BACKGROUND: Noninvasive estimation of pulmonary artery pressure is an important component of echocardiographic studies. A number of methods are available for estimation of pulmenary pressure, each with varying degrees of reported accuracy. To assess accuracy and difficulties, noninvasive pulmonary artery pressure estimates were performed in infants and children with congenital heart diseases. METHODS: Noninvasive estimates from 8 methods were compared with catheterization measurements. Systolic pressure was estimated by the Burstin method and from perak tricuspid regurgitation velocity, and also from systolic pressure gradients through the VSD(ventricular septal defect) and PDA(patent ductus arteriosus). Mean pressure was estimated by acceleration time divided by ejection time measured from Koppler spectrum obtained at the right ventricular out flow tract. Diastolic pressure was estimated from pulmonary regurgitation velocity spentrum at end-diastolic, and also from diastolic pressure gradient through the patent ductus arteriosus. RESULTS: IN systolic pressure, Burstin and tricuspid regurgitation velocities estimates correlated significantly(r=0.92, 0.90 respectively), whereas VSD and PDA estimates correlated less well with catheterization estimates(r=0.83, 0.65 respectively). The mean pressure, measured from RVOT(right ventricular outflow tract) Doppler spectrum corresponded well with catheterization pressure(r=0.89), whereas those obtained from the main pulmonary artery correlated less well(r=0.74). The diastolic pressure estimates from pulmonary regurgitation velocity spectrum, revealed good correlation(r=0.79), but those from diastolic Doppler spectrum at PDA correlated less well with catheterization estimates(r=0.63). CONCLUSION: All of eight Doppler echocardiographic methods seemed to be easily performable for estimation of pulmonary artery pressure. But, the degree of accuracy was variable. Because a pressure estimante from only a single method may be in error, care should be taken in combining use of other(one or two) methods.
Acceleration ; Blood Pressure ; Catheterization ; Catheters ; Child ; Ductus Arteriosus, Patent ; Echocardiography* ; Echocardiography, Doppler ; Heart Diseases ; Humans ; Infant ; Pulmonary Artery* ; Pulmonary Valve Insufficiency ; Tricuspid Valve Insufficiency

PURPOSE: We reviewed 5 years worth of experience with peritoneal drainage and dialysis in infants who underwent open heart surgery. The aim of this study was to investigate the effect of peritoneal drainage and peritoneal dialysis on fluid balance and several parameters of intensive care. METHODS: Six(10%) of 60 consecutive infants who underwent open heart surgery required peritoneal dialysis during peritoneal drainage. Simple peritoneal drainage was performed in the remaining 54 infants. The silicone rubber peritoneal dialysis catheter was inserted into the center of abdominal cavity just after operation, and subsequent peritoneal drainage was maintained during intensive care. RESULTS: Mean age of the study group was 0.48+/-0.21 years(M: F=32: 28). Early postoperative mortality amang the infants with congenital heart disease was 1.6%. Total amount of output was 7.0+/-2.28mL/kg/hr, urine output 5.14+/-2.9lmL/kg/hr, pleural fluid 0.80+/-0.5lmL/kg/hr, and peritoneal fluid 1.20+/-0.90mL/kg/hr. The ratio of output to intake(O/I) was 1.06. None of the complications required early termination of peritoneal drainage or peritoneal dialysis. Hemodynamics and pulmonary function were maintained steadily during postoperative intensive care. CONCLUSION: The early institution of peritoneal drainage and peritoneal dialysis in infants with congenital heart disease after cardiac operations not only removes fluid, thus easing fluid restriction, but may also improve cardiopulmonary function.
Abdominal Cavity ; Ascitic Fluid ; Catheters ; Dialysis ; Drainage* ; Heart Defects, Congenital* ; Heart* ; Hemodynamics ; Humans ; Infant* ; Critical Care ; Mortality ; Peritoneal Dialysis ; Silicone Elastomers ; Thoracic Surgery ; Water-Electrolyte Balance

