Background: The aim of this study is to investigate the changes in the patterns of power spectra of R-R interval variability of diabetic patients who are subject to autonomic neuropathy. Methods: The changes in power spectra of eight diabetic patients were compared with those of eight normal persons while changing positions from supine to Trendelenburg and from supine to standing each. Results: Low, high and total frequency power densities of diabetic patient group were significantly lower than those of control group in resting supine position. Low frequency power density and ratio of low frequency power to high frequency power of control group increased significantly while changing position from supine to standing compared with those of diabetic patient group. And low frequency power density of control group decreased significantly compared with that of diabetic patient group while changing position from supine to Trendelenburg. Conclusions: The decrease in power densities of low, high and total frequency suggest depressed overall autonomic activities in diabetic patient group and significantly decreased changes in low frequency power and ratio of low frequency power to high frequency power while changing positions from supine to standing suggest attenuated sympathetic activity in diabetic patient group, reflecting autonomic changes in diabetic group rapidly.
Diabetic Neuropathies* ; Humans ; Supine Position

We report a case of Neurofibromatosis in a 19-year-old male who showed a pinkish atrophic patch on the back. He presented with multiple caf au lait macules, neurofibromas and axillary freckling. Cervical and thoracic spine X-ray revealed wedge-shaped bony deformities due to neurogenic tumor involving the vertebral foramina. Histopathologic examination demonstrated dilated vessels in the papillary dermis, decreased collagen in the reticular dermis and entrapped eccrine gland. This case suggests pseudoatrophic macule should be regarded to be a rare cut manifestation in neurofibromatosis. To our best knowledge, this is the first report in korea to show atrophic patch in neurofibromatosis.
Collagen ; Congenital Abnormalities ; Dermis ; Eccrine Glands ; Humans ; Korea ; Male ; Neurofibroma ; Neurofibromatoses* ; Spine ; Young Adult

There are some kinds of neoplasms to be differentiated in the clival area, such as chordoma, invasive pituitary adenoma, craniopharyngioma, trigeminal neuroma, epidermoid cyst, and epidermoid tumor. A 12-year-old girl had admitted with a chief complaint of diplopia. On computed tomography and magnetic resonance(MR) image , cystic mass of about 4cm in diameter which partially destroyed bony structure at posterior part of the clivus was compressing brainstem slightly at anterior direction. This mass showed hyperintensity on T2-weighted MR image, hypointensity on T1-weighted MR image and especially hyperintensity on diffusion image, but no contrast enhancement. So, We suspected a epidermoid cyst and planned biopsy through a transsphenoidal approach. Fortunately, tumor was removed completely. This tumor was considered as epidermoid cyst on MR image. But, it was confirmed as chordoma in pathologic diagnosis. Therefore, we report this case and it may be helpful to make a differential diagnosis in clival cystic chordoma preoperatively that has multilobulation, bony erosion, and calcification on radiologic findings.
Biopsy ; Brain Stem ; Child* ; Chordoma* ; Cranial Fossa, Posterior ; Craniopharyngioma ; Diagnosis ; Diagnosis, Differential ; Diffusion ; Diplopia ; Epidermal Cyst ; Female ; Humans ; Magnetic Resonance Imaging* ; Neuroma ; Pituitary Neoplasms

PURPOSE: To characterize strain-specific differences in radiation response in murine tissues with different radiosensitivity. MATERIALS AND METHODS: Six-week old male mice of 2 strains, C57Bl/6J and C3H/HeJ, were given whole body gamma-radiation with a single dose of 10 or 25 Gy. At different times after irradiation, mice were killed and tissues with different radiosensitivity, thymus and liver, were collected. Each tissue sample was stained with hematoxylin and eosin and apoptotic cells were scored. Expression of p53, Bcl-2, Bcl-x, and Bax was analysed by western blotting and densitometry. RESULTS: Radiation induced massive apoptosis in thymus with a peak level at 8 h after radiation. With 10 Gy irradiation, apoptotic indices in C57Bl/6J and C3H/HeJ were 81.0 2.5% and 59.4 4.0%, respectively (p<0.05). Radiation upregulated the expression of p53, Bcl-x, and Bax, but not Bcl-2; p53 with a peak level of 2.5 fold (C57Bl/6J) and 1.4 fold (C3H/HeJ) at 4 h, Bax with a peak level of 2.6 fold (C57Bl/6J) and 1.3 fold (C3H/HeJ) at 8 h, and Bcl-x with a peak level of 11.1 fold (C57Bl/6J) and 8.2 fold (C3H/HeJ) at 8 h after radiation. In liver, however, radiation-induced apoptosis was minimal (peak apoptotic index of 2.1% in C57Bl/6J and 1.7% in C3H/HeJ). None of p53, Bcl-2, Bcl-x, and Bax was significantly increased. CONCLUSIONS: Induction of apoptosis and regulation of related genes by radiation were tissue specific. Strain difference of radiation-induced apoptosis was well coupled with theinduction of related genes in thymus, a radiosensitive tissue. This study shows that quantitative difference of radiation induced apoptosis by strain is regulated at the gene level with the involvement of multiple genes.
Animals ; Apoptosis* ; Blotting, Western ; Densitometry ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Liver ; Male ; Mice ; Radiation Tolerance ; Thymus Gland

