BACKGROUND: From our clinical experiences, there are some problems with a paratracheal stellate ganglion block at the 6th cervical level e.g. small changes in blood flow to the upper extremities and more difficulty in differentiating sympathetically-maintained pain from neuropathic pain. This study compared the effectiveness of the classic injection technique and the modified injection technique in paratracheal stellate ganglion block at the 6th cervical level. METHODS: Forty patients were randomly divided into 2 groups. In Group I, the patients underwent a paratracheal stellate ganglion block at the 6th cervical level with 1% mepivacaine 6 ml using the classic injection technique. In Group II, the patients underwent a paratracheal stellate ganglion block at the 6th cervical level with 1% mepivacaine 6 ml using the modified injection technique by applying strong pressure to the cephalad portion of the needle entry point. The skin temperature of the first finger was measured before and after the stellate ganglion block, and the warm sensation on the face and upper extremities, hoarseness and upper extremity paralysis were examined. RESULTS: The increase in skin temperature of the first finger after the procedure was 0.26 +/- 0.22 degrees C in Group I and 0.84 +/- 0.63 degrees C in Group II, which was statistically significant (P < 0.05). There were no significant differences in the warm sensation on the face and upper extremities, hoarseness and upper extremity paralysis between the two groups. CONCLUSIONS: The modified injection technique is more effective in the sympathetic block on the upper extremities than the classic injection technique.
Fingers ; Hoarseness ; Humans ; Mepivacaine ; Needles ; Neuralgia ; Paralysis ; Sensation ; Skin Temperature ; Stellate Ganglion* ; Upper Extremity*

Mesenchymal stem cells are classified as multipotent stem cells, due to their capability to transdifferentiate into various lineages that develop from mesoderm. Their popular appeal as cell-based therapy was initially based on the idea of their ability to restore tissue because of their differentiation potential in vitro; however, the lack of evidence of their differentiation to target cells in vivo led researchers to focus on their secreted trophic factors and their role as potential powerhouses on regulation of factors under different immunological environments and recover homeostasis. To date there are more than 800 clinical trials on humans related to MSCs as therapy, not to mention that in animals is actively being applied as therapeutic resource, though it has not been officially approved as one. But just as how results from clinical trials are important, so is to reveal the biological mechanisms involved on how these cells exert their healing properties to further enhance the application of MSCs on potential patients. In this review, we describe characteristics of MSCs, evaluate their benefits as tissue regenerative therapy and combination therapy, as well as their immunological properties, activation of MSCs that dictate their secreted factors, interactions with other immune cells, such as T cells and possible mechanisms and pathways involved in these interactions.
Animals ; Dinoprostone ; Homeostasis ; Humans ; Immunomodulation* ; In Vitro Techniques ; Mesenchymal Stromal Cells* ; Mesoderm ; Multipotent Stem Cells ; Regeneration* ; Regenerative Medicine ; T-Lymphocytes ; Toll-Like Receptors

Caudal pulmonary artery diameter (CPAD) to body surface area (BSA) ratios were measured in ventrodorsal thoracic radiographs to assess the correlation between CPAD to BSA ratios and systolic pulmonary arterial pressure (PAP) in dogs. Thoracic radiographs of 44 dogs with systolic pulmonary arterial hypertension (PAH) and 55 normal dogs were evaluated. Systolic PAP was estimated by Doppler echocardiography. CPADs were measured at their largest point at the level of tracheal bifurcation on ventrodorsal radiographs. Both right and left CPAD to BSA ratios were significantly higher in the PAH group than in the normal group (p < 0.0001). Linear regression analysis showed positive associations between PAP and right and left CPAD to BSA ratio (right, p = 0.0230; left, p = 0.0012). The receiver operating characteristic curve analysis revealed that the CPAD to BSA ratio had moderate diagnostic accuracy for detecting PAH. The operating point, sensitivity, specificity, and area under the curve were 28.35, 81.40%, 81.82%, and 0.870; respectively, for the right side and 26.92, 80.00%, 66.67%, and 0.822, respectively, for the left. The significant correlation of CPAD to BSA ratio with echocardiography-estimated systolic PAP supports its use in identifying PAH on survey thoracic radiographs in dogs.
Animals ; Arterial Pressure* ; Body Surface Area* ; Dogs* ; Echocardiography ; Echocardiography, Doppler ; Hypertension ; Hypertension, Pulmonary ; Linear Models ; Pulmonary Artery* ; ROC Curve ; Sensitivity and Specificity

