The corrected transposition of the great arteries is a rare congenital heart anomaly consisting of the discordant connections of both the atria to ventricles and the ventricles to the great arteries. But its circulation is physiologically corrected and therefore it is compatible with life unless there are associated lesions. Our case was associated with VSD, COA, and PDA. He was slightly cyanotic and irritable. Despite of oxygen supply, his symptoms were not improved and he eventually died in 52 hours after delivery. Medical record revealed severe respiratory and metabolic acidosis.
Acidosis ; Arteries* ; Heart ; Medical Records ; Oxygen

PURPOSE: A tracheostomy is an important, life-saving procedure to maintain a patent airway. Our aim was to evaluate the effects and safety of tracheostomies done by emergency physicians. METHODS: This was a retrospective study conducted in the emergency intensive care unit (ICU) of a regional emergency medical center. We enrolled consecutive patients who had a tracheostomy in the emergency ICU between November 2004 and September 2008. We collected data on demographic characteristics, diagnosis at admission, the indication for a tracheostomy, time from intubation to tracheostomy, weaning success, time from tracheostomy to weaning, hospital stay, survival discharge, and complications. We divided the patients into two groups: the EM group included patients who had a tracheostomy done by an emergency physician; the OL group had it done by an otolaryngologists. We then made between-groups comparisons. RESULTS: One hundred forty six patients were enrolled in this study. Of the 146 patients, 94 were included in the EM group and 52 in the OL group. There was no significant difference in the demographic characteristics except age, diagnosis at admission, indication of tracheostomy, time from intubation to tracheostomy, weaning success, time from tracheostomy to weaning, hospital stay, and survival discharge between the two groups. There was no significant difference in demographic characteristics? or in the incidence of complications between the two groups. CONCLUSION: Tracheostomy done by emergency physicians are as effective and safe as ones done by otolaryngologists.
Emergencies ; Emergency Medicine ; Humans ; Incidence ; Intensive Care Units ; Intubation ; Length of Stay ; Otolaryngology ; Postoperative Complications ; Retrospective Studies ; Tracheostomy ; Treatment Outcome ; Weaning

OBJECTIVE: To know if electro-magnetic stimulation can induce the contraction of gluteus medius and minimus muscles, and to compare pain induced by electro-magnetic stimulation of the gluteal muscles with that induced by transcutaneous neuromuscular electrical stimulation (NMES). METHOD: Two different intensity of transcutaneous NMES (40 mA, 60 mA) and electro-magnetic stimulation (60%, 100%) were applied to the left buttock of 15 healthy male volunteers in random order. The ultrasound images of gluteal muscles and visual analog scale (VAS) of pain were obtained three times at each type of stimulation. The grade of muscle contraction and the VAS score of each type of stimulation were compared. RESULTS: At maximal stimulation intensity of our equipments, the mean VAS score was lower (p=0.012) in electro-magnetic stimulation than in transcutaneous NMES, and the grade of gluteus minimus contraction was higher (p=0.035) in electro-magnetic stimulation than in transcutaneous NMES. When the mean VAS scores at the same grade of contraction were compared, the VAS scores of electro-magnetic were lower than transcutaneous NMES in both gluteus medius (3.92+/-1.79 vs. 5.35+/-2.98, p=0.033) and minimus (4.12+/-1.85 vs. 5.69+/-3.00, p=0.046). CONCLUSION: Electro-magnetic stimulation induced the contraction of gluteus medius and minimus muscles with less pain than electrical stimulation for the same amount of muscle contraction. These results suggest that electro-magnetic stimulation can replace transcutaneous NMES in deep, large muscles such as gluteal muscles.
Buttocks ; Contracts ; Electric Stimulation ; Humans ; Male ; Muscle Contraction ; Muscles

