No abstract available.
Hemolytic-Uremic Syndrome* ; Mycoplasma Infections* ; Mycoplasma*

Since the introduction of percutaneous mitral valvotomy(PMV) in 1984, PMV was an effecive alternative to surgical commissurotomy in selected patients with severe mitral stenosis. Also PMV was an excellent palliative strategy in such patients who were high risk for operative management or longterm anticoagulation was not feasible. We performed PMV in a patient with very tight mitral stenosis and severe pulmonary hypertension under the general anesthesia because the patient was anticipated to be uncooperative due to mental problem, who was diagnosed as schizophrenia 16 years ago. Robinol was used for premedication and i.v fentanyl was used for maintenance of anesthesia. Inoue balloon was introduced into the LV and gradual ballooning was performed with favorable results. Total anesthesia time and interval from internal jugular vein puncture to the completion of valvuloplasty were 1 hour 45 min and 40 minutes respectively. Hemodynamic variables were improved immediately after intervention and mitral valve area was increased from 0.5cm2 to 1.3cm2.
Anesthesia ; Anesthesia, General* ; Fentanyl ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Jugular Veins ; Mitral Valve ; Mitral Valve Stenosis* ; Premedication ; Punctures ; Schizophrenia*

No abstract available.
Fetal Blood* ; Humans ; Infant, Newborn* ; Insulin*

Percutaneous balloon mitral valvuloplasty(PMV) was comparable to surgical commissurotomy in initial and long term follow-up results in selected patients with symptomatic severe mitral stenosis. Transseptal puncture was necessary for antegrade introduction of balloon. In patient with kyphoscoliosis, PMV was relatively contraindicatied due to difficulty and risk of septal puncture. We performed the PMV in a patient with kyphoscoliosis and severe mitral stenosis. The patient was presented with NYHA class III. Echocardiographic evaluation revealed mitral valve area of 0.8cm2 and mean diastolic pressure gradient of 12mmHg. X-ray film of T-L spine showed severe kyphoscoliosis. Transseptal puncture was possible with modification of angle of Brockenbrough needle at the site of 15cm from the needle tip. After transseptal puncture, Inoue balloon was introduced into the LV and gradual ballooning was performed with optimal results. Hemodynamic variable were improved immediately after intervention and mitral valve area was increased from 0.7cm2 to 1.8cm2. Patient was discharged with NYHA class I.
Blood Pressure ; Echocardiography ; Follow-Up Studies ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Needles ; Punctures ; Spine ; X-Ray Film

PURPOSE: To report a case of retinal blot hemorrhage localized to 1 eye accompanied by Raynaud's phenomenon. CASE SUMMARY: A 65-year-old female was referred for vision disorder in the right eye. She had been taking an antihypertensive drug since diagnosed with systemic hypertension 2 years previously. On initial examination, her best corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye and intraocular pressure was 15 mm Hg in the right eye and 21 mm Hg in the left eye. Fundus examination showed retinal blot hemorrhage across the entire retina and increased retinal vascular tortuosity. No specific finding was found on visual field examination, transthoracic ultrasonography and carotid Doppler ultrasound. The blood test was positive for antinuclear and anticentromere antibodies, thus she was referred to the rheumatologic department. The patient was diagnosed with primary Raynaud's phenomenon because no correlation with other rheumatologic diseases was found. Subsequently, she was scheduled for regular follow-ups with a prescription of circulatory stimulant. Five months later, her best corrected visual acuity was 20/20 in the both eyes and retinal blot hemorrhage in the right eye was significantly decreased based on fundus examination. CONCLUSIONS: In the case of atypical retinal blot hemorrhage without other ophthalmic causes except Raynaud's phenomenon, the change in retinal circulatory autoregulation associated with the mechanism of retinal blot hemorrhage can be presumed. Therefore, a close examination and history taking should be conducted so that Raynaud's phenomenon as a pathological factor is not overlooked.
Aged ; Antibodies ; Female ; Fibrinogen ; Follow-Up Studies ; Hematologic Tests ; Hemorrhage* ; Homeostasis ; Humans ; Hypertension ; Intraocular Pressure ; Prescriptions ; Retina ; Retinaldehyde* ; Ultrasonography ; Vision Disorders ; Visual Acuity ; Visual Fields

BACKGROUND: Tracheal extubation can be performed while patients are deeply anesthetized or when they are awake. Each technique has its own advantages and disadvantages. But necessity for deep extubating conditions, and what level of anesthesia is adequately deep, is still controversial. Clinical conditions of patients or the preference of the anesthesiologist has dictated the choice of extubation technique. METHOD: Anesthesia was induced and maintained as usual manners. The 49 healthy children between 3 and 12 year of age undergoing tonsillectomy and adenoidectomy were randomly assigned to group 1(extubation at 1 MAC of enflurane) and group 2(awake extubation). SpO2 and airway-related complications(cough, breath-holding, airway obstruction, and laryngospasm) were observed for 5 minutes after extubation with 100% O2 by mask, and SpO2 and heart rate were measured for 90 seconds during transportation to the recovery room with room air breathing. RESULTS: The total incidence of airway-related complications in group 2 were higher than in group 1. However, group 1 showed severer complications than in group 2 such as airway obstruction and laryngospasm. There was no differences between the two groups in SpO2 and heart rate changes with 100% O2 mask just after extubation and during transportation. Group 1 showed higher SpO2 than group 2 upon arrival in the recovery room. CONCLUSION: We concluded that in healthy children undergoing elective oral surgery, airway-related complications are likely to be influenced more by the skill, experience and preference of the anesthesiologist than by the method alone.
Adenoidectomy ; Airway Extubation ; Airway Obstruction ; Anesthesia ; Child* ; Heart Rate ; Humans ; Incidence ; Laryngismus ; Masks ; Recovery Room ; Respiration ; Surgery, Oral ; Tonsillectomy ; Transportation

