BACKGROUND: This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33degrees C target temperature management. METHODS: A retrospective study was conducted on patients who underwent 33degrees C target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia. RESULTS: A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 +/- 0.15 microg/kg/h. Decisions of charged doctor's were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole. CONCLUSIONS: Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33degrees C target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33degrees C targeted temperature management.
Atropine ; Body Weight ; Bradycardia* ; Carbon Monoxide Poisoning ; Dexmedetomidine* ; Diagnosis ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Hypothermia, Induced ; Logistic Models ; Odds Ratio ; Retrospective Studies

BACKGROUND: Follicular dendritic cells (FDCs) play key roles during T cell-dependent humoral immune responses by allowing antigen-specific B cells to survive, proliferate, and differentiate within the FDC networks of secondary follicles, i.e., germinal centers (GC). METHODS: A novel monoclonal antibody, 3C8, was generated by immunizing with an FDC line HK, in order to understand the molecular signals involved in the FDC-B cell interactions in the microenvironment of the GC. RESULTS: The 3C8 antibody did not bind to mononuclear cells, including T cells, B cells, and monocytes. Murine L929 and human skin fibroblasts exhibited no or little reactivity to 3C8. However, 3C8 specifically recognized HK cells by flowcytometry. Furthermore, the antigen recognized by 3C8 was restricted to the GC of the human tonsil. Dendritic networks of the GC were intensely stained by 3C8, but cells out side the GC were not. CONCLUSION: Our result s suggest that the antigen 3C8 may play some unique role on FDCs during the GC reactions.
B-Lymphocytes ; Cell Communication ; Dendritic Cells, Follicular* ; Fibroblasts ; Germinal Center ; Humans ; Immunity, Humoral ; Monocytes ; Palatine Tonsil ; Skin ; T-Lymphocytes

Background: The reconstruction of defects in the lower eyelid region is prone to complications such as ectropion and epiphora. This area is also aesthetically important; therefore, operations should be carried out with caution. We introduce a simple and easy surgical approach for the repair of small to moderate-sized lower eyelid defects. Methods: A retrospective chart review was performed for all patients who underwent lower eyelid defect reconstruction using a sickle-shaped transposition flap in 2018 or 2019. Photographs were taken at each visit, and the Vancouver Scar Scale was used to evaluate residual marks every 3 months for 1 year. Patients reported their subjective satisfaction levels on a visual analogue scale that ranged from 0 to 10. Results: A total of nine patients were included. No flap necrosis, ectropion, epiphora, or other complications were observed. Among the eight patients with skin cancer, no recurrence was noted during the follow-up period. The mean Vancouver Scar Scale scores were 5.50±0.99 at 3 months postoperatively, 4.61±0.85 at 6 months postoperatively, 3.05±0.80 at 9 months postoperatively, and 1.11±0.58 at 12 months postoperatively. The mean overall patient satisfaction rating was 9.11±0.78 (as rated on the visual analogue scale). Conclusions In the reconstruction of lower eyelid defects, the sickle-shaped transposition flap could be a simple, fast, and aesthetically favorable surgical option.

Endomyocardial biopsy (EMB) is a valuable diagnostic procedure for the surveillance of cardiac allograft rejection. Interpretation of individual cases is still problematic due to variations of findings for grading of rejection and other associated lesions. We reevaluated an experience on endomyocardial biopsies to develop better diagnostic criteria for rejection and other complications. Immunohistochemical studies against cytokines were performed to assess the usefulness of the method for the diagnosis or researches. A total of 249 EMBs taken from 33 cardiac allograft recipients were reviewed. There were 25 males and 8 females. Dilated cardiomyopathy was present (24 cases) and valvular heart disease (4 cases), restrictive cardiomyopathy (3 cases) were also common conditions. We applied the grading system of the International Society for Heart Transplantation (ISHT) for the assessment of acute cellular rejection. Grades of 0, 1A, 1B, 2, 3A and 3B were 39.0%, 28.1%, 11.2%, 11.5%, 12.4% and 1.6% respectively, but 3.2% were inadequate. Thirty five episodes of grade 3A or 3B were present in 17 patients. The response to therapy was assessed using a next follow up biopsy, which revealed resolving or resolved rejection in 85% of patients. The intensity of immunohistochemical stains for IL-6 and TNF-alpha was increased in proportion to the histologic grade but Quilty lesion and cardiomyopathy also showed a positive reaction. The other pathologic findings were ischemic change, previous biopsy site, interstitial edema and fibrosis, and Quilty lesion. These findings showed usefulness of endomyocardial biopsy not only for the evaluation of cardiac allograft rejection but also for the diagnosis of associated cardiac lesions. Immunohistochemical study of the cytokines was related to the degree of inflammation rather than degree of rejection.
Allografts ; Biopsy* ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cardiomyopathy, Restrictive ; Coloring Agents ; Cytokines ; Diagnosis ; Edema ; Female ; Fibrosis ; Follow-Up Studies ; Heart Transplantation* ; Heart Valve Diseases ; Heart* ; Humans ; Inflammation ; Interleukin-6 ; Male ; Tumor Necrosis Factor-alpha

