It is well known that increasing tendency of emergency surgery of congenital snomalies such as tracheoesophageal fistu1a, esophageal atresia, esophageal hiatal hernia, hypertrophic pyloric stenosis,intestinal obstruction, imperforated anus, omphalocele, and meconium ileus by virtue of improvement of pediatric surgical procedure, anesthetic agent, and anesthetic method. The possibility of a low gastric pH and the resultant pulmonary damage if aspirated must be considered in the initial care of the newborn with poor muscle tone or reflex activity as well as in the anesthetic management of neonates. We became interested in the factors determining neonatal gastric pH in this point of view, and have measured gastric pH in 75 unselected neonates, 55 of whom were born vaginally and 20 by cesarean section. In premature infants, pH was high regardless of mode of delivery. In mature infants, pH was 1) significantly lower after vaginal delivery than after cesarean section; 2) tended to be lower after section preceded by labor than after elective section; and 3) was lowest after precipitate delivery. There was no correlation between neonatal gastric pH and duration of rupture of membranes, birth weight, or Apgar score. It was concluded that the mature human fetus produces gastric acidity in response to stresses associated with labor and vaginal delivery.
Anal Canal ; Apgar Score ; Birth Weight ; Cesarean Section ; Emergencies ; Esophageal Atresia ; Female ; Fetus ; Gastric Acid* ; Hernia, Hiatal ; Hernia, Umbilical ; Humans ; Hydrogen-Ion Concentration ; Ileus ; Infant ; Infant, Newborn ; Infant, Premature ; Meconium ; Membranes ; Pregnancy ; Reflex ; Rupture ; Virtues

The cardiovascular and CNS effects of MIDAZOLAM 0.25 mg/kg were studied in 40 patients, randomised and emergency operations(20 males and 20 females). The effects of the administration of MIDAZOLAM intravenously on the cardiovascular and central nervous system were determined. The results were as follows: 1) It had short duration of action and absence of vascular irritation compared with MIDAZOLAM. 2) Three minutes after injection, mean systolic pressure decreased from 132+/-16 mmHg to 115+/-18 mmHg and diastolic pressure from 87+/-11mmHg to 77+/-13 mmHg. One minute after injection heart rate increased from 89+/-19 beat/min to 95+/-20 beat/min and after three minutes returned to prior level. 3) Our study shows that the intraveous administration of MIDAZOLAM 0.25mg/kg produces. a statistically significant, but clinically unimportant, decrease in blood pressure and an increase in heart rate. 4) The effects of MIDAZOLAM on the central nervous system were determined from the time of onset of injection. Spontaneous eye closure, loss of eyelash reflex and apnes were observed at 113+/-66 sec, 133+/-65 sec, and 147+/-58 sec, after injection of MIDAZOLAM. 5) MIDAZOLAM as an induction agent for anesthesia is not indicated for in out-patient surgery due to the extended duration of drowsiness losting over 3 hours in the recovery room. 6) MIDAZOLAM was sufficient as an induction agent for general anesthesia.
Anesthesia* ; Anesthesia, General ; Blood Pressure ; Central Nervous System ; Emergencies ; Heart Rate ; Humans ; Male ; Midazolam ; Outpatients ; Recovery Room ; Reflex ; Sleep Stages

