The purpose of this study was to observe the additive effect of halothane anesthesia and propranolol, and also the effect of atropine and isoproterenol on the heart rate and the blood pressure after propranolol during halothane anesthesia in human-volunteers. The results were as follows: 1) In conscious patients, 10 minutes after intravenous administration of 1.0mg propranolol the heart rate was slower but there was no significant change in the blood pressure. 2) Twenty-thirty minutes after halothane anesthesia, the heart rate was slower by 6 to 8 beats per minute: systolic and diastolic blood pressure was lower by 20.4 torr and 10.5 torr, respectively. 3) 10 minutes after intravenous administration of 1.0mg propranolol during halothane anesthesia, the heart rate was decreased by 7.8, 7.0 per minute: systolic and diastolic blood pressure decreased by 6.7, 5.7 torr and 3.0, 3.9 torr in the atropine and isoproterenol group, respectively. 4) One minute after intravenous administration of atropine 0.5mg after propranolol 1.0mg during halothane anesthesia, the heart rate increased by 12.1 per minute and persisted so far 10 minutes, but the blood pressure did not increase. 5) One minute after intravenous administration of isoproterenol 0.025mg after propranolol 1.0mg during halothane anesthesia, the heart rate had markedly increased by 35, but normalized 10 minutes later. The systolic blood pressure was increased by 13.4 torr but normalized 10 minutes later. 6) The above results indicate: Atropine increases the heart rate which has been slowed with propranolol during halothane anesthesia: isoproterenol increases the heart rate and blood pressure but the duration of action was short. Therefore, authors considered that atropine is useful for the maintenance of heart rate, and continuous administration of isoproterenol for maintenance of blood pressure and heart rate after propranolol during halothane anesthesia.
Administration, Intravenous ; Anesthesia* ; Atropine* ; Blood Pressure* ; Halothane* ; Heart Rate* ; Heart* ; Humans ; Isoproterenol* ; Propranolol*

Morphine has been known to produce antidiuresis when given directly into a lateral ventricle of the rabbit brain, mainly through hemodynamic changes brought about by nerve stimulation to the kidney. This study was attempted to find out whether adrenergic fibers are involved in the action. Phentolamine, a potent alpha-adrenergic blocking agent, induced antidiuresis when given intravenously in a dose of 2 mg/kg. Morphine administered intracerebroventricularly 40 to 60 min. after phentolamine, when its effect is at the maximum, produced antidiuresis and typical changes in renal function, uninfluenced by the phentolamine pretreatment. This observation indicates that adrenergic fibers do not participate in the renal action of intracerebroventricular morphine and it is suggested that nerve fibers of other types might be involved in the action.
Adrenergic Fibers ; Brain ; Hemodynamics ; Kidney ; Lateral Ventricles ; Morphine* ; Nerve Fibers ; Phentolamine*

In propranolol (1. 0mg) pretreated men atropine (0.5mg), ephedrine (20mg) and aramine (2mg) were administered respectively by intravenous route under the ether anesthesia. The results were as follows. 1) Five minutes after intravenous administration of propranolol, the three groups showed decrease of pulse rates, 9, 6 and 8 per minutes respectively, but blood pressure changes were not observed. 2) After intravenous administration of atropine (0.5mg) the decreased pulse rates were increased and blood pressure was elevated. 3) After intravenous administration of ephedrine(20mg) the decreased pulse rates were decreased and lowered blood pressure was lowered further. 4) After intravenous administration of aramine(2.0mg) the lowered blood pressure was elevated, but pulse rate changes were not observed. 5) Circulatory depression due to ether anesthesia after propranolol pretreatment, was corrected by treatment with atropine and aramine, but was not corrected by ephedrine.
Administration, Intravenous ; Anesthesia* ; Atropine ; Blood Pressure* ; Depression ; Ephedrine ; Ether* ; Heart Rate* ; Humans ; Male ; Metaraminol ; Propranolol*

