No abstract available.
Hemangioma, Cavernous*

Time intervals and indices of left ventricular diastolic filling were studied by M-mode and pulsed Doppler Echocardiography in 18 dilated cardiomyopathy patients. After one two hours captopril(capril(R)) 25mg medication. 1)Systolic blood pressure, Diastolic blood pressure, Heart rate were significantly decreased. 2) Dimensions of LVSD, LVDD, LA, Aorta and EF were not changed measured by M-mode echocardiography. 3) IRT measured by M-mode and Pulsed Doppler echocardiography were significantly increased(45+/-33msec VS 74+/-35msec. 84+/-32msec VS 100+/-22msec P<0.05). 4) A2-E measured by M-mode and Pulsed Doppler echocardiography were significantly increased(114+/-45msec VS 134+/-46msec, 156+/-46msec VS 194+/-48msec, P<0.05). 5) Deceleration time was significantly increased(137+/-36msec VS 205+/-40msec P<0.05). 6) Transmitral peak flow velocities were not changed significantly. In summary captopril influences early diastolic time intervals with dilated cardiomyopathy patients and we interpreted these effects be beneficial on diastolic filling pattern.
Aorta ; Blood Pressure ; Captopril ; Cardiomyopathy, Dilated* ; Deceleration ; Echocardiography ; Echocardiography, Doppler, Pulsed ; Heart Rate ; Humans

We experienced a case of vitamin B12 unresponsive methlymalonic acidemia in a 4 day old female, who had poor feeding, dehydration with metabolic acidosis, and hyperammonernia and died at 7 days of age. Diagnosis was made by gas chromatography and mass spectrometry, and this case is probably a methylmalonyl CoA mutase apoenzyme deficiency type.
Acidosis ; Apoenzymes ; Chromatography, Gas ; Dehydration ; Diagnosis ; Female ; Humans ; Mass Spectrometry ; Methylmalonyl-CoA Mutase ; Vitamin B 12

The surgeries based on the outpstient department have increased recently. One of the indications of outpatient surgery is chemical peeling of the face that usually re- quires only deep sedation of short duration. The purpose of this study was to evaluate the effeets of ketamine and midszolam for out patient facial chemical peeling. Fifty-nine unpremedicated patients undergoing chemical peeling of the face were anesthetized with bolus intravenous injection of 1mg/kg of ketamine and 0.1 mg/kg of midazolam. Additional dose of ketamine(10-20mg) was given as needed. During operation, we observed systolic and diastolic blood pressure with noninvasive blood pressure monitor and peripheral oxygen saturation(SpO2) with pulse oximeter. All patients were allowed to breathe spontane- ously without ventilatory support during the operation. There was no case of airway ob- struction and SpO2 value was over 97% in most cases. The systolic and diastolic blood pressure and pulse rate were increased after the injection of ketamine and midazolam. And we observed the untoward effect of anesthetics such as the purposeless movement(6.8%), involuntary phonation(3.4%), skin rash(3.4%) and headache(1.7%). In postoperative analysis about the recall, bad dream, mood, and the degree of satisfaction of this type of anesthesia, the rate of patient's positive acceptance was high(86.4%) and the reeovery time was 58min. We conclude that combination of intravenous ketamine and midszolam can produce satisfactory anesthesia with few complications for outpatient chemical peeling surgery of the face.
Ambulatory Surgical Procedures ; Anesthesia* ; Anesthetics ; Blood Pressure ; Blood Pressure Monitors ; Deep Sedation ; Dreams ; Heart Rate ; Humans ; Injections, Intravenous ; Ketamine* ; Midazolam* ; Outpatients* ; Oxygen ; Skin

BACKGROUND/AIMS: Portal hypertension in cirrhosis is associated with a hyperdynamic circulation, which is characterized by hypervolemia, high cardiac output, arterial hypotension and low peripheral vascular resistance. These circulatory abnormalities are thought to be secondary to a splanchnic arteriolar vasodilation related to the increase in portal pressure. Studies assessing regional hemodynamics in patients of cirrhosis with ascites have shown vasoconstriction in the renal circulation and in peripheral vascular territory. This study was designed to assess the cerebral vascular resistance in cirrhotic patients with ascites. METHODS: The resistive index in the middle cerebral artery and in a renal interlobar artery were measured by Doppler ultrasonography in 12 cirrhotic subjects without ascites, 23 cirrhotic subjects with ascites, and 8 healthy subjects. The arterial blood pressure and plasma renin and norepinephrine concentration, which reflect the activity of the renin-ngiotensin and sympathetic nervous systems respectively, were also measured. RESULTS: The resistive index in the middle cerebral artery were significantly higher in cirrhotic patients with ascites (0.58 +/- 0.04, mean +/- standard deviation) than in cirrhotic patients without ascites (0.53 +/- 0.02, p<0.01) and in control subjects (0.50 +/- 0.05, p<0.01). The resistive index in the middle cerebral artery showed direct correlation with renal resistive index (r = 0.52, p<0.01), plasma renin activity (r = 0.44, p<0.01) and norepinephrine (r = 0.33, p<0.05). The resistive index in the middle cerebral artery showed an inverse correlation with mean arterial pressure (r = -.59, p<0.01). CONCLUSION: The results suggest that in patients of cirrhosis with ascites, independent of the amount of ascites, there is a cerebral vasoconstriction which is related with the arterial hypotension and the overactivity of vasoconstrictor systems.
Arterial Pressure ; Arteries ; Ascites* ; Cardiac Output, High ; Fibrosis ; Hemodynamics ; Humans ; Hypertension, Portal ; Hypotension ; Liver Cirrhosis* ; Liver* ; Middle Cerebral Artery ; Norepinephrine ; Plasma ; Portal Pressure ; Renal Circulation ; Renin ; Sympathetic Nervous System ; Ultrasonography, Doppler ; Vascular Resistance ; Vasoconstriction ; Vasodilation

