No abstract available.
Esophagus* ; Leiomyoma*

No abstract available.
Cardiopulmonary Bypass* ; Emergencies* ; Heart* ; Hemorrhage* ; Thoracic Surgery*

No abstract available.
Eating* ; Liver* ; Pneumonia* ; Sharks*

Descending Necrotizing Mediastinitis (DNM) is a complication of oropharyngeal infections that can spread to the mediastinum. It is difficult to diagnose early because clinical and radiologic findings appear in the late stage of the infection. late diagnosis is the principal reason for the high mortality in DNM. An 18-year-old female admitted with Ludwig's angina from dental caries. Despite of combined antibiotics, dental extraction and drainge of submental abscess, infection spread to the cervical area. Chest computed tomogram revealed extension of the abscess to the pretracheal and periaortic space and development of bilateral pleural empyema. We performed bilateral cervical mediastinotomy and thoracotomy for drainage and debridement. Tracheostomy to secure the airway and postoperative pleural irrigation were performed. Postoperative course was uneventful and patient was discharged on the 40th postoperative day. It is important to perform chest CT scanning for early diagnosis of DNM when oropharyngeal infection spreads to the cervical area. Improved survival of patients with DNM implies early and radical surgical drainage and debridement via a cervical mediastinomy and thoracotomy.
Abscess ; Adolescent ; Anti-Bacterial Agents ; Debridement ; Delayed Diagnosis ; Dental Caries* ; Drainage ; Early Diagnosis ; Empyema, Pleural ; Female ; Humans ; Ludwig's Angina ; Mediastinitis* ; Mediastinum ; Mortality ; Thoracotomy ; Thorax ; Tomography, X-Ray Computed ; Tracheostomy

No abstract available.
Hypothermia* ; Vena Cava, Inferior*

No abstract available.
Morphine* ; Respiration, Artificial* ; Weaning*

BACKGROUND: A randomized, multicenter, open-label, parallel group study was performed to compare the effects of remifentanil and morphine as analgesic drugs on the duration of weaning time from mechanical ventilation (MV). METHODS: A total of 96 patients with MV in 6 medical and surgical intensive care units were randomly assigned to either, remifentanil (0.1-0.2 mcg/kg/min, n = 49) or morphine (0.8-35 mg/hr, n = 47) from the weaning start. The weaning time was defined as the total ventilation time minus the sum of controlled mode duration. RESULTS: Compared with the morphine group, the remifentanil-based analgesic group showed a tendency of shorter weaning time (mean 143.9 hr, 89.7 hr, respectively: p = 0.069). Secondary outcomes such as total ventilation time, successful weaning rate at the 7th of MV day was similar in both groups. There was also no difference in the mortality rate at the 7th and 28th hospital day. Kaplan-Meyer curve for weaning was not different between the two groups. CONCLUSIONS: Remifentanil usage during the weaning phase tended to decrease weaning time compared with morphine usage.
Analgesics ; Humans ; Critical Care ; Morphine* ; Mortality ; Respiration, Artificial* ; Ventilation ; Ventilator Weaning ; Weaning*

BACKGROUND: Assessment of left ventricular function with conventional 2-dimensional echocardiography (2D echo) remains largely qualitative and subjective because the manual tracing of endocardial borders is laborious and tedious. An automatic border detection (ABD) echo has been recently developed that permits real-time measurements of chamber areas and cardiac function. METHODS: To determine usefulness of ABD echo, left ventricular cross-sectional areas were automatically measured from the parasternal short-axis image in 25 cases including 9 cardiac patients, and compared with those by off-line analysis of the conventional 2D echo image. RESULTS: In on-line ABD analysis, short axis end-diastolic area averaged 13.1+/-2.2cm2, end-systolic area 5.3+/-1.3cm2 and fractional area change 59.4+/-9.0% and off-line manual analysis yielded corresponding values of 14.7+/-2.5cm2, 6.2+/-1.3cm2, and 57.1+/-7.1%. The end-diastolic and end-systolic areas by both methods were significantly different, respectively. Left ventricular end-diastolic and end-systolic area and fractional area change obtained from ABD echo correlated significantly with those of off-line measurements(r=0.897, p<0.001 ; r=0.505, p<0.01 ; r=0.427, p<0.05). CONCLUSION: Thus, these facts suggest that ABD echo is useful for on-line continuous measurement of chamber areas and cardiac function.
Axis, Cervical Vertebra ; Echocardiography* ; Humans ; Ventricular Function, Left

