Background: Norepinephrine, a potent α-adrenergic agonist with β-adrenergic effects, has recently emerged as a potential alternative to phenylephrine that does not lower cardiac output (CO) and heart rate (HR) during cesarean deliveries. We examined the systemic hemodynamic effects of both agents in this setting, using intermittent bolus doses to treat spinal anesthesia-induced hypotension. Methods: A total of 56 parturients consenting to spinal anesthesia for elective cesarean delivery were randomly assigned to phenylephrine (100 μg/ml) or norepinephrine (5 μg/ ml) intermittent bolus dosing. The primary study outcome was maternal normalized CO, examining and other hemodynamic variables, maternal side effects, and fetal outcomes secondarily. Results: In terms of systolic blood pressure and HR, there were significant within-group differences over time (P < 0.001 and P < 0.001, respectively). Normalized CO and stroke volume (SV) also showed significant differences between groups (P < 0.001 and P = 0.002, respectively). In the phenylephrine group, normalized CO and SV declined (relative to baseline values) by as much as 13% and 9%, respectively; whereas in the norepinephrine group, normalized CO did not differ significantly from baseline, and SV increased up to 5% (relative to baseline). Normalized total peripheral resistance likewise displayed significant within-group differences over time (P < 0.001). Conclusions During elective cesarean delivery, intermittent bolus doses of norepinephrine proved effective for treating spinal anesthesia-induced hypotension, while maintaining CO and SV. No maternal complications or fetal effects were evident.

OBJECTIVE: To investigate the effect of deep brain stimulation (DBS) on reducing dystonia and disability in adults with cerebral palsy (CP) and to compare the therapeutic outcomes between primary dystonia patients and CP patients over two years after bilateral pallidal DBS. METHODS: Five patients with primary dystonia and seven CP patients with dystonia were recruited. All subjects received DBS surgery in both globus pallidus. Burke-Fahn-Marsden dystonia rating scale consisting of dystonia movement score and disability score and subjective satisfaction scale were assessed after 1 month and every 6 months over two years following DBS treatment. RESULTS: On the dystonia movement scale, both groups of primary dystonia patients and CP patients showed a significant decrease over time following DBS. On the disability scale, patients with primary dystonia showed a significant decrease over time, whereas the disability score of CP patients did not change over the two years. Comparing the dystonia movement and disability scores of CP patients at each assessment, patients with primary dystonia showed a significant reduction after 6 months. Comparing the satisfaction scores of CP patients after DBS, patients with primary dystonia showed significantly higher subjective satisfaction. CONCLUSION: Whereas dystonia can be significantly reduced in patients with primary dystonia, CP patients showed a modest improvement on the dystonia movement scale, but not on the disability scale. Therefore, DBS may be considered with caution as a treatment modality of CP patients with dystonia.
Adult* ; Cerebral Palsy* ; Deep Brain Stimulation* ; Dystonia ; Dystonic Disorders ; Globus Pallidus ; Humans

OBJECTIVE: To investigate the effect of deep brain stimulation (DBS) on reducing dystonia and disability in adults with cerebral palsy (CP) and to compare the therapeutic outcomes between primary dystonia patients and CP patients over two years after bilateral pallidal DBS. METHODS: Five patients with primary dystonia and seven CP patients with dystonia were recruited. All subjects received DBS surgery in both globus pallidus. Burke-Fahn-Marsden dystonia rating scale consisting of dystonia movement score and disability score and subjective satisfaction scale were assessed after 1 month and every 6 months over two years following DBS treatment. RESULTS: On the dystonia movement scale, both groups of primary dystonia patients and CP patients showed a significant decrease over time following DBS. On the disability scale, patients with primary dystonia showed a significant decrease over time, whereas the disability score of CP patients did not change over the two years. Comparing the dystonia movement and disability scores of CP patients at each assessment, patients with primary dystonia showed a significant reduction after 6 months. Comparing the satisfaction scores of CP patients after DBS, patients with primary dystonia showed significantly higher subjective satisfaction. CONCLUSION: Whereas dystonia can be significantly reduced in patients with primary dystonia, CP patients showed a modest improvement on the dystonia movement scale, but not on the disability scale. Therefore, DBS may be considered with caution as a treatment modality of CP patients with dystonia.
Adult* ; Cerebral Palsy* ; Deep Brain Stimulation* ; Dystonia ; Dystonic Disorders ; Globus Pallidus ; Humans