Retroperitoneal lipoma probably constitute the group of the most massive solid abdominal tumors; their etiology is unknown; their symptoms insidious; and recurrence and sarcomatous change frequent. The clinical diagnosis was made by clinical symptoms, physical findings and radiologic evaluation such as intravenous urography, ultrasonography, computed tomography, angiography and so on. Abdominal CF scan provided clinically the most useful information regarding the state of tumors and also their effect on adjacent structures and shows homogenous appearing fat tissue with a low attenuation coefficient identical to that found in the subcutaneous fat. We present a case of treatment for a huge retroperitoneal lipoma in a 46-year-old man.
Angiography ; Diagnosis ; Humans ; Lipoma* ; Middle Aged ; Recurrence ; Subcutaneous Fat ; Ultrasonography ; Urography

STUDY DESIGN: A prospective study. OBJECTIVES: To evaluate the effectiveness of ultrasound guidance in caudal epidural block and sonographic feature of sacral hiatus. SUMMARY OF LITERATURE REVIEW: High success rate of ultrasound-guided regional nerve block has been reported and recently, ultrasound-guided nerve block in spinal field has been introduced. MATERIALS AND METHODS: Ultrasound-guided caudal epidural block was performed in 48 patients with radiating pain to leg. Patient was placed in the prone position and sonographic image of sacral hiatus was obtained using linear probe. After measuring the intercornual distance, thickness of sacrococcygeal membrane and depth of sacral canal in transverse view, then the probe was rotated 90degrees to obtain the longitudinal view of the sacral hiatus. Under ultrasound guidance, a 21-gauge needle was inserted into the sacral hiatus in parallel with sacrum base. After contrast dye injection, needle placement was checked by the fluoroscopy and then medication was injected into the caudal epidural space. We investigated the change of radiating pain after caudal epidural block using visual analogue scale(VAS). RESULTS: The intercornual distance was mean 16.4+/-2.3mm, thickness of sacrococcygeal membrane was mean 2.8+/-0.9mm and depth of sacral hiatus was mean 2.6+/-0.9mm. There was 97.9% success rate of the caudal epidural block under ultrasound guidance. The mean VAS for radiating pain was improved from 7.5+/-0.7 before the block to 2.8+/-1.5 after the block. CONCLUSIONS: Ultrasound-guided caudal epidural block seems to provide good anatomical landmark of sacral hiatus and an effective tool with high success.
Epidural Space ; Fluoroscopy ; Humans ; Leg ; Membranes ; Needles ; Nerve Block ; Prone Position ; Prospective Studies ; Sacrum ; Ultrasonography*

BACKGROUND: The relatively recently developed I-gel (Intersurgical Ltd., Workingham, England) is a supraglottic airway device designed for single-use that, unlike conventional LMAs, does not require an inflatable cuff. In addition, the I-gel, much like the Proseal LMA (PLMA), has a gastric drainage tube associated with an upper tube for decompression of the stomach, thereby avoiding acid reflux and decreasing the risk of pulmonary absorption. The purpose of this study was to compare PLMA and I-gel devices in patients undergoing gynecological laparoscopy based on sealing pressure before and during pneumoperitoneum, insertion time, and gas exchange. METHODS: Following Institutional Review Board approval and written informed consent, 30 adult patients were randomly allocated to one of two groups (the PLMA or I-gel group). In each case, insertion time and number of attempts were recorded. After successful insertion, airway leak pressure was measured. RESULTS: Successful insertion and mechanical ventilation with both supraglottic airway devices was achieved on the first attempt in all 30 patients, and there were no significant differences with respect to insertion time. Likewise, leak pressure did not vary significantly either between or within groups after CO2 insufflation. In addition, differences between leak volume and leak fraction between groups were not significant. CONCLUSIONS: The results of our study indicate that the I-gel is a reasonable alternative to the PLMA for controlled ventilation during laparoscopic gynecologic surgery.
Absorption ; Adult ; Decompression ; Drainage ; Equipment Design ; Ethics Committees, Research ; Female ; Gynecologic Surgical Procedures ; Humans ; Informed Consent ; Insufflation ; Laparoscopy ; Pneumoperitoneum ; Respiration, Artificial ; Stomach ; Ventilation

