Coronary artery bypass grafting (CABG) without extracorporeal circulation (ECC) is now an accepted technique of myocardial revascularization in selective cases of coronary arterial occlusive disease. We experienced a case of CABG without ECC in a 20 year old female patient with complete occlusion of the right coronary artery. Anesthesia was induced and maintained with fentanyl, midazolam and isoflurane. Nitroglycerine and dopamine were given to stabilize the hemodynamics during intra- and post-operative periods. And esmolol was administered with a loading dose of 30 mg over 1 min, followed by a continuous infusion of 50~100 g/kg/min to maintain the heart rate (50~60 beats/min) and systolic blood pressure (60~80 mmHg) during distal anastomosis. The patient was recovered uneventfully and discharged on the 8th postoperative day.
Anesthesia* ; Arterial Occlusive Diseases ; Blood Pressure ; Coronary Artery Bypass* ; Coronary Vessels* ; Dopamine ; Extracorporeal Circulation ; Female ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Isoflurane ; Midazolam ; Myocardial Revascularization ; Nitroglycerin ; Young Adult

High output heart failure due to congenital arteriovenous fistula is a rare disease and is difficult to treat. A 27 year old man, suffering from dyspnea, palpitation, lower extremity edema, and abdominal distension admitted May, 1987. At admission there were continuous thrill and bruit at left supraclavicular and infraclavicular area. The heart sound was irregular and rapid, and grade IV/VI pansystolic murmur was audible at the apex. Chest PA showed marked cardiomegaly with pleural effusion and notching at superior aspect of left 2nd rib. Selective left subclavian artery angiogram showed extensive congenital arteriovenous fistula at the area of left subclavian artery and its branches. After setrial feeding artery embolization and palliative operation, the fistula size decreased much with clinical improvement.
Adult ; Arteries ; Arteriovenous Fistula* ; Cardiomegaly ; Dyspnea ; Edema ; Fistula ; Heart Failure ; Heart Sounds ; Humans ; Lower Extremity ; Pleural Effusion ; Rare Diseases ; Ribs* ; Subclavian Artery* ; Thorax

Nuedexta (dextromethorphan and quinidine) is an Food and Drug Administration approved medication for pseudobulbar affect. Interestingly, this drug was recently reported to improve speech, swallowing, and the ability to handle oral secretions along with emotional lability in amyotrophic lateral sclerosis (ALS) patients with bulbar symptoms. We report a Korean ALS patient whose bulbar function improved after administering Nuedexta for 6 months, extending therapeutic choice of approach in treating ALS patients.
Amyotrophic Lateral Sclerosis ; Deglutition ; Dextromethorphan ; Humans ; Quinidine ; United States Food and Drug Administration

Primary aldosteronism is a rare syndrome which may reault from adenoma hyperplasia or carcinoma of the adrenal cortex and may thus be amenable to surgical correction. The findings of hypertension, hypoklemia and metabolic alkalosis suggest the diagnosis. This case report is to present the possibility of cardiac arrest due to hypokalemia during surgery for primary an adrenal tumor that was causing aldosteronism. This 25 year-old male who had a long history of aldosteronism, was admitted for surgery correction. Anesthesia was induced with thiopental sodium and was maintained with nitrous oxide and halothane. While the adrenal gland was being manipulated the patient appeared to have a sudden cardiac arrest with ventricular fibrillation as seen on the monitoring EKG. Cardiopulmonary resuscitation and D.C. shock to reverse the ventricular fibrillation was carried out immediately. The rest of the scheduled operation was continued and finished uneventfully. We concluded that the cause of the cardiac arrest in this case seemed to be a preoperative hypokalemia resulting from aldosteronism which was not corrected. In addition to that, the respiratory alkslosis from hyperventilation during the anesthesia even moreso lowered the preoperative level of hypokalemia.
Adenoma ; Adrenal Cortex ; Adrenal Glands ; Adult ; Alkalosis ; Anesthesia ; Cardiopulmonary Resuscitation ; Death, Sudden, Cardiac ; Diagnosis ; Electrocardiography ; Halothane ; Heart Arrest* ; Humans ; Hyperaldosteronism* ; Hyperplasia ; Hypertension ; Hyperventilation ; Hypokalemia ; Male ; Nitrous Oxide ; Shock ; Thiopental ; Ventricular Fibrillation

OBJECTIVE: The LiquoGuard® system is a new ventricular-type monitoring device that facilitates intracranial pressure (ICP)-controlled or volume-controlled drainage of cerebrospinal fluid (CSF). The purpose of this study is to report the authors' experience with the LiquoGuard® ICP monitoring system, as well as the clinical safety, usefulness, and limitations of this device in the management of patients with traumatic brain injury (TBI). METHODS: Intraventricular ICP monitoring was performed on 10 patients with TBI using the LiquoGuard® monitoring system. ICP measurements, volume of drained CSF, and clinical outcomes were analyzed and discussed. RESULTS: ICP monitoring was performed on 10 patients for a mean duration of 6.9 days. With a mean 82,718 records per patient, the mean initial ICP was 16.4 mm Hg and the average ICP across the total duration of monitoring was 15.5 mm Hg. The mean volume of drained CSF was 29.2 cc/day, with no CSF drained in 4 patients. Seven of 10 patients showed 1 or 2 episodes of abnormal ICP measurements. No patient exhibited complications associated with ICP monitoring. CONCLUSION: The LiquoGuard® system is a versatile tool in the management of TBI patients. Its use is both reliable and feasible for ICP monitoring and therapeutic drainage of CSF. However, episodes of abnormal ICP measurements were frequently observed in patients with slit ventricles, and further study may be needed to overcome this issue.
Brain Injuries* ; Cerebrospinal Fluid ; Drainage ; Humans ; Injections, Intraventricular ; Intracranial Pressure* ; Monitoring, Physiologic