PURPOSE: The aim of this study was to compare the measurements of diameter and volume of hepatic metastases from CT images with the overall survival and tumor response, in patients with unresectable liver metastases of colorectal cancer treated with a targeted agent. MATERIALS AND METHODS: We recruited 43 patients with unresectable liver metastases of colorectal cancer, in whom targeted therapy was used as the first-line treatment. Three-dimensional quantification of the volume of hepatic metastases was performed for each patient. An independent survival analysis using the Response Evaluation Criteria in Solid Tumors guidelines was performed and compared to the volumetric measurement. Overall survival was evaluated using the Kaplan-Meier analysis and compared to the Cox proportional hazard ratios (HRs) following univariate and multivariate analyses. RESULTS: In patients classified as non-progressing and progressing by the volumetric criteria, the median overall survival time was 21 months [95% confidence interval (CI): 491.25–768.75] and 11 months (95% CI: 0–949.42), respectively (p = 0.001). Using a multivariate analysis, we found that volumetric response (HR: 3.467; p = 0.002) was a significant factor affecting the overall survival in patients with liver metastases of colorectal cancer. CONCLUSION Volumetric assessment of liver metastases could be an alternative predictor of the overall survival of patients with liver metastases of colorectal cancer treated with a targeted agent.

Dysphagia often occurs in cancer patients. The primary causes of dysphagia in cancer patients include new local dissemination of cancer cells or metastatic brain lesions, which needs to be accurately differentiated. Dermatomyositis is often associated with cancer and may manifest before or after the cancer diagnosis. Although early diagnosis and immunotherapy can improve dermatomyositis, its identification may be delayed in cancer patients due to complex comorbidities. We report a case of a 33-year-old woman with metastatic breast cancer who presented with dysphagia. The primary consideration was metastatic lesions. However, subsequent diagnosis revealed dermatomyositis.Symptoms, including facial swelling, dysarthria, and dysphagia, emerged 26 months after the cancer diagnosis. No new metastatic lesion was identified through imaging studies. A videofluoroscopic study (VFSS) revealed velopharyngeal insufficiency, reduced pharyngeal contraction, and excessive pharyngeal residue with silent aspiration. After a combination of further clinical, laboratory, and muscle biopsy findings, dermatomyositis was identified as the actual cause of dysphagia. The patient was treated with immunosuppressive and rehabilitative swallowing therapies, which improved her symptoms. This case underscores the critical importance of accurately identifying and promptly treating dysphagia in cancer patients. It particularly emphasizes the need to recognize dermatomyositis as a potential differential diagnosis in cancer patients presenting with dysphagia.

No abstract available.
Animals ; DNA* ; Mice* ; Vaccination*

BACKGROUND AND PURPOSE: To investigate the number and characteristics of patients eligible for endovascular treatment (EVT) determined using three different selection methods: clinical-core mismatch, target mismatch, and collateral status. METHODS: Using the data of consecutive patients from two prospectively maintained registries of university medical centers, the number and characteristics of patients according to the three selection methods were investigated and their correlation was analyzed. Patients with anterior circulation stroke due to occlusion of the middle cerebral and/or internal carotid artery and a National Institute of Health Stroke Scale (NIHSS) score of ≥6 points, who arrived within 8 hours or between 6 and 12 hours of symptom onset and underwent magnetic resonance imaging prior to EVT, were included. Collateral status was assessed using magnetic resonance perfusion-derived collateral flow maps. RESULTS: Three hundred thirty-five patients were investigated; the proportions of patients who were eligible and ineligible for EVT in all three selection methods were both small (n=85, 25.4%; n=54, 16.1%, respectively). The intercorrelation among the three selection methods was low (κ=0.235). The baseline NIHSS score and onset-to-selection time interval were associated with the presence of clinical-core mismatch, while the penumbra/core volume ratio and onset-to-selection time interval were related to target mismatch; none of these variables were associated with collateral status. The infarct core volume was associated with favorable profiles in all three selection methods. CONCLUSIONS: Although the application of individual selection methods resulted in favorable outcomes after EVT in clinical trials, there is a significant discrepancy in EVT eligibility depending on the selection method used.
Academic Medical Centers ; Carotid Artery, Internal ; Humans ; Magnetic Resonance Imaging ; Methods ; Prospective Studies ; Registries ; Stroke

