we compared propofol with thiopental for induction of anesthesia. Forty patients of ASA class III scheduled to undergoing valvular replacements divided two groups. Twenty patients were induced with thiopental, twenty patients were induced with propofol and maintained using 50% nitrous oxide in oxygen. Cardiovascular parameters were checked before induction, after propofol or thiopental injection, after succinylcholine injection, after tracheal intubation, after isoflurane mixed inhalations. The aim of this study is to examine a camparison of hemodynamic effects between propofol and thiopental for valvular replacement. The results were as follows. 1) There is little change in heart rate with thiopental group, but heart rate was decreased in propofol group. 2) There is slightly deaeased in arterial pressure with thiopental group, but markedly decreased in propofol group. 3) There is no difference of central venous pressure between two groups.
Anesthesia ; Arterial Pressure ; Central Venous Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation ; Isoflurane ; Nitrous Oxide ; Oxygen ; Propofol* ; Succinylcholine ; Tachycardia ; Thiopental*

BACKGROUND: Epidural anesthesia is thought to be relatively indicated for cesarean section in patients with severe preeclampsia. In contrast, avoidance of spinal anesthesia is recommended, postulating excessive hypotensive risks. In addition, general anesthesia is often avoided in this population because malignant hypertension following tracheal intubation is common and risks for difficult airway management are excessive. METHODS: In this study, we compared hemodynamic changes in patients with severe preeclampsia and normal pregnant women during spinal anesthesia for elective cesarean section. Spinal anesthesia was performed with 10 mg of 0.5% heavy bupivacaine mixed with 25 microgram fentanyl in 18 patients with severe preeclampsia and 17 normal pregnant women. We compared MAP, CI, and SVRI changes before and after spinal anesthesia. RESULTS: MAP responses following induction of spinal anesthesia for elective cesarean section in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. CI responses following induction of spinal anesthesia in patients with severe preeclampsia showed a statistically significant increase from 8 min after and normal pregnant women also showed a statistically significant increase from 4 min after spinal anesthesia. SVRI responses from induction of spinal anesthesia in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. Incidence of hypotension before delivery and used total dose of ephedrine during operation were statically insignificant between severe preeclamptic and normal pregnant women. CONCLUSIONS: We conclude that changes of MAP, CI and SVRI following spinal anesthesia for elective cesarean section in the severely preeclamptic and normal pregnant women are clinically similar. We suggest that spinal anesthesia for cesarean section is not contraindicated in the severely preeclamptic patient.
Airway Management ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal* ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Female ; Fentanyl ; Hemodynamics* ; Humans ; Hypertension, Malignant ; Hypotension ; Incidence ; Intubation ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women

PURPOSE: We analyzed the patients who needed reoperation after undergoing a thoracolumbar spine operation and investigated the causes, pattern of timing, medical history and clinical outcome after reoperation. MATERIALS AND METHODS: Out of 2,198 patients who underwent spine surgery for thoracolumbar spine disease from 1988 to 2011, we targeted 193 patients who underwent reoperation. We studied the causes, operative method of initial surgery, time-variant causes and outcome of reoperation. RESULTS: The number of patients who underwent thoracolumbar spine reoperation was 193 out of 2,198 and the reoperation rate was 8.7%. We researched time-variant causes of reoperation. In six weeks after the initial operation, exploration for hematoma and neurologic deficit was 18 (26.8%), recurred heniated intervertebral disc (HIVD) was 18 (26.8%), and surgical site infection was 17 (25.4%). From six weeks to six months, recurred HIVD was 10 (47.6%), surgical site infection was 7 (33.3%), and after six months, adjacent segmental disease (ASD) was 38 (35.7%), recurred HIVD was 26 (23.2%), and implant related problem was 17 (16.0%). CONCLUSION: Causes of thoracolumbar spine reoperation included complications (2.8%); infection, hematoma, neurologic deficit, incomplete decompression, and natural courses (5.9%); ASD, recurred HIVD, implant related problem, instability after decompression, tumor recur, progression of deformity.
Congenital Abnormalities ; Decompression ; Hematoma ; Humans ; Intervertebral Disc ; Neurologic Manifestations ; Reoperation ; Spine

PURPOSE: We made investigation into the etiology, clinical manifestations, laboratory findings, treatments, outcomes, prognosis and prognostic factors of acute myocarditis in children. METHODS: We have reviewed the medical records of the patients who were admitted to the Chonbuk National University Hospital for recent 10 years. Patients were divided in two groups with base on the outcomes. One is recovery group and the other is mortality group. And we analyzed the clinical findings and compared between two groups. RESULTS: Ten of 27 patients were expired with fulminant myocarditis or complication of acute myocarditis. Seventeen patients were recovered. Left ventricular fractional shortening on the echocardiogram was a valuable prognostic factor. Seventeen patients were treated with IVIG. Seven patients were evaluated the viral etiology. Coxsackie B5, coxsackie B3, coxsackie A10 and adenovirus were detected. CONCLUSION: Left ventricular fractional shortening was a valuable prognostic factor. It is necessary to research antegrade multicenter study about acute myocarditis.
Adenoviridae ; Child* ; Humans ; Immunoglobulins, Intravenous ; Jeollabuk-do ; Medical Records ; Mortality ; Myocarditis* ; Prognosis*

