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

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

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

Orthognathic Surgery ; Politics ; Prognosis ; Social Change

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

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

Scleroderma renal crisis is defined as rapidly progressive renal failure and/or new onset of malignant hypertension during the course of systemic sclerosis. Most patients show clinical features of malignant hypertension, but there have been several reports of normotensive renal crisis. We have experienced a 63 year old female patients with acute renal failure due to scleroderma renal crisis who did not show the clinical features of malignant hypertension. She had taken steroid for the treatment of degenerative osteoarthritis and gradually developed shortness of breath and edema. Her blood pressure on admission was 150/90 mmHg and easily controlled by diuretics. Renal biopsy showed onion-skin appearance in the interlobular arteries with varying degree of tubulointerstitial changes. Her renal function rapidly deteriorated despite ACE inhibitor therapy and cytotoxic therapy had to be initiated because of progressive interstitial pneumonitis and myocarditis. We describe a patient with scleroderma renal crisis who did not show the clinical features of malignant hypertension following steroid treatment.
Acute Kidney Injury ; Arteries ; Biopsy ; Blood Pressure ; Diuretics ; Dyspnea ; Edema ; Female ; Humans ; Hypertension, Malignant* ; Lung Diseases, Interstitial ; Middle Aged ; Myocarditis ; Osteoarthritis ; Renal Insufficiency ; Scleroderma, Systemic

BACKGROUND: Proteinuria is a predictor of chronic kidney disease and a common risk factor for cardiovascular disease. Previous studies have reported that a urinary albumin-creatinine ratio and a glomerular filtration rate was related to the metabolic syndrome. However, there have been few studies on association between the metabolic syndrome and proteinuria by the urine dip-stick test. We examined the association between the metabolic syndrome and the proteinuria by the urine dip-stick test. METHODS: The subject of this study included 20,075 adults aged more than 18 years old who visited the Health Promotion Center of the Seoul National University Hospital from April 2001 to March 2007. The metabolic syndrome was defined according to the criteria of the American Heart Association and National Heart, Lung and Blood Institute, and proteinuria was defined as a dipstick test above the '1+' level. The crude and multivariated-adjusted odds ratios of proteinuria were calculated by using logistic regression models with each component of the metabolic syndrome. RESULTS: Proteinuria was noticed in 5.7% of the subjects with metabolic syndrome, and 2.7% without metabolic syndrome. The multivariate-adjusted odds ratios of proteinuria in participants with elevated blood pressure level, elevated plasma glucose level and high triglyceride level were 2.23 (95% confidence interval [CI], 1.95 to 2.55), 2.33 (95% CI, 2.06 to 2.62), 1.64 (95% CI, 1.45 to 1.84). The multivariate-adjusted odds ratio of proteinuria in participants with the metabolic syndrome compared with participants without the metabolic syndrome was 2.30 (95% CI, 1.91 to 2.76), respectively. CONCLUSION: These findings suggest that proteinuria by the urine dip-stick test might be an important predictor in the metabolic syndrome.
Adult ; Aged ; American Heart Association ; Blood Pressure ; Cardiovascular Diseases ; Glomerular Filtration Rate ; Glucose ; Health Promotion ; Heart ; Humans ; Logistic Models ; Lung ; Odds Ratio ; Plasma ; Proteinuria ; Renal Insufficiency, Chronic ; Risk Factors ; Urinalysis