PURPOSE: The feasibility and differential effects of two music therapy methods (interventions with preferred music vs. classical relaxation music) were done to examine the effects on agitation and anxiety in patients weaning off mechanical ventilation. METHODS: This pilot study was conducted using a crossover design. Six patients listened to preferred music choices and classical relaxation music. Anxiety scores were measured using the Richmond Agitation Sedation Scale (RASS), State-Trait Anxiety Inventory (STAI), and visual analog scale (VAS). RESULTS: Patients showed a significant decrease in agitation and anxiety after both the preferred and classical relaxation music interventions. The difference in the effects of preferred music and that of classical relaxation music was not significant. As for feasibility, patients exhibited a change in agitated behaviors after the music interventions by not trying to take off medical devices and quietly listening to the music, and by smiling and moving lips along with the lyrics while listening. CONCLUSION: Music interventions which centered on either patients' preferences or classical relaxation music to enhance relaxation, helped reduce agitation and anxiety during the mechanical ventilation weaning process.
Anxiety ; Cross-Over Studies ; Dihydroergotamine ; Humans ; Lip ; Methods ; Music Therapy ; Music ; Pilot Projects ; Relaxation ; Respiration, Artificial ; Smiling ; Ventilation ; Visual Analog Scale ; Weaning

Tracheal gaenesis is an extremely rare congenital anomaly and is characterized by totally or partially undeveloped trachea. In many instances, the lesion has been associated with malformations in other organ systems. This anomaly is classified into 3 types based on developmental period of the respiratory tract. We report a case of tracheal agenesis with tracheoesophageal fistula in a 2-hour-old male. Postmortem examination revealed that the upper and mid portion of the trachea was absent but 1 cm segment of the trachea above the carina was present. The proximal end to this trachea opened to the esophagus by a fistula, 1 cm in diameter. The well-formed larynx ended blindly in a fibrous sac at which thyroids and cartilage islands are noted. Associated anomalies were bilobed right lung and single umbilical artery.

Fibrous histiocytoma is a common benign tumor which occurs usually in the dermis. It can be classified as fibrous type, cellular type, mixed type and angiomatoid type, depending on its major cellular components. Angiomatoid fibrous histiocytoma is a rare subtype, showing characteristic hemorrhagic cyst. Fibrous histiocytoma arises rarely in deep soft tissues such as fascia, muscle or periosteum, and shows clinical and histopathological characteristics somewhat different from the cutaneous histiocytoma. We report a case of angiomatoid fibrous histiocytoma of deep location which arose in the galea of scalp in a 7-year-old boy, who had a tender slightly fixed deep seated nodule, measuring 0.5 cm, for 5 months.
Child ; Dermis ; Fascia ; Histiocytoma, Benign Fibrous* ; Humans ; Male ; Periosteum ; Scalp

OBJECTIVE: The negative symptoms of schizophrenia usually are not responsive to drug therapy to persist and make schizophrenics more difficult in their rehabilitation. The authors investigated the therapeutic effect of token economy(TET) for negative symptoms of schizophrenic patients, and attempted to develop a TET program f3r psychiatric wards in general hospital. METHODS: Negative subscale of PANSS was rated for 35 schizophrenics with negative symptoms as their main problems before and after short-term TET(less than 3 months). Therapeutic factors were identified by comparing patient and program variables between the achieved and the non-achieved group of each level of target behaviors. RESULTS: 1) Subtotal of negative subscale of PANSS was decreased from 31.57+/-4.32 at baseline to 20.66+/-4.63 artier treatment. With TET, symptoms of difficulty in abstract thinking' and 'stereotypic thinking' were less responsive than the other 5 items of the scale Also the dose of antipsychotics prescribed was reduced to 291.21+/-287.74mg/day from 487.58+/-372.79mg/day. 2) The achievement rate of level I (self-help) was 75%, level II (ward-activity) 78%, and level III (social activity/occupation) 68%, resulting in average 74% for all target behaviors. 3) On level II, dose of antipsychotics was lower, and on level III, number of admission was lower and female sex was more frequent in achieving patient group than nonachieving group. The rate of achievement was higher in case of special flood, reception, and outing with family applied as a reinforcer on level I, and reception on level II . CONCLUSION: These results showed that TET was effective for schizophrenic patients with negative symptoms in psychiatric ward. Further investigations to refine the individual program of TET will be needed far enhancement of it s therapeutic efficacy and smart application of it.
Antipsychotic Agents ; Drug Therapy ; Female ; Hospitals, General ; Humans ; Rehabilitation ; Schizophrenia ; Token Economy*