BACKGROUND: Vecuronium and Pancuronium have been proven to be associated with nicotinic receptor of skeletal muscle. Generally, nondepolarizing muscle relaxant is associated with contraction of smooth tracheal muscle, but there have been few studies about effects of nondepolarizing muscle relaxant on the smooth tracheal muscle. METHODS: We studied the acetylcholine dose response curve of the tracheal smooth muscle contraction and effects of propranolol, L-NAME after pretreating with vecuronium and pancuronium. RESULTS: Vecuronium shifted the acetylcholine dose-response curve of the tracheal contraction to the left, and pancuronium shifted the curve to the right. Vecuronium and Pancuronium reduced the contraction of smooth tracheal muscle with the use carbachol. Propranolol and L-NAME had no effect on the contraction of smooth tracheal muscle after pretreating with vecuronium and pancuronium. CONCLUSION: We suggest that vecuronium has an anticholinergic effect, while pancuronium has some effect on the muscarinic receptor in addition to its anticholinergic effect.
Acetylcholine ; Animals ; Carbachol ; Muscle, Skeletal ; Muscle, Smooth* ; NG-Nitroarginine Methyl Ester ; Pancuronium* ; Propranolol ; Rats* ; Receptors, Muscarinic ; Receptors, Nicotinic ; Trachea* ; Vecuronium Bromide*

Hunter syndrome is one of the mucopolysaccharidoses, characterized by abnormal accumulation and deposition of mucopolysaccharides in the tissues of several organs which are known to complicate anaesthetic and airway management. We experienced a case of pulmonary edema which developed during induction of general anesthesia of Hunter syndrome after several attempts of intubation and airway obstruction.
Airway Management ; Airway Obstruction ; Anesthesia, General ; Glycosaminoglycans ; Intubation ; Intubation, Intratracheal* ; Mucopolysaccharidoses ; Mucopolysaccharidosis II* ; Pulmonary Edema*

The study of the ultrasonographic urethrogram on the male urethral stricture in 9 patients were performed. We could get the excellent three dimensional figures, which were demonstrating the nature of the urethral strictures in compared to the retrograde urethrogram. The ultrasonographic urethrography was useful in the diagnosis of the anterior urethral stricture, especially, but the delineation of the posterior urethra was difficult.
Diagnosis ; Humans ; Male ; Urethra ; Urethral Stricture*

No abstract available.
Hemorrhage*

Various classifications of congenital anomalies of the extremities and spine have been proposed and are in use. Some are based on anatomy, some on embryology, presumed etiology, or therapeutical approach. An ideal classification would help better understanding and treatment of various kinds of congenital anomalies. It should be simple, logical, and broad enough to include most of the congenital anomalies with minimal confusion. In this paper, we are proposing a functional classification of congenital anomalies of the extremities and spine based upon the concept that development of each organ is processed by differentiation and modulation according to the genetically determined information and by control mechanism at particular moment. We classified congenital anomalies into structural failure where quality of certain tissue is abnormal and functional failure where control mechanisms failed to regulate organogenesis. We divided structural failure into generalized and localized form while we divided functional failure into differentiation and modulation failures. Differentiation failure was subdivided as either forrnation failure or segmentation failure. Formation failure, segmentation failure, and modulation failure were specified according to the timing of failed inhibition and topography.
Classification ; Embryology ; Extremities ; Logic ; Organogenesis ; Spine

BACKGROUND: Opioids are the most widely used drugs to minimize the increase of blood pressure and heart rate in endotracheal intubation during the induction of anesthesia. The purpose of this study was to compare the effects of fentanyl, alfentanil, and remifentanil on the cardiovascular response to laryngoscopic endotracheal intubation. METHODS: Eighty ASA I-II patients were randomly allocated to four groups. The patients received 10 ml intravenous saline (control group), 3microgram/kg fentanyl (fentanyl group), 10microgram/kg alfentanil (alfentanil group) or 0.5microgram/kg remifentanil followed by an infusion of 0.1microgram/kg/min remifentanil (remifentanil group). Anesthesia was induced with propofol and rocuronium and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. The noninvasive blood pressure and heart rate were recorded before induction (baseline), after induction, before intubation, and at 1 min intervals until 5 min after endotracheal intubation. RESULTS: Arterial pressure and heart rate after endotracheal intubation were lower in the fentanyl, alfentanil, and remifentanil groups than in the control group (P < 0.05). There were no significant differences for arterial pressure or heart rate in the fentanyl, alfentanil, and remifentanil groups at any time. There were no significant differences for the incidence of hypotension and bradycardia among the four groups. CONCLUSIONS: Administration of 3microgram/kg fentanyl, 10microgram/kg alfentanil and 0.5microgram/kg remifentanil followed by an infusion of 0.1microgram/kg /min remifentanil have a similar effect in the suppression of the cardiovascular response to laryngoscopic endotracheal intubation during the induction of general anesthesia.
Alfentanil ; Analgesics, Opioid ; Androstanols ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Fentanyl ; Heart Rate ; Humans ; Hypotension ; Incidence ; Intubation ; Intubation, Intratracheal ; Methyl Ethers ; Nitrous Oxide ; Oxygen ; Piperidines ; Propofol