PURPOSE: Breast carcinoma in young patients has been reported to present with more aggressive biologic characteristics and to behave poorer compared with the disease in older patients. However, the association between the age and the prognosis in premenopausal patients has rarely been reported on. This study aimed to reveal the clinicopathologic characteristics and prognostic significance of young age (age< or =35) for the breast cancer of premenopausal women. METHODS: We retrospectively analyzed 1033 premenopausal women with breast cancer who underwent surgery in our institution between 1985 and 2003. A total of 180 patients were aged >35 years (the younger premenopausal group) and 853 patients were aged >35 years (the older premenopausal group). The clinicopathologic characteristics and treatment outcomes were compared between the younger and older groups. RESULTS: Compared to the older premenopausal group, the younger group showed earlier menarche (15.2+/-19 years old versus 16.0+/-1.7 years old, respectively, p<0.001), larger tumor (3.7+/-2.1cm versus 3.2+/-2.0cm, respectively, p=0.002), more metastatic axillary lymph nodes (3.8+/-7.0 versus 2.4+/-5.7, respectively, p=0.001), more advanced TNM stage (p=0.015), a lower PR positive rate (47.7% versus 59.9%, respectively, p=0.011), and a higher P53 positive rate (71.7% versus 54.9%, respectively, p=0.034). The recurrence rate for the younger group was 26% as compared with 14.4% for the older group. The overall 5-year and 10-year survival rates of younger group were 79.3% and 68.5%, respectively and these of older group were 91.1% and 84.3%, respectively. CONCLUSION: In premenopausal women with breast cancer, patients with an age< or =35 years have a greater chance of having an endocrine non-responsive tumor, and they are more likely present with larger tumor, more metastatic axillary lymph nodes and a more advanced TMN stage. These results show that younger premenopausal patients have a worse prognosis than older premenopausal patients.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Lymph Nodes ; Menarche ; Population Characteristics ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

STUDY DESIGN: A prospective study. OBJECTIVE: To determine whether phospholipase A2(PLA2) activity in herniated lumbar disc is correlated with clinical, radiographic and anatomic signs of the patients with herniated nucleus pulposus. SUMMARY OF LITERATURE REVIEW: Several studies have suggested inflammation around nerve root as a mechanism of sciatica and PLA2 emerges as a key enzyme of the inflammation. However, consensus about association between PLA2 and sciatica has been lacking. In addition, there has been no report that investigated the relationship between cytosolic and membrane PLA2 in herniated disc and patient's symptoms. MATERIALS AND METHODS: Human intervertebral disc materials were obtained from 33 patients who underwent discectomy for HNP. The information was noted about smoking history, medication of NSAID, symptom duration, pain score on a visual analog scale(VAS), positive angle of straight leg raising test (SLR), neurologic deficits, Thompson grade of herniated disc, volume of herniation shown by the MRI and type of herniation based on the operative record. These data were matched to the PLA2 a ctivity in herniated disc measured using Western blotting analysis. PLA2 activity was expressed as the relative percentage compared to that of a 33-year-old female disc obtained during an operation for spinal fracture. The analysis was carried out using Mann-Whitney test, Pearson correlation analysis, simple linear regression analysis. A value of p<0.05 was considered significant. RESULTS: Cytosolic and membrane PLA2 activity showed no statistical relationship to clinical, radiographic and anatomic characteristics of herniated disc. However, membrane PLA2(active form) activity was correlated with the pain score on VAS(p=0.013, r=0.481), while cytosolic PLA2(latent form) showed no statistically significant correlation with the pain score. CONCLUSION: This study demonstrates that membrane PLA2 activity is correlated with the pain score. It also suggests that selective PLA2 inhibitors could be used for the alternative treatment modality of HNP.
Adult ; Blotting, Western ; Consensus ; Cytosol ; Diskectomy ; Female ; Humans ; Inflammation ; Intervertebral Disc ; Intervertebral Disc Displacement ; Leg ; Linear Models ; Magnetic Resonance Imaging ; Membranes ; Neurologic Manifestations ; Phospholipases A2* ; Phospholipases* ; Prospective Studies ; Sciatica ; Smoke ; Smoking ; Spinal Fractures

