PURPOSE: To report the decreasing incidence of HBV(Hepatitis B virus)-associated membranous nephropathy in children after HBV vaccination and to elucidate the clinical course and treatment strategies of IMN (Idiopathic membranous nephropathy). METHODS: We retrospectively reviewed the clinico-pathological findings of HBV-MN and IMN patients who underwent a renal biopsy from 1986 to 2005. We compared the HBV-MN and the IMN groups and the remission and the non-remission groups of patients with IMN. RESULTS: Among 24 cases of MN patients, HBV-MN comprised 6 cases(25%) and IMN 18 cases(75%). Clinical masnifestations were nephrotic syndrome(3 cases, 50%), nephritic syndrome(1 case, 16.7%), asymptomatic(2 cases, 33.4%) in the HBV-MN group, asymptomatic(10 cases, 55.5%), nephrotic syndrome(5 cases, 27.8%), and gross hematuria(3 cases, 16.7%) in the IMN group. From 1996 to 2000, there were 2 cases(28%) of HBV-MN and 5 cases(72%) of IMN. After 2001, all 10 cases were IMN. In the HBV-MN group, 4 cases(66.7%) received interferon and 1 case received methylprednisolone pulse therapy. In the IMN group, 16 cases (88.9%) received methylprednisolone, 8 cases(44.4%) were in complete remission, 2 cases (11.1%) were in partial remission, 2 cases(11.1%) were in chronic renal failure, and 5 cases (27.8%) were lost to follow-up with sustained proteinuria, 1 case(5.6%) continued to have frequent relapse of nephrotic syndrome without renal insufficiency. In the comparison between remission and non-remission groups, nephrotic range proteinuria and hypertension were more significantly common in the non-remission group(P<0.05). CONCLUSION: With HBV vaccination, HBV-MN has decreased markedly. IMN is a rare glomerular disease in children. Because the prognosis for patients with nephrotic range proteinuria is poor, this group needs more aggressive treatment.
Biopsy ; Child* ; Glomerulonephritis, Membranous* ; Humans ; Hypertension ; Incidence ; Interferons ; Kidney Failure, Chronic ; Lost to Follow-Up ; Methylprednisolone ; Nephrotic Syndrome ; Prognosis ; Proteinuria ; Recurrence ; Renal Insufficiency ; Retrospective Studies ; Vaccination

Spontaneous intracranial hypotension is a syndrome caused by cerebrospinal fluid (CSF) leakage from the spinal dural sac. The most common symptom is a postural headache and other clinical symptoms may include nausea, vomiting, photophobia, diplopia, dizziness, and tinnitus. Usually, conservative treatments like hydration, bed rest, and administration of caffeine are recommended first, but epidural blood patch is regarded as the mainstay of treatment in the patients who do not respond to conservative therapy. Epidural blood patch was known that it provides the tamponade and seal of dural sac when performed at the leak site. Our patient was suspected the CSF leakage at cervicothoracic junction, but epidural blood patch was performed in lumbar level and the headache of patient was managed successfully for at least 1 year.
Bed Rest ; Blood Patch, Epidural* ; Caffeine ; Cerebrospinal Fluid ; Diplopia ; Dizziness ; Headache ; Humans ; Intracranial Hypotension* ; Nausea ; Photophobia ; Tinnitus ; Vomiting

We recently encountered a case of hereditary spherocytosis coexisting with Gilbert's syndrome. Patient was initially diagnosed with Gilbert's syndrome and observed, but other findings suggestive of concurrent hemolysis, such as splenomegaly and gallstones were noted during the follow-up period. Therefore, further evaluations, including a peripheral blood smear, osmotic fragility test, autohemolysis test, and red blood cell membrane protein test were performed, and coexisting hereditary spherocytosis was diagnosed. Genotyping of the conjugation enzyme uridine diphosphate-glucuronosyltransferase was used to confirm Gilbert's syndrome. Because of the high prevalence rates and similar symptoms of these 2 diseases, hereditary spherocytosis can be masked in patients with Gilbert's syndrome. In review of a case and other article, the possibility of the coexistence of these 2 diseases should be considered, especially in patients with unconjugated hyperbilirubinemia who also have splenomegaly and gallstones.
Adult ; Erythrocytes/physiology ; Gallstones/etiology ; Genotype ; Gilbert Disease/complications/*diagnosis/genetics ; Glucuronosyltransferase/genetics ; Hemolysis ; Humans ; Hyperbilirubinemia/etiology ; Male ; Polymorphism, Single Nucleotide ; Spherocytosis, Hereditary/complications/*diagnosis/genetics ; Splenomegaly/etiology

