No abstract available.
Carcinoma, Transitional Cell*

Lung cancer is the most common fatal malignant lesion in both sexes. Detection of the solitary pulmonary nodule is important because surgical series up to a third of solitary pulmonary nodules are bronchogenic carcinoma. Bronchioloalveolar cell carcinoma is a rare primary lung cancer and surgery is treatment of choice in brochioloalveolar cell carcinoma. We experienced a case of broschioloalveolar cell carcinoma in solitary pulmonary nodule with cavitary lesion in chest CT scan, which is an uncommon finding in brochioloalveolar cell carcinoma.
Carcinoma, Bronchogenic ; Lung Neoplasms ; Solitary Pulmonary Nodule ; Tomography, X-Ray Computed

BACKGROUND: Since the demonstration of the fact that vascular relaxation by acetylcholine(Ach) results from the release of relaxing factor from the endothelium, the identity and physiology of this endothelium-derived relaxing factor(EDRF) has been the target for many researches. EDRF has been identified as nitric oxide(NO). With the recent evidences that EDRF is an important mediator of vascular tone, there have been increasing interests in defining the role of the EDRF as a potential mediator of hypoxic pulmonary vasoconstriction. But the role of EDRF in modulating the pulmonary circulation is not compeletely clarified. To investigate the endotbelium-dependent pulmonary vasodilation and the role of EDRF during hypoxic pulmonary vasoconstriction, we studied the effects of N(G)-monornethyl-L-arginine(L-NMMA) and L-arginine on the precontracted pulmonary arterial rings of the rat in normoxia and hypoxia. METHODS: The pulmonary arteries of male Sprague Dawley(300~350g) were dissected free of surrounding tissue, and cut into rings. Rings were mounted over fine rigid wires, in organ chambers filled with 20ml of Krebs solution bubbled with 95 percent oxygen and 5 percent carbon dioxide and maintained at 37℃. Changes in isometric tension were recorded with a force transducer(FT. 03 Grass, Quincy, USA). RESULTS: 1) Precontraction of rat pulmonry artery with intact endothelium by phenylephrine(PE, 10(-6)M) was relaxed completely by acetylcholine(Ach, 10(-9) -10(-5)M) and sodium nitroprusside (SN, 10(-9) -10(-5)M), but relaxing response by Ach in rat pulmonary artery with denuded endothelium was significantly decreased. 2) L-NMMA(10-4M) pretreatment inhibited Ach(10(-9) -10(-5)M)-induced relaxation, but L-NMMA(10-4M) had no effect on relaxation induced by SN(10(-9) -10(-5)M). 3) Pretreatment of the L-arginine(10(-4)M) significantly reversed the inhibition of the Ach(10(-9) -10(-5)M)-induced relaxation caused by L-NMMA(10(-4)M). 4) Pulmonary arterial contraction by PE(10(-6)M) was stronger in hypoxia than normoxia but relaxing response by Ach(10(-9) -10(-5)M) was decreased. 5) With pretreatment of L-arginine(10(-4)M), pulmonary arterial relaxation by Ach(10(-9) -10(-5)M) in hypoxia was reversed to the level of relaxation in normoxia. CONCLUSION: It is concluded that rat pulmonary arterial relaxation by Ach is dependent on the intact endothelium and is largely mediated by NO. Acute hypoxic pulmonary vasoconstriction is related to the suppression on NO formation in the vascular endothelium.
Animals ; Anoxia ; Arginine ; Arteries ; Carbon Dioxide ; Endothelium ; Endothelium, Vascular ; Humans ; Male ; Nitric Oxide* ; Nitroprusside ; omega-N-Methylarginine ; Oxygen ; Physiology ; Poaceae ; Pulmonary Artery ; Pulmonary Circulation ; Rats* ; Relaxation* ; Vasoconstriction* ; Vasodilation

