BACKGROUND: Vasoconstrictors have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an 2-receptor agonist has been shown to prolong the duration of spinal anesthesia following intrathecal administration. Bupivacaine has been used for spinal anesthesia and compared with tetracaine in recent studies. We have undertaken this study to further evaluate the effect of clonidine in hyperbaric 0.5% bupivacaine spinal anesthesia. METHODS: Thirty patients who were scheduled for lower limb or urologic operation were divided into 2 groups: Group A (hyperbaric bupivacaine 13 mg, 2.6 ml + N/S 1 ml), Group B (hyperbaric bupivacaine 13 mg, 2.6 ml + clonidine 150 g, 1 ml). We used standardized techniques and injected above drugs to group A and B intrathecally for spinal anesthesia. We investigated the onset and the duration of spinal anesthesia along with hemodynamic changes (blood pressure and heart rate) in patients. RESULTS: There were no significant differences in the onset of spinal anesthesia and hemodynamic changes between two groups. The time taken to recover from the nerve block was more prolonged in the group B (touch 225, pain 262, foot dorsiflexion 271, knee flexion 290 minutes) than group A (touch 154, pain 188, foot dorsiflexion 198, knee flexion 216 minutes). There were no significant differences in sedation, and in experiencing dry mouth and other side effects between two groups. CONCLUSION: Intrathecal clonidine 150 g has been proved to prolong the duration of hyperbaric 0.5% bupivacaine spinal anesthesia without neurotoxicity or dangerous hemodynamic depression. Therefore, clonidine can be used as an effective adjunct in hyperbaric bupivacaine spinal anesthesia.
Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Clonidine* ; Depression ; Foot ; Heart ; Hemodynamics ; Humans ; Knee ; Lower Extremity ; Mouth ; Nerve Block ; Tetracaine ; Vasoconstrictor Agents

OBJECTIVE: To evaluate the effect of a transcranial magnetic stimulation on reciprocal inhibition of the human leg. METHOD: Twenty healthy human subjects who showed significant inhibition of soleus H reflex after conditioning electrical stimulation of tibialis anterior at a conditioning-test interval of 2 ms were included in this study. Changes in the amount of reciprocal inhibition by conditioning electrical stimulus were compared after transcranial magnetic stimulation of tibialis anterior. RESULTS: Approximately 12% inhibition of H reflex was produced by motor threshold stimulation, and 14% inhibition by maximum stimulation of common peroneal nerve. When a submotor threshold cortical shock was given with test-conditioning interval 0 ms, this inhibition was not significantly changed. There was no significant change of H reflex amplitude ratio by conditioning electrical stimulation after delivering supramotor threshold cortical shock. Amplitude of H reflex was enhanced by transcranial magnetic stimulation at each same conditioning electrical stimulation. CONCLUSION: We conclude that TMS can produce excitatory effects on spinal motor neurons rather than Ia inhibitory interneuron and there is no evidence for convergence onto Ia inhibitory interneurons from the fiber systems excited by magnetic stimulation over the cortex.
Electric Stimulation ; H-Reflex* ; Humans ; Interneurons ; Leg ; Motor Neurons ; Muscle, Skeletal* ; Peroneal Nerve ; Shock ; Transcranial Magnetic Stimulation*

We examined the associations between thigh muscle area (TMA) and insulin resistance (IR) according to body mass index (BMI) in middle-aged Korean general population.

Kearns-Sayre syndrome (KSS) is a mitochondrial disorder resulting in multi-system dysfunction. A 14-year-old boy with KSS underwent external levator muscle resection for correction of ptosis. There were no abnormalities on the pre-operative evaluation, except for low-grade heart block and ocular problems. General anesthesia was conducted with a minimum dose of thiopental sodium and sevoflurane under close monitoring, and a laryngeal mask was inserted without muscle relaxation. The surgery was uneventful; however, a careful approach was required during anesthesia because life-threatening complications may occur in patients with KSS.
Adolescent ; Anesthesia ; Anesthesia, General ; Heart Block ; Humans ; Kearns-Sayre Syndrome ; Laryngeal Masks ; Methyl Ethers ; Mitochondrial Diseases ; Muscle Relaxation ; Muscles ; Thiopental

An 8-year-old boy presented with abdominal pain and poor oral intake for two months. Serum amylase and lipase levels were elevated. CT of the abdomen and chest X-ray showed two pseudocysts at the pancreatic uncinate process, pancreatitis with a parenchymal defect, a large amount of ascites, and a right pleural effusion. MR cholangiography and endoscopic retrograde cholangiopanreaticography revealed a pancreatic duct disruption. The patient was successfully treated with a chest tube placement and percutaneous drainage. After surgery, his general condition improved; the serum level of amylase normalized and the pleural effusion resolved. Pancreatic injuries are rare in pediatric blunt trauma; however, diagnostic difficulty is common with isolated blunt trauma. Therefore, a high index of suspicion should follow such an injury. We report the case of an 8-year-old boy with pancreas transection, ductal disruption, ascites, and pleural effusion who was successfully treated.
Abdomen ; Abdominal Pain ; Amylases ; Ascites ; Chest Tubes ; Child* ; Cholangiography ; Drainage ; Humans ; Lipase ; Male ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Pleural Effusion* ; Thorax