BACKGROUND: The purpose of this study was to assess the effect of rocuronium pretreatment on the succinylcholine induced biochemical changes and fasciculations, myalgia and to compare it with vecuronium pretreatment. METHODS: We have studied 60 patients undergoing minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each were pretreated with saline 0.01 ml/kg (group C), rocuronium 0.05 mg/kg (group R), or vecuronium 0.007 mg/kg (group V). Three minutes after the pretreatment, 1.5 mg/kg succinylcholine was injected. Serum potassium five minutes after succinylcholine and creatine kinase 24 hr after operation were measured. Fasciculations and postoperative myalgia at 24 and 48 h were evaluated. RESULTS: The increase in creatine kinase and incidence of fasciculations were lowest in the rocuronium group (33 IU/L; 15%) and followed by vecuronium group (58 IU/L; 50%) and highest in the control group (101 IU/L; 100%). The increase in serum potassium concentration (0.3 mEq/L) was not attenuated by any regimen. The incidence of postoperative myalgia on day 1 and day 2 was lower in the rocuronium (40%, 30%) and the vecuronium (50%; 35%) group than control group (85%; 75%). CONCLUSIONS: Rocuronium pretreatment is more effective in reducing creatine kinase rise and fasciculations after succinylcholine than vecuronium. However rocuronium and vecuronium are also effective in preventing postoperative myalgia.
Creatine Kinase ; Fasciculation ; Humans ; Incidence ; Myalgia* ; Potassium ; Prospective Studies ; Succinylcholine* ; Vecuronium Bromide

The major goals of periodontal therapy are the functional regeneration of periodontal supporting structures already destructed by periodontal disease. There have been many efforts to develop materials and therapeutic methods to promote periodontal wound healing. With the development of non-resorbable membrane, GTR has proved to be the representive technique of periodontal regeneration. However, due to various clinical problems of non-resorbable membrane, resorbable membrane was developed and it showed to be clinically effective. The newly developed Para-Dioxanone membrane has a characteristic of non-woven fabric structures which is different from the generally used membranes with structure of mesh form. In addition, Chitosan membrane has been developed to apply its adventage maximally in GTR. Although a number of different types of membranes had been clinically used, researches on absorption rate of membranes were inadequate and limited to subjective opinions. However, since long term period of resorption and space maintenance are required in implant or ridge augmentation, accurate verification of resorption rate is clinically important. In this study, we had implanted Resolut(R), Biomesh(R), Para-Dioxanone membrane and Chitosan membrane (Size : 4mmx4mm) on dorsal side of Sprague Dawley rat, and sacrificed them after 4 weeks, 8 weeks, 12 weeks respectively. Histologic observation was carried out, and the following results were obtained by calculating the objective resorption rate. 1. In case of Resolut(R), external resorption took place initially, followed by internal resorption. Surface area are 5.76+/-2.37mm2, 4.91+/-1.06mm2, 4.90+/-0.98mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 31.6+/-4.5%, 52.8+/-9.4%, 56.4+/-5.1% respectively. 2. Biomesh(R) showed a pattern of folding, relatively slow resorption rate with small size of membrane. Surface area are 3.62+/-0.82mm2, 3.63+/-0.76mm2, 4.07+/-1.14mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 26.1+/-5.8%, 30.9+/-3.4%, 29.2+/-3.6%, respectively. 3. Para-Dioxanone membrane was surrounded by fibrous conncetive tissue externally, and resorption took place internally and externally. Surface area are 5.96+/-1.05mm2, 4.77+/-0.76mm2, 3.86+/-0.84mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 30.7+/-5.1%, 53.3+/-4.4%, 69.5+/-3.1%, respectively. 4. Each fiber of Chitosan membrane was surrounded by connective tissue and showed external resoption pattern. It showed little invasion of inflammatory cells and excellent biocompatability. The resorption rate was relatively slow. Surface area are 6.01+/-2.01mm2, 5.49+/-1.3mm2, 5.06+/-1.38mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 31.3+/-3.6%, 38.4+/-3.8%, 39.7+/-5.6%, respectively. Consequently, Para-Dioxanone membrane and Chitosan membrane are found to be clinically effective for their excellent tissue reaction and biocompatibility. Futhermore, the advantage of bone regenerating ability as well as the relatively long resorption period of Chitosan membrane, it might be widely used in implant or ridge augmentation.
Absorption ; Animals ; Chitosan ; Connective Tissue ; Membranes* ; Periodontal Diseases ; Rats ; Regeneration ; Space Maintenance, Orthodontic ; Wound Healing