No abstract available.
Granuloma* ; Leprosy, Lepromatous*

Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.
Acidosis, Lactic* ; Administration, Topical ; Anesthesia, General ; Anesthesia, Local ; Epinephrine ; Glucose ; Glycolysis ; Hemodynamics ; Hemostasis ; Humans ; Lactic Acid ; Orthognathic Surgery* ; Plasma ; Pyruvic Acid ; Vital Signs

BACKGROUND: Monitoring of "Depth of anesthesia" is an ongoing problem in anaesthesia. In this study, the author has compared the bispectral index (BIS) and Anemon monitor for monitoring depth of anesthesia in propofol or isoflurane anesthesia. METHODS: Anemon-1 and BIS index were obtained from 24 patients (ASA I, II) during general anesthesia with propofol or isoflurane. For patients in the propofol group, anesthesia was induced with fentanyl 100ng followed by propofol 2 mg/Kg. For patients in the isoflurane group, anesthesia was induced with thiopental 5 mg/Kg. The author observed changes of these values at 5 major times: before induction, during induction, after induction, at sKin incision, before extubation, after extubation. RESULTS: The anemon index showed a significant increase during induction (propofol group: 86.9 +/- 26.4, isoflurane group: 106.0 +/- 18.6) and at sKin incision (propofol group: 89.9 +/- 22.7, isoflurane group: 92.0 +/- 23.1), but this did not correlate with the level of consciousness. The BIS index showed a significant decrease in the score after induction (propofol group: 55.0 +/- 9.6, isoflurane group: 61.0 +/- 17.2), but no response to surgical stimuli. CONCLUSIONS: BIS had a good correlation with level of consciousness. The Anemon-1 index was recognized to reflect invasive stimulus. As the BIS and Anemon-1 had no correlation, it was not possible to assume changes of each index from the other. Both the anemon-1 index and BIS are useful to monitor the anesthesia level during surgery.
Anesthesia ; Anesthesia, General ; Consciousness ; Fentanyl ; Humans ; Isoflurane ; Propofol ; Skin ; Thiopental

Split hand and split foot(SHSF) is a human developmental defect characterized by missing digits, fusion of remaining digits, and a deep median cleft resulting in a clawlike appearance of the hands and feets. SHSF is usually inherited in an autosomer dominant fashion. The incidence of SHSF is between 1/10,000 and 1/90,000. Thirteen cases of SHSF and chromosomal aberrations involving 7q21-22 have been described so far in the world. We experienced a case of typical tetramelic SHSF in neonate. Chromosome studies showed a pericentric inversion of chromosome 7:46,XY,inv(7) (p22q22). Inspection of the extremities and chromosome studies in the parents were normal.
Chromosome Aberrations ; Chromosomes, Human, Pair 7* ; Extremities ; Foot* ; Hand* ; Human Development ; Humans ; Incidence ; Infant, Newborn ; Parents

No abstract available.
Dermatitis, Atopic* ; Food Hypersensitivity ; Milk Hypersensitivity* ; Milk*

Infantile spasm is an age-related refractory epilepsy. Topiramate is a new anticonvulsant with multiple mechanisms of action, and it may be effective for treating pediatric epilepsies. To evaluate the efficacy and tolerability of first-line topiramate treatment for infantile spasm, 20 patients received topiramate monotherapy during this study. They were treated with an initial dose of 1mg/kg/day, with a progressive titration of 1 mg/kg a week until their spasms were controlled and a maximum dose of 12mg/kg/day was achieved. The evaluation of the treatment efficacy was based on the spasm frequency data that was obtained by the scalp and video-EEG, and by the parental count of spasm. Thirty percent of the subjects became spasm-free during the study. Six of 20 subjects (30%) had cessation of spasm and disappearance of hypsarrhythmia as seen via the video EEG; four (50%) of eight idiopathic patients had a response, whereas two (17%) of 12 patients with symptomatic infantile spasm responded. Seventy of the patients, including the spasm-free patients, had a reduction in their seizure frequency of more than 50%, and 10% of the patients had a reduction in their seizure frequency of less than 50%. The clusters of spasm frequency decreased from 10.6 +/- 8.5 to 3.5 +/- 1.4 clusters/day. Topiramate is effective and tolerated in those patients suffering from infantile spasm. Our results suggest that this drug should be considered as a new first-line drug for treating infantile spasm.
Treatment Outcome ; Spasms, Infantile/*drug therapy ; Male ; Infant ; Humans ; Fructose/*analogs & derivatives/therapeutic use ; Female ; Electroencephalography ; Child, Preschool ; Anticonvulsants/*therapeutic use ; Age of Onset

