No abstract available.
Tooth*

BACKGROUND: Epidural steroids injections are often used for the treatment of low back pain but their effects on the endocrine system have not been determined. Few studies have quantified the degree or duration of the suppression of the hypothalamic-pituitary-adrenal (HPA) axis in humans given epidural triamcinolone injection (ETI) for low back pain. The evaluation of the blood adrenocorticotropic hormone (ACTH) and cortisol was undertaken to determine the extent of suppression of the HPA axis in patients given ETI. METHODS: Lumbar epidural triamcinolone injections were performed on the painful lumbar intervertebral space with patients in the lateral decubitus position. The injection consisted of 40 mg of triamcinolone acetonide diluted in 10 mL of 1% lidocaine. Patients remained in the lateral position for 10 min after the procedure. Basal blood sampling was performed at 30 min before ETI and tested blood sampling was obtained at 7 days, 10 days, and 14 days after ETI. RESULTS: The blood cortisol level was significantly decreased at 7 days and 10 days but at 14 days was not significantly decreased and the blood ACTH level was not significantly decreased at 7 days, 10 days, and 14 days. CONCLUSIONS: Above results demonstrate that blood ACTH and cortisol level normalize 7 days and 14 days, respectively, after epidural triamcinolone 40 mg injection.
Adrenocorticotropic Hormone* ; Axis, Cervical Vertebra ; Endocrine System ; Humans ; Hydrocortisone* ; Lidocaine ; Low Back Pain ; Steroids ; Triamcinolone Acetonide ; Triamcinolone*

Castleman disease is a relatively rare disease of differential diagnostic interest in patients with lymphadenophathy. The etiology and pathogenesis of the Castleman disease are still not elucidated and the MRI findings of disease has not yet been reported. Two patients with Castleman disease studied by MRI are presented: one case presented with a localized anterior mediastinal mass and the other case, with a neck mass. The lesions were characterized by relatively high signal intensities on both T1 and T2 weighted images in both cases, and significant degree of enhancement was seen in the cervical Castleman disease.
Giant Lymph Node Hyperplasia* ; Humans ; Lymph Nodes* ; Magnetic Resonance Imaging* ; Neck ; Rare Diseases

Calpain I (mu-calpain) and II (m-calpain) are well known calcium-activated neutral cysteine proteases. Many reports have shown that activation of calpain is related to cataract formation, neuronal degeneration, blood clotting, ischemic injuries, muscular dystrophy and cornified cell envelope (CE) formation. Here, we report that insoluble CE formation was reduced after treatment with calpain I inhibitor (N-acetyl-leucyl-leucyl-norleucinal) on normal human epidermal keratinocytes (NHEK), whereas serine and thiol protease inhibitors had no effect on the reduction of CE. When NHEK cells were confluent, keratinocytes were treated with various concentrations (0.5 microM-0.5 mM) of calpain I inhibitor or serine and thiol protease inhibitors under calcium induced differentiation. Insoluble CE formation was reduced about 90% in the 50 microM calpain inhibitor I treated group by day 9 of culture, whereas insoluble CE was reduced only 10% in the same condition. Interestingly TGase activity was blocked by 90% in the 0.5 mM calpain inhibitor treated group within 72 h, whereas TGase activity was retained by 80% in the 0.5 mM serine protease inhibitor treated group at 7 day treatment. Therefore it can be suggested that cysteine protease calpains might be responsible for the activation of the TGase 1 enzyme to complete insoluble CE formation during epidermal differentiation.
Calcium/pharmacology ; Calpain/metabolism* ; Calpain/antagonists & inhibitors* ; Cell Differentiation ; Dose-Response Relationship, Drug ; Epidermis/metabolism ; Human ; In Vitro ; Keratinocytes/metabolism ; Keratinocytes/enzymology ; Protease Inhibitors/pharmacology ; Protein-Glutamine gamma-Glutamyltransferase/metabolism* ; Protein-Glutamine gamma-Glutamyltransferase/antagonists & inhibitors* ; Tissue Culture

The obturator nerve is originated in lumbar 2, 3, 4 roots and inserted at the inner muscle of thigh, by way of sacral ala and obturator foramen. In the case of pelvic surgery or obstetric trauma, the obturator neuropathy is occasionally occurred. However, the obturator neuropathy is rarely seen in the orthopedic accident. In literature, one case of obturator neuropathy is reported after 2,012 cases of total hip replacement surgery. The useful diagnostic tools of obturator neuropathy are needle EMG on the obturater nerve innervated muscle, not conduction test on the nerve. We report of a case of obturator neuropathy after closed reduction of posterior hip dislocation complicated by traffic accident with a brief reviewed of literatures.
Accidents, Traffic ; Arthroplasty, Replacement, Hip ; Hip Dislocation* ; Hip* ; Needles ; Obturator Nerve ; Orthopedics ; Thigh

