Wolff-Parkinson-White syndrome in young people, from childhood to young adulthood: relationships between age and clinical and electrophysiological findings / 소아과

PURPOSE: The aim of the present study was to evaluate the characteristics of electrophysiologic studies (EPS) and radiofrequency ablation (RFA) performed in subjects aged less than 30 years with Wolff-Parkinson-White (WPW) syndrome, particularly pediatric patients under 18 years of age, based on our experience. METHODS: Two hundred and one consecutive patients with WPW syndrome were recruited and divided to 3 groups according to age: group 1, 6 to 17 years; group 2, 18 to 29 years; and group 3, 30 to 60 years. The clinical, electrophysiological, and therapeutic data for these patients were evaluated by a retrospective medical record review. RESULTS: A total of 73 (36%) of these patients were <30 years of age. Although there were more males than females in group 2 (male:female, 31:11), there was no sex difference in group 1 (male:female, 16:15). Left accessory pathway was detected less frequently in group 1 (32%, 10/31) than in group 2 (57%, 24/42) and group 3 (63%, 81/128) (P=0.023 and P=0.002, respectively). CONCLUSION: The present study describes several different electrophysiological characteristics in children and adolescents with WPW syndrome. Therefore, when EPS and RFA are performed in children and adolescence with WPW syndrome, we recommend that these characteristics be considered.

Feasibility of Foley Catheter Prior to Endoscopy for the Removal of Esophageal Coin in Children / 대한소아소화기영양학회지

PURPOSE: This study evaluated the efficiency and safety of the Foley catheter for esophageal removal of coins in children, compared to standard endoscopic extraction with respect to success rate, sedation, promptness and cost. METHODS: Twenty four children with coin lodgement in esophagus were managed with either a Foley catheter (n=14) or endoscopic extraction (n=10) from January 2007 through August 2010 at Kyungpook National University Hospital. A retrospective review of medical records and radiological findings was performed. RESULTS: Of the 14 patients who underwent Foley catheter extraction, successful and complication-free removal was achieved in 10 cases (71.4%). Of the 10 patients who underwent endoscopic extraction, all cases were successful (p=0.114). Sedation rate in the Foley catheter and endoscopic extraction group was 6/14 and 10/10 (p=0.006). The average wait time before the procedure and average hospital charge (US$) were 2.0+/-1.1 hours and 18.1+/-13.7 hours, and $113 and $428 for Foley catheter extraction and endoscopic extraction, respectively. CONCLUSION: Foley catheter extraction may be tried for the removal of esophageal coins in uncomplicated children. The technique is effective, safe, inexpensive and free of general anesthesia.

Unpredicted tachycardia and hypotension in a patient with medullary thyroid cancer and undiagnosed pheochromocytoma: A case report / 대한마취과학회지

A 35 year old woman with hypercalcitoninemia was scheduled for an operation to treat her medullary thyroid cancer (MTC). TIVA with propofol and remifentanil was planned, and about 3 minutes after the infusion of anesthetics, her heart rate was suddenly elevated to 180/min and the systolic blood pressure was lowered to nearly 50 mmHg. The blood pressure returned to normal after the injection of phenylephrine 100 microgram and a rapid infusion of 700 ml crystalloid solution. After the operation, bilateral pheochromocytoma and a RET proto-oncogene mutation related with multiple endocrine neoplasia 2A (MEN-2A) were found. Patients with MTC can present with peripheral vasodilation and relative hypovolemia that are related with hypercalcitoninemia. Patients with MEN-2A can be anesthetized for a MTC operation without the appropriate preparation for their pheochromocytoma. Therefore, we suggest that patients with MTC and hypercalcitoninemia should be cautiously anesthetized with TIVA. They also should be screened for pheochromocytoma and the RET proto-oncogene mutation to prevent deleterious hemodynamic events during anesthesia.

Characteristics of 3-D Visuospatial-Motor Distracter Processing During Cognitive Task Performance in Schizophrenia / 신경정신의학

OBJECTIVES: Abnormalities of cognitive responses to verbal and visual distracter in schizophrenia have been demonstrated in numerous studies but little is known about three dimensional visuospatial-motor distracter processing. The purpose of this study was to investigate the vulnerability of patients with schizophrenia to three dimensional visuospatial-motor distracter. METHODS: 14 patients with schizophrenia and 14 normal volunteers were assessed on three dimensional maze tasks requiring on working memory and reasoning ability in the virtual reality environment. Performances were compared according to with- or without-distracter conditions. RESULTS: Patients with schizophrenia showed significantly lower performances than normal control group on cognitive flexibility, simple motor function or motor control and motor coordination, working memory span and delayed performance times. The performance index tended to be more deteriorated, but not significantly, in with-distracter condition than in without-distracter condition in schizophrenia. CONCLUSIONS: Patients with schizophrenia tend to be vulnerable to visuospatial-motor distracter which simulate the real world of three dimensional environment.

Neurocognitive Function in the Euthymic Bipolar I Disorders / 신경정신의학

OBJECTIVES: The previous assumption that patients with bipolar I disorder make a full recovery of cognitive function in the euthymic phase has been challenged by studies that suggest neuronal changes, and recently persisting neuropsychological dysfunctions beyond episodes of the illness. The aim of the present study was to investigate the impairment of the neurocognitive performance of euthymic bipolar patients, the characteristics of cognitive impairment, and the relationship between cognitive dysfunction and clinical variables of illness in bipolar population. METHODS: 19 bipolar out-patients who had been euthymic for more than 3 months by Hamilton Depression Scale score below 7 and Young Mania Rating Scale score below 6 were compared with age- and education- matched 19 healthy subjects on neurocognitive tests. Patients showing observable extrapyramidal symptoms were excluded with the objective rating. The following tests were administered in according to cognitive domain: Korean-Wechsler Adult Intelligence Scale, subtests among Wechsler Memory Scale-Revised, Wisconsin Card Sorting Test, and Signal Detection/Decision-Reaction Timer/Psychomotor Performances among Vienna Test System. RESULTS: The bipolar group performed significantly lower than the control group on verbal and performance IQ, total IQ, and psychomotor function or coordination. There was no relationship between the cognitive impairment and clinical course of illness, except duration of neuroleptic exposure. CONCLUSIONS: Although our findings did not replicate the recently reported results, especially in the domain of executive function and verbal memory, they suggested the presence of neurocognitive difficulties, in the general ability and visuomotor function in stable bipolar patients. Also, we tailed to identify the influence of clinical course variables on cognitive area with statistically signficant differences.