Sodium nitroprusside(SNP) is used to induce hypotension for a wide variety of indica- tions. Ordinarily, blood pressure responds sensitively to infusion of SNP in low doses, but occasioally resistance is seen, and actual tachyphylaxis during SNP infusion has been reported. To investigste the continuous infusion rates of SNP, we retrospectively reviewed 144 cases of spinal fusion operations which had been performed under deliberate hypotensive anesthesia (mean arterial pressure at 50-60 mmHg). To produce deliberate hypotension, The mean dose of SNP was 17.16 mg, the mean infusion time 283.85 minutes, and the average infusion rates 1.05 ug/kg/min. Patients who received csptopril required less SNP than untreated patients(0.95 vs 1.23 ug /kg/min., p<0.05). Isovolemic hemodilution also reduced aversge infusion rates of SNP (0. 87 vs 1.22ug/kg/min., p<0.05). There were, however, no significant differences in preoperative hypertention vs normotension, mild hypothermia vs. normothermia during the operation, and male vs. female. In addition, the average infusion rates of SNP were significantly correlated with body mass index(r=0.3329, p<0.01). But those were not correlated with age, infusion time of SNP, weight, volume of transfusion, height/age, and height.
Anesthesia* ; Arterial Pressure ; Blood Pressure ; Female ; Hemodilution ; Humans ; Hypotension ; Hypothermia ; Male ; Nitroprusside ; Retrospective Studies ; Sodium* ; Spinal Fusion ; Tachyphylaxis

Cutaneous horns of the penis are rare. We report a case associated with squamous cell carcinoma in a 56-year-old male. A gradually enlarging nodule had been on the glans penis for four years. He had suffered from an erythematous crusted tumor mass and horny excrescence on the glans penis which recurred and was aggravated after excision of the nodule seven months ago. Histopathologic findings of the lesions showed characteristic findings of squamous cell carcinoma and cutaneous horn. In situ DNA hybridization for human papillomavirus types 6, 11, 16, 18, 32, and 33 were all negative. The tumor mass were surgically excised and we have not found any sign of recurrence since then.
Animals ; Carcinoma, Squamous Cell* ; DNA ; Epithelial Cells* ; Horns* ; Humans ; Male ; Middle Aged ; Penis* ; Recurrence

Spinal anesthesia has a rapid onset and requires small doses of local anesthenc to provide reliable surgical anesthesia and good muscular reiaxation but the disadvantages are the unpredictability of upper level of block, precipitous hypotension, inability to extend the block, and the risk of postdural puncture headache. A combined spinalepidural (CSE) technique can be used to reduce or eliminate some of the disadvantages of spinal and epidural anesthesia while preserving their activity. A combined spinalepidural block may combine the reliability of spinal block and the flexibility of epidural block while minimizing their drawbacks. CSE anesthesia was performed in the 19 patients scheduled for elective total knee arthroplasty. At first 17 G Tuohy needle was inserted L2-3 interspace, the epidual space would be identified, and then a long 22 G spinal needle was introduced through the Tuohy needle until the tip of the spinal needle would penetrate the dura. The correct placement of the spinal needle was confirmed by the appearence of cerebrospinal fluid at the head of needle, then 0.5% hyperbaric tetracaine 1.6-2 ml was injected into subarachnoid space. The spinal needle was withdrawn and a 18 G epidural catheter was introduced into the epidural space. If the patients complained pain during operation, 5 ml of 2% lidocaine was injected through epidural catheter, 2.5 mg Morphine was injected into epidural space for postoperative pain control after operation. Operations were well performed under CSE anesthesia and postoperative pain controls were well managed, too. The responses of the patients who has experienced CSE anesthesia were mostly good.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Arthroplasty* ; Catheters ; Cerebrospinal Fluid ; Epidural Space ; Head ; Humans ; Hypotension ; Knee* ; Lidocaine ; Morphine ; Needles ; Pain, Postoperative ; Pliability ; Post-Dural Puncture Headache ; Subarachnoid Space ; Tetracaine

