BACKGROUND: Bupivacaine is a amide type local anesthetic agent, widely used for its excellent quality of analgesia and long duration of action. But unintended intravenous injection causes severe complication such as convulsion and cardiovascular collapse, which is known for its difficulty in resuscitation. With all the study, the exact mechanism is still unclear and there are much debate on the method of resuscitation. METHOD: We studied the effect of clonidine pretreatment on bupivacaine-induced cardiac toxicity and resuscitation in anesthetized dog. Twelve dogs were divided into two groups. : saline pretreatment group (control, N=6) and clonidine pretreatment group (clonidine group, N=6). The dogs were anesthetized with N2O-O2-enflurane and vecuronium. Thoracotomy was done in 4th or 5th intercostal space for open cardiac massage. After confirming stability of vital signs, we administered clonidine (10 mcg/kg) or saline, and then administered bupivacaine with the rate of 2 mg/kg/min. When the electeocardiogram showed asystole, 20 mcg/kg of epinephrine was administered via central venous line and open cardiac massage with the rate of 120 beat/min. was performed. We observed electrocardiogram (lead II), arterial blood pressure, heart rate, dose of infused bupivacaine to be required for QRS widening and arrest, required time and administered dose of epinephrine for resuscitation. RESULTS: Clonidine group showed significant decrease of heart rate after pretreatment (p<0.05). There was no significant difference in required dose for QRS widening between two groups. The dose administered for inducing arrest was less in clonidine group than control group (p<0.05). The time required for resuscitation was shorter in clonidine group than control group (p<0.05). The total dose of epinephrine required for resuscitation was less in clonidine group than control group (p<0.05). The blood concentration of catecholamine did not showed significant difference during the whole course of experiment. CONCLUSIONS: Above results demonstrated that clonidine, a central nervous system-mediated sympatholytic agent, facilitated cardiac arrest when bupivacaine was infused intravenously and cardiac rescucitation.
Analgesia ; Animals ; Arterial Pressure ; Bupivacaine ; Clonidine* ; Dogs* ; Electrocardiography ; Epinephrine ; Heart Arrest ; Heart Massage ; Heart Rate ; Injections, Intravenous ; Resuscitation* ; Seizures ; Thoracotomy ; Vecuronium Bromide ; Vital Signs

PURPOSE: To evaluate the change of iris-trabecular contact index (ITC index) after cataract surgery in acute angle closure glaucoma. METHODS: Twelve patients (17 eyes) who had a history of acute angle closure glaucoma underwent swept source optical coherence tomography before and after cataract surgery. Correlations between lens vault (LV), ITC index and intraocular pressure (IOP), anterior chamber depth (ACD), anterior chamber volume (ACV), and angle parameters were analyzed before and after cataract surgery. RESULTS: IOP (p = 0.007), ACD (p < 0.001), ACV (p < 0.001), angle parameters (p = 0.001), and ITC index (p = 0.012) were improved after cataract surgery. ITC index decreased from 88.42 ± 23.59% to 48.91 ± 35.13% after cataract surgery (p = 0.012). There was no correlation between LV and ACD (p = 0.075), ACV (p = 0.864), angle parameter (p = 0.112-0.707), or ITC index (p = 0.288) before cataract surgery. The correlations between ITC index and IOP (p = 0.021), ACD (p = 0.002), ACV (p < 0.001), and angle parameter (p = 0.001-0.030) were statistically significant before surgery but not statistically significant (p = 0.223/0.206/0.761/ 0.096-0.819) after surgery. CONCLUSIONS: ITC index significantly improved after cataract surgery, but part of angle closure was not resolved in some cases of acute angle closure glaucoma.
Anterior Chamber ; Cataract* ; Glaucoma, Angle-Closure* ; Humans ; Intraocular Pressure ; Tomography, Optical Coherence

Lymphomatoid papulosis is a strange disease; clinically benign, histologically malignant. Clinically, it may simulate pityriasis lichenoides et varioliformis acuta. The diagnosis is based on the typical histopathological features suggestive of malignant lymphoma, due to the presence of polymorphous lymphoid infiltrate consisting of small lymphocytes intermingled with conspicuous large atypical cells. We experienced a case of lymphomastoid papulosis in 35-year-old woman. Initially, her skin lesions developed as erythematous papules on the extremities, gradually spreading centrifugally with a tendency to involute slowly without treatment, leaving brown wrinkled surface and shallow ulceration. These skin lesions tended to become worse in warm weather and better in cold weather. At first visit, multiple erythematous grouped, ulcerated papules and nodules are seen. 18 months after first visit, most skin lesions are regressed except 5 erythematous pinhead sized papules on right leg in spite of no treatrnent. Labcratory examiniations of CBC, VDRL, urinatlysis, blood chemistry and chest X-ray were all within normal limits. Histopathologically there were hygerkeratosis, mild acanthosis, exocytosis in epidermis, and numerous lymphoid cells were infiltrated especially on perivascular and periappendegeal area, and many atypical cells showing hyperchromatic nuclei, kidney-shaped nuclei and mitotic figures in dermis.
Adult ; Chemistry ; Dermis ; Diagnosis ; Epidermis ; Exocytosis ; Extremities ; Female ; Humans ; Leg ; Lymphocytes ; Lymphoma ; Lymphomatoid Papulosis* ; Pityriasis Lichenoides ; Skin ; Thorax ; Ulcer ; Weather

