The congenital long-QT syndrome (LQTS) is characterized by recurrent syncope, prolonged QT intervals, QT interval lability, polymorphic ventricular tachycardia, and sudden death. We report a case of congenital long QT syndrome in a 28-day-old male infant who presented with syncope, bradycardia with 2: 1 pseudo-atrioventricular block and a markedly prolonged QT inteval. One episode occured after crying and degenerated into ventricular fibrillation and terminated after cardioversion. A VVI type cardiac pacemaker was implanted. Subsequently, the infant's heart rate was over 110/min and 2: 1 AV block and any other arrhythmia were absent. The infant recovered from the accompanied pneumonia and sepsis and was discharged 47 days after adrnission. However, 13 days after discharge, the infant returned to our hospital ER with syncope. Ventricular fibrillation ceased after cardioversion. Despite medication with propranolol, ventricular tachycardia persisted. The infant expired the day after he was discharged against medical advice.
Arrhythmias, Cardiac ; Atrioventricular Block* ; Bradycardia ; Crying ; Death, Sudden ; Electric Countershock ; Heart Rate ; Hospitals ; Humans ; Infant ; Long QT Syndrome ; Male ; Pneumonia ; Propranolol ; Sepsis ; Syncope ; Tachycardia, Ventricular ; Ventricular Fibrillation

Gottron's acrogeria syndrome is a rare genetic disease of unknown etiology with some features suggestive of accelerated aging. The typical clinical presentation consists of premature aging of the skin with atrophy of the cutis and the subcutis. After a brief review of the literature available on this syndrome, we report a case of Gottron s acrogeria syndrome in a 19 year-old man whose right rectus femoris muscle had a fibrotic contracture.
Aging ; Aging, Premature ; Atrophy ; Contracture ; Humans ; Quadriceps Muscle ; Skin ; Young Adult

Spinal reflex activity that remains after insult to the spinal cord brings with it significant functional impairment. Our patient had suffered from general spasticity and hyperreflexic neurogenic bladder caused by sixth cervical cord injury. Unfortunately, the use of oral medication (baclofen) was limited by an inadequate effect. So we performed two times of subarachnoid block with 0.5% heavy bupivacaine, the patient experienced improvement in bladder and sphincter function. We concluded that subarachnoid block with 0.5% heavy bupivacaine is an effective and safe modality for spasticity control in patients who are refractory to oral medication before neurolytic block.
Bupivacaine ; Humans ; Muscle Spasticity ; Reflex ; Spinal Cord ; Urinary Bladder ; Urinary Bladder, Neurogenic*

BACKGROUND: Propofol has gained widespread popularity but it should at least be questioned in the presence of heart rate lowering medications such as beta-blockers. Esmolol, due to its ultrashort action and cardioselective properties, has been shown to be safe and effective for use in intraoprative tachycardia and hypertension. The purpose of this study is to evaluate the hemodynamic effects of esmolol and propofol under isoflurane anesthesia in dogs. METHODS: Six-mongrel dogs were induced with thiopental, intubated and ventilated with a mixture of isoflurane (1-1.5 vol%) and oxygen. A pulmonary artery catheter was placed via femoral vein and the femoral artery was cannulated. After stabilization, baseline hemodynamic measurements (HR, MAP, CO, SVR) were obtained. Measurements were repeated 5 and 15 minutes after injection of propofol (2 mg/kg), esmolol (1 mg/kg), and additional esmolol (1 mg/kg) for 30 seconds. Data was analyzed by repeated measurement of ANOVA. P < 0.05 was considered significant. RESULTS: Propofol produced no change in heart rate, MAP, CO and SVR. Heart rate decreased significantly during esmolol administration and remained decreased up to 15 minutes after the injection whereas the MAP, CO and SVR showed no significant changes. CONCLUSIONS: We have demonstrated that the decrease in heart rate continued up to 15 minutes after esmolol administration. These findings suggest that concomittent administration of propofol and esmolol requires monitoring of the heart rate after a bolus intravenous injection of esmolol.
Anesthesia* ; Animals ; Catheters ; Dogs* ; Femoral Artery ; Femoral Vein ; Heart Rate ; Hemodynamics* ; Hypertension ; Injections, Intravenous ; Isoflurane* ; Oxygen ; Propofol* ; Pulmonary Artery ; Tachycardia ; Thiopental

No abstract available.
Polychondritis, Relapsing*

No abstract available.
Polychondritis, Relapsing*

Anomalous right upper lobe bronchus takeoff from the trachea has been reported to occur in 1 of 250 otherwise normal patients. Difficulty with double-lumen tube(DLT) placement has been described previously and there are problems with Univent tube with the intention of using the bronchial blocker to achieve right lung collapse in this patient. In two cases, the fiberoptic bronchoscopic examination through Univent tube revealed a trifurcation, rather than the usual bifurcation, at the carina and revealed that the most rightward lumen was the right upper lobe bronchus and the middle lumen was the right middle and lower lobe bronchus. The left lumen was the left main bronchus. So in one case, the Univent tube was withdrawn and DLT was reinserted. In the other case right lung collpase achieved with the inflation of cuff of bronchial blocker. One lung anesthesia was performed without any problem in these two cases.
Anesthesia ; Bronchi ; Humans ; Inflation, Economic ; Intention ; Lung ; One-Lung Ventilation* ; Pulmonary Atelectasis ; Trachea

