Central venous catheterization has become an important aid in the correct management of the critically ill patient and is being used more often than in the past. However, no technic of cannulation has been entirely free of complications. A needle which is inserted properly and positioned in the vein is not likely to produce complications arising from injury to adjacent structures; hence accurate knowledge of their anatomic relations is essential for central venous catheterization. We have experienced a case of hydrohemothorax as a complication of subclavian vein catheterization. We report this case with a review of the literature of central venous cathetherization and its possible complications.
Catheterization* ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Critical Illness ; Humans ; Needles ; Subclavian Vein* ; Veins

Preoyerative sedation of children is a difficult problem of great importance, for the psychic trauma comsequent to anticipation of surgery may be as great a hazard to the patient as his original disease. Until now, a number of sedatives have been used commonly for adequate sedation of pediatric patients, but, no method has been universally accepted. At our hospital fifty pediatric patients receiving general anesthesia for minor elective surgery were studied to evaluate the effect of ketamine hydrochloride as a preanesthetic agent. The results were as follows: 1) The onset of drag action was about, about 5min. 2) The induction of anesthesia and maintenances of operation was smooth, because a sedative effect was obtained without cardiovascular and respiratory depression. 3) With a small dosage of ketamine(2mg/kg), patients were free from apprehension. So, perioperative psychic trauma was preventible. 4) The two excitable patients were anesthetized by intravenous anesthetics with ease. 5) Mild complications, accurred but they were not significant.
Anesthesia ; Anesthesia, General ; Anesthetics, Intravenous ; Child* ; Humans ; Hypnotics and Sedatives ; Ketamine* ; Methods ; Respiratory Insufficiency

The pharmacologic actions of ketamine in human volunteers were reported by Domino et al in 1965 and it was used in 130 patients by Corssen Domino in 1966. Chodoff and Stella were the first to investigate ketamines suitabilityas an in anesthetic in childbirth. Since then several authors reported that ketamine has several advantages over conventional anesthetics in obstetric anesthesia. Ketamine was used as the sole anesthetic agent for forceps delivery in 50 women who were selected randomly. Ketamine was administered intravenously just before delivery in doses of 30 to 60 mg and after delivery dosage was not limited, The following results were observed: 1) During delivery, a rapid and intense analgesic effect was sufficiently maintained with a small dose of ketamine. 2) With the use of ketarnine it is possible to shorten the second stage of labor with a short induction-delivery-interval because of the advantages of forceps delivery. 3) Ketamine could be used without intubation during with a short fasting time because protective laryngeal quate airway could be maintained. 4) Ketamine did not appear to induce an increase of Very. delivery even in patients and pharyngeal reflexes and an ade uterine bleeding during or after deli 5) The use of ketamine during delivery appeared to have almost no affect on the Apgar score. 6) The use of ketamine was accompanied by mild complications but they were not significant.
Anesthesia, Obstetrical* ; Anesthetics ; Apgar Score ; Fasting ; Female ; Gagging ; Healthy Volunteers ; Humans ; Intubation ; Ketamine* ; Parturition ; Pharmacologic Actions ; Surgical Instruments ; Uterine Hemorrhage

BACKGROUND:With the application of early reperfusion by thrombolysis after acute MI, the importance of nontransmural infarction is increasing. We evaluated 1) the changes of LV dimension, LV fibrosis and transforming growth factor-beta1 (TGF-beta1) mRNA expression in a rat model of nontransmural infarction and 2) effects of angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ATRB) treatment after nontransmural infarction. METHOD AND RESULTS: Female Sprague-Dawley rats were subjected to 45 minutes of coronary occlusion followed by reperfusion, and at 5 days after the operation, animals were randomized to untreated (MI-vehicle, n=19), captopril-treated (MI-captopril, n=15) and losartan-treated (MI-losartan, n=14) groups. LV dimension, measured by transthoracic echocardiography, was significantly increased at 26 days after MI, and both captopril and losartan treatment inhibited LV cavity dilatation (LV end-diastolic dimension (mm): MI-vehicle, MI-captopril, MI-losartan; 8.6 +/- 0.2, 7.8 +/- 0.2, 8.0 +/- 0.2, p<0.05 vs. MI-vehicle each). Interstitial fibrosis was reduced with both captopril and losartan treatment (p<0.05 vs. MI-vehicle). TGF-beta1 mRNA increased 2.6 fold at 10 days (p<0.05 vs. pre-MI), and normalized at 26 days after nontransmural MI. Captopril and losartan treatment blocked the induction of TGF-beta1 expression after nontransmural MI (p=S vs. pre-MI). CONCLUSION: After large nontransmural MI, ACEI and ATRB treatments attenuate LV remodeling and decrease interstitial fibrosis, at least partly by blocking the acute induction of TGF-beta1 mRNA expression.
Angiotensins* ; Animals ; Captopril ; Coronary Occlusion ; Dilatation ; Echocardiography ; Female ; Fibrosis ; Humans ; Infarction ; Losartan ; Models, Animal ; Peptidyl-Dipeptidase A* ; Rats, Sprague-Dawley ; Receptors, Angiotensin ; Reperfusion ; RNA, Messenger ; Transforming Growth Factor beta1 ; Transforming Growth Factors ; Ventricular Remodeling*

