No abstract available.
Magnetic Resonance Imaging* ; Spinal Cord*

Selective cervical nerve root block is executed for patients who have symptoms of cervical radiculopathy for diagnostic and therapeutic purposes. However several catastrophic complications caused by this procedure have been reported including neurological complications. A 43-year-old male received a C5 selective cervical nerve root block procedure due to continuous radiating pain even after cervical discectomy and interbody fusion was performed. At the time of the procedure, the contrast outline revealed reflux of the nerve root and epidural space. But after the procedure was performed, the patient experienced decreased sensation in the upper and low extremities as well as motor paralysis of both extremities. Our sspecting diagnosis was anterior spinal artery syndrome but both sensory and motor functions were subsequently recovered within a few hours after the procedure was completed. Due to the difficult nature of this case, we reported these complications and reviewed current literature related to this study.
Adult ; Anterior Spinal Artery Syndrome ; Diskectomy ; Epidural Space ; Extremities ; Humans ; Injections, Spinal ; Male ; Paralysis ; Quadriplegia ; Radiculopathy ; Sensation ; Spinal Nerve Roots

Truncus arteriosus is characterized by a single arterial vessel arising from the base of the heart and giving origin to the systemic, pulmonary and coronary circulation. To evaluate the incidence, types, and associated anomalies, 18cases of truncus arteriosus diagnosed by angiocardiography, were reviewed and were compared with other reports. Ten of them were confirmed by operation. The overall incidence of truncus arteriosus was 0.127%. Accordin to Collett and Edwards classification. Type I was encountered in 11cases(61%), type II in 4cases(22%), and type III in 3cases(17%), All the patients had subtruncal ventricular septal defects. Eight patients showed truncal valve regurgitation and valve stenosis was noted in one case. A right aortic arch was present in 9 cases. Associated anomalies were atrial septal defect(8cases), patent ductus arteriosus(3cases), coarctation of the aorta(2cases), isolation of the left subclavian artery(2 cases), and right aortic arch with an aberrant left subclavian artery(1case). Truncus arteriosus is an uncommon congenital cardio vascular malformation. In the group of cases which we encountered, type I was the most common anomaly. Frequently associated anomalies were right aortic arch, incompetent truncal valve and atrial septal defect.
Angiocardiography ; Aorta, Thoracic ; Classification ; Constriction, Pathologic ; Coronary Circulation ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Incidence* ; Truncus Arteriosus* ; Vascular Malformations

Although DNA damage responses (DDRs) are reported to be involved in nitric oxide (NO) production in response to genotoxic stresses, the precise mechanism of DDR-mediated NO production has not been fully understood. Using a genotoxic agent aphidicolin, we investigated how DDRs regulate NO production in bovine aortic endothelial cells. Prolonged (over 24 h) treatment with aphidicolin increased NO production and endothelial NO synthase (eNOS) protein expression, which was accompanied by increased eNOS dimer/monomer ratio, tetrahydrobiopterin levels, and eNOS mRNA expression. A promoter assay using 5’-serially deleted eNOS promoters revealed that Tax-responsive element site, located at −962 to −873 of the eNOS promoter, was respon-sible for aphidicolin-stimulated eNOS gene expression. Aphidicolin increased CREB activity and ectopic expression of dominantnegative inhibitor of CREB, A-CREB, repressed the stimulatory effects of aphidicolin on eNOS gene expression and its promoter activity. Co-treatment with LY294002 decreased the aphidicolin-stimulated increase in p-CREB-Ser133 level, eNOS expression, and NO production. Furthermore, ectopic expression of dominant-negative Akt construct attenuated aphidicolin-stimulated NO production. Aphidicolin increased p-ATM-Ser1981 and the knockdown of ATM using siRNA attenuated all stimulatory effects of aphidicolin on p-Akt-Ser473 , p-CREB-Ser133 , eNOS expression, and NO production. Additionally, these stimulatory effects of aphidicolin were similarly observed in human umbilical vein endothelial cells. Lastly, aphidicolin increased acetylcholine-induced vessel relaxation in rat aortas, which was accompanied by increased p-ATM-Ser1981 , p-Akt-Ser473 , p-CREB-Ser 133 , and eNOS expression. In conclusion, our results demonstrate that in response to aphidicolin, activation of ATM/Akt/CREB/eNOS signaling cascade mediates increase of NO production and vessel relaxation in endothelial cells and rat aortas.

