BACKGROUND: Although pulmonary artery catheters are useful to monitor hydration, these devices may be associated with severe morbidity and are not routinely used in kidney transplantation. A central venous pressure (CVP) catheter is preferred rather than a pulmonary artery catheter. Noninvasive continuous blood pressure monitors may substitute for intraarterial catheters, thereby preserving the radial artery in kidney transplantation patients should it be needed later to create an arteriovenous fistula. If there is a relationship between central venous and radial arterial blood for acid-base (pH, BE, HCO3(-)), we can use the blood sample from a CVP catheter instead of arterial blood from aradial artery catheter for testing acid-base and it can help patients. METHODS: A central venous catheter and radial artery catheter was inserted in 67 patients while undergoing kidney transplantation. To assess arteriovenous differences in acid-base status at operation start, before reperfusion of the transplanted kidney, after reperfusion, we measured the pH, BE and HCO3(-) simultaneously from the arterial and central venous circulation. RESULTS: Aacid-base using arterial and central venous samples at operation start, before reperfusion and after reperfusionb was evaluated. We found the relationship as follows: pH between arterial (pHa) and central venous blood (pHcv) in each: linear regression equation; pHcv = 0.668 + (0.906 X pHa), pHcv = 0.225 + (0.965 X pHa), pHcv = 0.646 + (0.908 X pHa), determination coefficient; 0.908, 0.926, 0.888, P values < 0.001 in each period. Base excess (BE) between BEa and BEcv in each period: linear regression equation; BEcv = 0.483 + (0.952 X BEa), BEcv = 0.032 + (0.939 X BEa), BEcv = 0.008 + (0.954 X BEa), determination coefficient; 0.844, 0.954, 0.962 P values < 0.001 in each period. HCO3(-) concentration between HCO3(-)a and HCO3(-)cv in each period: linear regression equation; HCO3(-)cv = 2.434 + (0.937 X HCO3(-)a), HCO3(-)cv = 2.093 + (0.942 X HCO3(-)a), HCO3(-)cv = 1.755 + (0.954 X HCO3 a), determination coefficient; 0.950, 0.925, 0.932 P values < 0.001 in each period. CONCLUSIONS: The acid base status of arterial blood is similar to that of central venous blood. Central venous blood gas values (pH, BE, HCO3(-)) may be an acceptable alternative to arterial blood gas values in kidney transplantation patients.
Arteries ; Arteriovenous Fistula ; Blood Pressure Monitors ; Catheters ; Central Venous Catheters ; Central Venous Pressure ; Humans ; Hydrogen-Ion Concentration ; Kidney ; Kidney Transplantation ; Linear Models ; Pulmonary Artery ; Radial Artery ; Reperfusion

A human malignant lymphoid cell line(JeKo-1) was established from a Korean patient with retroperitoneal tumor presenting peripheral blood and bone marrow involvement by malignant lymphoid cells. This cell line was established from peripheral blood, and the cell line had the identical immunophenotypic features as malignant cells from the peripheral blood. The established cell line had features of a mature B-cell phenotype with no evidence for commitment to other lineages. The JeKo-1 grows in suspension with a doubling time of 33 hours. By light and electron microscopic examination, the established cells had a follicular center showing, a small, cleaved, lymphoid appearance, and had a large amount of cytoplasm containing few vacuoles and an irregular cytoplasmic membrane. Immunophenotypic analyses with monoclonal antibodies using flow cytometry showed a monoclonal IgM kappa and CD5- B-cell phenotype. The cells were non-reactive for T-cells and myeloid/monocyte antigens, and no evidence of Epstein-Barr virus nuclear antigen by polymerase chain reaction. DNA analysis showed a hypodiploid stemline with a DNA index of 0.83. The established cells were strongly reactive for bcl-2 and c-myc onco-protein, but lacked expression of multidrug resistance gene protein, p-glycoprotein by Western blot analysis. Karyotypic analysis of JeKo-1 showed 40-41 chromosomes. This cell line should be a valuable tool to study the dissemination of malignant lymphoma into the peripheral blood and bone marrow.
Humans

BACKGROUND: Reactive oxygen species (ROS) induce lipid peroxidation and tissue damage in endothelium. We studied the influences of ketorolac and diclofenac on ROS effects using the endothelium of rabbit abdominal aorta. METHODS: Isolated rabbit aortic rings were suspended in an organ bath filled with Krebs-Henseleit (K-H) solution bubbled with 5% CO2 and 95% O2 at 37.5degrees C. After being stimulated to contract with phenylephrine (PE, 10(-6) M), changes in arterial tension were recorded following the cumulative administration of acetylcholine (ACh, 3 x 10(-8) to 10(-6) M). The percentages of ACh-induced relaxation of aortic rings before and after exposure to ROS, generated by electrolysis of K-H solution, were used as the control and experimental values, respectively. The aortic rings were pretreated with ketorolac or diclofenac at the same concentrations (10(-5) M to 3 x 10(-4) M), and the effects of these agents were compared with the effects of ROS scavengers: catalase, mannitol, sodium salicylate and deferoxamine and the catalase inhibitor, 3-amino-1,2,4-triazole (3AT). RESULTS: Both ketorolac and diclofenac maintained endothlium-dependent relaxation induced by ACh in a dose-related manner inspite of ROS attack (P < 0.05 vs. control value). The 3AT pretreated ketorolac (3 x 10(-3) M) group was decreased more significantly than un-pretreated ketorolac (P < 0.05). CONCLUSIONS: These findings suggest that ketorlac and diclofenac preserve the endothelium-dependent vasorelaxation against the attack of ROS, in a concentration-related manner. One of the endothelial protection mechanisms of ketorolac may be hydrogen peroxide scavenging.
Acetylcholine ; Amitrole ; Aorta, Abdominal ; Arterial Pressure ; Baths ; Catalase ; Contracts ; Deferoxamine ; Diclofenac ; Electrolysis ; Endothelium ; Hydrogen Peroxide ; Ketorolac ; Lipid Peroxidation ; Mannitol ; Phenylephrine ; Reactive Oxygen Species ; Relaxation ; Sodium Salicylate ; Vasodilation

