Endotracheal intubation has been a routine practice in general anesthesia and is accepted by anesthetiste and surgeons as an integral part of airway management during anesthesia and operation. Paradoxically however, there have been several cases of obstruction of the airway which occurred due to endotracheal intubation. The authors experienced two cases of airway obstruction due tendotracheal and endobronchial techniques, using tubes with malfunctioning cuffs. The lumen of an endotracheal tube was collapsed by intracuff pressure, shortly after inflation of the cuff and resulted in extremely high airway resistance. In the other case, gradual leakage of air from the distal cuff of a Carlens tube led to collapse of the distal cuff. This promoted the movement of blood, secretions, and pus from the diseased right lung to the normal healthy left lung in association with the left lateral recumbent position, which in turn resulted in total airway obstruction.
Airway Management ; Airway Obstruction ; Airway Resistance ; Anesthesia ; Anesthesia, General ; Inflation, Economic ; Intubation, Intratracheal* ; Lung ; Suppuration ; Surgeons

BACKGROUND AND OBJECTIVE: Mitral annulus velocity measured by doppler tissue imaging (DTI) has been used as a method of evaluation of the left ventricular diastolic function. This study was aimed to evaluate the left ventricular diastolic function using the mitral annulus velocity measured by DTI in the patients with hypertension. METHODS AND SUBJECTS: One hundered twenty nine patients with blood pressure above 140/90mmHg and age sex matched 123 normotensive subjects were studied. For measuring the mitral annulus velocities by DTI, we used the 2.5 MHz probe (Sequoia, Accuson) in apical four chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocities were easily obtained from all subjects. In the hypertension group, mitral annulus E'velocity was significantly lower than normotensive controls (5.4 1.3 cm/sec vs 6.5 1.8 cm/sec, p<0.001) and mitral annulus A' velocity was significantly higher than normotensive controls (8.6 1.4 cm/sec vs 7.9 1.1 cm/sec, p<0.001). In comparison with patients with normal LVML(IV mass index in hypertension group and subjects with normal LVMI in normotensive controls, mitral annulus E'velocity was reduced in patients with normal LVMI in hypertension group compared with subjects with normal LVMI in normotensive controls (5.6 1.4 cm/sec vs 6.7 1.8 cm/sec, p<0.001). CONCLUSION: Mitral annulus velocity measured by DTI could be used as one of the parameters in evaluating the early changes of left ventricular diastolic function in the patient with hypertension.
Blood Pressure ; Humans ; Hypertension*

We investigated the single- and multiple dose pharmacokinetics of a new controlled-release formulation (Orfil retard enteric coated tablet) of valproic acid in comparison with those of the plain tablet as a reference. Twelve healthy volunteers were given each formulation of 300 mg in the single-dose study. In the steady-state multiple-dose study, twelve epileptic patients received 1200 mg/day of the reference drug (300 mg 9 AM, 300 mg 3 PM, 600 mg 9 PM) and the test formulation (600 mg 9 AM, 600 mg 9 PM) with at least one week interval in cross-over manner. The AUC values of the test controlled release formulation were 91.7% (95% confidence interval: 78.4-100.4%) of the reference drug in the single-dose study and 98.2% (95% confidence interval: 86.2%-109.9%) in the steady-state study. The AUC's of the two formulations were not significantly different by ANOVA test. The Cmax and Tmax values of the test formulation were significantly different from the values of the reference in single-(Tmax: 158.4%, Cmax: 52.5% of the reference) and multiple-dose study (Tmax: 153.5% of the reference). The MRT values of the test formulation were also significantly greater (129.4% of the reference) in the single-dose study. Regarding the controlled-release characteristics of the test formulation, fluctuation index and percentage fluctuation of the twice a day dosage regimen of the test formulation were comparable with those of the thrice a day dosage regimen of the conventional tablet. Area deviation was even smaller in the test regimen of the controlled release formulation.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Oral ; Adult ; Biological Availability ; Delayed-Action Preparations ; Epilepsy/blood/*drug therapy ; Humans ; Male ; Tablets ; Tablets, Enteric-Coated ; Valproic Acid/*pharmacokinetics

Primary retroperitoneal cysts are rare. Symptoms may be absent, or only an increased abdominal size observed. However, some patients present with complaints associated with pressure or displacement of an abdominal organ due to the cyst. Most patients display some chronic symptoms that necessitate therapeutic intervention. These cysts may occur at any age, with the highest incidence being the fourth decade, but one-third of patients present at less than 10 years of age. A case of a retroperitoneal cyst, which presented as a simple renal cyst, and removed with a laparoscopy, is reported in a sixty one-year-old woman.
Female ; Humans ; Incidence ; Laparoscopy ; Retroperitoneal Space

