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

We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 15-18 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.0 multiples of the median (MoM). The exclusion criteria were fetal anomalies, an abnormal karyotype, molar pregnancy, and an MSAFP level greater than 2.5 multiples of the median (MoM). A group of randomly selected women with hCG levels under 2.0 MoM served as controls. Patients with elevated levels of hCG had a significantly higher risk for PIH (17.9% versus 4.5%; P <.05) and preterm delivery (17.9% versus 3.5%; P<, 05) than control. But no significant differences were observed in the incidence of intrauterine growth restriction and low birth weight and in the newborn weight. We suggested that pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies. And these patients require careful monitoring with adequate obstetric management.
Abnormal Karyotype ; Chorionic Gonadotropin* ; Cohort Studies ; Female ; Gestational Age ; Humans* ; Hydatidiform Mole ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome* ; Pregnancy* ; Pregnancy, High-Risk

Cutaneous horns of the penis are rare. We report a case associated with squamous cell carcinoma in a 56-year-old male. A gradually enlarging nodule had been on the glans penis for four years. He had suffered from an erythematous crusted tumor mass and horny excrescence on the glans penis which recurred and was aggravated after excision of the nodule seven months ago. Histopathologic findings of the lesions showed characteristic findings of squamous cell carcinoma and cutaneous horn. In situ DNA hybridization for human papillomavirus types 6, 11, 16, 18, 32, and 33 were all negative. The tumor mass were surgically excised and we have not found any sign of recurrence since then.
Animals ; Carcinoma, Squamous Cell* ; DNA ; Epithelial Cells* ; Horns* ; Humans ; Male ; Middle Aged ; Penis* ; Recurrence

Twenty-nail dystrophy is an idiopathic nail dystrophy in which all twenty nails are uniformly and simultaneously affected with excess longitudinal ridging and loss of lustre. The pathogenesis is controversial, and the treatment is unsuccessful. It is thought to have a self-limiting and reversible nature when it develops in childhood, but in adults, it is unusual and exists persistently. We re-port here two cases of adult patients with dystrophy of all twenty nails, whose ages were 58 and 55. The disease had been present for one year and may be associated with alopecia areata in the 58 year old and an idiopathic condition in the 55 year old. Negative results were obtained on mycological studies. Biopsies taken from the nail bed revealed marked hyperkeratosis consistent with nail dystrophy.
Adult ; Alopecia ; Alopecia Areata ; Biopsy ; Humans

BACKGROUND: The keratinocyte growth factor(KGF) is a recently identified mitogen for epithelial cells produced by nomal stromal fibroblasts. ln the skin, KGF has been shown to stimulate keratinocyte proliferation and differentiatian. Dendritic epidermal T cells(DETC) are skin-specific members of the epithelial y 8 T-cell family that reside normally in the murine epidermis. The DETCs recognize antigen expressed by damaged or diseased neighboring keratinoctyes and consequently secrete cytokines sueh as IFN- y, lL-2, IL-4, GM-CSF. OBJECTIVE: The purpose of this study was to observe the expression of KGF mRNA in keratinocyte and DETC as well as to investigate the cytokine-mediated intercellular communication between kerati- nocyte and DETC. METHODS: Using a RT-PCR(reverse transcription-polymerase chain reaction), we examined the expression of KGF mRNA in keratinocyte and DETC, and compared the level of KGF mRNA between resting and activated DETC with Con-A (concanavalin A).
Cytokines ; Epidermis ; Epithelial Cells ; Fibroblast Growth Factor 7* ; Fibroblasts ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Interleukin-4 ; Keratinocytes* ; RNA, Messenger* ; Skin ; T-Lymphocytes

A case of a 21-year old female with Maffucci's syndrome is presented where the patient developed multiple cutaneous spindle-cell hemangioendotheliomas. She had multiple pea to walnut sized, non-tender, normal skin colored or slight bluish nodules and bony mass-like lesions on the left upper extremity and hand. A histological examination of the lesions showed that they were composed of irregularly dilated, thin walled cavernous blood spaces containing phleboliths and collapsed vascular spaces separated by spindled fibroblastic cells. Radiologically, the bony lesions showed radiolucent densities with calcified spots within the second proximal phalanx and metacarpal bone of the left hand, which were consistent with enchondromas.
Chondroma ; Female ; Fibroblasts ; Hand ; Hemangioendothelioma* ; Humans ; Juglans ; Peas ; Skin Pigmentation ; Upper Extremity

We report a case of infantile digital fibromatosis in a 34 month-old boy, who presented with a painless subcutaneous tumor on the medial aspect of the left third toe. A histological examination showed scattered small, round eosinophilic inclusion bodies in the cytoplasm of the tumor cells, which was consistent with infantile digital fibromatosis. A'immunohistochemical study revealed that desmin, a-smooth muscle actin, and vimentin were clearly positive in the cytoplasm of the tumor cells, but the inclusions themselves showed negative staining, thus indicating a hollow-like staining pattern. Electron microscopy showed either well-defined or ill-demarcated dense bodies in the cytoplasm of the tumor cells. In some areas, small vesicles and intracellular organells were observed' in the inclusions. In the course of conservative treatment, a new lesion developed on the lateral aspect of the left third toe, seven months after the appearance of the initial lesion.
Actins ; Cytoplasm ; Desmin ; Eosinophils ; Fibroma* ; Humans ; Inclusion Bodies ; Male ; Microscopy, Electron ; Negative Staining ; Toes ; Vimentin

We evaluated the relationship between the surgical success of idiopathic macular hole and sex, age, duration, epiretinal membrane, preoperative visual acuity, size of the hole, and surgical method. Of all 25 eyes in 23 patients, 14 eyes(56%)showed anatomical success(disappearance of the hole), and 17 eyes(68%)functional success(the final visual acuity of 0.15 or more with more than one line improvement). There were statistically significant differences of anatomical(p=0.001)and functional success(p=0.020)between the Group I where its macular hole was less than one-fourth of the optic disc in size and the other group, and anatomical success(p=0.039)between the group with the age of less than 70 years(Group A)and the other group. In Group I, anatomical and functional success were both 92%(11 eyes/12 eyes). In Group A, anatomical and functional success were 72%(13 eyes/18 eyes)and 77%(14 eyes/18 eyes), respectively, and there was statistically significant relationship between size of the hole and anatomical success(p=0.024), and difference of anatomical success between the group with duration of less than 6 months and the other group(p=0.023). Good surgical result may be expected in the idiopathic macular hole of the age of less than 70 years with about 350 micrometer or less in size and duration of less than 6 months.
Epiretinal Membrane ; Humans ; Retinal Perforations* ; Visual Acuity

The transesophageal echocardiography (TEE) has been used for the assessment of right and left ventricular function, valvular structure and function, regional wall motion abnormalities and localization of intravascular catheters, cannular and prosthesis. We inserted the pulmonary artery catheter (PAC) under the guidance of intraoperative TEE because of the difficulty of placing PAC with the pressure tracing method in two patients. The PAC was inserted from right atrium to right ventricle with the basal four chamber view and advanced to pulmonary artery through pulmonary valve with the longitudinal view of TEE. We observed typical pulmonary arterial wave form to confirm the correct position. We suggest that the TEE can be used for successful placement of a PAC to facilitate manipulation of the catheter as an alternative method in the patients whose PAC can not be positioned with the pressure tracing method.
Catheters* ; Echocardiography, Transesophageal* ; Heart Atria ; Heart Ventricles ; Humans ; Prostheses and Implants ; Pulmonary Artery* ; Pulmonary Valve ; Ventricular Function, Left

One author's affiliation is misspelled in original article.