Sick sinus syndrome(SSS) is an important condition for anesthesiologists to recognize. The clinical manifestations of the SSS may be quite difficult to recognize as they may be intermittent, protracted, and multifared. SSS is defined by severe bradycardia and by sinus pause of arrest with escape. An imp-ulse originating in the sinus sode that is blocked before it can depolarize the atrium is referred to as sinoatrial(SA) lock. Physiologically, most signs and srmptoms result from hrpoperfusion of vital sign. The brain, heart, and kidneys are most prominently affected. While it can be mild, producing syncope, it is a frequent symptom and requires permanent pacemaker implantation. We experienced one case of anesthetic management of SSS using spinal anesthesia.
Anesthesia, Spinal* ; Bradycardia ; Brain ; Heart ; Kidney ; Sick Sinus Syndrome* ; Syncope ; United Nations ; Vital Signs

Myocardial infarction is almost regularly associated with severe and widespread obstructive coronary artery disease. Recently, there have been some reports of myocardial infarction with normal of near normal coronary arteries on cineangiography. The following report concerns 6 cases (4% of a series of 142 consecutively studied patients with myocardial infarction) of myocardial infarction proved on clinical grounds with normal or near normal coronary arteries at coronary angiography obtained several months later. The clinical data was shown in Table 1 and Table 2. All 6 patients were male. Three were in the fifth, two in the sixth, and one in the seventh decade. Multiple risk factors were present in only one patient. Areas of localized dyskinesia or hypokinesia were demonstrated in five on the left ventricular cineangiography. The left ventricular end-diastolic pressure was greater than 12 mmHg in all 6 patients. One patient had hypertrophic cardiomyopathy and the remaining 5 patients had no underlying heart diseases. One patient had moderate congestive heart tailure. It is possible that prolonged, localized coronary artery spasm or platelet thrombi that subsequently resolved are a part of the pathogenic mechanism.
Blood Platelets ; Cardiomyopathy, Hypertrophic ; Cineangiography ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Dyskinesias ; Estrogens, Conjugated (USP) ; Heart ; Heart Diseases ; Humans ; Hypokinesia ; Male ; Myocardial Infarction* ; Risk Factors ; Spasm

No abstract available.
Diskectomy*

BACKGROUND: Total obstruction of the left main coronary artery is a common cause of sudden death but is rarely seen in patients who survive to undergo diagnostic evaluation or treatment. METHODS: During twenty six-year period, we encountered 5 patients with chronic total obstruction of the left main coronary artery out of about 4,000 patients who underwent coronary angiography. RESULTS: All patients have undergone coronary bypass surgery. These patients present with increasingly severe angina. A right dominat coronary anatomy is always found, usually with well-developed right-to-left collaterals. Left ventricular function was severely impaired in two patients out of five patients. CONCLUSIONS: The results of surgical revascularization in our patients and others described in the literature can support the safety and efficacy of this approach.
Coronary Angiography ; Coronary Vessels* ; Death, Sudden ; Humans ; Ventricular Function, Left

This study was undertaken to evaluate the efficacy and safety of orally administered ketoconazole in the treatment of onychomycosis. Thirteen patients with onychomycoiis were selected for this study. For evaluation of ketoconazole efficacy twelve patients received a 200 mg tablet of ketoconazole daily and one patient received a. 10() mg tablet of ketoconazole daily. All patients were studied monthly clinically and mycologically by KOH mount and culture on Sabourauds medium. The results were as follows: 1. Seven(53.8%) of thirteen cases achieved remission, marked improvement occurred in three cases(23.1%) and moderate improvement occurred in three cases (23. 1 %). 2. The mean duration of remission or clinical improvement was 5 months for all lesions and toenail lesions(5. 4 months) took longer to heal than finger nail lesions (4 months). 3. One hundred percent of patient who previously failed to respond to griseofulvin were cured or clinically improved by ketoconazole. 4. Two patients cornplained of indigestion and one of headache. In our study, ketoconazole was highly effective in the treatment of onychomycosis.
Dyspepsia ; Fingers ; Griseofulvin ; Headache ; Humans ; Ketoconazole* ; Nails ; Onychomycosis*

Coronary arterivenous fistula(CAVF) is an uncommon congenital coronary anomaly-Bilateral CAVFs that originate from both coronary arteries are very rare. Coronary arteriography performed in recent years has clarified the incidence and various features of this lesion. Baim et al.1) reported that only 5% of the coronary artery fistulas arose from bilateral coronary arteries. In this report, we present a case of bilateral coronary artery pulmonary artery fistulas associated with atypical chest pain.
Angiography ; Arteries* ; Chest Pain ; Coronary Vessels ; Fistula* ; Incidence ; Pulmonary Artery

