No abstract available.
Dinoprostone* ; Suppositories*

BACKGROUD: Ephedrine has been most commonly used for the prevention and treatment of hypotension occurring frequently during spinal anesthesia for cesarean section. But recent studies reported that phenylephrine was more effective for treatment of maternal hypotension and for prevention of fetal acidosis than ephedrine. We compared effect of phenylephrine, ephedrine, and ephedrine combined with phenylephrine to maternal hypotension and fetal acidosis. METHODS: This study compared ephedrine 2 mg/min infusion with 6 mg bolus (n = 30), phenylephrine 33.3microgram/min infusion with 50microgram bolus (n = 30), and ephedrine combined phenylephrine with half the dose infusion rate & bolus (n = 30). Hypotension, defined as systolic blood pressure less than 100 mmHg and less than 80% of baseline, was treated with additional bolus injection. RESULTS: In ephedrine group, the number of bolus given for hypotension was larger than other groups (P < 0.001), the incidence of hypotension was also higher than other groups (P = 0.02). The heart rate was lower in phenylephrine group than other groups, but bradycardia which needs to be treated didn't occur. Umbilical blood gas analysis and Apgar score were similar for three groups, but only one patient in ephedrine group had fetal acidosis (pH = 7.130). Nausea and vomiting were more frequent in ephedrine group than other groups. CONCLUSIONS: In our study, giving phenylephrine alone was more effective in the prevention and treatment of maternal hypotension and nausea & vomiting than giving ephedrine alone or combined phenylephrine.
Acidosis ; Anesthesia, Spinal* ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Bradycardia ; Cesarean Section* ; Ephedrine* ; Female ; Heart Rate ; Humans ; Hypotension ; Incidence ; Nausea ; Phenylephrine* ; Pregnancy ; Vomiting

BACKGROUND: Local steroid injections for the treatment of carpal tunnel syndrome have become common, but median nerve injuries after the injections have rarely been reported. In our study, we checked the occurrence of a severe pain during local steroid injections through the flexor carpi radialis, and we evaluated the efficacy of injections for several short-term period. METHODS: A total of 24 patients with 32 affected hands were studied. The patients who presented with known medical causes or thenar muscle atrophy or a previous trauma history at the affected wrist were excluded from the study. The diagnosis was made both clinically and electrophysiologically, and then the injections were performed through the flexor carpi radialis with the hand in the supine position. Triamcinolone Acetonide (TA) 40 mg was injected first, and TA 20 mg was reinjected when the recovery rate on a 100 mm visual analog scale (VAS) score was below 50% 1 week after the injection. The patients were reevaluated with the VAS score before and 1, 3 and 6 months after the injections. RESULTS: In our study, no patients reported severe pain indicating there was median nerve injury during the injections. The mean VAS scores were 64.9, 9.5, 31.1 and 47.3 before and 1, 3 and 6 months after the injections respectively. As a result, the injections were deemed for the short-term period (P < 0.05). CONCLUSIONS: In our study, we concluded that local steroid injection through the flexor carpi radialis for treating carpal tunnel syndrome is a safe and effective method.
Carpal Tunnel Syndrome* ; Diagnosis ; Hand ; Humans ; Median Nerve ; Muscular Atrophy ; Supine Position ; Triamcinolone Acetonide ; Visual Analog Scale ; Wrist

BACKGROUND: To investigate the change of corpus callosal area in juvenile myoclonic epilepsy (JME), the mid-sagittal areas of corpus callosum and its seven sub-regions were measured in JME patients and normal subjects. METHODS: Nineteen JME patients (22.6+/-5.0 year-old, 6 males, 13 females) and 19 normal controls (22.9+/-7.3 year-old, 6 males, 13 females) underwent 1.6 mm thickness whole brain SPGR MRI. Exact mid-sagittal image was obtained with image reconstruction and geometric correction. According to Witelson's work, the area of corpus callosum was divided into 7 sub-regions (a1 to a7 from anterior to posterior) with a semi-automated method. In each sub-region, the pixel number was counted according to ROI definition. The whole cerebral volume was measured. The mid-sagittal cerebral area was measured by tracing inner surface of skull and basal cortical surface of the cerebrum except for corpus callosum and cerebellum. The difference of corpus callosum areas between JME patients and normal controls were tested by t-test and ANCOVA. RESULTS: There was no difference in sex [chi-square(1)=1.00, chi square] and age (p=0.941, Mann-Whitney U test). The areas of rostrum (p<0.001) and rostral body (p < or = 0.05) were significantly smaller in JME group by t-test and ANCOVA (adjusted by age and cerebral volume). Cerebral volume and mid-sagittal cerebral area were not different between JME and normal groups (p>0.25, t-test). CONCLUSION: Rostrum and rostral body are significantly smaller in JME patients, which suggests frontal lobe abnormality in JME. This finding is consistent with previous studies reported structural and functional abnormalities of frontal lobe in JME.
Brain ; Cerebellum ; Cerebrum ; Corpus Callosum ; Frontal Lobe ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging* ; Male ; Myoclonic Epilepsy, Juvenile* ; Skull

