BACKGROUND: The goal of this study was to demonstrate the effect of esmolol to prevent reflex tachycardia occurred during sodium nitroprusside(SNP) induced hypotension. METHODS: Thirty patients were randomly assigned to the SNP group(n=15) received continuous infusion of SNP at 2.72+/-0.56 mcg/kg/min or combined SNP and esmolol(SNP-ESM) group(n=l5) received combined continuous infusion of SNP at 1.54+/-0.34 mcg/kg/min and esmolol at 200 mcg/kg/min for 1 hour to maintain a 20~25% reduction of mean arterial pressure(MAP) from baseline. Heart rate(HR) and MAP were measured at baseline, during hypotensive period(5, 10, 20, 30, 60 min) and after hypotensive period(70, 80, 90,1 20 min). RESULTS: SNP-induced hypotension resulted in significant(P<0.001) increases in heart rate during hypotensive period and MAP after the end of SNP infusion. However, infusion of SNP-ESM resulted in significant(p<0.05) reduction in heart rate and SNP requirement during hypotensive period, and rebound hypertension was not observed after the end of induced hypotension. CONCLUSIONS: SNP-ESM infusion is a safe and effective pharmacologic means and provides several advantages over single SNP that include reduction in SNP requirement, no reflex tachycardia during induced hypotension and no rebound hypertension following hypotensive period.
Heart Rate* ; Heart* ; Humans ; Hypertension ; Hypotension* ; Nitroprusside* ; Reflex ; Sodium* ; Tachycardia

BACKGROUND: The goal of this study was to demonstrate the effect of esmolol to prevent reflex tachycardia occurred during sodium nitroprusside(SNP) induced hypotension. METHODS: Thirty patients were randomly assigned to the SNP group(n=15) received continuous infusion of SNP at 2.72+/-0.56 mcg/kg/min or combined SNP and esmolol(SNP-ESM) group(n=l5) received combined continuous infusion of SNP at 1.54+/-0.34 mcg/kg/min and esmolol at 200 mcg/kg/min for 1 hour to maintain a 20~25% reduction of mean arterial pressure(MAP) from baseline. Heart rate(HR) and MAP were measured at baseline, during hypotensive period(5, 10, 20, 30, 60 min) and after hypotensive period(70, 80, 90,1 20 min). RESULTS: SNP-induced hypotension resulted in significant(P<0.001) increases in heart rate during hypotensive period and MAP after the end of SNP infusion. However, infusion of SNP-ESM resulted in significant(p<0.05) reduction in heart rate and SNP requirement during hypotensive period, and rebound hypertension was not observed after the end of induced hypotension. CONCLUSIONS: SNP-ESM infusion is a safe and effective pharmacologic means and provides several advantages over single SNP that include reduction in SNP requirement, no reflex tachycardia during induced hypotension and no rebound hypertension following hypotensive period.
Heart Rate* ; Heart* ; Humans ; Hypertension ; Hypotension* ; Nitroprusside* ; Reflex ; Sodium* ; Tachycardia

BACKGROUND: Clonidine, which is known to have analgesic and sedative properties, has recently been shown to be an effective preanesthetic medication in humans. The drug may cause side effects, including bradycardia and hypotension. This study was conducted to evaluate the ability of intravenous atropine to increase the heart rate (HR) in awake adults receiving clonidine preanesthetic medication. METHODS: We studied HR responses to intravenous atropine in 45 patients assigned randomly to either a control group, who received no medication (group 1, n=15), or clonidine groups, who received oral clonidine of 2~2.5 mcg/kg (group 2, n=15), or 4.5~5 mcg/kg (group 3, n=15) 90 min before scheduled induction of anesthesia. When HR and blood pressure had been confirmed to be stable in operating room, all patients received incremental doses of atropine, 2.5, 2.5 and 5 mcg/kg at 2-min intervals. The HR and mean arterial pressure were recorded at 1-min intervals. RESULTS: Before atropine injection, the HR decreased significantly (P<0.05) in group 3. The increases in HR in response to a cumulative dose of atropine 10 mcg/kg were 21+/-8, 17+/-7 and 7+/-5 beats/min (mean+/-SD) in group 1, 2 and 3, respectively (P<0.05). The positive chronotropic response to intravenous atropine was attenuated significantly only in group 3 (P<0.01). CONCLUSIONS: It was concluded that oral clonidine of 4.5~5 mcg/kg decreased HR significantly, and blunted the increase in HR after intravenous atropine in awake adults although oral clonidine of 2~2.5 mcg/kg did not.
Adult* ; Anesthesia ; Arterial Pressure ; Atropine* ; Blood Pressure ; Bradycardia ; Clonidine* ; Heart Rate* ; Heart* ; Humans ; Hypotension ; Operating Rooms ; Preanesthetic Medication

No abstract available.
Cryptorchidism* ; Humans ; Infant* ; Male

OBJECTIVE: We studied clinical characteristics of patients have endometriosis to provide basic knowledge for diagnosis, treatment, and futher study of endometriosis. METHODS: We have performed a retrospective clinical study on 163 patients diagnosed with endometriosis during laparotomy, cesarean section, laparoscopic surgery at our medical center from January, 2000 to December, 2004. RESULTS: Incidence of endometriosis was 4.38%. The more frequent occurrence was noted in the young women with low parity and in the nulliparous women. Most frequent symptom comprised dysmenorrhea and lower abdominal pain. 33.7% of patients were asymptomatic. And 82.3% of the patients were in stage III and IV. The frequent sites involved were ovaries, Cul-de sac, uterus, tubes, peritoneum and rectum in order. Frequently combind gynecologic disease were uterine myoma, benign ovarian tumor. In Stage III & IV, there are more patients, who had abnormal elevated serum CA 125 level than patients of stage I & II. CONCLUSION: Early diagnose and appropriate management of Endometriosis for young women can lowered the development of hihger stage case and it is important for fertility and better life quality.
Abdominal Pain ; Cesarean Section ; Diagnosis ; Dysmenorrhea ; Endometriosis* ; Female ; Fertility ; Genital Diseases, Female ; Humans ; Incidence ; Laparoscopy ; Laparotomy ; Leiomyoma ; Ovary ; Parity ; Peritoneum ; Pregnancy ; Quality of Life ; Rectum ; Retrospective Studies ; Uterus