The aim of this study is to compare the adaptability of thermoplasticized injectable gutta-percha technique to the canal walls in ribbon-shaped canals. Thirty resin models simulated ribbon-shape canals were instrumented to #40 using .06 taper Profile systems. Three groups of each 10 resin models were obturated by the lateral condensation technique(LC) and the two thermoplasticized injectable gutta-percha technique; Ultrafil Endoset+Obtura II(EO) and Ultrafil Firmset(UF), respectively. After resin model were kept at room temperature for 4 days, they were resected horizontally with microtome at 1, 2, 3, 4 and 5mm levels from apex. At each levels, image of resected surface were taken using CCD camera under a stereomicroscope at x40 magnification and stored. Ratio of the area of gutta-percha was obtained by calculating area of gutta-percha cone to the total area of canal using digitized image-analyzing program. The data were collected then analyzed statistically using One-way ANOVA. The results were as follows. 1. At 1mm levels, there was no statistically significant difference in the mean ratio of gutta-percha among the groups. 2. At 2mm level, EO showed the highest mean ratio of gutta-percha (p<0.05) and there was no significant difference between LC and UF. 3. At 3, 4, 5mm levels, EO and UF had significantly greater mean ratio of gutta-percha than LC(p<0.05) and there was no significant difference between EO and UF. In conclusion, the thermoplasticized injectable gutta-percha techniques demonstrated relatively favorable adaptability to canal walls than lateral condensation technique in ribbon-shaped canals except for 1mm level.
Gutta-Percha

Congenital coronary arteriovenous fistula is a rare condition which is an abnormal communication of the coronary artery with the right ventricle, right atrium, left atrium or left ventricle. Coronary artery aneurysm is an uncommon disease which is defined as coronary dilatation which exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. In young ages, symptoms are unusual, but significant symptoms and complications such as congestive heart failure, subacute bacterial endocarditis, coronary steal syndrome, aneurysm formation, rupture, and pulmonary hypertension may appear among the older age group. We report a case of giant aneurysm of a congenital coronary arteriovenous fistula between left co-ronary artery and right ventricular outflow tract with significant left to right shunt confirmed in a 84-year old female with a brief review of literature.
Aged, 80 and over ; Aneurysm* ; Arteries ; Arteriovenous Fistula* ; Coronary Aneurysm ; Coronary Vessels* ; Dilatation ; Endocarditis, Subacute Bacterial ; Female ; Heart Atria ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension, Pulmonary ; Rupture

The purpose of this study is to evaluate the two warm gutta-percha filling techniques by measuring the weight changes of resin blocks before and after canal filling in ribbon shaped canal. Simulated ribbon shaped root canals in 30 transparent resin blocks were instrumented to #40 using .06 taper Profile. 15 resin blocks were obturated with gutta-percha using cold lateral condensation. Warm lateral condensation using the Endotec II was then accomplished on the same 15 blocks. Another 15 resin blocks were obturated using the System B. All canals were obturated without sealer. The resin blocks were weighed after canal preparation and after each subsequent obturation, and then weight changes of the resin blocks were calculated. The results were as follows. 1. Warm lateral condensation using Endotec II and continuous wave of condensation using System B produced a denser obturation of gutta-percha compared with conventional cold lateral condensation (p<0.01). 2. There was no significant difference between warm lateral condensation and continuous wave condensation. In conclusion, the warm gutta-percha condensation techniques like warm lateral condensation and continuous wave condensation can be expected to bring favorable canal obturation results in ribbon shaped canals.
Cold Temperature ; Dental Pulp Cavity ; Gutta-Percha

PURPOSE: Alarm interventions are effective and safe treatments for nocturnal enuresis when compared with the other treatments. However, the rate of doctors prescribing enuresis alarms is quite low in Korea. This study evaluated the application conditions and treatment results of an enuresis alarm in children with enuresis in Korea. MATERIALS AND METHODS: 147 out of 316 patients who purchased an enuresis alarm through a alarm sales agency in Korea were evaluated retrospectively. The questionnaire had two main categories: items of enuresis(number of episodes during the night, enuresis frequency during a week, etc.) and the items of the enuresis alarm(previous treatment history, a motivation of using enuresis alarm treatment, the period of using the enuresis alarm, initial success, continued success, dropout of using enuresis alarm, nocturia after treatment, etc.). RESULTS: A total 147 children participated in this study. The initial success rate was 30.6% whereas the continued success rate was 34.0%. In addition, the dropout rate was 27.2%. 46.2% of patients purchased the enuresis alarm with a doctor's prescription and 53.8% purchased the alarm without a prescription. Among the factors, the success and dropout rate were affected by only whether the patient visited the hospital. Thirty five patients who took combination therapy with medicine had a significantly lower initial success rate. CONCLUSIONS: In Korea, without a doctor's prescription, 53.7% patients attempt to treat enuresis alarm directly. The initial and continued success rate with the enuresis alarm was approximately 30% and the dropout rate was approximately 30%.
Child ; Commerce ; Enuresis ; Humans ; Korea ; Motivation ; Nocturia ; Nocturnal Enuresis ; Patient Dropouts ; Prescriptions ; Retrospective Studies

The extraaxial presentation of medulloblastoma is a rare phenomenon. This article describes the case of 19-year old woman who presented with mild headache and nausea and was diagnosed with medulloblastoma. The tumor arose from the right cerebellar cortex, and it was misdiagnosed meningioma on the basis of radiological examination. We review the literature and discuss the such atypical presentation of medulloblastoma.
Cerebellar Cortex ; Female ; Headache ; Humans ; Medulloblastoma* ; Meningioma ; Nausea ; Young Adult