Noonan syndrome is characterized by typical facies, congenital heart defect, and some clinical features similar to Turner syndrome, but with normal chromosomes. The most commonly associated cardiac defects are pulmonary valvular stenosis and strial septal defect. We experienced a case of Nonan syndrome associated with pulmonay valve stenosis with double-chambered right ventricle and atrial septal defect and cryptorchidism. Pulmonary valvotomy was done through transannular incision. Hypertrophied muscle bundles were excised. Atrial septal defect was closed directly. RVOT was reconstructed with pericardial transannular patch. Orchiopexy was performed simultaneously without any problem.
Constriction, Pathologic ; Cryptorchidism ; Facies ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Heart Ventricles* ; Male ; Noonan Syndrome* ; Orchiopexy ; Turner Syndrome

It already has been known that various ions were participated in phototransduction mechanism of the vertebrate photoreceptor during the visual adaptation. The vitreous humor(VH)contains certain amount of Na+, K+ and Ca++ as well. However, the roles of these ions are unknown except functioning of metabolic process. Our preliminary electroretinogram(ERG) experiments suggested that the permeability of these ions has light dependent activity during the light illumination. We have supported this suggestion more tangibly by trying out various experiments with bullfrog eyes as a reference of visual adaptation. The results are summarized as follows: 1)According to our atomic absorption spectroscopic measurements, the concentration of Na+, K+ and Ca++ in light adapted VH was higher than that of dark adapted VH. This result indicated that the light-dependention transport systems which affect the ionic movements might be in internal limiting membrane(ILM). 2)The amplitude of ERG b-wave was reduced by concentration decrement of Na+ and concentration increment of K+ respectively. On the other hand, the elimination of Ca++ within ringer solution resulted in b-wave amplitude increment. 3)Treatment of Na+ hannel blockers(TTX, STX)and K+ channel blockers(Ba++, Cd++, Cs+, 4-AP and TEA)in the vitreous humor side induced the increment and the decrement of b-wave response respectively. Taken together, these results suggest that the light dependent Na+ K+ channels exist in the ILM of vertebrate retina which participates visual adaptation.
Absorption ; Hand ; Ions ; Light Signal Transduction ; Lighting ; Membranes* ; Metabolism ; Permeability ; Photoreceptor Cells, Vertebrate ; Rana catesbeiana ; Retina ; Vertebrates* ; Vitreous Body

BACKGROUND: Although a number of visual evoked potentials (VEPs) studies have been performed to elucidate the pathophysiology of migraines, their results have been controversial. We studied the pattern-reversal visual evoked potentials (PRVEPs) during long periods of stimulation to show whether or not PRVEPs in migraines are abnormal. METHODS: Patients were divided into two groups; Group 1 (migraine with aura; MWA, n=29) and Group 2 (migraine without aura ; MOA, n=32) according to the International Headache Society criteria. PRVEPs were performed in both groups and in healthy volunteers (n=62). PRVEPs were averaged in 100 responses for a total duration of 10 minutes after an initial 3 minutes during stimulation and were analysed in terms of latencies and peak to peak amplitudes of N1-P1 and P1-N2 peaks. RESULTS: Amplitudes of PRVEPs in migraines showed significant increases compared to normal subjects (p<0.001), and amplitudes of PRVEPs in MWA showed significant increases compared to those in MOA (p<0.05). CONCLUSIONS: These results are explained by cortical hypoexcitability and hyper-responsiveness in migraine and by additional cortical hyper-responsiveness (another hyper-responsiveness) in MWA compared to MOA. We suggest that serotonergic and noradrenergic hyperactivity could be responsible for cortical hypoexcitability and hyper-responsiveness in a migraine brain. Another hyper-responsiveness in MWA could also be thought of as some evidence for cortical neuronal abnormality in MWA in addition to serotonergic and noradrenergic hyperactivity in a migraine brain. (J Korean Neurol Assoc 19(3):239~244, 2001)
Brain ; Epilepsy ; Evoked Potentials ; Evoked Potentials, Visual ; Headache ; Healthy Volunteers ; Humans ; Migraine Disorders* ; Neurons*

