BACKGROUND: The advantages of epidural anesthesia for Caesarean section are well documented. However, its disadvantages include a slow onset time, which preclude its use for urgent procedures. The object of this clinical trial was to ascertain if a useful reduction in onset time may be obtained by fentanyl supplementation versus plain ropivacaine. METHODS: Twenty healthy women scheduled for Caesarean section were allocated randomly to receive 20 ml of 0.75% ropivacaine with normal saline 1 ml (group 1) or 20 ml of 0.75% ropivacaine with fentanyl 50 mcg (group 2) via a epidural catheter inserted 3 cm into the epidural space, identified by the loss of resistance technique using a midline approach at the L3-4 interspace. After insertion of the catheter, and with the patient supine, a test dose of 3 ml of the solution was given, and then the remainder was injected at a rate of 10 ml/min. The time for sensory block to develop at T8 by loss of cold discrimination using an alcohol sponge was defined as the onset time. Onset of block was timed from the end of the last injection. If a sensory block of T6 or higher was not present at 30 min, 5 ml of 2% lidocaine mixed with 0.5 ml of 8.4% sodium bicarbonate were administered until an adequate height of block had been achieved. After surgery had started and discomfort was felt, 50 mcg of i.v. fentanyl was administered repeatedly after delivery. Side effects (hypotension, nausea/vomiting, shivering, bradycardia, respiratory depression) during surgery were recorded, and the upper limit of sensory analgesia to the alcohol sponge was determined. RESULTS: The onset time was 8.7 +/- 4.3 min in group 1 and 11.9 +/- 5.4 min in group 2, respectively. No significant difference was evident between the two groups in terms of onset time to the sensory block to T8. The number of patients that required supplementary analgesia and experiencing side effects was similar. The maximum upper level observed in any patient was C6 in group 1 and C4 in group 2. CONCLUSIONS: The combined use of ropivacaine and fentanyl did not reduce sensory onset or produce an unnecessarily extended sensory block level.
Analgesia ; Anesthesia, Epidural* ; Bradycardia ; Catheters ; Cesarean Section* ; Discrimination (Psychology) ; Epidural Space ; Female ; Fentanyl ; Humans ; Lidocaine ; Porifera ; Pregnancy ; Shivering ; Sodium Bicarbonate

Intranasal corticosteroid injection has been used for the control of allergic rhinitis or polypoid inflammation of the nasal cavity. Transient or permanent visual loss after therapeutic intranasal injection of corticosteroid is an extremely rare but well-known disease. In this report, we present a 54-year-old male patient with chronic sinusitis with nasal polyposis who had right visual loss after bilateral intranasal triamcinolone injection. Clinical examination and fluorescent angiography revealed vascular occlusions, which involved multiple small branches of right retinal circulations. Full recovery of vision occurred 3 months after the onset of the symptom. Extreme care should be exercised to avoid visiual complication when intranasal corticosteroid injection is performed.
Angiography ; Blindness* ; Humans ; Inflammation ; Male ; Middle Aged ; Nasal Cavity ; Retinaldehyde ; Rhinitis ; Sinusitis ; Triamcinolone

Heterotopic salivary gland tissue (HSGT) consists of salivary tissue in places where it does not normally exist. Usually, HSGT presents as a draining sinus or nodule of the neck. The pathogenesis of HSGT of the neck remains uncertain. But HSGT in the neck is most widely thought to arise from defective closures and ectodermal hetroplasia of the precervical sinus of His. HSGT in the neck is rare and only a few cases have been reported in Korea. We recently experienced a case of HSGT in the neck presenting as a fistula of the anterior lower neck. We thought this as a 2nd brachial cleft anomaly; however, biopsy revealed HSGT. HSGT in the neck should be considered as one of the causes of a neck mass or fistula in children. Herein, we report this case of HSGT with a literature review.

BACKGROUND: Hypoxic pulmonary vasoconstriction (HPV) is unique to pulmonary circulation but the mechanism remains elusive. Red blood cells (RBCs) are known to augment HPV and to release more ATP as oxygen content falls. Leukotrienes constrict smooth muscle and could be important for the regulation of the pulmonary circulation. Hence we hypothesized that ATP and leukotrienes are mediators of HPV produced during acute alveolar hypoxia. METHODS: In forty Sprague-Dawley rats, lungs were isolated and perfused. We administered ATP (10 micrometer) to the ATP group (n = 8), the ATP antagonist, suramin (100 micrometer) to the suramin group (n = 8), leukotriene C4 (LTC4, 5 microgram) to the LTC4 group (n = 8), the LTC4 antagonist, LY171883 (20 micrometer) to the LY171883 group (n = 8), and LTC4 (5 microgram) + ATP (10 micrometer) to the LTC4 + ATP group (n = 8) during normoxic ventilation. HPV responses were induced by three hypoxic challenges for 5 minutes separated by 5 minutes of ventilation with a normoxic gas mixture. Baseline pulmonary artery pressure change after exposure to each drug and hypoxic pressor response between a period 21% normoxic gas ventilation and that of 3% hypoxic gas ventilation were measured. RESULTS: ATP and LTC4 + ATP increased baseline pulmonary artery pressures but LTC4 did not alter it. ATP did not affect hypoxic pressor response. Suramin, LY171883 and LTC4 + ATP inhibited the pressor response to hypoxia. LTC4 increased hypoxic pressor response. CONCLUSIONS: In isolated rat lungs, HPV may be mediated by ATP and LTC4 appears more likely to be a modulator than a mediator of HPV.
Acetophenones ; Adenosine Triphosphate ; Animals ; Anoxia ; Erythrocytes ; Leukotriene C4 ; Leukotrienes ; Lung ; Muscle, Smooth ; Oxygen ; Pulmonary Artery ; Pulmonary Circulation ; Rats ; Rats, Sprague-Dawley ; Suramin ; Tetrazoles ; Vasoconstriction ; Ventilation

