Myoclouns is a complicated and poorly-understood phenomenon caused by many pathological conditions. Myoclonus which is triggered by sensory stimuli has been termed reflx myoclonus and divided into cortical, reticular and spinal types depending on the generator sites. Segmental myoclonus of spinal origin consists of synchronous rhythmical jerks confined to a group of muscles supplied by either one segment or several contiguous segments of the spinal cords. We present two cases of spinal reflex myoclonus. One was 50 years old female who showed complex myoclonic jerks involving the abdominal wall and paraspinal muscibs resembling 'belly dance'. The other was 26 years old male who showed intermittent synchronous upper cervical axial muscle contractions. In both cases, jerks were increased with certain stimuli, but disappeared during sleep. They showed normal EEGs and absence of enhancement of SSEPS.
Abdominal Wall ; Adult ; Electroencephalography ; Female ; Humans ; Male ; Middle Aged ; Muscle Contraction ; Muscles ; Myoclonus* ; Reflex ; Spinal Cord

BACKGROUND: Postoperative ileus is considered to be caused by the activation of spinal reflexes originating from the abdominal cavity with the sympathetic nerves as the efferent nerves. Epidural anesthesia as a perioperative adjunct has been shown to provide superior pain control, and has been implicated in more rapid postoperative ileus resolution possibly through a sympathetic block mechanism. This study was undertaken to compare the effects of epidural morphine-lidocaine with those of epidural morphine alone on postoperative bowel motility and pain. METHODS: Forty-four ASA I or II women scheduled for transabdominal hysterectomy were considered for the study. They were randomly allocated to one of two groups. Group M (n = 22) received postoperative epidural morphine 16 mg by infusion pump, 2 ml/h, for 2 days, group ML (n = 22) received morphine 16 mg plus 0.42% lidocaine by infusion pump, 2 ml/h, for 2 days. Both group received morphine 4 mg in 0.5% lidocaine 8 ml epidurally as a single bolus when the peritoneum was closed. Postoperative pain, and the time interval from termination of operation to the first passage of flatus were checked RESULTS: In group ML, the times for first passing of flatus (33.4 +/- 10.5 h; mean +/- SD) and visual analogue scale score (0.3 +/- 0.6) were significantly shorter and lower than in group M (flatus 42.6 +/- 8.4 h and VAS score 1.3 +/- 1.7). CONCLUSIONS: The epidural lidocaine infused with morphine demonstrated earlier recovery of bowel motility and better postoperative pain relief than the epidural morphine alone.
Abdominal Cavity ; Anesthesia, Epidural ; Female ; Flatulence ; Humans ; Hysterectomy* ; Ileus ; Infusion Pumps ; Lidocaine* ; Morphine* ; Pain, Postoperative ; Peritoneum ; Reflex

Appendicitis is one of the most common condition causing an acute abdomen in young adult population. Two-hundreds and fifty-nine cases of acute appendicitis provened by surgery and pathology during recent 2 years in Han-ll Hospital were studied and analyzed by preoperative plain abdominal X-ray. One case of barium enema was also done. The results were as follows; 1. Male fo female sex ration was 1:1. 2. In age distribution, the most commonage group was from two to four decade. (75.3%) 3. The most common clinical symptom was classical abdominal pain as86.5%. 4. The positive radiographic findings were obtained 75.7% of all cases. 5. Common radiographic findings as follows; 1) Reflex ileus on RLQ (73.7%) 2) Obliteration of Rt. psoas line (41.3%) 3) Scoliosis of lumbar spine(21.2%) 6. The most common site of appendix was retrocecal in position. (84.2%) 7. One case of appendicolith and one case of appendiceal diverticulum were demonstrated.
Abdomen, Acute ; Abdominal Pain ; Age Distribution ; Appendicitis ; Appendix ; Barium ; Diverticulum ; Enema ; Female ; Humans ; Ileus ; Male ; Pathology ; Reflex ; Scoliosis ; Young Adult