We experienced two cases of congenital localized skin defect and neonatal onset of relapsing subepidermal blisters associated with minor trauma in a female newborn infant and her mother. The mother of index case showed toe nail dystrophy at delivery of her daughter, but the index case did not reveal nail dystrophy until 14 months of age. The congenital skin defects healed with hypopigment, and mild atrophic scars and relapsing blisters healed without scars in both mother and daughter. These cases were considered as hereditary Bart's syndrome with respects to family history, clinical manifestations and histopathological findings.
Blister ; Cicatrix ; Epidermolysis Bullosa ; Female ; Humans ; Infant, Newborn ; Mothers* ; Nuclear Family* ; Skin ; Toes

BACKGROUND: In many cases, spinal anesthesia is performed in cesarean section. Many women want postoperative pain control. The purpose of this study was to compare the effects of intravenous patient-controlled analgesia (IV-PCA) and epidural patient-controlled analgesia (Epi-PCA) in patients undergoing cesarean section with spinal anesthesia. METHODS: Forty healthy women were randomly assigned to receive IV-PCA or Epi-PCA after cesarean section with spinal anesthesia. The IV-PCA group received ketorolac 30 mg and butorphanol 0.5 mg intravenously when the peritoneum was sutured, followed by IV-PCA with 0.15% ketorolac and 0.005% butorphanol 100 ml (basal infusion rate 2 ml/hr, bolus 2 ml, lock-out time 15 mins). The Epi-PCA group received 0.01% morphine 10 ml via an epidural catheter when the peritoneum was sutured, followed by Epi-PCA with 0.004% morphine and 0.1% bupivacaine 100 ml (basal infusion rate 2 ml/hr, bolus 2 ml, lock-out time 15 mins). The degree of pain was subjectively evaluated using a visual analogue scale (VAS). Patients were evaluated at 2, 6, 12, 24 and 48 hours after operation. Statistical analyses were performed using T-test, Mann White U test and the Chi-square test. RESULTS: VAS was not significantly different at any time, and the incidences of pruritus and sensory and motor changes of the lower extremities were significantly higher in Epi-PCA than IV-PCA. CONCLUSIONS: Although VAS in the two groups was not significantly different, we conclude that IV-PCA is more beneficial than Epi-PCA in patients undergoing cesarean section with spinal anesthesia, because of the side effects of Epi-PCA.
Analgesia, Patient-Controlled* ; Anesthesia, Spinal* ; Bupivacaine ; Butorphanol ; Catheters ; Cesarean Section* ; Female ; Humans ; Incidence ; Ketorolac ; Lower Extremity ; Morphine ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peritoneum ; Pregnancy ; Pruritus

BACKGROUND: Spinal anesthesia for cesarean section is regaining popularity. The effects of patient variables on the spread of sensory blockade have been reported to vary widely. We evaluated the effects of abdominal circumference, fundus height and cerebrospinal fluid pressure on the spread of sensory blockade following subarachnoid hyperbaric bupivacaine with fentanyl in term parturients. We also evaluated the effects of age, height, weight, body mass index on the spread of sensory blockade. METHODS: Sixty healthy term parturients scheduled for elective cesarean section, were measured for, abdominal circumference, fundus height, cerebrospinal fluid pressure, and received 8 mg of 0.5% hyperbaric bupivacaine with fentanyl 20microgram intrathecally. Maximal sensory block height and blood pressure were assessed. Intraoperative visceral pain was checked as discribed using four grades. RESULTS: Age, weight, abdominal circumference, fundus height and cerebrospinal fluid pressure were not found to be correlated with the spread of sensory blockade. However, height and body mass index correlated with the spread of sensory blockade (P<0.05). CONCLUSIONS: It is necessary to vary the dose of injected hyperbaric bupivacaine according to changes in height and body mass index.
Anesthesia, Spinal* ; Blood Pressure ; Body Mass Index ; Body Weight ; Bupivacaine* ; Cerebrospinal Fluid Pressure ; Cesarean Section ; Female ; Fentanyl ; Humans ; Pregnancy ; Visceral Pain