Malignant hyperthermia is a metabolic and genetic disease which present with multiple signs of variable intensity and time course. Most of signs are nonspecific to malignant hyperthermia an4 it is not unusual for malignant hyperthermia-susceptible patients to under- go their first anesthesia uneventfully. Thus,the accurate prediction of preanesthetic susceptibility and early diagnosis of malignant hyperthermis can be lifesaving. Recently, some episodes of signs and symptoms suggestive of malignant hyperthemia after spinal an- esthesia those were suspected to be malignant hyperthermia have been reported. In our hospital, two patients suffered from signs and symptoms suggestive of malignant hyperthermia after spinal anesthesia. One patient showed severe muscle rigidity on the un- blocked upper extremities and thorax, tachycardia (120-160beat/min) and hypertension (180-160/120-100mmHg) and later he showed high fever(38-40degrees C), generalized seizure and severe acidosis. He expired the next day of operation in spite of intensive care. The other patient showed shivering, high fever(39degrees C) and elevated serum CPK level(more than 1,500IU/ L) after spinal anesthesia. Intensive treatment with cooling was immediately initiated. Then, he recovered completely 6 hours later. His mother and a brother showed increased serum CPK level(91,112IU/L, respectively), too. Although we could not performed confirmatory diagnostic test, signs and symptoms were very similar to those of malignant hyperthermia. So, we suspected that it might be malignant hyperthermia.
Acidosis ; Anesthesia ; Anesthesia, Spinal* ; Diagnostic Tests, Routine ; Early Diagnosis ; Humans ; Hypertension ; Critical Care ; Malignant Hyperthermia* ; Mothers ; Muscle Rigidity ; Seizures ; Shivering ; Siblings ; Tachycardia ; Thorax ; Upper Extremity

No abstract available.

No abstract available.
Cicatrix* ; Contracture* ; Syndactyly*

Hypertension is a serious health problem due to high frequency and concomitant other diseases including cardiovascular and renal dysfunction. Olmesartan cilexetil is a new antihypertensive drug associated with angiotensin II receptor antagonist. This study was conducted to evaluate the mutagenicity of olmesartan cilexetil by bacterial reverse mutation test using Salmonella typhimurium (TA100, TA1535, TA98, and TA1537) and Escherichia coli (WP2 uvrA). At the concentrations of 0, 62, 185, 556, 1667, and 5000 microg/plate, olmesartan cilexetil was negative in both Salmonella typhimurium and Escherichia coli regardless of presence or absence of metabolic activation system (S9 mix). These results demonstrate that olmesartan cilexetil does not induce bacterial reverse mutation.
Biotransformation ; Escherichia coli ; Hypertension ; Imidazoles ; Receptors, Angiotensin ; Salmonella typhimurium ; Tetrazoles

The major risk factors for diabetics undergoing surgery are the end-organ diseases associated with diabetes. Autonomic neuropathy is relatively common in diabetic patients and associated with an increased risk of perioperative cardiovascular instability. We experienced a case of severe bradycardia and hypotension during general anesthesia for subtotal gastrectomy in a 59 year-old male diabetic patient. Anesthesia was induced with thiopental and vecuronium, and was maintained with nitrous oxide, oxygen and enflurane. Five minutes after induction, severe bradycardia and hypotension developed without specific events. The bradycardia was unresponsive to intravenous atropine and ephedrine, but the blood pressure was restored by administration of ephedrine. During operation his blood pressure was maintained in normal range but the bradycardia was not restored by additional administration of atropine. Postoperatively, myocardial infarcton was ruled out. The test performed after operation suggested that his cardiovascular autonomic nervous system was severely impaired. We think that cardiovascular autonomic dysfunction should be evaluated during preoperative period to plan the anesthetic management and to prevent severe cardiovascular complications in diabetic patients.
Anesthesia ; Anesthesia, General* ; Atropine ; Autonomic Nervous System ; Blood Pressure ; Bradycardia* ; Diabetes Mellitus ; Enflurane ; Ephedrine ; Gastrectomy ; Humans ; Hypotension ; Male ; Middle Aged ; Nitrous Oxide ; Oxygen ; Preoperative Period ; Reference Values ; Risk Factors ; Thiopental ; Vecuronium Bromide

BACKGROUND: The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. METHODS: Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. RESULTS: Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. CONCLUSIONS: The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis.
Aged ; Arthralgia/*surgery ; Arthroplasty, Replacement, Knee/*instrumentation/*methods ; Cementation ; Female ; Follow-Up Studies ; Humans ; Knee Joint/*surgery ; Knee Prosthesis ; Male ; Middle Aged ; Patella/surgery ; Prosthesis Failure ; Retrospective Studies ; Treatment Outcome

