The digastric muscle has two bellies and it has various variation in submental region. During dissection of a 79-year-old Korean female cadaver, bilateral variations at the anterior belly (AB) of the digastric muscle in submental region were shown. Two accessory bellies originated medial to the origin of the two normal ABs of the digastric muscle. They run medially and combined each other anterior to the median raphe of the mylohyoid muscle. In left side, AB of the digastric muscle was divided into two muscular bellies. Therefore, five bellies of ABs of the digastric muscle were found. This novel variation has not been described in the literature and this appearance will guide clinicians during surgical interventions and radiological diagnosis.
Aged ; Cadaver ; Diagnosis ; Female ; Head* ; Humans ; Korea*

Polymorphous low-grade adenocarcinoma (PLGA) is a distinctive salivary gland neoplasm with a propensity to arise from minor salivary glands, particularly of the palate. Reports of PLGA have increased with the establishment of specific histopathological criteria characterizing the PLGA, but there are only a few reports of major salivary gland origin. PLGA shares histological features with adenoid cystic carcinoma, so histopathologic diagnosis is essential and immunohistochemistry is an important tool when making differential diagnosis. The treatment of choice is wide surgical excision, and long-term follow up is necessary to evaluate local recurrences. We herein report a case of PLGA arising in a submandibular gland with a review of the relevant literature.
Adenocarcinoma* ; Carcinoma, Adenoid Cystic ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Immunohistochemistry ; Palate ; Recurrence ; Salivary Gland Neoplasms ; Salivary Glands ; Salivary Glands, Minor ; Submandibular Gland*

Hypertrophy of salivary gland was developed by sialadenitis, sialolithiasis, autoimmune diasease and other tumorous conditions. Mikulicz's disease has been used to describe symptomless hypertrophy of the salivary gland and lacrimal gland. In the past, it was thought that Mikulicz's disease is included within the diagnosis of Sjogren's syndrome. However, Mikulicz's disease represents Immunoglobulin G4 (IgG4)-related hypertrophy of salivary gland and lacrimal gland by an elevated level of IgG4 in the serum of the patient and good responsiveness to glucocorticoid, eventually leading to recovery of gland function. We have experienced a case of IgG4-related sialadenitis and dacryoadenitis with bilateral hypertrophy of parotid, submandibular and lacrimal glands. We report this case with a brief review of the literature.
Dacryocystitis ; Humans ; Hypertrophy ; Immunoglobulin G ; Immunoglobulins ; Lacrimal Apparatus ; Salivary Gland Calculi ; Salivary Glands ; Sialadenitis ; Sjogren's Syndrome

To accurately assess the potential hazard of exposure to ionizing radiation from portable radiographs taken in the emergency department,.a study was performed to measure such radiation at different distances from the edge of an irradiated field during portable cervical spine, portable chest radiographs, and portable anteroposterior pelvis radiographs. For all three types of portable radiographs, radiation exposure is high at the edge from the beam. However, radiation exposure is deceased at 20, 40, 80, 160cm away from the beam. This study confirms and supports the evidence that although radiation exposure is dependent on distance from the primary radiograph beam, exposure in the ED is minimal. Medical personnel should not have to leave a patient care area for fear of undue acute and chronic radiation exposure while portable radiographs are performed in the ED. By using protective garments and standing appropriate distance away from the patient, continuous patient care can be maintained while portable radiographs are taken in the ED.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Patient Care ; Pelvis ; Radiation, Ionizing ; Radiography, Thoracic ; Spine

BACKGROUND: Despite the established efficacy of dexamethasone and lidocaine for preventing postoperative airway symptoms, no study has investigated the effects of dexamethasone plus lidocaine for attenuating postoperative airway symptoms. The purpose of this study was to explore whether combined dexamethasone and lidocaine are superior to dexamethasone alone in reducing postoperative sore throat, cough, and hoarseness for 24 h after tracheal extubation. METHODS: In total, 70 female patients undergoing breast mass excision were randomized in a prospective, double-blinded manner into two groups: Group DL received intravenous dexamethasone (8 mg) plus lidocaine (1.5 mg/kg) 5 min before induction of anesthesia, and lidocaine was injected once more at the end of surgery. Group D received dexamethasone (8 mg) plus normal saline instead of lidocaine in the same manner as Group DL. We assessed the incidence and severity of postoperative sore throat, cough, and hoarseness 1 and 24 h after extubation. RESULTS: The incidence of sore throat for 24 h after tracheal extubation was significantly lower in Group DL than in Group D (62.9% vs. 85.7%, respectively; P = 0.029). The severity of sore throat and hoarseness for 24 h after extubation was lower in Group DL than in Group D (P < 0.05). The incidence and severity of cough did not differ between the two groups for 24 h after extubation. CONCLUSIONS: Lidocaine combined with dexamethasone is more effectively reduces the incidence and severity of sore throat and severity of hoarseness for 24 h after extubation in patients who have undergone breast mass excision surgery.
Airway Extubation ; Anesthesia ; Breast ; Cough* ; Dexamethasone* ; Female ; Hoarseness* ; Humans ; Incidence ; Lidocaine* ; Pharyngitis* ; Prospective Studies