Chronic inflammatory demyelinating polyneuropathy (CIDP) is characterized by symmetrical weakness, impaired sensation, absent or diminished tendon reflexes, an elevated cerebrospinal fluid protein level and nerve-conduction studies that show demyelination. The occurrence of CIDP in patients with systemic lupus erythematosus (SLE) has been rarely reported. We experienced a case of a 33 year-old woman with SLE and she presented with fever, abdominal pain, a tingling sensation of both of her hands and feet, and symmetrical weakness in both the proximal and distal extremities. Her symptoms had persisted for over 1 months before she visited our department. The CSF examination showed an elevated protein level and the nerve conduction studies revealed demyelination. Her symptoms showed minimal improvement with high dose steroid and immunoglobulin therapy, but she responded to cyclophosphamide therapy.
Abdominal Pain ; Cyclophosphamide ; Demyelinating Diseases ; Extremities ; Female ; Fever ; Foot ; Hand ; Humans ; Hypesthesia ; Immunization, Passive ; Lupus Erythematosus, Systemic ; Neural Conduction ; Polyneuropathies ; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating ; Reflex, Stretch ; Sensation

BACKGROUND: The aim of this study was to investigate the influences of visceral adiposity on cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus. METHODS: Two hundred eleven patients with type 2 diabetes participated in this study. Anthropometric and metabolic parameters were measured, and the visceral fat area was assessed using computed tomography. CAN was diagnosed using a cardiovascular reflex test. We analyzed the correlation between the visceral fat area and each parameter in this test. RESULTS: The mean age, body mass index (BMI), and duration of diabetes of the study population were 60+/-14 years (mean+/-standard deviation), 25.1+/-4.2 kg/m2, and 12.3+/-8.9 years, respectively. The visceral fat area showed positive correlations with age, BMI, waist circumference, and subcutaneous fat area. There was no statistically significant difference in the cardiovascular reflex test outcome between genders. Univariate linear regression analysis showed that an increased visceral fat area diminished good heart rate response to a Valsalva maneuver (R2=4.9%, P=0.013 in an unadjusted model), but only in women. This statistical association was preserved after adjusting for age and BMI (R2=9.8%, P=0.0072). CONCLUSION: The results of this study suggest that visceral adiposity contributes to an autonomic imbalance to some degree, as demonstrated by the impaired cardiovascular reflex test among women with type 2 diabetes.
Adiposity ; Body Mass Index ; Diabetes Mellitus, Type 2 ; Female ; Heart Rate ; Humans ; Intra-Abdominal Fat ; Linear Models ; Obesity ; Reflex ; Subcutaneous Fat ; Valsalva Maneuver ; Waist Circumference

BACKGROUNDThe neurogenic bladder dysfunction caused by spinal cord injury is difficult to treat clinically. The aim of this research was to establish an artificial bladder reflex arc in rats through abdominal reflex pathway above the level of spinal cord injury, reinnervate the neurogenic bladder and restore bladder micturition.

METHODSThe outcome was achieved by intradural microanastomosis of the right T13 ventral root to S2 ventral root with autogenous nerve grafting, leaving the right T13 dorsal root intact. Long-term function of the reflex arc was assessed from nerve electrophysiological data and intravesical pressure tests during 8 months postoperation. Horseradish peroxidase (HRP) tracing was performed to observe the effectiveness of the artificial reflex.

RESULTSSingle stimulus (3 mA, 0.3 ms pulses, 20 Hz, 5-second duration) on the right T13 dorsal root resulted in evoked action potentials, raised intravesical pressures and bladder smooth muscle, compound action potential recorded from the right vesical plexus before and after the spinal cord transaction injury between L5 and S4 segmental in 12 Sprague-Dawley rats. There were HRP labelled cells in T13 ventral horn on the experimental side and in the intermediolateral nucleus on both sides of the L6-S4 segments after HRP injection. There was no HRP labelled cell in T13 ventral horn on the control side.