BACKGROUND: Although midazolam administration may occasionally induce a paradoxical episode, such as threatened crying and violent behavior in children, systematic studies on the causes of paradoxical reaction are limited. We investigated the effect of children's age and a dose of midazolam on the paradoxical reaction. METHODS: A total of one hundred sixty four children of 1-3 years and 3-5 years, were enrolled in this study. Each age group randomly received 0.05 mg/kg or 0.1 mg/kg of intravenous midazolam (41 patients/group). RESULTS: The incidence of paradoxical midazolam reaction in the study groups, 1-3 years with 0.1 mg/kg of intravenous midazolam, 1-3 years with 0.05 mg/kg, 3-5 years with 0.1 mg/kg, and 3-5 years with 0.05 mg/kg were as follows: 29.3%, 12.2%, 7.3% and 2.4%, respectively. The incidence among the 4 groups was significantly different (P = 0.002), highest in the 1-3 years receiving 0.1 mg/kg of midazolam (29.3%). Both age (P = 0.004, OR [95%CI] = 5.3 [1.7-16.8]) and dose of midazolam (P = 0.036, OR [95%CI] = 3.0 [1.1-8.4]) were risk factors. Perioperative clinical data including anxiety scales of children were not associated with the paradoxical midazolam reaction. CONCLUSIONS: In conclusion, we suggest that children less than 3 years old receiving higher dose of intravenous midazolam are at risk for the paradoxical midazolam reaction.
Anxiety ; Child ; Crying ; Humans ; Incidence ; Midazolam ; Risk Factors ; Weights and Measures

Diffuse plane xanthoma is a group of plane xanthomas that appear as yellow to yellowish-brown flat patches or slightly elevated plaques with a widespread distribution. It is often associated with, or preceded by several years of, hematologic problems. Here, we describe a 63-year-old woman diagnosed with diffuse normolipemic plane xanthoma who developed multiple myeloma 20 years later. This case suggests that patients with diffuse normolipemic plane xanthoma should be followed for their entire life to detect health problems.
Female ; Humans ; Middle Aged ; Multiple Myeloma ; Xanthomatosis

Diffuse plane xanthoma is a group of plane xanthomas that appear as yellow to yellowish-brown flat patches or slightly elevated plaques with a widespread distribution. It is often associated with, or preceded by several years of, hematologic problems. Here, we describe a 63-year-old woman diagnosed with diffuse normolipemic plane xanthoma who developed multiple myeloma 20 years later. This case suggests that patients with diffuse normolipemic plane xanthoma should be followed for their entire life to detect health problems.
Female ; Humans ; Middle Aged ; Multiple Myeloma ; Xanthomatosis

OBJECTIVES: This multi-institutional study aims to investigate the survival rate of premature infants and the causes of death according to gestational age and birth weight during the past three years. METHODS: This study retrospectively examined medical records of 1,400 premature infants who were born at 23 to 34 weeks gestation and were hospitalized in the neonatal intensive care unit of seven hospitals from 2004 to 2006. Gestational age, birth weight, gender, plurality, survival rate, and cause of death were examined, and the survival rate was measured according to gestational age and birth weight. RESULTS: The average gestational age and the average birth weight of the subjects was 31+/-1.8 weeks and 1,775+/-530 g, respectively. The survival rate showed no difference by gender, plurality and years. The survival rate of very premature babies, low birth weight infants, very low birth weight infants, and extremely low birth weight infants were 87.6%, 93.8%, 83.2%, and 62.7% respectively. Causes of death were the complications of prematurity (83.8%), congenital anomalies (15.2%), birth asphyxia (5.0%) and others (2.5%). The survival rate increased significantly according to the gestational age and also by the birth weight. CONCLUSIONS: Our data do not represent of the survival rate and the causes of death in Korea. However, our data may reflect the common survival rate and the causes of death in Korean NICU, because the 7 hospitals participated in this study were common facilities and manpower in Korea.
Asphyxia ; Birth Weight ; Cause of Death ; Gestational Age ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Korea ; Medical Records ; Parturition ; Pregnancy ; Premature Birth ; Retrospective Studies ; Survival Rate

