Since the introduction of percutaneous mitral valvotomy(PMV) in 1984, PMV was an effecive alternative to surgical commissurotomy in selected patients with severe mitral stenosis. Also PMV was an excellent palliative strategy in such patients who were high risk for operative management or longterm anticoagulation was not feasible. We performed PMV in a patient with very tight mitral stenosis and severe pulmonary hypertension under the general anesthesia because the patient was anticipated to be uncooperative due to mental problem, who was diagnosed as schizophrenia 16 years ago. Robinol was used for premedication and i.v fentanyl was used for maintenance of anesthesia. Inoue balloon was introduced into the LV and gradual ballooning was performed with favorable results. Total anesthesia time and interval from internal jugular vein puncture to the completion of valvuloplasty were 1 hour 45 min and 40 minutes respectively. Hemodynamic variables were improved immediately after intervention and mitral valve area was increased from 0.5cm2 to 1.3cm2.
Anesthesia ; Anesthesia, General* ; Fentanyl ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Jugular Veins ; Mitral Valve ; Mitral Valve Stenosis* ; Premedication ; Punctures ; Schizophrenia*

BACKGROUND: Stellate ganglion block (SGB) is known to increase blood flow to the innervations area of the stellate ganglion. Near infrared spectroscopy reflects an increased blood volume and allows continuous, non-invasive, and bedside monitoring of regional cerebral oxygen saturation (rSO2). We investigated the influence of SGB on bilateral cerebral oxygenation using a near infrared spectroscopy. METHODS: SGB was performed on 30 patients with 1% lidocaine 10 ml using a paratracheal technique at the C6 level and confirmed by the presence of Horner's syndrome. The blood pressure (BP), heart rate (HR) and rSO2 were measured before SGB and 5, 10, 15 and 20 minutes after SGB. Tympanic temperature of each ear was measured prior to SGB and 20 minutes after SGB. RESULTS: The increments of the rSO2 on the block side from the baseline were statistically significant at 5, 10, 15 and 20 minutes. The rSO2 on the non-block side compared with the baseline, however, decreased at 15 and 20 minutes. The difference between the block and the non-block sides was significant at 15 and 20 minutes. The BP at 10, 15 and 20 minutes was increased and the HR was increased at 10 and 15 minutes. CONCLUSIONS: We observed an increment of the rSO2 on the block side from the baseline; however, the rSO2 on the non-block side decreased.
Blood Pressure ; Blood Volume ; Ear ; Heart Rate ; Horner Syndrome ; Humans ; Lidocaine ; Oxygen ; Spectrum Analysis ; Stellate Ganglion

Postlumbar puncture headache is a common complication of spinal anesthesia. It usually may be alleviated by adequate hydration, continuous recumbency, abdominal compression and analgesic medication. However, these conservative treatments are only symptomatic and epidural blood patch is curable approach based on pathophysiology. During the 3 year period from 1988 to 1990, 700 cases of spinal anesthesia were recorded by Wonju Christian Hospital, Wonju Medical College, Yonsei University. This study was primarily undertaken to observe several aspects of postspinal headache i.e. incidence, age and sex distribution, onset, duration and treatment. The results were as follows: 1) The overall incidence of headache was 10.6% (74 cases). 2) Headache occurred in highest frequency in patients in the third and fourth decades. 3) Frequency of headache was higher in women. 4) The onset of headache was within postop. 3 days. 5) The duration of headache was within 6 days. 6) a) 12 cases were cured spontaneously. b) 52 cases were cured by conservative treatment. c) 10 cases were cured by the epidural blood patch.
Anesthesia, Spinal ; Blood Patch, Epidural ; Female ; Gangwon-do ; Headache* ; Humans ; Incidence ; Punctures ; Sex Distribution

We examined the anatomical position of the mental foramina in mandibles foramen normal adult Koreans. 1. The percentages obtained from the study of the relationships between the mental foramen and the lower teeth showed that the most common location was type lv in which the mental foramen lay at the apex of the second promolar. The foramen between thr apices of ice two premolars (type lll) and the foramen between the second premolar and the first molar (type v) occured often and less often rspectively and find no foramen mesial to the first premolar or at the apex of the first premolar and posterior of the first molar (type l, ll, vl). 2. The study of relationship of the mental foramen to the bo of the mandible revealed that mental foramen was situated closer to the lowed border of the mandibular body. The distance ratio between the mental foramen and the alveolar crest to that between the mental foramen and the lower border was approximately 1.2 : 1. The height of the mandibular body was 31.09±2.80mm on the left side and 30.97±2.48mm on the right. 3. The distance from the mandibular symphysis to the anterior border of the mental foramen measured 29.52±2.01mm on the left, 30.82±2.04mm on the right side, and from the mandibular symphysis to the posterior border of the mandibular ramus was 104.20±4.74mm on the left, 105.44±4.49mm on the right side. It indicates that the mental foramen lies approximately at one-fourth of the distance from the mandibular symphysis to 2017-04-19 the posterior border of the ramus. 4. The distance from the superior border of the mental foramen to the bottom of the lower second premolar socket was found to be positive. It was 5.46±3.09mm on the left, 5.73±3.03mm on the right side. This indicates that the bottom of the lower second premolar socket is slightly higher than the superior border of the mental foramen.
Adult* ; Bicuspid ; Humans ; Ice ; Mandible* ; Molar ; Tooth

