BACKGROUND: Epidural clonidine reduces pain after surgery. The aim of this study was to evaluate the effect of adding low-dose clonidine to continuous epidural local anesthetics and fentanyl on pam relief. METHODS: 100 patients scheduled for gynecologic low abdominal surgery were investigated. All patients were given 10cc of 0.25% bupivacaine with fentanyl 100 ug through epidural catheter. Group I was infused with combined 0.15% bupivacaine and fentanyl 5 ug/ml at a rate of 2cc/hr. Group II was infused with combined 0.15% bupivacaine and fentanyl 5 ug/ml and 150 ug of clonidine at a rate of 2cc/hr. Pain was assessed on a visual analogue pain scale for 2 postoperative days. Changes in blood pressure, heart rate, and incidence of side effects were observed. RESULTS: VAS observed 20min, 1hr, 1day, 2days after operation were significantly lower in Group II than Group I . Blood pressure and heart rates were significantly changed in Group II but not in Group I for 2 hours after epidural injection. The incidence of side effects was similar between Group I and Group II. CONCLUSIONS: Continuous low-dose epidural clonidine infusion reduces blood pressure and heatt rates significantly but enhances postoperative analgesic effect of combined epidural bupivacaine and fentanyl without increased side effects.
Anesthetics ; Anesthetics, Local ; Blood Pressure ; Bupivacaine* ; Catheters ; Clonidine* ; Fentanyl* ; Heart Rate ; Humans ; Incidence ; Injections, Epidural ; Pain Measurement ; Pharmacology

BACKGROUND: The diastolic transmitral flow velocity pattern has been commonly used to assess left ventricular(LV) diastolic function. The effects of multiple factors(such as, LV preload, afterload and heart rate, etc.) make difficulties in accurate interpretation. METHODS: In order to investigate the diastolic transmitral filling patterns according to the changes of the proload or heart rate, we studied 27 normal subjects with pulsed Doppler echocardiography after the administration of nitroglycerin(0.6mg/tab.) sublingually or atropine(0.5mg/amp.) intravenously. RESULTS: 1) After nitroglycerin administration, the folowings were obtained. ; The systolic blood pressure and LV diastolic filling time(DFT) decreased by 10.1% and 15.3%, respectively(p<0.001), compared with baseline data. The ratio of peak early to late diastolic transmitral flow velocities (E/A) and time-velocity integrals(TVIE/TVIA) decreased by 10.3% and 14.8%, respectively(p<0.01). The early diastolic filling time(Time E) was unchanged. Therefore, we suggest that time E is helpful, compared with the increments of the preload or the diastolic dysfunction. 2) After atropin administration, the heart rate, peak late diastolic transmitral flow velocity(PA) and percent atrial contribution(%AC) significantly increased by 43.6%, 25.1% and 41.4%, respectively(p<0.001). The E/A, TVIE/TVIA and DFT significantly decreased by 42.9%, 38.9% and 43.0%, respectively(p<0.001) compared to the data before drug administration. 3) The heart rate correlated negatively to the E/A, TVIE/TVIA and DFT. It was correlated positively to %AC(r=+0.63; p<0.001). The normalized E/A ratio by DFT(E/A/DFT) didn't correlate. Therefore, E/A/DFT is helpful on the exclusion of the influences of heart rate by the administration of the atropine. CONCLUSION: The decrement of preload or the increment of heart rate changes the diastolic transmitral flow velocity patterns. Therefore, when the diastolic function is assessed by interpretation of the Doppler transmitral flow velocity pattern with pulsed Doppler echocardiogram, the potential influences of preload and heart rate must be taken into account.
Atropine* ; Blood Pressure ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Heart Rate ; Humans* ; Nitroglycerin* ; Time

Central retinal artery occlusion occurs rarely as a complication of spine surgery under general anesthesia in prone position, but is quite tragic. The suggested causes are hypotension during anesthesia and increased external ocular pressure by headrest, sand bag or others. We experienced a case of left central retinal artery occlusion following cervical spine surgery under general anesthesia using a horseshoe headrest. The patient was 53 years old male whose medical history was non remarkable except dislocation of cervical spine. He was positioned prone after induction. The vital signs were stable during opreration. At the recovery room, he presented left visual field disturbance and investigations revealed that left central retinal artery occlusion occured. This case demonstrates that proper positioning of the head on an adequate head rest and contineous cautious inspection during surgical procedure are important to prevent retinal damage.
Anesthesia ; Anesthesia, General* ; Dislocations ; Head ; Humans ; Hypotension ; Male ; Middle Aged ; Prone Position* ; Recovery Room ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinaldehyde ; Silicon Dioxide ; Spine* ; Visual Fields ; Vital Signs

