A 28-yr-old woman, weighing 61 kg with bleeding myoma of uterus was scheduled for total abdominal hysterectomy. There was no history of cardiac arrhythmia or syncope. She was not premedicated. The heart rate was 115 beats/min and arterial pressure was 155/95 mmHg, immediately before the induction of anesthesia. Under the preoxygenation, anesthesia was induced with IV injection of thiopental sodium 250 mg followed by succinylcholine 75 mg. About 20 seconds after the succinylcholine bolus, the ECG showed an abrupt change from sinus rhythm to asystole without any stimulus including laryngoscopy. After a precordial thump and atropine 0.5 mg IV, tracheal intubation and ventilation with 100% O2 were quickly accomplished. Normal sinus rhythm with heart rate of 87 beats/min returned during laryngoscopy and intubation. The interval from the sinus arrest to the reestablishment of normal sinus rhythm was only 15 seconds. Surgery proceeded uneventfully and the patient recovered without any complication.
Anesthesia ; Arrhythmias, Cardiac ; Arterial Pressure ; Atropine ; Electrocardiography ; Female ; Heart Arrest* ; Heart Rate ; Hemorrhage ; Humans ; Hysterectomy ; Intubation ; Laryngoscopy ; Myoma ; Succinylcholine* ; Syncope ; Thiopental ; Uterus ; Ventilation

BACKGROUND: The dose-responses of neuromuscular blocking agents may be influenced by many factors including age and inhalation anesthetics. This study was designed to determine the dose-response relationships of a new, short-acting muscle relaxant, mivacurium during nitrous oxide-halothane or nitrous oxide-enflurane anesthesia in two age groups, infants and 1 to 6 years old preschool children. METHODS: Neuromuscular blockade was monitored by recording the accelerographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. To estimate dose-response relationships, 24 infants or children of two anesthetic subgroups for each age group received single bolus doses of 45~100 g/kg of mivacurium. The ED50 and ED95 were estimated from linear regression plots of log-dose vs probit of twitch depression. The lag time, onset time and maximal depression of twitch height for the selective medium dose were mesured. RESULTS: The ED50 and ED95 for the infants group were 38.2 and 53.3 g/kg during halothane anesthesia, and 29.8 and 48.6 g/kg during enflurane anesthesia, respectively. And, those for preschool children group were 49.4 and 90.7 g/kg during halothane anesthesia, and 32.3 and 81.4 g/kg during enflurane anesthesia, respectively. There was a parallelism of the dose-response curve between halothane and enflurane anesthesia in either age group. Also, there was statistically significant difference in the maximal twitch depression for the selective medium dose of mivacurium between halothane and enflurane anesthesia in either group. CONCLUSIONS: The potency of mivacurium during enflurane anesthesia is higher than that during halothane anesthesia in infants and preschool children, and during either inhalation anesthesia the dose of mivacurium is less required in infants than preschool children.
Anesthesia* ; Anesthesia, Inhalation ; Anesthetics, Inhalation ; Child ; Child, Preschool* ; Depression ; Enflurane* ; Halothane* ; Humans ; Infant* ; Linear Models ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Ulnar Nerve

PURPOSE: To illustrate frequently encountered anatomic variations on PNS computed tomography(CT) and to assess their clinical significance. MATERIALS AND METHODS: CT findings of 1523 patients, who underwent PNS CT with no history of sinus surgery, were reviewed, and prevalence of each anatomic variation and its relationship with mucociliary clearance pathway was evaluated. RESULTS: Two categories of anatomic variations were encountered. The first group included variations of the turbinates, such as concha bullosa(28.6% ), paradoxical middle turbinate(31.5%), of the uncinate process, such as medially bent or folded(36.3%), laterally bent(3.7%) or uncinate bulla(0.5%), of the ethmoidal sinus, such as Haller's ce11(28.2%), large agger nasi ce11(9.6%) or large ethmoidal bulla(23.5%) and nasal septal deviation(24. 1%), which might cause obstruction of mucociliary clearance pathway and thus give rise to secondary obstructive sinusitis. The second group included Onodi ce11(1.4%) and medial depression of the lamina papyracea (3.5%), which were not related with obstructive sinusitis. 87 cases of large agger nasi cell were associated with obstruction of nasofrontal recess. Large ethmoidal bulla(452 cases), Haller's ce11(245 cases) and true concha bullosa (25 cases) contributed to narrowing of the infundibulum. Medially bent uncinate process(220 cases), concha bullosa(157 cases), paradoxical middle turbinate(126 cases) and nasal septal deviation(93 cases) were observed in middle meatal obstruction and supreme concha (3 cases) accompanied sphenoethmoidal recess obstruction. CONCLUSION: Recognition of anatomic variations on PNS CT is important to build a treatment plan in patients with obstructive sinusitis as they may represent causes of the disease, and to avoid critical complications during functional endoscopic sinus surgery.
Anatomic Variation ; Depression ; Humans ; Mucociliary Clearance ; Prevalence ; Sinusitis ; Turbinates