PURPOSE: This study was conducted to investigate the incidence, associated factors and clinical impact of hyperamylasemia in self-poisoning patients. METHODS: This study was based on a toxicology case registry of patients treated from 2009 to 2013 at a tertiary care university hospital. We retrospectively investigated the demographics, clinical variables, laboratory variables and intoxicants. Hyperamylasemia was defined as an elevation in serum amylase level to above the upper normal limit within 24 hours after admission. We analyzed the predisposing factors and clinical outcomes of patients in the hyperamylasemia group. RESULTS: Hyperamylasemia was identified in 49 (13.3%) of the 369 patients. Using multivariate logistic regression, the odds ratios for HA were 3.384 (95% confidence interval, 1.142-8.013, p=0.014), 3.261 (95% confidence interval, 1.163-9.143, p=0.025) and 0.351 (95% confidence interval, 0.154-0.802, p=0.013) for pesticides, multi-drug use and sedatives, respectively. In the hyperamylasemia group, the peak amylase levels during 72 hours were correlated with the peak lipase levels (r=0.469, p=0.002) and peak aspartate aminotransferase levels (r=0.352, p=0.013). Finally, none of these patients had confirmed acute pancreatitis. CONCLUSION: Hyperamylasemia occurred rarely in these self-poisoning patients, and pesticide and multi-drug use were independent predictors of hyperamylasemia. Peak amylase levels were correlated with the peak lipase and aspartate aminotransferase levels.
Amylases ; Aspartate Aminotransferases ; Causality ; Demography ; Humans ; Hyperamylasemia* ; Hypnotics and Sedatives ; Incidence* ; Lipase ; Logistic Models ; Odds Ratio ; Pancreas ; Pancreatitis ; Pesticides ; Poisoning ; Retrospective Studies ; Tertiary Healthcare ; Toxicology

OBJECTIVE: We wanted to evaluate the feasibility and efficacy of using a dexamethasone (DM) -eluting nitinol stent to inhibit the pseudointimal hyperplasia following stent placement in the transjugular intrahepatic portosystemic shunt tract (TIPS) of a swine. MATERIALS AND METHODS: Fifteen stents were constructed using 0.15 mm-thick nitinol wire; they were 60 mm in length and 10 mm in diameter. The metallic stents were then classified into three types; type 1 and 2 was coated with the mixture of 12% and 20%, respectively, of DM solution and polyurethane (PU), while type 3 was a bare stent that was used for control study. In fifteen swine, each type of stent was implanted in the TIPS tract of 5 swine, and each animal was sacrificed 2 weeks after TIPS creation. The proliferation of the pseudointima was evaluated both on follow-up portogram and pathologic examination. RESULTS: One TIPS case, using the type 1 stent, and two TIPS cases, using the type 2 stent, maintained their luminal patency while the others were all occluded. On the histopathologic analysis, the mean of the maximum pseudointimal hyperplasia was expressed as the percentage of the stent radius that was patent, and these values were 51.2%, 50% and 76% for the type 1, 2, and 3 stents, respectively. CONCLUSION: The DM-eluting stent showed a tendency to reduce the development of pseudointimal hyperplasia in the TIPS tract of a swine model with induced-portal hypertension.
Swine ; *Stents ; *Portasystemic Shunt, Transjugular Intrahepatic ; Hyperplasia ; Dexamethasone/*administration & dosage ; Animals ; Alloys

The congenital absence of an inferior vena cava is an uncommon abnormality. With the advent of modern imaging techniques, such cases are being found with increasing frequency. Here we report a case of a renal cell carcinoma with the absence of an inferior vena cava in a 44 year-old male. He was referred for a further evaluation of a right renal mass, which was observed by ultrasonography, and for persistent epigastric discomfort. Computed tomography showed a huge mass in the right kidney and multicystic lesions in the left. In addition, the inferior vena cava had disappeared at the infrahepatic portion. He was treated with a right radical nephrectomy.
Adult ; Carcinoma, Renal Cell* ; Humans ; Kidney ; Male ; Nephrectomy ; Ultrasonography ; Vena Cava, Inferior*

No abstract available.
Injections, Intralesional ; Isotretinoin ; Triamcinolone ; Triamcinolone Acetonide

No abstract available.
Lichen Planus ; Lichens

The sacral area is the most frequent site of pressure sore. Because bony prominence is broad and flat along with little soft tissue padding. Between many muscle flaps, the gluteus maximus myocutaneous flap is the most reliable one for surgery of sacral pressure sores. After complete resection of ulcer, the gluteus maximus muscle detached from its original site including posterior iliac crest. After adequate dissection proceeded and bony prominence removed, flap repair is done at the central line. When performing this flap, most surgeon use elliptical design and incision. In the past, we also used elliptical incision and sometimes experienced some drawbacks especially when wound extended close to anus. There are difficulties on repair of perianal skin, central tension of long vertical scar, perianal skin adhesion and natal cleft distortion and resulting asymmetry of gluteal contour and contamination of operation site by defication. After review of the photographs in the references dealing with pressure sores, we had an impression that there are skin adhesion near the anus in some cases and actually experienced such cases in other surgeon's operations. This time, we applicate new design called the "Bomb-shape" design when performing this flap to patients who have a broad wound extent close to anus or perianal skin. The "Bomb-shape" design is a concept of adding bilateral subcutaneous incisions to lower part of classic elliptical incision and we named as such because it resembles the military bomb in shape. We expect the effect of preserving the perianal skin and preventing the skin adhesion or natal cleft distortion and performed this procedure in 15 patients whose defect close to anus. Consequently, benefits of this method are spreading tension of vertical scar, decreased contamination in wound care, earn skin stability without perianal skin adhesion or natal cleft distortion, so maintain the symmetry of gluteal contour and get better cosmetic result. There is no significant increase in operation time in that no need of handling the "dog-ear", and all 15 patients have good results and are satisfied, so we introduce this flap design carefully with concurrent review of literature.
Anal Canal ; Bombs ; Cicatrix ; Concurrent Review ; Humans ; Military Personnel ; Myocutaneous Flap ; Pressure Ulcer* ; Skin ; Ulcer ; Wounds and Injuries