PURPOSE: To evaluate MRI(Magnetic Resonance Imaging) findings of miliary tuberculosis of the brain. MATERIALS AND METHODS: Six patients with miliary tuberculosis of the brain diagnosed by characteristic clinical or laboratory findings were studied with spin echo MRI before and after contrast enhancement. We retrospectively evaluated MRI findings acording to the appearance, distribution, location, and enhancement pattern of the granulomas as well as associated other abnormalities. RESULTS: In six patients, contrast-enhanced MRI of thebrain showed numerous punctate, contrast enhancing lesions scattered throughout the brain. Unenhanced MRI failed to demonstrate small granulomas except a few small foci of high signal intensity on T2-weighted images. The shapes of enhancing granulomas were homogeneous nodular enhancement in 86% of cases and small ring enhancement in 14%.98% of granulomas were smaller than 3-mm and 2% were larger. Although several lesions were located in the basalganglia, thalamus, and brain stem, the majority were located in the subpial and subarachnoid space. There was no significant difference in distribution of granulomas between the supratentorial and the infratentorial areas. Other associated abnormalities were focal meningitis in five cases and focal cerebritis in one. On chest radiograph, all patients had miliary tuberculosis in the lungs. CONCLUSION: Contrast-enhanced T1-weighted MRimaging showed numerous round, very small enhancing lesions scattered throughout the brain. The majority of lesions were located in the subpial and subarachnoid space. Contrast-enhanced T1-weighted images are helpful inthe detection and diagnosis of miliary disseminated tuberculous granulomas and meningitis.
Brain Stem ; Brain* ; Diagnosis ; Granuloma ; Humans ; Lung ; Magnetic Resonance Imaging* ; Meningitis ; Subarachnoid Space ; Thalamus ; Tuberculosis, Central Nervous System ; Tuberculosis, Miliary*

Corticosteroids have endowed the organism with the capacity to resist many types of noxious stimuli, and enviromental changes. Although many anesthetic agents and surgical stress have been shown to have some influence on adrenocortical function in man, there is no report on the effect of flunitrazepam-morphine-nitrous oxide anesthesia on endocrine activity. The present investigation was undertaken to study to what extent flunitrazepam-morphine-nitrousoxide anesthesia nfluences adrenocortical function by judging its effect on plasma cortisol levels in peripheral venous blood in man. Fifteen patients, ranging in age from 17 to 48 years (average 33 years) and in weight from 46kg to 73kg(average 58kg) who underwent various surgical operations, were free from endocrine, neurological, hepatic, renal and cardiopulmonary disease. Each patient was premedicated with atropine sulfate(0.01mg/kg) and Valium(0.15mg/kg) i.m. one hour before the induction of anesthesia. Anesthesia was induced at 9:00 a.m. with flunitreazepam(0.05+/-0.01mg/kg) and morphine(0.29+/-0.04mg/kg) was given by intreavenous injection. Pancuronium bromide(0.09+/-0.013 mg/kg) was given intreavenously for endotracheal intubation. General anesthesia was maintained with nitrous oxide 2L/min. and oxygen 1L/min. controlled ventilaration was carried on throughout the procedure. A moderate depth of anesthesia was maintained by clinical judgment based on signs including blood pressure and pulse rate. Blood samples were obtainesd at the following times: 1) the control group at 9:00 a.m. just prior to induction. 2) 30 min after anesthesia only. 3) 30 min. after the start of operation. Venous blood(5ml) was drawn into an aseptic syringe previously rinsed with heparin. The plasma was separated within 30 min. in a refrigerated centrifuge, then frozen at -40 degrees C. for storage. the cortisol levels in plasma were determined by a Gamma coat I 125 cortisol radiommunoassay kit. The plama cortisl level at 9:00 a.m. just prior to induction in the control group was 12.64+/-3.77 ug/ml. It decreased slightly (about 20%) but no significantly(p>0.01) to 10.11+/-2.47 ug/100ml at 30 min. after the anesthesia alone. At 30 min. after the start of operation it was elevated slightly (about 24%) but not significantly(p>0.1) to 15.42+/-6.88 ug/100ml. This finding indicated that flunitrazepam-nitrous oxide anesthesia has a depressing effect on adrenal cortical function, but did not block the influence on adrenal cortical function of surgical stress.
Adrenal Cortex Hormones ; Anesthesia ; Anesthesia, General ; Anesthetics ; Atropine ; Blood Pressure ; Flunitrazepam* ; Heart Rate ; Heparin ; Humans ; Hydrocortisone ; Intubation, Intratracheal ; Judgment ; Morphine* ; Nitrous Oxide* ; Oxygen ; Pancuronium ; Plasma ; Syringes

