Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. A 59 year-old woman received cholecystectomy and choledocholithotomy under general anesthesia. At the 9th postoperative day, syncope, hypoxemia and hypotension were developed suddenly and the patient was transfered to intensive care unit. PTE was suspected with hemodynamic monitoring from pulmonary arterial catheter and echocardiography and diagnosed with lung perfusion scan and venogram of lower extremities. Proper cardiopulmonary support was done and the patient was recovered and discharged in improved condition. In conclusion, if a patient have syncopal attack with shock in postoperative period, PTE must be thought to be an one of possible causes of syncope and thoroughly investigated.
Anesthesia, General ; Anoxia ; Catheters ; Cholecystectomy ; Diagnosis ; Echocardiography ; Female ; Hemodynamics ; Humans ; Hypotension ; Intensive Care Units ; Lower Extremity ; Lung ; Middle Aged ; Perfusion ; Postoperative Complications ; Postoperative Period ; Pulmonary Embolism* ; Shock ; Syncope

Tumor-draining lymph node (TDLN) lymphocytes contain immunologically sensitized to tumor but functionally deficient T cells. The 30 kDa protein antigen, a major secreted protein antigen of Mycobacterium tuberculosis, exhibits strong T cell stimulatory effect. In this study, it examined that the feasibility of using M tuberculosis 30 kDa antigen to stimulate tumor-draining lymph node cells for the generation of specific immune effector cells. Freshly isolated TDLN lymphocytes could directly respond to the 30 kDa antigen alone and their proliferative responses were markedly augmented by stimulation with rIL-2. TDLN cells were stimulated with the 30 kDa antigen for various time intervals and examined for the induction of IFN-r and IL-4 mRNA using RT-PCR. The expression of IFN-r mRNA was greatly augmented after 1 wk, whereas IL-4 mRNA is markedly decreased after 1 wk. Cytotoxic T cell activities induced by the 30 kDa antigen was also evaluated. TDLN cells stimulated with the 30 kDa antigen alone were able to generate remarkable cytotoxic response to K562 or Daudi cell lines after 6 days of culture. And their cytotoxic effects were highly augmented by stirnulation with rIL-2. These results suggest that the 30 kDa antigen of M. tuberculosis may selectively activate Thl cells of TDLN lymhocytes and induce the cytotoxic T cell activities. In conclusion, the 30 kDa antigen can be used as a biologic response modifier in tumor immunology.
Allergy and Immunology ; Cell Line ; Interleukin-4 ; Lymph Nodes* ; Lymphocytes* ; Mycobacterium tuberculosis* ; Mycobacterium* ; RNA, Messenger ; T-Lymphocytes ; Th1 Cells* ; Tuberculosis

BACKGROUND: To maintain adequate oxygen delivery and oxygen consumption is essential to care of the critically ill patients. The authors undertook this study to evaluate the patterns of oxygen delivery and oxygen consumption in hemodynamically unstable patients. METHODS: Twenty hemodynamically unstable patients were studied. Pulmonary artery catheters were inserted and the hemodynamic variables including oxygen delivery and oxygen consumption were calculated immediately, and 1, 8, 24 hours, respectively after catheterization, and immediately before catheter removal. Patients were divided into survivor and nonsurvivor groups, and the hemodynamic data were compared. The same patients were divided into septic and nonseptic patient groups and same study was done. RESULTS: There were no statistical differences in oxygen delivery and oxygen consumption between the survivors and the nonsurvivors, and the septic and the nonseptic patients. But oxygen delivery and oxygen consumption of the survivors were higher than those of the nonsurvivors. CONCLUSIONS: Although we could not find statistical significance, we concluded that supranormal level of oxygen delivery and oxygen consumption could improve the outcome of critically ill patients.
Catheterization ; Catheters ; Critical Illness* ; Hemodynamics* ; Humans ; Oxygen Consumption* ; Oxygen* ; Pulmonary Artery ; Survivors*

