BACKGROUND: A light plane of general anesthesia is chosen for fetal safety during a cesarean section. Therefore an experience of wakefulness and pain perception is not infrequent and can be distressful to patients. The electroencephalogram-derived bispectral index (BIS) is a promising new method to assess anesthetic adequacy. This study was designed to assess the adequacy of general anesthesia and to evaluate the usefulness of the BIS in monitoring the awareness during a cesarean section. METHODS: Twenty one parturients undergoing general anesthesia for an elective caesarean section were examined. Anesthesia was induced with 4 mg/kg thiopental and 1 mg/kg succinylcholine, and then followed with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min. Before administration of succinylcholine, a tourniquet was applied to the free arm and inflated to 250 mmHg. Responsiveness to verbal commands using the Tunstall isolated forearm technique was detected and the BIS was monitored throughout the study period. RESULTS: The incidence of responsiveness to verbal commands were 33% at the time of skin incision and fetal delivery respectively. BIS values of response to commands were significantly higher than that of no respose at both time points (p < 0.05). Fisher's exact test suggested that the BIS value less than 75 was related to unresponsiveness to verbal commands at time of skin incision (p < 0.05) and the BIS less than 85 at fetal delivery (p < 0.05). CONCLSIONS: These results suggest that adequate anesthesia is not provided with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min at the time of skin incision and fetal delivery. In addition BIS could be a predictor of awareness during cesarean section under general anesthesia.
Anesthesia ; Anesthesia, General* ; Arm ; Cesarean Section* ; Consciousness Monitors* ; Enflurane ; Female ; Forearm ; Humans ; Incidence ; Pain Perception ; Pregnancy ; Skin ; Succinylcholine ; Thiopental ; Tourniquets ; Wakefulness

We report a case of a 77-year-old woman with a cutaneous sinus tract located on the right cheek secondary to a periapical abscess of the right maxillary first molar. The lesion was a nodule with surrounding dimple and drained purulent fluid. Previous topical and systemic treatment was temporarily effective. Radiologic examination of the maxillary and mandibular regions demonstrated diffuse radiolucency involving the apices of the right maxillary first molar, consistent with periapical abscesses. Removal of the involved teeth and curettage of the granulation tissue accompanied by antibiotic therapy resulted in the complete healing of the cheek lesion. In the presence of a single chronic suppurative or nodulocystic lesion of the face, it is always useful to perform a radiologic evaluation of the maxillary and mandibular regions to promptly exclude a possible odontogenic background.
Aged ; Cheek ; Curettage ; Female ; Granulation Tissue ; Humans ; Molar ; Periapical Abscess ; Skin* ; Tooth

Papular mucinosis, or lichen myxedematosus, is a rare cutaneous disease characterized by papular-lichenoid eruptions, mucin deposition, paraproteinemia, no abnormalities of thyroid function and IgG or IgM deposition in the reticular dermis or just below the epidermis in about 35% cases on direct immunofluorescence study. We report a case of papular mucinosis in a 48-year-old male, who noticed the skin colored or yellowish waxy papules on his upper arm 1 year ago. Since then, similar lesions developed on his upper extremities, upper trunk, and neck during last year. Histopathological findings of the lichenoid papules showed that the collagen fibers in the upper dermis are loosly arranged and separated by amorphous materials. These amorphous materials were positve with colloidal iron stain. Serum protein electrophoresis showed no abnormal bands and an abnormal paraprotein was not detected. Direct immunofluorescenc study of a skin biopsy specimen showed a granular IgM deposit in the papillary dermis. This is the sixth case of papular mucinosis reported in Korea, but is the first case showing IgM deposit in the skin by immunofluorescence study.
Arm ; Biopsy ; Collagen ; Colloids ; Dermis ; Electrophoresis ; Epidermis ; Fluorescent Antibody Technique ; Fluorescent Antibody Technique, Direct ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Iron ; Korea ; Male ; Middle Aged ; Mucins ; Neck ; Paraproteinemias ; Scleromyxedema* ; Skin ; Thyroid Gland ; Upper Extremity

