We report a case of hereditary angioedema in a 48-year old female patient. She experidenced facial edema and dyspnea 5 to 6 times for a year. Similar episodes developed on some members of her family, especially her sisters and father. We examined her and her sister's serum complement levels. The results showed decreased levels of C1 esterase inhibitor and C4, compared to normal levels. We treated the patient with danazol effectively.
Angioedemas, Hereditary* ; Complement C1 Inhibitor Protein ; Complement System Proteins ; Danazol ; Dyspnea ; Edema ; Fathers ; Female ; Humans ; Middle Aged ; Siblings

No abstract available.
Hypothyroidism*

We report two human cases of tick bite. A 63-year-old male had a pruritic pea-sized brownish nodule on the left popliteal area. Another 41-year-old male had an asymptomatic bean-sized black nodule in the pubic area. The ticks were identified as Ixodes nipponensis, which are the 18th and the 19th cases in Korea.
Adult ; Animals ; Bites and Stings/*parasitology/pathology ; Human ; *Ixodes/anatomy & histology ; Male ; Middle Aged ; Skin/*parasitology/pathology ; Tick Infestations/*parasitology/pathology

This experiment was aimed to investigate the contractile responses of the fermoral artery to the electrical stimulation and the inhibitory effects of verapamil and papaverine on the electrical stimulation of the fermoral artery in the control (n=46) and the diabetic rabbits(n=40). Diabetic rabbits were made by and administration of alloxan (100 mg/kg) intravenously and sacrified 8 weeks later. Femoral arterial rings 3 mm in length were taken and mounted on the force-displacement transducer for the measurements of isometric tension. All experiments were done in the aerated (95% O2 with 5% CO2)biological chamber filled with Kreb's solution and the initial tension of 1.5g was applied to the rings. After 1 hour of equilibrium of the rings, the contractile responses of the electrical stimulation on the femoral arterial rings were taken without vasoactive drugs and then, under verapamil and papaverine solution. And we compared the morphologic findings of the vessels in the two groups in relation to the functional changes by transmission electron miroscopy. The results are as follows: 1. The contractile responses in the presence of verapamil or papaverine solutions to the electrical stimulation were lowed significantly in the fermoral arterial rings of the diabetic rabbits compared with that of the control rabbits (verapamil; 10M~10M: p<0.01, papaverine; 10M & 10M: p<0.01). 2. Transmission electron microphotographs showed many morphological differences of the femoral arteries between the control and the diabetic rabbits. These were irregularities of the internal elastic lamina and the hypertrophy of the cytoplasms of the smooth muscle cells. And also, there were many vacuoles in the cytoplasm of the endothelial cells, lateral to the internal elastic laminaes, and between the smooth muscle cells in the diabetic rabbit femoral artery. By this study, we found that the contractile responses of the femoral arterial rings to the electrical stimulation were decreased in the diabetic rabbits, and the vasodiatory effects of verapamil and papaverine on the electrically stimulated femoral arterial rings were also lowered in the diabetic rabbits compared with the control rabbits. These changes of the vasular responses of the diabetic vessel may be associated with morphological changes manifested by transmission electron microscopy or any other functional derangement of the vessels.
Alloxan ; Arteries ; Cytoplasm ; Electric Stimulation* ; Endothelial Cells ; Femoral Artery ; Hypertrophy ; Microscopy, Electron, Transmission ; Myocytes, Smooth Muscle ; Papaverine ; Rabbits ; Transducers ; Vacuoles ; Vasodilator Agents* ; Verapamil

Tracheoesophageal fistula (TEF) occurs in approximately 1 in 3,000 to 5,000 live births. TEF arises from failure of normal division of proximal foregut into separate respiratory and digestive tracts at 4 weeks' gestation. TEF and esophageal atresia are interrelated anomalies, and TEF usually occurs with esophageal atresia. These are usually diagnosed shortly after birth. However, the diagnosis is often delayed in TEF without esophageal atresia, because babies with this anomaly are usually normal in size and seldom have other anomalies. Therefore, sometimes TEF without esophageal atresia is found during operation for an unrelated condition when positive pressure ventilation causes massive inflation of the gastrointestinal tract. We report a case of TEF in adult patient found during general anesthesia for emergency exploratory laparotomy.
Adult ; Anesthesia, General* ; Diagnosis ; Emergencies* ; Esophageal Atresia ; Gastrointestinal Tract ; Humans ; Inflation, Economic ; Laparotomy* ; Live Birth ; Parturition ; Positive-Pressure Respiration ; Pregnancy ; Tracheoesophageal Fistula*

BACKGROUND: The aim of this study was to compare the cardiovascular changes followed by laryngoscopy with the McCoy laryngoscope blade with those followed by laryngoscopy with the Macintosh laryngoscope blade. METHODS: Forty eight patients were randomly divided into two groups. Following induction with fentanyl 2 mcg/kg and thiopental 5 mg/kg, and muscle relaxation with vecuronium 0.1 mg/kg, the vocal cords were visualized with either the McCoy or the Macintosh laryngoscope blade, then tracheal intubation was performed. Heart rate and arterial blood pressure were measured just before and after laryngoscopy, and 1, 3 and 5 min later. RESULTS: There was a significant increase in both heart rate and arterial blood pressure after tracheal intubation using the Macintosh laryngoscope. Also, use of the McCoy blade resulted in a significant increase in both heart rate and arterial blood pressure. CONCLUSIONS: There was no significant difference on arterial pressure and heart rate to laryngoscopy and tracheal intubation with either the McCoy blade or the Macintosh.
Arterial Pressure ; Blood Pressure* ; Fentanyl ; Heart Rate* ; Heart* ; Humans ; Intubation* ; Laryngoscopes* ; Laryngoscopy ; Muscle Relaxation ; Thiopental ; Vecuronium Bromide ; Vocal Cords

