Crossed pulmonary arteries is an uncommon anomaly in which the ostium of the left pulmonary artery originates superiorly and to the right of the right pulmonary artery. The pulmonary arteries then cross each other and supply their respective lungs. The recognition of this rare anomaly is important because of its association with significant cardiac and extracardiac congenital abnormalities. These congenital conotruncal malformations have long been considered part of the clinical spectrum of DiGeorge syndrome, velocardiofacial(Shprintzen) syndrome, and conotruncal face syndrome. More recent reports have shown that a high percentage of patients with these syndromes have microscopic deletions of chromosomal region 22q11. We experienced a case of crossed branch pulmonary arteries in Dandy-Walker malformation. The diagnosis of crossed branch pulmonary arteries was made by echocardiography and this case had no evidence of 22q11 deletion in high resolution chromosome study and fluorescence in situ hybridization. This case of both conotruncal malformation and Dandy-Walker malformaltion was due to an abnormal developmental process involving the neural crest. We report this case with related literature.
Congenital Abnormalities ; Dandy-Walker Syndrome* ; Diagnosis ; DiGeorge Syndrome ; Echocardiography ; Fluorescence ; Humans ; In Situ Hybridization ; Lung ; Neural Crest ; Pulmonary Artery*

No abstract available.
Echocardiography, Three-Dimensional*

With the exception of patients with epilepsy, transient splenial lesion of the corpus callosum (SCC) has been rarely reported. We investigated two young men with temporary encephalopathy. One had a staphylococcal infection, the other had a viral infection. The brain MRI findings of these patients showed a transient focal lesion in the splenium of the corpus callosum. Transient splenial lesions of the corpus callosum might be a non-specific end point of a different disease process leading to cytotoxic edema or osmotic demyelination of the brain.
Brain ; Communicable Diseases* ; Corpus Callosum* ; Demyelinating Diseases ; Edema ; Epilepsy ; Humans ; Magnetic Resonance Imaging ; Male ; Staphylococcal Infections

BACKGROUND: The patients with traumatic brain injury showed ischemia due to increased intracranial pressure. This study evaluated the relationship of pre-anesthetic serum lactate level with in-hospital mortality. METHODS: The archived medical records of 121 patients were retrospectively reviewed. Demographics and preoperative serum lactate level were analyzed. RESULTS: Of the 121 patients, 32 patients expired in the hospital after decompressive craniectomy. Preoperative serum lactate levels were 3.2 +/- 2.2 mmol/L in the survivors and 5.4 +/- 3.0 mmol/L in the dead (P = 0.001), and the receiver operating characteristic curve revealed that a cut off value of 3.60 mmol/L was reasonable for predicting mortality. CONCLUSIONS: Preoperative serum lactate level is highly correlated with in-hospital mortality after decompressive craniectomy in traumatic brain injury.
Brain Injuries* ; Decompressive Craniectomy* ; Demography ; Hospital Mortality* ; Humans ; Intracranial Pressure ; Ischemia ; Lactic Acid* ; Medical Records ; Mortality ; Retrospective Studies ; ROC Curve ; Survivors

When dealing with a mumps infection, the complication of meningoencephalitis is quite rare. A 24-year-old soldier with a past MMR vaccination was admitted because of aseptic meningitis. His cognitive functioning was rapidly deteriorating with the swelling of both parotid glands. MR findings revealed discrete lesions in the brainstem and thalamus. He barely recovered within 2 months. Among adults with a failure to get the immunity despite vaccination, institutional crowding can lead to a fatal CNS complication such as mumps meningoencephalitis.
Adult* ; Brain Stem ; Crowding ; Humans ; Meningitis, Aseptic ; Meningoencephalitis* ; Military Personnel ; Mumps* ; Parotid Gland ; Thalamus ; Vaccination* ; Young Adult

BACKGROUND: General anesthesia for cesarean section is usually maintained at a low dose after induction with using other agents. Many anesthesiologists have experience difficulty in maintaining stable blood pressure at intubation, as compared with nonobstetric anesthesia. We wanted to determine the efficacy of nicardipine for treating rising blood pressure that is related to intubation. METHODS: Twenty one parturient women, who were scheduled for elective cesarean section, were randomly allocated to two groups. Group 1 (n = 10) received no nicardipine and group 2 (n = 11) received nicardipine (7microg/kg) 60 seconds before intubation. The systolic blood pressures, diastolic blood pressures and heart rates were measured at preoperation, after induction of anesthesia, before intubation, immediately after intubation and at 1, 5, 10, 15 and 30 minutes after intubation. RESULTS: The systolic and diastolic blood pressures were lower in group 2 than group 1 at immediate after intubation. Yet the heart rate was higher in group 2 than in group 1 at the same time. CONCLUSIONS: Intravenous nicardipine given 60 seconds before intubation has some benefit from the viewpoint of blood pressure stability at intubation during cesarean section.
Anesthesia ; Anesthesia, General* ; Blood Pressure* ; Cesarean Section* ; Female ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal* ; Nicardipine* ; Pregnancy

