BACKGROUND: The perfect preanesthetic medication and its ideal route of administration are still debated. Transmucosal administration of midazolam has been of interest because of the rapid, reliable onset of action, predictable effects and avoidance of injections. Because many medications are well absorbed from the mucosa, we conducted a randomized, prospective, blinded study to compare acceptance and efficacy of intranasal and sublingual administration of midazolam as a preanesthetic medication in children. METHODS: One hundred twenty eight patients aged 0.5-12year were stratified by age: 38 infants and toddlers, 0.5-3yr; 48 preschoolers, 3.1-7yr; and 42 school age, 7.1-12yr. They were randomized to received 0.2 mg/kg of midazolam in the nose or under the tongue. Hemoglobin oxygen saturation by pulse oximetry and sedation score were recorded before drug administration, at 2.5min intervals for 15min, at separation from parents and during induction with enflurane in O2. Retention time of sublingual drug and duration of crying were recorded. RESULTS: The incidence of crying at the time of administration of midazolam was greater following intranasal compared with sublingual administration(60% vs 17%, p<0.05). Within age groups, only infants and toddlers showed a significant difference in the incidence of crying between treatment groups. Significant changes in sedation occured in both groups from 2.5min after administration. CONCLUSIONS: Sublingual midazolam is better accepted than intranasal midazolam as a preanesthetic sedative in children.
Administration, Mucosal ; Administration, Sublingual ; Child ; Crying ; Enflurane ; Humans ; Hypnotics and Sedatives ; Incidence ; Infant ; Midazolam* ; Mucous Membrane ; Nose ; Oximetry ; Oxygen ; Parents ; Preanesthetic Medication* ; Premedication ; Prospective Studies ; Tongue

BACKGROUND: Aside from its well known peripheral antihypertensive effects, calcium also lowers blood pressure, when administered into the cerebral ventricle. The present study was aimed to determine whether the central depressor response to calcium is mediated by a stimulation of endogenous L-arginine-nitric oxide (NO) pathway. METHODA: Mean arterial pressure (MAP) and heart rate (HR) were continuously recorded from the femoral artery in anesthetized rats. Administration of calcium was performed into the right lateral cerebral ventricle. The effects of N G-nitro-L-arginine methyl ester (L-NAME) on the cardiovascular response to calcium were examined. RESULTS: Intracerebroventricular (ICV) injection of calcium consistently produced a decrease in MAP and HR. The depressor and bradycardiac responses to calcium showed a dose-dependent fashion. Pretreatment with a calcium channel blocker, diltiazem (1 micromol, ICV), attenuated cardiovascular responses to calcium. ICV infusion (1 microl/min) of L-NAME (200 microgram/kg and 20 microgram/kg/min for 60 min) increased MAP without significant changes in HR. Chronic ingestion of L-NAME (5 mg/100 ml in drinking water, 4 weeks) also increased the systolic blood pressure as compared with control. The depressor effect of ICV calcium was significantly diminished in acute or chronic L-NAME treated rats. CONCLUSION: These findings suggest that the central depressor response to calcium, at least in part, is NO-dependent.
Animals ; Arterial Pressure ; Blood Pressure ; Calcium Channels ; Calcium* ; Cerebral Ventricles ; Diltiazem ; Drinking Water ; Eating ; Femoral Artery ; Heart Rate ; NG-Nitroarginine Methyl Ester ; Nitric Oxide* ; Rats

Verrucous carcinoma arising from the larynx is a specific clinical entity which is unfamiliar to many otolaryngologists. As judged by reported cases, the mucous membranes of the head and neck are sites of predilection. This lesion makes up approximately 1 to 4% of all laryngeal carcinoma. The biologic behavior of verrucous carcinoma of the larynx is characterized by warty appearance, slow growth, local invasion, scarcity of metastases and benign histology. Most authors prefer surgical treatment for patients with verrucous carcinoma. Radiation therapy appears to hold a higher risk of recurrence, anaplastic transformation of tumor. Recently, the authors have experienced two cases of verucous carcinoma originated from the larynx in old male patients. The two patients were treated by surgical excision.
Carcinoma, Verrucous* ; Head ; Humans ; Larynx* ; Male ; Mucous Membrane ; Neck ; Neoplasm Metastasis ; Recurrence

To determine the usefulness of the Bosniak classification of cystic renal masses, the computed tomographic findings of 30 pathologically proven cystic renal masses were reviewed retrospectively. We categorized cystic renal masses utilizing the Bosniak classification without knowledge of the final pathologic diagnosis. There were 10 category I lesions, 3 category II lesions, 6 category III lesions and 11 category IV lesions. All category l and II lesions were benign. All category IV lesions were malignant. Among the 6 category III lesions, 5 were malignant. The other was benign lesion with hemorrhagic renal cyst. We concluded that computed tomography and Bosniak classification are useful in management of cystic renal masses.
Classification* ; Diagnosis ; Kidney ; Retrospective Studies

