Heterotopic pregnancy is the coexistency of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy is about 1 to 30,000 pregnancy in a natural cycle. However, the frequency of heterotopic pregnancy has steadily increased because of rising incidence of pelvic inflammatory disease, pelvic surgery and the development of ovulation induction and assisted reproduction. Because heterotopic pregnancy is difficult to diagnose and it has high morbidity and mortality rate, one should always take this into consideration and should conduct careful and thorough gynecologic evaluation. We have experienced a case of heterotopic pregnancy in a 29-year old woman who presented with acute abdominal pain in a natural cycle and report this case with a brief review of literature.
Abdominal Pain ; Adult ; Female ; Humans ; Incidence ; Mortality ; Ovulation Induction ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Reproduction

BACKGROUND: Interactions between nimodipine, a calcium channel blocker, used perioperatively for the treatment of subarachnoid hemorrhage, and vecuronium, rocuronium, and atracurium were studied with phrenic nerve-hemidiaphragm preparations of rats. METHODS: Male 200-300 g Sprague-Dawley rats were randomly allocated into four groups (control, NMD(5), NMD(50) and NMD(500) group, n = 10, respectively) according to the nimodipine concentration, and three groups (control, NMD(2D) and NMD(7D), n = 10, respectively) according to the pretreatment duration. A square wave 0.1 Hz supramaximal stimuli was applied to the phrenic nerve-hemidiaphragm preparation and the twitch height response was recorded with mechanomyography. The dose-response curves were measured, and ED(5), ED(50), ED(90), and ED(95) of each vecuronium, rocuronium, and atracurium in different concentrations of nimodipine of 5, 50, and 500 ng/ml and rocuronium in pretreatment with nimodipine 2.5 mg/kg/d for 2 and 7 days were calculated using an inhibitory sigmoid Emax model. RESULTS: The dose-response curves of rocuronium and atracurium were significantly shifted to the left in NMD(500) group, and significantly shifted to the right in NMD(7D) group (P < 0.05). In NMD(500) group, ED(50), ED(90), and ED(95) of rocuronium and atracurium were significantly reduced, and those of rocuronium in NMD7D group were significantly increased compared with the control group (P < 0.05). CONCLUSIONS: Nimodipine 500 ng/ml in the phrenic nerve-hemidiaphragm preparation of rat increased sensitivity to rocuronium and atracurium, and the dose-response curve was significantly shifted to the left, but following pretreatment for 7 days, nimodipine decreased the potency of rocuronium, and the dose-response curve was significantly shifted to the right.
Animals ; Atracurium* ; Calcium Channels ; Colon, Sigmoid ; Humans ; Male ; Nimodipine* ; Rats* ; Rats, Sprague-Dawley ; Subarachnoid Hemorrhage ; Vecuronium Bromide*

No abstract available.
Anemia, Hemolytic* ; Child* ; Humans

We noticed a group of thoracolumbar and lumbar spine fractures showing a unique fracture pattern that consisted of 1) superior disc injury, 2) crush fracture of the upper half of the vertebral body, 3) sagittal fracture of the lower half of the vertebral body, 4) bone fragments in the spinal canal, and 5) lamina fracture. Some of these fracture patterns were present in type B burst fracture of Denis classification. The purpose of this study was to compare the difference between crush-cleavage fracture and type B burst fracture in the viewpoint of neural canal involvement and neurologic status, and functional outcome with surgical treatment. Ten cases were identified as crush-cleavage fractures in 22 type B burst fractures during a 5 year period from Mar. 1989 to Jun. 1993 at the Department of Orthopedic Surgery of Chonbuk National University Hospital. Four out of 10 crush-cleavage fractures and 4 out of 12 type B burst fractures were paraparetic. Crush-cleavage fracture must be an unstable thoracolumbar comminuted fracture, but there were no significant differences in the neural canal involvement, incidence of neurologic deficit, and in the functional outcome, compared with type B burst fracture (P>0.05). It could be classified as a progressed form of type B burst fracture in Denis classification, or as a burst-split fracture in Magerl classification in the anatomical viewpoint. In conclusion, crush-cleavage fracture must be a variant of burst fracture.
Classification ; Fractures, Comminuted ; Incidence ; Jeollabuk-do ; Neural Tube ; Neurologic Manifestations ; Orthopedics ; Spinal Canal ; Spine