BACKGROUND: In this prospective, randomized, double-blind, placebo-controlled trial, we tried to find out appropriate amounts of single-dose dexmedetomidine to prolong the duration of spinal anesthesia in a clinical setting. METHODS: Sixty patients who were scheduled for unilateral lower limb surgery under spinal anesthesia were randomized into three groups receiving normal saline (control group, n = 20) or 0.5 or 1.0 ug/kg dexmedetomidine (D-0.5 group, n = 20; D-1, n = 20) intravenously prior to spinal anesthesia with 12 mg of bupivacaine. The two-dermatome pinprick sensory regression time, duration of the motor block, Ramsay sedation score (RSS), and side effects of dexmedetomidine were assessed. RESULTS: The two-dermatome pinprick sensory regression time (57.6 +/- 23.2 vs 86.5 +/- 24.3 vs 92.5 +/- 30.7, P = 0.0002) and duration of the motor block (98.8 +/- 34.1 vs 132.9 +/- 43.4 vs 130.4 +/- 50.4, P = 0.0261) were significantly increased in the D-0.5 and D-1 groups than in the control group. The RSS were significantly higher in the D-0.5 and D-1 groups than in the control group. However, there were no patients with oxygen desaturation in dexmedetomidine groups. The incidences of hypotension and bradycardia showed no differences among the three groups. CONCLUSIONS: Both 0.5 and 1.0 ug/kg of dexmedetomidine administered as isolated boluses in the absence of maintenance infusions prolonged the duration of spinal anesthesia.
Anesthesia, Spinal* ; Bradycardia ; Bupivacaine ; Dexmedetomidine* ; Humans ; Hypotension ; Incidence ; Lower Extremity ; Oxygen ; Prospective Studies

BACKGROUND: In this prospective, randomized, double-blind, placebo-controlled trial, we tried to find out appropriate amounts of single-dose dexmedetomidine to prolong the duration of spinal anesthesia in a clinical setting. METHODS: Sixty patients who were scheduled for unilateral lower limb surgery under spinal anesthesia were randomized into three groups receiving normal saline (control group, n = 20) or 0.5 or 1.0 ug/kg dexmedetomidine (D-0.5 group, n = 20; D-1, n = 20) intravenously prior to spinal anesthesia with 12 mg of bupivacaine. The two-dermatome pinprick sensory regression time, duration of the motor block, Ramsay sedation score (RSS), and side effects of dexmedetomidine were assessed. RESULTS: The two-dermatome pinprick sensory regression time (57.6 +/- 23.2 vs 86.5 +/- 24.3 vs 92.5 +/- 30.7, P = 0.0002) and duration of the motor block (98.8 +/- 34.1 vs 132.9 +/- 43.4 vs 130.4 +/- 50.4, P = 0.0261) were significantly increased in the D-0.5 and D-1 groups than in the control group. The RSS were significantly higher in the D-0.5 and D-1 groups than in the control group. However, there were no patients with oxygen desaturation in dexmedetomidine groups. The incidences of hypotension and bradycardia showed no differences among the three groups. CONCLUSIONS: Both 0.5 and 1.0 ug/kg of dexmedetomidine administered as isolated boluses in the absence of maintenance infusions prolonged the duration of spinal anesthesia.
Anesthesia, Spinal* ; Bradycardia ; Bupivacaine ; Dexmedetomidine* ; Humans ; Hypotension ; Incidence ; Lower Extremity ; Oxygen ; Prospective Studies

BACKGROUND/AIMS: The clinical usefulness of nasogastric tube insertion in poisoning patients is controversial. This study compared the incidence of aspiration pneumonia between patients with or without nasogastric tubes. METHODS: We retrospectively reviewed the clinical reports of poisoning patients seen from January 2006 to December 2007. We classified the patients into groups with and without nasogastric tube insertion and evaluated the incidence and risk factors of aspiration pneumonia. RESULTS: Ultimately, 63 patients were included. The incidence of aspiration pneumonia was higher in patients with nasogastric tube insertion than in patients without nasogastric tube insertion (conscious patients: 58.8% vs. 11.8%, p=0.010; unconscious patients: 72.2% vs. 27.3%, p=0.027). Nasogastric tube insertion was a significant risk factor for developing aspiration pneumonia (odds ratio 3.54; 95% confidence interval 1.74~12.34). CONCLUSIONS: Nasogastric tube insertion did not prevent aspiration pneumonia, but was a risk factor. The results have implications in the development of a hypothesis about why a nasogastric tube increases the risk of aspiration pneumonia. This study has important limitations stemming mostly from other compounding factors and its retrospective design.
Charcoal ; Humans ; Incidence ; Pneumonia, Aspiration ; Retrospective Studies ; Risk Factors ; Unconscious (Psychology)