BACKGROUND AND OBJECTIVES: The success rate of endoscopic endonasal dacryocystorhinostomy (DCR) is not satisfactory enough compared to that of external approach because the newly made ostium is easily obstructed due to granulation tissue formed around the small ostium. The objective of this study is to describe a new technique of an endoscopic DCR which minimizes the stenosis of neo-ostium and to report its success rate. MATERIALS AND METHOD: Twenty patients who had undergone endoscopic DCR with the diagnosis of proximal nasolacrimal duct obstruction were investigated retrospectively. All procedures were done by the same surgeon. The surgical technique includes elevation of mucosal flap, full sac exposure using diamond drill, and design of mucosal flap to cover the denuded bone and approximate with opened sac mucosa. Postoperative symptom improvement and endoscopic finding of the neo-ostium were evaluated. The mean duration of follow-up was 8 months. RESULTS: Ninety percent success rate was noted without any serious complications. Obstruction of the neo-ostium with granulation tissue was observed in two patients. CONCLUSION: Endoscopic DCR using mucosal flap after full sac exposure gives satisfactory success rate without any serious complications.
Constriction, Pathologic ; Dacryocystorhinostomy* ; Diagnosis ; Diamond ; Endoscopy ; Follow-Up Studies ; Granulation Tissue ; Humans ; Mucous Membrane ; Nasal Mucosa ; Nasolacrimal Duct ; Retrospective Studies

Lipoblastoma is a rare benign tumor of embryonal fat. This condition most often presents during childhood, before the age of 7 years, affects males more than females, and is typified by a slowly growing, usually subcutaneous mass arising in the limbs. Cases involving the head and neck are extremely rare. Our case arose in a 44-month-old male presenting with a rapidly enlarging soft lump in the right supraclavicular area. Diagnosis is by histology, and treatment of choice is complete surgical resection. We report one case of lipoblastoma in the neck with a review of the literature.
Child ; Child, Preschool ; Diagnosis ; Extremities ; Female ; Head ; Humans ; Lipoblastoma* ; Male ; Neck*

The effects of hind-limb immobilization by skeletal fixation of bilateral ankle and knee joints. for sither one or five weeks on glycogen concentrations, glycogen resynthetic activities and insulin responses to glucose uptake of hind-limb muscles were studied on male Splague-Dawley rats. There were significant drops in muscle wet weight to body weight ratio of immobilized soleus and plataris. In the group immobilized for one week, the ratios of sleous and plantaris were decreased by 11% and 38% respectively; and in the group immobilized for five weeks, the ratios were decreased by 42% in both muscles equally. The glycogen concentration and glycogen resynthetic activities of soleus and plantaris muscles in immobilized rats were decreased significantly in the one week group. However, in the five week group, these values were increased significantly compared to the values of those muscles of the one week group. The increased values of the five week group did not exceed those of the control group. The glucose uptake rate of the soleus muscle of the hind-limbs immobilized for one week and for five weeks were studied in vitro. The basal glucose uptake rate of the muscle of the control group was 8.4 ± 0.77Mol/gm/20min. The values of basal rate and insulin responses to the glucose uptake rates in the doses of physiological and supramaximal on the soleus muscles immobilized for one week was significantly decreased, but after immobilization for five weeks, these values were not significantly different statistically those from of the control group statistically.
Animals ; Ankle ; Body Weight ; Extremities ; Fracture Fixation ; Glucose ; Glycogen ; Humans ; Immobilization ; In Vitro Techniques ; Insulin ; Knee Joint ; Male ; Metabolism ; Muscle, Skeletal ; Muscles ; Rats

BACKGROUND: Obstacles to the use of patient-controlled analgesia (PCA) by elderly surgical patients have not been well documented. This study was designed to compare the effectiveness of PCA in an older and a young group, and the satisfaction of PCA use in older patients. METHODS: The 122 patients who received intravenous PCA during the first 48 hours postoperatively were divided into a young and older group. Visual analog scale (VAS) scores at rest and movement were assessed on 8, 16, 24, 36, 40, and 48 hours postoperatively. When the PCA was discontinued, satisfaction and concerns about it were assessed. RESULTS: There were no age differences with regard to pain at rest or with movement. Satisfaction with PCA was high and did not differ between the groups. CONCLUSIONS: Younger and older patients attained comparable levels of analgesia and were equally satisfied with their pain control. However we must have further studies to learn how effective PCA would be in a group over the age of 75 yrs.
Aged ; Analgesia ; Analgesia, Patient-Controlled ; Humans ; Passive Cutaneous Anaphylaxis* ; Visual Analog Scale

