BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

OBJECTIVE: This study was conducted to identify differences between people with narcolepsy and the normal control of delta and theta activity using electroencephalogram (EEG) spectrum analysis of nocturnal polysomnography (PSG). METHODS: Seven narcolepsy patients and seven age-sex matched normal controls underwent PSG and multiple sleep latency tests. Participants' non-rapid eye movement (NREM) sleep EEGs in PSG was analyzed using a Fast Fourier Transform technique. RESULTS: While NREM delta activity of people with narcolepsy declined during the first three periods of NREM, there was no change during the 4th period of NREM. The increase in NREM theta activity also lasted until the 3rd period of NREM but did not occur during the 4th period of NREM. In comparing sleep parameters, REM sleep latency in the narcolepsy group was significantly shorter than in controls. CONCLUSION: These results suggest that people with narcolepsy are likely to have a delta and theta activity-related sleep disturbance mechanism in NREM sleep.
Electroencephalography ; Eye Movements ; Fourier Analysis ; Humans ; Narcolepsy* ; Polysomnography* ; Sleep, REM ; Spectrum Analysis

No abstract available.
Azithromycin* ; Pregnancy* ; Scrub Typhus*

Many agents for the treatment of osteoporosis are broadly classified as inhibitors of bone resorption and stimulators of bone formation. Many pharmacological derivatives of bisphosphonates are used in the treatment of osteoporosis by inhibiting osteoclast-mediated bone resorption. Although the pamidronate, derivative of bisphosphonates, has a potent antiresorptive activity, there are only a low reports about prevention and treatment of postmenopausal osteoporosis using it. The purpose of this study is to evaluate the changes of bone metabolism and bone mass after pamidronate administration during the early period of estrogen deficiency. Ninty-five Sprague-Dawley rats (weight 233-243 g) were divided into 3 groups. Group 1(n=28) was performed sham operation. Group 2 (n=25) was both ovariectomized and intravenously injected with 0.5 cc normal saline. Group 3 (n=42) was both ovariectomized and intravenously injected with 0.1 mg/kg pamidronate. During the first 8 weeks normal saline or pamidronate was intravenously injected twice a week(q 3 day or q 4 days). After 4 weeks of observation without injection the experiental animals were sacrificed at postoperative 12 weeks. There were statistically significant decrease in the body weight and the weight of uterus in group 1 compared with group 2, 3. There was statistically significant decrease in the bone mass of the spine, proximal femur, proximal tibia in the group 2 compared with group 1, 3. The difference of bone mass between group 1 and 3 was statistically insignificant. Serum osteocalcin and PICP concentration were significantly increased in group 2 and 3 compared with group 1. But there was no statistical significance between group 2 and 3 in serum osteocalcin and PICP concentration. Serum ICTP concentration was significantly decreased in group 1 and 3 compared with group 2, but the difference between group 1 and 3 was insignificant. These results suggests that the administration of the pamidronate during the early period of estrogen deficiency can inhibit bone resorption and prevent trabecular bone loss of the spine, proximal femur and proximal tibia metabolically.
Animals ; Body Weight ; Bone Resorption ; Diphosphonates ; Estrogens ; Female ; Femur ; Humans ; Metabolism ; Osteocalcin ; Osteogenesis ; Osteoporosis* ; Osteoporosis, Postmenopausal ; Ovariectomy ; Rats* ; Rats, Sprague-Dawley ; Spine ; Tibia ; Uterus

No abstract available.
Cesarean Section* ; Female ; Pregnancy

The transesophageal echocardiography (TEE) has been used for the assessment of right and left ventricular function, valvular structure and function, regional wall motion abnormalities and localization of intravascular catheters, cannular and prosthesis. We inserted the pulmonary artery catheter (PAC) under the guidance of intraoperative TEE because of the difficulty of placing PAC with the pressure tracing method in two patients. The PAC was inserted from right atrium to right ventricle with the basal four chamber view and advanced to pulmonary artery through pulmonary valve with the longitudinal view of TEE. We observed typical pulmonary arterial wave form to confirm the correct position. We suggest that the TEE can be used for successful placement of a PAC to facilitate manipulation of the catheter as an alternative method in the patients whose PAC can not be positioned with the pressure tracing method.
Catheters* ; Echocardiography, Transesophageal* ; Heart Atria ; Heart Ventricles ; Humans ; Prostheses and Implants ; Pulmonary Artery* ; Pulmonary Valve ; Ventricular Function, Left

Spinal intradural cysticercosis is a rare manifestation of neurocysticercosis. We report a unique patient who showed visual symptoms and normal imaging of the brain caused by isolated spinal neurocysticercosis. A 59-year-old male patient was admitted to the emergency unit with a history of severe headache and progressive blurred vision. Brain computed tomographic scanning and magnetic resonance imaging showed normal cerebral anatomy without hydrocephalus. The fundoscopic evaluation by an ophthalmologist showed bilateral papilledema. Perimetry studies revealed visual field defects in both eyes. With the diagnosis of pseudotumor cerebri, a lumbar tap was attempted; however, we could not drain the cerebrospinal fluid in spite of appropriate attempts. Lumbar magnetic resonance imaging revealed multilevel intraspinal lesions that were confirmed histologically to be neurocysticercosis. An intraoperative lumbar puncture revealed an increased opening pressure and cytochemical analysis showed elevated cerebrospinal fluid protein level. The headache resolved immediately after surgery. However, the visual symptoms remained and recovered only marginally despite antihelminthic medications after six months of operation.
Brain ; Cysticercosis ; Emergencies ; Eye ; Headache ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurocysticercosis ; Papilledema ; Pseudotumor Cerebri ; Spinal Puncture ; Vision, Ocular ; Visual Field Tests ; Visual Fields