No abstract available.
Phenylketonurias*

BACKGROUND: Tsutsugamushi disease is an acute, rashed febrile disease that shows widely varying prognoses from unsymptomatic infection to death. Early diagnosis and treatment lead to speedy recovery. Otherwise, many complications develop. This research was carried out to analyze the factors that affect the development of complications by comparing Tsutsugamushi patients with complicaions with those without complications. METHODS: Among the acute febrile disease patients who visited the emergency center of Chosun University Hospital from January to December 2000, 41 patients were clinically and serologically confirmed as having Tsutsugamushi disease. They were divided into two groups; 14 patients with complications and 27 patients without complications. We analyzed the two groups for correlations between complications and sex, age, period of occurrence, transfer or not, vital signs, laboratory findings, period before treatment, and checks for the existence of underlying disease, eschar, eruption, chest Xrays, and early diagnosis. RESULTS: 1) The aged have a high incidence of the disease, but there was no correlation between age and complications. Also, there was no correlation based on sex. 2) Although fall has a high incidence of the disease, the other seasons have higher complication rates. 3) The complication incidence rate has no correlation with either blood pressure or heart rate, also it does no correlate with eschar and skin rashes. 4) In the laboratory findings, hemoglobin and platelet, and Bun/Cr correlate with the complicaton incidence rate, but the white blood cell count and AST/ALT do not. 5) The complication incidence rate was high when treatment was started 10 days after the onset of Tsutsugamushi disease and no early diagnosis had been given. CONCLUSION: Early diagnosis and treatment are most important in preventing complications of Tsutsugamushi disease because the factors that affect the developement of complications of Tsutsugamushi disase are found during early diagnosis. Patients with doubtful clinical symptoms and abnormal lab findings should be started on a program of antibiotic treatment.
Blood Platelets ; Blood Pressure ; Early Diagnosis ; Emergencies ; Exanthema ; Heart Rate ; Humans ; Incidence ; Leukocyte Count ; Prognosis ; Scrub Typhus ; Seasons ; Thorax ; Vital Signs

No abstract available.
Humans ; Infant* ; Leukemia, Megakaryoblastic, Acute* ; Sarcoma, Myeloid*

PURPOSE: The purposes of this study were to evaluate the efficacy of thrombolysis and to find optimal dose of urokinase and injection time by modified pulse-spray method with multiside-hole catheter in patients of arterriosclerosis obliterans of lower limbs. MATERIALS AND METHODS: Over a 2 month period, 5 cases of peripheral arterial occlusion of lower limbs were treated with 0.7--1.3 million unit of urokinase by modified pulse spray method. With antegrade puncture at the site of superficial femoral artery, the tip of modified pig tail catheter was initially placed approximately 2cm proximal to the distal end of the clot. The procedure started with the use of initial bolus dose of UK(100,000U) of lacing, and then small pulses of highly concentrated urokinase, which are forcefully sprayed throughout the thrombus at a rate of 20,000U/min. After the initial rapid period of deposition, the concentration of UK was reduced to 4,000U/min for residual thrombus. RESULTS: Complete clot lysis were achieved in 3 of 5 occlusions. Mean duration for completion of lysis was 140 min(40-180min) and initial recanalization of artery required 45min(20-90min). Total required dose of UK was 1,120,000U and mean dose for initial recanalization was 660,000U. No significant complications occurred except distal vasospasm in one case. CONCLUSION: Modified pulse spray method using ultrahigh and high dose urokinase is safe, reguires less time and has cost effectiveness in the management of peripheral arterial thrombolysis. Further study is warranted.
Arteries ; Catheters ; Cost-Benefit Analysis ; Femoral Artery ; Humans ; Lower Extremity ; Punctures ; Thrombosis ; Urokinase-Type Plasminogen Activator

PURPOSE: This study was designed to assess the CT findings of a juxtapapillary duodenal diverticulum (JPDD) and to determine if there is an association between a JPDD and biliary disease using MDCT multiplanar reformation (MPR). In addition, a study was performed to determine if MPR is more useful than an axial image only for an analysis of duodenal diverticula. MATERIALS AND METHODS: A total of 49 patients who had JPDD as identified on an MDCT image were retrospectively included in this study. Patients were divided into two groups: patients with biliary disease (Group 1) and patents without biliary disease (Group 2). A total of 23 patients (46.9%) had biliary disease. We analyzed the size, location, content of the diverticulum, compression of the biliary duct by a diverticulum and the site of a duodenal papilla with an axial image only and MPR images. RESULTS: The frequency of biliary disease was increased when the papilla was located inside a diverticulum (p = 0.033). The use of an MPR image was more useful than an axial image alone for the evaluation of a site of a duodenal papilla. CONCLUSION: A JPDD is associated with the development of biliary disease and the risk of biliary disease is increased when the papilla is located in a diverticulum. An MPR image can provide more precise information about the site of a papilla than an axial image for the evaluation of a JPDD.
Bile Duct Diseases ; Diverticulum ; Duodenal Diseases ; Humans ; Retrospective Studies

Takotsubo cardiomyopathy, also called stress-induced cardiomyopathy, usually occurs in patients with severe emotional or physiologic stress. The prognosis is favorable, and the wall motion abnormlities normalize within weeks. However, stress-induced cardiomyopathy is rarely assosicated with left ventricular thrombus and thromboembolic complications. Here, we report a case of stress-induced cardiomyopathy with left ventricular thrombus that embolized to cause cerebral infarction.
Cardiomyopathies ; Cerebral Infarction ; Humans ; Prognosis ; Takotsubo Cardiomyopathy ; Thrombosis

The incidence of left ventricular pseudoaneurysm is not known, but it appears to be quite rare. We experienced a case of apical pseudoaneurysm of left ventricle in a 73-year-old female who presented with progressive orthopnea. On the 2nd hospital day, cardiac tamponade developed. A small pseudoaneurysm of left ventricle with narrow neck associated with massive pericardial effusion was demonstrated by transthoracic echocardiography. Emergency coronary angiogram showed normal. Emergency operation was performed on the suspicion of rupture of the pseudoaneurysm. Microscopic examination of the wall of the aneurysm revealed fibrous tissue adhered to the granulomatous inflammatory pericardium.
Aged ; Aneurysm ; Aneurysm, False ; Cardiac Tamponade ; Echocardiography ; Emergencies ; Female ; Heart Ventricles ; Humans ; Incidence ; Neck ; Pericardial Effusion ; Pericarditis, Tuberculous ; Pericardium ; Rupture