PURPOSE: The treatment of a clinically node-positive (cN+) neck is important in the management of oral cavity squamous cell carcinoma (OSCC). However, the extent of neck dissection (ND) remains controversial. The purpose of our study was to evaluate whether level IV or V can be excluded in therapeutic ND for cN+ OSCC patients. MATERIALS AND METHODS: We performed a retrospective chart review of 92 patients who underwent a comprehensive or selective ND as a therapeutic treatment of cN+ OSCC from January 1993 to February 2009. RESULTS: The incidence rate of metastasis to level IV or V was 22% (16 of 72) on the ipsilateral neck. Of 67 cases without clinically suspicious nodes at level IV or V, 11 cases (16%, 11 of 67) had pathologically proven lymphatic metastasis to level IV or V. Only a nodal staging above N2b was significantly relevant with the higher rate of level IV or V lymph node metastasis (p=0.025). In this series, selective ND, combined with proper adjuvant therapy, achieved regional control and survival rates comparable to comprehensive ND in patients under the N stage of cN2a OSCC. CONCLUSION: In conclusion, level IV and V patients can avoid recurrence under cN2a OSCC.
Adult ; Aged ; Carcinoma, Squamous Cell/mortality/*pathology/*surgery ; Chemoradiotherapy ; Disease-Free Survival ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Mouth Neoplasms/mortality/*pathology/*surgery ; Neck/surgery ; *Neck Dissection ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Retrospective Studies ; Treatment Outcome

Chronic fatigue of the respiratory muscles has contributed to the decreased ventilatory capacity and reduced excercise tolerance of individuals with COPD, especially in kyphoscoliosis. Nasal mask BiPAP has been shown to be useful for the patient with nocturnal muscle fatigue and COPD. A 35-year-old man with severe kyphoscoliosis was admitted to ICU due to acute respiratory failure. He had been diagnosed of COPD and had been intubated with mechanical ventilatory support for 7 times. This time he was intubated with ventilatory support, too, in ICU and readmitted to the ICU for severe hypoxemia and hypercarbia from general ward. Thereafter he refused the intubation. Nasal mask BiPAP ventilatory support system was applied and IPAP, EPAP level being adjusted to the 12, 4 cmH2O under monitoring vital signs and arterial blood gas analysis. His condition was improved and discharged home with support of nasal mask BiPAP system after 33 day-stay in the ICU.
Adult ; Anoxia ; Blood Gas Analysis ; Fatigue ; Humans ; Intubation ; Masks* ; Muscle Fatigue ; Patients' Rooms ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Insufficiency ; Respiratory Muscles ; Vital Signs

BACKGROUND: The APACHE II scoring system has been regarded as a useful tool in the assessment of the severity of injury and prognosis for acutely ill patients. Recently, there have been many reports that multiple organ failure(MOF) score is the better predictor of the mortality of critically ill patients than any other scoring system. The purpose of this study was to compare APACHE II score and MOF score for mortality prediction in critically ill patients. METHODS: 163 critically ill patients were studied. We analyzed the correlation between the mortality rate and the scores that were produced by APACHE II and MOF scoring system within the first 24 hours in the ICU. We analyzed the correlation between each score and the number of days of ICU stay. We also calculated the mortality rate according to the number of organ failure. RESULTS: 1) The APACHE II score and MOF score of the survivors(n=129) were 9 6 and 1 1, respectively and those of nonsurvivors(n=34) were 16 7 and 5 2(mean SD), respectively. 2) The r2 was 0.62 between APACHE II score and mortality rate, and 0.77 between MOF score and mortality rate. 3) The r2 was 0.06 between APACHE II score and ICU stay, 0.01 between MOF score and ICU stay. 4) The mortality rates were 0, 2, 20, 64, 73, 75 and 100 % in 0, 1, 2, 3, 4, 5 and 6 organ failures, respectively. CONCLUSIONS: The MOF score was more sensitive predictor of the mortality of critically ill patients than the APACHE II score.
APACHE* ; Critical Illness* ; Humans ; Critical Care ; Mortality* ; Multiple Organ Failure* ; Prognosis

Urine discoloration occurs in the intensive care unit (ICU) due to many causes such as medications, metabolic disorders, and infections. Propofol is advocated as one of the first line sedatives in the ICU, but it is not well known to the intensivists that propofol can induce urine color change. We experienced two cases of green urine after propofol infusion. Propofol should be warranted as the cause of urine discoloration during ICU stay.
Hypnotics and Sedatives ; Intensive Care Units* ; Propofol*