OBJECTIVE: The purpose of this study was to investigate the relationship between menarche and cervical vertebral maturation. METHODS: Lateral cephalograms of 67 young korean girls within the range of 1 year before or after their menarche were gathered. The concavity of the cervical vertebrae base and the ratio of the base length to the 3rd and 4th cervical vertebrae anterior height were measured and analyzed. RESULTS: The mean measured values were as follows; concavity of the 3rd cervical vertebrae base: 1.27 (+/- 0.18) mm, concavity of the 4th cervical vertebrae base: 1.06 (+/- 0.15) mm, ratio of the base length to the 3rd cervical vertebrae anterior height: 0.73 (+/- 0.06) and ratio of the base length to the 4th cervical vertebrae anterior height: 0.70 (+/- 0.05). There was a significant increase in the ratio of the base length to the 3rd vertebrae anterior height and the base concavity of the 3rd and 4th cervical vertebrae during the period of 1 year before to 1 year after their menarche. CONCLUSIONS: These characteristics of the 3rd and 4th cervical vertebrae on the lateral cephalogram can provide useful clues on evaluating the growth stage.
Cervical Vertebrae ; Female ; Menarche ; Spine

PURPOSE: Personal protection equipment (PPE) is compulsory for the safety of physicians and patients in the presence of biological hazards. In particular, such equipment is required for airway management of patients with highly contagious respiratory diseases. However, there are only a few studies about the effect of PPE on airway management with various advanced airway devices including the newly developed video-laryngoscope. We conducted a study on the effect of PPE level C on airway management with five different types of advanced airway devices including the laryngeal mask airway (LMA), direct laryngoscope (DL), airwayscope (AWS), video-laryngoscope made by Stortz (DCI), and the Levitanscope (LE). METHODS: Twenty-two emergency physician and residents in two emergency centers were trained to do trials with PPE and without PPE while performing airway management with five different airway devices. The procedures were done on two types of manikins. We compared the time from the start of the procedure to the first successful ventilation for each device and for each type of manikin. A short questionnaire was used to examine participants' subjective experiences. RESULTS: For both types of manikin, there were no significant differences in performance time between the group not wearing PPE and the PPE wearing group for any device. However, when compared with the other devices, the performance time for the LMA was faster than the other devices, and the Levitanscope(R) took a significantly longer time in both groups. According to the questionnaires, the most comfortable & uncomfortable airway devices were the LMA and the Levitanscope(R). CONCLUSION: When PPE level C was compared with the no protection state, there were no significant statistical time differences for performing advanced airway management with any particular airway device.
Airway Management ; Biohazard Release ; Emergencies ; Humans ; Laryngeal Masks ; Laryngoscopes ; Manikins ; Protective Clothing ; Surveys and Questionnaires ; Ventilation

A 73-year-old woman presented to the emergency department with submandibular pain and swelling. The patient was diagnosed to have Ludwig's angina, and she was planned to undergo urgent incision and drainage under general anesthesia. However, her physical examination revealed severe diffuse swelling extending from the bilateral submandibular spaces to the submental space and further down to the neck. As our view was blocked by the patient's neck swelling, we did not perform a regional anesthesia of the airway or a transtracheal block. Several non-invasive alternatives were considered. The “spray-as-you-go” technique was chosen, and it was performed using the OptiScope®. However, the OptiScope did not have a working channel or syringe adaptor for the administration of the local anesthetic solution. To solve this problem, we combined the OptiScope with a 27-G tunneled epidural catheter (100 cm) for the administration of lidocaine and this combination made the awake intubation successful.
Aged ; Anesthesia, Conduction ; Anesthesia, General ; Catheters* ; Drainage ; Emergency Service, Hospital ; Female ; Humans ; Intubation* ; Lidocaine ; Ludwig's Angina* ; Neck ; Physical Examination ; Syringes