No abstract available.
Blepharoptosis* ; Orbit*

This study was done to understand nonpharmacologic pain management for pediateric patients and nurses' knowledge and attitudes toward it. The aim of this study was that which method did the patient's use according to the nurses' age, and how did they effectively use these methods in their field. The subjects of this study were 77 nurses working in the Pediatric unit in the Kyung Medical Center from September 2 to 15, 1999 using questionnaire form. The results of this study were as follows : 1. We divided the subjects into four groups : Younger than one year old, 1-6 years, 6-12 years, 12-18 years group. In the group younger one year old, most of the nurses participating in this study used speaking in soft quiet tones, supportive touch, toys, pacifiers. In the group of 1-6 years, they used speaking in soft quiet tones, toys, distracting attention, story talking, and visual stimulus. In the group of 6-12 years. they used pop-up books, providing information, cold therapy, speaking in soft quiet tones, supportive touch. In the group of 12-19 years, most of them used providing information, controling respiration and supportive touch. 2. The effective nursing intervention used in their field are speaking in soft quiet tones, pacifiers and nesting with blanket in the group of younger than one year old. Un the group of 1-6 years old, speaking in soft quiet tones, toys, and supportive touch were effective method in the control of nonpharmacologic pain management. In the group of 6-12 years old, story talking, supportive touch, and speaking in soft quiet tones were effective method and in the group of 12-18 years old, providing information, cold therapy and supportive touch were effectively used to control nonpharmacologic pain management. 3. To compare the general characteristics and non-pharmacologic pain nursing intervention, in the group of younger than one year, touching stimuli is widely used. In the groups of 1-6, and 6-12 years old, visual and audio method were widely used. In the group of 12-18 years old, sensitive intervention were used as well as education, information and guided imagery. In conclusion, there was no significant difference in nurses' demographic characteristics, child's age and nonpharmacologic pain management. There was significant difference only in the nurses working area, that is nurses working in the surgical department used more audio-visual-tactile pain management methods than medical department.
Child* ; Cryotherapy ; Education ; Humans ; Imagery (Psychotherapy) ; Nursing* ; Pacifiers ; Pain Management ; Play and Playthings ; Respiration ; United Nations ; Child Health ; Surveys and Questionnaires

No abstract available.
Animals ; Horns* ; Pregnancy*

No abstract available.
Animals ; Horns* ; Pregnancy*

OBJECTIVE: The purpose of this article is to report mixed germ cell tumor, which revealed changes compatible with early transformation of dysgerminoma to endodermal sinus tumor(EST) through histogenetic considerations and immunohistochemical stains. METHODS: Ovarian germ cell tumors were reviewed from files of Dept. Ob/Gyn. Seoul Paik Hospital fiom 1992.1 to 1996.12. Total of 5 cases include 4 pure dysgerminoma and 1 mixed germ cell tumars. All tissues were fixed in 10% neutral buffered formalin and embedded in paraffin and reviewed by two pathologists with immunohistochemical staining for cytokeratin, vimentin, AFP, PCNA, p53 & bc1-2. RESULTS: Grossly, the areas of transformation were located at the middle of the mixed tumor. The outer layer of the tumor mass was filled with typical pure dysgerminoma. They were characterised as the presence of microcysts and small glandular structures in hematoxylin-eosin(H-E) stains with positive stain for vimentin, except the tissue of the EST. The cells in the intermediate layer were characterised as the mixed form of dysgerminomatous and EST structures in H-E stains. AFP in the dysgerminomatous cells in intermediate layer and EST were stained, but not in outer layer. CONCLUSION: Dysgerminoma may possess the ability to transform to EST. There might be intermediate stage between dysgerminoma and EST, and Immunohistochemical staining for AFP, cytokeratin, vimentin, PCNA also can be used for prognosis of germ cell tumor.
Coloring Agents ; Dysgerminoma* ; Endoderm ; Endodermal Sinus Tumor* ; Formaldehyde ; Germ Cells ; Keratins ; Neoplasms, Germ Cell and Embryonal ; Paraffin ; Prognosis ; Proliferating Cell Nuclear Antigen ; Seoul ; Vimentin ; Yolk Sac*

The burden of illness from herpes zoster and postherpetic neuralgia is quite high both to the affected patients and to the society. The incidence and severity of herpes zoster and postherpetic neuralgia increase with age in association with a decline in cell mediated immunity to varicella zoster virus. Antiviral agents have been shown to be effective in reducing the morbidity of herpes zoster. Zoster associated pain should be treated early and aggressively, because it is more difficult to treat once established. Therefore, patients at a high risk of developing postherpetic neuralgia should be referred to pain clinic specialist earlier, rather than later. Varicella zoster virus vaccine has proven to be effective in reducing the incidence of herpes zoster and postherpetic neuralgia in older adults.
Antiviral Agents ; Cost of Illness ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Immunity, Cellular ; Incidence ; Neuralgia, Postherpetic ; Pain Clinics ; Specialization