BACKGROUND: Serious pulmonary complications after lung surgery increase morbidity and mortality in perioperative period. Ketamine hydrochloride produces strong analgesic effect in spite of the psychomimetic effects. Intravenous anesthesia with ketamine was performed in lung surgery of patients with decreased pulmonary function and compared with inhalation anesthesia with enflurane. METHODS: Sixty patients, scheduled for elective lung surgery, were randomly assigned to two groups. Patients received either enflurane (Group 1, n=30) or ketamine (Group 2, n=30) as main anesthetic drug. Blood pressure and heart rate were compared in preinduction, postinduction, postintubation, postincision, intraoperative period (30 minutes, 60 minutes) and recovery room between groups, and in each group. Arterial blood gas analysis was compared in preoperative period, intraoperative period and recovery room between groups. Postoperative psychological complications evaluated in group 2. RESULTS: Blood pressure and heart rate were significantly different in postinduction, postintubation and recovery room between groups. PaO2 in group 2 was higher than in group 1 during intraoperative period and recovery room. Postoperative psychological complications occured in 4 patients (13%) in group 2. CONCLUSIONS: Ketamine affords advantage over enflurane anesthesia in terms of PaO2 during intraoperative period and recovery room in lung surgery of patients with decreased pulmonary function.
Anesthesia ; Anesthesia, Inhalation* ; Anesthesia, Intravenous* ; Blood Gas Analysis ; Blood Pressure ; Enflurane* ; Heart Rate ; Humans ; Inhalation* ; Intraoperative Period ; Ketamine* ; Lung* ; Mortality ; Perioperative Period ; Preoperative Period ; Recovery Room

No Abstract Available.
Humans ; Kidney Failure, Chronic* ; Rupture* ; Tendons*

BACKGROUND: A medulloblastoma is a primitive neuroepithelial tumor of the cerebellum that occurs in children and metastasizes through the cerebrospinal fluid. It is highly malignant and invasive, and the 5-year survival rate is only 60%. Surgical resection techniques, radiation, and chemotherapy have improved the overall survival but the patients suffer life-long cognitive dysfunctions or endocrine abnormalities as the side effects of treatment. Therefore it is essential to identify prognostic markers to determine the appropriate treatment strategy in order to minimize the side effects. METHODS: This study evaluated the immunohistochemical differentiation and survival rate with synaptophysin, glial fibrillary acidic protein, epithelial membrane antigen, vimentin and primitive neuroepithelial marker nestin of 55 paraffin-embedded medulloblastomas, using a tissue microarray. The expression of survivin, the apoptotic inhibitor, and the survival rate with regard to the proliferation index of Ki-67 were also investigated. RESULTS: The group testing positive to vimentin, a mesenchymal differentiation marker, had a worse prognosis and there was a strong correlation between vimentin expression and nestin expression. Patients with a survivin expression rate >35% had a significantly poorer clinical course and there was a correlation between the survivin expression rate and Ki-67 expression rate. CONCLUSION: In conclusion, vimentin and survivin are negative prognostic markers in medulloblastomas.
Cerebellum ; Cerebrospinal Fluid ; Child ; Drug Therapy ; Glial Fibrillary Acidic Protein ; Humans ; Medulloblastoma* ; Mucin-1 ; Nestin ; Neuroectodermal Tumors, Primitive ; Prognosis ; Survival Rate ; Synaptophysin ; Vimentin*

