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

Sedative and antiemetic effect of hydroxyzine as a premedicant were studied and results were compared with a placebo and Talwin. Two hundred and fourty patients were evaluated. These patients were divided into 6 groups. There were fourty patients in each group. Group 1: Hydroxyzine 50mg. Group 2: Hydroxyzine 100mg. Group 3: Placebo. Group 4: Talwin 20mg. Group 5: Hydroxyzine 5pmg plus Talwie 20mg. Group 6: Hydroxyzine 100mg plus Talwin 20mg. The results were as follows; 1) Satisfactory sedation was ovtained in 75% with group I, in 92.5% with group 2, in 30% with group 3, in 40% with group 4, in 82. 5% With group 5, and in 97. 5% with group 6. Better results were obtained with hydroxyzine plus Talwin group than hydroxyzine anly. 2) The incidence of postoperative nausea and vomiting in recovery room, 7. 5% wlth group 7. 5 % with group 3, 20% with group 4, 5%. with group 5. There was no case of nausea and vomiting in group 2 and group 6. We obtained a significant difference in antiemetic effect between Talwin only and the Talwin plus hydroxyzine group. 3) There was no adverse change on vital signs in all cases.
Antiemetics ; Humans ; Hydroxyzine* ; Incidence ; Nausea ; Pentazocine ; Postoperative Nausea and Vomiting ; Recovery Room ; Vital Signs ; Vomiting

The authors describe a male newborn with multiple congenital anomalies; craniofacial dysmorphism, bilateral cleft palate and lip, ambiguous external genitalia with absence of phallus, ventricular septal defect, agenesis of olfactory bulbs, and presence of small round cells simulating migration defect in the cerebellar white matter. Cytogenetic study demonstrated a chromosomal constitution of 47,XY, +21, +5q. Its pathological significance compared with Down's syndrome and hitherto reported partial trisomy 5q is discussed.
Abnormalities, Multiple/*genetics/pathology ; *Chromosomes, Human, Pair 5 ; Down Syndrome/*genetics/pathology ; Humans ; Infant, Newborn ; Male ; Phenotype ; *Trisomy

BACKGROUND: This study is aimed to elucidate the developmental pattern of human fetal lip by histological and immunohistochemical examinations. METHODS: Totally 231 normal human lip tissues obtained from autopsied fetuses were fixed with 10% buffered formalin, sectioned in cross and longitudinal directions, routinely stained for H&E and performed for immunohistochemistry with antibodies of S-100 protein, proliferating cell nuclear antigen (PCNA), transglutaminase C (TGase-C), metalloproteinase (MMP)-3, MMP-10, tenascin, KL1, K8.12, E-cadherin, tissue inhibitors of matrix metalloproteinase (TIMP)-1, TIMP-2 and total keratin (TK). RESULTS: The lip structure first appeared as an orifice of stomodeum around the 7-8th week of gestation, and a major structure of the midface was observed by the 11-12th week. As the squamous epithelium of the lip became thick and was keratinized, the vermilion border became distinguished in the 15-16th week, and the lip structure was almost completed with the presence of orbicularis oris muscle in the lingual side of vermilion border by the 17-18th week. Immunohistochemically, the vermilion border showed strong reactions for tenascin, E-cadherin and MMP-3 and increased positivity for PCNA, cytokeratins (TK, KL1, K8.12), and TGase-C. CONCLUSIONS: With the above findings we suppose that the cytodifferentiation of vermilion border epithelium plays an important role for the development of human fetal lip.
Antibodies ; Cadherins ; Epithelium ; Fetus ; Formaldehyde ; Humans* ; Immunohistochemistry ; Keratins ; Lip* ; Pregnancy ; Proliferating Cell Nuclear Antigen ; S100 Proteins ; Tenascin ; Tissue Inhibitor of Metalloproteinase-2

