A Clinical observation was made on five patients with ruptured right aortic sinus of valsalva who admitted Soonchunhyang College Hospital during the period of may, 1983-Jan., 1985. 1) Age distribution was from 18 to 46 years and four patients were male and the rest one was female. 2) Chief complaints were dyspnea, chest pain and palpitation. Continuous murmur was heard at third and fourth intercostal space along left sternal border with palpable thrill in all cases. 3) The ECG showed left ventricular hypertrophy in 4 cases and the M mode echocardiogram revealed the increased internal dimesion and the augmented motion of the left ventricle in all cases. The 2 dimensional echocardiogram revealed the aneurysmal sac in the right ventricle in 4 cases. 4) The aortogram by DSA method showed regurgitant flow from aorta to right ventricle in 4 cases. The cardiac catheterization showed a significant oxygen step up in the right ventricle in all cases. 5) Operation was done successfully in all cases, of which ventricular septal defect were in 3 cases and aortic regurgitation was in one case.
Age Distribution ; Aneurysm ; Aorta ; Aortic Valve Insufficiency ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Dyspnea ; Electrocardiography ; Female ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Hypertrophy, Left Ventricular ; Male ; Oxygen ; Sinus of Valsalva*

PURPOSE: To analyze factors related with patellar dislocation and evaluate clinical results after early surgical treatment in acute patellar dislocation. MATERIALS AND METHODS: The study was done in 11 patients who underwent surgery due to acute patellar dislocation from February 1997 to January 2000. patients who had history of previous patella dislocation were excluded in this study. The average follow up period was 23 months. Radiographs were antero-posterior, lateral at 30 degree of flexion, and Merchant view. We looked for of patella alta, trochlear dysplasia, intraarticular loose body and measured sulcus angle, congruence angle, Q-angle. We checked the location of injured medial retinaculum and ostochondral lesions, and associated intraarticular lesions from MRI, arthrosopic and operative findings. We performed the 3 operative methods: Upon the completion of the arthroscopic evaluation, medial retinacular repair (5 cases), medial retinacular repair and lateral release(3 cases). augmented repair and plication of medial retinaculum ie, modified Madigan technique(3 cases). RESULTS: patella alta was present in 7 cases(63.6%), trochlear dysplasia(crossing sign) in 5 cases(45.5%), and increased sulcus angle in 5 cases(45.5%). one or more predisposing factors contribut-ing to patella dislocation were seen in 9 of 11 cases(81.8 %). Medial retinacular tear was present in the adductor tubercle in 5 cases and midportion(parapatellar tear) in 4 cases, and relaxed without tear in 2 cases. The clinical results showed that the average Kujala score was 91 points. The congruence angle became normal in 10 cases and patella subluxation was seen in 1 case postoperatively. CONCLUSIONS: Acute patellar dislocation was related in those cases with trochlear dysplasia and patella alta and increased sulcus angle . During the 23 months follow up preiods, Excellent clinical results were obtained with early surgical treatment.
Causality ; Dislocations ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Patella ; Patellar Dislocation*

OBJECTIVES: Chigger mites are vectors for scrub typhus. This study evaluated the annual fluctuations in chigger mite populations and Orientia tsutsugamushi infections in South Korea.METHODS: During 2006 and 2007, chigger mites were collected monthly from wild rodents in 4 scrub typhus endemic regions of South Korea. The chigger mites were classified based on morphological characteristics, and analyzed using nested PCR for the detection of Orientia tsutsugamushi.RESULTS: During the surveillance period, the overall trapping rate for wild rodents was 10.8%. In total, 17,457 chigger mites (representing 5 genera and 15 species) were collected, and the average chigger index (representing the number of chigger mites per rodent), was 31.7. The monthly chigger index was consistently high (> 30) in Spring (March to April) and Autumn (October to November). The mite species included Leptotrombidium pallidum (43.5%), L. orientale (18.9%), L. scutellare (18.1%), L. palpale (10.6%), and L. zetum (3.6%). L. scutellare and L. palpale populations, were relatively higher in Autumn. Monthly O. tsutsugamushi infection rates in wild rodents (average: 4.8%) and chigger mites (average: 0.7%) peaked in Spring and Autumn.CONCLUSION: The findings demonstrated a bimodal pattern of the incidence of O. tsutsugamushi infections. Higher infection rates were observed in both wild rodents and chigger mites, in Spring and Autumn. However, this did not reflect the unimodal incidence of scrub typhus in Autumn. Further studies are needed to identify factors, such as human behavior and harvesting in Autumn that may explain this discordance.
Globus Pallidus ; Humans ; Incidence ; Korea ; Mites ; Orientia tsutsugamushi ; Polymerase Chain Reaction ; Rodentia ; Scrub Typhus ; Trombiculidae