PURPOSE: The replacement of functional genes into cells that lack genes or mutant genes is the basis of gene therapy. In cancer, where cells often have multiple genetic defects, the replacement of critical genes may suffice to suppress cell growth or induce cell death. In malignant brain tumors, p53 mutation are among the most frequently observed genetic findings and inactivation p53 suggests that p53 plays a critical role in carcinogenesis and tumor progression. Therefore, we study the successful transfer of the wild-type p53 gene using a replicative deficient adenovirus vector into human glioma and medulloblastoma c~ell lines. Meterials and Methods: The human glioma cell line T-98G, U-87MG, U-373MG were used. To determine the efficiency of the adenovirus vector, cell lines were transfected with the Ad-p gal and analysed with X-Gal staining. Cell viability was determined by trypan blue exclusion every day after infection and Westem blot analysis was used to conform the expression of the exogenous p53 protein. RESULTS: Cell growth of the Ad-CMV-p53 infected U-373MG, and U-87MG was significantly suppressed. It appeared that exogenous p53 protein expression had an earlier ad more profound suppressive effect on U-373MG having a mutated p53 gene than on U-87MG having a wild-type p53. The expression of the exogenous p53 was more than 10 times higher than the expression of the endogenous p53. To examine the decreased viability, U-373MG was stained with Hochest 33258 and detected nuclear condensation and apoptic body. Staining results suggest that cells undergo apoptosis. CONCLUSION: The replicative deficient adenoviral vector can transfer and express p53 in human glioma cell lines in vitro, restoring wild-type p53 tumor suppressor functions. The restoration of normal p53-encoded protein in the mutant ceil lines induced cell death. The high expression of the newly transduced protein had different effects on the growth rate of the infected cell lines depending on the p53 status of the cells.
Adenoviridae* ; Apoptosis ; Brain Neoplasms ; Carcinogenesis ; Cell Death ; Cell Line* ; Cell Survival ; Genes, p53 ; Genetic Therapy ; Glioma* ; Humans ; Medulloblastoma ; Trypan Blue

No abstract available.
Child* ; Edema* ; Gallbladder* ; Humans

Background: Brain MRI may unexpectedly display abnormalities in splenium of the corpus callosum (SCC). However, the clinical implications of this lesion are unclear and are not always consistent with ischemic infarctions. We performed this study to clarify the clinical and radiological implications in patients with SCC lesions. Methods: We retrospectively reviewed consecutive patients with MRIreported SCC changes between 2009 and 2012. We analyzed clinical and radiological findings, etiologies, cognitive impairment, and clinical outcomes. Results: We found 30 patients (16 females; mean 50.5 years) who had SCC lesions on MRI. Confusion was the most common clinical finding in 50% of cases. Cerebral infarction was the most common etiology (50%). The most consistent SCC changes on MRI were low signal in T1WI, high signal on T2WI and FLAIR, and high signal on DWI. We classified SCC lesions into in situ SCC lesions (SCC only) and multiple (SCC plus) lesions for patients with multiple lesions. The clinical symptoms of SCC only lesions were relatively mild. Cognitive functions were evaluated by Mini Mental State Examination (MMSE) and clinical dementia rating (CDR) scale at the time of discharge and patients with SCC only lesions showed less impaired cognition compared with those with SCC plus lesions. Clinical outcomes were evaluated by the modified Rankin scale at 1 month and patients with SCC only lesions revealed good clinical outcomes compared with those with SCC plus lesions. Conclusions: MRI-reported SCC lesions may have heterogeneous etiologies and present with various symptoms. The clinical course and outcome are relatively good, particularly in small isolated and oval shaped SCC lesions.

Background & Objective: Hiccups is a disabling condition of lateral medullary infarction (LMI). Unlike other symptoms of LMI, the anatomical lesions of hiccups are not well known. Few studies have evaluated the relationship between the lesional location of LMI and hiccups. We performed this study to correlate hiccups and magnetic resonance imaging (MRI)-based lesional location in pure LMI. Methods: Between January 1997 and February 2013, we identified 24 patients with pure LMI who presented with hiccups in addition to typical lateral medullary syndrome. Sixty six pure LMI patients without hiccups were included as a control group. Clinical and radiologic findings were compared between the two groups. MRI-identified lesions were classified rostrocaudally as rostral, middle and caudal, and horizontally as typical, ventral, large, lateral and dorsal. Results: The pure LMI patients with hiccups had significantly more frequent aspiration pneumonia (P = 0.001) and longer hospital stay (P = 0.03). The patients with hiccups significantly more often had dorsal rather than ventral lesion at horizontal levels (P = 0.012). But, there were no rostro-caudal differences at vertical levels (P = 0.162). Conclusions: We suggest that pure LMI associated with hiccups often locates in the dorsal medulla at horizontal correlation. This MRI-based comparative study has advanced the understanding of the neural substrate for hiccups in LMI, and indicates that hiccups become predictable when specific lesional locations in the lateral medulla are considered.