OBJECTIVE: Epithelial ovarian cancer is the most common cause of death due to gynecologic malignancies in adults, but is rare in children and adolescents. This is a report of series of such patients under 20 years of age documenting their presentation, histologic type, stage of disease, treatment, and outcome. METHODS: We collected data on 21 patients with epithelial ovarian cancer under 20 years of age between January 1990 and December 2005. Patient records and pathology were reviewed. RESULTS: Epithelial ovarian cancer under 20 years of age was 2.2% in overall ovarian cancer. Epithelial ovarian cancer was 42.0% among 50 patients under 20 years of age and the most common histologic type was germ cell tumors (54%). The median age at the time of diagnosis was 17.6 years (range, 13-20 years), and the median follow-up was 87 months (range, 4-175 months). There were seventeen (81.0%) mucinous tumors, four (19.0%) serous tumors. About thirty-eight percent were low malignant potential or borderline tumors. About Eighty-five percent (18 patients) of tumors were stage I disease and about fourteen percent (3 patients) were stage III disease at the time of diagnosis. Surgical treatment included conservative surgery in 18 patients (85.7%), total abdominal hysterectomy and bilateral salpingo- oophorectomy in 3 patients (14.3%). CONCLUSION: Epithelial ovarian cancers are rare in patients in children and adolescents. The majority of ovarian cancers in this age group are mucinous tumors, stage I at diagnosis and borderline ovarian tumor. Conservative management is feasible to achieve preservation of fertility.
Adolescent ; Adult ; Cause of Death ; Child ; Female ; Fertility ; Follow-Up Studies ; Humans ; Hysterectomy ; Mucins ; Neoplasms, Germ Cell and Embryonal ; Neoplasms, Glandular and Epithelial ; Ovarian Neoplasms ; Ovariectomy

Acute hemorrhagic edema of infancy (AHEI) is an uncommon form of cutaneous leukocytoclastic vasculitis that occurs in infants and children younger than 2 years. AHEI is characterized clinically by marked peripheral edema and fever as well as large palpable purpuric and ecchymotic skin lesions in a target-like pattern, mainly on the face, ears and extremities, similar to the skin findings of Henoch-Schonlein purpura (HSP). The skin lesions heal spontaneously within one to three weeks and internal organs are rarely affected. We report a case of AHEI occurring in a 23-month-old boy who was initially misdiagnosed as HSP, and was later diagnosed according to his clinical symptoms and histochemical characteristics.
Child ; Ear ; Edema* ; Extremities ; Fever ; Humans ; Infant* ; Male ; Purpura ; Purpura, Schoenlein-Henoch* ; Skin ; Vasculitis, Leukocytoclastic, Cutaneous

OBJECTIVE: The purpose of this study was to analyze the stress distribution and the displacement pattern of mandibular anterior teeth under various intrusive force vectors according to the position of orthodontic miniscrews and hooks, using three-dimensional finite element analysis. METHODS: A three-dimensional finite element model was constructed to simulate mandibular teeth, periodontal ligament, and alveolar bone. The displacement of individual tooth on three-dimensional planes and the von Mises stress distribution were compared when various intrusion force vectors were applied. RESULTS: Intrusive forces applied to 4 mandibular anterior teeth largely resulted in remarkable labial tipping of the segment according to the miniscrew position. All 6 mandibular anterior teeth were labially tipped and the stress concentrated on the labiogingival area by intrusive force from miniscrews placed mesial to the canine. The distointrusive force vector led to pure intrusion and the stress was evenly distributed in the whole periodontal ligament when the hook was placed between the central and lateral incisors and the miniscrew was placed distal to the canine. CONCLUSIONS: Within the limits of this study, it can be concluded that predictable pure intrusion of the 6 anterior teeth segment may be accomplished using miniscrews placed distal to the canine and hooks located between the central and lateral incisors.
Displacement (Psychology) ; Incisor ; Periodontal Ligament ; Tooth

Purpose: This retrospective study aimed to clarify the relation between nutritional index and length of hospital stay in elderly patients undergoing pancreatic cancer surgery, and to identify factors affecting the length of hospital stay. Methods: Total 102 patients aged over 65 years who underwent pancreaticoduodenectomy were retrospectively enrolled from January 1, 2010 to September 30, 2020. All patients were subjected to nutritional screening using Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI). Results: The GNRI average was 95. 66±6.95, with 67.6% of patients having a low GNRI score (malnutrition group). The average regarding PNI was 45.46±5.65, with 54.9% of patients having a low PNI (malnutrition group). The average total length of hospital stay was 23.12±10.69 days. Total length of hospital stay according to the nutritional indexes of the subjects was longer in the low GNRI (t=-2.09, p=.039) and low PNI (t=-2.29, p=.024) groups. Conclusion Poorer preoperative nutritional status increased total length of hospital stay in elderly patients with pancreatic cancer. Assessment of nutritional status of patients using GNRI and PNI is a good strategy for evaluating elderly patients at high risk of having to stay in hospital for more extended periods of time.