The incidence of conjoined twins is so rare that few anesthesiologists have an opportunity of managing them. Especially in Korea, there are only a few reports describing the anesthetic management for surgical separation of newborn conjoined twins. We experienced the successful anesthetic management for surgical separation of thoraco-xiphopagus conjoined twins without any particular problems. After applying the noninvasive monitors (ECG, pulse oximeter), one of the twins (twinA) with congenital heart disease was administered with intravenous ketamine for induction of anesthesia and intubated without neuromuscular blocker. Anesthesia was maintained with N2O-O2 and hand ventilation using Mapleson D breathing circuit. After maintaining airway of the twinA, the twinB was intubated and maintained with the same manner. Eighteen days after the separation procedure, the twinA with congenital heart disease died and the other one, twinB has been alive with normal growth and development.
Anesthesia ; Growth and Development ; Hand ; Heart Defects, Congenital ; Humans ; Incidence ; Infant, Newborn ; Ketamine ; Korea ; Neuromuscular Blockade ; Respiration ; Twins, Conjoined* ; Ventilation

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

Objective: Vasospasm remains the leading cause of cerebral damage after aneurysmal subarachnoid hemorrhage. Although magnesium regulates the calcium influx in vascular smooth muscle and endothelial cells, it has not been reported whether L-type calcium channels are involved in magnesiuminduced vascular relaxation in rat basilar artery. So, the effect of magnesium sulfate on L-type calcium currents in freshly isolated smooth muscle cells from rat basilar artery was investigated. Methods: The smooth muscle cells were isolated from rabbit basilar artery by enzyme treatment. L-type Ca2+ currents were identified using cesium chloride, a potassium channel blocker and Bay K8644, an activator of L-type Ca2+ channel. Currents were recorded under step pulse whole cell patch clamp technique. Results: In the presence of cesium chloride (in pipette solution), inward currents were observed by depolarizing step pulses. The inward currents were significantly reduced by nimodipine (n=4, p<0.05), an L-type Ca2+ channel blocker and increased by Bay K8644 (n=5, p<0.05), an L-type Ca2+ channel activator. The L-type calcium currents (156±17.0 pA, n=12) were significantly reduced by the application of 5 mM magnesium sulfate (53.8±7.0 pA, n=12, p<0.01). Conclusion: These results suggest that magnesium may relax cerebral vessel of rat basilar artery through decreasing intracellular Ca2+ ion by inhibition of L-type Ca2+ channels.

No abstract available.
Female ; HELLP Syndrome* ; Pregnancy

Dental Implants ; Female ; Follow-Up Studies ; Gingivitis ; Humans ; Male ; Membranes ; Prognosis ; Prosthodontics ; Retrospective Studies ; Sinusitis ; Survival Rate ; Tooth ; Transplants

Follow-Up Studies ; Humans ; Mandible ; Orthognathic Surgery ; Osteotomy ; Osteotomy, Sagittal Split Ramus ; Prognathism ; Recurrence

BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.
Arteries ; Bradycardia ; Catheters ; Coronary Vessels ; Humans ; Hypotension ; Stents

BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.
Arteries ; Bradycardia ; Catheters ; Coronary Vessels ; Humans ; Hypotension ; Stents

BACKGROUND: Pneumonia is the most common cause of death among patients with infectious disease in Korea. However, studies of pneumonia with septic shock in patients presenting to the emergency department are limited. The aim of this study was to investigate the prognostic factors associated with pneumonia with septic shock in patients presenting to the emergency department. METHODS: From January 2008 to September 2014, patients with pneumonia with septic shock admitted through the emergency department were retrospectively examined. RESULTS: Of the 561,845 patients who visited the emergency department, 398 were admitted for pneumonia with septic shock. The 28-day mortality rate in these patients was 36.4%. The independent prognostic factors were old age (>70 yrs) (odds ratio [OR], 2.42; 95%, confidence interval [CI], 1.35-4.32), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.04; 95% CI, 1.01-1.08), leukopenia (OR, 3.63; 95% CI, 1.48-8.94), prolonged PT-INR (OR, 2.53; 95% CI, 1.41-4.54), and hypoxemia (OR, 2.88; 95% CI, 1.30-6.38). CONCLUSIONS: A poor prognosis of patients with pneumonia is associated with old age (>70 yrs), increased APACHE II score, leukopenia, prolonged PT-INR, and hypoxemia.
Anoxia ; APACHE ; Cause of Death ; Communicable Diseases ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Korea ; Leukopenia ; Mortality ; Pneumonia* ; Prognosis ; Retrospective Studies ; Shock, Septic*

The severe form of chronic periodontitis(CP) has been reported to be strongly associated with the presence of allele 2 of composite IL-1B(+3954) and IL-1A(+4845) genetic polymor- phisms(genotype positive). However, other studies have reported conflicting findings. These might have resulted from differences in ethnic background and disease entities. The aim of this study was to determine the distribution of IL-1A(+4845), IL-1B(+3954), IL-1B(-511), and IL-1 RN(VNTR) genetic polymorphisms in children as a future Korean population. The study population consisted of 92 children from the Dept. of Pediatric Den- tistry, Chonnam National University Hospital. Genomic DNA was obtained from buccal swab. The IL-1A(+4845), IL-1B(+3954), and IL-1B(-511) genes were genotyped by amplifying the polymorphic region using multiplex polymerase chain reaction(PCR), followed by restriction enzyme digestion and gel electrophoresis. IL-1 RN(VNTR) polymorphism were then evaluat- ed by PCR amplification and fragment size analysis in agarose gel. The allele 2 frequency was 41.3%, 4.3%, 47.8%, and 9.9% for IL-1A(+4845), IL-1B(+3954), IL-1B(-511), and IL-1 RN respectively. The frequency of genotype with allele 2 carriage for IL-1A(+4845), IL-1B(+3954), IL-1B(-511), and IL-1 RN was 77.1%, 7.6%, 63.0%, and 15.2% respectively. The allele 2 frequency in IL-1B(+3954) was significantly higher in female than in male population(p<0.05). The negative association was shown between the presence of allele 2 in IL-1B(-511) and in IL-1B(+3954), and the carriage rate of IL-1B(+3954) allele 2 tended to lower in IL-1B(-511) allele 2(P=0.056). Only 7.3% of children carried the composite genotype of IL-1A(+4845) and IL-1B(+3954). These results suggest that the polymorphism of IL-1B(+3954) and the positive composite genotype was relatively rare in Korean population.
Alleles ; Child* ; Digestion ; DNA ; Electrophoresis ; Female ; Genotype ; Humans ; Interleukin-1* ; Jeollanam-do ; Male ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Sepharose