BACKGROUND: Surveillance of surgical site infection is a main component of nosocomial infection surveillance. To perform a valid comparison of rates among hospitals, among surgeons, across time, surgical site infection rates must account for the variation in patient's underlying severity of illness and other important risk factors. So, a risk index was developed to predict a surgical patient's risk of acquiring a surgical site infection. The risk index score, ranging from 0 to 3, was the number of risk factors present among the following: (1) a patient with an American Society of Anesthesiologists preoperative assessment score of 3,4,5, (2) an operation classified as contaminated or dirty-infected, and (3) an operation lasting over T hours, where T depends upon the operative procedure being performed. METHOD: We performed surgical site infection surveillance according to patient risk index after cardiovascular surgery from Mar 1, 1997 to May 31, 1997. In addition, we also monitored nosocomial infection of all patients after cardiovascular surgery Data was collected prospectively, Surgical site infection rate was classified according to patient risk index and compared with NNIS (National Nosocomial Infections Surveillance) semiannual report of 1995. RESULT: Overall nosocomial infection rate was 18.9% and among all patients detected by surveillance protocols, pneumonia was the most common (6.3%) nosocomial infection after cardiovascular surgery, and the remaining infections were distributed as follows: surgical site infection 45%, urinary tract infection 3.2%, bloodstream infection 3.2%. Surgical site infection rate for patient with scores of 0, 1, 2 and 3 were 0%, 3.1%, 4.6%, 66,7%, respectively and increased according to patient risk index (P<0.05). There is no statistical difference between our surgical site infection rate and 1995 NNIS semiannual report of surgical site infection rates (P>0.05). CONCLUSION: The patient risk index is a better predictor d surgical site infection risk than the traditional wound classification system and surgical site infection surveillance with patient risk index is useful for nosocomial infection surveillance after surgery.
Classification ; Cross Infection ; Humans ; Operative Time ; Pneumonia ; Prospective Studies ; Risk Factors ; Surgical Procedures, Operative ; Urinary Tract Infections ; Wounds and Injuries

OBJECTIVE: Our study aimed to measure inter-rater and test-retest reliability, concurrent and convergent validity, and factor solutions of the Korean version of the Clinical Language Disorder Rating Scale (CLANG). METHODS: The Korean version of the CLANG for assessing thought, language, and communication, the Brief Psychiatric Rating Scale, Young Mania Rating Scale, and Calgary Depression Scale for Schizophrenia were used to evaluate language disorder, formal thought disorder, positive and negative symptoms, manic symptoms, and depressive symptoms, respectively, in 167 hospitalized patients with schizophrenia. The factor solution was obtained by the direct oblimin method. A receiver operating characteristic curve was used to find the optimal cut-off score for discriminating schizophrenia patients with and without disorganized speech. RESULTS: Inter-rater reliability was considered moderate (intraclass coefficient=0.67, F=3.30, p=0.04), and test-retest reliability was considered high (r=0.94, p<0.001). Five factors, namely, pragmatics, disclosure, production, prosody, and association, were identified. An optimal cut-off score of 7 points with 84.5% sensitivity and 81.7% specificity was proposed for distinguishing schizophrenia patients with and without disorganized speech. CONCLUSION: Our findings suggest that the Korean version of the CLANG is a promising tool for evaluating language disorder in patients with schizophrenia.
Bipolar Disorder ; Brief Psychiatric Rating Scale ; Depression ; Disclosure ; Humans ; Language Disorders* ; Psychometrics* ; ROC Curve ; Schizophrenia ; Sensitivity and Specificity

No abstract available.
Pleura* ; Rhabdomyosarcoma*

The incidence of traumatic rupture of the tracheobronchial tree has been increased considerably with advent of widespread mechanization and high speed era. Rupture of the bronchus is an unusual result of nonpenetrating trauma to chest. Early diagnosis and primary repair not only restore normal lung function but also avoid difficulties and complications associated with delayed diagnosis and repair. These complications are pneumonia, atelectasis and lung abscess secondary to the bronchial obtruction. We experienced a case of partial rupture on left main bronchus caused by nonpenetrating blunt chest trauma with rib fractures 1 year ago. He was suffered from progressively developing dyspnea on exercise and treated as bronchial asthma at other hospital. Bronchoscopic finding was the narrowed lumen of left main bronchus at 1cm from carina by web-like membrane. We confirmed by bronchogram and repaired by end to end anastomosis, which is rare delayed finding in bronchial rupture without pulmonary complications. We report a case of nonpenetrating traumatic bronchial rupture, manifested by bronchial web in bronchoscopy.
Asthma ; Bronchi ; Bronchoscopy* ; Delayed Diagnosis ; Dyspnea ; Early Diagnosis ; Incidence ; Lung ; Lung Abscess ; Membranes ; Pneumonia ; Pulmonary Atelectasis ; Rib Fractures ; Rupture* ; Thorax* ; Trees