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

Exenteraion in early infancy by a tumor and radiotherapy caused the contracted eye socket and Orbital hypoplasia. This result is because of the abscence of the conjunctival fornix and in severe contraction of orbital fat and developmental bone abnormalities. The authors corrected a contracted eye socket and orbital hypoplasia simultaneously, secondary to previous surgery and radiotherapy. A one-stage surgical reconstruction was undertaken using a radial osteocutaneous flap, which were transfered for eye socket reconstruction and orbital hypoplasia. Adipofascia and fragment of radius inserted as an hypoplastic orbit rim susbtitute to enlarge the orbital region. We report that we have experienced a case of eye socket reconstruction with a radial forearm osteocutaneous free flap.
Forearm* ; Free Tissue Flaps* ; Orbit* ; Radiotherapy ; Radius

Two cases of familial asymmetric septal hypertrophy diagnosed by myocardial biopsy and clinical studies are reported with literature reviewed. Myocardial biopsy was done at right ventricular septal wall, and pedigree of family members was observed clinically and examined by noninvasive methods including chest X-ray and echocardiography.
Biopsy ; Cardiomyopathy, Hypertrophic* ; Echocardiography ; Humans ; Pedigree ; Thorax

Protothecosis is an unusual human infection, caused by the genus prototheca, especially Prototheca wickerhamii. A 80-year-old immunocompetent man presented with a 1-month history of multiple reddish brown lobulated plaques on the scalp and face. He denied any history of trauma and had no evidence of underlying diseases such as diabetes mellitus or malignancy. On histopathological examination, characteristic morula-like sporangia in the dermis was revealed. After treatment with oral itraconazole for 8 weeks, the patient's skin lesions are almost healed.
Aged, 80 and over ; Dermis ; Diabetes Mellitus ; Humans ; Itraconazole ; Prototheca ; Scalp* ; Skin ; Sporangia

PURPOSE: It is difficult to reconstruct nasal root defects because of complicated anatomy and function of the nose and eyelids, donor site morbidities, and aesthetic results. So, choosing suitable one of various reconstructive methods is very important and difficult. We report the island composite glabellar flap as an alternative reconstructive method of proximal nasal and medial canthal area. METHODS: From May 2005 to January 2007, we performed 8 cases of the island composite glabellar flap to reconstruct the defects in proximal nasal and medial canthal area after resection of skin cancer. The flap was elevated with the nasal skin, subcutaneous fat tissue, and procerus muscle based on the dorsal nasal branch of the angular artery. The flap donor site was closed in a V-Y fashion. RESULTS: This result was satisfactory in point of color, texture and donor site scar. There was no major complication such as wound disruption, hematoma, and atrophy of flap. But flap bulkiness was observed in one case. CONCLUSIONS: This island composite glabellar flap has several advantages in reconstruction of proximal nasal and medial canthal defects. This flap has reliable vascular pedicle and can be moved to multiple direction and has more mobility than other local flaps. Also, aesthetic outcome of the donor and the recipient site was good. We believe that this flap is a useful technique as a treatment of proximal nasal and medial canthal defects
Arteries ; Atrophy ; Cicatrix ; Eyelids ; Hematoma ; Humans ; Microscopy, Electron ; Nose ; Skin ; Skin Neoplasms ; Subcutaneous Fat ; Tissue Donors ; Wounds and Injuries

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

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