A healthy 35-year-old man who was scheduled for closed reduction of nasal bone fracture developed atrial fibrillation during induction of general anesthesia after intravenous glycopyrrolate injection. During emergence of general anesthesia, atrial fibrillation was suddenly changed to paroxysmal supraventricular tachycardia with 200 beat per minute and lasted for about 10 seconds. Because blood pressure was stable, esmolol was used to reduce ventricular response. At recovery room, ventricular response reduction about 55 beat per minute was observed after intravenous injection of verapamil 5 mg. Thereafter, the rhythm was returned to normal sinus rhythm with bradycardia.
Anesthesia, General ; Atrial Fibrillation ; Blood Pressure ; Bradycardia ; Glycopyrrolate ; Injections, Intravenous ; Nasal Bone ; Propanolamines ; Recovery Room ; Tachycardia, Paroxysmal ; Tachycardia, Supraventricular ; Verapamil

BACKGROUND: This study compared the incidence of emergence agitation and the recovery profile from sevoflurane anesthesia after thiopental sodium, propofol or ketamine induction in pediatric inguinal herniorrhaphy. METHODS: Forty eight children aged 1-7 years undergoing high ligation due to an inguinal hernia were examined. All patients received a 0.004 mg/kg glycopyrrolate injection for premedication prior to induction and were randomly assigned to receive thiopental sodium 5 mg/kg (Group T, n = 16), propofol 2 mg/kg (Group P, n = 16) or ketamine 1 mg/kg (Group K, n = 16) for induction. The side effects during the induction time were checked. All patients received sevoflurane (2-2.5 vol%)-N2O (2 L/min)-O2 (2 L/min) for the maintenance of anesthesia. Ventilation was given to assist spontaneous ventilation using a facial mask. The agitation score, pain score, discharge score, incidence of emergence agitation and postoperative side effects in the three groups were assessed at the recovery room and compared. RESULTS: The emergence time in Group T (7.5 +/- 1.8 min) was significantly rapid. The agitation and pain scores were significantly low in Group P. The discharge score was more rapid in Groups P and K than in Group T. The incidence of emergence agitation was similar in all three groups. CONCLUSIONS: Although recovery was faster and emergence agitation was low in the propofol group, propofol induction was not smooth compared with thiopental or ketamine induction. The incidence of emergence agitation after sevoflurane anesthesia in pediatric inguinal herniorrhaphy was similar in the thiopental sodium, propofol or ketamine induction groups.
Anesthesia* ; Anesthetics, Intravenous ; Child ; Dihydroergotamine* ; Glycopyrrolate ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Incidence ; Ketamine* ; Ligation ; Masks ; Premedication ; Propofol* ; Recovery Room ; Thiopental* ; Ventilation

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves that originate in the superior cervical ganglia (SCG). This study was conducted to determine the effect of an SCG block on brain injury caused by focal cerebral ischemia/reperfusion in a rat model. METHODS: Male Sprague-Dawley rats (270-320 g) were randomly assigned to one of three groups (lidocaine, ropivacaine, and control). After brain injury induced by middle cerebral artery (MCA) occlusion/reperfusion, the animals were administered an SCG bloc that consisted of 30 microliter of 2% lidocaine or 0.75% ropivacaine, with the exception of animals in the control group, which received no treatment. Twenty four hours after brain injury was induced, neurologic scores were assessed and brain samples were collected. The infarct and edema ratios were measured, and DNA fragmented cells were counted in the frontoparietal cortex and the caudoputamen. RESULTS: No significant differences in neurologic scores or edema ratios were observed among the three groups. However, the infarct ratio was significantly lower in the ropivacaine group than in the control group (P<0.05), and the number of necrotic cells in the caudoputamen of the ropivacaine group was significantly lower than in the control group (P<0.01). Additionally, the number of necrotic and apoptotic cells in theropivacaine group were significantly lower than inthe control group in both the caudoputamen and the frontoparietal cortex (P<0.05). CONCLUSIONS: Brain injury induced by focal cerebral ischemia/reperfusion was reduced by an SCG block using local anesthetics. This finding suggests that a cervical sympathetic block could be considered as another treatment option for the treatment of cerebral vascular diseases.
Anesthetics, Local ; Animals ; Blood Vessels ; Brain Injuries* ; Brain* ; DNA ; Edema ; Ganglia, Sympathetic* ; Humans ; Lidocaine ; Male ; Middle Cerebral Artery ; Models, Animal* ; Rats* ; Rats, Sprague-Dawley ; Superior Cervical Ganglion ; Vascular Diseases