PURPOSE: This study evaluated the clinical characteristics of brain tumors in children according to their location, the parental delay and the doctor's delay between the onset of symptoms and the diagnosis of a pediatric brain tumor. In addition, this study compared the relationship between the pre-diagnostic symptomatic interval and the tumor location. METHODS: A retrospective study was undertaken of 45 children with primary brain tumors admitted to Inha Hospital from July, 1986 to June, 2004. A diagnosis of the tumor location was made using brain MRI. RESULTS: The male to female ratio was 1:0.67. The median age at diagnosis was 6.0 years in supratentorial tumors, 7.0 years in infratentorial tumors. Twenty four cases(53.3 percent) were located in the supratentorial area, 21 cases(46.6 percent) were located in the infratentorial area. The distribution of supratentorial tumors were 14(58.3 percent) in the cerebral hemisphere and temporal lobe, seven (29.1 percent) in the suprasellar area, and three(12.5 percent) in the pineal gland and posterial lateral ventricle. The distributions of the infratentorial tumors were 12(57.1 percent) in the cerebellar vermis and fourth ventricle, four(19.1 percent) in the brain stem, and five(23.8 percent) in the cerebellar hemisphere. The most common initial symptom was seizure(37.5 percent) in the supratentorial tumor and headache(38.0 percent) in infratentorial tumors. The median pre-diagnostic symptomatic interval (PSI) was 21 days(range 0-240 days). The median PSI with a parental delay in supratentorial tumor was six days(range 1-240 days), and 30 days(range 1-40 days) in the infratentorial tumor. We immediately diagnosed most cases after visiting the hospital. There was no significant relationship between the tumor location and the pre-diagnostic symptomatic interval. CONCLUSION: The most common symptom of supratentorial tumors and infratentorial tumors was seizure and headache, respectively. Although, the median pre-diagnostic symptomatic interval was shorter than in previous studies, a detailed medical history and a correctly interpreted neurological examination should lead to an earlier diagnosis of pediatric brain tumors.
Brain Neoplasms* ; Brain Stem ; Brain* ; Cerebrum ; Child ; Diagnosis ; Female ; Fourth Ventricle ; Headache ; Humans ; Infratentorial Neoplasms ; Lateral Ventricles ; Magnetic Resonance Imaging ; Male ; Neurologic Examination ; Parents ; Pineal Gland ; Retrospective Studies ; Seizures ; Supratentorial Neoplasms ; Temporal Lobe

To investigate the effect of intrathecal fentanyl,36 ASA physieal status 1 or 2 parturients who underwent cesarean section with apinal anesthesis using 0.25% bupivacaine in 5.0% dextroae with 0.25mg morphine were studied. Patients were randomly allocated to receive either saline 0.2ml (group 1, n=17) or fentanyl 10ug(group 2, n=19) in 3.525ml volume mixed with the bupivacaine with morphine. Spinal anesthesia was performed in sitting position using a 25 guage spinal needle. At the completion of injection, patients immediately turned supine with left uterine diaplacement. There was no statistically significant difference in the incidence of the hypotension between groups. The progress of sensory and motor blocks was similar in the two groups. The times from drug injection ta the onset to maximal sensory blockade and complete motor blockade, complete recovery of sensation and motor power were not different between groups. post delivery,the incidence of visceral pain were significantly less in group 2, as 2 of 19 patients(10%) in group 2 compared to 8 of 17 patients(47%) in group 1(p< 0.05). The effective analgesia time was no significant different: 31.7+/-2.5 hour in group 1 compared to 28.6+/-5.6 hour in Group 2. The ineidence of patients not requiring narcotics until discharge was similar in two groups. No patient showed any evidence of respiratory depression. The incidence of other side effects,such as nausea,vomiting and pruritus was not different between groups. No neonate had an Apgar score below 7.
Analgesia ; Anesthesia, Spinal ; Apgar Score ; Bupivacaine* ; Cesarean Section* ; Female ; Fentanyl* ; Humans ; Hypotension ; Incidence ; Infant, Newborn ; Morphine* ; Narcotics ; Needles ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Sensation ; Visceral Pain

