No abstract available.
Fascia* ; Foot* ; Leg*

No abstract available.
Neuroma*

Pipecuronium bromide (Arduan) is a new steroid base, bisquatemary neuromuscular blocking agent in clinical use in Eastern Europe. The chemical structure, speed of onset and duration of neuromuscular effect of pipecuronium is similar to those of pancuronium. Unlike pancuronium, however, it has no unwanted cardiovascular effects. The neuromuscular and cardiovascular effects of pipecuronium were compared with those of pancuronium in 40 adult patients anesthetized with thiopentone, nitrous oxide with oxygen and intravenous meperidine nad diazepam. Twenty patients received pancuronium 0.02 mg/kg, followed 3 minutes later by pancuronium 0.1 mg/kg intravenously (pancuronium group). The other 20 patients received pipecuronium 0.015 mg/kg and 0.08 mg/kg (pipecuronium gmup). Patient's complaint was asked 2 minutes after administrations af the priming doses. Times to 75% and 100% twitch depression were measured and the conditions of tracheal intubation were evaluated at 100% twitch depression. Heart rate, and systolic and diastolic blood pressures were checked noninvasively on arrival in the operating room (control), before trachal intubation (maximal relaxation), 1, 3, and 5 minutes after tracheal intubation. The results obtained were as follows; 1) Mild complaint of patient, such as unable to open eyes or blurred vision after priming doses was 95% in the pancuronium group and 75% in the pipecuonium group. 2) The times to 75% and 100% twitch depression of the pipecuronium group were 72+/-2.2 sec and 112.8+/-3.3 sec and were shorter than those of the pancuronium group. 3) In the pancuronium group, there was significant increases of heart rate and rate pressure product (RPP) before tracheal intubation, 1, 3, and 5 minutes after tracheal intubation compared with control value. In the pipecuronium group, there was no significant change in heart rate before tracheal intubation and 5 min after tracheal intubation compared with control value, but significant decrease in blood pressure, occured with decrease in RPP. The heart rate and RPP following administration of pipecuronium decreased significantly before tracheal intubation and 5 min after tracheal intubation compared with the pancuronium group. The results from the above study suggest that pipecuronium would have advantages over patients with significant cardiovascular diseases for a prolonged operation.
Adult ; Blood Pressure ; Cardiovascular Diseases ; Depression ; Diazepam ; Europe, Eastern ; Heart Rate ; Humans ; Intubation ; Meperidine ; NAD ; Neuromuscular Agents ; Neuromuscular Blockade ; Nitrous Oxide ; Operating Rooms ; Oxygen ; Pancuronium ; Pipecuronium* ; Thiopental

No abstract available.
Gestational Age* ; Intracranial Hemorrhages*

Postoperative hypertension occurs often in hypertensive patients due to pain, hypercapnia, hypoxemia, or excessive intravascular fluid volume. In addition, tracheal extubation exacerbates hypertension and tachycardia, which leads to left ventricular failure, myocardial infarction, or cerebral hemorrhage. We experienced a case of recurrent intracerebral hemorrhage after extubation in the postanesthetic care unit. The patient was 50-year old female who underwent total abdominal hysterectomy. Three months ago, she suffered a hypertensive cerebral hemorrhage with conservative treatment. Anesthesia induction and intraoperative course were relatively uneventful. In the postanesthetic care unit, she had voluntary movement of all limbs to command and fully awake consciousness. Immediately after tracheal extubation, the blood pressure was increased sharply to 200/110 mmHg. After then, the patient's mental status was deteriorated and the motor weakness of left extremities was developed. Brain CT showed a hypertensive hemorrhage at the right putamen and emergency stereotaxic aspiration was performed. After rehabilitative treatment, the patient was discharged with alert mental status and moderate improvement of motor weakness.
Airway Extubation ; Anesthesia ; Anoxia ; Blood Pressure ; Brain ; Cerebral Hemorrhage* ; Consciousness ; Emergencies ; Extremities ; Female ; Hemorrhage ; Humans ; Hypercapnia ; Hypertension ; Hysterectomy ; Intracranial Hemorrhage, Hypertensive ; Middle Aged ; Myocardial Infarction ; Putamen ; Tachycardia