BACKGROUND: Positive end expiratory pressure (PEEP) ventilation is well established as an integral part of the management of patients with the acute lung injury. PEEP is a key element in the treatment of hypoxemia resulting from pulmonary edema. Pulmonary capillary pressure (Pcap) is the most important factor influencing lung edema formation, and an understanding of how Pcap is altered by variations of PEEP or pulmonary arterial occlusion pressure (PAOP) is important to improve the treatment of acute lung injury patients. This study was performed to evaluate the effects of PEEP on the pulmonary capillary pressure in acute lung injury patients. METHODS: This was a prospective study of 11 acute lung injury patients. The effect of PEEP on pulmonary circulation at four different levels (0,4,8, and 12cm H2O) was analyzed. Pcap was estimated visually at bed side with Swan Ganz catheters. The pulmonary vasculature was analyzed by calculating the pressure difference at the arterial and venous parts of the circulation. RESULTS: As PEEP increased from 0 to 12 cm H2O, the mean puhnonary arterial pressure (PAP) and Pcap increased respectively from 22.7 ± 7.4 to 25.3 ± 7.3 mmHg and 15.3 ± 3.3 to 17.8 ±3.2 mmHg (p<0.05). Similarly, PAOP increased from 9.8 ± 2.1 to 12.8 ± 2.1 mmHg and the central venous pressure increased from 6.1 ± 1.6 to 9.3 1: 2.3 mmHg(p<0.05). However, the pressure gradient at the arterial (PAP-Pcap) and venous (Pcap-Pcwp) part of pulmonary circulation remained unchanged at all evaluated PEEP levels. CONCLUSION: Although Pcap increasoo gradually with increased PEEP, the pressure gradient at the arterial and venous part of the pulmonary vasculature remained unchanged at all evaluated PEEP levels in acute lung injury patients.
Acute Lung Injury* ; Anoxia ; Arterial Pressure ; Capillaries* ; Catheters ; Central Venous Pressure ; Edema ; Humans ; Lung ; Positive-Pressure Respiration* ; Prospective Studies ; Pulmonary Circulation ; Pulmonary Edema ; Ventilation

A 33-year-old woman was presented with dyspnea and chest discomfort after indigesting approximately 500ml of oil paint brush washing fluid. Hypoxic symptoms and radiographic infiltrates rapidly progressed. The patient was intubated and received mechanical ventilation. Bronchoalveolar lavage and transbronchial lung biopsies were performed. The CT scan of the lung showed bilateral extensive pneumonitis with necrosis and the lung tissue pathologic findings showed diffuse alveolar damage with extensive necrosis and numerous lipidladen macrophages. After intensive medical care with mechanical ventilation, her symptoms and radiological findings improved.
Adult ; Biopsy ; Bronchoalveolar Lavage ; Dyspnea ; Eating* ; Female ; Humans ; Lung ; Macrophages ; Necrosis ; Paint ; Pneumonia* ; Respiration, Artificial ; Thorax ; Tomography, X-Ray Computed

A case of intracerebral tension pneumatocele as a complication of an Osteoma in the Fronto-ethmoid sinus is reported. The commonest causes of intracranial air are head trauma and neurosurgical procedures. Less common etiologies include infection due to gas-forming organisms, mucoceles, tumors(e.g. osteomas carcinomas pituitary adenomas peripheral nerue tumors) and congenital neurenteric cysts or dural defects. Computed tomography permitted rapid diagnosis including localization of the air thus facilitating prompt treatment.
Craniocerebral Trauma ; Diagnosis ; Mucocele ; Neural Tube Defects ; Neurosurgical Procedures ; Osteoma* ; Pituitary Neoplasms

We have studied 1927 cases of primary tumor patients, who were admitted, managed and registered at Cancer Center of Maryknoll Hospital from Nov. 1985 to Jun. 1988. Of these, 50 cases were metastasized to central nervous systems, and the cases of brain metastases were 31 cases. This report presents an analysis of 31 cases of metastatic brain tumors. The results are as followings: 1) The sexes were represented with 20 males and 11 females. In 20 cases(65%), the metastases occurred between the 6th decade and 7th decade. 2) The most frequent anatomical site of brain metastases was brain parenchyme(67.7%). 3) The most frequent site of primary malignancy was lung(45.2%), and the next order was choriocarcinoma of the uterus. 4) The clinical symptoms and signs of metastatic brain tumors were headache(87%), nausea, vomiting(35.5%) orderly. 5) In C-T scan findings, the metastatic brain tumors presented hyperdense area at 50% of cases before contrast enhancement, and were enhanced nearly almost of cases. 6) In cases which could be treated surgical procedure, radiation and chemotherapy seemed to improve the prognosis.
Brain Neoplasms* ; Brain* ; Central Nervous System ; Choriocarcinoma ; Drug Therapy ; Female ; Humans ; Male ; Nausea ; Neoplasm Metastasis ; Pregnancy ; Prognosis ; Uterus

Spinal anesthesia has been widely used for operations performed in the lower abdomen, inguinal regions, lower extremities, and perineum. When patient have aevere systemic disease and a full . stomach, spinal anesthesia is may be more safe than general aneethesia. Bradycardia and hypotension have been accepted to be the most common complications in cardio-vascular system during spinal anesthesia. The mechanisms are a decrease in total peripheral vascular resistance, a decrease in cardiac output or a combination of both. Accessory factors include bradycardia resulting from block of accelerator impulses to the heart or decrease in endogeneous release of norepinephrine from sympathetic nerve endings, thereby reducing myocardial contractility. We report 2 cases of sudden extreme bradycardia and hypotension in patients who had received spinal anestesia. Although the exact pathophysiology of this phenomenon is unknown, the etiology is probably vagal effect. Thus the patient who receives spinal anestbesia should be required constant monitoring and vigilance throughout all procedures.
Abdomen ; Anesthesia, Spinal* ; Bradycardia* ; Cardiac Output ; Heart ; Humans ; Hypotension* ; Lower Extremity ; Nerve Endings ; Norepinephrine ; Perineum ; Stomach ; Vascular Resistance