Acute obstruction of the upper airway in children demands prompt diagnosis and treatment. The management is complex and therefore demands serious, detalled and expert attention. An artificial airway is often required to alleviate the obstruction and due consideration should then be given to the relative merits of the passage of an endotracheal tube and tracheostomy. These are measures which should be carried out early in the illness and must not be postponed until the child is in a critical condition when emergency intervention is often associated with a high incidence of morbidity and mortality. Tracheostomy has been the procedure of choice to relieve airway obstruction; however, in recent years several investigators have reported the encouraging results of nasotracheal intubation as an alternate procedure in the management of upper airway obstruction in children. The purpose of this report is to evaluate the relative effectiveness of two procedures; nasotracheal intubation ami tracheostomy, Nasotracheal intubation or tracheostomy were employed in the management of 27 cases, and it would appear that the two methods of handling airway obstractiorr wer.e equally satisfactory. It was suggested that nasotracheal intubation was superior to tracheostomy in terms of the duration of hospitalization (13,0 days vs. 21. 3 days) and intubation (108. 4 hours vs 167. 2 hours). All patients tolerated well the nasotracheal tube without accidental extubation.
Airway Obstruction* ; Child* ; Diagnosis ; Emergencies ; Hospitalization ; Humans ; Incidence ; Intubation* ; Mortality ; Research Personnel ; Tracheostomy*

The recovery process of brain damage caused by an acute severe cerebral hypoxia has been reported in various literatures. And the possibility of complete recovery of such case was said to be good in younger age group than in adult's group. We experienced a case of cardiac arrest of a 12 year old girl during halothane anesthesia induction and the cardiac and pulmonary resuscitation was succeeded promptly. But the hypotensive period persted for few minutes before the diagnosis was made. The condition of the patient after the resuscitation was good except that her unconsciousness state persisted unusually. The proposed appendectomy performed uneventfully and the anesthesia recovery of the patient was carefully observed in our I.C.U. The uncoscious state lasted for 2 days with agitated movements of legs, EEG showed abnormal, irregular patterns but showed no signs of damage of gobus pallidum and putamen. During the first month, the order of recovery of cerebral function was comatous state, swallowing, eating, and urination. The cerebellar dysunction was prominent. Then recovery of amnesia and defection followed. Speech and gate started to regain in the 26 and 36 post-operative day respectively. Writing function started recover quickly with the recovery of speech function, which occurred in 4 to 6 post-operative months. Recovery of intelligence was slowest and gradually reached to the intelligent level of 11 year old child in one year. It was found the primitive function recovered first and the highly cultivated function recovered last.
Amnesia ; Anesthesia* ; Appendectomy ; Brain* ; Child ; Deglutition ; Diagnosis ; Dihydroergotamine ; Eating ; Electroencephalography ; Female ; Halothane ; Heart Arrest* ; Humans ; Hypoxia, Brain ; Intelligence ; Leg ; Putamen ; Resuscitation ; Unconsciousness ; Urination ; Writing