PURPOSE: To evaluate the clinical usefulness of a home-made histographic analysis system using a lung volume controller. MATERIALS AND METHODS:Our study involved ten healthy volunteers, ten emphysema patients, and two idio-pathic pulmonary fibrosis (IPF) patients. Using a home-made lung volume controller, images were obtained in the upper, middle, and lower lung zones at 70%, 50%, and 20% of vital capacity. Electron beam tomography was used and scanning parameters were single slice mode, 10-mm slice thickness, 0.4-second scan time, and 35 -cm field of view. Using a home-made semi-automated program, pulmonary parenchyma was isolated and a histogram then obtained. Seven histographic parameters, namely mean density (MD), density at maximal frequency (DMF), maximal ascending gradient (MAG), maximal ascending gradient density (MAGD), maxi-mal descending gradient (MDG), maximal descending gradient density (MDGD), and full width at half maxi-mum (FWHM) were derived from the histogram. We compared normal controls with abnormal groups includ-ing emphysema and IPF patients at the same respiration levels. RESULTS: A normal histographic zone with +/-1 standard deviation was obtained. Histographic curves of normal controls shifted toward the high density level, and the width of the normal zone increased as the level of inspi-ration decreased. In ten normal controls, MD, DMF, MAG, MAGD, MDG, MDGD, and FWHM readings at a 70% inspiration level were lower than those at 20% (p<0.05). At the same level of inspiration, histograms of emphysema patients were located at a lower density area than those of normal controls. As inspiration status decreased, histograms of emphysema patients showed diminished shift compared with those of normal con-trols. At 50% and 20% inspiration levels, the MD, DMF, and MAGD readings of emphysema patients were significantly lower than those of normal controls (p<0.05). Compared with those of normal controls, his-tograms of the two IPF patients obtained at three inspiration levels were located in an area of higher density. CONCLUSION: Using a home-made histographic analysis system which included a lung volume controller, pa-tients with diffuse parenchymal lung disease could be distinguished from normal controls. The method may be useful for the diagnosis and follow up of diffuse parenchymal lung diseases.
Diagnosis ; Emphysema ; Healthy Volunteers ; Humans ; Lung Diseases* ; Lung Diseases, Interstitial ; Lung* ; Pilot Projects* ; Pulmonary Emphysema ; Pulmonary Fibrosis ; Reading ; Respiration ; Tomography, X-Ray Computed ; Vital Capacity

PURPOSE: CT or MRT is performed in preoperative staging of laryngeal cancer. These methods are used in assessment of the deep tissues and cartilage of the larynx, but cannot compete with laryngoscopy in the evaluation of the laryngeal surface. The purpose of this study is to evaluate feasibilty and clinical value of the 3-D reconstruction of the mucosal surface in laryngeal cancer. METHODS AND MATERIALS: Twenty two patients with laryngeal cancer proved by means of surgical.exploration (pathologic) or clinical examinations including laryngoscope, imaging studies and biopsy underwent preoperative staging with computed tomography(G-P);and three dimensional(3D) CT reconstruction. The TNM classification of the American Joint Committee on Cancer was used to compare the imaging findings with pathologic or clinical staging. RESULTS: When the extension of primary tumor(T staging) was evaluated, the findings at only transaxial CT and those at pathologic or clinical examination were concordant in 8 of 14 cases(57.1%) of supraglottic tumor, and 3 of 6 cases(50%) of glottic tumor. The overall accuracy of CT with additional 3D-reconstruction was 85.7% for assessment of supraglottic tumor, and 66.6% for glottic tumor. CONCLUSION: 3D CT reconstruction after transaxial CT may improve outcome in preoperative staging of laryngeal cancer and has a potential value in guiding management decisions.
Biopsy ; Cartilage ; Classification ; Humans ; Joints ; Laryngeal Neoplasms* ; Laryngoscopes ; Laryngoscopy ; Larynx

