BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

No abstract available.
Kidney Transplantation*

This study was performed to elucidate the hormone dependence of collagen levels in male accessory sex organs. Sex hormones were administered to male rats with castration, and their effects on the ventral prostate and seminal vesicles were studied by changes of parameters such as organ weight, DNA and collagen contents. 1. In normal rat ventral prostate and seminal vesicles, organ weight, DNA and collagen contents were found to increase with aging. 2. After castration, all the parameters(organ weight, DNA content, and collagen content) were decreased in both ventral prostate and seminal vesicles. While castration produced marked reductions in organ weight and DNA content, collagen levels in seminal vesicles and ventral prostate were reduced only 43% and 59%, respectively. 3. in the ventral prostate, estrogen treatment of castrates had no stimulatory effects of collagen or other parameters. In contrast, estrogen treatment significantly decreased the reduction of organ weight and collagen levels in seminal vesicles, but neither collagen levels nor other parameters were restored to normal. 4. In castrates, the regression in seminal vesicles and ventral prostate collagen levels and other parameters were prevented by testosterone treatment. Since effects of combined treatment of testosterone and estrogen were not different with those of testosterone treatment, there may be no synergistic relationship between androgen and estrogen. 5. According to above results, androgen is of primary significance in collagen growth of male accessory sex organ. In castrates, estrogen has some stimulatory effects to collagen of seminal vesicle, but no stimulatory effect to collagen of ventral prostate.
Aging ; Animals ; Castration ; Collagen* ; DNA ; Estrogens ; Genitalia* ; Gonadal Steroid Hormones* ; Humans ; Male* ; Organ Size ; Prostate ; Rats* ; Seminal Vesicles ; Testosterone

According to the autopsy study for the temporomandibular joint disc position, rotation and sideway displacements as well as anterior displacement of TMJ discs are important aspect of internal derangement. There were some trials to suspect anterior and sideway disc displacements through MR images. But the sagittal and the coronal views of MRI could only show the image of cutted slices, these images were not sufficient for showing the entire correlations amomg glenoid fossa, condylar head and articular disc. In this study we combined the images of the each slice of sagittal views like drawing a map, then we could see the interrelations among these three major components of TMJ smore precisely. Applying this method to both asymtomatic volunteers and TMD patients, we classified the interrelationships between condylar head and articular disc of TMJ as twelve types. The distributions are as follows: 1. In asymptomatic volunteers cases, normal relations were 65.0%, sideways or rotational displacements without anterior displacement were 20.0%, only anterior displacements were 15.0%, and anterior displacements combined with rotational displacements were 5.0%. 2. In unaffected sides of TMD patients, normal relations were 42.1%, rotational displacements were 11.8% and anterior displacements were 47.0%. 3. In affected sides of TMD patients, normal relations were 10.6%, sideways or rotational displacements were 13.6%, anterior displacements were 75.8%. 4. In asymptomatic volunteers or unaffected sides of TMD patients, pure anterior displacement was more prominent than combined with sideways or rotational displacement, but in affected sides of TMD patients pure anterior displacement was less prominent.
Autopsy ; Head ; Humans ; Magnetic Resonance Imaging ; Temporomandibular Joint Disc ; Temporomandibular Joint* ; Volunteers

BACKGROUND: Remifentanil appears to have a pharmacologic profile similar to other potent mu agonists, but with exceptionally short lasting pharmacokinetics. It is likely to make it a very useful opioid for clinical practice. The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to anesthetic agents and noxious stimulus. The purpose of this study is to compare sedative and cardiovascular effects of remifentanil and fentanyl during target controlled infusion (TCI) of propofol by monitoring BIS and hemodynamics. METHODS: Fifty-two patients undergoing total abdominal hysterectomy were randomly assigned to remifentanil group and fentanyl group with 26 cases in each group. Anesthesia was induced with propofol (4microgram/ml) and either remifentanil (0.5microgram/kg) or fentanyl (1.5microgram/kg) and was maintained with inhalation of 50% nitrous oxide and 50% oxygen mixture and a continuous infusion of either remifentanil (0.2microgram/kg/min) or fentanyl (0.03microgram/kg/min). Depth of anesthesia, hemodynamic changes and adverse reactions were observed. RESULTS: The number of patients exhibited light depth of anesthesia during tracheal intubation and maintenance in the remifentanil group was significantly lesser than that in the fentanyl group (P<0.05). During intubation, skin incision, maintenance of anesthesia and extubation, remifentanil group shows lesser fluctuation of hemodynamic value than those in the fentanyl group (P<0.05). BIS was significantly decreased both groups during infusion of propofol, but no difference was found between the two groups. There was no significant difference between the two groups in the aspect of adverse reactions. CONCLUSIONS: Remifentanil with propofol TCI based anesthetic can prevent the fluctuation of heart rate and mean arterial pressure during the operation especially, during intubation.
Anesthesia ; Anesthetics ; Arterial Pressure ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Hysterectomy ; Inhalation ; Intubation ; Nitrous Oxide ; Oxygen ; Pharmacokinetics ; Propofol* ; Skin