We herein describe a case of a 55-year-old healthy woman with localized primary thymic amyloidosis presented as a mediastinal mass, found incidentally by chest radiography. Computed tomography revealed a 4.1 cm soft tissue lesion with nodular calcification in the left anterior mediastinum. The resected specimen was a well-defined lobulating mass with calcification. Microscopically, the mass was consisted of amorphous eosinophilc hyalinized substances involving the thymus and intrathymic lymph nodes. These eosinophilic substances showed apple-green bi-refringence under polarized light after staining with Congo red. In immunohistochemical study, they were positive for kappa and lambda light chains and negative for amyloid A. There was no evidence of systemic amyloidosis in clinical investigations. A final diagnosis of localized primary thymic amyloidosis was made.
Amyloid ; Amyloidosis ; Congo Red ; Eosinophils ; Female ; Humans ; Hyalin ; Light ; Lymph Nodes ; Mediastinum ; Middle Aged ; Thorax ; Thymoma ; Thymus Gland

Twenty five patients (twenty seven hips) who had Chiari osteotomy at Kang Nam St. Marys Hospital between 1980 and 1995 were reviewed to evaluate the factors in the operative technique that contribute to successful outcome and assess the clinical results in various conditions. The length of follow-up ranged from one to fourteen years and the age of at operation ranged from four to twentythree years. Eighteen patients had developmental dysplasia of the hip: four, septic hip: three had another disorders, Prior to the Chiari osteotomy, fourteen hips had an femoral osteotomy and four, trochanteric arthroplasty. We used to the standard osteotomy as described by Chiari with certain modification. A pneumatic saw and osteotome are used instead of Gigli saw. This technique is simple procedure to make the correct level and angle. Bone graft was not performed in all cases even the osteotomy was displaced more than 50 percent of the iliac width. The overall results were 12 excellent, eight good, five fair, and two poor. In eleven patients, the osteotomy had to be displaced more than 50 percent to provide good coverage of the femoral head. Their results were good or excellent. A good result will be obtained if enough attention is paid to displacing the osteotomy. The osteotomy using the pneumatic saw provides accurate level and direction of osteotomy and it is an simple procedure also.
Adolescent* ; Arthroplasty ; Child* ; Femur ; Follow-Up Studies ; Head ; Hip ; Humans ; Osteotomy* ; Transplants

PURPOSE: Osteoarticular infections in children and adolescents are important because it can cause functional compromise if appropriate treatment is delayed. Therefore, this study was designed to describe the clinical presentations and causative organisms of osteoarticular infections in children and adolescents in order to propose early diagnosis method and an appropriate empiric antimicrobial therapy. METHODS: Forty-two medical records were reviewed retrospectively, which were confirmed as osteomyelitis (OM) or septic arthritis (SA) at Department of Pediatrics or Orthopedic Surgery in patients under 18 years old of Ewha Womans University Mokdong Hospital from March 2008 to March 2015. RESULTS: We identified 21 cases of OM, 13 cases of SA and 8 cases of OM with SA. There were 31 males and 11 females and mean age was 7.1 years old. The most common symptoms were pain and tenderness of involved site. Major involved bones were femur (10 cases, 34.5%), tibia (7 cases, 24.1%) and major involved joints were hip (9 cases, 42.9%), and knee (5 cases, 23.8%). Increased serum C-reactive protein and erythrocyte sedimentation rate were observed in 37 cases (88.1%) respectively. Magnetic resonance imaging was performed in 40 cases among 42 cases and was used to demonstrate osteoarticular infections and other adjacent infections. Nine cases (23.7%) among 38 cases and 20 cases (50.0%) among 40 cases were positive in blood culture and infected site culture respectively. The most common causative organism was Staphylococcus aureus, which was represented in 22 cases (75.9%), of which nine cases (40.9%) were resistant to methicillin. CONCLUSIONS: S. aureus was the most common causative organism of osteoarticular infections in children and adolescents and the proportion of MRSA was high in this study. Therefore, we recommend vancomycin as the first empiric antimicrobial therapy and suggest that further study is necessary to elucidate an appropriate guideline for treatment which takes into account MRSA proportion.
Adolescent* ; Arthritis, Infectious ; Blood Sedimentation ; C-Reactive Protein ; Child* ; Early Diagnosis ; Female ; Femur ; Hip ; Humans ; Joints ; Knee ; Magnetic Resonance Imaging ; Male ; Medical Records ; Methicillin ; Methicillin-Resistant Staphylococcus aureus ; Orthopedics ; Osteomyelitis ; Pediatrics ; Retrospective Studies* ; Staphylococcus aureus ; Tibia ; Vancomycin

