BACKGROUND: Many reports on the change of pseudocholinesterase activity in pregnant women showed that it declines during pregnancy and in the immediate postpartum period. In Korea, there are two papers that show dissident results. However, they didn't prove that the subjects in their studies had genotypically normal enzyme. So, we compared the pseudocholinesterase activities between nonpregnant and term-pregnant women who have the genotypically normal enzyme. METHODS: We measured the dibucaine, fluoride, chloride number as well as the pseudocholinesterase astivity using butyrylthiocholine as substrate by automatic analyser, urea and scoline numbers using benzoylcholine as substrate by manual technique in nonpregnant(n=15) and term-pregnant(n=15) women aging 20 to 40 years old before induction of anesthesia. RESULTS: The dibucaine, fluoride, chloride, urea and scoline numbers(mean+/-SD,%) in female subjects were 86+/-1.2, 50+/-5.2, 5+/-2.4, 47+/-2.8 and 92+/-2.0, respectively. There were two subjects showing low pseudocholinesterase activity(<4.8 U/ml) and the one(3.9 U/ml) was in nonpregnant group, the other(4.5 U/ml) in term-pregnant group. We found that they had genotypically normal enzymes because their inhibition numbers were within normal ranges. Pseudocholinesterase activity(mean+/-SD) in term-pregnant group(7.04+/-1.30) was significantly decreased compared with that in nonpregnant group(9.15+/-2.01)(P<0.01). CONCLUSIONS: We conclude that in subjects with the genotypically normal enzyme, term-pregnant women had significantly lower pseudocholinesterase activity than nonpregnant ones did.
Adult ; Aging ; Anesthesia ; Benzoylcholine ; Butyrylthiocholine ; Dibucaine ; Female ; Fluorides ; Humans ; Korea ; Postpartum Period ; Pregnancy ; Pregnant Women ; Pseudocholinesterase* ; Reference Values ; Urea

Supravalvular aortic stenosis may be defined as an obstructive congenital deformity of the ascending aorta whitch originates just distal to the level of the origins of the coronary arteries, and whitch includes a wide spectrum of pathologic changes. A 27 years-old-female was admitted because of further evaluation of known some heart disease. Clinical diagnosis of supravalvular aortic stenosis was made by echocardiography and angiography. We presented a case of supravalvular aortic stenosis with a review of literature.
Angiography ; Aorta ; Aortic Stenosis, Supravalvular* ; Congenital Abnormalities ; Coronary Vessels ; Diagnosis ; Echocardiography ; Heart Diseases

Typically, patients afflicted with syndrome X complained of stress induced angina pectoris, and their electrocardiograms show corresponding ST-segment depressions during exercise. However, angiography is unable to demonstrate significant coronary artery luminal narrowing and significant coronary artery spasm to provocation test. And left ventricular performance at rest remains remarkably unimpaired. Syndrome X is characterized by reduction of coronary vascular reserve but without depression of left ventricular performance or negative effect on survival. The reduction of coronary vascular response is supposed to be resulted from reduced coronary vasodilator reponse due to abnormal contraction of coronary prearteriolar vessels. This case is a 43-year-old female who has had exertional chest pain since 5 months ago. The chest pain was relieved by rest and subligual nitroglycerin administration. The exercise electrocardiography showed significant ST segment depressions on lead II, III aVF and V4-V6 at stage 1, when she experienced chest pain. On 24 hour ambulatory electrocardiogram, significant ST segment depression was recorded at the time when the patient had chest pain. But coronary arteriography demonstrated normal coronary artery and no significant coronary artery spasm to provocation test with ergonovine maleate. On exercise thallium-201 scintigraphy, perfusion decrease was suspected on anterolateral wall of left ventricle. The patient was diagnosed as a syndrome X and was managed with isosorbide and nifedipine and her exercise tolerance increased significantly on follow up exercise test performed 1 month later. But she has complained of a few of attack of chest pain until now.
Adult ; Angina Pectoris ; Angiography ; Chest Pain ; Coronary Vessels ; Depression ; Electrocardiography ; Ergonovine ; Exercise Test ; Exercise Tolerance ; Female ; Follow-Up Studies ; Heart Ventricles ; Humans ; Isosorbide ; Nifedipine ; Nitroglycerin ; Perfusion Imaging ; Phenobarbital ; Spasm

The provocation test of variant angina are known as ergonovine test, hyperventilation, acetylcholine, exercise and cold pressor test, but beta-blocker provocation test has not been reported as a case. So, this paper reports on the diagnosis of variant angina by beta-blocker provocation test and the case of subendocardial infarcion induced by this test. This study reports with literature and investigation about the following case : A 45-year-old man with a history of recurrent episode of typical angina on the early morning for the past 20 days. He was administrated beta-blocker given by oral route, and on the next morning there was chest pain as same degree as before, Holter EKG displayed ST segment elevation and ventricular tachycardia. It was confirmed focal spasm on coronary angiography, ST segment elevation on EKG, and newly developed hypokinesia on left ventriculogram and followed-up echocardiagraphy. When the chest pain is absent, EGK was normal. And we confirmed that elevation of cardiac enzyme was absent as a result of serial follow up study.
Acetylcholine ; Chest Pain ; Coronary Angiography ; Diagnosis ; Electrocardiography ; Ergonovine ; Follow-Up Studies ; Humans ; Hyperventilation ; Hypokinesia ; Infarction* ; Middle Aged ; Spasm ; Tachycardia, Ventricular