There are many causes of chronic abdominal pain and abdominal protrusion. But, they are likely to be confused with diabetic thoracic polyradiculopathy. Differentiation between this self-limiting complication and abdominal herniation is important to avoid unnecessary procedure. We describe the case of 77-years-old man with 10 years history of non-insulin dependent diabetes mellitus, who was suffering from postherpetic neuralgia for 10 months and presented with a abdominal segmental paresis and protrusion. The paraspinal electromyography showed bilateral lower thoracic radiculopathy.
Abdominal Pain ; Diabetes Mellitus ; Electromyography ; Humans ; Neuralgia, Postherpetic ; Paresis ; Polyradiculopathy ; Radiculopathy ; Stress, Psychological ; Unnecessary Procedures

Paraplegia is a relatively rare complication of epidural anesthesia. Several possible factors may contribute to the development of paraplegia including arachnoiditis, trauma and ischemia. We experienced a case where paraplegia had developed after epidural anesthesia for cesarean section. So we present the case and consider the possible etiologies. A 30-year-old previously healthy woman was referred to our hospital for postpartum motor weakness of the lower limbs. Six days prior, the patient was admitted at a local obstetric clinic for delivery at 39 weeks gestation. The patient underwent a Cesarean section under epidural anesthesia induced with 20 ml 2% lidocaine and 5 ml 0.5% bupivacaine. In the early morning of the day following the Cesarean section, a motor and sensory deficit in both lower extremities was noted. A lumbar MRI showed diffuse enhancement along the cauda equina and spinal cord surface in the lower lumbar spine, suggesting diffuse arachnoiditis.
Adult ; Anesthesia, Epidural ; Arachnoid ; Arachnoiditis ; Bupivacaine ; Cauda Equina ; Cesarean Section ; Female ; Humans ; Ischemia ; Lidocaine ; Lower Extremity ; Paraplegia ; Postpartum Period ; Pregnancy ; Spinal Cord ; Spine

Seizure associated with antiemetics is rare. We report seizure associated with a 5-HT3 receptor antagonist in a 38 years old female. The patient underwent ureterorenoscopic lithotripsy due to left upper ureter stone. After operation, the patient complained of nausea in the postanesthetic recovery unit. In order to subside symptom, the patient was administrated 5-HT3 receptor antagonist, palonosetron, 0.075 mg intravenously. Shortly after administration of that, the patient developed generalized tonic-clonic seizures. The symptom was subsided after midazolam and thiopental sodium were injected. But 40 minutes later, seizure recurred and subsided with midazolam again. The patient recovered completely without any specific sequelae.
Antiemetics ; Female ; Humans ; Injections, Intravenous ; Isoquinolines ; Lithotripsy ; Midazolam ; Nausea ; Quinuclidines ; Receptors, Serotonin, 5-HT3 ; Seizures ; Thiopental ; Ureter

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglion (SCG). The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats subjected to permanent focal cerebral ischemia. METHODS: Thirty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of three groups (control, lidocaine and ropivacaine). A brain injury was induced in all rats by middle cerebral artery occlusion with a nylon thread. The animals of the local anesthetic group received 30 microl of 2% lidocaine or 0.75% ropivacaine in the SCG. Neurologic scores were assessed 24 hours after brain injury. Brain samples were then collected. The infarct and edema ratios were measured by 2.3.5-triphenyltetrazolium chloride staining. RESULTS: There were no differences in the death rates, neurologic scores, or infarction and edema ratios between the three groups. CONCLUSIONS: These findings suggest that superior cervical sympathetic ganglion block may not influence the brain damage induced by permanent focal cerebral ischemia in rats.
Amides ; Animals ; Blood Vessels ; Brain ; Brain Injuries ; Brain Ischemia ; Edema ; Ganglia, Sympathetic ; Humans ; Infarction ; Infarction, Middle Cerebral Artery ; Lidocaine ; Male ; Neuroprotective Agents ; Nylons ; Rats ; Rats, Sprague-Dawley ; Superior Cervical Ganglion