Tracheobronchial rupture following tracheal intubation with double-lumen endobronchial tube (DLT) is a rare complication, but may result in a massive air leakage with resultant pneumothorax, mediastinal emphysema and extensive subcutaneous emphysema in the postoperative period. We report a case of sustained laceration of the posterior membranous part of the trachea possibly due to overinflation of the double-lumen endobronchial tube. A 76-year-old, 45 kg, female was scheduled for a repair of her bronchopleural fistula. Following induction of anesthesia, intubation was performed with Robertshaw's DLT, and a tracheal cuff was inflated with 6 ml of air, but the sound of an air leak was heard coming from the patient's mouth during controlled ventilation. A further 5 ml of air was added 1 ml at a time into the tracheal cuff but the air leak sound continued. At that point, the sound was considered to originate from the bronchopleural fistula rather than from lack of sufficient air. After a thorough deflation of the tracheal cuff, 6 ml of air was reinjected and the operation was resumed. A 4 cm split was unexpectedly noticed in the posterior wall of the trachea during the operation and was repaired without complication.
Aged ; Anesthesia ; Female ; Fistula ; Humans ; Intubation ; Lacerations ; Mediastinal Emphysema ; Mouth ; Pneumothorax ; Postoperative Period ; Rupture* ; Subcutaneous Emphysema ; Trachea ; Ventilation

Assessing the working memory of the rodent by using a touch-screen system has several advantages (e.g., allowing highly accurate data collection and flexibility in memory task design). However, there is currently no available testing paradigm utilizing touch-screen systems that can assess working memory in the mouse. In this study, we developed a touch-screen testing paradigm in which mice were trained to choose a location that is matched to a sample location after a time delay. Consistent with previous studies, this study showed that mice could not only learn the rule in the delayed matched to position (DMTP), but also could retain a transitory memory of the sample position during delay. This indicates that a touch-screen system can provide a DMTP testing platform to assess working memory in the mouse.
Animals ; Data Collection ; Memory ; Memory, Short-Term* ; Mice* ; Pliability ; Rodentia

Holoprosencephaly is a rare malformation complex or development defect including different degrees of incomplete cleavages of the embryonic prosencephalon and varying degrees of the midface defects, resulting from the defect of prechordal mesoderm, migrating forward into the area anterior to the notochord during the third week of fetal development. Early antenatal diagnosis of holoprosencephaly is important to find out its severity, to predict its prognosis, and to determine proper management according to its prognosis and severity. The possibility of early antenatal diagnosis of holoprosencephaly by ultrasound has been suggested, but occasionally missed and rarely confirmed. We present one case of lobar holoprosencephaly, diagnosed postnatally and one case of alobar holoprosencephaly, diagnosed antenatally in our hospitals.
Fetal Development ; Holoprosencephaly* ; Mesoderm ; Notochord ; Prenatal Diagnosis ; Prognosis ; Prosencephalon ; Ultrasonography

Aberrant right subclavian artery (ARSA) is an anomaly with a reported incidence of 0.5% to 2%. Most patients with an ARSA remain asymptomatic; however about 10% of adult patients have compressive symptoms. A case is reported of a 64-year old female patient who had a few years of history of dysphagia and recurrent pneumonia. Angiography was performed, which demonstrated an ARSA with common origin of the right and left carotid arteries. Surgical correction was performed via right thoracotomy. The proximal aberrant artery was mobilized behind the esophagus. The distal, right subclavian artery was exposed, transected, and transposed with reimplantation into the aortic root by graft bypass.
Adult ; Angiography ; Arteries ; Carotid Arteries ; Deglutition Disorders* ; Esophagus ; Female ; Humans ; Incidence ; Middle Aged ; Pneumonia* ; Replantation ; Subclavian Artery* ; Thoracotomy ; Transplants ; Vascular Diseases

