Twenty patients with congenital aortic stenosis excluding valvular stenosis were studied beween April 1980 and April 1984 at Seoul National University Hospital. The clinical and radiologic findings with the emphasis on the cineangiographies were analyzed separately according to the type of aortic stenosis as subaortic and supravalvular aortic stenosis. The summaries of the analysis are as follows: 1. Among the 20 cases, 12 cases were subaorticstenosis and 8 cases were supravalvular stenosis. 2. The anatomic types of subaoritc stenosis were the discrete membranous type (8 cases), the fibromuscular type (2 cases) and the tunnel type (2 cases). 3. The obstruction of subaoritic types was usually severe, and the median left ventricular to aortic systolic pressure gradient was 60mmHg, and associated cardiac defects were found in 10 cases (84%), an incidence greater than that reported in mostother large series. 4. The anatomic types of 8 cases of supravalvular aortic stenosis were mainly focal type (7cases ) and 1 case of diffuse hypoplastic type. 5. The median left ventricular to aortic systolic pressure gradient of supravalvular stenosis was 75mmHg, and associated anomalies were seen in 6 cases(75%) with 3 cases of suspected mental retardation and facial abnormalities without definite hypercalcemia. 6. For accurate diagnosis of congenital aortic stenosis, retrograde left ventricular angiograms obtainend in axial pojections are of crucial importance in demonstration of anatomic types of stenosis and associated anomalies. And supravalvular aortic injection is sometimes helpful to outline the anatomy of the valve and to evaluate the degree of aortic regurgitation.
Aortic Stenosis, Supravalvular ; Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Blood Pressure ; Cineangiography ; Constriction, Pathologic ; Diagnosis ; Humans ; Hypercalcemia ; Incidence ; Intellectual Disability ; Seoul

OBJECTIVE: To evaluate the basophil histamine releasability in response to IgE- and non- IgE-mediated stimuli in children with atopic asthma. Met: Basophil histamine releasability was measured in Dermatophagoides farinae (D. farinae)-sensitive atopic asthmatics, D.farinae-sensitive healthy atopics, non-atopic asthmatics, and healthy non-atopics. Basophils were stimulated with D.farinae, goat antihuman IgE antibody, formyl-Met-Leu-Phe(fMLP), and Calcium ionophore A23187. Histamine was measured by automated fluorometric technique. RESULTS: Sponianeous histamine release was higher in atopic asthmatics compared to healthy non-atopics. Histamine release by D.farinae and by anti-IgE antibody was higher in atopic asthmatics compared to the other groups. There was no difference in histamine release by fMLP among all groups. Histamine release by Calcium ionophore was higher in healthy atopics and non-atopic asthmatics compared to healthy non-atopics. The atopics showed correlation between histamine release by D.farinae, by anti-IgE antibody and total serum IgE levels. CONCLUSIONS: Spontaneous and IgE-mediated histamine release were related to the presence of both atopy and asthma, whereas non-IgE mediated histamine release was different depending on the stimuli.
Asthma* ; Basophils* ; Calcimycin ; Calcium ; Child* ; Dermatophagoides farinae ; Goats ; Histamine Release ; Histamine* ; Humans ; Immunoglobulin E

Surgical stress causes changes in the composition of white blood cells (WBCs). Ketorolac is believed to have analgesic effects and to reduce the stress response and may therefore improve postoperative outcomes. The aim of this study was to assess the effect of preoperative ketorolac on the WBC subsets in patients who had laparoscopic surgery for endometriosis. Fifty patients who had laparoscopic surgery for endometriosis were randomly assigned to one of two groups: the ketorolac group (n = 25) received ketorolac 0.5 mg/kg before the induction of anesthesia, and the control group (n = 25) received saline. White cell count, differential, and pathology studies were done immediately after surgery, on postoperative day 1, and on postoperative day 3. We compared the baseline values within and between the two groups. We also assessed postoperative pain and side effects. The time that elapsed before the first patient request for analgesia, total meperidine dose and VAS (Visual Analog Scale) for postoperative pain were significantly lower in the ketorolac group than in the control group. Compared to the pre- surgical values, there was an increase in total WBC count and percentage of neutrophils, but a decrease in percentages of lymphocytes, monocytes, eosinophils, basophils, and leucocytes. Total WBC count, neutrophils, monocytes, eosinophils and leucocytes showed significant differences between the two groups. The incidences of postoperative side effects, such as nausea, dizziness, headache, and shoulder pain were not different between the groups. Preoperative ketorolac reduced postoperative pain and influenced the WBC response in laparoscopic surgery for endometriosis.
Pain, Postoperative/*prevention & control ; Leukocytes/*drug effects ; Leukocyte Count ; *Laparoscopy ; Ketorolac/*therapeutic use ; Humans ; Female ; Endometriosis/diagnosis/*surgery ; Analgesics/*therapeutic use ; Adult