A 23-year-old woman with Down syndrome presented erythematous keratotic plaques with whitish scales on the elbows, forearm, knee and leg. Histopathological findings revealed acanthosis with broad and short rete ridges, alternating orthokeratosis and parakeratosis oriented in both vertical and horizontal directions, and dermal superficial perivascular lymphocytic infiltration, compatible with pityriasis rubra pilaris.
Down Syndrome* ; Elbow ; Female ; Forearm ; Humans ; Knee ; Leg ; Parakeratosis ; Pityriasis Rubra Pilaris* ; Pityriasis* ; Weights and Measures ; Young Adult

BACKGROUND: Postoperative myocardial ischemia has been regarded as one of the major predictors of adverse cardiac outcomes after noncardiac surgery in high risk patients. Many schemes have been proposed to stratify the potential risk of this patient group in more noninvasive and cost-effective ways and analysis of heart rate variability (HRV) is one of them. To uncover the underlying changes in HRV with postoperative myocardial ischemia five analytical methods were introduced; SDNN (standard deviation of normal to normal intervals), SDANN (standard deviation of the mean of normal RR intervals for each 5 min period of the entire electrocardiographic recording), RMSSD (root mean square successive difference, the squre root of the mean of the sum of the squares of differences between adjacent normal RR intervals over the entire electrocardiographic recording), PNN50 (percent of difference between adjacent normal RR intervals that are greater than 50 ms computed over the entire electrocardiographic recording) for linear time domain analysis and approximate entropy for nonlinear complexity analysis. METHODS: Sixteen vascular surgical patients were monitored by an ambulatory electrocardiogram preoperatively and during the first postoperative day (POD1). HRV values analyzed by five different measures were compared between a control group (C group) of eight patients with no postoperative ischemia and a postoperative ischemic group (PI group) of eight with ischemia on POD1. RESULTS: Approximate entropy was the only measure of HRV which was significantly lower in PI group than that of C group (P< 0.01) on POD1. CONCLUSIONS: Approximate entropy, a complexity measure could provide more sensitive information about the physiologic changes associated with postoperative ischemia which could not be obtained from the conventional HRV measures. Time domain analyses can be used as adjuvant measures providing information about the cardiac autonomic regulation.
Electrocardiography ; Entropy* ; Heart Rate* ; Heart* ; Humans ; Ischemia ; Myocardial Ischemia

BACKGROUND: The aim of this study was to investigate the underlying changes in heart rate variability (HRV) of preoperative diabetic patients using five analytical methods; SDNN (standard deviation of normal to normal intervals), SDANN (standard deviation of the mean of normal RR intervals for each 5 min period of the entire electrocardiographic recording), RMSSD (root mean square successive difference, the squre root of the mean of the sum of the squares of differences between adjacent normal RR intervals over the entire electrocardiographic recording), PNN50 (percent of difference between adjacent normal RR intervals that are greater than 50 ms computed over the entire electrocardiographic recording) for linear time domain analysis and approximate entropy for nonlinear complexity analysis. METHODS: HRV values analyzed by five different measures were compared between a control group of ten nondiabetics without any significant systemic disease and a diabetic group of ten patients from the preoperative ambulatory electrocardiographic recordings. RESULTS: Approximate entropy, SDNN and SDANN values were significantly lower in the diabetic group than those of the control group (P< 0.01). CONCLUSIONS: Significantly decreased approximate entropy, SDNN and SDANN could provide information about decreased cardiovascular complexity and sympathetic output, suggesting the nature of dysfunction of the diabetic cardiovascular system.
Cardiovascular System ; Electrocardiography ; Entropy ; Heart Rate* ; Heart* ; Humans ; Nonlinear Dynamics*

