No abstract available.
Female ; Lactation*

No abstract available.
Carcinoma, Small Cell* ; Female ; Ovary*

BACKGROUND: This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33degrees C target temperature management. METHODS: A retrospective study was conducted on patients who underwent 33degrees C target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia. RESULTS: A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 +/- 0.15 microg/kg/h. Decisions of charged doctor's were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole. CONCLUSIONS: Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33degrees C target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33degrees C targeted temperature management.
Atropine ; Body Weight ; Bradycardia* ; Carbon Monoxide Poisoning ; Dexmedetomidine* ; Diagnosis ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Hypothermia, Induced ; Logistic Models ; Odds Ratio ; Retrospective Studies

No abstract available.
Humans ; Perfusion* ; Prenatal Diagnosis*

In spite of the appropriate antibiotic treatment and the development of newer antibiotics, bacterial meningitis still has a high risk of complications. Especially, vascular involvements of meningitis, including vasospasms and infarctions, frequently result in neurologic sequelae. Here, we report a case of bacterial meningitis complicated by arterial vasospasms and multiple infarctions during a clinically improving course. This case suggests that in the management of bacterial meningitis, early evaluation and monitoring of vasculitis by TCD and its management could prevent fatal outcomes.
Anti-Bacterial Agents ; Cerebral Infarction* ; Fatal Outcome ; Infarction ; Meningitis ; Meningitis, Bacterial* ; Vasculitis

BACKGROUND: There is a clinical need for a simpler measurement of global cardiac function incorporating elements of both systole and diastole. Doppler time index is theoretically regarded as a sensitive index of global left ventricular perfomance and defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET). This study was designed to determine the clinical usefulness of the Doppler time index in patients with left ventricular diastolic dysfunction as well as systolic dysfunction. METHODS: The study population consisted of 23 patients with hypertension as a diastolic dysfunction group, 16 patients with low ejection fraction as a systolic dysfunction group and 31 subjects with normal LV function. The ejection fraction (EF) was measured using M-mode echocardiography. Doppler profiles such as IVCT, IVRT and ET were obtained from Doppler echocardiography. The Doppler time index [ (IVCT+RT)/ET] was calculated from each Doppler velocity profiles. RESULTS: IVRT, IVRT/ET and (IVCT+VRT)/ET were significantly increased in the diastolic dysfunction group (120.5+/-19.5 msec, 0.45+/-0.1, 0.64+/-0.2, respectively:p<0.001, p<0.001, p<0.001, respectively) compared with normal subjects (66.1+/-17.4 msec, 0.25+/-0.0, 0.41+/-0.1). IVCT and IVRT were significantly increased and ET was significantly shortened in systolic dysfunction group (75.4+/-25.7, 144.0+/-39.5 msec, 242.7+/-46.5 msec respectively:p<0.001, p<0.05, p<0.05, respectively) compared with diastolic dysfunction group (50.4+/-23.0 msec, 120.5+/-19.5 msec, 276.8+/-44.6 msec, respectively). IVCT/ET, IVRT/ET and (IVCT+IVRT)/ET also were increased in patients with systolic dysfunction group (0.32+/-0.1, 0.61+/-0.2, 0.93+/-0.2 respectively:p<0.01, p<0.01, p<0.001, res-pectively) compared with diastolic dysfunction group (0.19+/-0.1, 0.45+/-0.1, 0.64+/-0.2). Ejection fraction calculated by M-mode parameters was significantly correlated with (IVCT+IVRT)/ET (correlation coefficient - 0.605, p<0.001). CONCLUSION: The Doppler time index was significantly difficient from normal subjects in patients with isolated LV diastolic dysfunction as well as in those with systolic dysfunction. Thus, this index can be used as a sensitive indicator of myocardial performance.
Diastole ; Echocardiography ; Echocardiography, Doppler ; Humans ; Hypertension ; Relaxation ; Systole ; Ventricular Dysfunction, Left

There have been very few reports on reflex seizures induced by writing. Complex precipitating behaviors such as calculation, writing, copying of complicated figure, and spatial construction have been recognized as triggering factor of epileptic seizures. We report a case of a patient with a very unusual form of complex reflex epilepsy in which seizures are usually induced by writing or spatial construction. Neurological examination was normal and brain magnetic resonance imaging showed mild brain atrophy without focal lesion. During long-term video-EEG monitoring, she was instructed to write a letter with the right hand. About 20 minutes after writing, she experienced similar aura and motion arrest and then showed an elevation of bilateral upper extremities like myoclonic jerk followed by generalized tonic clonic seizure. On ictal EEG, spike and wave complexes appeared from both centroparietal region followed by 10 Hz rhythmic activities for 20 seconds. Interictal EEG was normal. Ictal-interictal subtraction image of brain SPECT (99mTc-HMPAO) showed hyperperfusion in the middle frontal gyrus and precentral gyrus of left frontal lobe and superior and inferior frontal gyrus of right frontal lobe. We suggest that this reflex epilepsy might be originated from both central areas with maximum on the left side. Oxcarbazepine was effective in controlling this reflex epileptic seizure.
Atrophy ; Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Reflex* ; Frontal Lobe ; Hand* ; Humans ; Magnetic Resonance Imaging ; Myoclonus ; Neurologic Examination ; Reflex* ; Seizures ; Tomography, Emission-Computed, Single-Photon ; Upper Extremity ; Writing