CONCLUSIONUsing the surviving somatic reflex above the level of spinal cord injury to reconstruct the bladder autonomous reflex arc by intradural microanastomosis of ventral root with a segment of autologous nerve grafting is practical in rats and may have clinical applications for humans.

Anastomosis, Surgical ; Animals ; Atropine ; pharmacology ; Male ; Models, Theoretical ; Rats ; Rats, Sprague-Dawley ; Reflex, Abdominal ; drug effects ; physiology ; Trimethaphan ; pharmacology ; Urinary Bladder, Neurogenic ; physiopathology

Familial dysautonomia, first described by Riley and co-workers in 1949, is a congenital, heritable syndrome. It is transmitted by a recessive autosomal gene which is generally limited to persons of Jewish extraction; however, rare occurrences among non-Jewish Caucasians and in a black girl have been reported. An eight-year old Korean boy was admitted to Severance Hospital with bulbar conjunctival injection OU for 1 month and visual disturbance OS for 10 days. Examination revealed exfoliated epithelium in an area of about 3mm in diameter in the center of the left cornea, multiple punctate erosions and edema of the corneal epithelium. Yet, he experienced no discomfort, blepharospasm, nor photophobia. He had decreased corneal sensation, decreased lacrimation by Schirmer test and miosis was induced biJaterally by 0.25% pilocarpine (equivalent to 2.5% methacholine). The patient had decreased deep tendon reflexes and postural hypotension, and showed emotional lability, indifference to pain, and abnormal temperature control. He also had marked anorexia, swallowing difficulty, cyclic vomiting, abdominal pain, headache, intermittent vascular hypertension and one episode of convulsive seizure. He was positive to histamine intradermal injection test and had abnormal EEG. EMG was suggestive of some form of neuropathy. He was treated with toplca 0.5% chloramphenicol solution and 10% dextran solution alternatively q.2 hrs., terramycin ophthalmic ointment q.h.s. and bilateral patching; he also received 50,000 units of vitamin A for 10 days. He showed marked improvement of his ocular symptoms in 6 days. The above patient shows many of the essential features of the familial dysautonomia syndrome as outlined by Riley; however, he also lacks some of the most important features. Therefore, we feel that the patient has a case of some other type of autonomic dysfunction simulating Riley-Day svndrome.
Abdominal Pain ; Anorexia ; Blepharospasm ; Chloramphenicol ; Cornea ; Deglutition ; Dextrans ; Dysautonomia, Familial* ; Edema ; Electroencephalography ; Epithelium ; Epithelium, Corneal ; Female ; Headache ; Histamine ; Humans ; Hypertension ; Hypotension, Orthostatic ; Injections ; Injections, Intradermal ; Male ; Miosis ; Oxytetracycline ; Photophobia ; Pilocarpine ; Primary Dysautonomias* ; Reflex, Stretch ; Seizures ; Sensation ; Vitamin A ; Vomiting

Acute intermittent porphyria(AIP) is a rare hepatic disorder resulting from defects in the synthesis of heme. This occurs in approximately 0.01% of the general population and is even rare in black and orientals. Acute episode of this disease can be triggered by surgery, certain drug, pregnancy, mensturation, fasting and etc. We report a porphyrinogenic neuropathy occured after general anesthesia in a oriental woman who presented with abdominal pain and other typical sign and symptom. 56 year-old female patient was diagnosed as acute appendicitis for 2 days of constipation and abdominal pain and appendectomy was performed under general anesthesia at local clinic. Anesthesia was induced with penthothal and maintained with halothane, and she was recovered from anesthesia without event. After operation she experienced difficult swallowing and generalized weakness which were aggrevated day by day. Therefore she was transferred to our hospital on fourth postoperative day. Physical examination revealed Grade II motor weakness of Gxtremities and decreased deep tendon reflex. Neostigmine test and Jolly test were done under impression of myasthenia gravis but revealed negative. Guillian-Barre syndrome was difficult to rule out in this patient, but urinalysis revealed increased delta aminolevulinic acid and urine color changed dark under light. Therefore we diagnosed her as AIP. 6 days after appendectomy she complained severe dyspnea with vital capacity 350 ml and arterial blood gas analysis revealed PO2 of 56 mmHg and PCO2 of 44 mmHg under nasal oxygen 5 1/min inhalation. Therefore we diagnosed this peripheral neuropathy as AIP and report here with references.
Abdominal Pain ; Aminolevulinic Acid ; Anesthesia ; Anesthesia, General ; Appendectomy ; Appendicitis ; Blood Gas Analysis ; Constipation ; Deglutition ; Dyspnea ; Fasting ; Female ; Halothane ; Heme ; Humans ; Inhalation ; Middle Aged ; Myasthenia Gravis ; Neostigmine ; Oxygen ; Peripheral Nervous System Diseases ; Physical Examination ; Porphyrias ; Pregnancy ; Reflex, Stretch ; Urinalysis ; Vital Capacity

