There are many reports of ventricular arrhythmias following the injection of epinephrine under general anesthesia with halothane or cyclopropane. Raventos reported that catecholamines given animals during chloroform, cyclopropane or halothane anesthesia have caused ventricular arrhythmias which sometimes developed into ventricular fibrillation. But there are a few reports of atrial arrhythmias in patients under general anesthesia with alone halothane. While it is known that hypercapnia can elicit arrhythmia during halothane anesthesia, Black and coworkers that hypercapnia of 60 to 140mmHg (average 92mmHg) is necessary for the occurrence of arrhythmias during halothane anesthesia. Hellewell and Potts reported 12 cases of arrhythmias under halothane anesthesia which were treated by propranolol, producing a return of sinus rhythm in an average time of 46 seconds. The authors reported one case with atrial arrhythmias induced by halothane anesthesia, which were arrested by the IV injection of 5mg of tolamolo, beta-receptor blocking agent. Thereafter arrhythmias did not reappear.
Anesthesia* ; Anesthesia, General ; Animals ; Arrhythmias, Cardiac* ; Catecholamines ; Chloroform ; Epinephrine ; Halothane* ; Humans ; Hypercapnia ; Propranolol ; Ventricular Fibrillation

The antiphospholipid syndrome is characterized by arterial thrombosis, venous thrombosis, pregnancy wastage, and thrombocytopenia associated with a persis tently positive lupus anticoagulant and/or moderate to high positive anticardiolipin antibodies(IgG or IgM). The antiphospholipid antibodies have been detected in many medical conditions, but the antiphospholipid syndrome (APS) has mainly been restricted to the primary antiphospholipid syndrome and APS associated with systemic lupus erythematosus. Rarely, the APS has been reported in other autoimmune disorders in the literature. We describe a woman with a limited form of scleroderma and the APS manifested by complete occlusion of left axillary artery with probable thrombotic occlusive nature, thrombocytope nia, prolonged aPTT, and persistently positive lupus anticoagulant.
Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Axillary Artery ; Female ; Humans ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic ; Pregnancy ; Scleroderma, Limited* ; Thrombocytopenia ; Thrombosis ; Venous Thrombosis

No abstract available.
Biliary Atresia* ; Hepatitis*

The goal of total knee replacement is to relieve pain, to stabilize joint movement and to correct deformity. It is indicated for patients with rheumatoid arthritis, osteoarthritis and severe post-traumatic arthritis. The author analyzed 71 patients(106 cases), who received the PFC type of total knee replacement from August 1992 and the results were as follows; 1. Among the 71 patients, male was 8 patients and female was 63 patients whose average age was 56 years and average follow up period was 24 months, ranged from 8 months to 3 years 8 months. 2. Rheumatoid arthritis was the most common cause with 31 patients(56 cases) followed by osteoarthritis with 39 patients(49 cases). There was also one patient(1 case) that showed bony union of the knee due to old tuberculosis. The average duration of the illness was 12 years and the average weight of the patients was 57.7kg. 3. Flexion contracture decreased from an average of 21 degrees to 5 degrees after the operation. The range of motion increased from an average of 92 degrees before the operation to 117 degrees afterwards in cases of rheumatoid arthritis and decreased slightly from 108 degrees to 106 degrees in cases of osteoarthritis. 4. The tibiofemoral angle was corrected from an average 1.5 degrees varus before the operation to an average 6.7 degrees valgus after operation. Eighty seven percent of patients with rheumatoid arthritis showed valgus deformity and seventy eight percent of degenerative osteoarthritis patients showed varus deformity preoperatively. 5. Radiographically, the joint line position shifted an average 2.3mm in rheumatoid arthritis and an average 0.3mm in osteoarthritis. The component position, the femoral flexion was an average 89.6 degrees in the anteroposterior view, an average 87 degrees in the lateral view. 6. The thickness of the patella measured in the operating room of 61 cases was an average 21mm and after resection of patella, the remaining bone measured an average of 13.6mm. 7. To achieve soft tissue balance, 29 patients(33 cases) underwent medial stripping and 23 patients(30 cases) had patella lateral release. 8. The Insall Knee Rating Score was used to evaluate the results. The results were 69 cases excellent, 33 cases good, 3 fair and 1 poor. Ninety two percent of the patients had good or excellent results in average 24 months follow-up. 9. The complications consisted of one case of delayed deep infection, one case of patellar subluxation and one case of supracondylar fracture of the femur.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Contracture ; Female ; Femur ; Follow-Up Studies ; Humans ; Joints ; Knee ; Male ; Operating Rooms ; Osteoarthritis ; Patella ; Range of Motion, Articular ; Tuberculosis

