A Case of Type 2 Diabetes Mellitus in Adolescent Presenting with Bell's Palsy

Bell's palsy is manifested by unilateral facial paralysis, but its cause is not clearly elucidated yet. Though the relationship between Bell's palsy and diabetes mellitus (DM) has been well established in adults, the relationship is not obvious in children and adolescents. Here, we report a case of adolescent Bell's palsy accompanied by DM. In this case, steroids were used for the treatment of Bell's palsy, and the blood glucose level in the patients was well controlled by metformin alone without additional use of insulin. We suggest that the presence of diabetes should be determined by blood test in the childhood and adolescent patients with facial paralysis, especially who are obese. As the use of steroids, however, is associated with the elevated blood glucose levels, it should be used with caution.

A rise and fall in AST and ALT level in nonspecific reactive hepatitis / 소아과

PURPOSE: The study was performed to assess the distribution of the diseases associated with nonspecific reactive hepatitis (NRH) for the past 10 years and to evaluate the change in the level of AST and ALT, and the difference by several variable factors. METHODS: From January 1997 to December 2006, 646 patients had elevated liver enzymes among 22,763 patients admitted to the Holy Family Hospital. We analyzed the difference in the age distribution, the period of elevated levels of AST and ALT, the resolution period, the peak value, the daily resolution value of AST and ALT, the sexual differences and the difference in several disease entities. One hundred and ninety-seven patients not confirmed as NRH or lost during follow-up were excluded. RESULTS: The prevalence rate of NRH was 2.84%. When compared to AST, ALT showed longer period of morbidity and resolution and the peak value was also higher in ALT. The male and female ratio showed significant value of 1.63:1. The morbid and resolution periods of AST and ALT between males and females were longer periods in males. The most prevalent disease entities were respiratory and gastrointestinal infections. Between the respiratory and the gastrointestinal diseases, the highest level of AST and ALT was observed in the respiratory disease. CONCLUSION: NRH is a common disease that occurs in 2.84% of the admitted pediatric patients. However, the pathogenesis and the progress of the disease have not been well known due to the lack of generalized information. Further research is necessary in the future.

Clinical Study of the Changes in End tidal PCO2 Arterial Blood Gas and Vital Signs by Increased Minute Ventilation After Deflation of Tourniquet / 대한마취과학회지

Tourniquets are often used for surgery on the extremities to provide a bloodless surgical field. However, tourniquets may cause nerve and other tissue injuries.While the tourniquet is inflated, metabolic changes occur in the ischemic limb, chages that include increased PaCO2, lactic acid and pottasium, and decreased levels of PaO2 and pH. Deflation of the tourniquet results in the release of these products of ischemia into the general circulation. The resultant decreases in arterial pH and PaO2 and increased in arterial lactic acid, potassium, PaCO2 and P(ET)CO2 are associated with significant decrease in mean arterial and central venous pressure and increase in heart rate. Since Pa is one of the important factor to control the cerebral blood flow and intracranial pressure, a sudden increase in PaCO2 immediately after toumiquet deflation may cause detrimental effects in head injured patients with elevated intracranial pressure. The purpose of this study was investigate the effect of the degree of hyperventilation by means of increased minute ventilation by 25%, 50% and 75% respectively, after deflation of toumiquets to keep P(ET)CO2 at former levels, for twenty minutes period, with arterial blood gas analysis, endtidal PaCO2 and vital signs was monitored serially. We compared normal minute ventilation group I with increased minute ventilation groups(II, III and IV) before and after deflation of tourniquet. In summary, we calculated from our data that increasing minute ventilation by more than 50% for 5 minutes following tourniquet deflation could prevent P(ET)CO2 from increasing more than 1.5-6.5 mmHg in all patients.

Effect of Propranolol on Changes in Sereum K+ Induced by brachial Plexus Block / 대한마취과학회지

When we perform the regional blockade, we usually addit epinephrine to the local anesthetics for the purpose of lengthening anesthesia time and preventing the systemic reaction of local anesthetics. In that situation, epinephrine produces decrease in serum potassium concentration and changes in electrocardiogram. We investigated the influence of propranolol on changes in serum potassium and ECG induced by brachial plexus block with 30ml of mixture of local anesthetic (2% lidocaine +0.5% bupivacaine) which contains 1:200,000 epinephrine. The subjects classified as following two groups: Group l : Brachial plexus block with mixture of local anesthetic and 1:200,000 epinephrine(n=20). Group ll : Pretreated with 2 mg of propranolol(slow intravenous injection for 5 min. before block) and performed as Group l. The results were as follows: 1) Group l showed statistically significant decrease of serum potassium after 10, 20, 30 min. of block(p<0.05). Group ll did not show any significant change. 2) Group l showed progressive flattening of T wave and appearance of U wave (25% of pts) in ECG as the serum-potassium decreased progressively, but Group ll did not sho any significant change. 3) The epinephrine mediated beta-adrenergic stimulation may be considered as the cause of epinephrine induced hypokalemia during brachial plexus block.