Beriberi, which is caused by thiamin deficiency, is a rare disease in recent years. But it has been described in the Eastern literature as far back as the 17th century. Early symptoms are fatigue, apathy, irritability, drowsiness, anorexia, nausea, vomiting and abdominal pain. Signs and symptoms of progression are peripheral neuritis, paresthesia, decreased tendon reflex and congestive heart failure. Thiamin deficiency remains as an important health care issue in many world population, specially in AIDS, pregnancy women and TPN associated patients. The best diagnostic test is assessing clinical response to administration of thiamin. We have experienced a case of Beriberi caused by continuous rice-soup feeding during one and half years in a 7-year-old boy.
Abdominal Pain ; Anorexia ; Apathy ; Beriberi* ; Child ; Delivery of Health Care ; Diagnostic Tests, Routine ; Fatigue ; Female ; Heart Failure ; Humans ; Male ; Nausea ; Neuritis ; Paresthesia ; Pregnancy ; Rare Diseases ; Reflex, Stretch ; Sleep Stages ; Vomiting

Thirty-six cases of paroxysmal supraventricular tachycardia which were observed at the Department of Pediatrics, Seoul National University Hospital from 1976 till October 1982, were analyzed. 1. The sex ratio was 1.8:1, male predominance. Sixteen cases (44.4%) were under 1 year of age and 11 cases (30.6%) were under 4 months of age. 2. Cases without known heart disease were 22(61.6%). Among Known etiology, most frequent one was 7 cases(19.4%) of W-P-W syndrome. 3. The sex ratio of group without known heart disease was 2.1:1, and that of group with known heart disease was 1.3:1. Under 4 months of age, there were more cases without known heart disease(72.7%) and after 4 months of age number of cases with and without known heart disease were similar. 4. Most frequent clinical manifestation was tachydyspnea. hepatomegly, irritability, palipitation, cyanosis and pallor, vomiting, chest pain, edema, abdominal pain, and fever were followed in order of frequency. 5. Congestive heart failure occurred in 22 cases(61%). The incidence was related to the duration of attack of tachycardia, age of patients, and heart rate. The longer the duration of attack and the younger the age of patients and the faster the heart rate, the higher incidence of heart failure was observed. 6. As treatment, vagal reflex stimulation was almost ineffective, and digitalization was effective in most of the cases. Verapamil and electrical cardioversion were tried in small number of cases and proved to be effective. 7. One case (2.8%) expired becase of the supraventricular tachycardia. 8. Eight cases (30.8%) had recurrence. In younger age group, recurrence rate was lower. 9. Digoxin was given in 15 cases for prevention of recurrence and was effective in 12 cases.
Abdominal Pain ; Chest Pain ; Child* ; Cyanosis ; Digoxin ; Edema ; Electric Countershock ; Fever ; Heart ; Heart Diseases ; Heart Failure ; Heart Rate ; Humans ; Incidence ; Infant* ; Male ; Pallor ; Pediatrics ; Recurrence ; Reflex ; Seoul ; Sex Ratio ; Tachycardia ; Tachycardia, Supraventricular* ; Verapamil ; Vomiting