PURPOSE: Many gene polymorphisms are associated with coronary artery abnormalities in Kawasaki disease. Catechol-O-methyltransfe rase (COMT) plays an important role in the metabolism of catecholamines, catechol estrogen, and catechol drugs. Polymorphisms of the COMT gene are reported to be associated with myocardial infarction and coronary artery abnormalities. The aim of this study was to evaluate the relationship between COMT gene polymorphisms and coronary artery abnormalities in Kawasaki disease patients. METHODS: One hundred and one Korean children with Kawasaki disease and 306 healthy Korean control subjects were enrolled in this study. The polymorphisms of the COMT gene were analyzed by direct sequencing. RESULTS: There were no differences in the genotype and allelic frequency of the rs4680 and rs769224 polymorphic sites between Kawasaki disease and control subjects. Further, no significant difference was found in the rs4680 polymorphism between patients with coronary artery abnormalities and patients without coronary artery abnormalities (codominant P=0.32, dominant P=0.74, recessive P=0.13). However, the distribution of the rs769224 polymorphism was significantly different between patie nts with coronary artery abnormalities and patients without coronary artery abnormalities (codominant P=0.0077, dominant P=0.0021, recessive P=0.16). CONCLUSION: Our results indicate that the polymorphisms of the rs769224 gene might be related to the development of coronary artery abnormalities in Kawasaki disease.
Catechol O-Methyltransferase ; Catecholamines ; Catechols ; Child ; Coronary Artery Disease ; Coronary Vessels ; Estrogens ; Genotype ; Humans ; Mucocutaneous Lymph Node Syndrome ; Myocardial Infarction ; Polymorphism, Genetic

Lymphocytic infundibuloneurohypophysitis is a neuroendocrine disorder characterized by autoimmune inflammation of the pituitary stalk and neurohypophysis. Clinical findings such as acute onset central diabetes insipidus and the regression of characteristic magnetic resonance imaging (MRI) findings allow for the possible diagnosis of this disease. Three cases of lymphocytic infundibuloneurohypophysitis have been previously reported in Korea. Here we report a case in a 66-year-old woman, along with a review of previously reported occurrences in Korea. A woman presented with abrupt-onset central diabetes insipidus. Sella MRI showed thickening of the pituitary stalk and loss of high T1 signals that are associated with a normal neurohypophysis. Basal pituitary hormone levels were normal with the exception of growth hormone, which was low. The patient refused transsphenoidal pituitary biopsy and we thus chose to continue close clinical and radiologic follow-up after desmopressin nasal spray application. The need for desmopressin decreased slightly over time and MRI obtained after 6 months showed regression of the pituitary stalk lesion.
Aged ; Biopsy ; Deamino Arginine Vasopressin ; Diabetes Insipidus ; Diabetes Insipidus, Neurogenic ; Female ; Follow-Up Studies ; Growth Hormone ; Humans ; Inflammation ; Korea ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Gland, Posterior

Cholelithiasis is rarely recognized in children, especially in infants. Hemolytic disorders, long-term total parenteral nutrition (TPN), congenital anomalies of the biliary tree leading to stasis of bile flow, congenital IgA-deficiency, furosemide treatment, and prolonged fasting have been reported as predisposing factors for cholelithiasis in childhood. Hemolytic disease of the newborn due to anti-E has rarely been reported as a risk factor for cholelithiasis. We report a case of gallbladder stones in a neonate associated with anti-E antibody hemolytic disease.
Bile ; Biliary Tract ; Child ; Cholelithiasis ; Fasting ; Furosemide ; Gallbladder ; Humans ; Infant ; Infant, Newborn ; Parenteral Nutrition, Total ; Risk Factors