Respiratory pump failure is a condition which the respiratory system can not meet the metabolic demand because of the inability of respiratory muscles to ventilate the lungs without any pulmonary pathology. Two cases of respiratory pump failure(myasthenia gravis and Guillian-Barre syndrome) had been treated with controlled and assisted ventilation using the Bennet MA II ventilator. Large tidal volume with high peak flow rate was given to permit leakage of gases during inspiration when the patients were ventilated with CMV with asaistance. This made the patients capable of communicating with persons by phonation which was the greatest advanage of this mode of assisted ventilation.
Gases ; Humans ; Lung ; Pathology ; Phonation ; Respiratory Muscles ; Respiratory System ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

Among various mehtods for postoperative pain management, epidural narcotics is one of the most prevalent techniques used by anesthesiologists. Although it is a highly effective analgesia, epidural morhpine has disadvantages such as delayed onset, nausea, vomiting, pruritus, urinary retension and even life-threatening respiratory depression. To search for a more effective analgesic mehtod with minimum side effects, we studied the effects of morphine, bupivacaine and a combination of each durg with different dosages in patients undergoing upper abdominal surgery. Hemodynamic changes, duration of analgesia, and side effects were compared. The results suggested that the combination of 2 mg of morphine and 0.125% of bupivacaine is the most effective method with minimum side effects for postoperative pain.
Analgesia ; Analgesia, Epidural ; Bupivacaine* ; Hemodynamics ; Humans ; Morphine* ; Narcotics ; Nausea ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Vomiting

BACKGROUND: Propofol is a widely-used intravenous anesthetic with a rapid onset, short duration of action and rapid elimination but the molecular mechanisms of action are not completely understood. Not only neurons but astrocytes are potential substrates for anesthetics, specifically for propofol. Intracellular calcium ion ([Ca2 ]i) is known to play a key role in the transduction and propagation of various chemical signals in astrocytes. METHODS: In the present study, the effects of propofol on the intracellular calcium concentration of astrocytoma cells by using a fura-2 fluorescence spectroscopy was investigated. RESULTS: In an isotonic standard solution, propofol (50 and 500microM) produced a transient increase in [Ca2 ]i while the intralipid did not change [Ca2 ]i. In several cells (20%), a transient increase in [Ca2 ]i was followed by sustained elevation which was sensitive to depletion of external calcium. A propofol-induced increase in [Ca2 ]i was not altered by an L-type calcium channel blocker (nifedipine 2microM). In cells bathed in a Ca2 -free external solution, a transient increase in [Ca2 ]i was observed. After the pretreatment of cyclopiazonic acid (CPA), an endoplasmic reticulum Ca2 -ATPase blocker, propofol 500microM did not produce any significant increase in [Ca2 ]i. Carbachol, which is known to release calcium from the inositol 1,4,5-triphosphate (IP3)-induced calcium release (IICR) stores, prevented the [Ca2 ]i increase by propofol and vice versa. High concentrations of caffeine (10 mM), which release calcium from the calcium-induced calcium release (CICR) stores, had no effect on [Ca2 ]i. CONCLUSIONS: From the above results, it is suggested that an increase in [Ca2 ]i by propofol in astrocytoma cells is mainly due to calcium release from the IICR stores.
Anesthetics ; Astrocytes ; Astrocytoma* ; Baths ; Caffeine ; Calcium Channels, L-Type ; Calcium* ; Carbachol ; Cytosol* ; Endoplasmic Reticulum ; Fura-2 ; Inositol 1,4,5-Trisphosphate ; Neurons ; Propofol* ; Spectrometry, Fluorescence