Not infrequently, we meet urgent situations that emergency cardiac pacing is inevitable. Paricularly, in patients with impending brady-asystole cardiac arrest, we cannot but introduce pacing cartheter without fluroscopic guidance in emergency department if transcutaneous pacing is not available. There is little report about emergency transvenous cardiac pacing without fluoroscopic guidance in patients with impending cardiac arrest in korea. We report our experiences of temporary transvenous pacing by blind approach performed in patients with impending bradyasystolic cardiac arrest in emergency department. Among 10 patients who blind pacing were performed. 7 were successfully paced and 3 were not. 5 of 7 patients with successful pacing died of underlying diseases. 2 patients wiere alive. A hematoma around the puncture site was developed in a patient receiving thrombolytic therapy. We concluded that temporary transvenous pacing withoup fluoroscopy should be tried in the emergency situations if fluoroscopy or transcutaneous pacemaker is not avialable.
Emergencies* ; Emergency Service, Hospital ; Fluoroscopy* ; Heart Arrest* ; Hematoma ; Humans ; Korea ; Punctures ; Thrombolytic Therapy

BACKGROUND: In korea, significant proportion of victims with out-of-hospital cardiac arrest have no change to survive because some physicians regard the victim with cardiac arrest outside the hospital as the dead and they do not attempt cardiopulmonary resuscitation(CPR). And we cannot expect bystander-initiated CPR and emergency medical system in resuscitating the victims with cardiac arrest. We studies the outcome of resuscitation attempts and the factor associated with survival in patients with out-of-hospital cardiac arrest in current situation of emegency medical system. Method: We attempted cardiopulmonary resuscitation(by standard guidelines) in 74 consecutive victims with non-traumatic out-of-hospital cardiac arrest in emergency department. RESULTS: Of 74 victims with cardiac arrest 35(47%) had no any restoration of spotaneous circulation(ROSC), 26(35%) had transient ROSC but died within 24 hours,6(8%) survived over 24 hours but died in the hospital, and 7(10%) discharged alive. Factors associated with survival were cardiac origin as a cause of cardiac arrest, ventricular fibrillation as a initial ECG rhythm, and short circulatory arrest time. CONCLUSION: Survival rate of victims with non-traumatic out-of-hospital cardiac arrest was 10%. Considering the feasibility to survive, CPR should be attempted in patients with out-of-hospital cardiac arrest if do-no-resusciate(DNR) is not indicated.
Cardiopulmonary Resuscitation ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Korea ; Out-of-Hospital Cardiac Arrest* ; Resuscitation* ; Survival Rate ; Ventricular Fibrillation

No abstract available.
Nausea* ; Ondansetron* ; Vomiting*

PURPOSE: Interleukin(IL)-10 is an antiinflammatory cytokine produced by monocytes/macrophages. Granulocyte colony-stimulating factor(G-CSF) plays an important role, not only as a hemopoietic factor but also as a regulating factor for a biologic defense system by neutrophils, in the foci of infection. We studied G-CSF and IL-10 levels in the serum and cerebrospinal fluid(CSF) of patients with aseptic meningitis and investigated the relationship of G-CSF and IL-10 with other inflammatory cells. METHODS: We measured IL-10 and G-CSF levels in the serum and CSF of children with or without aseptic meningitis using ELISA and compared them with other inflammatory cells in the CSF. RESULTS: CSF levels of IL-10 & G-CSF on admission were significantly higher in the aseptic meningitis group than in the control group. IL-10 and G-CSF levels in the CSF were higher than those in the serum(P<0.001). Mean CSF IL-10 & G-CSF levels during the recovery stage decreased significantly compared to those of the symptomatic stage(P<0.001). Significant correlations were found between CSF IL-10 levels and mononuclear cell counts(r=0.26, P<0.05), and between G-CSF levels and neutrophil counts in the CSF(r=0.44, P<0.005). CSF levels of G-CSF were highest on the 1st day of the illness, although CSF IL-10 levels reached its peak on the 3rd day of the illness. CONCLUSION: IL-10 and G-CSF are produced in the CSF of patients with aseptic meningitis and may play an immunoregulatory role by recruiting inflammatory cells from the peripheral blood at the initial stage of aseptic meningitis.
Cerebrospinal Fluid* ; Child* ; Enzyme-Linked Immunosorbent Assay ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Humans ; Interleukin-10* ; Meningitis, Aseptic* ; Neutrophils