The authors analyzed 50 microsurgically treated middle cerebral artery(MCA) aneurysms among 266 intracranial aneurysms in the Department of Neurosurgery, Yonsei University Hospital from September 1975 through September 1982, in order to study the differences from those of other intracranial aneurysms, and analyze the surgical outcome versus preoperative clinical status of the patients, surgical timing, and the microsurgical techniques. The results of the analysis were summarized as follows ; 1) The middle cerebral artery aneurysms occupied 19.5% of the microsurgically treated intracranial aneurysms. 2) The brain CT scan showed subarachnoid hemorrhage in 77.5%, hemorrhage in the unilateral Sylvian cistern in 39.7%, and intracranial hematoma in 48.4%. 3) The most common location of middle cerebral artery aneurysms was the M1 M2 junction in 84%, and MCA bifurcation aneurysms occupied 44%, and trifurcation ones 40%. 4) Clipping with reinforcement of the aneurysms were performed in 74% of total cases due to difficult complete clipping of the aneurysmal neck. And the rest were wrapped. 5) The surgical timing was around the 3rd week after the last bleeding in most cases. 6) Patients in Botterell's grade I to III showed no motality and good surgical outcome. Only one case of grade V expired postoperatively, and morbidity was 10%.
Aneurysm ; Brain ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Neck ; Neurosurgery ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

Ipsilateral femur shaft and neck fractures are occurred by high energy trauma, usually in motor vehicle accidents or fall from a height. Simultaneous Ipsilateral femur shaft and neck fractures and contralateral femur neck fracture are not yet reported in Korea. Authors report a case of simultaneous bilateral femoral neck fractures combined with a ipsilateral femoral shaft fracture in a young adult treated with anatomical reduction, internal fixation and vascularized bone graft with a review of the literature.
Femoral Neck Fractures* ; Femur ; Femur Neck* ; Humans ; Korea ; Motor Vehicles ; Neck ; Transplants ; Young Adult*

Primary biliary cirrhosis is frequently associated with a variety of disorders presumed to be autoimmune in nature, such as Sjogrens syndrome, scleroderma, rheumatoid arthritis, systemic lupus erythematosus, and autoimmune thyroiditis. Scleroderma has been recognized in association with primary biliary cirrhosis. Most cases present as the CREST (calcinosis cutis, Raynauds phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome. Isolated pulmonary hypertension develops in a small proportion of patients, nearly all of whom have limited cutaneous involvement. We report a case who has diffuse scleroderma associated with primary biliary cirrhosis and isolated pulmonary hypertension.
Arthritis, Rheumatoid ; Esophageal Motility Disorders ; Humans ; Hypertension, Pulmonary* ; Liver Cirrhosis, Biliary* ; Lupus Erythematosus, Systemic ; Scleroderma, Diffuse* ; Sjogren's Syndrome ; Thyroiditis, Autoimmune

The objectives of this study were to investigate the efficacy and dose-effect relationship for glycopyrrolate in the suppression of the oculocardiac reflex, and to compare glycopyrrolate with the reported equivalent dose of atropine. Glycopyrrolate 5 and 7.5ug/kg and atropine 10 and 15ug/kg were studied in 40 paediatric patients to assess more fully the dose of glycopyrrolate required for adequate prevention of the oculocardiac reflex. The results obtained were summarized as follows: 1) The increase in the mean heart rate 5 min after the test drug was statistically significant in all of the four groups. 2) Both drugs showed a dose-related response for reduction in slowing of heart rate after rectus muscle traction. 3) There is great individual variation in response to muscle traction within each group, no group being fully protected from marked slowing in heart rate. 4) The frequency of arrhythmias with low doses of both drugs was more than in high doses with both drugs.
Anesthesia* ; Arrhythmias, Cardiac ; Atropine* ; Child* ; Glycopyrrolate* ; Heart Rate* ; Heart* ; Humans ; Reflex, Oculocardiac ; Traction

Bronchiolitis obliterans is a distinct pathologic entity, characterized by the accumulation of pigmented macrophages within respiratory bronchioles and adjacent to air spaces, and thickening of the peribronchial interstitium. It has been reported to be associated with viral infection, drug, toxic fume, bone marrow transplantation, and connective tissue disorders such as rheumatoid arthritis. The etiology of bronchiolitis obliterans in the post-renal transplantation state is not yet clear, although several possibilities such as drug toxicity, graft-versus-host disease or postinfectious condition have been postulated. We presented three patient who had bronchiolitis obliterans, as a complication following renal transplantation. Chest radiograph showed bilateral perihilar reticular infiltration or ground glass appearances that progressed to either diffuse alveolar consolidations or solitary nodule. The main finding in each lung biopsy was the presence of macrophages within respiratory bronchioles as well as in the neighboring alveolar ducts and alveoli. Alveolar septa in these areas often showed nonspecific thickening by fibrosis, mild chronic inflammatory cell infiltrate, and hyperplasia of alveolar lining cells and type II pneumocytes.
Arthritis, Rheumatoid ; Biopsy ; Bone Marrow Transplantation ; Bronchioles ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Connective Tissue ; Drug-Related Side Effects and Adverse Reactions ; Fibrosis ; Glass ; Graft vs Host Disease ; Humans ; Hyperplasia ; Kidney Transplantation ; Lung ; Macrophages ; Pneumocytes ; Radiography, Thoracic

No abstract available.
Catheterization* ; Catheters* ; Hemothorax* ; Subclavian Vein*