The mechanism of forward blood flow during closed chest cardiac massage remains controversial. Two theories have been suggested: the cardiac pump theory and the thoracic pump theory. Case report is presented to illustrate the use of transesophageal echocardiography during cardiopulmonary resuscitation. The findings included right and left ventricular compression, closure of the mitral valve during compression, opening of the mitral valve during the release phase, and atrioventricular regurgitation during compression, indicating a positive ventricular-to-atrial pressure gradient. These findings suggest that direct cardiac compression was the predominant mechanism of forward blood flow during cardiopulmonary resuscitation in this patient. Transesophageal echocardiography offers a new approach for study of the flows and cardiac morphologic features during chest compressions in humans. An understanding of the actual mechanisms involved is necessary if improved cardiopulmonary resuscitative techniques are to be rationally developed for enhancing the outcome of resuscitation.
Cardiopulmonary Resuscitation ; Echocardiography* ; Echocardiography, Transesophageal ; Heart Massage* ; Humans ; Mitral Valve ; Resuscitation ; Thorax*

Anetoderma is loose and wrinkled skin lesions that show the characteristic histopathological feature of focal loss of elastic fibers in the dermis. The primary type of anetoderma arises in clinically normal skin and the secondary type replaces the lesions of associated disorders including various infections, infiammatory diseases and tumors. However, anetoderma due to pilomatricoma is very rare. Our patient, a 21-year-old female, presented with a soft and wrinkled skin overlying a firm, pedunculated tumor on her left upper arm. The histopathological examination showed anetodermic cutaneous changes which were associated with the underlying pilomatricoma.
Anetoderma* ; Arm ; Dermis ; Elastic Tissue ; Female ; Humans ; Pilomatrixoma* ; Skin ; Young Adult

No abstract available.
Thyroid Gland* ; Thyroid Nodule*

No abstract available.
Histiocytoma, Benign Fibrous* ; Pulmonary Sclerosing Hemangioma*

