This case was an acquired aplastic anemia patient who required a major operation for excision of a mediastinal mass. The authors previewed that the coagulation abnormalities would be developed due to major operation. Thus we decided to monitoring the coagulation function using the thromboelastography during the perioperative period and checked the complete blood count, concommitantly. The total blood volume lost during operation was 1800 ml, so we gave him a transfusion of 10 U's of platelet concentrate, 10 U's of pheretic platelet rich plasma and 5 U's of whole blood. The thromboelastography was a good guide that helped us to avoid excessive treatment of the coagulation abnormalities. We concluded that the thromboelastograhy was a reliable and effective monitoring system at the intraoperative coagulation management.
Anemia, Aplastic* ; Anesthesia, General ; Blood Cell Count ; Blood Platelets ; Blood Volume ; Humans ; Perioperative Period ; Platelet-Rich Plasma ; Thrombelastography

BACKGROUND: The current recommendation of rescue breathing techniques in the infant is to blow both the nose and mouth of infants by caregiver's mouth but recent studies suggest some caregivers may have trouble sealing a infant's mouth and nose. The purpose of this study is to estimate the ability of mothers to create a seal to their infants for the provision of rescue breathing according to current recommendation. METHODS: Infants up to 1 year of age(n=98) and their mothers were enrolled from emergency department of Chonbuk National University Hospital. We measured the facial lengths of the infants and the width of mouth in their mothers and compared mouth widths of mothers with their infant's nose-to-mouth lengths. RESULTS: In infants between 0 to 6 months, Mother transverse lengths were significantly larger than mouth, nose and nose-to-mouth lengths of the infants. In infants between 7 to 12 months, Mother transverse lengths were significantly larger than mouth and nose lengths of the infants but there was no statistically significant difference between mother transverse lengths and nose-to-mouth lengths of infants. CONCLUSION: The finding indicate that the present recommendation to cover mouth and nose is partly not possible. We recommend that the mouth-to-nose ventilation of rescue breathing techniques for the infants who have respiratory arrest be taught to mothers.
Caregivers ; Emergency Service, Hospital ; Humans ; Infant* ; Jeollabuk-do ; Mothers ; Mouth ; Nose ; Respiration* ; Ventilation

BACKGROUND: The growth of cells is closely related to components in a culture medium. There are many reports about cellular characteristics of melanocytes grown in a PMA-contained medium. However, only a few reports have been studied by using a physiologic mitogens-contained medium. To understand melanocyte in vivo, it is necessary to know the cellular biology of melanocytes grown in a physiologic mitogens-contained medium. OBJECTIVE: To investigate any differences between melanocytes grown in phorbol 12-myristate 13-acetate(PMA)-contained medium and in physiologic mitogens-contained medium. METHOD: We examined morphology, number and melanin contents of cultured human melanocytes grown in a PMA-contained medium and physiologic mitogens-, such as bFGF, ET-1 and a a-MSH contained medium. Result : The results are summarized as follows : 1. There were no significant morphologic differences between cells in PMA-contained medium and in physiologic mitogens-contained medium. 2. The number of melanocytes were significantly more numerous in PMA-contained medium on the 2nd day (p<0.05), but significantly less numerous in the same medium on the 6th day (p<0.05). So, the proliferation rate of melanocytes in PMA-contained medium became lower than in physiologic mitogens-contained medium as time went by. 3. Melanocytes grown in PMA-contained medium had significantly increased melanin contents regardless of the time (p<0.05). Conclusion : The proliferation of melanocytes was better in physiologic mitogens-contained medium, the melanization was higher in melanocytes of PMA-contained medium.
Humans* ; Melanins ; Melanocytes*

Since the myofascial trigger point(MFTrP) has been described fifty years ago, its underlying pathophysiology has been remained unclear. The diagnosis also depends on the characteristic pain, tenderness and physical findin gs, which is yery subjective. In recent years, some physicians investigated the objective findings of MFTrP, using the pressure algometer and thermography. We investigated the electromyographic findings of MFTrP to evaluate the clinical usefulness of local twitch response(LTR) and sympathetic skin response (SSR), and to evaluate the electrophysiologic characteristics of MFTrP. 21 patients, diagnosed as myofascial trigger point syndrome on upper trapezius and so on, were evaluated for the triggering pain with visual analog scale(VAS), pressure threshold(THpr) using pressure algometer(Dolorimeter), LTP with concentric needle electrode and SSR on the palm. There was a significant negative correlation between VAS and THpr, but no significant correlation with electromyographic findings of LTR. Thus LTR could support the existence of MFTrP electrodiagnostically, but, could not explain the clinically correlated severity of MFTrP. There were only 3 patients showing abnormal SSR, who were all complaining the sympathetic sympathetic symptoms on the affected arm with reffered pain. Even though referred pain to arm and hand existed. SSR was normal because suggested autonomic dysfunction of MFTrP is localized mechanism. Among the 13 patients underwent the trigger point block, 8 patients who showed no residual LTR immediate after MFTrP block, had a great symptomatic improvement of MFTrP in a week, but 5 patients who showed the residual LTR did not, Regardless of complaint of pain and soreness immediate after block, loss of LTR would be predicted as a good treatment result. In some cases, spontaneous EMG activity exist within the 3-4mm sized focus of MFTrP. although the taut band of MFTrP is 3-4cm length and depth. But this focus of MFTrP is a electrophysiologic changes within a muscle, not a structural changes seen by ultrasonography.
Arm ; Diagnosis ; Electrodes ; Electromyography ; Hand ; Humans ; Needles ; Pain, Referred ; Skin ; Superficial Back Muscles ; Thermography ; Trigger Points* ; Ultrasonography