Drug-induced hypersensitivity syndrome is a rare, but severe, life-threatening disease with multiorgan failure. Aromatic antiepileptic drugs are frequent causes of this syndrome. The association of the human herpes virus-6 has been recently reported in patients with drug-induced hypersensitivity syndrome. We report two patients who were diagnosed as having antituberculosis drug-induced hypersensitivity syndrome based on clinical course and laboratory data. In addition, human herpes virus-6 DNA was detected by polymerase chain reaction in peripheral blood mononuclear cells and the serum. There was a favorable outcome after discontinuation of the causative drug, plus corticosteroid therapy. After the treatment, human herpes virus-6 DNA was not detected by polymerase chain reaction. This is the first report of antituberculosis drug-induced hypersensitivity syndrome associated with reactivation of human herpes virus-6.
Anticonvulsants ; DNA ; Humans ; Hypersensitivity* ; Polymerase Chain Reaction

PURPOSE: To assess the value of dynamic fast infusion of contrast material in the detection and diagnosis of hepatocellular carcinoma(HCC) with spiral CT. MATERIALS AND METHODS: Two-phase dynamic spiral CT was performed in 59 patients with 104 HCCs. 150ml of nonionic contrast material was injected with an automatic injector at the rateof 5 ml/sec. Two-phase images were obtained at 20-45 sec(arterial dominant phase) and 2-5 min(equilibrium phase)after the initiation of bolus injection of contrast material. The tumors were divided into three groups(<3cm,3-5cm, and >5cm) according to the size and the enhancement patterns on two-phase images were compared. RESULTS: Inthe arterial phase, HCCs showed total or partial hyperattenuation in 79% of cases(82/104), isoattenuation in 12%,and hypoattenuation in 9%. In the equilibrium phase, HCCs showed hypoattenuation in 86%(89/104) and isoattenuationin 14%. The most common and characteristic enhancement patterns of HCCs were hyperattenuation in the arterialphase and hypoattenuataion in the equilibrium phase ; in the latter, capsules were demonstrated in 45% of cases. Invasions of the portal and/or hepatic vein were demonstrated in 34% of cases. CONCLUSION: Dynamic fastinfusion(5ml/sec) of contrast material(150ml) is useful in the detection and diagnosis of HCCs with spiral CT.
Capsules ; Carcinoma, Hepatocellular* ; Diagnosis ; Hepatic Veins ; Humans ; Tomography, Spiral Computed*

PURPOSE: To evaluate the usefulness of dynamic spiral computed tomography(CT) during the portal phase with ahigher IV injection rate of contrast material in detecting hepatic metastases. MATERIALS AND METHODS: We reviewed two-phase dynamic spiral CT in 44 patients with hepatic metastases of pathologically proven primary malignancy. One hundred and fifty ml. of non-ionic contrast material was administered with a power injector at a rate of 5ml/sec., and two-phase images at 55-80 sec.(portal phase) and 2-5 min.(equilibrium phase) were obtained after thestart of bolus injection. Two phase images were compared for detectability of hepatic metastases according tosize, number and enhancement pattern. RESULTS: In cases of metastases less than 1cm, 113 lesions(100%) that showed clearly defined hypodense lesions were detected in the portal phase of dynamic CT. However, the equilibriumphase images showed hypodense lesions in 58 cases(51%) and isodense lesions in 55cases(49%). In cases of metastases 1-2cm in size, the portal phase images detected 70 hypodense lesions(92%) and six hyperdense lesions(8%). In the equilibrium phase, however, the lesions were hypodense in 54 cases(71%), hyperdense infour(5%), and isodense in 18(24%). In cases of metastases larger than 2 cm, portal phase images showed 29 hypodense lesions(97%) and one hyperdense lesion(3%). In the equilibrium phase, however, the lesions were hypodense in 25 cases(83%), hyperdense in two(7%), and mixed in three(10%). As compared with the portal phase, most metastatic lesions were detected as poorly defined hypodense or isodense lesions in the equilibrium phase and decrease in size due to peripheral enhancement. CONCLUSION: Dynamic spiral CT during the portal phase with a higher IV injection rate(5 ml/sec) of contrast material is a useful method for detecting hepatic metastases, especially small lesions less than 1cm.
Humans ; Liver* ; Neoplasm Metastasis* ; Tomography, Spiral Computed*