BACKGROUND: The implementation of intraoperative normovolemic hemodilution is a strategy used in an attempt to diminish the need for or obviate allogeneic transfusion and to avert the potential complications. The goal of this study was to evaluate the safety and efficacy of moderate intraoperative normovolemic hemodilution. METHODS: Fifteen patients scheduled for posterolateral spinal fusion underwent intraoperative normovolemic hemodilution with 10% pentastarch to a target hematocrit level of 25% (hemodilution group). All units of blood procured by hemodilution and additional allogeneic blood was transfused in the perioperative period to maintain the hematocrit level of>25%. We investigated the effect of hemodilution on whole blood coagulation as measured by the thromboelastography and, evaluated its efficacy of decreasing the need for allogeneic blood transfusion as compared to the nonhemodilution group, retrospectively. RESULTS: Hemodilution with pentastarch caused a decrease in response and coagulation time (p<0.01) but did not influence on the alpha angle and maximum amplitude on thromboelstogram. Amount of transfusion of allogeneic blood was 4.1 1.7 units for the hemodilution group and 5.0 1.5 units for the nonhemodilution group. Net red blood cell volume ""saved"" from hemodilution was about 120 ml. CONCLUSION: Moderate intraoperative normovolemic hemodilution with pentastarch does not affect the coagulability of whole blood. But its efficacy of decreasing the need for allogeneic blood transfusion is minimal.
Blood Coagulation ; Blood Transfusion ; Erythrocytes ; Hematocrit ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Perioperative Period ; Retrospective Studies ; Spinal Fusion* ; Thrombelastography

BACKGROUND: The afferent and efferent pathways of fentanyl cough response (FCR) and central organization are poorly understood at present. The aim of this study was to investigate the pretreatment effects of morphine, propofol, atropine, and midazolam on FCR. METHOD: The 120 healthy patients were randomly assigned to six equal pretreatment groups. They received 2ug/kg fentanyl rapidly through a peripheral venous catheter. The patients in each group were pretreated before the time necessary for peak plasma levels with different drugs as follows: group 1, no premedication; group 2, morphine 0.05 mg/kg iv; group 3, morphine 0.05 mg/kg iv naloxone 0.01mg/kg iv; group 4, propofol 0.5 mg/kg iv; group 5, atropine 0.01 mg/kg iv; group 6, midazolam 0.05 mg/kg iv. The patients were observed for any coughing or side effects, including oxygen desaturation, bronchoconstriction, chest wall rigidity and seizure. RESULT: 40% of patients in group 1 (control) had a cough response to fentanyl. Group 2 (morphine) and group 3 (morphine naloxone) showed a reduced FCR of 10%. The incidence of coughing was 60% of the patients in group 4 (propofol), 30% in group 5 (atropine), and 40% in group 6 (midazolam). These were not statistically significant. CONCLUSION: FCR is not altered by pretreatment with propofol, atropine, or midazolam, but morphine inhibits cough response and this antitussive effect was not antagonized by naloxone.
Atropine* ; Bronchoconstriction ; Catheters ; Cough* ; Efferent Pathways ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Morphine* ; Naloxone ; Oxygen ; Plasma ; Premedication ; Propofol* ; Seizures ; Thoracic Wall

BACKGROUND: Korean Journal of Anesthesiology was published in 1968 and its volume has been increased every year. The purpose of this study was to investigate and to clarify the trend of increasing volumes for 28 years (1968~1996) as quantitative analysis. METHODS: Using computerized index of Korean Journal of Anesthesiology (""ART""), the trend, volumes and cumulative records (top ranked 22 frequently cited key words, 16 persons and 10 departments of University) were calculated. Some key words such as ""Anesthetic techniques: spinal, Anesthetics, intravenous:, Anesthetics, volatile: halothane, Complications:"" was traced every year for grasping the trend of academic concerns. RESULTS: 1. Total volumes of articles were about 3,000 (1968~1996). The volumes were increased slowly until 1976 and steeply since 1986. 2. The ratio of clinical case reports has been decreased every year. 3. Key words ""Anesthetic techniques"", ""Surgery"" and ""Complications"" were more frequently cited than the others. 4. Tracing some key words showed their vitality in anesthetic fields. 5. The personal top ranked number of records revealed each author's contribution to Korean Journal of Anesthesiology and the number of records in each department of University could be used as an index of academic activity. CONCLUSIONS: The extent of the increasing volumes was great especially from 1986 to 1996 and the proportion of original articles has been increased every year. The frequency of the investigated key words showed their own vitality in the field of anesthesiology. The rank according to personal and departmental records suggested the possibility of reflecting a measure of academic concerns and activity.
Anesthesiology* ; Anesthetics ; Anesthetics, Intravenous ; Halothane ; Hand Strength ; Humans