The frequency of metastasis to the skin from lung cancer is 1-12%. The incidence of cutaneous metastasis was high in patients with large-cell lung cancer, whereas squamous cell and small-cell lung cancer showed the least tendency to extend to cutaneous sites. Adenocarcinoma was intermediate in the tendency to metastasize in the skin. Histological findings of small-cell lung cancer show solid, tumor cell nests composed of neoplastic cells with large, round nuclei. So, it is often difficult to distinguish small-cell lung cancer from other poorly differentiated small-cell tumors, such as Merkel cell carcinoma, metastatic carcinoid, lymphoma, etc. We report here two cases of skin metastasis from small-cell lung cancer. Case one was a 74-year-old man presenting with a single, round, dome-shaped nodule on the alar nasi which had been present for 1 month. The second case was a 73-year-old man who had found three, non-tender, freely movable subcutaneous nodules on the abdomen 3 days before. Both cases were diagnosed as small-cell lung cancer. On histopathological examination of the skin lesions, we could observe that small round to oval cells with dark staining nuclei and scant cytoplasms were arranged in anastomosing trabecular streams through the dermis, separated by strands of connective tissue in both cases. In the first case, the tumor cells were positive to cytokeratin and NSE, negative to neurofilament antiagen and LCA.
Abdomen ; Adenocarcinoma ; Aged ; Carcinoid Tumor ; Carcinoma, Merkel Cell ; Connective Tissue ; Cytoplasm ; Dermis ; Humans ; Incidence ; Keratins ; Lung Neoplasms ; Lymphoma ; Neoplasm Metastasis* ; Rivers ; Skin ; Small Cell Lung Carcinoma*

A 23-year-old woman with Down syndrome presented erythematous keratotic plaques with whitish scales on the elbows, forearm, knee and leg. Histopathological findings revealed acanthosis with broad and short rete ridges, alternating orthokeratosis and parakeratosis oriented in both vertical and horizontal directions, and dermal superficial perivascular lymphocytic infiltration, compatible with pityriasis rubra pilaris.
Down Syndrome* ; Elbow ; Female ; Forearm ; Humans ; Knee ; Leg ; Parakeratosis ; Pityriasis Rubra Pilaris* ; Pityriasis* ; Weights and Measures ; Young Adult

BACKGROUND: The cornified cell envelope (CE) is a unique structure found in the terminal differentiation of the skin. The precursor proteins of the CE are composed of many candidate structural proteins, among which invalucrin and filaggrin are important ones to participate in the complicated process of forming, the complex structure. OBJECTIVE: The purpose of this study was to evaluate the usefulness of expression of involucrin and filaggrin as markers of terminal differentiation in various skin disorders including tumors. METHODS: Immunohistochemical studies were performed in the formalin-fixed, paraffin-embedded skin samples of non-tumors (41 cases) and tumors (43 cases).
Skin*

To investigate the effect of Kawasaki disease on left ventricular function, we studied 92 patients with Kawasaki disease at initial visit, after 3 months (78 patients) and after 1 year (9 patients). Using serial M-mode echocardiogram, we obtained LVD(d) (left ventricular internal dimension at end diastole), LVD(s)(left ventricular internal dimension at end systole), FS (fractional shortening), ET (ejection time), VmCF (mean velocity of circumferential fiber shortening), PWTD (posterior wall thickness at end diastole), PWTS (posterior wall thickness at end systole) and peak systolic wall stress. Fractional shortening was significantly decreased in Kawasaki disease, being a mean (+/-SD) of 38.9 (+/-8.2)% in the control group, 33.8 (+/-7.8) at initial visit (P<0.05), 34.8(+/-7.0) after 3 months (P<0.05), and 33.8 (+/-3.4) after 1 year (P<0.05). Rate corrected VmCF was significantly decreased in Kawasaki disease, being a mean (+/-SD) of 1.25 (+/-0.28) circ/sec in the control group, 1.05 (+/-0.28) at initial visit (P<0.01), 1.10 (+/-0.25) after 3 months (P<0.05), 1.08 (+/-0.15) after 1 year (P<0.05). Peak systolic wall stress was significantly increased in Kawasaki disease, 51.7 (+/-16.6) gm/cm2 in the control group, 64.9 (+/-20.7) at initial visit (P<0.05), 63.2 (+/-18.3) after 3 months (P<0.05), 76.6 (+/-17.3) after 1 year (P<0.01). Peak systolic wall stress adjusted, rate corrected mean velocity of circumferential fiber shortening was significantly decreased only at initial visit. We concluded that abnormalities of left ventricular function, as assessed by M-mode echocardiography, generally persist after 1 year.
Echocardiography* ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Ventricular Function, Left

BACKGROUND: The mechanically ventilated patient's stay in the emergency department (ED) is brief but ventilatory management and intervention must be optimal. Agitation, anxiety, distress, and discomfort are common complications far the ventilated patient. So, sedation is necessary to reduce these complications. METHODS: Patients were monitored and mechanically ventilated. Midazolam was intravenously administered as loading dose(3-5mg), followed by continuous infusion at a rate of 0.06mg/kg/hr, titrated to achieve a predetermined sedation level (Ramsay's sedation score: 2-5 points, Glasgow coma score scathe : 8-11 points). RESULTS: After onset of predetermined sedation, systolic and diastolic blood pressure and heart rate remained stable during continuous infusion when compared with those of the initial state. Arterial blood gas and peak inspiratory pressure remained unchanged but respiratory rate was decreased to allowable ranges. CONCLUSION: A short-term continuous infusion of midazolam was a safe and erective method for sedation of ventilated patients in ED.
Anxiety ; Blood Pressure ; Coma ; Dihydroergotamine ; Emergency Service, Hospital ; Heart Rate ; Humans ; Midazolam* ; Respiratory Rate

No abstract available.
Bronchopulmonary Sequestration*