Craniodiaphyseal dysplasia is a rare hereditary bone dysplasia, transmitted as autosomal recessive trait. This disorder is defined by Gorlin in 1969 as one of a family of severe bone disorders called "Craniotubular bone dysplasia", which is charaterized by massive and generalized hyperostosis and sclerosis, especially involving the skull facial bones. The major clinical features include marked craniofacial changes associated with bony overgrowth such as an enlarged head circumference, cranial nerve palsies and severe facial distortion. We experienced a case of craniodiaphyseal dysplasia in 2 year-9 month-old female patient who presented with typical clinical manifestation and radiologic findings nearly identical to those described by Gorlin. This is the first description of this rare disease in the Korean literature. Thus, we report a case of craniodiaphyseal dysplasia with brief related literature.
Bone Diseases, Developmental ; Cranial Nerve Diseases ; Facial Bones ; Female ; Head ; Humans ; Hyperostosis ; Rare Diseases ; Sclerosis ; Skull

Craniodiaphyseal dysplasia is a rare hereditary bone dysplasia, transmitted as autosomal recessive trait. This disorder is defined by Gorlin in 1969 as one of a family of severe bone disorders called "Craniotubular bone dysplasia", which is charaterized by massive and generalized hyperostosis and sclerosis, especially involving the skull facial bones. The major clinical features include marked craniofacial changes associated with bony overgrowth such as an enlarged head circumference, cranial nerve palsies and severe facial distortion. We experienced a case of craniodiaphyseal dysplasia in 2 year-9 month-old female patient who presented with typical clinical manifestation and radiologic findings nearly identical to those described by Gorlin. This is the first description of this rare disease in the Korean literature. Thus, we report a case of craniodiaphyseal dysplasia with brief related literature.
Bone Diseases, Developmental ; Cranial Nerve Diseases ; Facial Bones ; Female ; Head ; Humans ; Hyperostosis ; Rare Diseases ; Sclerosis ; Skull

The time course of recovery in vestibular neuritis varies between individuals. The aim of this study was to identify the predictors for the early or late recovery of vestibular neuritis. The inclusion criteria were patients 1) who had an acute onset of vertigo lasting at least 24 hours, 2) with a horizontal-torsional unidirectional spontaneous nystagmus, and 3) with a canal paresis of 20% or more on the bithermal caloric tests. The primary endpoint for this study was an early or late recovery of vestibular neuritis as a dependent variable. A functional level scale was used to define the late recovery (5 or more points) at seven days after the symptom onset. The secondary endpoint was the duration of hospitalization. One hundred twenty eight patients met the inclusion criteria for this study, and among them, 71 patients had an early recovery. Multiple logistic regression analysis showed that diabetes mellitus was the only independent significant variable for the prediction of a late recovery of vestibular neuritis. In addition, the diabetes mellitus was a predicting variable for long duration of hospitalization. Diabetes mellitus was a predictor for a late recovery of vestibular neuritis.

BACKGROUND: Intravenous injection of rocuronium produces intense discomfort at the site of injection in conscious patients. The aim of this study was to compare the effects of intravenous ondansetron, lidocaine, and tramadol for minimizing pain caused by the injection of rocuronium. METHODS: One hundred twenty patients were randomly assigned four groups. Before general anesthesia was induced with thiopental sodium (5 mg/kg), manual occlusion (70 mmHg) with tourniquet of venous inflow was performed. The patients were given saline 4 ml (Group 1, n = 30), ondansetron 8 mg (Group 2, n = 30), lidocaine 60 mg (Group 3, n = 30), or tramadol 50 mg (Group 4, n = 30) diluted into a 4 ml solution. The occlusion was released after 20 seconds and rocuronium was injected over 10 15 seconds. The patients were asked immediately if they had pain in the arm, and the response was assessed. The pain response to rocuronium injection was graded with using Memis' 4-point scale. The side effects were recorded for 24 hours after administration of rocuronium. RESULTS: There were no difference among groups in respect of age, weight, and gender (P < 0.05). Lidocaine reduced the incidence of rocuronium injection pain but ondansetron and tramadol did not (P < 0.05). Ondansetron, lidocaine, and tramadol reduced the severity of rocuronium injection pain (P < 0.05). CONCLUSIONS: I conclude that lidocaine is the most effective among these drugs in the prevention of rocuronium injection pain.
Anesthesia, General ; Arm ; Humans ; Incidence ; Injections, Intravenous ; Lidocaine* ; Ondansetron* ; Thiopental ; Tourniquets ; Tramadol*