Primary ovarian pregnancy is rare form of ectopic pregnancy. It can be diagnosed if the only implantation occurs in the ovary. The clinical diagnosis of ovarian pregnancy is difficult. Owing to the availability of sensitive assays for human chorionic gonadotropin and the development of transvaginal ultrasonography, early diagnosis of an ectopic pregnancy has been made more feasible. But clinical and even intraoperative diagnosis of ovarian pregnancy is still difficult and only microscopic examination of tissue specimen can confirm the diagnosis. Misdiagnosis is common because it can be confused with a ruptured corpus luteum. Laparoscopic wedge resection is treatment of choice. The authors present a case of ovarian pregnancy with a brief review of the literatures.
Chorionic Gonadotropin ; Corpus Luteum ; Diagnosis ; Diagnostic Errors ; Early Diagnosis ; Female ; Ovary ; Pregnancy ; Pregnancy, Ectopic* ; Ultrasonography

Infantile hepatic hemangioma is benign vascular tumor and the most common liver tumor in infants. Small hepatic hemangioma is usually asymptomatic and seldom require therapy. Giant hepatic hemangioma, defined as more than 4 cm in diameter, is rare, but can lead to life-threatening complications such as consumptive coagulopathy, anemia, hemorrhage after tumor rupture and congestive heart failure due to arteriovenous shunting. Neonatal mortality rate is about 70-90%. The differential diagnosis of a fetal liver mass includes hemangioma, hepatoblastoma, and mesenchymal harmatoma. Although hepatic hemangioma represents the most common tumor of the liver in infant, the prenatal diagnosis of this condition has been rarely reported in the literature. we experienced a case of fetal hepatic hemangioma by prenatal sonography and report our case with a brief review of literature.
Anemia ; Diagnosis* ; Diagnosis, Differential ; Heart Failure ; Hemangioma* ; Hemorrhage ; Hepatoblastoma ; Humans ; Infant ; Infant Mortality ; Liver ; Prenatal Diagnosis ; Rupture ; Ultrasonography*

Pulmonary alveolar proteinosis is a rare disorder in which lipoproteinaceous material accumulates within the alveoli. We report a case of pulmonary alveolar proteinosis in a 41 year old female patient. She complained of a dry cough in the preceding 6 months. She presented symptoms of mild hypoxemia and diffuse infiltration at both lower lung fields. A milky fluid was obtained by bronchoalveolar lavage. We confirmed by light microscopic examinations of the lung tissues obtained by transbronchial lung biopsy. Through several follow-ups, the patients symptoms were mild.
Adult ; Anoxia ; Biopsy ; Bronchoalveolar Lavage ; Cough ; Female ; Follow-Up Studies ; Humans ; Lung ; Pulmonary Alveolar Proteinosis

BACKGROUND: Intertrochanteric fractures of the femur are the most common type of fracture, and are an increasing occurrence due to the aging of the population. The objectives of our study are to predict the fate of intertrochanteric fractures treated with intramedullary hip nails by assessing the postoperative fracture stability utilizing the newly developed scoring system, and to help rehabilitate these patients. METHODS: Eighty-two patients with intertrochanteric fractures that were treated with intramedullary hip nails between December, 2004 and January, 2011 were subjected to this study. The patients who could be followed for a minimum of one year postoperatively were enrolled. The immediate postoperative conditions were determined by radiograms: reduction status (3 parameters/4 points: contact accuracy of posteromedial cortex, severity of angulation, and distraction), fixation status (3 parameters/3 points: tip-apex distance, location of tip of the lag screw, entry point of the intramedullary nail), and fracture type (1 parameter/1 point: stable or unstable type by the Kyle's classification). Postoperative reduction loss and fixation failure were checked by radiograms taken at a minimum 3 months postoperative. RESULTS: Reduction loss and fixation failure were observed in 14 consecutive patients (17%). The fixation failure rate was 100% (2 patients) in score 1, 60% (3 out of the 5 patients) in score 2, 39% (3 out of the 8 patients) in score 3, and 50% (4 out of the 8 patients) in score 4 groups. There were fixation failures only in 1 out of 13 patients with score 5, and in 1 out of 18 patients with score 6. There was no fixation failure in 17 patients with score 7 and 11 patients with score 8. CONCLUSIONS: Maintenance of the fracture reduction by the stable fixation in the patient scores over 5 could be predicted by the postoperative radiograms.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Early Ambulation ; Female ; Femur/surgery ; Fracture Fixation, Intramedullary ; Health Status Indicators ; Hip Fractures/classification/rehabilitation/*surgery ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Recovery of Function ; Retrospective Studies ; Treatment Outcome

We experienced two cases of the intramural pregnancy, the rarest form of ectopic pregnancy and a life-threatening condition, that were successfully managed through different techniques of uterus-preserving laparoscopic surgery, thus we present these cases with a review of the literature.
Female ; Laparoscopy* ; Pregnancy* ; Pregnancy, Ectopic