BACKGROUND: For the treatment of primary varicose vein of greater saphenous vein(GSV) due to reflux from incompetent saphenofemoral junction(SFJ), several methods such as ligation and stripping, or duplex-guided sclerotherapy have traditionally been introduced. As for sclerotherapy, the recurrence rate has been reported to be very high. In spite of higher success rate, traditional high ligation with stripping of GSV requires several days' admission with general anesthesia and several more days before returning to normal daily life. New modalities, which are less invasive and possibly have lower recurrence to rate with a chance for early ambulation, are being proposed. They are such as endovenous radiofrequency(RF) therapy, endovenous laser therapy, etc. OBJECTIVE: We tried to evaluate the efficacy and safety of endovenous RF therapy as an alternative to high ligation and stripping in case of GSV varicosity in mild to moderate degrees. METHODS: Both GSV varicosities and varicosed tributaries are marked by doppler and/or ultrasonic imaging. A catheter connected to RF generator is inserted proximally through the incision of vein wall percutaneously, usually above or below the knee. After confirming position of the SFJ using ultrasound, the catheter is progressed as far as to 1-2cm below the SFJ. Then, the generator is activated and the catheter withdrawn slowly for complete heating and occlusion of the target vein. Additional ambulatory phlebectomy or sclerotherapy is optional. We wrap the limbs with self-adhesive short stretch bandage for 2-3 days and encourage the patient to walk regularly and wear compressive stocking later. RESULTS: We performed endoluminal RF treatment on 10 legs of 9 patients(5 males and 4 females). Follow-up intervals varied from 2 to 10 months. Patients were generally satisfied with improvement of symptom. On the clinical evaluation with doppler and duplex examination, there were a few blood flows except only some segments of GSV in 7 patients CONCLUSION: Although endoluminal RF therapy may have a somewhat higher recurrence rate than that of traditional high ligation with stripping of GSV, endoluminal RF therapy is expected to have several advantages over traditional surgery, including less invasiveness, no need for admission or general / spinal anesthesia, earlier return to normal daily life, and finally easy performance, especially for the dermatologist.
Anesthesia, General ; Anesthesia, Spinal ; Bandages ; Catheters ; Early Ambulation ; Extremities ; Follow-Up Studies ; Heating* ; Hot Temperature* ; Humans ; Knee ; Laser Therapy ; Leg ; Ligation ; Male ; Recurrence ; Saphenous Vein* ; Sclerotherapy ; Ultrasonography ; Varicose Veins* ; Veins

PURPOSE: This study was designed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during TRUS-guided biopsies. MATERIALS AND METHODS: From April 2003 to September 2003, 90 men undergoing a transrectal prostate biopsy were randomized into three groups. In group 1, 30 patients intrarectally received 20ml of 2% lidocaine gel; and group 2, 30 patients received 5ml(2.5ml per side) of 2% lidocaine solution injected along each side of the prostate, near the junction of the seminal vesicle and the base of the prostate(along the neurovascular bundles); in group 3, 30 patients received 5ml(2.5ml per side) of normal saline injected along the neurovascular bundles. The pain level after the biopsy was assessed using a 10-point linear visual analog pain scale(VAS). A statistical analysis was performed using the Wilcoxon Rank Sum test, and the results compared. RESULTS: Patient who received lidocaine solution injections along the neurovascular bundles (Group 2) had significantly lower VAS scores compared to the control group(mean score 3.56+/-2.13 versus 5.83+/-1.94, p<0.0001), but patients who received intrarectal lidocaine gel did not (mean score 5.46+/-2.70 versus 5.83+/-1.94, p=0.671). Gross hematuria, rectal bleeding and hemospermia occurred in 36(40.0%), 6(6.7%) and 5(5.6%) subjects, respectively. One patient had a vasovagal syncope. No patient reported febrile UTI or urinary retention. CONCLUSIONS: Bilateral nerve blockade with local anesthetic is a safe technique that significantly reduces pain during a prostate biopsy. However, in this study, intrarectal lidocaine injection did not reduce the pain compared to the control group during the prostate biopsy.
Anesthesia, Local* ; Anesthetics, Local ; Biopsy* ; Hematuria ; Hemorrhage ; Hemospermia ; Humans ; Lidocaine ; Male ; Nerve Block ; Prospective Studies* ; Prostate* ; Seminal Vesicles ; Syncope, Vasovagal ; Urinary Retention