Pericentric inversion of chromosome 4 can give rise to 2 alternate recombinant (rec) chromosomesby duplication or deletion of 4p. The deletion of distal 4p manifests as Wolf-Hirschhorn syndrome (WHS). Here, we report the molecular cytogenetic findings and clinical manifestations observed in an infant with 46,XX,rec(4)dup(4q)inv(4)(p16q31.3)pat. The infant was delivered by Cesarean section at the 33rd week of gestation because pleural effusion and polyhydramnios were detected on ultrasonography. At birth, the infant showed no malformation or dysfunction, except for a preauricular skin tag. Array comparative genomic hybridization analysis of neonatal peripheral blood samples showed a gain of 38 Mb on 4q31.3-qter and a loss of 3 Mb on 4p16.3, and these results were consistent with WHS. At the last follow-up at 8 months of age (corrected age, 6 months), the infant had not achieved complete head control.
*Chromosome Deletion ; *Chromosome Duplication ; *Chromosome Inversion ; *Chromosomes, Human, Pair 4 ; Comparative Genomic Hybridization ; Female ; Gestational Age ; Humans ; Infant ; Pleural Effusion/ultrasonography ; Polyhydramnios/ultrasonography ; Pregnancy ; Wolf-Hirschhorn Syndrome/*genetics

OBJECTIVE: Topical steroids are a good option for preventing postoperative sore throat (POST). This study examined whether triamcinolone paste applied as lubricant reduces the severity of POST following laryngeal mask airway (LMA) insertion. METHODS: This was a prospective, randomized, double-blind, placebo-controlled clinical trial. The study enrolled 50 American Society of Anesthesiologists (ASA) I-II patients who were between 20 and 70 years of age and scheduled for elective surgery under general anesthesia. The patients were divided randomly into two groups. Patients in the chlorhexidine group (the placebo group) were inserted with a LMA lubricated with chlorhexidine gluconate jelly, whereas patients in the triamcinolone group were inserted with a LMA lubricated with 0.1% triamcinolone acetonide paste. The patients were interviewed 1, 6, and 24 hours after the operation. The incidence and severity of POST and the incidence of cough and hoarseness were recorded. RESULTS: The difference of the POST incidence during the 24 hours after the operation was not significant (34.8% in triamcinolone group vs. 45.5% in chlorhexidine group, P=0.381). The severity score in the triamcinolone group was significantly lower than the chlorhexidine group at 1 hour after the operation (P<0.001). No significant differences were found in the incidence of cough, hoarseness, dysphagia, nausea, or dry throat between the two groups. CONCLUSION: Triamcinolone paste applied as lubricant reduces the severity of POST following LMA insertion.
Analgesics ; Anesthesia, General ; Chlorhexidine ; Cough ; Deglutition Disorders ; Hoarseness ; Humans ; Incidence ; Laryngeal Masks ; Nausea ; Pharyngitis ; Pharynx ; Prospective Studies ; Steroids ; Triamcinolone ; Triamcinolone Acetonide

OBJECTIVE: The aim of this study was to investigate the effects of intravenous magnesium sulfate on the prevention of pain during the injection of microemulsion propofol. Magnesium is a known calcium channel blocker and a physiological N-methyl-D-aspartate receptor antagonist. METHODS: American Society of Anesthesiologists I and II adults (n=114) undergoing general anesthesia for surgery were randomly assigned into two groups (n=57 per group). This study was designed in prospective and double-blind manner. Patients in the LM group (n=57) received pretreatment with 2% lidocaine (40 mg) and magnesium sulfate 10 mg/kg, while patients in group L (n=57) received pretreatment with 2% lidocaine (40 mg) and normal saline (2 mL) accompanied by venous occlusion. Induction with microemulsion propofol (Aquafol) 2 mg/kg was accomplished following the release of venous occlusion. Pain intensity was assessed on a four-point scale according to patient movement (grade 0, no movement; grade 1, movement in wrist only; grade 2, movement in the upper arm & shoulder of injected arm; grade 3, generalized movement). Systolic blood pressure, diastolic blood pressure, and heart rate were evaluated. RESULTS: A significant difference in pain intensity following injection of microemulsion propofol between the groups was found (P<0.05). In addition, the incidence of hypertension after injection was lower in the LM group than in the L group (P<0.05). CONCLUSION: The combination of magnesium and lidocaine are effective in attenuating the pain induced by microemulsion propofol injection when compared with lidocaine alone.
Adult ; Anesthesia, General ; Arm ; Blood Pressure ; Calcium Channels ; Heart Rate ; Humans ; Hypertension ; Incidence ; Lidocaine ; Magnesium Sulfate* ; Magnesium* ; N-Methylaspartate ; Propofol* ; Prospective Studies ; Shoulder ; Wrist