BACKGROUND: Endoscopic urologic surgery including transurethral resection of prostate (TURP) requires adequate sacral analgesia for insertion of resectoscope. But epidurally administered local anesthetic does not produce anesthetic effects uniformly. Failure to completely block S1 during epidural anesthesia because of the large size of nerve root has been noted. The purpose of this study to compare the relation between catheter direction and sensory anesthesia. METHODS: Thirty patients scheduled for endoscopic urologic surgery were enrolled. The epidural catheter was inserted at L3-4 using a standard 18 gauge Tuohy needle. In group A (n=15), the Tuohy needle with bevel pointed in a cephalad direction during catheter insertion. In group B (n=15), it pointed caudally. And the catheter was introduced 3 cm into the epidural space. After test dose, 2% lidocaine 5 cc, 0.5% bupivacaine 5 cc and 2% lidocaine 3 cc were administered with fractionate dose through it. The extent of the sensory anesthesia to loss of cold sensation and pin prick test was measured every 5minute for 30 minutes. RESULTS: Analgesia spread to loss of cold sensation and pin prick test was no significant statistical difference between the two groups. In 15 minutes after injection of surgical dose, complete blockade in L5, S1 dermatome was present in both groups. CONCLUSION: Our results conclude that epidural catheter direction is not significantly influence the epidural anesthetic spread including sacral area in continuous lumbar epidural anesthesia in elderly patients.
Aged ; Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Anesthetics ; Bupivacaine ; Catheters* ; Epidural Space ; Humans ; Lidocaine ; Needles ; Sensation ; Transurethral Resection of Prostate

The authors analyzed statistically, 223 cases of anethesia for operations after traffic accidents at the Department of Anesthesiology, Ewha Woman University Hospital from January 1978 to December 1982. The results were as follows: 1) There was a upward trend in the numbers of patients undergoing surgery. 2) The ratio of male to female was 3.5:1. 3) In the distribution by age, the 4th decade numbered 49cases (22.2%), the 3rd decade numbered 48 cases (21.1%), and the 6th decade was 44cases(19.7%). 4) in the physical status by the American Society of Anesthesiologists, there were 63 cases (28.3%) in class 1, 54 cases (24.2%) in class 2, 27 cases (12.4%) in class 4E and 25 cases (11.2%) in class 3E. 5) There were 128 cases of elective surgery (57.4%) and 95% cases (42.6%) of emergency surgery. 6) Among 191 cases of general endotracheal anesthesia, 22 cases (11.5%) were already intubated or had a tracheostomy before the general anesthesia. 7) The premedicants(atropine sulfate, opioid and tranquilizer) were administrated in 143 cases(54.1%). 8) The head injuries numbered 153 cases. The extremities 124 cases and abdominal injuries numbered 9 cases. 9) 121 cases (54.3%) were done by orthopedic surgery, 80 cases(35.9%) by neurosurgery and 8 cases(3.6%) done by the dental surgery department. 10) In the anesthetic techniquie, general endotracheal anesthesia was used in 191 cases (85.7%): regional anesthesia in 32 cases which included 22cases(9.9%) of spinal anesthesis, and 8 cases (8.6%) of epidural anesthesia. 11) For the main anesthetic of the general endotracheal anesthesis halothane was used in 41 cases (18.4%) and balanced anesthesia (opioid, tranquilizer, neuromuscular blocking agent with nitrous oxide) was used in 138 cases (61.9%). 12) Fro the anesthetic period there were 90 cases (40.4%) which ran 1~2 hours: 47 cases (21.8%) ran less than 1 hour or ran 2~3 hours: 26 cases (11.7%) ran 3~$ hours and 13 cases (5.8%) ran more than 4 hours.
Abdominal Injuries ; Accidents, Traffic ; Anesthesia* ; Anesthesia, Conduction ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesiology ; Balanced Anesthesia ; Craniocerebral Trauma ; Emergencies ; Extremities ; Female ; Halothane ; Humans ; Male ; Neuromuscular Blockade ; Neurosurgery ; Orthopedics ; Tracheostomy

The distribution and properties of branched chain amino acid aminotransferase(EC 2.6.1.42) was investigated in adult Fasciola hepatica. Fasciola hepatica was fractionated by differential centrifugation into nuclear, mitochondrial and cytosolic fractions. The activity of branched chain amino acid aminotransferase was measured by the method of Ichihara and Koyama (1966) . Isozyme patterns of this enzyme was also examined by DEAE-cellulose column chromatography. The results obtained were as follows: The activity in homogenate was found to be 12.69 units/g wet tissue. The activity of this enzyme was relatively high compared with those in rat tissues. The distribution of branched chain amino acid aminotransferase in the subcellular organelles showed that 87.8 percent of the activity was in cytosolic, 10.9 percent in mitochondrial and 1.3 percent was in nuclear fraction. Cytosolic fraction of Fasciola hepatica contained Enzyme I, but not Enzyme II and III, of branched chain amino acid aminotransferase. Enzyme I was eluted by 50 mM phosphate buffer from DEAE-cellulose column and catalyzed the transamination of all three branched chain amino acids. The Enzyme I was purified about 22-folds increase in specific activity after chromatography on DEAE-cellulose. The best substrate among three amino acids (leucine, isoleucine and valine) was L-isoleucine. The optimal temperature of Enzyme I was 45 C and the optimal pH was 8.2. The Km value for leucine of Enzyme I was 4.17 mM. The Km values for alpha-ketoglutarate and pyridoxal phosphate of Enzyme I were 0.41 mM and 4.76 x 10(-3) mM, respectively.
parasitology-helminth-trematoda ; Fasciola hepatica ; biochemistry ; enzyme ; aminotransferase