Osteosarcoma commonly develops around the knee joint, and rarely in the hand. Patients with osteosarcoma of the hand often present with pain and swelling, and osteosarcoma of the hand has a biological behavior that differs from that of osteosarcoma at conventional sites. However, although it usually occurs in the older age group, compared with conventional osteosarcoma, the most common sites of hand osteosarcoma correlate with the most active growth and longest growing bones in the hand like conventional osteosarcoma, particularly in the metacarpophalangeal joints in the second and third digits. However, development of osteosarcoma in the metacarpal bone of the hand in an elderly patient has not yet been reported in the country. Thus, we report on two cases of osteosarcoma in the metacarpal bone of the hand in elderly patients, treated by ray amputation of the digit and preoperative and postoperative chemotherapy.
Aged ; Amputation ; Drug Therapy ; Hand ; Humans ; Knee Joint ; Metacarpal Bones ; Metacarpophalangeal Joint ; Osteosarcoma*

BACKGROUND AND OBJECTIVES: Vestibular evoked myogenic potential (VEMP) is a relatively new diagnostic tool that is in the process of being investigated in patients with specific vestibular disorders. In this study, we examed the responses of VEMP in patients who complained of dizzines. MATERIALS AND METHOD: Eighty-six patients with complaint of dizziness and ten normal volunteers are included in this study. Among these patients, forty-six patients were diagnosed as unilateral vestibulopathy (A), five patients were bilateral vestibulopathy (B), nine patients were sudden sensorineural hearing loss with vertigo (C), fifteen patients were benign paroxysmal positional vertigo (D) and eleven patients were Meniere's disease (E). We compared VEMP parameters in each group. RESULTS: In each group, abnormal response in VEMP was 33%(A), 0%(B), 11%(C), 12%(D) and 36%(E) respectively. and there was no absent VEMP formation, and there was no abscent VEMP formation. CONCLUSION: VEMP is a promising method for diagnosing and following patients with many vestibular disorders.
Dizziness ; Healthy Volunteers ; Hearing Loss, Sensorineural ; Humans ; Meniere Disease ; Vertigo

OBJECTIVE: To determine the effect of lowering the cutoff values of 3-hour oral glucose tolerance test (OGTT) for gestational diabetes mellitus (GDM). METHODS: Patients with an abnormal 50 gm glucose challenge test (GCT) of more than 130 mg/dL at 24-28 weeks of gestation underwent a 3-hour OGTT at 28-32 weeks of gestation. Patients were divided into four groups according to the criteria recommended by Carpenter-Coustan or National Diabetes Data Group (NDDG) (Control: 50 gm GCT negative [n=268], Borderline: 2 or more abnormal values met or exceeded Carpenter-Coustan criteria but not the NDDG criteria [n=100], NDDG I: 2 or more abnormal values met or exceeded NDDG criteria, [treated, n=70], NDDG II: [not treated, n=42]). Obstetric and perinatal outcomes were analyzed retrospectively. RESULTS: Of 5,827 pregnant women screened for GDM, 112 (1.9%) met the NDDG criteria, whereas 212 (3.6%) met the Carpenter-Coustan criteria. The incidences of poor maternal outcomes were 20.1%, 28.0%, 47.1%, 21.4%, and the incidences of poor neonatal outcomes were 3.7%, 6.0%, 14.3%, 16.7% in the four groups (p<0.05). Multivariable logistic regression analysis showed that 1) NDDG I showed an independent risk factor for poor maternal outcome (OR, 3.37), but the borderline group did not, 2) NDDG I showed an independent risk factor for poor neonatal outcome (OR, 3.87), but the borderline group did not, 3) the borderline group showed an independent risk factor for preterm delivery (OR, 2.67). CONCLUSION: Lowering the cutoff values would increase the number of pregnant women with GDM, while only minimally affecting the perinatal outcomes. Further large-scale prospective studies for Korean pregnant women may be needed.
Diabetes, Gestational* ; Female ; Glucose ; Glucose Tolerance Test ; Humans ; Incidence ; Logistic Models ; Pregnancy ; Pregnant Women ; Retrospective Studies ; Risk Factors