BACKGROUND: This study was performed to ultrasonographically demonstrate the changes in relationship between the right internal jugular vein (IJV) and an anatomical landmark in two different head positions: neutral and rotated. METHODS: This was a randomized clinical trial. One hundred patients scheduled for elective surgery under general anesthesia with endotracheal intubation were enrolled in this study. The patients were placed in the supine position with a neutral head position and without a pillow. The apex of the triangle formed by the sternal and clavicular heads of the sternocleidomastoid muscle and clavicle was marked (AL point : anatomical landmark point). Ultrasonography of the neck anatomy was performed and the skin was marked at the central point of the IJV (US point: ultrasonography point). The other investigator measured the distance from the AL point to the US point (AL-US distance). The patient's head was then turned 30degrees to the left; the same procedure was repeated and the AL-US distance was again measured. The changes in AL-US distance were calculated. RESULTS: The AL-US distance increased significantly after 30degrees head rotation compared with that in a head neutral position. The mean +/- SD of the AL-US distance was 0.28 +/- 0.78 cm in the neutral head position and 0.83 +/- 1.03 cm in the head rotated position. CONCLUSIONS: The anatomical landmark point becomes more distant from the actual right IJV point and moves more medially after head rotation. We suggest minimizing the angle of head rotation and taking this distance into consideration when using the landmark-guided method.
Anesthesia, General ; Clavicle ; Head ; Humans ; Intubation, Intratracheal ; Jugular Veins ; Muscles ; Neck ; Research Personnel ; Skin ; Supine Position

We report a case of failed epidural anesthesia despite successful identification of the epidural space, loss of resistance technique, hanging drop method and drip infusion. This case evaluated the use of computed tomography to confirm epidural catheter position, which showed the catheter accidentally positioned at the T2 lamina. Because epidural anesthesia can even after successful procedure using standardized techniques such as loss of resistance, we recommend performing the procedure under fluoroscopic guidance to improve success rate and patient safety.
Anesthesia, Epidural ; Catheters ; Epidural Space ; Infusions, Intravenous ; Patient Safety

Although rare, intraoperative anaphylaxis can lead to significant morbidity and mortality. Aquafol(R) (Daewon Pharmaceutical Co. Ltd., Seoul, Korea), a microemulsion propofol, was developed to eliminate lipid solvent-related adverse events, and was used in clinical anesthesia since 2009 with little data about severe side effects such as anaphylaxis. A healthy 16-yr-old male patient who had past medical history with two previous operations of no complications developed cardiovascular shock with generalized erythema following administration of microemulsion propofol during anesthesia induction. Intravenous injection of epinephrine and steroid rescued him. He remained in a stable state without any problems postoperatively and was discharged. Clinicians should consider this rare but serious complication during induction of anesthesia with propofol.
Adolescent ; Anaphylaxis/*chemically induced/drug therapy ; Anesthetics, Intravenous/*administration & dosage/adverse effects ; Bronchodilator Agents/therapeutic use ; Dexamethasone/therapeutic use ; Emulsions/chemistry ; Epinephrine/therapeutic use ; Glucocorticoids/therapeutic use ; Humans ; Injections, Intravenous ; Male ; Propofol/*administration & dosage/adverse effects

BACKGROUND AND OBJECTIVES: Nicorandil is a potassium channel opener, and it has been known to have a cardioprotective effect against ischemia/reperfusion injury. However, the exact mechanisms of the effect are not known. In the previous studies on cardioprotection, administration of nicorandil was started early during the coronary occlusion. Therefore, it is not clear whether nicorandil can also be beneficial when it is administered from the time of coronary recannalization. MATERIALS AND METHODS: We studied 15 cats that had their chests surgically opened (8 nicorandil cats and 7 control cats). The proximal portion of the left anterior descending artery (LAD) was occluded with ligation for 90 minutes, then it was recannalized for 60 minutes. Intravenous injection of nicorandil was started at the time of recannalization of the artery (a bolus of 100 microgram.kg(-1) plus an infusion at a rate of 10 microgram.kg(-1).min(-1) ). At each stage of the experiments, the risk area and myocardial perfusion were assessed using color microspheres and myocardial contrast echocardiography. The size of the infarction was evaluated by postmortem triphenyltetrazolium chloride staining. Myocardial contrast echocardiography was performed with Pulse Inversion Harmonic Imaging (Sonoace9900, Medison). RESULTS: The risk area during coronary occlusion was 18.8+/-12.6% in the nicorandil group and 19.3+/-9.6% in the control group (p=NS). The perfusion defect immediately after and 1 hour after reperfusion was 13.0+/-8.7% and 8.4 +/-7.6%, respectively, in nicorandil group, and 16.7 +/-11.1 % and 13.4+/-8.8%, respectively, in the control group, (p=NS between groups). Myocardial blood flow in the LAD territory during occlusion immediately after and 1 hour after reperfusion was 56+/-31 %, 73+/-31 % and 69+/-28%, respectively, of the normal myocardium in the nicorandil group, and 65+/-20%, 101+/-75% and 77+/-42%, respectively, in the control group (p=NS between groups). The postmortem infarction size was 8.1+/-9.6% in the nicorandil group and 7.7+/-7.5% in the control group (p=NS). CONCLUSION: With administration of nicorandil from the time of recannalization in the ischemia/reperfusion injury model, we could not find any significant cardioprotective effect. The cardioprotective effect of nicorandil may be associated with preconditioning before reperfusion.
Animals ; Arteries ; Cats ; Coronary Artery Disease ; Coronary Occlusion ; Drug Therapy ; Echocardiography ; Infarction ; Injections, Intravenous ; Ischemia ; Ligation ; Microspheres ; Myocardium ; Nicorandil* ; Perfusion ; Potassium Channels ; Reperfusion ; Thorax