Pneumatosis cystoides intestinalis (PCI) is a relatively rare condition in which gas is found as a linear or cystic form in the submucosa or subserosa of bowel wall. PCI is usually found incidentally on an imaging study. Treatment is usually conservative including oxygen and antibiotics therapy. So far, etiology and pathogenesis of PCI remain uncertain. PCI is associated with various medical conditions including various pulmonary diseases, connective tissue diseases, and endoscopic procedures. However, there are only few reports on lactulose causing PCI in patients with cirrhosis. Oral lactulose or enema is one of the main treatment modalities in hepatic encephalopathy. Here, we report a case of PCI which was found during the treatment with lactulose therapy in a patient with liver cirrhosis and hepatic encephalopathy.
Gastrointestinal Agents/therapeutic use ; Humans ; Lactulose/therapeutic use ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Pneumatosis Cystoides Intestinalis/etiology/*radiography ; Tomography, X-Ray Computed

Tailgut cyst is a rare congenital lesion in retrorectal space. The clinical significance of tailgut cyst presents its morbidity that occurs in the unrecognized and incompletely treated lesion. A forty four year-old female patient visited with lower abdominal pain during defecation. Preoperative abdominopelvic MRI and endorectal ultrasonography revealed a retrorectal mass suggestive of leiomyoma, dermoid cyst, teratoma, or duplication cyst of rectum. She underwent complete resection of retrorectal mass by transsphincteric approach. The mass was multilocular cyst lined by multiple types of epithelium. It was histologically confirmed as a tailgut cyst. She recovered uneventfully. This report includes the case and a brief review of tailgut cyst.
Abdominal Pain ; Defecation ; Dermoid Cyst ; Epithelium ; Female ; Humans ; Leiomyoma ; Magnetic Resonance Imaging ; Rectum ; Teratoma ; Ultrasonography

BACKGROUND/AIM: Serial measurement of serum carcinoembryonic antigen was assessed to define its significance and to determine the adequacy in detecting recurrence after curative resection for colorectal cancer. METHODS: Six hundred forty-five patients with colorectal cancer underwent curative resection were included. The median follow-up period was 49 months (range, 24~94 months). Serum CEA was analyzed in accordance with location, histologic differentiation, stage of the tumor, recurrence and survival. RESULTS: The incidence of elevated preoperative serum CEA (> 6 ng/ml) was correlated with tumor stage (stage I vs. II, P=0.01; stage II vs. III, P=0.0001). Fifty five patients among 87 patients with recurrence (63.2%) had concomitant elevation of serum CEA, whereas 32 of 558 patients (5.7%) without recurrence showed a false-positive result. Measurement of serum CEA was more sensitive in patients with elevated preoperative serum CEA and liver metastases than in patients without elevated preoperative serum CEA and local recurrence (P=0.0397). The leading time of serum CEA between the first elevated serum CEA and the identification of recurrence was 3.5 months (range, 1~12 month). Tumor stage and preoperative serum CEA level were found to be significant prognostic variables by multivariate analysis. The overall 5-year survival rate in the normal preoperative serum CEA and the elevated group were 76% and 64% respectively (P=0.00019). CONCLUSION: Serum CEA seemed to be closely correlated with survival and to be an useful tool to detect recurrence after curative resection for colorectal cancer. The appropriate measurement of serum CEA might be suggested in stage II and III postoperatively: every three month for two years, every 6 month for succeeding 2 years, and annually thereafter. Monitoring of serum CEA in stage I could be individualized by preoperative serum CEA and clinical course.
Carcinoembryonic Antigen* ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Incidence ; Liver ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Survival Rate

No abstract available.
Choledochal Cyst*

The early diagnosis and treatment of tuberculous otitis media can prevent it from becoming irreversible and spread to other organs. Only 0.04% of chronic suppurative otitis medias are tuberculous origin, so that the index of suspicion is often low. The clinical signs of the disease have changed in recent years, making it more difficult to recognize and thus investigate for. False negatives for culture often occur, due both to the fastidious nature of the tuberculous bacilli, and other bacteria in the specimen interfering with the growth of bacilli. Recently, We experienced four cases of pathologically confirmed primary tuberculous otitis media without pulmonary involvement, so report these cases with review of literature.
Bacteria ; Early Diagnosis ; Otitis Media* ; Otitis Media, Suppurative ; Otitis* ; Tuberculosis*

A subepithelial tumor-like esophageal carcinoma is rare. We report a case of an esophageal squamous cell carcinoma with lymph node metastasis presenting as a small subepithelial tumor. A 68-year-old man presented to our hospital complaining of hoarseness since last three months. Endoscopic examination revealed a 1 cm hard and fixed subepithelial tumor with surface erosion in the lower esophagus. A biopsy specimen was obtained using conventional forceps, and histopathological evaluation revealed few atypical squamous epithelial cells. Subsequent EUS demonstrated a homogeneous hypoechoic lesion in the deep mucosal layer. A CT scan of the chest showed a 3 cm mass in the right upper paratracheal area. EUS-guided fine needle biopsy of the lesion led to the diagnosis of squamous cell carcinoma with lymph node metastasis.
Aged ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Squamous Cell ; Diagnosis ; Endosonography ; Epithelial Cells ; Esophageal Neoplasms ; Esophagus ; Hoarseness ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Surgical Instruments ; Thorax ; Tomography, X-Ray Computed