Colonoscopy is a relatively safe tool for diagnosis and treatment of colorectal disease. But colonic perforation during colonoscopy is a severe complication and sometimes becomes a life-threatening condition. It occurs with a frequency of 0.07% among patients having diagnostic colonoscopy and in up to 0.40% of patients having therapeutic colonoscopy. In these cases, surgical treatment is needed but endoscopic repair and conservative management could reduce the need for immediate operations. Endoscopic clipping has been the principal method for non-operative treatment of iatrogenic colonic perforation, but it has important limitations. One of them is that it is technically difficult to clip when the angle of approach is tangential. Here we report a case of an iatrogenic colonic perforation treated with endoscopic band ligation rather than endoscopic clipping, because of approach difficulties.
Colon ; Colonoscopy ; Humans ; Intestinal Perforation ; Ligation

OBJECTIVE: To analyze the plain chest radiographic and CT findings of superficial endobronchial lung cancer and to correlate these with the findings of histopathology. MATERIALS AND METHODS: This study involved 19 consecutive patients with pathologically proven lung cancer confined to the bronchial wall. Chest radiographs and CT scans were reviewed for the presence of parenchymal abnormalities, endobronchial nodules, bronchial obstruction, and bronchial wall thickening and stenosis. The CT and histopathologic findings were compared. RESULTS: Sixteen of the 19 patients had abnormal chest radiographic findings, while in 15 (79%), CT revealed bronchial abnormalities: an endobronchial nodule in seven, bronchial obstruction in five, and bronchial wall thickening and stenosis in three. Histopathologically, the lesions appeared as endobronchial nodules in 11 patients, irregular thickening of the bronchial wall in six, elevated mucosa in one, and carcinoma in situ in one. CONCLUSION: CT helps detect superficial endobronchial lung cancer in 79% of these patients, though there is some disagreement between the CT findings and the pathologic pattern of bronchial lesions. Although nonspecific, findings of bronchial obstruction or bronchial wall thickening and stenosis should not be overlooked, and if clinically necessary, bronchoscopy should be performed.
Carcinoma in Situ/pathology/radiography ; Carcinoma, Squamous Cell/pathology/*radiography ; Human ; Lung/pathology ; Lung Neoplasms/pathology/*radiography ; Male ; Middle Age ; Neoplasm Invasiveness ; *Tomography, X-Ray Computed

PURPOSE: The use of automatic circular staplers for gastroduodenostomy after distal gastrectomy is now widely accepted. We compared the clinical outcomes of two different methods. MATERIALS AND METHODS: Between March 2005 and February 2008, 134 patients with gastric cancer underwent distal gastrectomies. Seventy-six consecutive patients received end-to-side gastroduodenostomies (ES) between March 2005 and September 2006. The remaining 58 consecutive patients received end-to-end gastroduodenostomies (EE) between November 2006 and February 2008. We analyzed the surgical outcomes between the two groups (ES versus EE) on the basis of prospectively collected data. RESULTS: Among the clinical factors, there were no differences between the two groups. The overall complication rates were 19.7% in the ES group and 13.8% in the EE group (P=0.489). With respect to anastomosis-related complications, 2 cases had bleeding and 2 cases had stenoses in the ES group, while 2 cases in the EE group had bleeding. Re-operation was needed in the case of intraluminal bleeding in the ES group. There were no mortalities in our study. CONCLUSION: The two methods for gastroduodenostomy were safe and technically feasible. Although there was no statistical difference in the overall complications, including anastomosis-related complications, we demonstrated better outcomes with respect to anastomotic stenosis in the EE group.
Constriction, Pathologic ; Gastrectomy ; Hemorrhage ; Humans ; Prospective Studies ; Stomach Neoplasms