Meigs' syndrome consists of an ovarian fibroma, or fibroma-like benign tumor, associated with fluid in both abdomen and chest. Characteristically, the ascites and hydrothorax disappeared and do not recurred following removal of the ovarian tumor. The authors presented a case of Meigs' syndrome that was cured by surgical removal of ovarian tumor and resulted in normal pregnancy outcome in 27-year-old pregnant woman with a brief review of literatures.
Abdomen ; Adult ; Ascites ; Female ; Fibroma ; Humans ; Hydrothorax ; Meigs Syndrome* ; Pregnancy Outcome ; Pregnancy* ; Pregnant Women ; Thorax

No abstract available.
Acne Vulgaris*

No abstract available.
Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Jaundice* ; Phototherapy*

OBJECTIVE: It has been reported that the sleep apnea syndrome in the asthmatic patients is prevalent, however, the systematic study in this field using polysomnography has rarely been performed. The aim of this study is to investigate the relationship between the apnea-hypopnea index (AHI) and the pulmonary function in asthmatic children. METHODS: This study enrolled 19 male and 12 female asthmatic children aged 6-13 years (average 8.2+/-1.7 years old). Complete overnight polysomnography and pulmonary function test were performed for the participants. RESULTS: Of the 31 asthmatic children, 21 (67.7%) met the diagnostic criteria of the pediatric sleep apnea and the average AHI was 1.7+/-1.5/h. The children with higher AHI showed poorer pulmonary function (FEV1/FVC ratio : p=0.002, FEV1%pred : p=0.047). CONCLUSION: These results suggest that the prevalence of the pediatric sleep apnea could be very high among the asthmatic children and the severity of the sleep apnea correlates with the pulmonary function. However, the case-control study to compare the AHI between the asthma and control groups is absolutely necessary because few normative data are available for the children.
Aged ; Asthma ; Case-Control Studies ; Child ; Female ; Humans ; Male ; Polysomnography ; Prevalence ; Respiratory Function Tests ; Sleep Apnea Syndromes

No abstract available.
Intervertebral Disc* ; Retrospective Studies*

The deliberate hypotension with esmolol or sodium nitroprusside(SNP) was provided subsequently in random order with six dogs. Anesthesia was maintained with 0.8 vol% halothane, end-tidal, in N2O/O2, 50: 50, with vecuronium. Mean arterial pressure was reduced 30-35% to 70 mmHg, with use of SNP or esmolol. Mean arterial pressure, heart rate, mean pulmonary arterial pressure, arterial blood gas analysis, and cardiac output were measured both prior to the deliberate hypotension and at 70 mmHg of mean arterial pressure induced with esmolol or SNP. The following results were observed; 1) The mean doses required were 725+/-250 ug/kg/min in esmolol and 12+/-2 ug/kg/min in SNP. 2) Esmolol was associated with a decrease in cardiac output (from 2.13+/-0.23 to 1.27+/-0.23 L/min), in heart rate (from 128+/-14 to 91+/-11/min), and an increase in central venous pressure (from 9.2+/-3.27 to 11.60+/-3.21 mmHg)(p<0.05). 3) SNP decreased systemic vascular resistance from 41111+/-484 to 2175+/-451 dynessec/cm5 (P<0.05), trended to increase heart rate. 4) A change in arterial blood gas analysis before and during deliberate hypotension with esmolol or SNP was not significant. As to mechanism of hypotensive effect, SNP caused decrease in systemic vascular resistance by 47% but esmolol significantly reduced cardiac output by 40% and heart rate by 29%. The result of present study suggests that when moderately deliberate hypotension with only esmolol was done, the potential for marked myocardial depression must be recognized. The differences in pharmacologic properties for the different hypotensive agents suggest that combinations of these agents may be provide a pharmacologic profile superior to either agent alone.
Anesthesia ; Animals ; Arterial Pressure ; Blood Gas Analysis ; Cardiac Output ; Central Venous Pressure ; Depression ; Dogs* ; Halothane ; Heart Rate ; Hemodynamics* ; Hypotension* ; Nitroprusside* ; Sodium* ; Vascular Resistance ; Vecuronium Bromide

No abstract available.