PURPOSE: Interleukin (IL) -13 plays a pivotal role in the induction of immunoglobulin E (IgE) and in the pathogenesis of atopic dermatitis (AD). Recently, an association was reported between the polymorphism of the IL-13 promoter region (-1512A/C) and atopic asthma. We investigated the association between the IL-13 single nucleotide polymorphism (SNP) in the promoter region (-1512A/C) and atopic dermatitis in Korean children with AD. METHODS: We enrolled 204 allergic AD, 92 non-allergic AD, and 116 non-atopic healthy children. Evaluated phenotypes of atopic dermatitis included total IgE, total eosinophil count, and eosinophil fraction. We used a PCR-RFLP method to identify IL-13 genotypes. RESULTS: The allele frequencies of the IL-13 promoter polymorphism (-1512A/C) did not differ statistically among the three groups. Children with one or two copies of risk alleles in the promoter region (-1512C) did not show any significant association with the clinical phenotypes of atopic dermatitis including total IgE, eosinophil phenotypes and SCORAD score in the allergic or non-allergic atopic dermatitis. CONCLUSION: These data suggest that the -1512A/C polymorphism of IL-13 gene may not be associated with neither the development nor the clinical phenotypes of atopic dermatitis in Korean children.
Alleles ; Asthma ; Child* ; Dermatitis, Atopic* ; Eosinophils ; Gene Frequency ; Genotype ; Humans ; Immunoglobulin E ; Immunoglobulins ; Interleukin-13* ; Interleukins ; Phenotype ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic

PURPOSE: To assess the changes in mean corneal refractive power (DeltaK) following pterygium surgery and to predict DeltaK in cases of combined cataract and pterygium surgery. METHODS: Thirty-seven eyes of unilateral pterygium patients who underwent pterygium surgery were analyzed retrospectively with at least more than 1 month of follow-up. Preoperative and postoperative 1 month corneal refractive power was measured using auto-keratometer (RK-F1, Canon, Tokyo, Japan). Pterygium horizontal extension, width, and area were measured and correlation with DeltaK before and after surgery analyzed. We also compared DeltaK of the contralateral normal eye. RESULTS: The mean corneal refractive (Km) power measured before and 1 month after surgery was 43.30 +/- 1.66 D and 44.07 +/- 1.42 D, respectively. The Km significantly increased at 4 weeks after surgery (p < 0.001). However, postoperative Km was not significantly different when compared with the contralateral normal eye (43.86 +/- 1.34 D; p = 0.59). All parameters of pterygium size including horizontal extension, width, and area were positively correlated with the mean DeltaK. Among parameters, horizontal extension was best correlated with mean DeltaK (p < 0.001). The mean DeltaK with horizontal extension was predicted using linear regression (2.5 mm to 1 D, 4.0 mm to 1.8 D). CONCLUSIONS: We recommend contralateral corneal refractive power or prediction of corneal refractive power using linear regression with pterygium horizontal extension for determining intraocular lens power in cases of combined cataract and pterygium surgery.
Cataract ; Follow-Up Studies ; Humans ; Lenses, Intraocular ; Linear Models ; Pterygium* ; Retrospective Studies

Subclavian steal syndrome caused by an acute thrombus is very rare. We present a case of cerebellar infarction with proximal subclavian artery thrombosis. A 56-year-old woman was admitted for sudden vertigo. One day prior to admission, she received a shoulder massage comprised of chiropractic manipulation. On examination, her left hand was pale and radial pulses were absent. Blood pressure was weak in the left arm. Downbeat nystagmus and a right falling tendency were observed. Brain MRI showed multiple acute infarctions in the left cerebellum. The findings of Doppler ultrasonography in the left vertebral artery were compatible with a partial subclavian artery steal phenomenon. Digital subtraction angiography demonstrated a large thrombus in the left subclavian artery. After heparin infusion, thrombus size markedly decreased. Cerebellar infarction caused by acute subclavian thrombosis following minor trauma is rare, but the thrombus can be successfully resolved with anticoagulation.
Brain Infarction/*diagnosis/etiology/pathology ; Cerebellar Diseases/diagnosis/etiology ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Thrombosis/*complications