Intramural implantation is among the rarest forms of ectopic pregnancy.Since the first description by Perli, 21 cases were reported in worldwide literatures.The pathologic criteria required for intramural pregnancy is that the product of conception is completely surrounded by uterine musculature and is separated from the uterine cavity and the fallopian tube or round ligament.The previous history of uterine injury or adenomyosis is known as possible etiology of intramural implantation. Because the early diagnosis is very difficult, most cases is found after onset of complication such as a uterine rupture or hemoperitoneum. We have recently experienced a case of intramural pregnancy diagnosed and treated by laparoscopy in a 9 weeks gestation nulliparous woman without previous history of uterine injury or disease, and report with a brief review of literatures.
Adenomyosis ; Early Diagnosis ; Fallopian Tubes ; Female ; Fertilization ; Hemoperitoneum ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy, Ectopic ; Uterine Rupture ; Round Ligaments

There has recently been an increased interest in the use of hypertonic saline for the fluid resuscitation of trauma victims and to control intracranial hypertension. In this study, the cerebral and hemodynamic effects of a 3.2% hypertonic saline solution were compared with those of either a 0.9% saline or 20% mannitol solution in a rabbit model of brain injury. Forty-five minutes following the creation of a left hemispheric cryogenic brain lesion, equal volumes of hypertonic saline, 0.9% saline, or mannitol were infused over a 5 minute period. Monitored variables over the ensuing 120 minutes included mean arterial pressure, central venous pressure, intracranial pressure, hematocrit and serum osmolality. Upon conclusion of the two hour study period, regional cortical water content was determined by the specific gravity method. There were no significant differences in mean arterial pressure between the three groups at any point during the experiment. Plasma osmolality was signifieantly increased by 10-11 mOsm/kg in the mannitol and hypertonic groups. The infusion of either mannitol or hypertonic saline produced a transient decrease in intracranial pressure lasting approximately 60 minutes, whereas animals in the saline group demonstrated a continual increase in intracranial pressure. The lesioned hemisphere demonstrated a significantly greater water content than the non-lesioned hemisphere. There was no difference in regional cortical water content at any sampling site between the various groups.
Animals ; Arterial Pressure ; Brain Edema ; Brain Injuries* ; Brain* ; Central Venous Pressure ; Hematocrit ; Hemodynamics* ; Intracranial Hypertension ; Intracranial Pressure ; Mannitol* ; Osmolar Concentration ; Plasma ; Resuscitation ; Saline Solution, Hypertonic ; Specific Gravity

This study was undertaken to determine whether intravenous lidocaine could prevent the acute increase in intraocular pressure associated with laryngoscopy and tracheal intubation. Twenty surgical patients(ASA class 1) who do not have any disease influencing on the intraocular pressure(IOP)(e.g. ophthalmic diseases, diabetes, hypertension, etc.) were studied and divided into two groups, experimental group(n= 10) and control group(n=10). After measurement of preinduction IOP, anesthesia was induced by pentothal 5 mg/kg and vecuronium 0.15 mg/kg, and maintained with 100% oxygen for 3 minutes and baseline IOP was measured. Then, saline and lidocaine(1.5 mg/kg) were injected to controls and experimental group, respectively. One minute and 30 seconds after this, IOP was measured and trachea was intubated. After intubation, anesthesia was maintained with 100% oxygen and 1,5 vo1% halothane and IOP was measured on 1, 3 and 5 minutes after intubation. The results were as follows. 1) One minute and 30 seconds after saline or lidocaine injection(immediately before intubation), IOP was significantly lower in lidocaine group than control group. 2) Peak increases in IOP after intubation were significantly less in lidocaine group than control group. From the above results, the use of 1.5 mg/kg of intravenous lidocaine approximately 1 minute and 30 seconds before tracheal intubation significantly attenuates the increase in IOP. This procedure will be useful in the induction of anesthesia in patients in whom the increase in IOP should be avoided.
Anesthesia ; Halothane ; Humans ; Hypertension ; Intraocular Pressure ; Intubation* ; Laryngoscopy ; Lidocaine* ; Oxygen ; Thiopental ; Trachea ; Vecuronium Bromide