BACKGROUND: Etomidate is an intravenous anesthetic which has properties of hemodynamic stability, minimal respiratory depression, and cerebral protection. Also, it is a useful induction agent for patients compromised by asthma and other reactive airway diseases. The aim of this study was to investigate the effect and action mechanism of etomidate on isolated tracheal smooth muscle in rats. METHODS: The rat's trachea was dissected free, cut into rings (2 mm) and mounted for isometric tension in Tris Tyrode solution. Cumulative dose-response curves for etomidate (3 X 10(-7) 3 X 10 (-4) M) were obtained from the tension measurements of acetylcholine (10 (-5)M)-contracted rings. The effects of propranolol, L-NAME and indomethacin on the etomidate induced tracheal response were investigated. Also, the effect of etomidate on the extracellular Ca2+ influx and Ca2+ release from internal stores was investigated. RESULTS: Etomidate produced relaxation of acetylcholine-precontracted trachea in a dose-dependent fashion. Pretreatment with propranolol, L-NAME had no effects on concentration-response curves to acetylcholine. Pretreatment with indomethacin had an effect on the concentration-response curve to acetylcholine. Pretreatment with etomidate inhibited acetylcholine-induced contractions in the absence of extracelluar Ca2+ and the presence of extracellular Ca2+ . CONCLUSIONS: The tracheal smooth muscle relaxation by etomidate is not related with beta-adrenergic activation and NO synthesis but related with prostaglandin production. The relaxation effect of etomidate is induced by a decrease in concentration of intracellular Ca2+ through the blockade of extracellular Ca2+ influx and the simultaneous release of Ca2+ from internal stores.
Acetylcholine ; Animals ; Asthma ; Etomidate* ; Hemodynamics ; Humans ; Indomethacin ; Muscle, Smooth* ; NG-Nitroarginine Methyl Ester ; Propranolol ; Rats* ; Relaxation ; Respiratory Insufficiency ; Trachea

We examined the hepatitis G virus infections among 227 Koreans who were healthy or were suspected of hepatitis and determined the phylogenetic relationship based on a part of the NS-5 region of 5 positive samples. Viral RNA was extracted from sera and cDNA was synthesized and subsequently amplified by RT-PCR (reverse transcription-polymerase chain reaction) or RT-nested PCR using random hexamer and NS-5 specific primers (470-20-1-77F, 470-20-1-211R, HGVNESTFO, HGVNESTRE). Five positives were found to belong to samples of patients showing symptoms of viral hepatitis. Primers used for PCR or nested PCR were derived from the NS-5 region. On the other hand, no amplification was detected using primers derived from the 5'-NCR (G-146F, G-401R). We performed TA cloning and sequencing of 5 amplified fragments, and their sequences were compared with those of foreign isolates of HGV. The phylogenetic analysis using MegAlign programme of DNAstar has shown that the Korean isolates are clustered on the phylogenetic tree. In summary, we confirmed the hepatitis G virus infection in 5 cases out of 12 patients showing the symptoms of viral hepatitis. The phylogenetic analysis of sequences of 5 amplified fragments showed that their relations to each other were closer than those to the foreign HGV isolates reported.
Clone Cells ; Cloning, Organism ; DNA, Complementary ; GB virus C* ; Hand ; Hepatitis* ; Humans ; Korea* ; Polymerase Chain Reaction ; RNA, Viral