BACKGROUND: Mannitol is widely used in neurosurgical patients and may induce an increase in serum potassium concentration according to doses and administration rates with unknown mechanism. The treatment of hyperkalemia is aimed at eliminating the causes and includes calcium, sodium bicarbonate, glucose with insulin, loop diuretics and hyperventilation. This study was undertaken to observe the effects of hyperventilation on the serum potassium concentration following infusion of mannitol (2.0 gm/kg). METHODS: We studied 30 patients who were operated brain aneurysm clipping surgery and were divided into 3 groups (n=10). In control group, mild hypocapnia was maintained (PaCO2, 32 2 mmHg) before and after mannitol infusion. In group I, moderate hypocapnia was maintained (PaCO2, 27 2 mmHg) before and after mannitol infusion. In group II, mild hypocapnia (PaCO2, 32 2 mmHg) was maintained before 30 minutes of mannitol infusion and moderate hypocapnia (PaCO2, 27 2 mHg) after mannitol infusion. We started infusion of 20% mannitol with a dosage of 2.0 gm/kg, 15~20 min after cranium was opened. RESULTS: The changes of serum potassium were as follows (Mean SD mEq/l) (just before and 15min, 30min, 60min after mannitol infusion): 3.79 0.48, 4.66 0.60, 4.44 0.48, 4.13 0.40 (Control group), 3.62 0.18, 3.63 0.42, 4.14 0.51, 3.95 0.33 (Group I), 3.76 0.20, 3.91 0.15, 4.11 0.30, 4.04 0.23 (Group II). After 15 minutes of mannitol infusion, the serum potassium levels of group I and II were lower than that of control group (p<0.05) and there was no significant difference between group I and II. CONCLUSIONS: These results suggest that hyperventilation may blunt the increase in serum potassium concentration following rapid infusion of high dose mannitol.
Calcium ; Glucose ; Humans ; Hyperkalemia ; Hyperventilation* ; Hypocapnia ; Insulin ; Intracranial Aneurysm ; Mannitol* ; Potassium* ; Skull ; Sodium Bicarbonate ; Sodium Potassium Chloride Symporter Inhibitors

Multiple myeloma is malignant proliferation of plasma cells whose pathologic condition is produced by bone marrow invasion as well as excessive production of immunoglobulin. Its invasion into bone marrow causes severe pancytopenia. Therefore these patients are susceptible to thrombocytopenia and have bleeding tendency, especially during surgery. We experienced an anesthetic management of meningioma operation in a patient with multiple myeloma who showed severe thrombocytopenia and excessive abonormal immunoglobulin.
Anesthesia, General ; Bone Marrow ; Hemorrhage ; Humans ; Immunoglobulins ; Meningioma ; Multiple Myeloma* ; Pancytopenia ; Plasma Cells ; Thrombelastography* ; Thrombocytopenia*

Multiple myeloma is malignant proliferation of plasma cells whose pathologic condition is produced by bone marrow invasion as well as excessive production of immunoglobulin. Its invasion into bone marrow causes severe pancytopenia. Therefore these patients are susceptible to thrombocytopenia and have bleeding tendency, especially during surgery. We experienced an anesthetic management of meningioma operation in a patient with multiple myeloma who showed severe thrombocytopenia and excessive abonormal immunoglobulin.
Anesthesia, General ; Bone Marrow ; Hemorrhage ; Humans ; Immunoglobulins ; Meningioma ; Multiple Myeloma* ; Pancytopenia ; Plasma Cells ; Thrombelastography* ; Thrombocytopenia*