BACKGROUND: Heat-treated cells are known to be protected from lysis by TNF, which is considered to play a central role in the pathogenesis of sepsis-induced acute lung injury. The objective of the study was to investigate the effect of heat shock response by heat-pretreatment on the acute lung injury of the rats induced by intratracheally administered TNF-alpha. METHODS: We intratracheally instilled either saline or TNF (R&D, 500ng) with and without heat pretreatment in Sprague-Dawley rats weighing 250-350 g. The heated rats were raised their rectal temperature to 41degrees C and was maintained thereafter for 13 minutes at 18 h before intratracheal administration of saline or TNF. After 5 h of intratracheal treatment, lung leak, lung myeloperoxidase activity (MPO) and heat shock proteins were measured in rats. Lung leak index was defined as counts per minute of I125 in the right lung divided by counts per minutes of I125 in 1.0 ml of blood. All data are expressed as means+/-SE. RESULTS: There is no difference in acute lung leak index (0.099+/-0.024 vs 0.123+/-0.005) among the rats given saline intratracheally with and without heat pretreatment, but MPO activity showed a decreased tendency in heat-pretreated rats (4.58+/-0.79 U/g) compared with heat-unpretreated rats (7.32+/-0.97 U/g) (P= 0.064). Rats administered TNF intratracheally with heat-pretreatment had decreased lung leak index (0.137+/-0.012) and lung MPO activity (5.51+/-1.04 U/g) compared with those of heat-unpretreated and TNF-administered rats (0.186+/-0.016, 14.34+/-1.22 U/g) (P<0.05 in each). There were no significant difference of lung leak index and MPO activity between TNF-treated rats with heat-pretreatment and saline-treated rats with and without heat-pretreatment CONCLUISON: The heat shock response attenuated neutrophil recruitment and acute lung leak induced by intratracheal instillation of TNF-in rats.
Acute Lung Injury* ; Animals ; Heat-Shock Proteins ; Heat-Shock Response* ; Hot Temperature* ; HSP70 Heat-Shock Proteins ; Lung ; Necrosis* ; Neutrophil Infiltration ; Neutrophils ; Peroxidase ; Rats* ; Rats, Sprague-Dawley ; Respiratory Distress Syndrome, Adult ; Tumor Necrosis Factor-alpha

In September 2011, the Korean Society of Hematology Lymphoma Working Party held a nationwide conference to establish a consensus for assessing bone marrow (BM) involvement in patients with lymphoma. At this conference, many clinicians, hematopathologists, and diagnostic hematologists discussed various topics for a uniform consensus in the evaluation process to determine whether the BM is involved. Now that the discussion has matured sufficiently to be published, we herein describe the consensus reached and limitations in current methods for assessing BM involvement in patients with lymphoma.
Bone Marrow* ; Consensus* ; Hematology* ; Humans ; Lymphoma*

OBJECTIVE: The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. METHOD: This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points: at baseline, and 1,2,4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. RESULTS: 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action: a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. CONCLUSIONS: This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.
Dyskinesias ; Dystonia ; Electrocardiography ; Hospitalization ; Hospitals, University ; Humans ; Parkinsonian Disorders ; Risperidone* ; Schizophrenia* ; Vital Signs ; Weights and Measures