Actinomycosis is a chronic suppurative and granulomatous disease characterized by peripheral spread and extension to contagious tissue, rare hematogenous spread, and the formation of multiple draining sinus tracts. In the rare case of hematogenous disseminated Actinomycosis; lesions appear in all parts of the body. Bone involvement, however, is very rare except the jaw and there has been only some reports about the ribs and vertebral columns. To our knowledge, this case represents the first report of documented distal femoral involvement.
Actinomycosis ; Femur ; Fractures, Spontaneous ; Jaw ; Osteomyelitis ; Ribs ; Spine

We report a case of a 44 year old femele with unilateral aldosterone-proudcing adrenal adenoma characterized by hypertension, plasma aldosterone excess, and low plasma renin, commonly but not invariably with hypokalemia. She also had asymmetric septal hypertrophy of left ventricle established with two-dimensional echocardiography. The electrocardiogram showed inverted T wave and prominent U wave with high QRS voltage on precordial leads. In the case of this patient, we are not sure whether asymmetric septal hypertrophy was caused by secondary hypertension and chronic aldosterone excess of primary aldosteronism, or hypertrophic cardiomyopathy per se, so further long=term follow-up is required to determine it. Following the successful unilateral adrenalectomy, however, the systemic pressure fell down to the normal level and electrolyte abnormalities were corrected immediaterly within a few days and the modest regression in septal hypertrophy was noted in one year, suggesting that the promary aldosteronism contributes to the development or porgression of asymmetric septal hepertrophy.
Adenoma ; Adrenalectomy ; Adult ; Aldosterone ; Cardiomyopathy, Hypertrophic* ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Heart Ventricles ; Humans ; Hyperaldosteronism* ; Hypertension ; Hypertrophy ; Hypokalemia ; Plasma ; Renin

Dryness has harmful effect on the harvested autogenous bone. But there was no report how the bone cells response to the drying condition and recuperate after exposure. Cytotoxic effect of dryness on the osteoblast-like cells were examined from 18- day chick calvaria. The cells were rinsed with lactated Ringer solution or lactated Ringer solution with 10% fetal bovine serum to see whether the added serum could help the cells live longer. Cultured cells were exposed to room air for period of time ranging from 0 minute to 35 minutes and viability was determined using the MTT test. Cultured cell death increased with the increase of exposure time to air between 25 and 30 minutes. No live cells existed after 35 minutes exposure. Lactated Ringers solution containing 10% fetal bovine serum did not prolong the survival time of osteoblast-like cells compared with lactated Ringers solution alone. These results suggest that the drying of bone cells that occurs in the operating room, especially after a prolonged reconstructive procedure, may severely damage the cell viability of exposed bone or grafted bone and thereby compromise the fusion rate.
Cell Survival* ; Cells, Cultured ; Operating Rooms ; Skull ; Transplants

The possibility that immediate neurovascular injury will follow fracture of the clavicle has been generally known. A case of delayed involvement of the subclavian vein following a nonunion of clavicular fracture is reported emphasizing the proper reduction and union of the clavicle fracture is essential if delayed neurovascular complication are to be avoided or treated.
Clavicle ; Subclavian Vein ; Thrombosis* ; Veins*

No abstract available.
Chorionic Gonadotropin* ; Female ; Gonadotropins* ; Humans* ; Ovulation*

Although ventricular pacing alone initially had deemed adequate for most clinical situations, some patients did not do well after ventricular pacing was initiated, and developed various symptoms attributed to this mode of pacing. The pacemaker syndrome is complex of clinical signs and symptoms related to the adverse hemodynamic and electrophysiologic consequences of ventricular pacing in the absence of other causes. Neurologic symptoms or those congestive heart failure predominated. We recently experienced a case of pacemaker syndrome in a 44-year-old female who had suffered sick sinus syndrome and was implanted with dual chamber pacing system being programmed to VVI pacing. She complained of chest discomfort, dyspnea, and near-fainting in a day after being programmed to VVI. Blood pressure was decreased to 9/60mmHg. Electrocardiography showed toPwave onT wave, representing retrograde ventriculoatrial conduction. The symptoms and signs were disappeared immediately after the pacing system was programmed to DDD pacing.
Adult ; Blood Pressure ; Dichlorodiphenyldichloroethane ; Dyspnea ; Electrocardiography ; Female ; Heart Failure ; Hemodynamics ; Humans ; Neurologic Manifestations ; Sick Sinus Syndrome ; Thorax