BACKGROUND: Invasive central venous catheterization is necessary in critically ill patients for hemodynamic monitoring and for administration of hypertonic fluids, drugs, and parenteral nutrition. Common access sites are the internal jugular veins, subclavian veins, and femoral veins. Yoffa's percutaneous supraclavicular subclavian vein catheterization technique has some disadvantages and difficulties which include dislodgement of the puncture needle and difficult enhancement of the guide wire. To overcome these problems, we modified Yoffa's technique as a symmetrical puncture against the clavicle. METHODS: A patient was placed supine with his/her head turned to the opposite side with the arm at the side. The needle was inserted through the skin at a point around 1 cm below the clavicle, toward the imaginary midline of the clavicular head of the sternocleidomastoid muscle (SCM). The guide wire was inserted with a J-wire. Measurements were made to determine the length from the puncture site to the lower border of the clavicle, the depth and angles from the needle to mid sagittal line, the coronary line and skin (Fig. 2). We also evaluated the No. of punctures, wire insertions, and complications. RESULTS: Our success rate was 95.1% and 6 cases with complications (5.9%) occurred in 102 attempts. The most serious complication was a delayed tension pneumothorax 6 h postoperatively. CONCLUSIONS: These results suggest that the new landmark for infraclavicular subclavian vein catheterization is an easy and safe procedure for an experienced physician. We also recommend close observation postoperatively for at least 24 h for complications.
Arm ; Catheterization* ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Clavicle ; Critical Illness ; Femoral Vein ; Head* ; Hemodynamics ; Humans ; Jugular Veins ; Needles ; Parenteral Nutrition ; Pneumothorax ; Punctures ; Skin ; Subclavian Vein*

BACKGROUND AND OBJECTIVES: Although the incidence of tuberculosis has decreased recently, cervical tuberculous lymphadenitis is one of the most common causes of neck mass in Korea. Its confirmative diagnosis is not common, especially when the presence of acid-bacilli is not proven. So, the treatment of cervical tuberculous lymphadenitis is generally carried out by clinical diagnosis, not by confirmative diagnosis. In this study, we designed to verify theusefulness of fine needle aspiration cytology (FNAC), AFB stain, Mycobacterium tuberculosis polymerase chain reaction (PCR) and excisional biopsy prospectively. MATERIALS AND METHODS: We underwent FNAC, AFB stain and PCR as a first stage work-up through fine needle aspiration in forty-eight patients who were suspected of cervical tuberculous lymphadenits. In patients with positive results on the first stage work-up, we treated the patients with antituberculosis chemotherapy under clinical diagnosis of tuberculosis. In patients with negative test results, we performed excisional biopsy. Also in patients who revealed positive results with no response to the antituberculosis chemotherapy, we performed an excisional biopsy too. RESULTS: The sensitivity and specificity of first stage work-up were 64.9% and 81.8%, respectively. The sensitivity of FNAC, AFB stain and PCR were 8.1%, 13.5% and 56.8 %, respectively. The specificity of PCR was 81.8%. Thirteen (59.1%) of 22 patients who revealed negative results in their first stage work-up were proven to have cervical tuberculous lymphadentis through excisional biopsy, and two of the positive results in PCR were false positive. CONCLUSION: In clinical diagnosis of cervical tuberculous lymphadentis, the first stage work-up used in this study is found to be useful methods which resulted 64.9% sensitivity and 81.8% specificity. Especially, PCR is the most useful tool among them and suggest that, if its result is negative, excisional biopsy should be considered positively.
Biopsy ; Biopsy, Fine-Needle ; Diagnosis* ; Drug Therapy ; Humans ; Incidence ; Korea ; Mycobacterium tuberculosis ; Neck ; Polymerase Chain Reaction ; Prospective Studies ; Sensitivity and Specificity ; Tuberculosis ; Tuberculosis, Lymph Node*

Subcutaneous emphysema often occurs as a result of surgery, trauma of the aerodigestive tract, and increased alveolar pressure. Generally, spontaneous emphysema is rare, because "spontaneous" is only used to describe emphysema that has no obvious etiology. We reviewed six cases of non-traumatic subcutaneous emphysema occurring in the head and neck. Among them, four cases were associated with pneumomediastinum. Two occurred without obvious etiology, another two were due to heavy lifting events, one due to severe vomiting, and the last one due to severe blowing. Most cases occurred in young males. Clinical symptoms, commonly involved sites, treatments and results of these cases of spontaneous emphysema were analysed.
Emphysema ; Head* ; Humans ; Lifting ; Male ; Mediastinal Emphysema ; Neck* ; Subcutaneous Emphysema* ; Vomiting