Dupuytren's contracture is characterized by a proliferative fibroplasia and contracture of the palmar fascia with resultant deformity of hand and finger. It is most common in those of Scandinavian and Celtic origin but it is very rare in the orientals. We experienced 30 hands of 21 patients from January 1985 to December 1995 in Soonchunhyang University Hospital. Among 21 patients, operative treatment was done in 28 hands of 19 patients. Partial fasciectomy was done in 24 hands and complete fasciectomy was done in 4 hands. The longitudinal straight skin incision was done in 14 cases and the transverse or Zig-Zag incision was done in 12 cases. Average follow-up period was 24 months. The results of the operative treatment were classified by Honner's classification. Excellent result was obtained in 16 cases (57%), good in 8 (29%), fair in 3 (11%), poor in 1 (3%). The complications were 5 cases as follows; recurrence 2, skin defect 1, hypoesthesia 2. In conclusion, partial fasciectomy utilizing longitudinal straight incisions overlying diseased area is suggested as one of the good method for the treatment of Dupuytren s contracture.
Classification ; Congenital Abnormalities ; Contracture ; Dupuytren Contracture* ; Fascia ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Hypesthesia ; Recurrence ; Skin

PURPOSE: This study was done to identify the effects of nurse-physician collaboration on nursing performance and organizational commitment in intensive care unit (ICU) nurses. METHODS: A cross-sectional survey was used and data were collected from 203 ICU nurses working in two advanced general hospitals and two general hospitals. Data were analyzed using descriptive statistics, independent t-test, One-way ANOVA, Scheffé test, Pearson correlation coefficients and Hierarchical multiple regression with SPSSWIN 23.0 program. RESULTS: The sub-domains of nursephysician collaboration were as follows: 3.77±0.51 for sharing of patient information, 3.36±0.65 for decision-making process on the cure or care, and 3.20±0.72 for relationship between nurse and physician. Nurse-physician collaboration was significantly positively correlated with nursing performance and organizational commitment. Regression analysis showed that nurse-physician collaboration explained an additional 24.9%p of nursing performance and an additional 13.4%p of organizational commitment. 'Sharing of patient information' and 'Relationship between nurse and physician' were significant predictors of nursing performance. 'Relationship between nurse and physician' was a significant predictor of organizational commitment. CONCLUSION: These results provide evidence that the collaboration between nurses and physicians should be enhanced in terms of sharing patient information and mutual respect, to improve nursing performance and organizational commitment of ICU nurses.
Cooperative Behavior ; Critical Care ; Cross-Sectional Studies ; Hospitals, General ; Humans ; Intensive Care Units ; Nursing ; Work Performance

Osmotic myelinolysis syndrome in central nervous system is classified into central pontine myelinolysis(CPM) and extrapontine myelinolysis(EPM). The former can cause a spastic quadriplegia, pseudobulbar palsy, and varying degree of mental disorder, but the latter a movement disorder(tremor, dystonia, parkinsonism, and chorea, etc), behavior change(mood instability, personality change, agitated delirium, and disinhibition, etc), and cognitive dysfunction. Although a few cases of asymptomatic CPM have been reported, asymptomatic EPM were rare. A 67-year-old woman with diabetes mellitus and old cerebral infarction has suffered from the common bile duct stone. She had hyponatremia(Na=126mEq/L) on admission and was corrected rapidly. Incidental findings of her brain MRI showed EPM. We experienced a case of bilateral middle cerebellar peduncle myelinolysis incidentally without neurological presentations and report a rare case of asymptomatic EPM recoverd in diabetic woman after rapid correction of hyponatremia.
Aged ; Brain ; Central Nervous System ; Cerebral Infarction ; Chorea ; Common Bile Duct ; Delirium ; Diabetes Mellitus ; Dihydroergotamine ; Dystonia ; Female ; Humans ; Hyponatremia ; Incidental Findings ; Magnetic Resonance Imaging ; Mental Disorders ; Myelinolysis, Central Pontine* ; Parkinsonian Disorders ; Pseudobulbar Palsy ; Quadriplegia