OBJECTIVES: To determine the effectiveness and clinical utility of antenatal corticosteroids in the reduction of neonatal morbidity and mortality on preterm birth Material and method: Neonatal outcomes of 312 preterm babies were evaluated retrospectively. One hundred and two preterm babies(study group) were given dexamethasone more than 1 dose antenatally and 210 preterm babies(control group) were not given dexamethasone antenatally. Antenatal steroids were administered in the form of four 5mg intramuscular doses of dexamethasone 12 hours apart. Maternal and neonatal outcomes of study group were compared with those of control group. Student t- test, x2 test, Fisher's exact test, and logistic regression analysis were used where appropriate. p-value< 0.05 was considered significant. RESULTS: Antentenatal corticosteroid significantly decreased the incidence of RDS(OR:0.47, 95% CI:0.25-0.86), IVH/PVL(OR : 0.32, 95% CI : 0.12-0.86), necrotizing enterocolitis(OR : 0.49, 95% CI : 0.25-0.98), and neonatal death(OR: 0.30, 95% CI: 0.10 - 0.89) in preterm delivery. In the presence of PROM, antenatal corticosteoid seemed to have no protective effect on the neonatal complications such as RDS, IVH/PVL, NEC, PDA, and neonatal death. CONCLUSIONS: Antenatal administration of corticosteroids was effective to decrease the incidence of neonatal morbidity and neonatal mortality in the preterm neonates with no apparent maternal complications.
Adrenal Cortex Hormones ; Dexamethasone ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn ; Logistic Models ; Mortality ; Premature Birth* ; Retrospective Studies ; Steroids

No abstract available.
Amnion* ; Cyclooxygenase 2*

BACKGROUND: Many pieces of previous research on measuring blood pressure (BP) using different methods focused on the disparity in the results. However, none of them dealt with the disparity caused by the difference in age and inhalation anesthetics. We attempted to find the variance in accordance with age, body part, and measuring methods (invasive vs noninvasive) and also studied how sevoflurane influences BP as the operation progresses. METHODS: In sixty patients, we measured the arterial BP in the upper and lower limbs by noninvasive methods before inducing anesthesia. After induction, we used sevoflurane to maintain anesthesia, and injected catheters into the radial artery and dorsalis pedis artery to measure arterial pressure at every ten minute by both invasive and noninvasive methods. RESULTS: The patients who were 40 or older showed significantly higher values in the systolic BP than the patients younger than 40. The values of systolic and diastolic BP measured by a noninvasive oscillometric method were meaningfully higher than those measured by an invasive method. As the operations progressed, the lower limbs showed higher systolic pressure than the upper limbs regardless of measuring methods, whereas the opposite is true for diastolic pressure. CONCLUSIONS: The values in the arterial BP were measured high by noninvasive method. Systolic BP were estimated significantly high in the older patients and in the lower leg. Due to the effect of sevoflurane, the diastolic BP in the lower limbs becomes lower than that of upper limbs regardless of measuring methods, as the operation progresses.
Anesthesia ; Anesthesia, General ; Anesthetics, Inhalation ; Arterial Pressure ; Arteries ; Blood Pressure ; Catheters ; Humans ; Leg ; Lower Extremity ; Methyl Ethers ; Radial Artery ; Upper Extremity

Many types of glomerulonephritis are associated with human immunodeficiency virus (HIV) infection. We present a case of a 50-year-old Korean man with an HIV infection, who developed nephrotic syndrome and progressive renal failure. Renal biopsy showed lupus-like glomerulonephritis without clinical or serologic evidence of systemic lupus erythematosus. After the administration of antiretroviral agents and steroids, there was reduction in the amount of proteinuria and improvement in renal function.
AIDS-Associated Nephropathy ; Anti-Retroviral Agents ; Biopsy ; Glomerulonephritis ; HIV ; HIV Infections ; Humans ; Lupus Erythematosus, Systemic ; Middle Aged ; Nephrotic Syndrome ; Proteinuria ; Renal Insufficiency ; Steroids