Early attempts at determining the effects of experimental ablation of the hypophysis in the mammal resulted ambiguously, for the animals usually died from attendant injury to the brain or form infection, or , if they survived, some of the effects observed often were due to injury to the adjacent regions of the brain during the operation. In 1912, Aschner performed removal of the pituitary body by a transbuccal transsphenoidal route in the dog. Smith in 1927 and 1930 reported two methods of hypophysectomy in the rat; the first one was temporal approach, in this method he exposed the pituitary and destroyed with chromic acid injection; the second one was parapharyngeal route. In 1963, Falconi and Rossi described transauricular hypophysectomy in the rat and mice. It is well known that in studying the effects of hypophysectomy removal of the pituitary must be essentially complete without injury to the adjacent regions of the brain, especially in the hypothalamus. The present study was undertaken to device a method of total hypophysectomy and observe the effects on pancreatic structure and carbohydrate metabolism. In this study twenty adult mongrel dogs, weighting from 7 to 10 kg, were used. Twelve of them were male and eight were female. Operative procedure: Under pentobarbital sodium, 30 mg/kg body weight, intravenous anesthesia the dog was placed on the operating table in prone position, and a tube was inserted in the mouth to displace the mandibular angle anterodownwardly. A vertical incision from the midline to just behind the mandibular angle was made, the temporal muscles were also incised vertically and retracted to expose the temporal bone. Following wide craniectomy down to the base of middle cranial fossa and careful opening the dura, temporal lobe was elevated with about 1cm wide brain retractor at the tip of the middle cranial fossa. Since this approach was deep and narrow, a brilliant illumination was thrown from head lamp at neat the center of the binocular magnifier. As the third cranial nerve and intracranial portion of the internal carotid artery were exposed, arachnoid membrane was torn and aspirated cerebrospinal fluid slowly to obtain wider exposure, then elevated posterior communicating artery to expose the pituitary body and stalk. The stalk was clipped and sectioned then pituitary body was removed in a piece or sucked out under direct vision, and the would was closed in layers. In all experimental dogs, pre- and postoperative fasting blood sugar was measured, and the brain and pancreas were removed and fixed in 10 % neutral formalin solution following intracarotid artery infusion of 10% neutral formalin. The removed brain was examined and the pancreas was stained with hematoxylin-eosin, Maldonado, and Toluidine blue sating methods. The following results were obtained: 1. The average preoperative fasting venous blood sugar was 98.5+/-5.4mg% in 20 mongrel dogs. 2. In five hypophysectomized dogs, their preoperative average blood sugar was 99.2+/-5.2mg% and their postoperative blood sugar was decreased in the rage from 13.0 to 35.4mg% during the period from 56 to 77 days. 3. In ten dogs who received daily intramuscular injection of 2mg dexamethasone following hypophyseetomy, their average venous blood sugar was 99.5+/-6.12mg%, and their postoperative blood sugar was decreased in the range from 9.7 to 30.5mg%. 4. In five normal dogs, the number of cells per islet varied from 14 to 96 and the average number was 45, and the average ratio of alpha, beta to delta cells was 14.2 : 79.4 : 6.4; in hypophysectomized group the average number per islet was 53 and their ratio was 19.5 : 75.1: 5.4; in the group which received dexamethasone for a week following hypophysectomy, the average number per islet was 53 and the average ratio was 14.6 : 80.5: 4.9, and in the group which received dexamethasone for two weeks, the average number per islet was 37 and the ratio was 15.2 : 80.2 : 4.5. 5. The acini in the hypophysectomized dogs were rather atrophic and illustrated mild intracytoplasmic vacuolization, and the Langerhans islet demonstrated exhausted pattern with small and degranulated beta cells. However, the Langerhans islets of hypophysectomized dogs with dexamethasone administration showed regranulated beta cells in one dog. 6. In pancreas of hypophysectomized dogs increased number of mast cells along the interstitial tissue, periductal region, and peripancreatic fat tissue were observed. There were also one or two mast cells in the islet mainly along the capsule of islets. 7. In pancreas of hypophysectomized dog with dexamethasone administration a few mast cells were observed along the lobular margin and just beneath the capsule of the islets.
Adult ; Anesthesia, Intravenous ; Animals ; Arachnoid ; Arteries ; Blood Glucose* ; Body Weight ; Brain ; Carbohydrate Metabolism ; Carotid Artery, Internal ; Cerebrospinal Fluid ; Cranial Fossa, Middle ; Dexamethasone ; Dogs* ; Fasting ; Female ; Formaldehyde ; Head ; Humans ; Hypophysectomy ; Hypothalamus ; Injections, Intramuscular ; Islets of Langerhans ; Lighting ; Male ; Mammals ; Mast Cells ; Membranes ; Mice ; Mouth ; Oculomotor Nerve ; Operating Tables ; Pancreas* ; Pentobarbital ; Pituitary Gland ; Prone Position ; Rage ; Rats ; Somatostatin-Secreting Cells ; Surgical Procedures, Operative ; Telescopes ; Temporal Bone ; Temporal Lobe ; Temporal Muscle ; Tolonium Chloride

Pulmonary edema is a recognized comphcation of acute airway obstruction. When pulmonary edema occurs, it usually follows relief of obstruction and is likely to be of noncardiogenic origin. We present a case of noncanhogenic pulmonary edema that occured in a ncy woman who was transfered to our hospital, because of endotracheal intubation failure and unrelieved bronchospasm, during general anesthesia for Cesarian section.
Airway Obstruction* ; Anesthesia, General ; Bronchial Spasm ; Female ; Humans ; Intubation, Intratracheal ; Pulmonary Edema*