Comparative Hemodynamic Effects of ED95 Dose of Metocurine and Tubocurarine / 대한마취과학회지

On account of its histamine releasing and ganglionic blocking properties tubocurarine is known to have significant hemodynamic effects. Methylation of the compound produces metocurine and should decrease both histamine release and ganglionic blockade. The hemodynamic effects of these two compounds were compared in 40 patients anesthetized with halothane, nitrous oxide, oxygen. These 40 patients were divided into two groups by administering tubocurarine or metocurine. Group I: When patients had no responses to surgical stimuli after induction, mean arterial blood pressure, pulse rate, pulse pressure were measured 1, 3, 5 min before administration of tubocurarine as control value. After administration of tubocurarine 0.51 mg/kg (ED), mean arterial blood pressure, pulse rate, pulse pressure were measured every minute for twenty minutes as experimental value. (n= 20) Group IL Metocurine 0,2S mg/kg (ED) was administered in the same way as the group I. (n=20) Result: Tubocurarine produced a decreaaed mean arterial blood pressure 22.9%, pulae pressure 16%, and an increaaed pulee rate 14.3%, 2 min after administration of drug(p<0.05). Also mean arterial blood pressure decreased for whole 20 min, pulse pressure for 7 min, and pulse rate increased for 4 min, significantly. But metocurine produced no significant hemodynamic effects. These data suggest that the hemodynamic margin of safety of metocurine is much grater than tubocurarine.

The Hemodynamic Effects of Metocurine during Enflurane Anesthesia / 대한마취과학회지

This study was undertaken to determine the hemodynamic effects of metocurine in 40 adult patients (ASA class I-II) scheduled for elective operation. Anesthesia was induced with thiopental sodium 3-5 mg/kg IV and maintained with enflurane at a constant inspired concentration of 1.5-2.5 vo1%. After 30-minutes of hemodynamic stabilization and when operative stimulus was judged to be unchanged, each patient was randomly assigned to one of following three groups. Group I: Bolus injection of metocurine(0. 28 mg/kg, ED95) within 5 seconds. Group II: Slow injection of metocurine(0.28mg/kg, ED95) within 3 minutes. Group III: Metocurine injection as group I with prophylactic use of H(1)-H(2)-receptor blocker(Cimetidine 300 mg PO, 1 hour before induction and chlorpheniramine 1. 0 mg/kg IV, 10 min. before metocurine injection). There were no significant changes in mean arterial pressure and heart rate throughout the study (p< 0.05), but only one case of group I revealed the evidence of systemic histamine release. Group II and Group III showed no evidence of systemic histamine release. Therefore, we felt that metocurine might be used safely with slow injection or prophylactic use of H(1) and H(2) receptor blocker with rapid bolus injection for any surgical operation, including cardiovascular operations.

Anesthetic Management of a Patient with Pheochromocytoma - A case report / 대한마취과학회지

The anesthetic management of patients with pheochromocytoma presents many difficult problems, such as hypertension, cardiac arrhythmias, and hypotension. A 21 year-old male underwent resection of pheochromocytoma under general anesthesia with isoflurane and fentanyl. Hypertensive crisis during induction of anesthesia and surgical manipulation of the tumor were managed with phentolamine and sodium nitroprusside drips. Anesthesia was maintained wtih nitrous oxide : oxygen, 50% : 50%, isoflurane, 0.5-2% and supplemented with fractional doses of fentanyl and vecuronium for muscular relaxation. We also used propranolol for the cardiac arrhythmia. An endotracheal semi-closed circle absorption technique with controlled ventilation was employed. Fentanyl does not release histamine, and has stable hemodynamics. Isoflurane has also advocated on the grounds that arrhythmias are less esaily provocated by circulating catecholamines than with other volatile agents, and has been shown to be a satisfactory agent. Vecuronium does not provoke catecholamine release, does not release histamine, has no autonomic effects at clinical plasma concentrations, and is clearly the neuromuscular blocking agent of choice in this case. Optimal pre-operative preparation, smooth induction of anesthesia, adequate alveolar ventilation, proper cardiovascular control, and good communication between surgeon and anesthesiologist are most important for the anesthetic management of pheochromocytoma.

Clinical Study of Subarachnoid Blockade with Bupivaeaine / 대한마취과학회지

The effects of subarachnoid administration of 0.5% bupivacaine in 5% and 10% glucosesolution were investigated in a randomized 30 cases undergoing a low limb and low abdominal surgery in the Department of Anesthesiology at the Hanyang University Hospital from October 1st, 1984 to March 31st, 1985. The results are as follows: 1) These were no significant differences between the patients of the three groups in relation to sex, age, weight, height and operation time. 2) The oneset time of the maximum segmental spread of analygesia in the control group was 5 to 10 minutes and 10 to 15 minutes in the experimental groups. 3) The spread of sensory blockade in the experimental groups was lowered 2~3 segment compared with control group. 4) The onset time of complete motor blockade in the control group was 5 minutes and 5~10 minutes in the experimental group. 5) Duration of complete motor blockade in experimental groups was shorter than the control group. 6) The cardiovascular changes were investigated with no significant differences between the patients of the three groups. 7) The minimal complications such as mild hypotension in three cases, micturition difficulty in one case, mild translent headache in one case were investigated in the three groups. According to our investigation of subarachnoid blockade with 0.5% bupivacain 2ml in 5% and 10% glocose solution, it considered that the spread was limited and produced intense sensory and motor block of long duration which was suitable of the low limbs and low abdominal surgery.