The treatment of massive bone and soft tissue defect in the lower leg has a high complication rate of nonunion, chronic infection, and amputation without well-vascularized tissue coverage of the open fracture. Despite adequate free soft tissue coverage, massive skeletal defect may result in segmental bone defects, angulation deformity, and limb length discrepancies. In the last decade, major advances have occurred in the Ilizarov method of distraction osteogenesis in lower leg salvage as a delayed procedure or simultaneous distraction after free-tissue transfer. The authors have performed Ilizarov transport in conjunction with muscle and musculocutaneous flap coverage in nine cases of lower leg salvage. The flaps consist of rectus, gracilis, latissimus dorsi, parascapular, and serratus muscle or musculocutaneous fashioning using ipsilateral or contralateral pedicle in consideration of vessel condiation. Revision, recorticotomy and flap elevation were also used as a secondary procedure for satisfactory results. The conclusions, were as follows: 1) Multidisciplinary team approach with conjoining departments at the time of preoperative evaluation, postoperative care and rehabilitation care; 2) Muscle flap covered with split-thickness skin graft was preferred to musculocutaneous flap; 3) To reduce the total reconstructive period, simultaneous free tissue transfer with Ilizarov distraction should be considered.
Amputation ; Congenital Abnormalities ; Extremities ; Fractures, Open ; Ilizarov Technique ; Leg* ; Myocutaneous Flap ; Osteogenesis* ; Osteogenesis, Distraction ; Postoperative Care ; Rehabilitation ; Skin ; Superficial Back Muscles ; Transplants

Adequate growth is the most importment and principal factor in the fields of pediatrics and also it is great concern to all parents. There are many causes of short stature, secondary to a variety of causes. Clinical evaluation of short stature requires a wide variety of clinical, radiographic, pathologic, and biochemical tools. The most important thing is early and accurate diagnosis of disease. As a first step to do so, we performed the clinical analysis of 25 short statured children who had been admitted to Severance Hospital in recent 10 years. Results were as follows; 1) In 25 cases, male were 11 and female were 14 cases. Etiologically, contitutional slow growth 2, mongolism 1, gargoylism 3, achondroplasia 3, spondylometaphyseal dsplasia 1, cretinism 12, and pitutary dwarfism 3 cases.2) Chronological age at the beginning of diagnostic approach were generally delayed. 3) Height age and bone age of dwarfism were markedly retarded than chronological age wheras weight age showed no specific relationship except in case of malnutrition. 4) skeletal dysplasia and endocrine dwarfism, bone age was retarded than height age. But in constitutional slow growth, discrepancy was not marked. 5) Head circumference in each type of short stature was variable. 6) Diagnostic methods include measurement of height and bone age, X-ray, thyroid function test, growth hormone stimulation test and chromosome study.
Achondroplasia ; Child ; Congenital Hypothyroidism ; Diagnosis ; Down Syndrome ; Dwarfism ; Female ; Growth Hormone ; Head ; Humans ; Male ; Malnutrition ; Mucopolysaccharidosis I ; Parents ; Pediatrics ; Thyroid Function Tests

BACKGROUND: Ketamine, a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, may prevent central sensitization and result in preemptive analgesia when administered before surgically induced trauma. The goal of this study was to determine whether intravenous low dose ketamine would reduce postoperative pain and cumulative analgesic requirements after total intravenous anesthesia (TIVA) with propofol and fentanyl. METHODS: The thirty-four patients undergoing total abdominal hysterectomy were randomly allocated to according to anesthetic agent to a propofol-fentanyl-N2O (60%)-O2 (40%) group (group PFN) or a propofol-fentanyl-ketamine-O2 (40%) group (group PFK); 0.3 mg/kg of ketamine initially during induction followed by a continous infusion at 0.15 mg/kg/h. Propofol and fentanyl were continuously administered using target controlled infusion (TCI). Intravenous patient-controlled analgesia (IV-PCA) using a fentanyl-ketorolac mixture was started in all patients after full recovery in a postanesthetic care unit (PACU). Verbal numerial scale (VNS) pain scores, cumulative total analgesic consumptions, and side effects were recorded immediately before and at 1, 3, 6, 12, 24, and 48 h after IV PCA. RESULTS: No significant intergroup differences were seen in the VNS pain scores and in side effects during entire study period. But, patients in the PFK group had significantly lower total analgesic consumptions at 48 h after IV PCA. No significant differences were observed between the two groups in terms of side effects. CONCLUSIONS: Intravenous low dose ketamine during TIVA with propofol and fentanyl did not reduce postoperative pain scores, but did reduce total analgesic requirement at 48 h after IV PCA.
Analgesia ; Analgesia, Patient-Controlled ; Anesthesia, Intravenous* ; Central Nervous System Sensitization ; Fentanyl ; Humans ; Hysterectomy ; Ketamine* ; N-Methylaspartate ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Propofol

