No abstract available.

No abstract available.
Fatigue* ; Sciatica*

Atrial flutter is and infrequent, but potentially unstable tachyarrythmia that occurs in pediatric ages. Transesophageal atrial pacing was used for treatment of 10 episodes of atrial flutter in 7 patients. At the time of atrial flutter conversion, patients were 6 days to 14 years old. 6 patients had associated with congenital heart disease. The atrial cycle length of atrial flutter ranged from 140 to 280 msec with variable atrioventricular conduction. Transesophageal atrial pacing was performed using a bipolar 4 F transesophageal electrode catheter. Atrial flutter conversion was accomplished with stimulation bursts using about 5 seconds of stimuli, 10 msec in duration at 20 to 27 mA. Pacing cycle length was 45 to 110 msec less than the atrial cycle length of tachycardia in 6 episodes. But in a neonate, underdrive pacing converted atrial flutter to sinus rhythm. Conversion attempts were unsuccessful on 2 occasions. Transesophageal atrial pacing is a safe and effective, minimally invasive technique for treatment of atrial flutter in infants and children.
Adolescent ; Atrial Flutter* ; Catheters ; Child* ; Electrodes ; Heart Defects, Congenital ; Humans ; Infant* ; Infant, Newborn ; Tachycardia

BACKGROUND: Head-down suspension (HDS) of rats has been used as a model for the simulation of a microgravity environment. Atrial natriuretic peptide (ANP), C-type natriuretic peptides (CNP) and their receptors are found in the kidney, suggesting that these peptides could play a significant physiological role in the kidney. Therefore, this study was investigated the changes in the adaptations of renal natriuretic peptides and their receptors syntheses after 4 weeks of HDS in rats. METHODS: Unanesthetized, unrestrained, male Sprague-Dawley rats were subjected to either a horizontal position (control rats) or a -45degreeshead-down tilt using the tail-traction technique (HDS rats). This study observed the renal syntheses of natriuretic peptides as a expression of ANP and CNP mRNA, and also determined the expression of A-type natriuretic peptide receptor (NPR-A) mRNA and B-type NPR (NPR-B) mRNA. The expressions of natriuretic peptide and NPR mRNA were measured by reverse transcription-polymerase chain reaction with [(32)P]-dCTP following 4 weeks of HDS in the kidney of both control and HDS rats. RESULTS: After 4 weeks of HDS, the expression of ANP mRNA significantly (P<0.01) decreased, while CNP mRNA expression was showed the non-significant increasing trend in the kidney of HDS rats. NPR-A, which binds with ANP, was significantly (P<0.001) decreased in renal mRNA expression of HDS rats compared with controls. Expression in mRNA of NPR-B, which binds with CNP, showed a slightly decreasing trend in the kidney of rats following HDS. CONCLUSION: These results suggest that the renal adaptation following 4 weeks of HDS exerts to maintain the blood volume and electrolyte balance through attenuation of syntheses in the natriuretic peptide and its binding receptor, especially in ANP rather than in CNP systems.
Animals ; Atrial Natriuretic Factor ; Blood Volume ; Humans ; Kidney ; Male ; Natriuretic Peptides* ; Peptides ; Rats* ; Rats, Sprague-Dawley ; Receptors, Peptide ; RNA, Messenger* ; Water-Electrolyte Balance ; Weightlessness

No abstract available.
Brain Injuries* ; Child* ; Glasgow Coma Scale ; Humans

No abstract available.
Female ; Hemangioendothelioma/metabolism/*pathology/surgery ; Humans ; Infant ; Interferon-alpha/therapeutic use ; Liver Neoplasms/metabolism/*pathology/surgery ; Tomography, X-Ray Computed ; alpha-Fetoproteins/*analysis

No abstract available.
Carcinoma, Hepatocellular/*pathology/secondary/surgery ; Diagnosis, Differential ; Hepatitis B, Chronic/diagnosis ; Humans ; Liver Neoplasms/diagnosis/*pathology/surgery ; Male ; Middle Aged ; Sarcoma/diagnosis/*pathology/surgery ; Tomography, X-Ray Computed ; Vimentin/metabolism

No abstract available.
Adult ; Antigens, CD34/metabolism ; Female ; Hemangiosarcoma/diagnosis/*pathology/surgery ; Humans ; Liver Neoplasms/diagnosis/*pathology/surgery

OBJECTIVE: Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. METHODS: We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3-8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. RESULTS: Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. CONCLUSION: Ethical training and developing decision-making skills are necessary including shared decision making.
Aged* ; Brain Injuries ; Coma ; Craniocerebral Trauma* ; Decision Making* ; Humans ; Medical Records ; Missions and Missionaries ; Mortality ; Patient Participation ; Prognosis ; Pupil ; Retrospective Studies

Objective: To assess the contrast-enhanced CT and ultrasonography (US) findings of intracholecystic papillary neoplasm (ICPN) and determine the imaging features predicting ICPN associated with invasive carcinoma (ICPN-IC). Materials and Methods: In this retrospective study, we enrolled 119 consecutive patients, including 60 male and 59 female, with a mean age ± standard deviation of 63.3 ± 12.1 years, who had pathologically confirmed ICPN (low-grade dysplasia [DP] = 34, high-grade DP = 35, IC = 50) and underwent preoperative CT or US. Two radiologists independently assessed the CT and US findings, focusing on wall and polypoid lesion characteristics. The likelihood of ICPN-IC was graded on a 5-point scale. Univariable and multivariable logistic regression analyses were performed to identify significant predictors of ICPN-IC separately for wall and polypoid lesion findings. The performances of CT and US in distinguishing ICPN-IC from ICPN with dysplasia (ICPN-DP) was evaluated using the area under the receiver operating characteristic curve (AUC). Results: For wall characteristics, the maximum wall thickness (adjusted odds ratio [aOR] = 1.4; 95% confidence interval [CI]: 1.1–1.9) and mucosal discontinuity (aOR = 5.6; 95% CI: 1.3–23.4) on CT were independently associated with ICPN-IC.Among 119 ICPNs, 110 (92.4%) showed polypoid lesions. Regarding polypoid lesion findings, multiplicity (aOR = 4.0; 95% CI: 1.6–10.4), lesion base wall thickening (aOR = 6.0; 95% CI: 2.3–15.8) on CT, and polyp size (aOR = 1.1; 95% CI: 1.0–1.2) on US were independently associated with ICPN-IC. CT showed a higher diagnostic performance than US in predicting ICPN-IC (AUC = 0.793 vs. 0.676; p = 0.002). Conclusion ICPN showed polypoid lesions and/or wall thickening on CT or US. A thick wall, multiplicity, presence of wall thickening in the polypoid lesion base, and large polyp size are imaging findings independently associated with invasive cancer and may be useful for differentiating ICPN-IC from ICPN-DP