Many types of glomerulonephritis are associated with human immunodeficiency virus (HIV) infection. We present a case of a 50-year-old Korean man with an HIV infection, who developed nephrotic syndrome and progressive renal failure. Renal biopsy showed lupus-like glomerulonephritis without clinical or serologic evidence of systemic lupus erythematosus. After the administration of antiretroviral agents and steroids, there was reduction in the amount of proteinuria and improvement in renal function.
AIDS-Associated Nephropathy ; Anti-Retroviral Agents ; Biopsy ; Glomerulonephritis ; HIV ; HIV Infections ; Humans ; Lupus Erythematosus, Systemic ; Middle Aged ; Nephrotic Syndrome ; Proteinuria ; Renal Insufficiency ; Steroids

H type of congenital tracheoesophageal fistula (TEF) is rare, occurring approximately once in 100,000 births. The presentation of this anomaly in adults is indeed uncommon. We report a case of a 47-year-old male with congenital TEF dectected during epidural hematoma removal under general anesthesia. Intermittent disappearance of normal capnography, bubbling sound at substernal area, and air leakage at oral cavity observed during manually assisted ventilation, especially during inspiration. We observed a H-type of TEF and tracheal intubation via esophagus in chest CT after operation.
Adult ; Anesthesia, General ; Capnography ; Esophagus ; Hematoma ; Humans ; Intubation ; Male ; Middle Aged ; Mouth ; Parturition ; Thorax ; Tracheoesophageal Fistula ; Ventilation

BACKGROUND: Breast reconstruction following mastectomy has become increasingly popular in recent years. The purpose of this study was to compare the efficacy of cervical epidural patient-controlled analgesia (CEA) and intravenous patient-controlled analgesia (IV-PCA) for controlling the postoperative pain and the side effects after mastectomy with immediate Latissimus dorsi (LD) flap breast reconstruction. METHODS: Sixty patients who were to undergo mastectomy with immediate LD flap breast reconstruction were randomly assigned to receive CEA [Group CEA, (n = 30), 0.15% ropivacaine + fentanyl 4 microg/ml] or IV-PCA [Group IV-PCA (n = 30) fentanyl 20 microg/kg + ketorolac 3 mg/kg] for postoperative pain control via a PCA pump (basal rate: 2 ml/h, bolus: 2 ml, lock out interval: 15 min) after their operation. Before general anesthesia, an epidural catheter was inserted at the cervical (C)7-thoracic (T)1 level in the patients of the CEA group. The resting visual analogue scale (VAS) for pain, the systolic blood pressure, the heart rate and the side effects were recorded for 48 hours after operation. RESULTS: The VAS at rest was significantly lower in the CEA group than that in the IV-PCA group at 16 hours after surgery. The CEA group required less additional analgesics as compared with the group IV- PCA. There were no significant differences in the systolic blood pressure, the heart rate and the incidence of side effects between the two groups. CONCLUSIONS: We conclude that cervical epidural analgesia, as compared with intravenous patient-controlled analgesia, provides effective pain control and it shows a similar incidence of side effects after mastectomy with immediate LD flap breast reconstruction.
Amides ; Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Analgesics ; Anesthesia, General ; Blood Pressure ; Breast ; Catheters ; Female ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Ketorolac ; Mammaplasty ; Mastectomy ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis

BACKGROUND: Neostigmine has been added to local anesthetic regimen for epidural or intrathecal block, and this resulted in prolonged and improved analgesia, but evidence of its benefit in intravenous regional anesthesia (IVRA) is controversial. The purpose of this study was to evaluate the effects of neostigmine added to ropivacaine for IVRA. METHODS: Forty patients undergoing hand or forearm surgery were randomly assigned to two groups to receive IVRA: Group I received 40 ml of 0.2% ropivacaine plus 1 ml of normal saline, and group II received 40 ml of 0.2% ropivacaine plus 500microgram (1 ml) of neostigmine. Sensory block onset time, postoperative visual analogue scale (VAS) scores, recovery time from motor block after deflation, mean arterial pressure (MAP), heart rate (HR), and pulse oximeter saturation (SpO2) values were measured. The incidence of side effects was recorded. RESULTS: Group II had a shorter sensory block onset time, a prolonged motor block recovery time, and lower postoperative VAS scores. No significant difference was found between the two the groups in terms of MAP, HR, SpO2 and side effects. CONCLUSIONS: The addition of neostigmine to ropivacaine in IVRA is believed to be a useful effective method for outpatient arm surgery due to a shortened sensory onset time and improved postoperative analgesia.
Analgesia ; Anesthesia, Conduction* ; Arm ; Arterial Pressure ; Forearm ; Hand ; Heart Rate ; Humans ; Incidence ; Neostigmine* ; Outpatients