Angioma serpiginosum is a rare acquired vascular lesion that usually presents in the first two decades of life with a predilection for females. A typical lesion is characterized by deeply red nonpalpable puncta that are grouped closely together in a macular or netlike pattern on the lower extremities and buttocks. Histopathologically, thin-walled dilated capillaries are seen in some of the dermal papillae and the superficial reticular dermis without extravasation of red blood cells. We report a case of angioma serpiginosum on the left chest and left upper extremity in a 37-year-old man.
Adult ; Buttocks ; Capillaries ; Dermis ; Erythrocytes ; Female ; Hemangioma* ; Humans ; Lower Extremity ; Thorax ; Upper Extremity

Only 6% of conjoined twins are of the ischiopagus type in which the twins are joined symmetrically at the pelvis and fusion begins at the level of the common umbilicus. Two sets of female ischiopagus tetrapus conjoined twins were born in August, 1994. The longitudinal axis extended in a straight line in opposite directions and the heart, large vessels, musculo-skeletal system and genitourinary tracts were shared. Tetrapus is a subtype in which all 4 extremities are present. At 20 hours of age, separation was successfully performed under general anesthesia, requiring 185 minutes for twin A and 225 minutes for twin B at the Hanyang University Hospital. We describe the associated anomalies, surgical operation and anesthesia management of these 2 sets of ischiopagus tetrapus twins and now, l year after the operation, the two continue to live.
Anesthesia* ; Anesthesia, General ; Axis, Cervical Vertebra ; Extremities ; Female ; Heart ; Humans ; Pelvis ; Twins, Conjoined* ; Umbilicus

BACKGROUND/AIMS: Entecavir is a synthetic nucleoside analogue, cyclopentyl guanine nucleoside, which has a potent antiviral effect and the least viral breakthrough in hepatitis B virus (HBV) replication. Entecavir has been available in Korea since 2007 but there are few reports on its effects. The aim of this study was to evaluate the virological response (VR) and biochemical response (BR) to entecavir in HBV patients at 3, 6 and 9 months after treatment with entecavir. MATERIALS AND METHODS: Thirty-three chronic hepatitis B patients who took entecavir for at least 9 months were enrolled. We investigated VR and BR by retrospectively reviewing medical records. Patients who satisfied the following criteria were chosen: 1) initial alanine aminotransferase (ALT) levels = 1.5upper limit of normal (ULN) and 2) initial HBV DNA levels = 5 log10 copies/ml. We measured ALT levels every 3 months until month 9. HBV DNA was measured every 2 or 3 months by polymerase chain reaction (PCR) method. RESULTS: Most patients taking entecavir showed good BR (ALT < 40 IU/L). The BR rates were 61%, 73% and 67% at months 3, 6 and 9, respectively. VR (HBV DNA < 5 log(10) copies/ml or 2 log lower than initial HBV DNA) rates were 82%, 91% and 91% at months 3, 6 and 9, respectively. Undetectable HBV DNA (HBV DNA < 4 log(10) copies/ml) rates were 49%, 73% and 85% at months 3, 6 and 9, respectively. Two patients presented with virological breakthrough without adverse effects until month 9. CONCLUSIONS: Entecavir showed good BR and VR from month 3 and these effects continued through the 9-month observation period. This suggests that entecavir is also a good choice for the first line treatment of chronic hepatitis B (CHB). Further studies are needed to determine the long-term efficacy and drug resistance of entecavir in Korean CHB patients.
Alanine Transaminase ; DNA ; Drug Resistance ; Guanine ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Korea ; Medical Records ; Polymerase Chain Reaction ; Retrospective Studies