To investigate the effect of intrathecal fentanyl,36 ASA physieal status 1 or 2 parturients who underwent cesarean section with apinal anesthesis using 0.25% bupivacaine in 5.0% dextroae with 0.25mg morphine were studied. Patients were randomly allocated to receive either saline 0.2ml (group 1, n=17) or fentanyl 10ug(group 2, n=19) in 3.525ml volume mixed with the bupivacaine with morphine. Spinal anesthesia was performed in sitting position using a 25 guage spinal needle. At the completion of injection, patients immediately turned supine with left uterine diaplacement. There was no statistically significant difference in the incidence of the hypotension between groups. The progress of sensory and motor blocks was similar in the two groups. The times from drug injection ta the onset to maximal sensory blockade and complete motor blockade, complete recovery of sensation and motor power were not different between groups. post delivery,the incidence of visceral pain were significantly less in group 2, as 2 of 19 patients(10%) in group 2 compared to 8 of 17 patients(47%) in group 1(p< 0.05). The effective analgesia time was no significant different: 31.7+/-2.5 hour in group 1 compared to 28.6+/-5.6 hour in Group 2. The ineidence of patients not requiring narcotics until discharge was similar in two groups. No patient showed any evidence of respiratory depression. The incidence of other side effects,such as nausea,vomiting and pruritus was not different between groups. No neonate had an Apgar score below 7.
Analgesia ; Anesthesia, Spinal ; Apgar Score ; Bupivacaine* ; Cesarean Section* ; Female ; Fentanyl* ; Humans ; Hypotension ; Incidence ; Infant, Newborn ; Morphine* ; Narcotics ; Needles ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Sensation ; Visceral Pain

PURPOSE: This study was aimed to evaluate the clinical features of hypoxic ischemic encephalopathy(HIE) in children with and without seizures. METHODS: Fifty five children who had been diagnosed as HIE at Inha University Hospital from June 1999 to December 2011 were enrolled in this study. Subjects were divided into two groups by the presence of seizures and their medical records were retrospectively analyzed. RESULTS: Among the 55 cases, 34 patients (61.8%) had seizures, while 17 patients (32.2%) did not have them. Male to female ratio was 1:1 for the 'seizure' group and 2.5:1 for the 'no seizure' group. The onset age was 9.7 months (range: 0-158 months) for the 'seizure' group and 10 months (range : 0-108 months) for the 'no seizure' group. The most common risk factor was birth asphyxia (17.7%) for the 'seizure' group, and prematurity (23.8%) for the 'no seizure' group. The most common symptom other than seizure was respiratory arrest for both groups. On radiologic imaging studies of the brain, main causative lesion was most commonly observed in the cerebral cortex in both groups. The neurologic deficits or death were detected in 67.7% of the 'seizure' group, and 76.3% of the 'no seizure' group. There were no statistically significant differences in risk factors between the two groups. CONCLUSION: Although the characteristics between patients with and without seizures from HIE revealed no significant differences, HIE still can result in death or permanent disability in children. Therefore, permanent brain damage may be minimized by early suspicion and treatment in these patients.
Age of Onset ; Asphyxia ; Brain ; Cerebral Cortex ; Child* ; Female ; Humans ; Hypoxia-Ischemia, Brain* ; Male ; Medical Records ; Neurologic Manifestations ; Parturition ; Retrospective Studies ; Risk Factors ; Seizures*