Subarachnoid hemorrhage from a ruptured intracranial aneurysm during pregnancy is rare but results in significant maternal and fetal mortality. The authors report 5 cases of anesthetic experience with pregnant patients undergoing a surgical aneurysmal clipping out of 2,100 patients with subarachnoid hemorrhages due to a ruptured cerebral aneurysm from 1972 until May 2001. All of the patients were diagnosed with a subarachnoid hemorrhage by a brain CT and cerebral angiography. Anesthetic modality and surgical timing should be adjusted by gestational age and the physiologic changes which accompany the pregnancy and the potential risks to the fetus from investigating and treating the mother. Anesthetic goals for this patient include maintenance of uteroplacental perfusion, and fetal as well as maternal well-being. We gave a general anesthesia with isoflurane-nitrous oxide and fentanyl. The patients were monitored with standard monitorings for surgical repair of a cerebral aneurysm and perioperative fetal heart monitoring. All of the five patients recovered well from the surgical aneurysmal repair. After surgical aneurysmal repair, 4 patients maintained their pregnancies and had their babies delivered at term through a cesarean section in 3 patients and transvagina in 1 patient. However, 1 patient who presented persisting hypertension experienced an intrauterine fetal death at 25 weeks of gestational age.
Anesthesia, General ; Aneurysm ; Brain ; Cerebral Angiography ; Cesarean Section ; Female ; Fentanyl ; Fetal Death ; Fetal Heart ; Fetal Mortality ; Fetus ; Gestational Age ; Humans ; Hypertension ; Intracranial Aneurysm* ; Mothers ; Perfusion ; Pregnancy* ; Rupture* ; Subarachnoid Hemorrhage

A case of acute Gingko poisoning in a year and 7 months old boy was presented. The patient manifested vomiting and tonic convulsive seizure after 2 hours of Gingko ingestion and followed by sensory disturbance, miosis, positive Babinski sign, leukocytosis and increased CSF pressure. Patient recovered 3 days later with symptomatic treatment such as anticonvulsanr and parenteral fluid administration. The authors report the case with review of prtinent literature.
Eating ; Fruit* ; Ginkgo biloba* ; Humans ; Infant ; Leukocytosis ; Male ; Miosis ; Poisoning ; Reflex, Babinski ; Seizures ; Vomiting

Although many weakening procedures for the inferior oblique muscle have been advocated, there is some controversy as to the most beneficial procedure for weakening overacting inferior oblique muscles. This study was undertaken to determine if unilateral anterior transposition of the inferior oblique muscle alone could be a safe and effective procedure for treating unilateral superior oblique palsy from the perspective of hypertropia, inferior oblique overaction, and abnormal head posture. The records of 33 patients, who underwent anterior transposition of the inferior oblique muscle for unilateral superior oblique palsy at our institution between Jan 1995 and Dec 2002, were retrospectively reviewed. The average preoperative inferior oblique overaction was 2.3 +/-0.64, and the hypertropia in the primary position was 12.3 +/-7.69 prism diopter (PD). Twenty-six patients showed head tilt to the opposite direction preoperatively. After the anterior transposition of the inferior oblique, inferior oblique overaction was diminished in 32 patients (97%). Twenty-six out of 33 patients (79%) had no hypertropia in the primary position at last postoperative assessment. Of the 26 patients with head tilt before surgery, 21 patients (81%) achieved full correction after surgery. Satisfactory results were obtained in most of the patients in our study with the exception of three patients who required additional surgery. No patient demonstrated postoperative hypotropia in the primary position. None of the patients noticed elevation deficiency or lower lid elevation. The anterior transposition of the inferior oblique was found to be safe and effective for treating superior oblique palsy with secondary overaction of the inferior oblique muscle.
Adolescent ; Adult ; Child ; Child, Preschool ; Diplopia/physiopathology/*surgery ; Female ; Follow-Up Studies ; Head ; Humans ; Infant ; Male ; Oculomotor Muscles/*transplantation ; Posture ; Retrospective Studies ; Treatment Outcome ; Trochlear Nerve Diseases/physiopathology/*surgery

BACKGROUND: Balloon kyphoplasty is the new technique that helps to decrease the pain and improve mobility as well as restore the vertebral body height and kyphotic curve in fractured vertebrae. We evaluated the outcome of balloon kyphoplasty in the reduction of vertebral body height, kyphotic curve and clinical improvement in the patients with painful vertebral compression fractures. METHODS: From July 2002 to February 2005, 84 levels of vertebral compression fractures in 66 patients were treated with balloon kyphoplasty. The assessment criteria were the changes over time in visual analogue scale (VAS) and mobility score. We evaluated the vertebral body height and kyphotic curve at preoperative 1 day and postoperative 1 day. RESULTS: Procedures were performed in 66 patients with a total of 84 affected vertebral bodies. The anterior wall height was restored in 74 / 84 (88%) levels with a mean increment of 2.9 mm, and the mid-vertebral body height was restored in 79 / 84 (94%) levels with a mean increment of 4.2 mm. Kyphosis correction was achieved in 60 / 84 (71.4%) from 10.1 degrees to 7.5 degrees. Pain intensity reduced by 60% in one day after operation and by 75-85% in later time. Mobility scores of all patients were improved immediately after the procedure. Cement leakage occurred in 3 levels but there was no clinical problem. CONCLUSIONS: Kyphoplasty is an efficient and safe treatment of painful vertebral compression fracture in pain relief, mobility improvement, and reduction of deformity.
Body Height ; Congenital Abnormalities ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Kyphosis ; Spine