Patterns of abnormality in regional cerebral perfusion and its relation to clinical severity were evaluated with 29 brain injury patients with neurologic symptoms using 99mTc-HMPAO single photon emission tomography(SPECT). The findings were compared with computed tomography done within 48 hours of each SPECT study. The initial SPECT study was done within 3days of injury in 10 cases, between 4days and 3 weeks in 7 cases and after over 3 weeks in 12 cases. Nineteen patients underwent both SPECT and CT after a mean interval of 1 to 2 months. SPECT could detect abnormal perfusion in patients with nonspecific CT finding, and especially, SPECT was significant in chronic stage patients. SPECT detected more lesions than CT in size and number. There were a total of 54 supratentorial SPECT lesions in all. Ninity one percent(49/54) of these were of regional hypoperfusion, while 5 lesions(9%) showed focal hyperperfusion. The lesions were most often localized in the frontal and temporal lobes. Cerebellar diaschisis was observed in 55%(16/29) of patients, The degree of perfusion abnormality was quantified by product of differential percents activity and size factor. The degree of perfusion abnormality(SPECT grade) correlates well with clinical grade(P<0.01). And clinical improvement correlate well with follow up SPECT(P<0.05). Conclusively, SPECT can defect brain perfusion abnormality not found by CT. SPECT may be useful as a complementary study in the evaluation of head injury patient.
Brain ; Brain Injuries ; Craniocerebral Trauma* ; Follow-Up Studies ; Head* ; Humans ; Neurologic Manifestations ; Perfusion* ; Technetium Tc 99m Exametazime ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon*

Anatomical information of the circle of Willis is important in evaluating the various cerebrovascular diseases and surgical procedures. In this study, we present the anatomical structures of the circle of Willis in 54 Korean adults. The authors observed the morphological characteristics of the vasculature, the incidence of deficiency or incompleteness in the circle and clinical considerations. Measurements of the outer diameter and the length of each arterial segments were performed. Number and the origin of perforators from individual arteries were also oserved. Results of this study were as followings. Normal circles of Willis was oserved in 35 cases(64.81%) and abnormal circles in 19 cases(35.9%). 2) Incidental detection of aneurysms occurred in 5 cases(9.26%). 3) Frequency of anomalies were most commonly observed in the anterior communicating arteries(N=16, 20.37%). 4) A string-like artery was most frequently observed in te post-erior communicating artery(N=11, 20.37%). 5) Anomalous origin of the P1 segment of the posterior cerebral artery was observed, fetal type was in 12 cases(22.2%) and transitional typ was in 3 cases(5.55%) respectively. 6) The longest artery was the A1 segmnt of the anterior cerebral artery;the second, posterior communicating artery;the third, P1 segment of the posterior cerebral artery;and the shortest, anterior communicating artery. 7) The outer diameters of the basilar artery and internal carotid artery were almost, equal, A1 segment was half of ICA, AcoA was two thirds of A1 segment, PcoA was half of P1 segment and P1 segment was two thirds of the basilar artery. There were difference the anterior and posterior portion of the circle Willis. In the anterior communicating arteries, duplicated structure were frequently found. And also, inequality in the outer diameter of both A1 segmnts was observed. String-like arteries were often revealed in the posterior communicating arteries. Anomalous origin of P1 segments that may be persistant embryonic derivatives were frequently demonstrated in posterior cerebral arteries.
Adult* ; Aneurysm ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Circle of Willis* ; Humans ; Incidence ; Posterior Cerebral Artery ; Socioeconomic Factors

The authors presented an unusual case of an occipital artery aneurysm which developed spontaneously. The patient was a 41-year-old woman who suffered from the sudden onset of right hemiparesis and slurred speech. Computerized tomography scans of the brain demonstrated an intracerebral hemorrhage in the left parietal lobe. The carotid angiography revealed an incidental saccular aneurysm in the left occipital artery. The aneurysm was not treated because the patient's relatives refused operation and there were no subjective complaints by the patient. Certain particularities of this lesion are discussed in the context of the literature.
Adult ; Aneurysm* ; Angiography ; Arteries* ; Brain ; Cerebral Hemorrhage ; Female ; Humans ; Paresis ; Parietal Lobe

The authors present a case of Fahr's disease which is characterized by idiopathic symmetrical calcifications in the basal ganglia and the dentate nuclei. Computerized tomographic scans of the brain demonstrated bilateral calcified lesions recognized in the region of the dentate nuclei of both cerebellar hemispheres and the basal ganglia. A review of the literature on several cases of intracranial ferrocalcinosis is presented.
Basal Ganglia ; Brain