Cardiac electromechanical dissociation is a cause of cardiac arrest and this is characterized by regularly recurring QRS complexes and T waves- P waves may even be present. without an obtainable blood pressure and pulse. Such findings in man are almost invariably associated with a fatal outcome although one can observe this phenomenon in potentially treatable disorders. Recognition of these disorders on the basis of certain clinical and electrocardiographic findings may be of clinical importance. This experimental study on rabbits was performed to observe electromechanical dissociation (E.M.D.) and to recognize its clinical importance, in exsanguinating hemorrhage with the cutting of the right femoral artery. The results were as follows: 1) The incidence of E.M.D. was 100 percent. 2) In the all cases except two cardiac rhythm showed sinus rhythm but in two cases it was difficult to distinguish it from nodal rhythm. 3) Heart rate at the time of E.M.D showed a significant increase of 13,8 percent as compared with the control. 4) The voltage of the P wave and QRS complex at the time of E.M.D. showed a significant decreases of the former, 34.7%, and the latter, 30%, as compared with the control. and the QRS complex at the time of E.M.D showed severe axis deviation. 5) In seven cases in all, the voltage of the T wave at the time of E.M.D, showed a significant decrease of 61. 3 percent (one case showed T wave inversion) and the others showed. conversely a significant increase of 271 percent. 6) Regarding change of interval, the QRS interval showed no changes and P-R and Q-T intervals showed shortening of 14, 7% and 2.4%. 7) We consider that devices for heart sound, pulse or blood pressure monitoring should be: combined with ECG monitoring.
Blood Pressure ; Blood Pressure Monitors ; Electrocardiography ; Exsanguination* ; Fatal Outcome ; Femoral Artery ; Heart Arrest ; Heart Rate ; Heart Sounds ; Incidence ; Rabbits*

Cyanide intoxication results in severe metabolic acidosis and catastrophic prognosis with conventional treatment. Indications of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are expanding to poisoning cases. A 50-year-old male patient arrived in the emergency room due to mental change after ingestion of cyanide as a suicide attempt 30 minutes prior. He was comatose, and brain stem reflexes were absent. Initial laboratory analysis demonstrated severe metabolic acidosis with increased lactic acid of 25 mM/L. Shock and acidosis were not corrected despite a large amount of fluid resuscitation with highdose norepinephrine and continuous renal replacement therapy. We decided to apply ECMO and CRRT to allow time for stabilization of hemodynamic status. After administration of antidote infusion, although the patient had the potential to progress to brain death status, vital signs were improved with correction of acidosis. We considered the evaluation for organ donation. We report a male patient who showed typical cyanide intoxication as lethal metabolic acidosis and cardiac impairment, and the patient recovered after antidote administration during vital organ support through ECMO and CRRT.
Acidosis ; Brain Death ; Brain Stem ; Coma ; Cyanides ; Eating ; Emergency Service, Hospital ; Extracorporeal Membrane Oxygenation* ; Hemodynamics ; Humans ; Lactic Acid ; Male ; Middle Aged ; Norepinephrine ; Organ Transplantation ; Poisoning ; Prognosis ; Reflex ; Renal Replacement Therapy* ; Resuscitation ; Shock ; Suicide ; Tissue and Organ Procurement ; Vital Signs

Lovastatin, a competitive inhibitor of the rate limiting enzyme in cholesterol biosynthesis was administered to 34 patients with primary hypertlipidemia, 20 mg once daily with the evening meal. Patients experienced mean total and LDL cholesterol reductions of 30.9% and 34.0% respectively. HDL cholesterol level was significantly increased by 15.4% and plasma triglyceride level was decreased by 11.2%. maximal hypocholesterolemic effects were evident at 8 weeks, after which the effects were stable. Adverse effects were noted in 2 patients who had mild gastrointestinal symptoms, that subsided after discontinuing the drug. We concluded that lovastatin is a well tolerated and effective agent for the treatment of primary hyperlipidemia.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Humans ; Hyperlipidemias* ; Lovastatin ; Meals ; Plasma* ; Triglycerides