BACKGROUND: To evaluate the usefulness of admission and daily acute physiology and chronic health evaluation (APACHE) III score in relation to length of stay in the intensive care unit (ICU) for outcome prediction, 4,554 patients were studied. METHODS: These patients were admitted to the ICU from June 6, 1994 to December 31, 2002. Exclusion criteria included patients being treated for burns, having surgery for coronary artery bypass grafts, having a diagnosis of myocardial infarction, being under 16 years of age and being discharged less than 16 hours after admission. To evaluate the discrimination power of admission and daily APACHE III score, the area under the receiver operating characteristic curve was computed for each of the initial 16 days of ICU care. RESULTS: Admission APACHE III score loses discrimination power over time, from admission day to day 4 in the ICU, the area under the receiver operating characteristic curve was above 0.8 and after day 16, it dropped to below 0.7. However, daily APACHE III score maintained discrimination power at about 0.8 over time. CONCLUSIONS: In the early days after ICU admission, admission and daily APACHE III score are useful. With time daily APACHE III scores are more useful than admission APACHE III score.
APACHE* ; Burns ; Coronary Artery Bypass ; Diagnosis ; Discrimination (Psychology) ; Humans ; Intensive Care Units ; Length of Stay* ; Myocardial Infarction ; ROC Curve ; Transplants

We report a case of mature cystic teratoma of the anterior mediastinum that ruptured into the pulmonary artery requiring an emergent surgical treatment. A 39-year-old woman presented an episode of massive hemoptysis and treated with bronchial artery embolization (BAE). On the 10th day after BAE, however, she developed sudden massive hemoptysis and had a deteriorated mental status. For a definitive treatment, she underwent the left pneumonectomy and the tumor resection in the anterior mediastinum. On histologic examination, the tumor disclosed cystic structures composed of mature squamous epithelium, pilosebaceous glands, mature fat tissue, cartilage and bone tissue. Also, there was intrapulmonary hemorrhage due to left pulmonary artery invasion of the tumor.
Adult ; Bone and Bones ; Bronchial Arteries ; Cartilage ; Epithelium ; Female ; Hemoptysis ; Hemorrhage ; Humans ; Lung ; Mediastinum ; Pneumonectomy ; Pulmonary Artery* ; Teratoma*

Phosphodiesterases (PDEs) play a key role in the regulation of cyclic adenosine monophosphate (cAMP), which in turn mediates various cellular functions including learning and memory. We previously cloned and characterized three PDE4 isoforms (ApPDE4) from Aplysia kurodai. Using reverse transcription polymerase chain reaction (RT-PCR), we found that ApPDE4 isoforms are primarily expressed in the central nervous system. However, the detailed distribution of ApPDE4 mRNA in Aplysia individual ganglions was not evident. In this study, to determine the distribution of ApPDE4 mRNAs in Aplysia ganglions, we performed in situ hybridization (ISH) using a probe targeting ApPDE4, including the PDE catalytic domain. Interestingly, we found the strongest ISH-positive signals in the symmetrical bag cell clusters of the abdominal ganglion. The R2, R14, L7, L2 and L11 neurons in the abdominal ganglion, LP1 neuron in pleural ganglion, and metacerebral (MCC) neurons were ISH-positive. Mechanosensory neurons of the sensory cluster were also stained on the ventral aspect of the right and left pleural ganglia. Taken together, we found the detailed distribution of ApPDE4 mRNA in Aplysia ganglion and support their roles in serotonin (5-HT)-induced synaptic facilitation of Aplysia mechanosensory neurons.
Adenosine Monophosphate ; Aplysia* ; Catalytic Domain ; Central Nervous System ; Clone Cells ; Cyclic Nucleotide Phosphodiesterases, Type 4* ; Ganglia ; Ganglion Cysts ; In Situ Hybridization* ; Learning ; Memory ; Neurons ; Phosphoric Diester Hydrolases ; Polymerase Chain Reaction ; Protein Isoforms ; Reverse Transcription ; RNA, Messenger ; Serotonin

