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

BACKGROUND: This study was designed to determine the efficacy of a combined use of esmolol and nicardipine for blunting hypertension and tachycardia after tracheal intubation in hypertensive patients. METHODS: Forty-five hypertensive patients were randomly divided into three group: group E (esmolol 0.5 mg/kg, n = 15), group N (nicardipine 30microgram/kg, n = 15), group EN (esmolol 0.25 mg/kg, nicardipine 15microgram/kg, n = 15). All patients received midazolam 0.5 mg/kg, and glycopyrrolate 0.2 mg IM for premedication. Fentanyl 1microgram/kg was injected before induction of anesthesia, and then esmolol, nicardipine, or the mixed drugs were administrated as an IV bolus and immediately followed by the induction drugs: thiopental 5 mg/kg, and succinylcholine 1 mg/kg. Endotracheal intubation was performed 90 seconds after injection of the experimental drugs. Thereafter 50% Nitrous Oxide in oxygen and 2 vol % enflurane were inhaled. BP and HR were recorded at the resting state, before fentanyl injection (base {T0}), after injection test drug (T1), after induction (T2), immediately after intubation (T3), 2 min (T4), 3 min (T5), 4 min (T6), and 5 min (T7) after intubation. RESULTS: There was a significant attenuation in SBP, MBP, DBP after tracheal intubation on the nicardipine and mixed groups compared to the esmolol group. HR was significantly lower in the esmolol and mixed groups than in the nicardipine group after tracheal intubation. CONCLUSIONS: Combined administration of esmolol (0.25 mg/kg) and nicardipine (15microgram/kg) was effective in attenuating an increase of BP and HR during tracheal intubation in hypertensive patients.
Anesthesia ; Blood Pressure* ; Enflurane ; Fentanyl ; Glycopyrrolate ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal* ; Midazolam ; Nicardipine* ; Nitrous Oxide ; Oxygen ; Premedication ; Succinylcholine ; Tachycardia ; Thiopental

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

BACKGROUND: The study was designed to compare neonatal outcome biochemically and clinically. We examined the administration of sevoflurane below 1.0% with 50% oxygen and 50% nitrous oxide and spinal anesthesia during elective cesarean section. METHODS: The study examined 60 parturients, who were planned after 36 weeks gestation, ASA I-II, at term undergoing elective cesarean section, and who were allocated to receive 1.0% sevoflurane with 50% oxygen and 50% nitrous oxide (n = 30), and spinal anesthesia (n = 30). General anesthesia was induced with thiopental 5 mg/kg followed by succinylcholine 1.0 mg/kg to facilitate tracheal intubation. Parturients received sevoflurane given in a 50 : 50 oxygen and nitrous oxide mixture, using 0.5-1.0% progressive incremental dosing up to 1.5-2.0 MAC. Spinal anesthesia involving a spinal injection of 8 mg hyperbaric (plain) bupivacaine 0.5% with 20microgram fentanyl was added. A systolic blood pressure of less than 90 mmHg or a reduction in the systolic pressure of greater than 20% from baseline was considered as hypotension and treated with a bolus of 5 mg of intravenous ephedrine. We studied neonatal data including umbilical artery gas analysis results and Apgar scores at 1 and 5 min. RESULTS: Comparing the general and the spinal anesthetic groups, no significant differences could be detected in neonatal outcome biochemically or clinically. CONCLUSIONS: Anesthesia type does not seem to influence the biochemical or clinical results of the neonates delivered by elective cesarean section. We believe that both general anesthesia with sevoflurane and spinal anesthesia could be performed in elective term cesarean sections without risk to neonates.
Anesthesia ; Anesthesia, General* ; Anesthesia, Spinal* ; Blood Pressure ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Female ; Fentanyl ; Humans ; Hypotension ; Infant, Newborn ; Injections, Spinal ; Intubation ; Nitrous Oxide ; Oxygen ; Pregnancy ; Succinylcholine ; Thiopental ; Umbilical Arteries

PURPOSE: We performed this study to evaluate the risk of rehospitalization for respiratory syncytial virus(RSV) infection among premature infants discharged from a neonatal intensive care unit(NICU). METHODS: We performed a retrospective study for rehospitalization for RSV infection and risk factors among premature infants who were admitted to NICU and discharged between May 2001 and April 2003 in Wonkwang University Hospital. RSV detection was utilized by direct fluorescent antibody tests in nasopharyngeal aspirates. We also reviewed various risk factors including gestational age, birth weight, sex, ventilatory care, surfactant administration, chronic lung disease(CLD), siblings in school or kindergarten age, and month of discharge. RESULTS: The rehospitalization rate for RSV infection was 6.6%(26/381) in premature infants and 22.2%(4/18) in premature infants with CLD. The most common season of rehospitalization for RSV infection was between November to January, this was 69.2%(18/26) in premature infants, the same as children: 61.2%(93/152). The risk factors for RSV rehospitalization among premature infants were CLD, siblings in school or kindergarten age and discharge between October to December from NICU. CONCLUSION: The risk for RSV rehospitalization among premature infants from NICU was low. Preterm infants subject to risk factors of CLD, siblings in school or kindergarten age, and discharge between October to December from NICU, were most likely to require hospitalization for RSV disease. In CONCLUSION: Prophylaxis for RSV infection should be considered one month before discharge from NICU in the RSV season between October and December.
Birth Weight ; Child ; Gestational Age ; Hospitalization ; Humans ; Incidence* ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Lung ; Respiratory Syncytial Viruses* ; Retrospective Studies ; Risk Factors* ; Seasons ; Siblings

Herpes zoster is viral infection that presents unilateral skin rash or vesicle along the sensory nerve. It is known that pediatric herpes zoster rarely occurs and usually not so severe when it developed, except in immunocompromised children. We report an uncommon case of herpes zoster ophthalmicus in a 9-year-old boy. He presented with acute onset of vesiculopapular rash covering his left forehead, upper eyelid. He was treated with oral acyclovir and stellate ganglion block, with complete resolution without sequelae. In addition, we also review the literature on herpes zoster in childhoods.
Acyclovir ; Child ; Exanthema ; Eyelids ; Forehead ; Herpes Zoster ; Herpes Zoster Ophthalmicus ; Humans ; Stellate Ganglion

PURPOSE: The aim of this study was to identify the predictive factors in the early laboratory findings for cardiac sequelae in Kawasaki disease(KD). METHODES: A retrospective review of the records was conducted of all children with KD who were admitted to the Ulsan Dongkang General Hospital, Masan Samsung Hospital, and Gyeongsang National University Hospital between January 1995 and December 1999. We analyzed and compared the early laboratory findings between the patients with and without coronary artery dilatation. RESULTS: A total of 981 patients were divided into two groups : 826 patients(84.3%) with normal coronary artery and 155 patients(15.7%) with coronary artery dilatation. Age and sex were not significantly different between the two groups. The mean serum C-reactive protein(CRP) in the coronary artery dilatation group and in the normal coronary artery group were 5.0 mg/dl(+/-5.3) and 4.1 mg/dl(+/-5.0), respectively, with a significant difference(P<0.05), whereas the other early laboratory findings had no difference between the groups. CONCLUSION: This study shows that the early serum CRP was higher in patients with KD who had coronary artery dilatation than in those with normal coronary artery. There may be a strong possibility of cardiac sequelae at a high level of serum CRP. However, the cut-off value of serum CRP could not be determined for the prediction of cardiac sequelae in patients with KD.
Child ; Coronary Vessels ; Dilatation ; Hospitals, General ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies ; Staphylococcal Protein A* ; Ulsan