Canine hyperadrenocorticism (HAC) is one of the most common causes of general osteopenia. In this study, quantitative computed tomography (QCT) was used to compare the bone mineral densities (BMD) between 39 normal dogs and 8 dogs with HAC (6 pituitary-dependent hyperadrenocorticism [PDH]; pituitary dependent hyperadrenocorticism, 2 adrenal hyperadrenocorticism [ADH]; adrenal dependent hyperadrenocorticism) diagnosed through hormonal assay. A computed tomogaraphy scan of the 12th thoracic to 7th lumbar vertebra was performed and the region of interest was drawn in each trabecular and cortical bone. Mean Hounsfield unit values were converted to equivalent BMD with bone-density phantom by linear regression analysis. The converted mean trabecular BMDs were significantly lower than those of normal dogs. ADH dogs showed significantly lower BMDs at cortical bone than normal dogs. Mean trabecular BMDs of dogs with PDH using QCT were significantly lower than those of normal dogs, and both mean trabecular and cortical BMDs in dogs with ADH were significantly lower than those of normal dogs. Taken together, these findings indicate that QCT is useful to assess BMD in dogs with HAC.
Adrenocortical Hyperfunction* ; Animals ; Bone Density* ; Bone Diseases, Metabolic ; Dogs* ; Linear Models ; Spine

We experienced a case of enteritis mimicking acute appendicitis in Dengue fever. This is the first case report of such complication in Korea. A 36-year-old man presented with fever and abdominal pain after a trip to the Philippines. He complained of severe pain on the right iliac fossa region. Complete blood cell count showed thrombocytopenia with leucopenia. Computed tomogram (CT) of abdomen and pelvis revealed a normal appendix. Dengue fever was confirmed by IgM capture enzyme-linked immunosorbent assay against dengue virus. During the follow-up period of 4 weeks, he was recovered and platelet count gradually. We can see from this case that dengue fever may present with abdominal pain, which mimics acute appendicitis. Early recognition of dengue fever mimicking appendicitis is important to prevent unnecessary surgical intervention.
Abdomen ; Abdominal Pain ; Adult ; Appendicitis ; Appendix ; Blood Cell Count ; Dengue ; Dengue Virus ; Enteritis ; Enzyme-Linked Immunosorbent Assay ; Fever ; Follow-Up Studies ; Humans ; Immunoglobulin M ; Korea ; Pelvis ; Philippines ; Platelet Count ; Thrombocytopenia

We experienced a case of enteritis mimicking acute appendicitis in Dengue fever. This is the first case report of such complication in Korea. A 36-year-old man presented with fever and abdominal pain after a trip to the Philippines. He complained of severe pain on the right iliac fossa region. Complete blood cell count showed thrombocytopenia with leucopenia. Computed tomogram (CT) of abdomen and pelvis revealed a normal appendix. Dengue fever was confirmed by IgM capture enzyme-linked immunosorbent assay against dengue virus. During the follow-up period of 4 weeks, he was recovered and platelet count gradually. We can see from this case that dengue fever may present with abdominal pain, which mimics acute appendicitis. Early recognition of dengue fever mimicking appendicitis is important to prevent unnecessary surgical intervention.
Abdomen ; Abdominal Pain ; Adult ; Appendicitis ; Appendix ; Blood Cell Count ; Dengue ; Dengue Virus ; Enteritis ; Enzyme-Linked Immunosorbent Assay ; Fever ; Follow-Up Studies ; Humans ; Immunoglobulin M ; Korea ; Pelvis ; Philippines ; Platelet Count ; Thrombocytopenia

PURPOSE: The objective of this study was to evaluate our institutional experience with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory failure (ARF). MATERIALS AND METHODS: From January 2007 to August 2013, 31 patients with severe ARF that was due to various causes and refractory to mechanical ventilation with conventional therapy were supported with VV ECMO. A partial pressure of arterial oxygen (PaO2)/inspired fraction of oxygen (FiO2) <100 mm Hg at an FiO2 of 1.0 or a pH <7.25 due to CO2 retention were set as criteria for VV ECMO. RESULTS: Overall, 68% of patients survived among those who had received VV ECMO with a mean PaO2/FiO2 of 56.8 mm Hg. Furthermore, in trauma patients, early use of ECMO had the best outcome with a 94% survival rate. CONCLUSION: VV ECMO is an excellent, life-saving treatment option in patients suffering from acute and life-threatening respiratory failure due to various causes, especially trauma, and early use of VV ECMO therapy improved outcomes in these patients.
Acute Disease ; Adult ; Cause of Death ; *Extracorporeal Membrane Oxygenation ; Female ; Humans ; Male ; Middle Aged ; Respiratory Insufficiency/complications/*therapy ; Survival Analysis ; Treatment Outcome