No abstract available.
Ixodes* ; Tick Bites* ; Ticks*

BACKGROUND: Since percutaneous mitral valvuloplasty(PMV) using balloon was introduced by Inoue in 1984, this procedure has been accepted as a new non-surgical therapeutic modality for the treatment of selected patients with mitral stenosis. Pregnant women with mitral stenosis has suffered from life threatening complication due to altered hemodynamic changes and heart failure. Surgical valvotomy has been performed after failure of medical therapy with high risk of fetal mortality and teratogenicity. PMV can be an adequate alternative to surgical valvotomy in pregnant women. METHODS: After precise echocardiographic examination of mitral valve and its surrounding structures including thrombi in left artrium was performed, antegrade transseptal procedure was done in all 3 cases with abdominal shield using Inoue balloon technique. RESULTS: Mitral valve area increased over 1.5cm2 and hemodynamic variables improved immediately after PMV. Symptoms subsided soon after PMV in all 3 cases. Healthy normal babies were delivered transvaginally without difficulties in all 3 patients. CONCLUSIONS: Percutaneous mitral valvuloplasty is a safe and effective therapeuteic alternative to surgical valvotomy in a pregnant women with mitral stenosis who failed medical therapy, in a high risk or symptomatic pregnant women.
Echocardiography ; Female ; Fetal Mortality ; Heart Failure ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Pregnancy* ; Pregnant Women

OBJECTIVE: The changes of the production of nitric oxide in preeclampsia are still controversial. To determine the changes of nitric oxide production in preeclamptic pregnancies, NOS activity and eNOS and iNOS expression in preeclamptic placentae were compared with those in normal placentae, and to determine the changes of nitirc oxide production according to the sites of placenta, NOS activity and eNOS expression in preeclamptic placentae were also compared with those in normal placentae. METHODS: Human placentae were obtained from 15 normal and 15 preeclamptic pregnant women at the time of cesarean section. NOS activity was assessed by measuring the conversion of [3H]-arginine into [3H]-citrulline. The eNOS and iNOS expression were assessed by using western blot analysis. Data were analyzed by Student t-test and paired t-test where appropriate. RESULTS: The NOS activity(judged by measurement of [3H]-citrulline production) was significantly increased in preeclamptic placentae compared to normal(P<0.05). In normal and preeclamptic pregnant placentae, the NOS activity in main stem villi was increased compared to that in terminal villi. However, the difference of NOS activity between main stem villi and terminal villi was not significant(P>0.05). Quantification of the autoradiographic images demonstrated that the integrated optical density of the immunoreactive bands of eNOS were significantly lower in preeclamptic placentae compared to normal(p<0.05). Conversely, the integrated optical densities of the bands of iNOS were significantly higher in preeclamptic placentae compared to normal(p<0.05). CONCLUSIONS: Although the eNOS expression in preeclamptic placentae was lower than that in normal placentae, the NOS activity was significantly higher in preeclamptic placentae than that in normal in this study. These are result from increased production of iNOS in the compensatory mechanisms for the decreased nitric oxide production in pre-eclamptic placentae.
Blotting, Western ; Cesarean Section ; Female ; Humans* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Placenta* ; Pre-Eclampsia ; Pregnancy* ; Pregnant Women

OBJECTIVE: The prescription rates of long-acting injectable (LAI) antipsychotics are very low around 1% in Korea. This study was aimed to explore the preference of LAIs in patients with schizophrenia, who are currently living in community, and their caregivers. METHODS: The patients, diagnosed with schizophrenia by DSM-IV TR and were registered in the 31 mental health centers of Gyeonggi province and their caregivers were inquired the knowledge of the LAIs. The questionnaires contained information such as demographic characteristics, history of psychiatric treatment, and so on. RESULTS: About 5,318 were registered in 31 community mental health centers of Gyeonggi province in February 2012. The questionnaires of 614 patients and 365 caregivers were gathered from 20 community mental health centers. The mean ages (+/-SD) of patients and caregivers were 41.9 (+/-10.2) and 62.2 (+/-13.4) years old, respectively. 272 patients (44.6%) had experienced the discontinuation of medications without doctor's consent. 217 patients (35.9%) and 97 caregivers (27.1%) knew about the LAIs. The preference rates for LAIs were 35.2% and 46.8% for the patients and caregivers, respectively. CONCLUSION: There is still huge discrepancy between the preference and the real prescriptions of LAIs in community-dwelling patients and their caregivers, much higher than in those of hospital settings. This study suggests that both patients and caregivers registered in the community mental health centers have a strong commitment to live in the community. The obstacles against the benefits of LAIs need to be resolved.
Antipsychotic Agents ; Caregivers ; Community Mental Health Centers ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea ; Mental Health ; Prescriptions ; Surveys and Questionnaires ; Schizophrenia