Purpose: To report a rare case of bilateral optic nerve sheath meningocele diagnosed in a patient with exophthalmos.Case summary: A 33-year-old male visited our clinic with bilateral exophthalmos for 6 months. The patient had been diagnosed with hypertension 3 years previously; however, the condition had been poorly controlled. He also had a history of treatment associated with retinal vein occlusion, macular edema, and papilledema 2 years earlier. There was no limitation in his ocular movement. A Hertel exophthalmometry test showed bilateral exophthalmos of 20 mm in both eyes. Visual field tests showed an inferior arcuate visual field defect in the right eye and a superotemporal peripheral field defect in the left eye. In orbital magnetic resonance imagery, cerebrospinal fluid space widening along the optic nerve and flattening of the bilateral posterior pole of the eye were evident. The patient was diagnosed with optic nerve sheath meningocele. Conclusions Optic nerve sheath meningocele should be considered as a differential diagnosis of exophthalmos patients. Because it is a disease that can affect visual function in a manner similar to that of a visual field defect, rapid diagnosis through imaging study and thorough regular follow-up examinations are essential.

Purpose: To report a rare case of bilateral optic nerve sheath meningocele diagnosed in a patient with exophthalmos.Case summary: A 33-year-old male visited our clinic with bilateral exophthalmos for 6 months. The patient had been diagnosed with hypertension 3 years previously; however, the condition had been poorly controlled. He also had a history of treatment associated with retinal vein occlusion, macular edema, and papilledema 2 years earlier. There was no limitation in his ocular movement. A Hertel exophthalmometry test showed bilateral exophthalmos of 20 mm in both eyes. Visual field tests showed an inferior arcuate visual field defect in the right eye and a superotemporal peripheral field defect in the left eye. In orbital magnetic resonance imagery, cerebrospinal fluid space widening along the optic nerve and flattening of the bilateral posterior pole of the eye were evident. The patient was diagnosed with optic nerve sheath meningocele. Conclusions Optic nerve sheath meningocele should be considered as a differential diagnosis of exophthalmos patients. Because it is a disease that can affect visual function in a manner similar to that of a visual field defect, rapid diagnosis through imaging study and thorough regular follow-up examinations are essential.

Objective: Cyber addiction, which is more vulnerable in adolescents, is defined as the excessive use of computers and the Internet that causes serious psychological, social, and physical problems. In this study, we investigated the resting-state functional connectivity (rsFC) in adolescents with cyber addiction. Methods: We collected and analyzed resting-state functional neuroimaging data of 20 patients with cyber addiction, aged 13−18 years, and 27 healthy controls. Based on previous studies, the seed regions included the dorsolateral prefrontal cortex, medial orbitofrontal cortex, lateral orbitofrontal cortex, dorsal anterior cingulate cortex, insula, hippocampus, amygdala, nucleus accumbens, and the ventral tegmental area. Seed-to-voxel analyses were performed to investigate the differences between patients and healthy controls. A correlation analysis between rsFC and cyber addiction severity was also performed. Results: Patients with cyber addiction showed the following characteristics: increased positive rsFC between the left insular−right middle temporal gyrus; increased positive rsFC between the right hippocampus−right precentral gyrus;increased positive rsFC between the right amygdala−right precentral gyrus and right parietal operculum cortex; increased negative rsFC between the left nucleus accumbens−right cerebellum crus II and right cerebellum VI. Conclusion Adolescents with cyber addiction show altered functional connectivity during the resting state. The findings of this study may help us better understand the neuropathology of cyber addiction in adolescents.

BACKGROUND: Aspiration of gastric contents is an ever -present risk in the use of general anesthesia, particularly in emergency and obstetric situations, and morbidity and mortality associated with this complication increases with the volume and acidity of the aspirate. Since direct inhibition of acid secretion may be a preferable method, we studied the effectiveness of ranitidine in increasing gastric pH. METHODS: Sixty patients scheduled for elective cesarean section under general anesthesia before midday were randomly divided into three groups. The control group (n=20) did not received preanesthetic ranitidine. Group I (n=20) received a slow intravenous injection of 50 mg ranitidine, one hour before surgery. Group II (n=20) received 150 mg ranitidine orally, both the night before surgery and the morning of surgery. RESULTS: Compared with the control group, the mean gastric pH increased significantly in group I and II (P<0.05). There was no significant difference of gastric pH between group I and II. CONCLUSIONS: The results of this study indicate that ranitidine is a useful agent in increasing the gastric pH in women undergoing elective cesarean section. Ranitidine administered intravenously and orally were equally effective means in increasing the gastric pH.
Anesthesia, General ; Cesarean Section* ; Emergencies ; Female ; Gastric Acid* ; Humans ; Hydrogen-Ion Concentration ; Injections, Intravenous ; Mortality ; Pregnancy ; Ranitidine*