BACKGROUND: This study was designed to examine the interactions between mivacurium and vecuronium when administered during a standardized technique. METHODS: Eighty patients (ASA physical status I or II) were randomly assigned to one of four groups (n=20). Their neuromuscular function was measured in response to ulnar nerve supramaximal square-wave TOF stimulation at 10-sec intervals. After the attainment of a stable baseline neuromuscular response, the patients were randomly assigned to receive a rapid iv bolus of either: (1) 3M group (n=20): mivacurium 0.21 mg/kg. Alone, or (2) 2M1V group (n=20): mivacurium 0.14 mg/kg plus vecuronium 0.05 mg/kg, or (3) 1M2V group (n=20): mivacurium 0.07 mg/kg plus vecuronium 0.10 mg/kg, or (4) 3V group (n=20): vecuronium 0.15 mg/kg alone. The onset time of the neuromuscular block, time of recovery of T1 to 25% and reblock time (the time from the reinjection of vecuronium at the time of recovery of T1 to 25% to the time of recovery of T1 to 25%: T25-25) were measured. The intubating condition was evaluated clinically with a scoring system. RESULTS: The onset of block in the 3M group was 33% slower than in the 3V group. The time durations until 25% recovery in the 2M1V, 1M2V and 3V groups were longer than in the 3M group, and the durations in the 1M2V and 3V groups were longer than in the 2M1V group. The T25-25 reblock times of the 2M1V, 1M2V and 3V groups were prolonged in comparison to that of the 3M group. There was no difference in intubating conditions between any of the groups. CONCLUSIONS: A combination of mivacurium with vecuronium provides rates of onset and duration of block which are more effective than an equivalent dose of mivacuriun alone as an additive reaction.
Anesthesia, General* ; Humans ; Neuromuscular Blockade* ; Ulnar Nerve ; Vecuronium Bromide*

This study was undertaken to investigate the characterization and distribution patterns of MHC class II positive dendritic cells[DCs] and ED2 positive tissue macrophages throughout the estrous cycle and during pregnancy in the rat ovary. The immunohistochemical characterization of the cells was carried out using the monoclonal antibodies OX6 and ED2 in cryostat-cut sections. DCs were distributed in the theca cell layer of the growing and mature follicles,stroma and corpus luteum. Tissue macrophages were distributed in the theca externa of the growing and mature follicles, stroma and corpus luteum but they were smaller in number than DCs. None of DC and tissue macrophage was found in the ovum, granulosa layer and follicular cavity of the ovarian follicle. However, DCs and tissue macrophages were present in the granulosa layer and follicular cavity in the atretic follicles. Degenerating corpus luteum contained a vast number of OX6 positive cells. On the contrary, fewer tissue macrophages were founcl in the degenerating corpus luteum. More macrophages tended to be observed in the former follicular cavity and theca lutein cell layer than in the granulosa lutein cell layer of the corpus luteum. In stroma,DCs and tissue macrophages were more frequently found around the blood vessels than in the other region, however, DCs were relatively greater in number than tissue macrophages. There was no estrous cycle and pregnancy dependent variation in the numbers and distribution patterns of DCs and tissue macrophages. In conclusion, the rat ovary contains rich networks of MHC class II positive dendritic cells and ED2 positive tissue macrophages. These findings suggest the existence of a well-developed system of immunological surveillance in the rat ovary. The results of this study have potentially important implications for the understanding not only of the ovarian immune system and the pathogenesis of various ovarian diseases but also of various physiologic functions of the ovary.
Animals ; Antibodies, Monoclonal ; Blood Vessels ; Corpus Luteum ; Dendritic Cells* ; Estrous Cycle ; Female ; Immune System ; Immunologic Surveillance ; Luteal Cells ; Macrophages* ; Ovarian Diseases ; Ovarian Follicle ; Ovary* ; Ovum ; Pregnancy ; Rats* ; Theca Cells

Opsoclonus-myoclonus syndrome (OMS) is a rare neurologic disorder characterized by progressive opsoclonus (irregular, rapid, horizontal and vertical eye movements), myoclonus, cerebellar dysfunction and severe hypotonia. Here we present the case of a 19-year-old man with OMS induced by mumps virus infection. Emergency physicians should know about the typical presentation of OMS and make a proper response.
Cerebellar Diseases ; Emergencies ; Eye ; Humans ; Mumps ; Mumps virus ; Muscle Hypotonia ; Myoclonus ; Nervous System Diseases ; Ocular Motility Disorders ; Opsoclonus-Myoclonus Syndrome ; Young Adult