BACKGROUND: Most morphometric studies of the airway have relied on plain radiographs or CT scan with their attendant limitations. We evaluated the length from vocal cord to carina and diameter of the trachea in adults who had no abnormality of the airway using three-dimensional chest CT scan and compared with demographic data. METHODS: We performed a multiplane reconstruction of the airway using axial, sagittal, and coronal slices (aged 18-87, 100 men, 100 women). We measured that the lengths from vocal cord to carina and the diameters (AP, anteroposterior; TR, transverse) of 50 mm above carina of the trachea. RESULTS: The lengths from vocal cord to carina was 130.2 +/- 11.4 mm in men and 119.5 +/- 10.5 mm in women. The AP and TR diameters of the trachea at 50 mm above carina were men; 18.0 +/- 2.4 mm, 17.2 +/- 2.6 mm, women; 14.4 +/- 2.0 mm, 14.4 +/- 1.9 mm, respectively. The correlation between airway length and age and height was statically significant in men and women but less clinically significant. The correlation between diameter of trachea and height was only statically significant in men but less clinically significant. CONCLUSIONS: This study suggests that these measured data are helpful for the endotracheal intubation and endotracheal tube placement in airway management.
Adult ; Airway Management ; Female ; Humans ; Intubation, Intratracheal ; Male ; Thorax ; Trachea ; Vocal Cords

PURPOSE: There is much confusion surrounding the methods of RNA extraction from the middle ear mucosa of mice. In this study, we worked to develop a "melting method," which is faster, purer, and more reliable than other methods in common use. MATERIALS AND METHODS: Thirty-two ears were used for this study. Light microscopy with hematoxylin-eosin staining of the bullae, scanning electron microscopy (SEM), spectrophotometer analysis, and reverse transcription polymerase chain reaction were performed before and after melting the half lateral bullae, which were detached from the temporal bone by using a lateral retroauricular approach. RESULTS: Each resected half bulla contained a well distributed mucosal membrane. After a TRIzol melting duration of 10-30 minutes, only mucosal marker (MUC5AC) was expressed without bony marker (total osteocalcin). The same results were determined from SEM. CONCLUSION: This melting method, compared with stripping and irrigation methods, is effective and offers an easier, more robust approach to extracting RNA from the middle ear mucosal membranes of mice.
Animals ; Ear, Middle/*metabolism/pathology ; Mice ; Microscopy, Electron, Scanning ; Mucin 5AC/genetics/*metabolism ; RNA, Messenger/*genetics/metabolism ; Reverse Transcriptase Polymerase Chain Reaction/*methods ; Spectrophotometry

PURPOSE: There is much confusion surrounding the methods of RNA extraction from the middle ear mucosa of mice. In this study, we worked to develop a "melting method," which is faster, purer, and more reliable than other methods in common use. MATERIALS AND METHODS: Thirty-two ears were used for this study. Light microscopy with hematoxylin-eosin staining of the bullae, scanning electron microscopy (SEM), spectrophotometer analysis, and reverse transcription polymerase chain reaction were performed before and after melting the half lateral bullae, which were detached from the temporal bone by using a lateral retroauricular approach. RESULTS: Each resected half bulla contained a well distributed mucosal membrane. After a TRIzol melting duration of 10-30 minutes, only mucosal marker (MUC5AC) was expressed without bony marker (total osteocalcin). The same results were determined from SEM. CONCLUSION: This melting method, compared with stripping and irrigation methods, is effective and offers an easier, more robust approach to extracting RNA from the middle ear mucosal membranes of mice.
Animals ; Ear, Middle/*metabolism/pathology ; Mice ; Microscopy, Electron, Scanning ; Mucin 5AC/genetics/*metabolism ; RNA, Messenger/*genetics/metabolism ; Reverse Transcriptase Polymerase Chain Reaction/*methods ; Spectrophotometry