OBJECTIVE: Our aim was to evaluate the accuracy of prenatal sonographic detection of fetal gastrointestinal(GI) anomalies and to present perinatal outcome of fetal GI anomalies, incidence of polyhydramnios, other malformations and chromosomal abnormalities associated with fetal GI anomalies. MATERIALS AND METHODS: Prenatal sonographic results were compared with GI anomalies found in 32 neonates during recent 8 years. 32 cases of fetal GI anomalies were divided into three groups based on the level of obstruction and complication; group 1: upper GI obstruction(4 esophageal, 5 duodenal and 8 ileojejunal atresia); group 2: lower GI obstruction(1 colonal, 9 anorectal atresia); group 3: GI obstruction with secondary complication(1 ascites, 2 meconium peritonitis, 2 meconium pseudocyst). RESULTS: The accurate prenatal sonographic detection rate of fetal GI anomalies was 70.6% in group 1 and 100% in group 3 and there was no detection in group 2. False positive diagnosis was made in 5 cases(2: esophageal atresia, 3:ileojejunal atresia), but none of them except one case of multiple cardiac anomalies confirmed by autopsy, was followed by termination of pregnancy. Polyhydramnios was significantly associated with group 1 and associated malformations with group 2. An abnormal karyotype existed in three out of 32(1 case of trisomy 18 in esophageal atresia, 2 cases of trisomy 21, each one in duodenal and anorectal atresia). Survival rate of group 1, 2, 3 were 76%, 25%, and 40% respectively. CONCLUSIONS: The upper GI anomalies were easily detected by prenatal sonographic examination and had a good prognosis. But, the lower GI anomalies were difficult to diagnose prenatally and had a poor prognosis. Therefore, further efforts to diagnose for lower GI anomalies should be performed.
Abnormal Karyotype ; Ascites ; Autopsy ; Chromosome Aberrations ; Colon ; Diagnosis ; Down Syndrome ; Esophageal Atresia ; Humans ; Incidence ; Infant, Newborn ; Meconium ; Peritonitis ; Polyhydramnios ; Pregnancy ; Prognosis ; Survival Rate ; Trisomy ; Ultrasonography*

PURPOSE: To correlate the preoperative staging of gastric adenocarcinoma using two-phase spiral CT withpathologic staging. MATERIALS AND METHODS: One hundred and eighty patients with gastric cancers confirmed duringsurgery underwent two-phase spiral CT, and were evaluated retrospectively. CT scans were obtained in the proneposition after ingestion of water. Scans were performed 35 and 80 seconds after the start of infusion of 120mL ofnon-ionic contrast material with the speed of 3mL/sec. Five mm collimation, 7mm/sec table feed and 5mmreconstruction interval were used. T- and N-stage were determined using spiral CT images, without knowledge of thepathologic results. Pathologic staging was later compared with CT staging. RESULTS: Pathologic T-stage was T1 in70 cases(38.9%), T2 in 33 (18.3%), T3 in 73 (40.6%), and T4 in 4 (2.2%). Type-I or IIa elevated lesions accountedfor 10 of 70 T1 cases(14.3%) and flat or depressed lesions(type IIb, IIc, or III) for 60 (85.7%). PathologicN-stage was N0 in 85 cases(47.2%), N1 in 42 (23.3%), N2 in 31 (17.2%), and N3 in 22 (12.2%). The detection rate ofearly gastric cancer using two-phase spiral CT was 100.0%(10 of 10 cases) among elevated lesions and 78.3%(47 of60 cases) among flat or depressed lesions. With regard to T-stage, there was good correlation between CT image andpathology in 86 of 180 cases (47.8%). Overstaging occurred in 23.3%(42 of 180 cases) and understaging in 28.9%(52of 180 cases). With regard to N-stage, good correlation between CT image and pathology was noted in 94 of 180cases (52.2%). The rate of understaging(31.7%, 57 of 180 cases) was higher than that of overstaging(16.1%, 29 of180 cases)(p<0.001). CONCLUSION: The detection rate of early gastric cancer using two-phase spiral CT was 81.4%,and there was no significant difference in detectability between elevated and depressed lesions. Two-phase spiralCT for determing the T- and N-stage of gastric cancer was not effective ; it was accurate in abont 50% of casesunderstaging tended to occur.
Adenocarcinoma* ; Eating ; Humans ; Pathology ; Retrospective Studies ; Stomach Neoplasms ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Water

The treatment of a long segment stricture of the upper ureter, destroyed pelvis and ureteropelvic junction obstruction with intrarenal pelvis presents a difficult surgical question. A small isolated segment of the ileum was interposed between the lower pole calyx of the kidney and the ureter. This procedure takes advantage of the presence of normal and nonrefluxing ureterovesical junctions, and serves to diminish any potential problems of electrolyte imbalance and restricture of the ileal ureter. Here, a case of calycoileoureterostomy in a 32-year-old man, with an intrarenal pelvis and a severe ureteropelvic junction obstruction following pyelolithotomy, is described.
Adult ; Constriction, Pathologic* ; Humans ; Ileum ; Kidney ; Pelvis ; Ureter