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 report a case of disseminated cutaneous metastatic carcinoma from stomach carcinoma in a 66-year-old male who complained chiefly of widespread cutaneous nodules. He had been admitted to the Department of Internal Medicine for stomach carcinoma. A radiological examination revealed a diffuse stomach wall thickening from the fundus to the antrum, and enlargement of paraaortic and pericaval lymph nodes during an abodominal CT scan. The clinical findings manifested above may suggest cutaneous metastasis from stomach carcinoma. A histological examination of the skin and stomach biopsies showed atypical cells with pleomorphic, hyperchromatic nuclei and bubble-like cytoplasm, which are consistent with poorly differentiated adenocarcinoma. Immunohistochemical stainings showed that these cells were positive for epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA) and low molecular weight cytokeratin.
Adenocarcinoma ; Aged ; Biopsy ; Carcinoembryonic Antigen ; Cytoplasm ; Humans ; Internal Medicine ; Keratins ; Lymph Nodes ; Male ; Molecular Weight ; Mucin-1 ; Neoplasm Metastasis ; Skin ; Stomach* ; Tomography, X-Ray Computed

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

Pretibial myxedema, which consists of localized cutaneous accumulations of acid mucopolysaccharides, oceurs in a few patients with hyperthyroidi';m after its correction by surgery or radioactive iodine therapy. We report a case of pretibial myxedema with exophthalmos in a 36 year old male. He has suffered from hyperthyroidism with bilateral pretibial myxedema for a period of 4 years. He was treated with a subtotal thyroidectomy and excision of both pletibia lesions 1 year ago. The lesions recurred on t,he left pretibial area, as a 11 X 16cm sized, non pitting, non tender, swollen, brownish plaque. The histopathologic findings showed epidermal hyperkeratosis and a considerable arnount of mucin in the mid-dermis. We treat.ed him with intralesional injection of triamcinolone acetonide with marked improvement.
Adult ; Exophthalmos ; Glycosaminoglycans ; Humans ; Hyperthyroidism ; Injections, Intralesional ; Iodine ; Male ; Mucins ; Myxedema* ; Thyroidectomy ; Triamcinolone Acetonide

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

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.

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 regular use of soaps and synthetic detergents has been associated with skin dryness and aggravation of dermatological conditions. OBJECTIVE: Our purpose was to investigate the irritancy of 10 hand dishwashing liquids on normal skin. METHODS: The skin changes, responding to repeat patch testing with 10 hand dishwashing liquids, were measured by visual scoring. RESULTS: The results are summarized as follows; 1. Of the 16 healthy volunteers 8 had reactions. 5 women and 3 men, but there was no significant difference in irritancy between men and women. 2. The mean irritancy scores of the 10 hand dishwashing liquids ranged from 0.06 to 0.88. 3. A prominent increase in the degree of erythema in the first 24 hour patch test did not persist beyond exposure day 5, but after day 5, augmented responses of the erythema and scales, even fissuring occurred. 4. The pH of the test solutions of the hand dishwashing liquids ranged from 5.0 to 6.0, but there appeared to be no correlation between pH and irritancy in the dishwashing liquids tested. CONCLUSION: Our data suggests that regular exposure to hand dishwashing liquids may cause disturbances of the skin in a substantial proportion of individuals, and workers should use hand dishwashing liquids in lower concentrations than recommended and only for short periods with protective measures.
Detergents ; Erythema ; Female ; Hand* ; Healthy Volunteers ; Humans ; Hydrogen-Ion Concentration ; Male ; Patch Tests ; Skin* ; Soaps ; Weights and Measures