In this study, we investigated interleukin (IL)-18 and IL-12 following in vitro stimulation with either the 30-kDa or purified protein derivative (PPD) antigens (Ag) of pleural mononuclear cells from 12 cases of tubercular pleurisy (TB-PMC) and 8 cases of malignant pleurisy (MG-PMC). Ag-stimulated TB-PMC produced significantly more IL-12 than did MG-PMC and the levels correlated with those of IFN - gamma. Although elevated IL-18 levels were found in freshly isolated pleural fluids, in vitro IL-18 production in response to either Ag was dramatically decreased in TB-PMC. Pro-IL-18 mRNA was detected before and after Ag stimulation in TB patients. Supernatants from the Ag-stimulated TB-PMC significantly suppressed IL-18 production in normal peripheral blood mononuclear cells (PBMC) and primary malignant cells over an 18 h incubation period. In addition, this suppressive activity was not inactivated by either heat or trypsin. Our findings imply that modulation of IL-12 and IL-18 levels may contribute to the Th1 elevation induced in human TB-P VIC by the 30-kDa and PPD antigens.
Hot Temperature ; Humans ; Interleukin-12* ; Interleukin-18* ; Interleukins ; Mycobacterium tuberculosis ; Pleurisy ; RNA, Messenger ; Trypsin ; Tuberculosis, Pleural

Ross syndrome is characterized by a triad of segmental anhidrosis, tonic pupil, and generalized areflexia. Selective postganglionic autonomic denervation could be the differential diagnostic point for other diseases of the autonomic nervous system. Here we report a patient with regional anhidrosis in his left hand and sole, and anisocoria. An evaluation of sweating and the pupillary response together with generalized areflexia confirmed the diagnosis of Ross syndrome. The finger wrinkle test is a simple and useful tool for revealing segmental sympathetic denervation.
Anisocoria* ; Autonomic Denervation ; Autonomic Nervous System ; Diagnosis ; Fingers* ; Hand ; Humans ; Hypohidrosis* ; Sweat ; Sweating ; Sympathectomy ; Tonic Pupil

A 54-year-old woman presented with vaginal bleeding. On gynecologic and radiologic examinations, bilateral cystic ovarian tumors were suspected. A laparoscopic examination revealed multiple cysts involving both the uterine horns and the posterior surface of the uterus. These were removed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Microscopically, multiple cysts were identified in the subserosal layer of the uterus, and they were lined with benign tubal type epithelium surrounded by a smooth muscle wall. These features were consistent with "florid cystic endosalpingiosis". Considering the location of the lesion, the lesion has to be distinguished from other benign cystic lesions of the uterus and adnexa, including multicystic mesothelioma, serous cystadenoma and mucinous cystadenoma. Awareness of this lesion will facilitate a correct diagnosis by both the clinician and pathologist.
Female ; Humans ; Cysts

PURPOSE: Traditional cardiopulmonary resuscitation (CPR) training methods have been gradually replaced by practice-oriented methods such as the American Heart Association (AHA) basic life support (BLS) course for healthcare providers. We attempted to investigate nurses' and other healthcare professionals' retention of BLS skills over time after taking the AHA BLS course for healthcare providers. METHODS: Healthcare providers were screened for their retention of CPR skills at regular intervals up to 1 year after completing the AHA BLS course. Certified BLS instructors administered skills tests. RESULTS: The degree of skills maintained over time decreased, but not significantly (p=0.207, p=0.160). The scores of written tests decreased over time, but not significantly (p=0.082). The degree of CPR knowledge and skills main-tained was higher in the nurse group than in the healthcare professional group; this difference was statistically significant (p=0.02, <0.001, <0.001). However, regarding the degree of knowledge and skills for CPR maintained over time, there was no statistically significant difference between each group. CONCLUSION: After the AHA BLS course for healthcare providers, in-hospital healthcare professionals retain significantly less information after 3 months. We suggest that a skill review is needed within 3 months after CPR training.
American Heart Association ; Cardiopulmonary Resuscitation ; Delivery of Health Care ; Health Personnel ; Hospitals, General ; Humans ; Retention (Psychology)

Complete trisomy 9 is a rare chromosomal aneuploidy in live born infants. The majority of cases of trisomy 9 end in spontaneous abortion in the first trimester. Clinical finding of co-mplete trisomy 9 demonstrate multiple organ abnormalities in the craniofacial, cardiovascular, skeletal, genitouronary systems. We report a fetus with Dandy Walker syndrome which was diagnosed prenatally and was subsequently found to have a complete trisomy 9.
Abortion, Spontaneous ; Aneuploidy ; Dandy-Walker Syndrome* ; Female ; Fetus ; Humans ; Infant ; Pregnancy ; Pregnancy Trimester, First ; Trisomy*

A 62-year-old man with left flank pain and hematuria was shown to have a staghorn stone in left renal pelvis. Grossly, renal pelvis and calyces were markedly dilated with cystic and hemorrhagic degeneration and renal parenchyma was atrophied. A tumor-like mass was located in a hemorrhagic cyst of the renal upper pole. This mass consisted of giant cells and stromal cells mimicking a giant cell tumor of bone. This giant cell tumor-like proliferation may represent a response to hemorrhage into a cystic cavity. Recognition of this finding is important to avoid the over-diagnosis of neoplastic lesions.
Calculi ; Cell Proliferation ; Flank Pain ; Giant Cell Tumor of Bone ; Giant Cell Tumors ; Giant Cells ; Hematuria ; Hemorrhage ; Humans ; Kidney ; Kidney Pelvis ; Middle Aged ; Stromal Cells