A new fluorinated benzodiazepine compound Ro 5-4200 was used for induction in 58 surgical patients to evaluate the possibility of an intravenous anesthetic induction agent (Table 2 and 3). The hypnotic properties as well as respiratory, cardiovascular, muscle relaxant and local effects were observed. 1. Ro 5-4200 in doses of 2mg was slowly injected intravenously to adult patients (body weight ; 54.2+/-10.3 kg) and 1 mg to a child (body weight; 22 kg, 5 yr.) (Table 2). The tim between the start of injection and the loss of consciousness was 110.3"+/-68.6", taken from the beginning of the injection until the patient was asleep and eyelash and corneal reflexes abolished. Sleep did not occur in 2 patients (Table 4). 2. But the time to sleep after the injection varied remarkebly according to the dilution of the drug. When the dose of 2 mg of the drug was injected, undiluted directly to the small vein, the time to sleep was 83.2"+/-31.4" and 69.1"+/-31.4"; in the former case the patients complained of pain along the injected vein and the latter did not. 3. The hypnotic time with the diluted solution of the drug was 144.5" +/-4.6" and 117.3"+/-77.8", in which the former complained of pain during injection, and the latter did not. 4. Blood pressure, pulse rate and respiratory rate were measured immediately prior to induction and again 2 and 5 minutes after induction. A slight but insignificant rise in blood pressure with a mean of 3.4% in systolic and 6.7% in diastolic pressure above control value was observed in 2 minutes after injection. And at 5 minutes there was a significant fall in blood pressure, 11.3% and 4.3% respectively (p<0.05) (Table 5). 5. Pulse rate increased significantly by 12.7 beats (14.2%) a minute in 2 minutes after injection and 15.7 beat (17.5%) a minute in 5 minutes after injection from a control level of 89.6 (p<0.01) ,(Table 6). 6 Respiration became shallower and the rate decreased as the patients fell asleep. Apnea occurred in 4 patients (6.9%). In the apnea cases, respiration was controlled by mask and positive pressure ventilation. It needed that the facilities for positive pressure ventilation be available in case apnea develops. 7. During induction, tremors, abnormal muscle movements, and laryngospasm were not observed. Hiccough was observed in 4 cases (6.9%). Hiccugh had the tendency to recur during intra-abdominal procedure. 32 patients (55.0%) had an antegrade amnesia, that is shortly before the injection of the drug. They did not remember being moved to the operating table or the insertion of the injection needle. 8. Ro 5-4200 caused pain on injection when given undiluted directly into a small vein on the dorsum of the hand, and the pain was also complained of even when the drug was diluted to 5 times with normal saline or intravenous drip infusion. A localized thrombophlebitis was not seen. 9. Laryngeal reflexes were retained on induction but endotracheal intubation was tried successfully without muscle relaxant in three cases. In this procedure the patients tended to be awake and showed some resistance. The help of muscle relaxants in intubation is recommended. As to degree of everity and nature of muscle fasciculation after succinylcholine, there was somewhat delayed appearance but degree was not altered by Ro 5-4200 10. Recovery from anesthesia and reversal of muscle relaxation was unaltered. The induction was satisfactory, but slow, and characterized by minimal change in blood pressure, pulse rate and respiration. Because of this delayed induction time and the varied degree of depth of sleep, the agent seemed to be improper as an intravenous induction agent. Acknowledgements: Samples of Ro 5-4200 have been kindly supplied by Hoffmann La Roche, Hong Kong. The authors wish to thank Dr. S.S.Lo and Dr. P.A. Bulhr of Roche Products Ltd., for their assistance and advice.
Adult ; Amnesia ; Anesthesia ; Apnea ; Benzodiazepines* ; Blinking ; Blood Pressure ; Child ; Fasciculation ; Flunitrazepam* ; Hand ; Heart Rate ; Hiccup ; Hong Kong ; Humans ; Infusions, Intravenous ; Intubation ; Intubation, Intratracheal ; Laryngismus ; Masks ; Muscle Relaxation ; Needles ; Operating Tables ; Positive-Pressure Respiration ; Reflex ; Respiration ; Respiratory Rate ; Succinylcholine ; Thrombophlebitis ; Tremor ; Unconsciousness ; Veins

No abstract available.
Abscess*

No abstract available.
Leiomyoma* ; Scalp*

Click sound can evoke myogenic potentials in active sternocleidomastoid(SCM) muscle. These are due to activity of vestibular afferent rather than cochlear, which produce very short latency inhibition of ipsilateral motor unit activity. We investigated the click-evoked vestibulocollic reflexes in neck muscles to find out the significance and relationship of latency and amplitude of myogenic potentials between two different methods of muscles activation. EMGs were recorded from surface electrode evoked by sound stimuli(95dB SPL, 5/sec repetitive rate, 512 times) over SCM muscles on each side. Myogenic potentials have two biphasic responses which were termed P1, N1, P2, N2 based on the polarity of their components. The subjects were 24 normal volunteers. EMG recordings were obtained from 12 subjects(Group 1) who keeped head 10 cm above ground in supine position to activate their neck flexors to the degree required through the averaging runs(bilateral SCM muscles activation method). EMGs from another 12 subjects(Group 2) were recorded by rotating head to the opposite side to activate SCM muscle throughout the procedure(unilateral SCM muscle activation method). The latencies and amplitudes of myogenic potentials in the SCM muscle after stimulation were analysed and compared between the two methods. The latencies(msec) of P1 and N1 were 11.2+/-2.4, 21.7+/-1.1 respectively in Group 1 and 13.3+/-2.4, 23.0+/-1.1 respectively in Group 2. The amplitude(uV) of P1-N1 were 38.78.1 in Group 1 and 33.28.1 in Group 2. There were no significant differences in latencies and amplitudes of P1 and N1 between the groups(p<0.05). Unilateral muscle activation is easier and comfortable than the bilateral muscle activation and there were no significant difference in latency and amplitude of P1. The myogenic potential of unilateral vestibular function loss disappeared in a patient who was labyrinthectomized but there was normal response of potential in a patient who is profound sensory neural hearing loss. Click evoked myogenic potentials is a simple method of examining vestibulocollic reflex. Click evoked myogenic potential is related to vestibular status.
Electrodes ; Head ; Healthy Volunteers ; Hearing Loss ; Humans ; Muscles ; Neck ; Neck Muscles ; Reflex* ; Supine Position