The purpose of this study was to investigate the characteristics or the potassium channels existing in the rat urinary bladders. Smooth muscle strips of rat detrusor urinae were examined by isometric myography. Relaxation responses of detrusor muscle strips to the three potassium channel openers pinacidil, a cyanoguanidine derivative, BRL 38227, a benzopyran derivative and RP 52891, a tertrahydrothiopyran derivative were examined. The potassium channel openers reduced the basal tone, and the rank order of potency was RP 52891>pincidil>BRL 38227. Procaine, an inhibitor of the voltage-sensitive potassium channel tended to increase the basal tone, but it did not affect the relaxant effects of the calcium-activated potassium channel opener did not antagonize the relaxant effects, but it reduced the Emax of RP 52891 and BRL 38227. Glibenclamide, an inhibitor of the ATP-sensitive potassium channel, antagonized the relaxant effects of pinacidil, RP 52891 and BRL 38227 reducing the Emax of RP 52891 and BRl 38227. Galanin which inhibits secretion of insulin through opening the ATP-sensitive potassium channels in pancreatic β-cells rather increased the basal tone of the isolated detrusor strips. These results suggest that the urinary bladder of the rat has mainly the ATP-sensitive, glibenclamide sensitive potassium channel, which is a different type from that in the pancreatic β-islet cells.
Animals ; Cromakalim ; Galanin ; Glyburide ; Insulin ; KATP Channels ; Muscle, Smooth ; Myography ; Pinacidil ; Potassium Channels* ; Potassium Channels, Calcium-Activated ; Potassium* ; Procaine ; Rats* ; Relaxation ; Urinary Bladder

No abstract available.
Female ; Hysterectomy, Vaginal*

BACKGROUND: The use of laparoscopic techniques in general surgery has gained increasing popularity. The small, limited incisions are well accepted by patients and there is the benefit of a faster recovery. But the contribution of N2O to nausea and vomiting is still controversial. This study was undertaken to evaluate the effect of N2O for airway pressure, blood gas and postoperative emesis in laparoscopic cholecystectomy. METHODS: Twenty ASA physical status I, II patients for elective laparoscopic cholecystectomy were randomly divided into two groups. First group (n=10) of patients was anesthetized with isoflurane(0.5~1.5 vol%)-O2 (2 l/min)-air (2 l/min). Second group (n=10) of patients was anesthetized with isoflurane (0.5~1.5 vol %)-O2 (2 l/min)-N2O(2 l/min). After induction of anesthesia, ventilation was controlled with tidal volume 10 ml/kg and respiratory rate 11/min and not changed throughout the operation. After measuring of control value of PaCO2, pH and airway pressures before CO2 insufflation, repeatedly measured at 20 min, 40 min after CO2 insufflation and 10 min after CO2 exsufflation. We observed the patients concerning nausea and vomiting for postoperative period. RESULTS: There were no significant intraoperative differences between the both groups with respect to PaCO2, pH and airway pressures. In the both groups, PaCO2 and airway pressure throughout the operation are significantly increased in comparison to control values. The pH is significantly decreased in comparison to control values. The incidence of postoperative nausea and vomiting was similar in both groups. CONCLUSIONS: N2O had no clinically apparent effects on airway pressure, blood gas and postoperation emesis during laparoscopic cholecystectomy.
Anesthesia ; Anesthetics ; Blood Pressure* ; Cholecystectomy, Laparoscopic* ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Insufflation ; Isoflurane ; Nausea ; Postoperative Nausea and Vomiting* ; Postoperative Period ; Respiratory Rate ; Tidal Volume ; Ventilation ; Vomiting

BACKGROUND: Blunted perception of dyspnea, which may be related to the increased mortality, has been demonstrated in patients with a history of near-fatal asthma and in the elderly. OBJECTIVE: The purpose of this study was to evaluate the relationship between the perception of dyspnea and the severity of asthma. METHOD: Baseline spirometry and Borg score change(A Borg score) during breathing through an inspiratory muscle trainer were measured in 27 consecutive asthma patients and 11 normal subjects. RESULTS: The baseline Borg score was negatively related to FEV1 A Borg score was significantly lower in asthmatics than in controls at high level of loads. A Borg score was lower in severe asthma than in mild asthma. A Borg score was positively related to the baseline FEV1. Seventy-five percent of severe asthma, 62.5% of moderate one, and 9.1% of mild one showed impaired dyspnea perception. Dyspnea perception was related to age(r, = -0.49, p<0.001). CONCLUSION: Three quarters of patients with severe asthma showed impaired dyspnea perception to inspiratory resistive load. Dyspnea perception was related to asthma severity and age.
Aged ; Asthma ; Dyspnea* ; Humans ; Mortality ; Respiration ; Spirometry