Pelvic lipomatosis is a rare disease of unknown etiology characterized by overgrowth of mature, nonmalignant fat cells in the pelvis, especially in the perivesical and perirenal space. An overgrowth of fat surrounding the bladder and rectosigmoid colon produces a radiologic picture characterized by 1) radiolucent pelvic densities, 2) elevation and vertical elongation of the bladder, 3) straightening and elevation of the rectosigmoid colon and 4) absence of malignant vessels on pelvic angiography. Cystoscopy has shown a high incidence of cystitic changes: chronic inflammation, cystitis glandularis and cystitis cystica. We report a case of pelvic lipomatosis associated with cystitis glandularis.
Adipocytes ; Angiography ; Colon ; Cystitis* ; Cystoscopy ; Incidence ; Inflammation ; Lipomatosis* ; Pelvis ; Rare Diseases ; Urinary Bladder

Patients with medullary spongy kidney(MSK) who recurrently form and pass stones are in danger of developing obstructive nephropathy. Since extracorporeal shock wave lithotripsy (ESWL) was introduced to treat urinary tract stones, the shock wave application to MSK with stones has been performed. Between February, 1990 and August, 1992, 11 renal units in 7 patients were diagnosed as stones in MSK on intravenous urography. These patients were all symptomatic with hematuria and/or flank pain, and then treated by ESWL. The number of stone-burden minor calyces was 1 to3 in 2 cases( 18.2%), 4 to 6 in 8 cases ( 72.7% ) and 7 or more in 1 case(9.1%). The average numbers of treatment for these stones were 8.5, 13.4 and 4 sessions, respectively and the average storage was 386, 470 and 115, respectively. Reduction in the number and size of the stones on plain films was more than ?5% in 5 cases( 45.4%), 25 to 75% in 4 cases( 36.4%), and less than 25% in 2 cases( 13.2%). Serum creatinine, blood urea nitrogen, and creatinine clearance rate did not show any change after the treatments. The post-ESWL complication was only persistent gross hematuria for 4 days in 1 case( 14.3% ) In conclusion, although ESWL does not clear the stones completely, the ESWL is considered to be an effective procedure to prevent an obstructive nephropathy and to reduce the frequency of symptomatic stone passage in medullary spongy kidney with stones.
Blood Urea Nitrogen ; Creatinine ; Flank Pain ; Hematuria ; Humans ; Kidney* ; Lithotripsy* ; Nephrocalcinosis* ; Shock* ; Urinary Calculi ; Urography

No abstract available.
Histocompatibility Antigens* ; Histocompatibility* ; Humans ; Young Adult*

To objectively compare the response of the palliative radiotherapy in bone metastatic patients which decreases pain and prevents pathologic fractures, we introduced and applied the RTOG pain and narcotic measure system. From Oct in 1991 to July in 1993, thirty-two patients with painful bone metastases, 17 of them were solitary lesions and others were multiple lesions, were treated with mainly 6 MV photon otherwise 15 MV photon. Radiation doses to bone metastatic sites ranged about from 2000 to 4600cGy. Responses of radiation therapy were compared with days of pre-RT, RT finish, 3, 6, 9 months after the start of RT and solitary versus multiple lesions and follow up scores according to the RTOG measure system. Survival analysis was done. Pain and narcotic score of the entire patients were 7.3, 7.8 at the pre-RT period and 2.6, 3.9 at the immediate or 2 weeks after RT, which was 64%, 50% decrement compared with the pre-RT score. Pain scores of 3, 6 and 9 months after the beginning of irradiation were 3.6, 3.7 and 3.3. The best response found in the breast and prostate primaries was 84%, 78% decrement of pain score as compared with pre-RT score (statistically insignificant). Median survival was 5.5 months and mean survival was 5 months. We conclude that the RTOG pain and narcotic measure system in relatively effective scale in the comparison of before and after palliative irradiation to the painful bone metastatic sites but more detailed parameters will be required in the narcotic scoring system. More aggressive but less or similar toxic radiotherapy is needed in the patients having relatively long life expected time.
Breast ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Neoplasm Metastasis ; Prostate ; Radiotherapy*