Muscle pain following succinylcholine chloride(SCC) is well documented, as are elevated serum potassium and increased creatine phosphokinase(CPK) levels. Pretreatment with a subparylsing dose of a non-depolarizing muscle relaxant before SCC is standard and accepted clinical practice in prevention of SCC induced fasciculation and associated sequlae but pretreatment redners the end-plate less sensitive to SCC: hence larger doses of SCC: hence larger doses of SCC are necessary to ensure adequate degree of relaxation. Recontly fahmy et al showed in a study that small doses of diazepam suppressed the fasciculation as well as the increase in serum potassium and creatine phosphokinase(CPK). Our study was undertaken to evaluate the effect of pretreatment with diazepam on the potential side effects of SCC. Eight cases were studied in four different groups. In the first group(control group): no diazepam was used, secoun group: with diazepam 0.05mg/kg, third group:: with diazepam 0.1mg/kg, grouth group: with diazepam 0.2mg/kg. As a result of this study, we can summarize as follows: 1) Diazepam pretreatment groups had no significant change in the prevention of muscle fasciculation following SCC than control groups. 2) Conditions for intubation were assessed as excellent to good in diazepam pretreatment and control groups. 3) The increase in serum potassium and CPK produced by SCC was not inhibited by diazepam pretreatment. 4) In the prevention of incidence of muscle pain, there were no significant difference between the control and diazepam pretreatment groups.
Creatine ; Diazepam* ; Fasciculation ; Incidence ; Intubation ; Myalgia ; Potassium ; Relaxation ; Succinylcholine

Tricuspid valve endocarditis accounts for 5% to 10% of cases of infective endocarditis. It commonly occurs in intravenous drug abusers, intravenous catheters, alcoholism, immune deficiency and genital sepsis. But right sided infective endocarditis without predisposing factor is very rare. S. aureus is the usual pathogen. We experienced a case of tricuspid valve endocarditis in a 32 year old female with vegetation in a non drug addict without underlying cardiac disease. The vegetation on the septal cusp of tricuspid valve and tricuspid regurgitation were found by TTE & TEE. S. aureus was identified in 4 bottles of blood cultures. The diagnosis was delayed because the cardiac manifestations of the disease were subtle, and pleuropulmonary manifestations predominant. So we report a case of tricuspid valve endocarditis in a non drug addict without underlying cardiac disease with a review of literature.
Adult ; Alcoholism ; Catheters ; Causality ; Diagnosis ; Drug Users ; Endocarditis* ; Female ; Heart Diseases* ; Humans ; Sepsis ; Tricuspid Valve Insufficiency ; Tricuspid Valve*

PURPOSE: The purpose of this study is to compare the sensitivity and specificity of axial 3-D imaging with those of conventional 2-D imaging in the diagnosis of meniscal injuries. MATERIALS AND METHODS: Twenty-nine kneesof 27 patients with clinically suspected meniscal tears were imaged at a 1.5 T MR system. Conventional 2-D imagesand axial 3-D GRASS images were obtained in all cases. Arthroscopic or surgical confirmation was available in allcases and was used as the gold standard. RESULTS: Among the 29 knee-joints evaluated, 21 of 23 meniscal tears and 33 of 35 normal menisci were correctly identified with axial 3-D imaging, yielding a sensitivity of 91.3% and specificity of 94.3%. Conversely, the sensitivity was 82.6% and the specificity was 97.1% for the conventional 2-Dtechnique. A combination of both techniques yielded 95.7% sensitivity and 100% specificity in the diagnosis of meniscal tears. Of the 23 meniscal tears proven at arthroscopy or surgery, there were four discrepancies between the two techniques ; three of the four represented false-negative 2-D images and one was a false-negative axial3-D image. Of 35 normal menisci, two false-positives occurred with axial 3-D imaging and one with 2-D imaging. CONCLUSION: Despite the lack of a statistically significant difference between the efficacy of the two techniques, these results suggest that the sensitivity in the diagnosis of meniscal tears can be improved by adding thin-sliced axial 3-D GRASS imaging to conventional 2-D imaging in the limited cases with clinically suspected meniscal tears.
Arthroscopy ; Diagnosis* ; Fourier Analysis* ; Humans ; Imaging, Three-Dimensional ; Knee* ; Poaceae* ; Sensitivity and Specificity