PURPOSE: We investigated the direct labeling method of antibody with 99mTc and 188Re and examined the stability and function of these labeled compounds in in vitro and in vivo. MATERIALS AND METHODS: Disulfide bond of nonspecific human IgG was reduced to -SH group by 2-mercaptoethanol. Stannous ion was used to reduce 99mTc and 188Re. The stability of 99mTc-IgG and 188Re-IgG was estimated upto 24 hrs. Biodistribution was evaluated in abscess bearing rats at 4 and 24 hr post-injection of 99mTc or 188Re labeled IgG. RESULTS: The number of -SH group per reduced IgG molecule was 2.34. The labeling yield of 99mTc-IgG and 188Re-IgG were 90% and 95%, respectively. The stability of 99mTc-IgG at 1, 4, 6 and 24 hr was 91%, 83%, 78%, 7% and that of 188Re-IgG, high uptake was found on kidney, blood, stomach and abscess (9.42+/-0.68, 1.43+/-0.24, 0.86+/-0.18, 0.72+/-0.10 %ID/g, respectively). The uptakes at 24 hr were kidney, abscess, stomach, and blood in descending order. In case of 188Re-IgG, high uptake at 4 hr post injection appeared on kidney, blood, abscess and stomach (3.92+/-0.62, 1.32+/-0.08, 0.88+/-0.01, 0.26+/-0.06, respectively). The upatkes at 24 hr were kidney, abscess, blood abd stomach in descending order. The abscess to blood uptake ratio of 99mTc-IgG was 0.5 at 4 hr and 2.02 at 24 hr and that of 188Re-IgG was 0.67 and 1.29. CONCLUSION: 99mTc-IgG and 188Re-IgG and 188Re-IgG canbe labeled efficiently with direct labeling method. However, 99mTc-IgG and 188Re-IgG, labeled with direct method, was unstable. Further study in needed to enhance the stability of the antibody labeling.
Abscess ; Animals ; Humans ; Immunoglobulin G ; Kidney ; Mercaptoethanol ; Rats ; Stomach

No abstract available.
Mucormycosis* ; Technetium Tc 99m Exametazime*

No abstract available.
Kidney* ; Perfusion* ; Radionuclide Imaging*

BACKGROUND: Transient global amnesia (TGA) is characterized by a severe disturbance of memory, lasting less than a day, and complete resolution. However, some authors have suggested the occurrence of permanent memory impairment in such cases. In this study, we investigated whether the gray-matter structure suffers degeneration in TGA, based on the assumption that TGA attacks appear to be related to underlying permanent pathology. METHODS: T1-weighted magnetic resonance imaging data for 20 TGA and 55 normal subjects were analyzed. The gray-matter volume was measured using voxel-based morphometry. The subjects also completed the Seoul Neuropsychological Screening Battery (SNSB). RESULTS: The gray-matter volume was reduced in the left superior frontal gyrus, right precentral gyrus, right superior frontal gyrus, left caudate nucleus, left precentral gyrus, left post central gyrus, and both putamens. The SNSB revealed the presence of selective neuropsychological dysfunctions after clinical recovery. Most of the cases exhibited attention deficit, and difficulties in copying of the Rey-Osterrieth Complex Figure, and in the Seoul verbal learning test. CONCLUSIONS: Left caudate nucleus atrophy could explain the attention deficit and memory impairment experienced in these TGA patients. Many patients with TGA have neuropsychological dysfunctions even after they appear to be clinically improved.
Amnesia, Transient Global ; Atrophy ; Caudate Nucleus ; Coat Protein Complex I ; Humans ; Magnetic Resonance Imaging ; Mass Screening ; Memory ; Putamen ; Verbal Learning