Intracranial manifestations associated with autosomal dominant polycystic kidney disease (ADPKD) include arachnoid cysts, dolichoectasias, and subdural hematoma (SDH), although there are only a few reports of SDH in patients with ADPKD. We report a case of spontaneous SDH in a patient with ADPKD. A 33-year-old woman complained of severe nausea and vomiting for 10 days. She had suffered from a headache for several months. She was diagnosed with ADPKD and hypertension 6 years earlier, and the hypertension was well controlled. Her mental state was drowsy in the emergency room. Her blood pressure was 180/105 mmHg. There was no evidence of head trauma. Results of a peripheral blood CBC and blood chemistry analysis were within normal limits, as were the results of a blood coagulation test and urinalysis. She was pregnant and in the eighth week of gestation. Brain magnetic resonance imaging revealed SDH in the left lateral convexity and focally in the right lateral convexity, and brain herniation. Surgical drainage was performed through a burr hole, under general anesthesia. Intra-operatively, 62 mL of liquefied subdural hematoma were removed. She recovered completely without sequelae.
Adult ; Anesthesia, General ; Arachnoid Cysts ; Blood Coagulation Tests ; Blood Pressure ; Brain ; Craniocerebral Trauma ; Drainage ; Emergencies ; Female ; Headache ; Hematoma, Subdural ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Nausea ; Polycystic Kidney, Autosomal Dominant ; Pregnancy ; Urinalysis ; Vomiting

PURPOSE: Peripheral arterial disease (PAD) is a predictable marker of coronary heart disease and cerebrovascular disease and its prevalence among chronic kidney disease (CKD) patients especially in end-stage renal disease (ESRD) patients undergoing dialysis is apparently increasing. Ankle-brachial index (ABI) is regarded as an easy, reliable, and noninvasive measure of the presence and severity of lower-extremity PAD (ABI<0.9). The aims of this study are to find out the prevalence of lower limb PAD measured by ABI, and to assess the risk factors of PAD in patients with ESRD. METHODS: One hundred thirty eight ESRD patients from May 2005 to September 2009 who were performed ABI examination were categorized into PAD (ABI<0.9) or non-PAD (ABI> or =0.9) and the prevalence of PAD was analyzed. We measured ABI with VP2000 PWV/ankle-brachial index. We also reviewed the clinical characteristics and evaluated the risk factors of PAD, retrospectively. RESULTS: One hundred seventeen patients on hemodialysis, and twenty one patients on peritoneal dialysis were included in this study. The mean age of total patients was 60.1 (24-84) years old. Thirty five patients out of one hundred thirty eight patients had an ABI index of less than 0.9 (PAD indicative). PAD was independently associated with age (p=0.013), duration of dialysis (p=0.013), history of coronary artery disease and cerebrovascular disease (p=0.001, p=0.001 respectively), diabetes (p=0.034), and increased LDL cholesterol (p=0.004) in univariate analysis. In multivariate logistic regression analysis, duration of dialysis, increased level of LDL-cholesterol and history of coronary artery disease were significantly related with PAD (p=0.008, p=0.019, p=0.018 respectively). CONCLUSION: Duration of dialysis, increased level of LDL-cholesterol and coronary artery disease were independent risk factors for PAD in patients with ESRD on dialysis.
Ankle Brachial Index ; Cholesterol, LDL ; Coronary Artery Disease ; Coronary Disease ; Dialysis ; Humans ; Kidney Failure, Chronic ; Logistic Models ; Lower Extremity ; Peripheral Arterial Disease ; Peritoneal Dialysis ; Prevalence ; Renal Dialysis ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors