BACKGROUND: Epidural anesthesia is becoming an increasingly important aspect of anaesthetic practice because it has many advantages. To achieve the appropriate sedation, various methods have been described. The authors applied the ketamine for this purpose in subanesthetic dose and compared with the midazolam that has been most commonly used for intravenous sedation. METHODS: Fifty-seven adult patients undergoing lower abdominal and extremity surgery who were receiving epidural anesthesia were randomely enrolled into this clinical study. They were allocated to three groups to receive only normal saline (group C), midazolam 0.05 mg/kg (group M) and ketamine 0.5 mg/kg midazolam 0.05 mg/kg (group K) in normal saline 10ml, respectively. Hemodynamic and respiratory measurements were recorded at baseline, 1 minute, 3 minute, 5 minute, 10 minute, 20 minute and 30 minute after sedation. The degree of sedation was assessed by a blinded observer using sedation score. RESULTS: There were no significant differences for hemodynamic and respiratory parameters, but decrements of arterial pressure at 1 minute after sedation were most remarkable in the group M. Sedation was satisfactorily achieved by combination of ketamine and midazolam without significant emergence reaction. CONCLUSIONS: The combination of ketamine and midazolam was judged to be suitable alternative for sedation during epidural anesthesia.
Adult ; Anesthesia, Epidural* ; Arterial Pressure ; Extremities ; Hemodynamics ; Humans ; Ketamine* ; Midazolam*

Spontaneous cervical epidural hematoma (SCEH) is a rare condition that causes paraparesis or quadriparesis. As spontaneous resolution is seldom expected, it usually requires surgical treatment for relieve symptoms. Even if spontaneous resolution occurs, relief from symptoms usually requires several hours to days. In contrast, hemiparesis is the most common symptom of a transient ischemic attack (TIA), and usually resolves over minutes to hours. We report here two patients with SCEH who presented with hemiparesis with severe neck pain. Both patients were taking antiplatelet drugs. Their neurological symptoms recovered spontaneously over a very short time. They were initially misdiagnosed as TIA. These cases show that patients with transient hemiparesis may have SCEH if there is severe neck pain and no cranial nerve involvement.

PURPOSE: To describe the clinical features of nonconvulsive status epilepticus (NCSE) associated with cephalosporins in patients with renal failure and to emphasize the importance of EEG in diagnosing NCSE in patients with altered consciousness.METHODS: We described the detailed clinical characteristics of 8 patients with renal failure who underwent cephalosporin-induced NCSE.RESULTS: Six of the patients showed unresponsiveness with preserved alertness and two patients presented confusion and irritability. 6 patients presented altered consciousness with intermittent jerky movements of face or arms. Altered consciousness developed 6+/-5 days (mean+/-SD) after starting the above antibiotics. The EEG showed continuous generalized high voltage 1.0 to 2.5 Hz sharp waves or sharp and wave complexes. All patients improved 3+/-1 days after withdrawing the offending antibiotics without administration of antiepileptic drugs.CONCLUSIONS: Cephalosporin-induced NCSE should be differentiated from metabolic encephalopathy in patients with renal failure, which is clinically difficult. Early detection with EEG and withdrawal of the offending antibiotics can result in full recovery.
Anti-Bacterial Agents ; Arm ; Brain Diseases, Metabolic ; Cephalosporins ; Consciousness ; Electroencephalography ; Humans ; Renal Insufficiency ; Status Epilepticus

A 44-year-old woman who comlpained of dizziness and generalized weakness was admitted. The hemoglobin was 6.6g/dL, hematocrit 25.5%, and serum ferritin 2.14 ng/mL Stool occult blood was positive and microcytic hypochromic anemia was found on periyheral blood smear. Gastroscopic examination showed about 2 x 1 cm sized hemispherical sebmucosal tumor on antrum. The patient underwent operatioh for confirmatory diagnosis and treatment. The final pathologic diagnosis of the resected lesion was hemangioma of stomach. Cavernous hemangioma of stomach is a rare disease.Mostly, it has a benign course clinically, but early diagnosis is important because massive hemorrhage and anemia by chronic blood loss can occur. We report a case of hemangioma of stomach with review of literature.
Adult ; Anemia ; Anemia, Hypochromic ; Diagnosis ; Dizziness ; Early Diagnosis ; Female ; Ferritins ; Hemangioma ; Hemangioma, Cavernous* ; Hematocrit ; Hemorrhage ; Humans ; Occult Blood ; Stomach*

PURPOSE: The aim of this study was to obtain single cell-derived clones from human umbilical cord blood (hUCB) derived mesenchymal stem cell (MSC) population, to compare the gene expression patterns and differentiation characteristics among the hUCB derived MSC population and its monoclonal cell populations, and to determine if the MSC population is homogenous. MATERIALS AND METHODS: The single cells were isolated from a hUCB derived MSC population and cultured on each well of a culture plate. The gene expression pattern of each monoclonal cell population expanded from the single cells was detected by RT-PCR for osteogenic, chondrogenic, and adipogenic specific genes. The monoclonal cell populations were differentiated into osteogenic, chondrogenic, and adipogenic lineages and were confirmed by specific staining. RESULTS: Fifteen monoclonal cell populations were obtained from the total seeding of 864 single cells. The cell morphology and gene expression patterns among the hUCB derived MSCs and its monoclonal cell population were different. Tri-lineage differentiation potency was different among the monoclonal cell populations. CONCLUSION: The difference in the cell morphology, gene expression patterns, and differentiation characteristics among the monoclonal cell populations suggest heterogeneity of the MSC population isolated using the currently available method.
Clone Cells ; Fetal Blood* ; Gene Expression ; Humans* ; Mesenchymal Stromal Cells* ; Population Characteristics ; Umbilical Cord*

We previously reported an identification of a 77-kDa GTP-binding protein that co-purified with the alpha 1-adrenoceptor following ternary complex formation. In the present paper, we report on the purification and characterization of this GTP-binding protein (termed G alpha h5) isolated from pig heart membranes. After solubilization of pig heart membranes with NaCl, G alpha h5 was purified by sequential chromatographies using DEAE-Cellulose, Q-Sepharose, and GTP-agarose columns. The protein displayed high-affinity GTP gamma S binding which is Mg(2+)-dependent and saturable. The relative order of affinity of nucleotide binding by G alpha h5 was GTP > GDP > ITP >> ATP > or = adenyl-5'-yl imidodiphosphate, which was similar to that observed for other heterotrimeric G-proteins involved in receptor signaling. Moreover, the G alpha h5 demonstrated transglutaminase (TGase) activity that was blocked either by EGTA or GTP gamma S. In support of these observations, the G alpha h5 was recognized by a specific antibody to G alpha h7 or TGase II, indicating a homology with G alpha h (TGase II) family. These results demonstrate that 77-kDa G alpha h5 from pig heart is an alpha 1-adrenoceptor-coupled G alpha h (TGase II) family which has species-specificity in molecular mass.
Animal ; Binding Sites ; Binding, Competitive ; Cross Reactions ; GTP-Binding Proteins/metabolism* ; GTP-Binding Proteins/isolation & purification* ; GTP-Binding Proteins/immunology ; Guanosine 5'-O-(3-Thiotriphosphate)/metabolism ; Molecular Weight ; Myocardium/chemistry* ; Protein-Glutamine gamma-Glutamyltransferase/metabolism ; Receptors, Adrenergic, alpha-1/metabolism ; Swine

OBJECTIVE: We undertook this study to determine the clinical characteristics and the prognostic factors of neonatal survival in patients with fetal anemia who were treated by intraumbilical venous transfusion (IUT). METHODS: From July 2000 to March 2009, 16 cases of fetal anemia were diagnosed at Asan Medical Center in Seoul, Korea. These patients underwent intraumbilical venous transfusions and were thus included in our study. Doppler measurement of the middle cerebral artery peak systolic velocity was performed before and after cordocentesis in all fetuses. RESULTS: The gestational age at the time of the diagnosis of anemia ranged from 21.3 to 33.6 weeks. There was a linear correlation between pre- and post-procedure fetal hemoglobin (Hb,MoM, (x)) and the MCA-PSV (MoM, (y)), i.e., y=0.810-0.229x, r2=0.542, CI 0.316-0.141, p<0.005; and y=1.374-0.391x, r2=0.499, CI 0.584-0.197, p<0.005. The survival was better in patients with severe anemia than those with mild to moderate anemia (p<0.05), and survival was better in patients with anemia of a known cause than those with anemia of an unknown cause (p<0.001). CONCLUSION: In fetuses with anemia, the severity of the anemia before IUT and the change of hemoglobin concentration after IUT, can be estimated noninvasively using Doppler ultrasonography, on the basis of an increase in the peak velocity of systolic blood flow in the middle cerebral artery. Both severity and etiology were meaningful factors for the survival of neonates with fetal anemia who were treated by intraumbilical venous transfusion. Although fetuses have severe anemia, they expected improved survival through IUT. These data are valuable information for use when counseling the parents of an affected fetus.
Anemia ; Blood Transfusion, Intrauterine ; Cordocentesis ; Counseling ; Fetal Hemoglobin ; Fetus ; Gestational Age ; Hemoglobins ; Humans ; Hydrops Fetalis ; Infant, Newborn ; Korea ; Middle Cerebral Artery ; Parents ; Ultrasonography, Doppler

BACKGROUND: Pontine infarction extending to the basal surface has been reported to possess different characteristics from deep pontine infarction without extending to the basal surface. METHODS AND RESULTS: We studied 54 patients ; 30 patients with pontine infarction extending to the basal surface (group SE) and 24 patients with deep pontine infarction without extension (group DL) based on the site of the infarcts on precontrast sagittal T2WI. We assessed angiographic findings(MRA, 54; DSA, 31), risk factors, clinical features and the effectiveness of the intraluminal signal changes on spin-echo MRI in the diagnosis of occlusion or stenosis of the basilar artery. The incidence of basilar artery stenosis or occlusion in MRA or DSA in group SE(60%) was significantly more frequent than group DL(12.5%), whereas the incidence of vertebral artery stenosis or occlusion was not different between two groups. A noteworthy finding was that five patients (17%) of the group SE had not been extended to the basal surface on axial T2WI. The risk factors were similarly distributed between the two groups. The effectiveness of abnormal signal void of axial MRI was poor in the diagnosis of basilar artery occlusion or stenosis. CONCLUSIONS: Our results suggest that the two types of pontine infarction may be caused by different arterial pathology. Although the presence of abnormal flow void on MRI cannot predict the stenosis or occlusion of basilar artery, sagittal T2WI and angiographic study help to evaluate the patients with pontine infarction.
Basilar Artery* ; Constriction, Pathologic ; Diagnosis ; Humans ; Incidence ; Infarction* ; Magnetic Resonance Imaging ; Pathology ; Risk Factors ; Vertebrobasilar Insufficiency

Lumbar hernia is a relatively rare clinical phenomenon. They may be classified according to their anatomic location and they can be either congenital or acquired. These patients usually present with a protruding bulge in the posterolateral abdominal wall. Portions of the small and large intestine may be found in the sac. This may be asymptomatic or it can become incarcerated and strangulated. We report here on a rare case of secondary lumbar hernia combined with descending colon incarceration. The diagnosis of lumbar hernia was made by CT scan and barium enema. Excision of the sac was performed and the hernial defect in the fascia was repaired with polypropylene mesh reinforcement.
Abdominal Wall ; Barium ; Colon, Descending* ; Diagnosis ; Enema ; Fascia ; Hernia* ; Humans ; Intestine, Large ; Polypropylenes ; Tomography, X-Ray Computed

PURPOSE: This study was done to provide basic data for education of elementary school students on life-respect and peer bullying prevention. METHODS: Participants were 5th and 6th grade elementary school students. Data from the questionnaires of 218 participants were analyzed. RESULTS: 1) The mean score for degree of life-respect was 4.23 (+/-0.38). The types of peer bullying were 'defenders of victims' (3.19+/-0.93), 'bullies' (2.04+/-0.72), 'victims' (1.91+/-0.84), 'bystanders' (1.79+/-0.80), and 'bully-followers' (1.66+/-0.60). 2) There was a significant difference in the degree of life-respect according to gender (t=-2.410, p=.017). Likewise, in the degree of peer bullying, among the type of 'bullies' there were significant differences according to grade (t=-2.285, p=.004), and gender (t=3.191, p=.002). Also, among the types of 'bully-followers' there were significant differences according to gender (t=2.053, p=.041), and having a religion or not (t=3.319, p=.001). 3) There was a significant correlation between life-respect and types of peer bullying. CONCLUSION: The results of this study provide helps for more effective provision of educational programs regarding life-respect and peer bullying.
Bullying* ; Child ; Education ; Humans ; Peer Group ; Value of Life ; Surveys and Questionnaires