BACKGROUND: We evaluated the hemodynamic responses and the rapidly extracted auditory evoked potential index (A-line ARX index or AAI) responses during induction and intubation at different effect site concentration of propofol using target-controlled infusion. METHODS: Thirty patients scheduled for elective surgery under general anesthesia were randomly assigned to 3 groups (Groups I, II, and III). Anesthesia was induced using the infusion of propofol at three different effect site concentrations as a target (Group I: 3.0microgram/ml, Group II: 3.5microgram/ml, and Group III: 4.0microgram/ml) following midazolam premedication. We measured AAI, systolic, diastolic, and mean arterial blood pressures and the heart rate after midazolam premedication, loss of consciousness, just before intubation, immediately after intubation, and 1, 2, and 3 minutes after intubation. RESULTS: In Groups II and III, AAI were significantly lower than that in group I immediately after intubation, and % changes in diastolic and mean arterial blood pressures were significantly lower than that in group I 1 minute after intubation (P<0.05). CONCLUSIONS: Effect site concentration of propofol targeted at 3.5microgram/ml or 4.0microgram/ml produces better hemodynamic stability and AAI responses during intubation than that achieved at 3.0microgram/ml.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Evoked Potentials, Auditory* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Midazolam ; Premedication ; Propofol* ; Unconsciousness

BACKGROUND: We evaluated bispectral index (BIS) and hemodynamic and catecholamine responses to induction and intubation at different effect site concentrations during the target-effect site-controlled infusion of propofol with fentanyl coadministration. METHODS: Thirty patients scheduled for elective surgery under general anesthesia were randomly assigned to two groups. Anesthesia was induced using the target-effect site-controlled infusion of propofol at different effect site concentrations (Group I: 3.0microgram/ml, Group II: 3.5microgram/ml) following bolus injection of fentanyl (2microgram/kg). We measured BIS and systolic, diastolic, and mean arterial blood pressures, heart rate, epinephrine (E), and norepinephrine (NE) 5 min before induction, at loss of consciousness, just before intubation, immediately after intubation, and 1, 2, and 3 minutes after intubation. RESULTS: No significant differences were observed in hemodynamic or catecholamine responses to induction or intubation between the two groups. In both groups, hemodynamic changes to induction and intubation were within 30% and 20% of pre-induction levels, respectively, and catecholamine responses significantly decreased or did not change versus pre-induction levels. But in group II, the dose of propofol administered was significantly more than in group I, and BIS levels immediately before and after intubation were below 40. CONCLUSIONS: With fentanyl coadministration of 2microgram/kg, targeting 3.0microgram/ml as an effect site concentration of propofol during target-effect site-controlled infusion is better than targeting 3.5microgram/ml, because targeting the latter produced too low a BIS and too much propofol administration, although both targeted values produced similar hemodynamic and catecholamine responses.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Epinephrine ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Norepinephrine ; Propofol* ; Unconsciousness

BACKGROUND: An aortocaval compression by the gravid uterus in late pregnancy leads to acute hypotension in the mother and decreases uteroplacental blood flow which may affect neonatal outcome. The purpose of this study was to evaluate maternal hemodynamic changes, which affect neonatal outcome under general anesthesia for an elective cesarean section depending on the maternal position-supine or left lateral 15degrees tilting by wedge. METHODS: Forty women undergoing an elective cesarean section under general anesthesia delivered through the supine position or left lateral 15degrees tilting by wedge position randomly. The maternal brachial blood pressure and heart rate were recorded, and the maternal arterial blood, umbilical artery and vein blood were sampled. Induction-to-delivery time (IDT), uterine incision-to-delivery time (UDT), and Apgar scores were measured. RESULTS: The two groups had no maternal hypotension less than 100 mmHg, and there were no significant differences in brachial blood pressure and heart rate of the mother, or acid-base status and Apgar scores of the neonate. CONCLUSIONS: In conclusion, maternal position had no clinical significant effects on maternal brachial blood pressure and heart rate, and neonatal outcome.
Anesthesia, General ; Blood Pressure ; Cesarean Section ; Female ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Infant, Newborn* ; Mothers ; Pregnancy ; Supine Position ; Umbilical Arteries ; Uterus ; Veins