No abstract available.
Adrenoleukodystrophy* ; Anesthesia* ; Child* ; Humans

BACKGROUND: The adhesion of polymorphonuclear neutrophils (PMNs) to the coronary endothelium is an crucial step in PMN-mediated reperfusion injury. The purpose of this study was to investigate whether thiopental inhibits the postischemic coronary vascular adhesion of PMNs, and results in reduced postischemic myocardial dysfunction in isolated guinea pig hearts. METHODS: Hearts (n = 6-8/group) were isolated from male-guinea pigs and perfused with modified Krebs-Henseleit solution. After isolation, hearts were stabilized for 10 minutes, perfused for 15 minutes, allowed an ischemic period for 30 minutes, and a reperfusion period of 60 minutes (C group). In the P group, a bolus of 1x10(6) PMNs was infused 2 minutes after reperfusion, and in the T group additional thiopental was infused 5 minutes after the start of reperfusion, and PMNs were infused on 2 minutes after reperfusion. PMN adhesion (%), LVDP, LVEDP, +/-dP/dt, HR, and CF were measured pre- and postischemia. RESULTS: The addition of thiopental (25 microM) to the perfusate reduced the postischemic coronary vascular adhesion of PMNs (72.5+/-4.5% vs 40.0+/-7.4%, P < 0.05) and prevented postischemic myocardial dysfunction compared with group P (73.5+/-6.9% vs 48.4+/-3.0%, P < 0.05). CONCLUSIONS: Postischemic myocardial dysfunction is significantly more pronounced after PMN infusion. Thiopental reduced the postischemic coronary vascular adhesion of PMNs and attenuated the myocardial dysfunction, which was responsible at least in part, for the cardioprotective effect.
Animals ; Endothelium ; Guinea Pigs* ; Guinea* ; Heart* ; Ischemia ; Neutrophils* ; Reperfusion ; Reperfusion Injury ; Swine ; Thiopental*

BACKGROUND: Laparoscopic appendectomy (LA) is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. We expected that dexmedetomidine would compensate for the problems arising from spinal anesthesia alone. Thus, we performed a feasibility study of spinal anesthesia with intravenous dexmedetomidine infusion. METHODS: Twenty-six patients undergoing LA received spinal anesthesia with intravenous dexmedetomidine infusion. During surgery, the patient's pain or discomfort was controlled by supplemental fentanyl or ketamine injection, and all adverse effects were evaluated. RESULTS: No patient required conversion to general anesthesia, and all operations were completed laparoscopically without conversion to open surgery. Seventeen (65.4%) patients required supplemental injection of fentanyl or ketamine. Bradycardia occurred in seven (26.9%) patients. CONCLUSIONS: Spinal anesthesia with dexmedetomidine infusion may be feasible for LA. However, additional analgesia, sedation, and careful attention to the potential development of bradycardia are needed for a successful anesthetic outcome.
Analgesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Appendectomy* ; Bradycardia ; Conversion to Open Surgery ; Dexmedetomidine* ; Feasibility Studies ; Fentanyl ; Humans ; Ketamine

BACKGROUND: Laparoscopic appendectomy (LA) is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. We expected that dexmedetomidine would compensate for the problems arising from spinal anesthesia alone. Thus, we performed a feasibility study of spinal anesthesia with intravenous dexmedetomidine infusion. METHODS: Twenty-six patients undergoing LA received spinal anesthesia with intravenous dexmedetomidine infusion. During surgery, the patient's pain or discomfort was controlled by supplemental fentanyl or ketamine injection, and all adverse effects were evaluated. RESULTS: No patient required conversion to general anesthesia, and all operations were completed laparoscopically without conversion to open surgery. Seventeen (65.4%) patients required supplemental injection of fentanyl or ketamine. Bradycardia occurred in seven (26.9%) patients. CONCLUSIONS: Spinal anesthesia with dexmedetomidine infusion may be feasible for LA. However, additional analgesia, sedation, and careful attention to the potential development of bradycardia are needed for a successful anesthetic outcome.
Analgesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Appendectomy* ; Bradycardia ; Conversion to Open Surgery ; Dexmedetomidine* ; Feasibility Studies ; Fentanyl ; Humans ; Ketamine