Lipoma is one of the most common benign tumors of soft tissue which tends to be left untreated due to unremarkable clinical features and its property of slow growth. It comes to clinical attention only when it causes concern of malignancy because of inordinate size or is perceived as faults in need of cosmetic removal and consequently the incision line is, frequently long and may result in high risk of intra- and postoperative complications such as hematoma and hypertropic scars. So it requires cosmetically acceptable and convenient methods for treatment of lipoma, especially located in the exposed area. The liposuction was tried to get less complications and smaller incision line. But for deep seated variants of lipoma they tend to be less well-circumscribed and often have thick fibrous septa around the lipoma, simple liposuction showed some limitations. So we tried the new liposuction method using arthroscopic shaver for 5 patients having lipomas larger than 5 cm in diameter. The surgery was performed with arthroscopic shaver system equipped with a motorized blade rotating in the suction cannula and emulsifying the lipoma tissue for easy aspiration. The aspirated material was collected and examined histopathologically to rule out the evidence of malignancy. Lipomas were removed completely without any remarkable complications, and no recurrence was seen till three years after surgery. The new method was easier to operate and took less operation time and left only small incision line.
Catheters ; Cicatrix ; Hematoma ; Humans ; Lipectomy ; Lipoma* ; Postoperative Complications ; Recurrence ; Suction

Lipoma is one of the most common benign tumors of soft tissue which tends to be left untreated due to unremarkable clinical features and its property of slow growth. It comes to clinical attention only when it causes concern of malignancy because of inordinate size or is perceived as faults in need of cosmetic removal and consequently the incision line is, frequently long and may result in high risk of intra- and postoperative complications such as hematoma and hypertropic scars. So it requires cosmetically acceptable and convenient methods for treatment of lipoma, especially located in the exposed area. The liposuction was tried to get less complications and smaller incision line. But for deep seated variants of lipoma they tend to be less well-circumscribed and often have thick fibrous septa around the lipoma, simple liposuction showed some limitations. So we tried the new liposuction method using arthroscopic shaver for 5 patients having lipomas larger than 5 cm in diameter. The surgery was performed with arthroscopic shaver system equipped with a motorized blade rotating in the suction cannula and emulsifying the lipoma tissue for easy aspiration. The aspirated material was collected and examined histopathologically to rule out the evidence of malignancy. Lipomas were removed completely without any remarkable complications, and no recurrence was seen till three years after surgery. The new method was easier to operate and took less operation time and left only small incision line.
Catheters ; Cicatrix ; Hematoma ; Humans ; Lipectomy ; Lipoma* ; Postoperative Complications ; Recurrence ; Suction

Sweet's syndrome is an uncommon reactive dermatosis characterized by fever, polymorphonuclear leukocytosis, painful erythematous cutaneous plaques and dense dermal infiltrate of neutrophils at the skin lesions. Unlike Sweet's syndrome associated with patients with malignancies, autoimmune diseases, antecedent infectons-most commonly the upper respiratory infections, it is reported to be rarely associated with systemic lupus erythematosus (SLE). Here we report a rare case of young female with Sweet's syndrome and SLE presenting with high fever.
Autoimmune Diseases ; Female ; Fever ; Humans ; Leukocytosis ; Lupus Erythematosus, Systemic* ; Neutrophils ; Respiratory Tract Infections ; Skin ; Skin Diseases ; Sweet Syndrome*

Pyoderma-pyostomatitis vegetans (PD-PSV) is a rare, benign, eosinophilic pustular and vegetating mucocutaneous disease characterized by skin lesions which typically involve the axillary and genital regions, the face and the scalp. PD-PSV was at first regarded as a subtype of bullous disease. However, due to the lack of abnormality under a immunofluorescent microscope, it could be diffentiated from bullous disease. A 48-year woman presented with a 6-month history of sharply-outlined, exudative, papillomatous and vesiculopustular vegetating plaques on the perioral, umbilicus and nasal mucosa, tips of her fingers and toes and perianal region. A skin biopsy taken from the lip and umbilicus showed papillary dermal edema and focal inflammatory cell infiltration composed of many eosinophils, intraepithelial microabscesses, focal spongiosis, and exocytosis. No abnormalities were found during an immunofluorescence study. The lesions were almost cleared with 20 mg of triamcinolone and 200 mg of cyclosporin medication during a 3-month treatment period.
Biopsy ; Cyclosporine ; Edema ; Eosinophils ; Exocytosis ; Female ; Fingers ; Fluorescent Antibody Technique ; Humans ; Lip ; Nasal Mucosa ; Scalp ; Skin ; Toes ; Triamcinolone ; Umbilicus