Peripartum cardiomyopathy is a myocardial disease associated with pregnancy and leading to heart failure. A twenty-eight years old primipara was scheduled for a cesarean section due to a twin pregnancy. She had no previous cardiac or other systemic illness. But periodic episode of sudden hypertension, tachycardia, hypoxemia(PaO2/FiO2=58) and pulmonary edema were developed in the perioperative period. After being transferred to the intensive care unit, mechanical ventilation with positive end expiratory pressure was applied for six days and pulmonary infiltration subsided. However, two days after extubation, acute pulmonary edema redeveloped in both lung fields in spite of fluid restriction. In echocardiogram demonstrated global hypokinesia of the left ventricle with an ejection fraction of 31%. Dobutamine infusion was started and one day after infusion the pulmonary edema subsided. In conclusion echocardiogram would be helpful for diagnosis of peripartum cardiomyopathy and adequate cardiac support with assisted ventilation will improve prognosis.
Cardiomyopathies* ; Cesarean Section ; Diagnosis ; Dobutamine ; Edema ; Female ; Heart Failure ; Heart Ventricles ; Hypertension ; Hypokinesia ; Intensive Care Units ; Lung ; Perioperative Period ; Peripartum Period* ; Positive-Pressure Respiration ; Pregnancy ; Pregnancy, Twin ; Prognosis ; Pulmonary Edema* ; Respiration, Artificial ; Tachycardia ; Ventilation

BACKGROUND: Midazolam is distinguished from other benzodiazepines by its water solubility, rapid onset, short duration, and lack of accumulation of active metabolites. These pharmacokinetic cbaracteristics support its use by continuous infusion. We evaluated the continuous infusion dose of midazolain for adequate sedation of ventilated patients with hemodynamic and respiratory monitoring. METHODS: We started continuous infusion of midazolam at a rate of 0.5~1.0 ug/kg/minute after bolus injection of 3.0 to 5.0 mg and adjusted infusion dose monitoring sedation scale in the 15 patients. Blood pressure, heart rate and central venous pressure were monitored before and 30 minute, 1, 2, 3 and 6 hours after midazolam infusion. Arterial blood gases were measured and peak inspiratory pressure was monitored. We evaluated liver and kidney function before start of infusion and after discontinuation of midazolam infusion. RESULTS: The mean loading dose, infusion rate and total dose of midazolam were 4.1+/-0.9 mg, 1.2+/-0.4 ug/kg/minute and 251.9+/-84.0 mg. The mean duration of infusion was 59.0+/-37.0 hours. After infusion, systolic and diastolic blood pressure and heart rate and central venous pressure remained stable when compared with those of the preinfusion state. Arterial blood gas and peak inspiratory pressure remained unchanged. The function of liver and kidney did not deteriorate after infusion. CONCLUSIONS: Continuous infusion of midazolam at a rate of 1.2+/-0.4 ug/kg/minute after 4.1+/-0.9 mg intravenous bolus injection was a safe and effective method for sedation of ventilated patients in intensive care unit without hemodynamic disturbance.
Benzodiazepines ; Blood Pressure ; Central Venous Pressure ; Gases ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Intensive Care Units* ; Critical Care* ; Kidney ; Liver ; Midazolam* ; Solubility ; Ventilation

A hemorrhagic disease due to acquired prothrombin complex deficiency is presented in five infants from 3 weeks to 2 months of age. There are 2 cases of intracranial hemorrhage, 1 case of hemothorax, 2 cases of gastrointestinal bleeding, 1 case of epistaxis and 3 cases of petechia, purpura or bleeding from injection site. After the administration of vitamin K, bleeding ceased and prolonged prothrombin time was corrected promptly. Vitamin K dependent coagulation factor deficiency due to vitamin K deficiency is accounted for the pathogenesis of bleeding. Diarrhea, treatment with antimicrobial agents and a diet low in vitamin K are suggested as etiologic factors acting together.
Anti-Infective Agents ; Blood Coagulation Factors ; Diarrhea ; Diet ; Epistaxis ; Hemorrhage ; Hemothorax ; Humans ; Infant ; Intracranial Hemorrhages ; Osteopetrosis ; Prothrombin ; Prothrombin Time ; Purpura ; Vitamin K ; Vitamin K Deficiency