PURPOSE: Interstitial lung disease(ILD) is a rare and poorly characterized disorder in children with poor prognosis. To understand the ILD in children, we reviewed our experience with 21 patients who were diagnosed interstitial lung disease during 9-year period at Asan Medical Center retrospectively. METHODS: Severity-of-illness score was measured by the Denver protocol. We evaluated underlying diseases, clinical manifestations, high resolution computed tomography findings, lung pathology and clinical responses after steroid therapy and prognosis. Fifteen patients were performed open lung biopsy, but six patients were diagnosed bronchiolitis obliterans by HRCT. RESULTS: The median ages at onset of ILD was 1 year 5 month old. Common clinical findings were tachypnea(90.0%), hypoxemia(90.0%). 14 patients among 15 patients were diagnosed specifically after open lung biopsy. Interstitial pneumonitis was 6 cases, including 3 nonspecific interstitial pneumonitis, 2 cases of desquamative interstitial pneumonitis and one usual interstitial pneumonitis. Other diagnosis included idiopathic pulmonary fibrosis, cytomegalovirus pneumonitis, diffuse aspiration bronchiolitis, pulmonary lymphangiomatosis, BOOP(bronchiolotis obliterans organizing pneumonia) and pulmonary histiocytosis. Six patients showed clinical and HRCT findings consistent with bronchilitis obliterans. Common radiologic findings were mosaic perfusion(12/21), bronchial wall thickening(9/21). 13 patients among 15 patients with methylprednisolone pulse therapy showed improvement of clinical symptoms. The severity-of-illness score was improved significantly after methylprednisolone pulse therapy. CONCLUSION: Pediatric ILD includes heterogeneous disorders. Open lung biopsy was helpful to make early diagnosis. Severity-of-illness score is a noninvasive and useful measure of disease progression or response to therapy. Methylprednisolone pulse therapy may be effective to treat ILD.
Biopsy ; Bronchiolitis ; Bronchiolitis Obliterans ; Child* ; Chungcheongnam-do ; Cytomegalovirus ; Diagnosis ; Disease Progression ; Early Diagnosis ; Histiocytosis ; Humans ; Idiopathic Pulmonary Fibrosis ; Infant ; Lung Diseases, Interstitial* ; Lung* ; Methylprednisolone ; Pathology* ; Pneumonia ; Prognosis ; Retrospective Studies

Recommended treatment options for acute septic arthritis in children include repeated aspiration, open arthrotomy, and arthroscopic drainage. However, reports of arthroscopic treatment of septic arthritis of the hip in a child are rare. We experienced a case of arthroscopic management of acute septic arthritis of the right hip joint in a three-year-old child using a 30degrees, 2.7 mm arthroscope for the ankle joint through manual traction without use of a traction table. The patient had complete range of motion in the right hip joint two weeks after surgery and recurrent infection was not observed at the final follow-up two years postoperatively.
Ankle Joint ; Arthritis, Infectious ; Arthroscopes ; Child ; Drainage ; Follow-Up Studies ; Hip ; Hip Joint ; Humans ; Range of Motion, Articular ; Traction

No abstract available.
Mortality* ; Rhinoplasty* ; Sepsis* ; Transplants*

BACKGROUND: Although intraoperative opioids provide more comfortable anesthesia and reduce the use of postoperative analgesics, it may cause opioid induced hyperalgesia (OIH). OIH is an increased pain response to opioids and it may be associated with N-methyl-D-aspartate (NMDA) receptor. This study aimed to determine whether intraoperative nefopam or ketamine, known being related on NMDA receptor, affects postoperative pain and OIH after continuous infusion of intraoperative remifentanil. METHODS: Fifty-four patients undergoing laparoscopic cholecystectomy were randomized into three groups. In the nefopam group (N group), patients received nefopam 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 0.065 mg/kg/h. In the ketamine group (K group), patients received ketamine 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 3 µg/kg/min. The control group did not received any other agents except for the standard anesthetic regimen. Postoperative pain score, first time and number of demanding rescue analgesia, OIH and degrees of drowsiness/sedation scale were examined. RESULTS: Co-administrated nefopam or ketamine significantly reduced the total amount of intraoperative remifentanil and postoperative supplemental morphine. Nefopam group showed superior property over control and ketamine group in the postoperative VAS score and recovery index (alertness and respiratory drive), respectively. Nefopam group showed lower morphine consumption than ketamine group, but not significant. CONCLUSIONS: Both nefopam and ketamine infusion may be useful in managing in postoperative pain control under concomitant infusion of remifentanil. However, nefopam may be preferred to ketamine in terms of sedation.
Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthesia ; Cholecystectomy, Laparoscopic* ; Humans ; Hyperalgesia ; Ketamine* ; Morphine ; N-Methylaspartate ; Nefopam* ; Pain, Postoperative*