OBJECTIVE: To evaluate the effects of the videofluoroscopic swallowing study (VFSS) timing after the nasogastric tube (NGT) removal on swallowing function of the patients with dysphagia. METHODS: This study was conducted on 40 NGT-fed patients with dysphagia. To assess the patients' swallowing function, VFSS was performed twice using a 5-mL 35% diluted barium solution. For the initial examination, VFSS was performed immediately after the NGT removal (VFSS 1). For the second examination, VFSS was performed five hours after the NGT removal (VFSS 2). We used the functional dysphagia scale (FDS) to assess swallowing function. In the FDS, a significant difference in the four items in the oral phase, seven items in the pharyngeal phase, and total scores were assessed (p<0.05). We also used modified penetration-aspiration scale (mPAS) to compare the two examinations (p<0.05). RESULTS: A paired t-test was performed to confirm the statistical significance of the two examinations (p<0.05). The overall swallowing function was assessed as better in VFSS 2 than in VFSS 1. In the FDS, significant differences in the residue in valleculae (p=0.002), the residue in pyriform sinuses (p=0.001), the coating of pharyngeal wall after swallow (p=0.001), and the total scores (p<0.001) were found between the two examinations. Also, in the mPAS that assessed the degree of penetration-aspiration, a significant difference was found between the two examinations (p<0.001). CONCLUSION: The results of this study confirmed that the timing of the VFSS after the NGT removal affects the swallowing function. Thus, to accurately assess the swallowing function, VFSS must be performed in NGT-fed patients after they have rested for a certain period following the removal of their NGT.
Barium ; Deglutition Disorders* ; Deglutition* ; Enteral Nutrition ; Humans ; Pyriform Sinus

Cervical incompetence is one of the main contributors to repeated pregnancy loss and preterm delivery. Typically it results in progressive cervical dilatation, leading to a painless second or early third trimester abortion. Emergency cerclage can be used in the setting of advanced cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure, various techniques have been developed to replace the fetal membranes into the uterine cavity. We performed six successful cases of emergency cerclage combined with amnioreduction in advanced incompetent internal os of cervix (IIOC). Interval from emergency cerclage to delivery was 8.1 +/- 2.4 weeks (range 4-10 weeks) and we delivered viable fetuses in all but one. Hereby we report our experiences with a brief review of literature.
Cervix Uteri ; Emergencies* ; Extraembryonic Membranes ; Female ; Fetus ; Humans ; Labor Stage, First ; Pregnancy ; Pregnancy Trimester, Third

Intravascular extension of malignancy is rare. Some cases of this have been reported, and these have mostly been seen in cases of lung cancer with extension into the pulmonary vein and left atrium. This is the first case of tumor involvement from the right atrium through the SVC to the azygous vein of the diaphragm level and all this was clearly visualized on 18FDG-PET/CT. A 68-year-old man was admitted for evaluation of SVC syndrome. Chest CT showed that the SVC was near completely obstructed by extension of tumor that had first invaded the thoracic spine and azygous vein. Multiple enlarged mediastinal lymph nodes were also noted. The pathologic examination of the biopsied tissues made the diagnosis of sarcomatoid carcinoma. The high metabolic activity within a thrombus on 18FDG-PET/CT has been suggested to indicate tumor thrombus because a blood thrombus typically shows lower metabolic activity that's caused by incorporated fibroblasts and endothelial cells within the thrombus (1). However, because some reports demonstrated that a high FDG uptake could also occur in a blood thrombus (2), the exact differentiation of the two by 18FDG-PET/CT seems to be difficult.
Aged ; Diaphragm ; Endothelial Cells ; Fibroblasts ; Heart Atria ; Humans ; Lung Neoplasms ; Lymph Nodes ; Positron-Emission Tomography ; Pulmonary Veins ; Spine ; Thorax ; Thrombosis ; Veins

Pulmonary atelectasis is a common complication following surgery under general anesthesia. However, collapse during anesthesia and surgery is rare, and usually is not diagnosed until the surgical procedure is well under way. Total or segmental lung collapses are usually resulted from the obstruction of bronchial pathway by secretions such as mucus, blood and pus etc. We experienced acute lung collapse of right upper lobe during left thoracotomy. We assumed that the cause of the atelectasis was an obstruction of right superior lobar bronchus by mucus. The possible cause of lung collapse is described.
Anesthesia ; Anesthesia, General ; Anesthesia, Inhalation* ; Bronchi ; Inhalation* ; Lung ; Mucus ; Pulmonary Atelectasis* ; Suppuration ; Thoracotomy*

Acute airway obstruction during endotracheal anesthesia is embarrassing and critical situation which requires early diagnosis and immediate management. A 57-year-old man was scheduled for right pneumonectomy for a destroyed lung by fibroatelectatic changes and pleural calcification of right lung. We experienced high arterial PCO2 and inspiratory resistance during Left - Sided Double Lumen Endobronchial anesthesia in the left decubitus position. We exchanged tube after failure of suction and found airway obstruction due to mucous plug attached to the bevel of the endobronchial lumen.
Airway Obstruction* ; Anesthesia ; Anesthesia, Inhalation* ; Early Diagnosis ; Humans ; Inhalation* ; Lung ; Middle Aged ; Pneumonectomy ; Suction

No abstract available.
Lung ; Thorax