No abstract available.
Gram-Positive Bacterial Infections* ; Teicoplanin*

Nine patients of mean age 47.8 years, with suspected sinus node dysfunction, underwent extensive electrophysiological studies. Sinus bradycardia(6the electrophysiological study, AH and HV intervals were prolonged in 2/9 and 1/9 patients, respectively. Maximal sinus node recovery times were prolonged in 7/9 patients, ranging from 1,330 msec to 12,330msec. Sinoatrial conduction times measured by atrial premature stimulation technique were prolonged in 5/7 patients, ranging from 137msec to 310 msec. And sinoatrial conduction time measured by continuous pacing technique also revealed prolonged value in 4/6 patients ranging from 140 msec to 195 msec. The effective refractory periods, of atrium were prolonged in 6/8 patients (320 msec to 470 msec). The effective and functional refractory periods of AV node were prolonged in 3/8 patients (440 csec to 490 msec) and 4/8 patients (530 msec to 560 msec), respectively. Retrograde VA conduction could be observed in 3/7 patients and ventricular effective refractory periods were normal in 7/7 patients. Atrial flutter was induced in 1/9 patients by electric stimulation during electrophysiological study. Above data suggest that the electrophysiological study is very useful in assessing the sinus node function and other electrophysiological properties in sick sinus syndrome patients and also suggest that the data could be utilized in choosing the proper mode of artificial pacemaker for each patient.
Atrial Flutter ; Atrioventricular Node ; Electric Stimulation ; Humans ; Pacemaker, Artificial ; Sick Sinus Syndrome* ; Sinoatrial Node

We report on a 28 years old female with recurred cardiac myxomas who presented with dizziness, headache, and blurred vision. She had an excision of biatrial atrial myxomas 10 years age. Varying sized multiple cerebral aneuysms and myxomas in left atrium and left ventricle were found on a cerebral angiogram and echocardiogram, respectively. After wide excision including interatrial septum and part of left ventricular septum, her symptoms were much improved.
Adult ; Dizziness ; Female ; Headache ; Heart Atria ; Heart Ventricles ; Humans ; Intracranial Aneurysm ; Myxoma* ; Ventricular Septum

No abstract available.
Pregnancy*

BACKGROUND: Unexpected failed mask ventilation can result in brain damage or death. The purpose of this study was to demonstrate that the tests for predicting difficult tracheal intubation can be used to predict difficult mask ventilation in Koreans. METHODS: One hundred ninety one patients were assessed before operation using the modified Mallampati test and by measuring the atlanto-occipital angle (AOA), thyromental distance (TM), hyomental distance (HM), sternomental distance (SM), and horizontal length of mandible (HLM). The mask ventilation grades and the laryngeal grades were determined. The sensitivities, specificities and positive predictive values of tests were calculated. RESULTS: Eleven patients (5.7%) had difficulty in mask ventilation and 8 patients (4.1%) had difficulty in intubation. AOA grade had the highest sensitivity and every tests had relatively high specificities for predicting difficult mask ventilation. CONCLUSIONS: The tests for predicting difficult tracheal intubation can be used to predict difficult mask ventilation.
Brain ; Humans ; Intubation* ; Mandible ; Masks* ; Ventilation*

No abstract available.
Ring Chromosomes*

PURPOSE: Lennox-Gastaut syndrome is an intractable epilepsy which is comprised of several types of etiology and generalized seizures. It also combines with mental retardation. The present study was made to ascertain the clinical study on Lennox-Gastaut syndrome in Korea. METHODS: From January, 1985 to December, 1995, 31 children, diagnosed with Lennox-Gastaut syndrome at Kyung Hee University Hospital, were analyzed retrospectively. RESULTS: The ratio of male to female was 2.4:1. With regard to etiology, idiopathic form was found in 7 cases (22.6%) and symptomatic form in 24 cases (77.4%). Transition from West syndrome to Lennox-Gastaut syndrome was observed in 14 cases (45.2%). The most common type of seizure was tonic seizure which was seen in 19 cases (61.3%) and atypical absence, myoclonic seizure and atonic seizure were also observed. The most common clinical signs and symptoms were mental retardation, but others such as progressive loss of psychomotor function and attention deficit were also frequently associated with this syndrome. The EEG usually had abnormal background activity, slow spike and wave complexes and often showed multifocal abnormalities. In spite of intractable epilepsy, 18 cases (58.1%) were controlled with complex anticonvulsant therapy. CONCLUSION: Lennox-Gastaut syndrome manifested itself in children aged 1-6 years and had polyetiology. Most tonic seizures and mental retardation were observed. After complex anticonvulsant therapy with vigabatrin, complete remission was induced in many cases.
Child ; Electroencephalography ; Epilepsy ; Female ; Humans ; Infant ; Infant, Newborn ; Intellectual Disability ; Korea ; Male ; Retrospective Studies ; Seizures ; Spasms, Infantile ; Vigabatrin