BACKGROUND: In hypovolemic shock, multiple organ failure is caused by translocation of endotoxins and microorganisms from the ischemic gut mucosa. Therefore, much attention has been paid to the gut mucosa oxygenation in shock resuscitation. The current guidelines on cardiopulmonary resuscitation restrain the use of sodium bicarbonate due to paradoxical intracellular acidosis. Because THAM, CO2-consuming agent, does not produce CO2 and induce intracellular acidosis, THAM has been known as a effective buffering agent. This study was purposed to investigate the effect of THAM and sodium bicarbonate on the gut mucosa oxygenation in cats which were in hemorrhagic shock and resuscitation. METHODS: 18 anesthetized cats were subjected to hemorrhage to decrease the mean arterial blood pressure to 35-45 mmHg and this blood pressure was maintained for 120 minutes. After 90minutes, we infused 1.945% hypertonic saline, 2.8% sodium bicarbonate and 0.3M THAM as same volume and osmolality. Mean arterial pressure(MAP), mesenteric arterial-venous pH differences[pH(a-v)], mesenteric venous oxygen tension(PvO2), mesenteric arterial-venous carbon dioxide tension differences[P(v-a)CO2], mesenteric arterial-venous lactate differences[Lactate(v-a)] were measured 1, 5, 15, 30 minutes after drug infusion and 30, 60 minutes after reperfusion. RESULTS: There were no statistical significances in MAP, pH(a-v), PvO2, Lactate(v-a) among the three groups. There were significant differences in P(v-a)CO2 and ETCO2 between sodium bicarbonate group and THAM group. CONCLUSIONS: This study suggest that THAM and sodium bicarbonate do not have significant effects on the tissue oxygenation and hemodynamic improvement in hypovolemic shock. We suppose that THAM does not produce carbon dioxide but may correct intracellular acidosis.
Acidosis ; Animals ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Cardiopulmonary Resuscitation ; Cats* ; Endotoxins ; Hemodynamics ; Hemorrhage ; Hydrogen-Ion Concentration ; Lactic Acid ; Mucous Membrane* ; Multiple Organ Failure ; Osmolar Concentration ; Oxygen* ; Reperfusion ; Resuscitation ; Shock ; Shock, Hemorrhagic* ; Sodium Bicarbonate* ; Sodium* ; Tromethamine*

PURPOSE: To analyze the radiographic and HRCT findings of Pneumocystic carinii pneumonia. MATERIALS AND METHODS: We reviewed the medical records and retrospectively analysed the chest radiographs(n=31) and HRCT scans(n=17) of 31 patients with Pneumocystis carinii pneumonia who had been followed up at our institute between, 1993 and March 1998. Pneumocystis carinii pneumonia was confirmed by cytologic evaluation of sputum stained with methenamine silver(n=25) or on the basis of clinical history(n=6). The study group included 17 men and 14 women aged 28 -78(average, 53.6) years. Twenty-eight patients had underlying conditions such as hematologic diseases(n=13), AIDS(n=8), malignancy(n=2), DM(n=2) and malnutrition(n=1), and three were free from underlying diseases. RESULTS: Twenty patients had pure Pneumocystis carinii pneumonia and 11 had combined lung diseases, namely pulmonary tuberculosis(n=4), pulmonary metastasis(n=2), bacterial pneumonia(n=2), atypical mycobacterial infection(n=1), pulmonary edema(n=1), and Kaposi's sarcoma(n=1). Chest radiographic findings of 20 cases of pure Pneumocystis carinii pneumonia included consolidation(n=12), l inear-reticular opacity(n=8), ill defined haziness(n=7), and nodules(n=6), with bilaterality in is cases and zonal predominance in ten [central(n=5), lower(n=5)]. Ancillary findings included pleural effusion(n=10), cysts(n=5), lymphadenopathy(n=4) and pneumothorax(n=1). In two patients, findings were entirely normal. HRCT findings in ten cases of pure Pneumocystis carinii pneumonia included ground-glass opacity(n=6), consolidation(n=6), linear-reticular opacity(n=8), and nodules(n=5), with bilaterallity in seven cases and zonal predominance in five [central(n=5), lower(n=2)]. Ancillary findings among these cases included pleural effusion(n=4), lym-phadenopathy(n=2), cysts(n=1), and pneumothorax(n=1). HRCT findings in seven cases of Pneumocystis carinii pneumonia combined with other lung diseases included nodules(n=6), ground-glass opacity(n=5), linear-reticular opacity(n=4), and consolidation(n=3). CONCLUSION: Although ground-glass opacity in both pure Pneumocystis carinii pneumonia and this same condition combined with other lung diseases is a common radiologic finding, the possibility of variable radiologic findings in cases of Pneumocystis carinii pneumonia and other lung diseases with which it frequently combines is essential for approximate diagnosis of Pneumocystis carinii pneumonia.
Diagnosis ; Female ; Fluconazole ; Humans ; Lung Diseases ; Male ; Medical Records ; Methenamine ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis* ; Radiography, Thoracic ; Retrospective Studies ; Sputum ; Thorax

