No abstract available.
Facial Nerve* ; Paralysis* ; Temporal Bone*

OBJECTIVES: To evaluate the effects on the formation of benzidine-hemoglobin, and benzidine metabolite-hemoglobin adducts, caused by pretreatment with the known xenobiotic metabolism effectors, ethanol and phenobarbital, in rats administered Direct Black 38 dye. METHODS: The experimental rats were divided into three groups: a control group, an ethanol group and a phenobarbital group. Rats were pretreated with ethanol (1g/kg) or phenobarbital (80mg/kg) 24 hours prior to the oral administration of Direct Black 38 (0.5mmol/kg), with the control group being administered the same amount of distilled water. Blood samples were obtained from the vena cava of 5 rats from each group prior to, and at 30 min, 3 h, 6 h, 9 h, 12 h, 24 h, 48 h, 72 h, 96 h, and 144 h following the oral administration of Direct Black 38. Directly after sampling the blood was separated into hemoglobin and plasma, with the adducts being converted into aromatic amines by basic hydrolysis. Hydrolyzed benzidiene, monoacetylbenzidine and 4-aminobiphenyl were analyzed by reverse-phase liquid chromatography with an electrochemical detector. The quantitative amount of the metabolites was expressed by the hemoglobin binding index (HBI). RESULTS: In the ethanol group, benzidine-, monoacetylben-zidine-, and 4-aminobiphenyl-HBI were increased to a greater extent than those in the control group. These results were attributed to the ethanol inducing N-hydroxylation, which is related to the formation of the hemoglobin adduct. In the phenobarbital group, all the HBIs, with the exception of the benzidine-HBI, were increased to a greater extent than those of the control group. These results were attributed to the phenobarbital inducing N-hydroxylation related to the formation of the hemoglobin adduct. The N-acetylation ratio was only increased with the phenobarbital pretreatment due to the lower benzidine-HBI of the phenobarbital group compared to those of the control and ethanol groups. The N-acetylation ratios for all groups were higher than 1 for the duration of the experimental period. Although the azo reduction was unaffected by the ethanol, it was inhibited by the phenobarbital. The ratio of the benzidine-HBI in the phenobarbital group was lower than those of the ethanol the control groups for the entire experiment. CONCLUSION: Our results indicate that both ethanol and phenobarbital increase the formation of adducts by the induction of N-hydroxylation, but also induced N-acetylation. Phenobarbital decreased the formation of benzidine-HBI due to the decrease of the azo reduction. These results suggest that the effects of ethanol and phenobarbital need to be considered in the biochemical monitoring of Direct Black 38.
Administration, Oral ; Amines ; Animals ; Chromatography, Reverse-Phase ; Ethanol* ; Hydrolysis ; Metabolism ; Phenobarbital* ; Plasma ; Rats* ; Water

BACKGROUND: Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU. METHODS: Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE. RESULTS: The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE. CONCLUSIONS: To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.
Adult ; Heart Arrest ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Mortality ; Multivariate Analysis ; Respiration, Artificial ; Risk Factors

The estimated incidence of duodenal Crohn,s disease ranges from 0.5-4% of the patients with Crohn,s disease. However, isolated involvement of Crohn,s disease in the duodenum is very rare, and most duodenal Crohn's disease is accompanied with it elsewhere in the gastrointestinal tract. As clinical, radiographic, and endoscopic features may overlap with those of peptic ulcer disease, patients presenting with isolated duodenal involvement may be perplexing diagnostically. The initial treatment for duodenal Crohn,s diease is medical, but if complications such as gastric outlet obstrution, intractable pain during medical therapy, or hemorrhage occur, surgical intervention is necessary. We experienced one case of isolated duodenal Crohn,s disease showing gastric outlet obstruction without any lesion elsewhere in the gastrointestinal tract and report the case with a review of the literature.
Crohn Disease* ; Duodenum ; Gastric Outlet Obstruction ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Incidence ; Pain, Intractable ; Peptic Ulcer

No abstract available.
Humans ; Lymphocytes* ; Stomach Neoplasms* ; Stomach*

No abstract available.
Facial Paralysis* ; Humans

Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.
Adult ; Aged ; Emergency Service, Hospital ; Endotoxins ; Extracorporeal Membrane Oxygenation* ; Hemodynamics ; Hemoperfusion ; Humans ; Nephrectomy* ; Polymyxin B ; Pyelonephritis ; Shock, Septic*

The most common cardiac cause of massive hemoptysis is mitral stenosis. Mitral regurgitation is rarely complicated by massive hemoptysis. A 48-year-old man with no significant medical history was admitted to our hospital with hemoptysis and production of 500 mL of blood within 24 hours. A pan-systolic murmur was found on chest examination. A chest computed tomography showed airspace consolidation in the right upper and middle lobes, with faint bilateral ground glass opacity. Echocardiography revealed mitral valve prolapse and grade IV mitral regurgitation. The patient was diagnosed with sporadic primary mitral valve prolapse. After mitral valve repair surgery, the patient recovered fully.
Echocardiography ; Glass ; Hemoptysis* ; Humans ; Middle Aged ; Mitral Valve Insufficiency* ; Mitral Valve Prolapse* ; Mitral Valve Stenosis ; Mitral Valve* ; Thorax

Descending necrotizing mediastinitis (DNM) is one of the most lethal form of mediastinitis originating from an oropharyngeal infection. It requires an early and aggressive sugical treatment, but the operative approach and optimal form of mediastinal drainage remains controversial. We report a case of DNM in a 45-year-old male who underwent right cervicomediastinotomy to drain the deep neck space, upper mediastinum and anterior mediastinal drainage was accomplished through a subxiphoid approach. After this procedure, he steadily improved and was dischrged on hospital day 36. We report this case with a brief review of the literature.
Drainage ; Humans ; Male ; Mediastinitis* ; Mediastinum ; Middle Aged ; Neck

No abstract available.