BACKGROUND: The aim of this study was to determine the clinical effective dose of rocuronium for tracheal intubation using a lightwand after induction with propofol, alfentanil, and a low concentration of sevoflurane. METHODS: Twenty-eight adults scheduled to undergo elective surgery lasting less than one hour were enrolled in this study. All patients received alfentanil (10 microgram/kg) and propofol (1.5 mg/kg) for the induction of anesthesia. Tracheal intubation using a lightwand was attempted 3 minutes after administering rocuronium and mask ventilation with 2 vol% of sevoflurane. The initial rocuronium dose was 0.5 mg/kg. The rocuronium dose for consecutive patients, determined by Dixon's up-and-down method, was increased or decreased by 0.05 mg/kg according to the result of the previous patient. The mean arterial pressure and heart rate were recorded before induction, 1 min before intubation, 1 and 2 min after intubation. RESULTS: The 50% clinical effective dose (cED(50)) of rocuronium for tracheal intubation using a lightwand was 0.20 +/- 0.05 mg/kg according to Dixon's up and down method. Isotonic regression revealed the cED(50) and cED(95) (95% confidence intervals) to be 0.20 mg/kg (0.10-0.3 mg/kg) and 0.35 mg/kg (0.16-0.49 mg/kg), respectively. CONCLUSIONS: The cED(50) and cED(95) of rocuronium for tracheal intubation using the lightwand were 0.20 mg/kg and 0.35 mg/kg, respectively, after induction with alfentanil, propofol, and a low concentration of sevoflurane.
Adult ; Alfentanil ; Androstanols ; Anesthesia ; Arterial Pressure ; Heart Rate ; Humans ; Intubation ; Masks ; Methyl Ethers ; Propofol ; Ventilation

This study explores the internal standards for hearing tests and benefits of implementing international standard protocols, including the International Organization for Standardization (ISO) and International Electrotechnical Commission (IEC), and discusses how ISO and IEC standards provide a framework for designing, calibrating, assessing hearing test instruments and methods, and exchanging and comparing data globally. ISO and IEC standards for hearing tests improve accuracy, reliability, and consistency of test results by applying standardized methods and environments. Moreover, they promote international harmonization and data interoperability, enabling information exchange and research collaboration. Those standards for hearing tests are beneficial but have challenges and limitations, such as variation in equipment and calibration, lag in updating standards, variation in implementation and compliance, and lack of coverage of clinical aspects, cultural diversity, and linguistic diversity. These affect the quality and interpretation of test results. Adapting ISO or IEC standards locally would improve their applicability and acceptability, while balancing customization and compatibility with global standards.

Pure-tone audiometry, using an audiometer, is the fundamental hearing test for diagnosing hearing loss. The requirements of the devices and the detailed process for calibrating the related equipment are described in international standards. However, traceable calibration and uncertainty evaluation processes are not widely accepted or applied to the qualification and maintenance of audiometric equipment. Here, we briefly review standard measurement systems for audiometric devices and introduce their calibration procedures. The uncertainty of each calibration process was investigated, and its impact on hearing test results was considered. Our findings show that the traceability of each procedure can be secured, satisfying the uncertainty requirement and being sufficiently smaller than the permissible deviation from the audiometer requirement. To guarantee the objectivity and reliability of hearing tests and maintain low uncertainty, close cooperation and mutual understanding between the metrology field and the medical community are necessary.

Pure-tone audiometry, using an audiometer, is the fundamental hearing test for diagnosing hearing loss. The requirements of the devices and the detailed process for calibrating the related equipment are described in international standards. However, traceable calibration and uncertainty evaluation processes are not widely accepted or applied to the qualification and maintenance of audiometric equipment. Here, we briefly review standard measurement systems for audiometric devices and introduce their calibration procedures. The uncertainty of each calibration process was investigated, and its impact on hearing test results was considered. Our findings show that the traceability of each procedure can be secured, satisfying the uncertainty requirement and being sufficiently smaller than the permissible deviation from the audiometer requirement. To guarantee the objectivity and reliability of hearing tests and maintain low uncertainty, close cooperation and mutual understanding between the metrology field and the medical community are necessary.