BACKGROUND: Diabetic cardiovascular autonomic neuropathy (CAN) causes perioperative cardiovascular instability. A rapid increase in the desflurane concentration induces tachycardia and hypertension (HTN). This study examined the effects of the cardiovascular response to desflurane on patients with diabetic CAN. METHODS: Forty diabetes mellitus (DM) patients with CAN were divided two groups: one with HTN (DM+HTN group, n = 17) and one without HTN (DM group, n = 23). The control group (n = 20) was composed of healthy patients without DM or HTN. In each group, the concentration of desflurane inspired was increased abruptly to 12.0 vol% 2 minutes after a thiopental injection. The target was to produce an end-tidal concentration of desflurane of 10.0 vol%, which was maintained until the end of the study by adjusting the vaporizer dial setting. The heart rate (HR), mean arterial pressure (MAP), and cardiac index (CI) were measured. RESULTS: The HR, MAP and CI increased significantly in all three groups when compared with the baseline (P<0.05). Additionally, the HR and MAP showed did not differ among the three groups at any of sampling times. However, the CI of the DM group and the DM+HTN group differed when compared with the control group at 90 and 120 seconds after intubation (P<0.05). CONCLUSIONS: In diabetic patients with CAN, the hemodynamic responses to a rapid increase in desflurane concentration are similar to those in non-diabetic patients before endotracheal intubation. However, after endotracheal intubation, increments in CI are blunted in diabetic patients with CAN.
Arterial Pressure ; Diabetes Mellitus ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal ; Isoflurane ; Nebulizers and Vaporizers ; Tachycardia ; Thiopental

Diplopia ; Ecchymosis ; Edema ; Enophthalmos ; Epistaxis ; Frontal Bone ; Humans ; Orbit ; Subcutaneous Emphysema ; Zygoma

Orthognathic Surgery ; Politics ; Prognosis ; Social Change

Superficial siderosis results from the deposition of hemosiderin in subpial layers of the central nervous system following hemorrhage in subarachnoid spaces. Infratentorial superficial siderosis (ISS) presents with unique clinical features including progressive hearing loss, ataxia, and myelopathy, and the most common cause of idiopathic ISS is dural abnormality. Here we report a case of idiopathic ISS with radiological findings of spontaneous intracranial hypotension, whose clinical symptoms of ISS including cerebellar dysfunction improved after supine position was maintained for 2 months.
Ataxia ; Central Nervous System ; Cerebellar Diseases ; Hearing Loss ; Hemorrhage ; Hemosiderin ; Intracranial Hypotension ; Siderosis ; Spinal Cord Diseases ; Subarachnoid Space ; Subdural Effusion ; Supine Position

Neovascular glaucoma is a subtype of secondary glaucoma that is characterized by proliferation of fibrovascular tissue in the anterior chamber angle. This condition may be acutely aggravated by carotid revascularization therapies. There have been few previous reports of acute aggravation of neovascular glaucoma following carotid artery stenting. We report the case history of a patient who had acute exacerbation of neovascular glaucoma following carotid artery stenting and required surgical management.
Anterior Chamber ; Carotid Arteries ; Carotid Stenosis ; Glaucoma ; Glaucoma, Neovascular ; Humans ; Stents

Hydrothorax complicating continuous ambulatory peritoneal dialysis (CAPD) occurs approximately 2% of continuous ambulatory peritoneal dialysis. Management might begin with interruption of peritoneal dialysis for 2-6 weeks. But, approximately half of the patients failed to respond to the conservative approach, as thus some authors advocated the combined use of intrapleural sclerosing agents and discontinuation of CAPD. As a rule of thumb, a 10-day wait is recommended after pleurodesis before resuming CAPD. As opposed to closed pleurodesis, the diaphragmatic defects can be identified and repaired under direct vision with surgical approach. But, limited eligibility of dialysis patients for open thoracostomy or video-assisted thoracostomy has been a major impediment for this definitive treatment of choice. From 1999 to 2003, among patients undergoing CAPD in Korea University Hospital, hydrothorax developed in four patients. Discontinuation of CAPD and conventional pleurodesis were performed. Three patients were treated successfully. A patient who interrupted peritoneal dialysis only for four days recurred after resuming CAPD. In conclusion, when pleural effusion complicates in a CAPD patient, chemical pleurodesis and cessation of CAPD during at least 10 days might be an initial tratement of choice.
Dialysis ; Humans ; Hydrothorax* ; Korea ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory ; Pleural Effusion ; Pleurodesis* ; Sclerosing Solutions ; Thoracostomy ; Thumb