Purpose: To determine whether travoprost 0.003% has a similar intraocular pressure (IOP) reduction effect to that of travoprost 0.004% while reducing side effects. Methods: This was a prospective study from January 2018 to December 2018 that included 102 patients diagnosed with open angle glaucoma who switched from travoprost 0.004% to travoprost 0.003%. We investigated the changes in IOP, conjunctival hyperemia, corneal erosion, and eyelid pigmentation before and at 3 months after switching to travoprost 0.003%. Additionally, a questionnaire survey of these patients was conducted to determine possible side effects, including hyperemia, stinging, pruritus, irritation, blurred vision, dryness, and foreign body sensation. Results: IOP readings before and after switching to travoprost 0.003% were 12.95 ± 4.25 and 12.94 ± 3.89 mmHg, respectively, showing no significant change (p = 0.974). No changes were observed in corneal erosion or eyelid pigmentation; however, conjunctival hyperemia was reduced significantly from 1.60 ± 0.88 to 1.36 ± 0.84 (p = 0.001). No significant changes in hyperemia, stinging, pruritus, irritation, or foreign body sensation were reported; however, a significant improvement was noted for blurred vision and dryness (p = 0.008, p = 0.007, respectively). Conclusions We were able to show the effectiveness and safety of travoprost 0.003% as being as effective as travoprost 0.004% in reducing IOP and injections while improving blurred vision and dryness.

Purpose: To determine whether travoprost 0.003% has a similar intraocular pressure (IOP) reduction effect to that of travoprost 0.004% while reducing side effects. Methods: This was a prospective study from January 2018 to December 2018 that included 102 patients diagnosed with open angle glaucoma who switched from travoprost 0.004% to travoprost 0.003%. We investigated the changes in IOP, conjunctival hyperemia, corneal erosion, and eyelid pigmentation before and at 3 months after switching to travoprost 0.003%. Additionally, a questionnaire survey of these patients was conducted to determine possible side effects, including hyperemia, stinging, pruritus, irritation, blurred vision, dryness, and foreign body sensation. Results: IOP readings before and after switching to travoprost 0.003% were 12.95 ± 4.25 and 12.94 ± 3.89 mmHg, respectively, showing no significant change (p = 0.974). No changes were observed in corneal erosion or eyelid pigmentation; however, conjunctival hyperemia was reduced significantly from 1.60 ± 0.88 to 1.36 ± 0.84 (p = 0.001). No significant changes in hyperemia, stinging, pruritus, irritation, or foreign body sensation were reported; however, a significant improvement was noted for blurred vision and dryness (p = 0.008, p = 0.007, respectively). Conclusions We were able to show the effectiveness and safety of travoprost 0.003% as being as effective as travoprost 0.004% in reducing IOP and injections while improving blurred vision and dryness.

BACKGROUND: Propofol is increasingly being used as an anesthetic since the introduction of the TCI (target controlled infusion) technique, but previous reports have demonstrated that hypotension and injection pain occur especially during fast infusion of propofol. We therefore studied the effect of ketamine preadministration on induction and recovery when using propofol TCI. METHODS: Thirty-four patients undergoing elective surgery within 2 hours were randomly assigned to one of two groups according to induction methods; Group P (propofol TCI, 6 microgram/ml, flash mode), Group KP (ketamine 0.25 mg/kg followed by propofol TCI, 4.5 microgram/ml, flash mode). Anesthesia was maintained with fentanyl, N2O, and propofol TCI. Outcome measures were induction time, injection pain, hemodynamic responses during induction period, propofol doses, emergence time and postoperative side effects. RESULTS: Incidence of injection pain and induction dose of propofol were significantly reduced in Group KP but there was no significant difference in induction time, emergence time or postoperative side effects between two groups. Heart rates showed no differences between the two groups, but the changes of mean arterial pressures from base line at 30 sec after intubation were significantly greater in Group P compared to Group KP. CONCLUSIONS: During fast induction with the flash mode of propofol TCI, small amounts of ketamine preadministration could significantly reduce the target concentration for hypnosis, injection pain and hemodynamic changes without a delay of emergence and an increase of postoperative side effects.
Anesthesia ; Arterial Pressure ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Hypnosis ; Hypotension ; Incidence ; Intubation ; Ketamine* ; Outcome Assessment (Health Care) ; Propofol*