BACKGROUND: Minimum alveolar concentration (MAC) is decreased during pregnancy, but there are no data regarding the requirements for intravenous agents. Recently only one study showed that the requirement for thiopental in pregnant women of 7-13 weeks' gestation was less than the requirement obtained in nonpregnant women. Thus we wanted to determine whether pregnant patients needed less propofol for hypnosis and anesthesia than nonpregnant patients. METHODS: One hundred nonpregnant women having gynecologic surgery and 100 pregnant women of 5-13 weeks' gestation undergoing elective abortions were recruited. They were randomly allocated 10 groups according to the doses of propofol and each group had 10 patients. During a period of 30 seconds, one of the doses of propofol 1.0, 1.25, 1.5, 1.75, 2.0, 2.25, 2.5, 2.75, 3.0 or 3.25 mg/kg was administered. Two minutes later, patients were asked to open their eyes as a test for hypnosis. Patients who did not open their eyes were given a 10 seconds, 50-Hz, 80-mA transcutaneous tetanic electrical stimulus to the ulnar nerve as a test for anesthesia. Estimates of ED50 and ED95 for hypnosis and anesthesia were obtained by logistic regression. RESULTS: In the pregnant women, the median effective doses (ED50) (95% confidence interval) for hypnosis and anesthesia were 1.25 (1.13-1.35) mg/kg and 2.71 (2.49-3.04) mg/kg, the ED95 (95% CI) were 1.51 (1.16-1.87) mg/kg and 3.04 (2.80-3.58) mg/kg respectively. Whereas in the nonpregnant women, the ED50 for hypnosis and anesthesia were 1.27 (1.39-1.90) mg/kg and 4.12 (3.50-6.01) mg/kg, the ED95 were 1.53 (1.41-1.93) mg/kg and 4.35 (3.66-7.26) mg/kg respectively. CONCLUSIONS: In early pregnant women, the doses of propofol for hypnosis and anesthesia were 1.6% and 34.2% less compared with those in nonpregnant women.
Anesthesia ; Female ; Gynecologic Surgical Procedures ; Humans ; Hypnosis ; Logistic Models ; Pregnancy* ; Pregnant Women ; Propofol* ; Thiopental ; Ulnar Nerve

BACKGROUND: Hypotension associated with epidural anesthesia for cesarean section is common and serious, despite the use of uterine displacement and volume preload. This study evaluated the role of crystalloid volume preload for prevention of hypotension during epidural anesthesia. METHODS: Forty parturients undergoing elective cesarean section were allocated randomly to receive either no preload (Group II, n=20) or preload with Ringer's lactate solution 1000 ml over 10-15 minutes (Group I, n=20) before epidural anesthesia. Hypotension was defined as a decrease of systolic blood pressure to less than 90 mmHg and to less than 80% of baseline value. Systolic blood pressure and heart rate were measured 2 minutes interval during first 20 minutes after epidural injection. Apgar score, umbilical venous, arterial and maternal arterial blood gas analysis were done. RESULTS: Significant hypotension occured in seven of the twenty parturients in no preload group (Group II) and seven of twenty parturients in Ringer's lactate preload group (Group I). There were no statistical differences in systolic blood pressure, heart rate, amount of used ephedrine, Apgar score, umbilical venous, arterial and maternal arterial blood gas analysis. CONCLUSIONS: Ringer's lactate preload (1000 ml) before epidural anesthesia in the supine tilted parturients did not decrease the incidence or severity of hypotension.
Anesthesia, Epidural* ; Anesthesia, Obstetrical ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section* ; Ephedrine ; Female ; Heart Rate ; Hypotension* ; Incidence ; Injections, Epidural ; Lactic Acid* ; Pregnancy