The high prevalence of migraine. Raynaud's phenomenon, visual field defect and Crohn's disease in variant angina raises the possibility that a common underlying defect of mechanism may partially account for all conditions. These are generalized vascular smooth muscle hypercontractility syndromes. Recently high prevalence of esophageal motility disorders has been noted in patients with coronary artery spasm or microvascular angina, leading to the hypothesis of a generalized abnormality in smooth muscle function1,4,5). We expirienced a case of 55-year-old man with angiographically proven variant angina. Who showed reflux esophagitis, classic migraine and Raynaud's disease.
Coronary Vessels ; Crohn Disease ; Esophageal Motility Disorders ; Esophagitis, Peptic* ; Humans ; Microvascular Angina ; Middle Aged ; Migraine Disorders ; Migraine with Aura* ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Prevalence ; Raynaud Disease* ; Spasm ; Visual Fields

Preoperative uterine artery embolization and cervical evacuation as conservative management of cervical pregnancy has been tried in recent years. However, cervical suturing, vasoconstrictor injection, or cervical ballooning was frequently used as an ancillary measures in those procedures in most of the previous studies. We report two cases of cervical pregnancy that were successfully treated with preoperative uterine artery embolization and removal of gestational material without ancillary procedures. Our therapeutic modality seems to be safe and effective for conservative management of cervical pregnancy.
Adult ; Case Report ; Cervix Uteri ; Dilatation and Curettage ; *Embolization, Therapeutic ; Female ; Human ; Pregnancy ; Pregnancy, Ectopic/*therapy/ultrasonography ; Preoperative Care ; Uterine Hemorrhage/prevention & control ; Uterus/*blood supply

BACKGROUND: When performing spinal anesthesia, glucose is frequently added to control the extent of the anesthesia by increasing the specific gravity of the local anesthetic solution. It is not clearly known whether the added glucose directly affects the nerve blockade or not. The purpose of this study is to examine the effect of glucose solution on isolated nerve fibers in vitro. METHODS: Compound action potentials (CAPs) of A-fiber range were recorded from isolated nerves of adult Sprague-Dawley rats (300 400 gm). Tonic (0.5 Hz) and phasic (30 Hz) supramaximal stimuli were repeatedly applied to one end of the nerves and the recordings were made on the other end. Nerves were perfused with modified Krebs solution for 45 minutes initially to get baseline data and then perfused with test solutions containing different concentrations of glucose (2.5%, 5%, 7.5%) for 30 minutes. The same experiments were repeated with mannitol at the same osmolality as the glucose. RESULTS: Glucose produced a decrease in the amplitude of CAPs in a dose-dependent manner (79.2 +/- 3.4, 50.3 +/- 3.7, 34.6 +/- 4.0 for 2.5%, 5%, 7.5% glucose solutions, respectively). At each of the same concentration levels, the degree of nerve conduction blockade did not have any significant difference within the glucose groups and mannitol groups. CONCLUSIONS: Glucose, in clinically employed concentration range, directly depressed peripheral nerve conduction in vitro, probably via osmotic effect.
Action Potentials* ; Adult ; Anesthesia ; Anesthesia, Spinal ; Animals ; Glucose* ; Humans ; Mannitol ; Nerve Block ; Nerve Fibers ; Neural Conduction ; Osmolar Concentration ; Peripheral Nerves ; Rats* ; Rats, Sprague-Dawley ; Sciatic Nerve* ; Specific Gravity

Methemoglobinemia is an uncommon but potentially fatal disorder. Most cases have no adverse clinical consequence and require no treatment, but methemoglobinemia is often overlooked as a cause of low oxygen saturation, and often mistaken for the more common causes of hypoxia by anesthesiologists despite simple bedside tests that indicate the presence of this treatable abnormality. We present a 68-year-old female patient who underwent gastrectomy for advanced gastric cancer with bleeding. In the preoperative period, the patient showed cyanosis and oxygen saturation was 85% by pulse oximeter, but oxygen saturation by arterial blood gas analysis was 100%. After tracheal intubation, the methemoglobin level was 18.3%. Ascorbic acid and methylene blue were administered. During preanesthetic evaluation, the patient had not informed the anesthesiologist that she had been taking dapsone.
Aged ; Anesthesia, General ; Anoxia ; Ascorbic Acid ; Blood Gas Analysis ; Cyanosis ; Dapsone ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Intubation ; Methemoglobin ; Methemoglobinemia ; Methylene Blue ; Oximetry ; Oxygen ; Preoperative Period ; Stomach Neoplasms