The authors report a rare case of gunshot injury to the head by a nail-gun which was treated by stereotactic surgery. In the case, a 23-year-old male patient, presented with semicomatose mentality and decerebrated rigidity. The large nail was located in the 3rd ventricular area in the mid-line with vertical stature. The entry point was identified 1cm anterior to the coronal suture line and just lateral to the sagittal suture line. The foreign body was removed stereotactically with the guidance of gluoroscope. But the died of initial severe brain damage.
Brain ; Craniocerebral Trauma ; Foreign Bodies ; Head* ; Humans ; Male ; Sutures ; Young Adult

No abstract available.
Coinfection* ; Female ; Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Humans

Although coronary atherosclerosis occupies more than 90% of myocardial infarctions, anomalous coronary arteries are a potential cause of myocardial ischemia resulting in arrhythmia, angina, infarction, and sudden death. A medico-legal autopsy conducted on a 22 year-old healthy man who died suddenly after exercise, revealed that the right coronary artery ostium was situated higher the aortic ridge (sinotubular junction) with acute downward angulation of the proximal right coronary artery. There was no evidence of any other disease process. Coronary artery anomalies may be overlooked or misssed by the examining forensic pathologist. We described the pathology of this condition and briefly reviewed.
Arrhythmias, Cardiac ; Autopsy ; Coronary Artery Disease ; Coronary Vessels ; Death, Sudden* ; Humans ; Infarction ; Myocardial Infarction ; Myocardial Ischemia ; Pathology ; Young Adult

Sclerosing mesenteritis is a rare disease presenting as chronic inflammation and fibrosis of mesentery around the small and large intestine. And in most cases, it shows indolent and benign clinical course resulting in favorable prognosis. It is often diagnosed through characterized radiologic finding in abdominal examinations including computed tomography scan. However, it is important to rule out other conditions involving mesentery when diagnosing sclerosing mesenteritis. In the case of malignancy, the method of treatment and prognosis can be completely different therefore thorough examinations are essential. We herein report a 75-year-old male who suffered from frequent diarrhea and weight loss. Initially, he was diagnosed with sclerosing mesenteritis through abdominal computed tomography scan showing "misty" soft-tissue attenuation around the mesenteric vessel. However, follow up positron emission tomography scan and biopsy finding confirmed the common bile duct cancer with lymph node metastasis.
Aged ; Biopsy ; Cholangiocarcinoma* ; Common Bile Duct ; Diarrhea ; Fibrosis ; Follow-Up Studies ; Humans ; Inflammation ; Intestine, Large ; Lymph Nodes* ; Male ; Mesentery ; Methods ; Neoplasm Metastasis* ; Panniculitis ; Panniculitis, Peritoneal* ; Positron-Emission Tomography ; Prognosis ; Rare Diseases ; Weight Loss

Sclerosing mesenteritis is a rare disease presenting as chronic inflammation and fibrosis of mesentery around the small and large intestine. And in most cases, it shows indolent and benign clinical course resulting in favorable prognosis. It is often diagnosed through characterized radiologic finding in abdominal examinations including computed tomography scan. However, it is important to rule out other conditions involving mesentery when diagnosing sclerosing mesenteritis. In the case of malignancy, the method of treatment and prognosis can be completely different therefore thorough examinations are essential. We herein report a 75-year-old male who suffered from frequent diarrhea and weight loss. Initially, he was diagnosed with sclerosing mesenteritis through abdominal computed tomography scan showing "misty" soft-tissue attenuation around the mesenteric vessel. However, follow up positron emission tomography scan and biopsy finding confirmed the common bile duct cancer with lymph node metastasis.
Aged ; Biopsy ; Cholangiocarcinoma* ; Common Bile Duct ; Diarrhea ; Fibrosis ; Follow-Up Studies ; Humans ; Inflammation ; Intestine, Large ; Lymph Nodes* ; Male ; Mesentery ; Methods ; Neoplasm Metastasis* ; Panniculitis ; Panniculitis, Peritoneal* ; Positron-Emission Tomography ; Prognosis ; Rare Diseases ; Weight Loss