BACKGROUND: Spontaneous pneumothorax is a common respiratory condition and has been postulated that it develops because of rupture of subpleural blebs. Although the morphology and ultrastructure of causative lesions are well known, the reason for rupture of sbupleural blebs is not absolutely clear. Broad consensus concerning the role of meteorological factors in spontaneous pneumothorax dose not exist. The aim of the study was to examine the influence of change of atmospheric pressure and temperature on the occurrence of spontaneous pneumothorax. MATERIAL AND METHOD: One hundred twenty eight consecutive spontaneous pnemothorax events that occurred between January 2003 and December 2004 were selected. Changes of meteorological factors of particular days from the day before for 5 consecutive days were calculated and compared between the days with pneumothorax occurrence (SP days) and the days without pneumothorax occurrence (Non SP days). The correation between change of pressure and temperature and the occurrence of SP was evaluated. RESULT: SP occurred on 117 days (16.0%) in the 2-year period. Although there was no significant differences in change of pressure factors prior 4 days of SP occurrence compare to the 4 days prior Non SP day, change of mean pressure was higher (+0.934 vs. -0.191hPa, RR 1.042, CI 1.003~1.082, p=0.033), and change of maximum pressure fall was lower (3.280 vs. 4.791 hPa, RR 1.051, CI 1.013~1.090, p=0.009) on the 4 days prior SP day. There were significant differences in change of temperature factors prior 2 days and the day of SP, Changes of mean temperature (-0.576 vs.+0.099 degrees C, RR 0.886, 95% CI 0.817~0.962, p=0.004) and maximum temperature rise (7.231 vs. 8.079 degrees C, RR 0.943 CI 0.896~0.993, p=0.027) were lower on the 2 days prior SP. But changes of mean temperature (0.533 vs. -0.103 degrees C, RR 1.141, CI 1.038~1.255, p=0.006) and maximum temperature rise (9.209 vs. 7.754 degrees C, RR 1.123, CI 1.061~1.190, p=0.000) were higher on the SP days. CONCLUSION: Change of atmospheric pressure and temperature seems to influence the chance of occurrence of SP. Meteorological phenomena that pressure rise 4 day prior to SP and following temperature fall and rise might explain the occurrence of SP. Further studies should be continued in the future.
Atmospheric Pressure* ; Blister ; Consensus ; Meteorological Concepts ; Pneumothorax* ; Rupture

BACKGROUND: Apoptosis plays a crucial role in carcinogenesis, as well as in development and tissue homeostasis. Terminal deoxyribonucleotidyl transferase mediated neck end labelling (TUNEL) and in situ nick end labelling (ISEL) have been used to investigate the apoptosis in tissues. Since the introduction of the M30 monoclonal antibody to overcome drawbacks of TUNEL and ISEL, the apoptosis in various tumors, with the exception of pulmonary carcinomas, has been studied. In this study, attempts were made to examine the correlation of apoptosis in non-small cell carcinomas, using both M30 and the expression of p53 protein, with the clinicopathological factors. MATERIAL AND METHOD: Forty five patients with surgically resected non-small cell carcinomas were included. Immunohistochemical staining with M30 and p53 monoclonal antibody were performed, and their expressions compared with the clinicopathological features. The overall survival time and recurrence-free survival time were calculated, and the factors influencing the survival time analyzed using a univariate analysis. The effects of the expression stati of M30 and p53 on the risks of cancer related to both death and recurrence were evaluated using a multivariate analysis. RESULT: The p53 positive group had many more M30 positive cells than the p53 negative group (p53 positive group; 61.7+/-26.8 cells vs. p53 negative group; 45.6+/-29.6 cells, p=0.005) and significantly more p53 positive patients showing at least 10 positive cells (apoptotic index, AI > or =1) on M30 staining (p53 positive group; 52.4% [11/21] vs. p53 negative group 16.7% [4/24], p=0.025). In the univariate analysis, the survival times in relation to smoking (pack-year), performance status (PS) and AI showed significant differences. The multivariate analysis demonstrated the relative risk (R.R) of cancer death increased almost 7.5-fold (R.R 7.482; 95% CI 1.886~29.678; p=0.004) and the risk of recurrence almost 3.8-fold (R.R 3.795; 95% CI; 1.184~12.158; p=0.025) in the high AI (> or =1) compared to the low AI (<1) group. There was no prognostic effect of p53 expression on the survival time or risk of cancer death and recurrence. CONCLUSION: In non-small cell lung carcinomas, M30 immunohistochemistry was an excellent method for analyzing apoptosis; the high apoptotic index could be an adverse prognostic predictive factor.
Apoptosis* ; Carcinogenesis ; Cell Death ; DNA Nucleotidylexotransferase ; Homeostasis ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Lung Neoplasms ; Lung* ; Multivariate Analysis ; Neck ; Recurrence ; Smoke ; Smoking