OBJECTIVES: Carcinomas of the external auditory canal (EAC) are rare, and management remains challenging. Previous studies seeking prognostic factors for EAC cancers included cancers other than carcinomas. In this study, we analyzed the treatment outcomes of, prognostic factors for, and survival rates associated with specifically squamous cell carcinoma (SCC) of the EAC. METHODS: A retrospective review of 26 consecutive patients diagnosed with SCCs of the EAC in a 10-year period was performed in terms of clinical presentation, stage, choice of surgical procedure, and adjunct therapy. Overall survival (OS) and recurrence-free survival (RFS) were calculated and univariate analysis of prognostic factors was performed. RESULTS: The median age of the 26 patients with SCCs of the EAC was 63 years (range, 40 to 72 years), and 16 males and 10 females were included. According to the modified University of Pittsburgh staging system, the T stages were T1 in 11, T2 in six, T3 in four, and T4 in five cases. The surgical procedures employed were wide excision in three cases, lateral temporal bone resection (LTBR) in 17, and extended LTBR in four, and subtotal temporal bone resection in two. Two patients underwent neoadjuvant chemotherapy, and two underwent adjuvant chemotherapy. One patient received preoperative radiation therapy, and eleven received postoperative radiation therapy. Of the possibly prognostic factors examined, advanced preoperative T stage and advanced overall stage were significant predictors of RFS, but not of OS. CONCLUSION: The advanced T stage and overall stage were associated with decreased survival after surgical treatment in patients with SCC of the EAC, highlighting the importance of clinical vigilance and early detection.
Carcinoma, Squamous Cell* ; Chemotherapy, Adjuvant ; Drug Therapy ; Ear Canal* ; Ear Neoplasms ; Epithelial Cells* ; Female ; Humans ; Male ; Retrospective Studies ; Survival Rate ; Temporal Bone

OBJECTIVES: Bone-anchored hearing aids (BAHA) occasionally cause soft tissue problems due to abutment. Because Sophono does not have abutment penetrating skin, it is thought that Sophono has no soft tissue problem relating to abutment. On the other hand, transcutaneous device's output is reported to be 10 to 15 dB lower than percutaneous device. Therefore, in this study, Sophono and BAHA were compared to each other from surgical and audiological points of view. METHODS: We retrospectively reviewed the medical records of 9 Sophono patients and 10 BAHA patients. In BAHA cases, single vertical incision without skin thinning technique was done. We compared Sophono to BAHA by operation time, wound healing time, postoperative complications, postoperative hearing gain after switch on, and postoperative air-bone gap. RESULTS: The mean operation time was 60 minutes for Sophono and 25 minutes for BAHA. The wound healing time was 14 days for Sophono and 28 days for BAHA. No major intraoperative complication was observed. Skin problem was not observed in the 2 devices for the follow-up period. Postoperative hearing gain of bilateral aural atresia patients was 39.4 dB for BAHA (n=4) and 25.5 dB for Sophono (n=5). However, the difference was not statistically significant. In all patients included in this study, the difference of air-bone gap between two groups was 16.6 dB at 0.5 kHz and 18.2 dB at 4 kHz. BAHA was statistically significantly better than Sophono. CONCLUSION: Considering the audiologic outcome, BAHA users were thought to have more audiologic benefit than Sophono users. However, Sophono had advantages over BAHA with abutment in cosmetic outcome. Sophono needed no daily skin maintenance and soft tissue complication due to abutment would not happen in Sophono. Therefore, a full explanation about each device is necessary before deciding implantation.
Bone Conduction ; Follow-Up Studies ; Hand ; Hearing Aids* ; Hearing Loss ; Hearing Loss, Conductive ; Hearing* ; Humans ; Intraoperative Complications ; Medical Records ; Postoperative Complications ; Retrospective Studies ; Skin ; Wound Healing