PURPOSE: To compare the usefulness of contrast-enhanced voiding ultrasonography(US) with that of radiographic voiding cystourethrography(VCUG) for the diagnosis of vesicoureteral reflux(VUR) in children. MATERIALS AND METHODS: Ninety-five kidney-ureter units of 47 patients referred for investigation of VUR underwent contrast-enhanced voiding US followed by radiographic VCUG. After baseline US examination of the urinary tract, residual urine in the bladder was drained through an inserted Foley catheter and the bladder was gravity filled at a height of 1 m with normal saline. A galactose-based, microbubble-containing echo-enhancing agent (Levovist; Schering, Berlin, Germany) was then administered. The amount of this was approximately 10% of bladder capacity, and VUR was diagnosed when microbubbles appeared in the ureter or pelvo-calyceal system. Using radiographic VCUG as a reference point, the accuracy with which contrast-enhanced voiding US detected VUR was calculated. RESULTS: In 87 of 95 kidney-ureter units (91.6%), the two methods showed similar results regarding the diagnosis or exclusion of VUR, which was detected by both in 12 units, but by neither in 75. VUR was shown to occur in a total of 20 units, but in eight of these by one method only. In two units, VUR detected by contrast-enhanced voiding US was not demonstrated by radiographic VCUG; in six units, the reverse was true. In the detection of VUR, contrast-enhanced voiding US showed a sensitivity of 66.7%, a specificity of 97.4%, a positive predictive value of 85.7%, and a negative predictive value of 92.6%. CONCLUSION: Contrast-enhanced voiding US is highly specific and has high positive and negative predictive values; its sensitivity, however, is not sufficiently high. The modality appears to be a useful diagnostic tool for the detection of VUR without exposure to ionizing radiation, though to be certain of its value, more experience of its use is first required.
Berlin ; Catheters ; Child* ; Diagnosis ; Gravitation ; Humans ; Microbubbles ; Radiation, Ionizing ; Sensitivity and Specificity ; Ultrasonography* ; Ureter ; Urinary Bladder ; Urinary Tract ; Vesico-Ureteral Reflux*

Gastric teratomas are extremely rare neoplasms and almost exclusively benign. They occur predominantly in males and generally present as a palpable abdominal mass. To our knowledge, only one adult case has been described in the Korean literature. We report a case in which an immature gastric teratoma in a 3-month-old boy was revealed by CT and US.
Case Report ; Human ; Infant ; Male ; Stomach Neoplasms/*epidemiology/radiography/ultrasonography ; Teratoma/*epidemiology/radiography/ultrasonography ; Tomography, X-Ray Computed

PURPOSE: The purpose of this experimental study was to evaluate early CT and MRI findings of cerebral sparganosis, to correlate the imaging findings with histopathologic findings, and to determine capability of CT and MRI to differentiate live worm from the dead. MATERIALS AND METHODS: After scolices of three to four spargana, which were obtained from naturally infected snakes, were introduced into cerebral hemispheres of 21 mongrel cats, sequential brain CT and MRI were performed at the 2nd, 4th, 8th and 12th week, and the imaging findings were analyzed and compared with the histopathologic findings. RESULTS: Spargana were found in 16 sites of 10 cat brains(48%);they were located in basal ganglia(5 cases), periventricular white matter and centrum semiovale(4 cases), subdural(2 cases) or subarachnoid spaces(1 case), and lateral ventricle(2 cases). The larvae were also observed in the contralateral hemisphere(3 cases). The lesions without larvae(presumably tracts) were found in 22 sites of 14 cat brains(67%) ;they were located in periventricular white matter and centrum semiovale(11 cases), basal ganglia(5 cases), midbrain(3 cases) and frontal 10be(2 cases). The lesions without larvae were also found in the contralateral hemi- sphere (7 cases). On CT, the lesions with larvae showed high density in 75%(9/12) and were enhanced in 38%(3/8) as a nodular pattern. On MRI they showed iso-(7/11) or low signal intensity(4/11) on Tl-weighted images, mainly isosignal intensity on proton density- weighted images, and variable signal intensity on T2-weighted images. Contrast enhancement of variable shapes was seen in 50%(4/8). The lesions without larvae showed iso-(14/22) or low density(6/22) on CT and were rarely enhanced(2/17). On MRI they mostly showed isosignal intensity on both T1-weighted and proton density- weighted images, and variable signal intensity on T2- weighted images. They were enhanced in 29%(5/17) on contrast-enhanced MRI. Dilatation of ipsilateral ventricle was found in 43% (9/21) ;it was seen as early as the second week in 5 cats. On histopathologic examinations, there was only mild degree of inflammation and edema around both the larvae and the lesions without larvae in most cases. Granulation tissues, small calcifications, and small morrhages were observed nearby the larvae in six, one and two cases, respectively. At the lesions without larvae, small calcifications and hemorrhages were found in three and nine cases, respectively. It was not possible to determine the viability of the larvae by using CT or MRI findings and even by histopathologic findings. CONCLUSION: The results indicate that the spargana actively move within brain tissue in early stage, cause mild degree of inflammation and edema around the larvae and the tracts, but presumably produce early degeneration of cerebral white matter, resulting in dilatation of ipsilateral ventricle. Additionally, CT may differ. entiate the lesions with worms from tracts(the lesions without worms), but viability of the larvae can not be determined by either CT or MRI.
Animals ; Brain ; Cats ; Cerebrum ; Diagnosis* ; Dilatation ; Edema ; Granulation Tissue ; Hemorrhage ; Inflammation ; Larva ; Magnetic Resonance Imaging ; Protons ; Snakes ; Sparganosis*

No abstract available.
Blood Flow Velocity*

No abstract available.
Humans

The term 'ancient' schwannoma was proposed for a group of neural tumors showing degenerative changes and marked nuclear atypia. The findings from abdominal ultrasound and computed tomography, in a patient with a retroperitoneal ancient schwannoma, are presented, and the histological features of this unusual type of tumor are reviewed. The presence of a large, well-delineated complex cystic mass in the deep soft tissues should raise the possibility of an ancient schwannoma. The treatment of choice for an ancient schwannoma is complete excision. It is important to recognize these tumors as benign, with excellent prognosis, so as to avoid unnecessary radical surgery. A recurrence, or persistence, seems to be associated with incomplete resection, which occurred in 10% of the reported cases.
Humans ; Neurilemmoma* ; Prognosis ; Recurrence ; Ultrasonography