OBJECTIVES: Using two stimuli, this study was designed to evaluate variations of P300 in relations to reaction time of pressing the button for target tones in patients with schizophrenia. METHODS: The auditory oddball paradigm was used for the patients (N=22) and normal controls (N=23). The two stimuli were composed of target (20%, 2000 Hz, 75 dB) tone and standard (80%, 1000 Hz, 75 dB) tone, with 2 sec inter-stimulus interval, 50 msec duration and 10 msec rise or fall time. In each subject, P300s were acquired for both fast reaction time (FRT) and slow reaction time (SRT) to target response. RESULTS: P300 amplitude in patients with schizophrenia was lower than controls across FRT and SRT (p<0.001), but P300 latency was not delayed (p>0.8). In this study, even though the reaction time for the button pressing task might be faster in patients with schizophrenia (p<0.1), the P300 to FRT in patients with schizophrenia was lower than the P300 to SRT in controls (p<0.01). CONCLUSION: These results suggest that the lower P300 in patients with schizophrenia might be due to cognitive dysfunction and the patient's performance in reaction time for pressing buttons, both independently. Thus, P300 as well as reaction time may be used to further explore a variety of domains of cognitive function.
Evoked Potentials* ; Humans ; Reaction Time* ; Schizophrenia*

The objective of this study is to define optimal diagnosis and treatment strategies for patients with urachal anomalies in the pediatric age group. The medical records of 21 children who had undergone surgery for urachal anomalies at Severance Hospital, Yonsei University College of Medicine from January 1990 to April 2005 were reviewed. The subjects included 14 males and 7 females (M:F 2:1). The four types of urachal anomalies confirmed were a urachal cyst in 10 patients (47.6%), a patent urachus in 6 (28.6%), a urachal sinus in 4 (19.0%) and a urachal diverticulum in 1 (4.8%) patient. The most common presenting complaint was umbilical discharge (n = 10, 40.0%), followed by abdominal mass (n = 9, 36.0%). Urachal anomalies were diagnosed by ultrasonography in 18 patients, and 7 of them were additionally examined by computed tomography. The remaining patients were diagnosed solely by surgical exploration. Excision was performed in all patients and was supplemented by partial cystectomy in three. Umbilical discharge was the most common clinical manifestation in our patients, suggesting that ultrasonography should be performed in patients with umbilical discharge to differentiate urachal anomalies. We found the most common anomaly to be the urachal cyst, and all patients were successfully treated by surgical excision.
Urachus/*abnormalities/surgery ; Urachal Cyst/*diagnosis/surgery ; Male ; Infant, Newborn ; Infant ; Humans ; Hospitals, University ; Female ; Child, Preschool ; Child ; Abnormalities/diagnosis/surgery

A case of histiocytic medullary reticulosis in 14-years-old girl was presented, who had characteristic clinical and histiopathologic findings. The patient manifested intermitten fever, general weakness, weight loss, multiple skin lesion and pancytopenia with terminal massive bleeding. The clinical finding with fatal course and hematologic features were basically identical to those of previously documented histiocytic medullary reticulosis and verified with autopsy. On autopsy, systemic proliferation of the actively phagocytic atypical histiocytes was found. The authors report the case with review of pertinent literature.
Autopsy ; Female ; Fever ; Hemorrhage ; Histiocytes ; Humans ; Pancytopenia ; Skin ; Weight Loss

No abstract available.
Adenocarcinoma, Clear Cell* ; Urinary Bladder*

Lymphangioma occasionally occurs in gastrointestinal tract, small intestine and mesentery. Cystic lymphangioma is a rare cause of colonic submucosal mass. Endoscopic ultrasonography is very valuable in differential diagnosis of colonic submucosal masses. A 61-year old woman visited our hospital due to lower abdominal pain for two months. In the colonoscopic examination, cystic mass which had smooth mucosal surface was noted at the ascending colon. Endoscopic ultrasonography showed anechoic, multicystic mass confined to the submucosa. The underlying muscularis propria was intact. Endoscopic resection, using a ligating device, was performed for histopathologic diagnosis and treatment. On the histopathologic examination, the cystically dilated spaces lined by endothelium and separated by fibrous septa were present in the submucosa. The histological diagnosis was cystic lymphangioma of the colon.
Abdominal Pain ; Colon* ; Colon, Ascending ; Diagnosis ; Diagnosis, Differential ; Endosonography* ; Endothelium ; Female ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Lymphangioma ; Lymphangioma, Cystic* ; Mesentery ; Middle Aged

Although most ingested foreign bodies pass through the gastrointestinal tract spontaneously, those that are sharp, pointed, or large require removal to avoid serious complications. Here we report an interesting case of a 60-year-old man who swallowed a clamshell that passed through the pylorus and was caught in the duodenum. Radiologic findings made it look like a biliary stone. Endoscopic retrieval of the clamshell with a Dormia Basket was performed safely and the patient was discharged uneventfully on the day of the procedure.
Diagnostic Errors ; Duodenum/*pathology ; Endoscopy ; Endoscopy, Gastrointestinal ; Foreign Bodies/*diagnosis/surgery ; Foreign-Body Migration/*diagnosis/surgery ; Gallstones/*diagnosis/pathology ; Humans ; Male ; Middle Aged ; Seafood/*adverse effects