BACKGROUND: The arterial to end-tidal carbon dioxide tension difference(Pa-ETCO2) can be increased in patients with congenital heart disease(CHD) and, therefore, end-tidal carbon dioxide tension(PETCO2) does not accurately approximates arterial carbon dioxide tension(PaCO2). The purpose of this study was to evaluate the stability of the Pa-ETCO2 in pediatric patients with congenital heart disease undergoing open heart surgery. METHODS: Forty three children with CHD were studied: twenty two were acyanotic and twenty one were cyanotic. Simultaneous PETCO2 and PaCO2 measurements, as well as pulse rate, blood pressure, pH and arterial oxygen tension(PaO2) were obtained for each patient during four intraoperative events: (1) after induction of anesthesia and before sternotomy, (2) after sternotomy and before cardiopulmonary bypass(CPB), (3) after weaning of CPB, and (4) after closure of sternotomy. RESULTS: The PETCO2 of cyanotic group were lower than that of acyanotic group throughout operation period, and did not change significantly after CPB. Cyanotic children demonstrated a greater Pa-ETCO2 difference before CPB as compared with acyanotic group. In acyanotic group, Pa-ETCO2 difference increased significantly after CPB(P <0.05), whereas it remained unchanged in cyanotic group. CONCLUSIONS: Since cyanotic children had higher Pa-ETCO2 differences intraoperatively and acyanotic children showed an increase in Pa-ETCO2 after CPB, the PETCO2 cannot be the alternative value to estimate reliably the PaCO2 during open heart surgery of pediatric CHD.
Anesthesia ; Blood Pressure ; Carbon Dioxide ; Child ; Heart Defects, Congenital ; Heart Diseases* ; Heart Rate ; Heart* ; Humans ; Hydrogen-Ion Concentration ; Oxygen ; Sternotomy ; Thoracic Surgery* ; Weaning

BACKGROUND: The purpose of this study was to examine the association of metabolic syndrome (MS) coronary heart disease (CHD) with socioeconomic status (SES). METHODS: The participants were 2,170 (631 men and 1,539 women), aged over 40 years who had visited for health screening from April to December in 2009. We classified them into three SES levels according to their education and income levels. MS was defined using the criteria of modified National Cholesterol Education Program Adult Treatment Panel III and CHD risk was defined using Framingham risk score (FRS) > or = 10%. RESULTS: High, middle, and low SES were 12.0%, 73.7%, and 14.3%, respectively. The prevalence of MS was 18.1%. For high, middle, and low SES, after adjusted covariates (age, drinking, smoking, and exercise), odds ratios for MS in men were 1.0, 1.41 (confidence interval [CI], 0.83 to 2.38; P > 0.05), and 1.50 (CI, 0.69 to 3.27; P > 0.05), respectively and in women were 1.0, 1.74 (CI, 1.05 to 3.18; P < 0.05), and 2.81 (CI, 1.46 to 2.43; P < 0.05), respectively. The prevalence of FRS > or = 10% was 33.5% (adjusted covariates were drinking, smoking, and exercise) and odds ratios for FRS > or = 10% in men were 1.0, 2.86 (CI, 1.35 to 6.08; P < 0.001), and 3.12 (CI, 1.94 to 5.00; P < 0.001), respectively and in women were 1.0, 3.24 (CI, 1.71 to 6.12; P < 0.001), and 8.80 (CI, 4.50 to 17.23; P < 0.001), respectively. CONCLUSION: There was an inverse relationship between SES and FRS > or = 10% risk in men, and an inverse relationship between SES and both risk of MS and FRS > or = 10% in women.
Adult ; Aged ; Cholesterol ; Coronary Disease ; Drinking ; Female ; Humans ; Male ; Mass Screening ; Odds Ratio ; Prevalence ; Smoke ; Smoking ; Social Class

PURPOSE: The purpose of this study was to examine the effect of laughter therapy on arthralgia, ankylosis, depression and sleep of elderly housebound women suffering from osteoarthritis. METHODS: The study used a nonequivalent control group pretest-posttest design. The participants were 48 elderly women: 23 in the experimental group and 25 in the control group. The experimental group received laughter therapy twice a week for 4 weeks. The results were analyzed by using chi2-test, ANCOVA, and t-test with the SPSS/WIN 21.0 program. RESULTS: The results showed that laughter therapy had a significant statistical effective in reducing arthralgia, ankylosis, and depression and improving the quality of sleep as evidenced by the differences between the two groups. CONCLUSION: The results of this study indicated that laughter therapy is an effective nursing intervention reducing arthralgia, ankylosis, and depression and improving the quality of sleep in these women. Therefore, it is necessary to develop laughter therapy as an independent nursing intervention for elderly women with osteoarthritis who are housebound.
Aged* ; Ankylosis* ; Arthralgia* ; Depression* ; Female ; Humans ; Laughter Therapy* ; Laughter* ; Nursing ; Osteoarthritis*

No abstract available.