Dilutional hyponatremia as one of the postoperative complications shows around 0.34% in pediatric patients, of which iatrogenic administration of salt-free water is the major cause. Aggressive management should be performed if neurologic symptoms and signs coexist. He/she may be expired of respiratory arrest in severe cases, or permanent neurologic sequelae might persist. We report a case of female pediatric surgical patient who received general anesthesia for Salter innominate osteotomy and had generalized convulsions following 5% dextrose administration. Sodium concentration at immediate postconvulsive period revealed 122 mEq/L, appropriate fluid & electrolyte therapy was performed, then sodium level was successfully restored without any sequelae found. We emphasize that it should be checked out prudently whether postoperative free water is administered in the case of postoperative convulsion, while surgical stimuli and anesthesia itself elevate serum antidiuretic hormone level.
Anesthesia ; Anesthesia, General ; Female ; Glucose ; Humans ; Hyponatremia ; Neurologic Manifestations ; Osteotomy ; Postoperative Complications ; Seizures* ; Sodium ; Water ; Water Intoxication

Thrombotic thrombocytopenic purpura (TTP) is an uncommon disorder, frequently fatal, characterized by a pentad of thrombocytopenia, microangiopathic hemolytic anemia, fluctuating neurologic symptoms, fever, and renal disease. TTP is characterized by widespread noninflammatory thrombotic occlusions of arterioles and capillaries with material containing fibrin and platelets. Generally, gross infarct is rare in the patient with TTP. We present a case of TTP with multiple gross infarcts on brain CT scan. A 53-year-old-man was presented with left hemiparesis and confused mentality. On laboratory study, he had microangiopathic hemolytic anemia & thrombocytopenia. Brain CT showed multiple gross infarct areas in the right basal ganglia, right parietal lobe and right cerebellar hemisphere. When managing the patient with acute stroke syndrome, we should consider TTP as a diagnostic possibility for early proper treatment, even if CT scan of brain show multiple gross infarctions.
Anemia, Hemolytic ; Arterioles ; Basal Ganglia ; Brain ; Capillaries ; Fever ; Fibrin ; Humans ; Infarction* ; Neurologic Manifestations ; Paresis ; Parietal Lobe ; Purpura, Thrombotic Thrombocytopenic ; Stroke ; Thrombocytopenia ; Tomography, X-Ray Computed

OBJECTIVES: Cognitive impairment in restless legs syndrome (RLS) patients can be affected by sleep deprivation, anxiety and depression, which are common in RLS. The objective of this study is to investigate relationship between cognitive impairment and RLS in the non-medicated Korean elderly with controlling for psychiatric conditions. METHOD: The study sample for this study comprised 25 non-medicated Korean elderly RLS patients and 50 age-, sex-, and education-matched controls. All subjects were evaluated with comprehensive cognitive function assessment tools-including the Korean version of Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K), severe cognitive impairment rating scale (SCIRS), frontal assessment battery (FAB), and clock drawing test (CLOX). Sleep quality and depression were also assessed with Pittsburgh sleep quality index (PSQI) and geriatric depression scale (GDS). RESULTS: PSQI and GDS score showed no difference between RLS and control group. There was no significant difference between two groups in nearly all the cognitive function except in constructional recognition test, in which subjects with RLS showed lower performance than control group (t=-2.384, p=0.02). Subjects with depression (GDS> or =10) showed significant cognitive impairment compared to control in verbal fluency, Korean version of Mini Mental Status Examination in the CERAD-K (MMSE-KC), word list memory, trail making test, and frontal assessment battery (FAB). In contrast, no difference was observed between subjects who have low sleep quality (PSQI>5) and control group. CONCLUSIONS: At the exclusion of the impact of insomnia and depression, cognitive function was found to be relatively preserved in RLS patients compared to control. Impairment of visual recognition in RLS patients can be explained in terms of dopaminergic dysfunction in RLS.
Aged ; Alzheimer Disease ; Anxiety ; Depression ; Humans ; Memory ; Restless Legs Syndrome ; Sleep Deprivation ; Sleep Initiation and Maintenance Disorders ; Trail Making Test

We report a case of 54-yr-old woman who presented with 4-extremities weakness and sensory changes, followed by cervical spinal cord lesion in magnetic resonance imaging. Based on the suspicion of spinal tumor, spinal cord biopsy was performed, and the histology revealed multinucleated giant cells, lymphocytes and aggregated histiocytes within granulomatous inflammation, consistent with non-caseating granuloma seen in sarcoidosis. The patient was treated with corticosteroid, immunosuppressant and thalidomide for years. Our case indicates that diagnosis of spinal cord sarcoidosis is challenging and may require histological examination, and high-dose corticosteroid and immunosuppressant will be a good choice in the treatment of spinal cord sarcoidosis, and the thalidomide has to be debated in the spinal cord sarcoidosis.
Adrenal Cortex Hormones/therapeutic use ; Biopsy ; Central Nervous System Diseases/drug therapy/pathology ; Female ; Humans ; Immunosuppressive Agents/*therapeutic use ; Magnetic Resonance Imaging ; Middle Aged ; Sarcoidosis/drug therapy/pathology ; Spinal Cord/*pathology ; Spinal Cord Diseases/drug therapy/*pathology ; Thalidomide/*therapeutic use