No abstract available.
Adrenal Hyperplasia, Congenital* ; Adrenogenital Syndrome*

No abstract available.
Diarrhea* ; Korea*

No abstract available.
Congenital Hypothyroidism* ; Diagnosis* ; Prognosis*

BACKGROUND: Vasoconstricting drugs such as dopamine, phenylephrine (PE) and epinephrine constrict normoxic lung vessels preferentially, thereby disproportionately increasing normoxic lung pulmonary vascular resistance (PVR) and inhibit hypoxic pulmonary vasoconstriction (HPV). In this study, we evaluated the effect of PE on HPV and arterial oxygenation. METHODS: This study was performed on 21 patients undergoing thoracotomy. After induction of anesthesia, Swan-Ganz catheter was inserted. After one lung ventilation was started, systolic blood pressure (SBP) of the patient was reduced to 100 mmHg using inhalation anesthetic agent and then the blood pressure was raised up to 140 mmHg by PE infusion. Hemodynamic variables were measured and arterial blood gas was analyzed at the start of one lung ventilation (control), SBP of 100 mmHg and SBP of 140 mmHg. RESULTS: The mean dose of PE infused was 5.9 +/- 3.8 microgram/kg. Infusion of PE did not increase pulmonary vascular resistant index (PVRI) significantly and did not reduce arterial PO2. There was no statistically significant difference in intrapulmonary shunt fraction (Qs/Qt) between the time of low and high blood pressures. CONCLUSION: Pulmonary vasomotor changes induced by PE are minimal and so should not affect the distribution of blood flow during one lung ventilation. On the basis of this result, PE appears to a reasonable vasoconstrictor to be used in patients undergoing thoracotomy.
Anesthesia ; Blood Pressure ; Catheters ; Dopamine ; Epinephrine ; Hemodynamics ; Humans ; Hypertension ; Inhalation ; Lung ; One-Lung Ventilation* ; Oxygen* ; Phenylephrine* ; Thoracotomy ; Vascular Resistance ; Vasoconstriction*

A patient with encephalopathy associated with autoimmune thyroid disease (EAATD), which is one of the most important differential diagnoses of treatable dementia, presents with various neurological symptoms, such as repetitive epileptic seizures, altered mental status, and cognitive dysfunction. Steroid treatment is effective for EAATD. The incidence of EAATD increases considerably with age, particularly in female patients. Most patients with EAATD have normal thyroid function test results or mild hypothyroidism. Patients with EAATD with Graves' disease are very rarely reported. Here, we report a case of a 63-year-old woman who complained of declining cognitive ability and ataxia. She was diagnosed with EAATD accompanied by Graves' disease. Her neurological symptoms improved after intravenous steroid administration.
Ataxia ; Brain Diseases ; Dementia ; Diagnosis, Differential ; Epilepsy ; Female ; Graves Disease* ; Humans ; Hypothyroidism ; Incidence ; Middle Aged ; Thyroid Diseases* ; Thyroid Function Tests ; Thyroid Gland*

Myelodysplastic syndromes (MDS) are a group of refractory anemias resulting from a clonal stem cell disorder often associated with cytogenetic abnormalities. There is increasing recognition of immunological abnormalities in patients with MDS, including defective B- and T-cell function, hyper- or hypogammaglobulinemia and monoclonal gammopathy. MDS have been associated with Sjogren's syndrome, polymyalgia rheumatica, relapsing polychondritis and systemic lupus erythematosus. Although there may be various rheumatologic features, including acute arthritis in MDS, chronic inflammatory arthritis is uncommonly combined. There have been a few reports that described cases of rheumatoid arthritis (RA) concurrent with MDS, but advanced rheumatoid arthritis with typical joint deformities has rarely been reported. We report a case of rheumatoid arthritis with atlantoaxial subluxation combined with refractory anemia in a 31-year-old woman.
Adult ; Arthritis, Rheumatoid/radiography ; Arthritis, Rheumatoid/pathology ; Arthritis, Rheumatoid/complications* ; Arthritis, Rheumatoid/blood ; Case Report ; Female ; Follow-Up Studies ; Human ; Myelodysplastic Syndromes/pathology ; Myelodysplastic Syndromes/complications* ; Myelodysplastic Syndromes/blood

PURPOSE: Episodic memory is described as an 'autobiographical' memory responsible for storing a record of the events in our lives. We performed functional brain activation study using H215O PET to reveal the neural basis of the encoding and the retrieval of episodic memory in human normal volunteers. MATERIALS AND METHODS: Four repeated H215O PET scans with two reference and two activation tasks were performed on 6 normal volunteers to activate brain areas engaged in encoding and retrieval with verbal materials. Images from the same subject were spatially registered and normalized using linear and nonlinear transformation. Using the means and variances for every condition which were adjusted with analysis of covariance, t-statistic analysis were performed voxel-wise. RESULTS: Encoding of episodic memory activated the opercular and triangular parts of left inferior frontal gyrus, right prefrontal cortex, medial frontal area, cingulate gyrus, posterior middle and inferior temporal gyri, and cerebellum, and both primary visual and visual association areas. Retrieval of episodic memory activated the triangular part of left inferior frontal gyrus and inferior temporal gyrus, right prefrontal cortex and medial temporal area, and both cerebellum and primary visual and visual association areas. The activations in the opercular part of left inferior frontal gyrus and the right prefrontal cortex meant the essential role of these areas in the encoding and retrieval of episodic memory. CONCLUSION: We could localize the neural basis of the encoding and retrieval of episodic memory using H215O PET, which was partly consistent with the hypothesis of hemispheric encoding/retrieval asymmetry.
Brain ; Cerebellum ; Gyrus Cinguli ; Healthy Volunteers ; Humans* ; Memory ; Memory, Episodic* ; Positron-Emission Tomography ; Prefrontal Cortex