To investingate the effects of fentanyl on the renal function and the renin secretion rate(RSR), the author measured the urine volume(UV), excreted amount of urinary sodium, potassium and chloride(UNaV, UKV, and UCLV), fractional excretion of sodium(FENa), renal plasma flow(RPF), glomerular filtration rate(GFR), filtration fraction(FF) and free water clearance(CH2O) after adminis- tration of fentanyl in 53 unanesthetized white rabbits. Fentanyl was given intrarenally(0.1ug/kg/min in group I, 0.3ug/kg/min in group II, and 1.0ug/kg/ min in group III), or intravenously(0.1ug/kg/min in group IV, 1.0ug/kg/min in group V, and 0.1ug/ kg/min in after preinfusion with naloxone 0.1ug/kg/min in group VI). After administration of fentanyl, urinary and plasma osmolalities and the levels of sodium, potas-sium, chloride, paraaminohippuric acid (PAH) and creatinine were measured. Heart rate (HR) and mean arterial pressure (MAP) were also measured. The results were as follows. 1) There were no statistically significant changes in HR and MAP in all groups. 2) The levels of UV, UNaV, UKV, VCIV, RPF and CH2O decreased significantly by low dose of fentanyl, not changed by moderate dose of fentanyl and the levels of UV and CH2O increased signifi-cantly by large dose of fentany. 3) Naloxone pretreatment blocked all of the observed renal responses of low dose of fentanyl. 4) There was no statistically signficant change in renin secretion rate in all groups. From the above results, it is suggested that the fentanyl has dual effects on the renal function and may have systemic effects through opioid receptors.
Arterial Pressure ; Creatinine ; Fentanyl* ; Filtration ; Heart Rate ; Naloxone ; Osmolar Concentration ; Plasma ; Potassium ; Rabbits* ; Receptors, Opioid ; Renin ; Sodium ; Water

BACKGROUND AND OBJECTIVES: Sometimes the oral cavity functions such as swallowing and articulation may be seriously disabled after surgery despite excellent reconstruction. So, the preservation of the functions and oncologic resection of cancer in the treatment of oral tongue cancer are challenging problems for head and neck surgeon. We evaluated speech and swallowing functions in postoperative stage in the patients with oral tongue cancer to help predict the postoperative status of speech and swallowing according to the size of defect and the reconstruction methods. SUBJECTS AND METHOD: In 10 oral tongue cancer patients who had been treated by surgery as initial management, we performed speech function tests (speech intelligibility score, articulation score, predominant class of errors, diadochokinetic test, and tongue mobility test) and swallowing function tests (modified barium swallow (MBS) test, deglutition test, and swallowing ability score) and reviewed operation findings. RESULTS: In the primary repair group, the speech and swallowing function test was nearly normal, except mild mis-articulation of the lingua alveolars. In the free flap group, the speech function was intelligible despite impaired tongue mobility and mis-articulation of the lingua alveolars, the lingua palatals and the lingua velars. Impaired lateral tongue movement, marked stasis in oral cavity, delayed swallowing reflex on the MBS test resulted in decreased pharyngeal peristalsis, stasis in vallecula, incomplete laryngeal closure and elevation and aspiration. Swallowing ability was also impaired. In less over-reconstructed group (less than 200%) according to tongue defect and reconstruction volume ratio, much earlier oral diet start, seal-up and more excellent speech and swallowing function were observed because adynamic portion was relatively small. We observed that the postoperative speech and swallowing functions were not affected in the group with less than 3 cm of the tongue defect and the reconstruction with primary closure. The lingua alveolars were mainly affected on postoperative speech evaluation in primary closure and free flap group irrespective of defect volume. Speech and swallowing functions in less over-reconstructed group were superior to those in over-reconstructed group. CONCLUSION: We suggest that the results of this study can aid in counseling patients and predicting the postoperative status of speech and swallowing function according to the size of primary defect and the reconstruction methods. To better predict the postoperative functional status, we need to carry out functional evaluations and comparative assessment of the preoperative and postoperative status.
Barium ; Counseling ; Deglutition* ; Diet ; Free Tissue Flaps ; Head ; Humans ; Mouth ; Neck ; Peristalsis ; Reflex ; Tongue Neoplasms* ; Tongue*