BACKGROUND: The effectiveness of some therapeutic modalities for cutaneous sporotrichosis may be changed depending on the individual and geographic characteristics, and the clinical type. Itraconazole has been known to be effective for it, however, there have been no standard and ideal guideline on the oral dosage and duration yet. OBJECTIVE & METHODS: In this study, we evaluated the effectiveness of oral itraconazole in patients with cutaneous sporotrichosis in relation to dosage and clinical status. The observation of 17 patients with sporotrichosis were made retrospectively Oral itraconazole was administered at the dose of 200 mg daily in 15 adults over 18 years old and 100 mg in the other 2 children. RESULTS: The duration for healing was within 30 days in 4 cases, within 60 days in 4 cases, within 90 days in 2 cases, within 120 days in 3 cases, and within 150 days of therapy in 2 cases. The average duration in all cases was 12.1+/-8.6 weeks. Comparison our results to the previous reported one revealed that more shorter treatment time was needed in cases treated with 200 mg daily than that with 100 mg. There was no treatment failure by drug intolerance or resistance. The duration for healing was significantly shorter in the patient groups with prevalence duration more than 5 months, however there was not any significant difference in sex of patients, and the clinical types. The cases with the lesion on the face and cases with fixed type tended to be healed more rapidly than the others. CONCLUSION: Oral itraconazole may be a safe and e(fictive antifungal agent for the treatment of cutaneous sporotrichosis in a daily dose of 200 mg for 3 months on the average. However, duration for healing could be influenced by the clinical status.
Adolescent ; Adult ; Child ; Humans ; Itraconazole* ; Prevalence ; Retrospective Studies ; Sporotrichosis* ; Treatment Failure

No abstract available.
Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography*

Mature teratoma is the most common germ cell tumor of the ovary. The tumor is essentially a benign neoplasm and surgical resection of the tumor is the treatment of choice. Recurrence with colorectal involvement after surgical removal of the primary lesion is exceedingly rare and has not been reported in Korea. We present a 43-year-old patient with a rectal mass who had already undergone left oophorectomy due to mature cystic teratoma and right oophorectomy due to hemorrhagic corpus luteum. The rectal mass was composed of a mature teratoma tissue. We postulate that leakage of the tumor elements from the cyst wall led to peritoneal tumor implantation and invasion to the rectal wall.
Adult ; Female ; Humans ; Ovarian Neoplasms/*pathology ; Rectal Neoplasms/diagnosis/*secondary ; Teratoma/diagnosis/*secondary

BACKGROUND: Stellate ganglion block (SGB) has been used to treat over 150 diseases which include diabetes mellitus and gout. This study was planned to investigate whether stellate ganglion block (SGB) could lower the levels of blood glucose, uric acid, epinephrine, and norepinephrine. METHODS: Sixty Sprague-Dawley rats within the weight of 250-350 gm were randomly devided into four groups. CS group was normal group with sham SGB with normal saline, CL group was normal group with SGB with lidocaine, DS group was diabetic group with SGB with normal saline, DL group was diabetic group with SGB with lidocaine. The diabetes was induced by intraperitoneal injection of 40 mg/kg of streptozotocin in citrate buffer (0.01 M, pH 4.5). Nondiabetic groups were given same amount of the citrate buffer. Seven days after the last injection of the streptozotocin blood glucose level was checked and more than 300 mg/dl was considered diabetic. The SGB was performed three times at right superior cervical ganglion two days apart from two days after the conformation of diabetes. Successful SGB was conformed by the ipsilateral ptosis or conjunctival congestion. Blood samplings from tail vein for the check of glucose, uric acid, and catecholamines were done before the injection of streptozotocin, seven days after the last injection of streptozotocin, and two days after the last SGB. RESULTS: The SGB with lidocaine reduced the blood glucose level only in the diabetic rats while SGB with the saline did not. The epinephrine levels were increased in the diabetics and decreased by the SGB with lidocaine without any statistical significance. Norepinephrine and uric acid levels had not been effected by the SGB and both of them had no correlationship with the glucose level. CONCLUSIONS: SGB in the diabetic rats decreases the blood glucose level. But for the effects of the SGB on the level of epinephrine further study would be needed.
Animals ; Blood Glucose* ; Catecholamines* ; Citric Acid ; Diabetes Mellitus ; Epinephrine ; Estrogens, Conjugated (USP) ; Glucose ; Gout ; Hydrogen-Ion Concentration ; Injections, Intraperitoneal ; Lidocaine ; Norepinephrine ; Rats* ; Rats, Sprague-Dawley ; Stellate Ganglion* ; Streptozocin ; Superior Cervical Ganglion ; Uric Acid* ; Veins