BACKGROUND: Dobutamine and amrinone, phosphodiesterase-III inhibitor, are known to have both inotropic and vasodilatory properties. We evaluated the effects of both drugs on systemic and pulmonary hemodynamics in patients with pulmonary hypertension (PH). METHODS: With Institutional Review Board approval, 45 patients whose mean pulmonary arterial pressure was greater than 30 mmHg were studied. After sternotomy under the steady state of anesthesia and controlled ventilation (30 mmHg < PaCO2 < 40 mmHg), patients recieved one of following drugs for 30minutes (min); dobutamine 5.0ug/kg/min (Group I), low dose amrinone (loading dose 1.0 mg/kg, followed by infusion 7.5 g/kg/min, Group II) or high dose amrinone (loading dose 2.0 mg/kg, followed by infusion 10 g/kg/min, Group III). Hemodynamic variables were measured at 10 min and 30 min after start of infusion. RESULTS: Dobutamine didn't decrease pulmonary arterial pressure (PAP) and cause no hemodynamic change while low and high dose amrinone reduced PAP and especcially decrease of PAP in low dose amrinone group was statistically significnat. High dose amrinone increased cardiac index (CI) and decreased both systemic vascular resistance index (SVRI) and central venous pressure (CVP) more significantly than control value. CONCLUSIONS: In patients with chronic right ventricular failure associated with PH, amrinone may decrease the PAP and improve cardiac performance more effectively than dobutamin does. Increment of dosage of amrinone may not result in significant reduction of PAP.
Amrinone* ; Anesthesia ; Arterial Pressure ; Central Venous Pressure ; Dobutamine* ; Ethics Committees, Research ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Sternotomy ; Vascular Resistance ; Ventilation

We performed 1st day Tc-99m-sestamibi gated SPECT with dipyridamole/rest T1-201 SPECT and 2nd day 24 hour delay T1-201 SPECT/rest Tc-99m-sestamibi gated SPECT in 27 patients with coronary artery disease(24) or having chest pain(3). Stress and rest Tc-99m- sestamibi gated SPECT was acquired at 60min post-injection. A 4-point scoring system(0 to 3 for normal to absent tracer uptake) for 17 segments was used. Wall motion was scored on another 4 point scale(0 to 3 for normal to dyskinesia) in the lst day post-stress gated and the 2nd day rest gated SPECT. Post-stress gated SPECT showed wall motion abnormality in 94 segments(20%). Fifty-five segments among these 94 showed the same wall motion between post-stress and rest gated SPECT:i.e. 1-1: 23 segments, 2-2: 29 segments, 3-3: 3 segments. Re-maining 39 segments (41.5%) showed different wall motion between post-stress and rest Tc-99m-sestamibi gated SFECT. Twenty one segments with wall motion abnormality had normal perfusion(rest:15 segments, 24 hour delay: 6 segments) at either rest or 24 hour delay. Fifteen among these 21 segments showed persistent post-stress and the 2nd day rest wall motion abnormality(persistent stunning). However, in 6 segments with prolonged (1 hour after stress) stunning, abnormal wall motion did improve in the 2nd day rest Tc-99m-sestamibi gated SPECT(transient prolonged stunning). These 6 segments had normal perfusion at rest(n=4) or at 24 hour delay(n=2). Post stress wall motions showed significantly higher scores in persistent stunning than in prolonged transient stunning(P value<0.05). It was concluded that we could find stunned myocardium with gated Tc-99m-sestamibi SPECT at either post-stress or rest and that some myocardial walls of post-stress 1 hour gated SPECT did not show truly rest wall motion. So, we should be cautious if we use post-stress Tc-99m-sestamibi wall motion to assess rest wall motion.
Coronary Vessels ; Dipyridamole* ; Humans ; Myocardial Stunning ; Perfusion ; Thorax ; Tomography, Emission-Computed, Single-Photon*

BACKGREOUND: The pneumonectomy may depress the right ventricular (RV) function transiently. The thermodilution ejection/volumetric catheter is known to be most useful method assessing the changes in RV performance during pulmonary resection. The purpose of this study was to examine the RV function during and immediately after pneumonectomy using thermodilution methods. METHODS: 16 patients undergoing pneumonectomy were studied. After induction of anesthesia, a multilumen thermodilution catheter mounted with a rapid response thermister was inserted. Using computer system, RV ejection fraction (RVEF), cardiac output, and RV end-diastolic volume (RVEDV) were measured when the patient was in lateral position (control), after one lung ventilation (OLV) and the main pulmonary artery ligated, and at the completion of resection. Arterial blood gases were analyzed and pulmonary vascular resistance (PVR) was calculated. RESULTS: Systolic pulmonary blood pressure (SPAP)(28.3 +/- 6.2 mmHg) increased compared to the control (24.6 +/- 5.9) without a significant change of PVR. No statistically significant difference was found in either RVEF or RVEDV at each times. CONCLUSIONS: Our study demonstrate the pneumonectomy do not depress the RV function immediately and RVEF do not show any correlation with PVR or RVEDV.
Anesthesia ; Blood Pressure ; Cardiac Output ; Catheters ; Computer Systems ; Gases ; Humans ; One-Lung Ventilation ; Pneumonectomy* ; Pulmonary Artery ; Thermodilution ; Vascular Resistance ; Ventricular Function, Right*