Actinomycosis infection can involve most part of the human body including mouth, cervicoface, chest, abdomen and pelvis. Cardiac involvement occurs in less than 2 percent of the infection of actinomyces israelii and pericardial involvement is rare. 34 year male was admitted because of chest pain and general weakness for several months. Echocardiography revealed akinesia of apex suggesting myocardial infarction and large pericardial effusion. Under the impression of pericardial effusion from tuberculosis infection, the patient was started on anti-tuberculosis medicine. Pericardial window operation with pericardial biopsy was performed 7 days later when the patient failed to show a significant improvement. Pericardial biopsy confirmed actinomycosis infection. During admission, the patient had a cerebral infarction with left hemiparesis. The patient was treated with high dose penicillin and improved symptomatically. Echocardiography showed resolution of pericardial effusion.
Abdomen ; Actinomyces ; Actinomycosis* ; Biopsy ; Cerebral Infarction* ; Chest Pain ; Echocardiography ; Human Body ; Humans ; Male ; Mouth ; Myocardial Infarction* ; Paresis ; Pelvis ; Penicillins ; Pericardial Effusion ; Thorax ; Tuberculosis*

Recently completed mitochondrial genome databses from public resources provide us with a better understanding of individual mitochondrial genomes for population genomics. By determining the substitution rate of the genomic sequences, it is plausible to derive dates on the phylogenetic tree and build a chronology of events in the evolution of human species. MitGEN is specially designed as a mitochondrial genome browser for analyzing, comparing and visualizing single nucleotide polymorphism for human mitochondrial genomes between human races for comparative genomics.It is a standalone application and is available free for non-commercial work.
Computational Biology ; Continental Population Groups ; Genome, Mitochondrial* ; Humans* ; Metagenomics ; Polymorphism, Single Nucleotide*

We report a case of atrophoderma of Pasini and Pierini in which the characteristic soft atrophic patch with cliffdrop border developed on the neck and two well-demarcated indurated atrophic patches were on both shoulders. We took biopsies from centers and margins of each lesion. Histipathologic findings from atrophic center showed marked dermal atrophy comparing to that from margin of the lesion on the neck, but the atrophic center and margin of the lesion on the shoulder showed morphea-like features without, distinct differences between two.
Atrophy ; Biopsy ; Neck ; Shoulder

PURPOSE: To evaluate the incidence and CT findings of the medial depression and bony dehiscence of lamina papyracea as an anatomic variation. MATERIAL AND METHODS: 1472 PNS CTs of the patients with symptoms of chronic sinusitis were retrospectively evaluated. RESULTS: The total incidence of depressed lamina papyracea as an anatomic variation was 3.5%(52/1472) on PNS CT. There was a statistically significant correlation between the increasing age and the incidence of delamina papyracea. Depression of lamina papyracea anterior to the basal lamella were more common those of the posterior depression. Associated findings were herniation of adjacent fatty tissue in all cases and the roedial bowing and hypertrophied configuration of the medial rectus muscle without significant herniation in 19 cases(34%). CONCLUSION: Nontraumatic, asymptomatic depression with bony dehiscence of lamina papyracea as an anatomic variation is not uncommon with the incidence of 3.5%. Recognition of its existence and degree may helpful in avoiding various ocular complication during ethmoid surgery.
Adipose Tissue ; Anatomic Variation* ; Depression* ; Humans ; Incidence ; Retrospective Studies ; Sinusitis

Leiomyoma is a benign tumors derived from smooth muscle cell. It is most commonly found in the uterus. However, leiomyoma rarely occurs in extremities and is more common in the lower limb than in the upper extremity. Leiomyoma in the hand is even rare. We present a case of leiomyoma which developed in the right hand of a man with a review of literatures.
Extremities ; Hand* ; Leiomyoma* ; Lower Extremity ; Myocytes, Smooth Muscle ; Upper Extremity ; Uterus

A fracture of the distal tibial articular surface is fortunately an uncommon injury, since it can be exeptionally difficult to manage. The term plafond is gar'nering general acceptance since there is no anatomic name for the specific location of this fracture. The term was introduced more than 50 years ago in American orthopaedic literature to describe these injuries. The literal meaning of plafond is the underside of a floor, i.e., a ceiling, so the term refers to that portion of the distal articular surface of the tibia which articulates with the superior articular surface of the talus. It excludes the medial malleolar joint surface. Fracture of the plafond have also been called compression, pylon, Malgaigne and explosion fractures. A plafond fracture is defined as one caused primarily from direct axial compression resulting in elevation andgor displacement of all or part of the distal articular surface of the tibia, excluding isolated or combined fractures of the medial and posterior malleoli that are recognizably caused by rotational forces. We reviewed 16 cases(14 patients) of tibial plafond fractures treated at the Department of Orthopaedic Surgery of Soan Chun Hyang University Hospital during 8.5 years period from June 1974 to December 1982. The longest duration of follow-up was 5 years and 6 months, the shortest, 6 months, and the average, 1 year and 6 months. They were classified according to Moore et al., and assessed according to the criteria of Joy et al. The following results were obtained: l. Of the 14 patients, male were 12, female were 2. 2. The average age of the patients was 38 years old. 3. The most common causative injury was fall-down. 4. The most common type in radiological study was dorsiflexion type. 5. In method of treatment, operative treatment was done in 9 cases and non-operative in 6 cases. 6, The average duration of the cast immobilization in non-operative treatment was 12 weeks and operative, 10 weeks. 7. Better results were obtained by operative treatment than non-operative treatment. 8, The complications were encounted in 1 case of non-operative, 2 cases of operative treatment. 9. We agree that the accurate anatomical reduction with rigid internal fixation assures better results in the tibial plafond fracture.
Clinical Study ; Explosions ; Female ; Follow-Up Studies ; Humans ; Immobilization ; Joints ; Male ; Methods ; Talus ; Tibia

No abstract available.