OBJECTIVE: Perinatal infarcts are an important cause of neonatal neurologic morbidity accounting up to 10~20% of neonatal seizures and annual incidence rate is about one in 4,000 live births. The purpose of this study is to describe the clinical presentation, course, radiologic and Electroencephlogram (EEG) findings and to evaluate the neurologic outcome of cerebral infarcts. METHODS: Between January 2000 to May 2004, 8 of 40,204 delivered newborns (0.02%) were diagnosed as having cerebral infarcts. The clinical presentation, course, radiologic and EEG findings were characterized by retrospective chart review and neurological outcome was evaluated by neurological examination and developmental test (Bayley Scales of Infant Development-II) at out-patient department. RESULTS: There were 5 males and 3 females. Six cases of them were full term, and other 2 cases were near-term neonates. Five cases presented neonatal seizure and 3 presented apnea or respiratory distress. All cases showed abnormal finding in the cranial ultrasonography that was performed immediately after the first symptoms. After then, diagnosis of cerebral infarct was confirmed by computed tomography and magnetic resonance imaging. Abnormal EEG finding was found in the 4 cases and a correlation between the location of these abnormalities and cerebral infarcts existed. The location of infarct was on the left hemisphere in five of the 8 cases and predominantly in the distribution of the middle cerebral artery. 7 cases were followed and the mean duration of follow up was 17 months (range 3~42 months). Neurologic outcome was normal in 3 cases and abnormal in 4 cases. Mild hemiparesis was present in 3 cases and recurrent epilepsy in 1 case. Developmental test was performed in 4 cases, all of them were normal. CONCLUSION: Neonatal seizure is an important presentation as the first sign of perinatal infarcts and cranial ultrasound can be used for initial evaluation of these perinatal infarcts. Neuological sequelae remains over half of the patients. Performing long term follow-up study of large cohort study is needed.
Apnea ; Cohort Studies ; Diagnosis ; Electroencephalography ; Epilepsy ; Female ; Follow-Up Studies ; Humans ; Incidence ; Infant ; Infant, Newborn ; Live Birth ; Magnetic Resonance Imaging ; Male ; Middle Cerebral Artery ; Neurologic Examination ; Outpatients ; Paresis ; Retrospective Studies ; Seizures ; Ultrasonography ; Weights and Measures

PURPOSE: This study is directed to evaluate standardized developmental test performances of infants and children who, as fetuses, had mild isolated cerebral ventriculomegaly diagnosed by ultrasound. METHODS: All prenatal sonographic findings from 2001 to 2002 were evaluated. Live isolated mild ventriculomegaly (IMVM) of 10-15 mm were observed in 95 cases (1.1 percent). Standardized developmental testing of 40 cases of IMVM and 36 cases in a comparison group were offered to parents Both groups of children were adjusted to normal antepatum subjects with respect to sex, race, indication for ultrasound and gestational age at the time of ultrasound. Test of cognitive and motor development (Bayley Scales of Infant Development, Second Edition; BSID-II) were administered by developmental examiners. RESULTS: Forty cases and 34 comparison sujects completed the testing. The IMVM and comparison groups were similar with respect to parental age, gestational age, birth weight, familial socioeconomic status. The IMVM subjects scored lower than the comparison group on both the BSID-II, but there was not statistically significant. differences; metal development index (MDI) (92.7+/-12.9 vs 94.7+/-14.1, P=0.47) and psychomotor development index (PDI) (100.3+/-14.1 vs 101.3+/-10.7, P=0.75). Eleven cases (27.5 percent) of IMVM group and five cases (14.7 percent) of the comparison group were developmentally delayed, but most cases in both groups showed mild delays. Resolution or lack of progression, lateral ventricle diameter < or= 12 mm and females were associated with better scores, but there were not statistically significant. Polarity, and head circumference were not related to later development. CONCLUSION: This study show children with MIVM did not delay performance in the developmental test, but we might suggest a tendency to increase the risk of mild developmental delay.
Birth Weight ; Child ; Child Development ; Continental Population Groups ; Female ; Fetus ; Gestational Age ; Head ; Humans ; Hydrocephalus ; Infant ; Lateral Ventricles ; Parents ; Social Class ; Ultrasonography ; Weights and Measures

OBJECTIVE: In this study, we tested the correlation between the body temperature measured by non-contact temporal artery thermometer which has been developed recently and the rectal temperature using conventional glass mercury thermometer, also evaluate the reliability of non-contact temporal artery thermometer by comparing with other methods of temperature measurement. METHODS: One-hundred-and-seventeen newborn infants who were born at Samsung Cheil Hospital were included in this study. Tympanic and forehead temperatures were taken three times each with tympanic thermometer and non-contact infrared temporal artery thermometer respectively on a newborn infant by two authors. we also measured the rectal and axillary temperatures by using a mercury-in-glass thermometer. RESULTS: The normal body temperature measured by non-contact temporal artery thermometer was 36.2 +/- 0.22degrees C, and rectal, axillary and tympanic temperatures were 36.8 +/- 0.30degrees C, 36.7 +/- 0.30 and 36.1 +/- 0.27degrees C, respectively. There was a significant correlation between temperatures measured by non-contact temporal artery thermometer and rectal temperature (p<0.01, r=0.891). The differences between repeated measurements by non-contact temporal artery thermometer were significantly less than those by tympanic thermometer (p<0.01). CONCLUSION: Forehead temperature measured by non-contact temporal artery thermometer is correlated with rectal temperature and has good reproducibility. It can be used to measure body temperature in newborn infants.
Body Temperature* ; Forehead ; Glass ; Humans ; Infant, Newborn* ; Temporal Arteries* ; Thermometers*