OBJECTIVE: The aim of this study is to determine prognostic factor affecting the mode of delivery in women with one previous low transverse cesarean section by comparing success group with failure group in Vaginal birth after cesarean (VBAC). METHODS: In this retrospective study, 79 patients with one previous low transverse cesarean section who attempted vaginal birth at Jeon-Ju Jesus Presbyterian hospital from January 1, 1997 to December 31, 2007. Information was collected and analyzed to see if there is significant difference between success group and failure group in VBAC. and the significance was set at P<0.05. RESULTS: The VBAC success rate turned out to 88.6%. There was one case of uterine rupture which was associated with hypoxic -ischemic encephalopathy in neonate. But, there was no case of the fetal death or mother death. There were significant difference between two groups in gestational age, expected fetal body weight, cervical dilation, Bishop score, thickness of lower uterine segment. CONCLUSION: The prognostic factors on success of VBAC can be aid in deciding the mode of delivery after cesarean section. Patient being chosen under strict indication, can enhance the VBAC trial and success rate.
Cesarean Section ; Female ; Fetal Death ; Fetal Weight ; Gestational Age ; Humans ; Infant, Newborn ; Lipids ; Mothers ; Parturition ; Pregnancy ; Protestantism ; Quaternary Ammonium Compounds ; Retrospective Studies ; Uterine Rupture ; Vaginal Birth after Cesarean

Wilms' tumor is the most common renal malignancy in childhood. However Wilms' tumor originating in horseshoe kidney is rare. We present a case of Wilms' tumor arising from the isthmus of horseshoe kidney, and aim to highlight the problems faced in the diagnosis and management.
Diagnosis ; Kidney* ; Wilms Tumor*

PURPOSE: Hydroxychloroquine has been used as the antimalarial agent and drug of the treatment for autoimmune disease such as rheumatoid arthritis. Hydroxychloroquine retinopathy can cause serious visual disturbance although the incidence is low. This report is to describe a case of Hydroxycholoroquine retinopathy on 73 year old female. CASE SUMMARY: A 73 year old female patient presented our clinic with complaints of visual disturbance for several months. She had taking 400 mg/day (8.8 mg/kg of lean body weight/day) of hydroxychloroquine for 2 years. The best corrected visual acuity was 20/30 in both eyes. Bull's eye maculopathy was observed on her fundus examination and Humphrey Automated Visual Field 24-2 showed central scotoma in both eyes. Parafoveal thinning of photoreceptor layers, loss of the inner and outer segment junction and external limiting membrane was observed on spectral domain Optical Coherence Tomography. Window defect was visible at the parafoveal area on fluorescein angiography. Electroretinogram revealed subtle dysfunction of cone cell and multifocal ERG trace array showed decreased amplitudes at the parafoveal area. Electrooculogram showed decreased Arden ratio. CONCLUSIONS: We strongly advise that all patients taking Hydorxycholoroquine therapy have a regular examination to find hydroxychloroquine retinopathy in early stage especially in the patients having high risk factors.
Arthritis, Rheumatoid ; Autoimmune Diseases ; Electrooculography ; Eye ; Female ; Fluorescein Angiography ; Humans ; Hydroxychloroquine ; Incidence ; Membranes ; Risk Factors ; Scotoma ; Tomography, Optical Coherence ; Visual Acuity ; Visual Fields

Keloids are abnormal wound reactions, which develop from connective tissue as a result of skin trauma such as inflammation, burns, piercing or surgery in predisposed individuals. This fibrous growth extends beyond the boundaries of the original wound and rarely regresses. Keloids have a thick and glassy appearance. These characteristics distinguish keloids from hypertrophic scars, which are confined to the original wound and show spontaneous regression. Despite of various treatment options, there is no consensus on the best way to treat keloids. Surgical excision followed by radiation therapy is considered to be the most effective treatment available for severe recurrent keloids. We present three cases of patients with recurred keloids in the auricle, which were treated with surgical excision and adjuvant radiation therapy.
Burns ; Cicatrix, Hypertrophic ; Connective Tissue ; Consensus ; Humans ; Inflammation ; Keloid ; Recurrence ; Skin

Mucosal melanoma is a very rare disease. Most cases of mucosal melanoma have their origins in the head and neck region. To date, only three cases of melanoma originating from the eustachian tube have been reported. We present a case of mucosal melanoma of eustachian tube origin in which a complete excision was performed. The treatment of mucosal melanoma is not well established, but surgical excision is considered to be the treatment of choice. Radiotherapy is controversial but given consideration in the present case because of the anatomic complexity and difficulty in performing a complete excision. In this case, the patient underwent adjuvant radiotherapy and the mass size was greatly decreased which aided the subsequent surgical excision. Systemic chemotherapy was not utilized in this case. However, it is often used for palliative purposes. A literature review was conducted in the presentation of this case.
Drug Therapy ; Eustachian Tube* ; Head ; Humans ; Melanoma* ; Neck ; Radiotherapy ; Radiotherapy, Adjuvant ; Rare Diseases