In recent years, it has been common to use bupivacaine for prolonged operation because of its long duration of action but, besides of this benefits, we always are cautious of using bupivacaine for its possible systemic, toxicity, such as convulsion, myocardial depression. We experienced a case of asthmatic attack right after injection of 0.5% bupivacaine 125 mg for BPB(brachial plexus block) in a 26 year old male patient with chronic renal failure for the revision of a-v fistula. With the administration of aminophylline and oxygen by mask the patient was anounced about delaying operation and the symptoms were gone. Next day with local infiltration of 2% lidocaine operation was done uneventfully.
Adult ; Aminophylline ; Bupivacaine ; Depression ; Fistula ; Humans ; Kidney Failure, Chronic ; Lidocaine ; Male ; Masks ; Oxygen ; Seizures

BACKGROUND AND OBJECTIVES: The diagnosis of Meniere's disease is based on audiological test and clinical symptoms. Cochlear Hydrops Analysis Masking Procedure (CHAMP) was introduced as a test for detecting changes in physical characteristics of basilar membrane by hydrops of endolympahtic system. The aim of this study is to evaluate the diagnostic value and usefulness of CHAMP tests for detection of endolymphatic hydrops. SUBJECTS AND METHOD: This study was performed on 11 cases of Meniere's disease and 10 cases of vestibular neuritis who visited ENT outpatient clinic and 25 cases of normal healthy volunteers. We defined the positive value as being less than 0.3 ms in latency delay (0.5 kHz HPN-click alone) and less than 0.95 nV in compound amplitude ratio (click alone 0.5 kHz HPN/ click alone) regardless of age or sex. RESULTS: There were significant latency delays in the Meniere's disease group compared with the vestibular neuritis and normal control group. The amplitude ratio gave significant differences between the Meniere's disease group and the normal group but there were no differences between the Meniere's disease group and the vestibular neuritis group. Without assuming the test failure, the sensitivity and specificity of latency delay was 81% and 100%, respectively, and the sensitivity and specificity of amplitude ratio was 100% and 84%, respectively. In 8 of 54 cases (14.8%), we couldn't get interpretable wave. CONCLUSION: CHAMP test is a clinically useful method that can detect endolymphatic hydrops and it can be used as an objective test for the diagonosis of Meniere's disease.
Ambulatory Care Facilities ; Basilar Membrane ; Edema ; Endolymphatic Hydrops ; Masks ; Meniere Disease ; Sensitivity and Specificity ; Vestibular Neuronitis

BACKGROUND: Discrepancies exist in the currently available data on the prevalence of diabetic neuropathy. Variations in the prevalence of diabetic neuropathy have reflected the different criteria used to form its diagnosis. The majority of diagnostic criteria are less practical in many routine clinical settings where there is a need for a simple assessment using widely available techniques to rapidly screen large numbers of patients. We already reported that the questionnaire of Feldman's two-step assessment was less useful in Koreans, because of the different expression of neuropathic symptoms. We proposed a representative questionnaire which was based on patients' own complaints, and assessed its clinical availability. METHODS: Ninety diabetic patients(45 cases with diabetic neuropathy, 45 cases without neuropathy) were included in this study. Diabetic neuropathy was diagnosed by neurologic examination and nerve conduction velocity. The questionnaire consisted of 7 questions on foot sensation (prickling, lancinating, burning, numb), which are frequent complaints of diabetic patients. All subjects were assessed with the questionnaire. RESULTS: 1. The most sensitive symptom was tingling sensation (75.6%) and the least sensitive one was numbness(28.9%). 2. The most specific symptom was numbness(82.2%) and the least specific one was tingling sensation(33.3%). 3. If we would assume that three or more of symptoms were diagnostic, the sensitivity and specificity were 66.7% and 53.3%, respectively. CONCLUSION: Our new questionnaire can be used as a screening test or a follow-up tool for the diagnosis of diabetic peripheral neuropathy in Koreans.
Burns ; Diabetic Neuropathies ; Diagnosis* ; Follow-Up Studies ; Foot ; Humans ; Mass Screening ; Neural Conduction ; Neurologic Examination ; Peripheral Nervous System Diseases* ; Prevalence ; Sensation ; Sensitivity and Specificity ; Surveys and Questionnaires