BACKGROUND: We observed fentanyl known as centrally-acting antitussive agents provoke a cough response in some patients at induction of anesthesia. This may be of clinical importance. METHOD: 121 patients (ASA class I) were assigned randomly to 4 groups. Each group was given different doses of fentanyll Group 1 (n=30); 0.5ug/kg, Group 2 (n=30); 1ug/kg, Group 3 (n=33); 2ug/kg, Group 4 (n=28); 4 g/kgl, within 1 second through a peripheral venous cannula before induction of anesthesia. All patients were observed carefully in order to detect a cough response and any side effects. RESULT: The incidences of FCR (Fentanyl Cough Response) were 0% in Group 1, 10.0% in Group 2, 30.3% in Group 3, and 39.3% in Group 4. The ED50 of FCR was 4.25ug/kg. The mean onset-time from the end of fentanyl administration to the beginning of coughing was 12.5 seconds. FCR was decreased with aging, but not affected by weight, height, or smoking. Other serious side effects were not accompanied. CONCLUSION: Fentanyl can evoke the pulmonary chemoreflex dose-dependently and the ED50 was 4.25 g/kg.
Aging ; Anesthesia ; Antitussive Agents ; Catheters* ; Cough* ; Fentanyl* ; Humans ; Incidence ; Reflex* ; Smoke ; Smoking

No abstract available.
Endometriosis* ; Female

BACKGROUND: Oculocardiac reflex (OCR) and postoperative nausea/vomiting are major complications of pediatric strabismus surgery. The aim of the study was to assess, in children undergoing strabismus surgery, the incidence of OCR and postoperative emesis with a inhalational and a intravenous technique. METHODS: 44 healthy children undergoing elective strabismus surgery as inpatients were randomly allocated to four anesthetic techniques: (1) induction with propofol, maintenance with propofol infusion and 50% N2O-O2 (propofol-N2O); (2) induction with propofol and fentanyl 1 microgram/kg bolus, maintenance with propofol infusion and 50% air-O2 (propofol-fentnyl-air); (3) induction with thiopental, maintenance with enflurane and 50% N2O-O2 (enflurane-N2O); (4) induction with thiopental and fentanyl 1 microgram/kg, maintenance with enflurane and 50% air-O2 (enflurane-fentanyl-air). RESULTS: The incidence of an OCR significantly increased in the propofol-fentanyl-air group as compared to the enflurane-N2O or enflurane-fentanyl-air groups. Times to extubation were shorter in the propofol- N2O group than in the propofol-fentanyl-air or enflurane-fentanyl-air groups. Alertness scores were lower in the propofol-N2O group than in the enflurane-N2O or enflurane-fentanyl-air groups. Postanesthetic recovery scores and nausea/vomiting during the 24 hr after the operation did not show any differences among the groups. CONCLUSIONS: We concluded that children undergoing strabismus surgery anesthetized with propofolfentanyl-air had more episodes of OCR, propofol-N2O had shorter times to extubation and higher alertness scores, and the addition of N2O or fentanyl to anesthetic regimen was not associated with nausea and vomiting.
Child ; Enflurane ; Fentanyl ; Humans ; Incidence ; Inpatients ; Nausea ; Postoperative Nausea and Vomiting ; Propofol ; Reflex, Oculocardiac* ; Strabismus* ; Thiopental ; Vomiting

PURPOSE: The purpose of this study was to describe the clinical characteristics of neonatal urinary tract infection (UTI) caused by Klebsiella pneumoniae and non- Klebsiella pneumoniae UTI. METHODS: We compared clinical characteristics of 84 neonatal patients with UTI caused by Klebsiella pneumoniae who were hospitalized at the Department of Pediatricsat Han Dong University, Sunlin Hospital during the period between May, 1994 and August, 1998. The cases were divided into two groups depending upon causative organisms' Klebsiella pneumoniae UTI vs non-Klebsiella pneumoniae UTI, and the clinical characteristics of these groups were compared. RESULTS: Escherichia coli was the most common bacterial pathogen causing neonatal UTI, followed by Klebsiella pneumoniae. There was no significant difference in the sex distribution of Klebsiella pneumoniae UTI, but non-Klebsiella pneumoniae UTI showed male predominence. There were no significant differences in the incidences of hematologic, urologic, radiologic findings and perinatal complications in between these 2 groups. CONCLUSION: Klebsiella pneumoniae is the second most common pathogen causing neonatal UTI. There were no specific differences in the laboratory, symptomatologic, and radiologic findings in these two groups.
Escherichia coli ; Humans ; Incidence ; Klebsiella pneumoniae* ; Klebsiella* ; Male ; Pneumonia ; Sex Distribution ; Urinary Tract Infections* ; Urinary Tract*