BACKGROUND: A strategy of mechanical ventilation that limits tidal volume while permitting hypercapnia has been recommended for patients with the acute respiratory distress syndrome. We attempted to evaluate the effects of protective-ventilatory strategy on the outcome of the acute respiratory distress syndrome. METHODS: The study was performed on 31 patients over 16 years old who were under the mechanical ventilation with the diagnosis of acute lung injury (ALI)/ARDS in the Surgical ICU. Pulmonary artery catheter was inserted after start of ventilation. A tidal volume (VT) of 10 to 12 ml per kg and positive end expiratory pressure (PEEP) 10 cmH2O or less was used in conventional group (n = 15), and VT of 6 to 8 ml/kg and PEEP 15 cmH2O or less was used in protective group (n = 16). Arterial blood gas analysis, hemodynamic parameters and metabolic parameters were recorded 1, 3, 5 and 7 day interval. RESULTS: 1) VT, PEEP and respiratory rate showed statistical differences between groups (10.5 +/- 1.2 vs. 6.7 +/- 0.8 ml/kg, 7.7 +/- 3.3 vs. 13.3 +/- 3.1 cmH2O, 15.0 +/- 3.7 vs. 20.3 +/- 4.1 rate/min), but minute volume didn't showed significant difference in between groups. 2) Mortality was 46% in the conventional group and 25% in protective group (P < 0.001). 3) Significant difference was identified in PaO2/FiO2 (176.9 +/- 81.7 vs. 274.7 +/- 83.5), wedge pressure (11.1 +/- 3.7 vs. 16.2 +/- 3.9 mmHg) and mean pulmonary artery pressure (23.0 +/- 4.5 vs. 30.2 +/- 6.5 mmHg) during study periods. 4) The incidence of barotrauma and dialysis for renal failure were similar in the both groups. CONCLUSIONS: Protective ventilatory strategy with low VT and high PEEP shows low mortality in ALI/ARDS patients, it is recommended method for the ALI/ARDS patients.
Acute Lung Injury ; Adolescent ; Barotrauma ; Blood Gas Analysis ; Catheters ; Diagnosis ; Dialysis ; Hemodynamics ; Humans ; Hypercapnia ; Incidence ; Mortality ; Positive-Pressure Respiration ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Renal Insufficiency ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Respiratory Rate ; Tidal Volume ; Ventilation

BACKGROUND AND OBJECTIVES: Fulminant invasive fungal sinusitis (IFS) is an aggressive, destructive disease most commonly affecting the immunocompromised hosts. This study aimed to investigate the clinical features of invasive fungal sinusitis and to determine its prognostic factors. MATERIALS AND METHOD: Fifteen cases of invasive fungal sinusitis were retrospectively reviewed. Prognosis was analyzed according to predisposing factors including the underlying disease, the extent of disease, the mycotic species, and treatment modalities. RESULTS: Overall 5-year survival rate of the patients with IFS was 60%. There was significant survival gain in the group for which underlying disease was well controlled (p=0.04). There was no difference in survival in terms of mycotic species and extent of disease at presentation. No statistically significant difference in survival was observed between the conservative surgery and the radical surgery group. CONCLUSION: Survival is usually determined at the very early period of treatment. The most important prognostic factor is not the surgical modalities including wide surgical resection or conservative debridement, but the optimal control of underlying disease.
Causality ; Debridement ; Fibrinogen ; Humans ; Immunocompromised Host ; Prognosis ; Retrospective Studies ; Sinusitis* ; Survival Rate

OBJECTIVE: The objectives of this study were to obtain information on MIS levels in normal and RDS neonates and to investigate the relationship between the RDS prevalence and MIS level in preterm and term neonates. METHODS: Total 131 male neonates were selected randomly and they were consisted of 50 term normal neonates, 15 term neonates with RDS, 50 prematurely born normal neonates, and 16 prematurely born neonates with RDS. Total 131 female neonates were also selected like male neonates. The venous blood was collected from all subjects and measured the level of MIS using ELISA. The ANCOVA was conducted to evaluate any influence of adjusted value of gestational age and body weight on MIS level between normal neonates and neonates with RDS. RESULTS: 1) The MIS levels of female neonates were significantly lower than those of male neonates with no overlap. 2) The MIS levels of normal female neonates were not significantly different from those of female neonates with RDS. 3) There were significant negative relationships between MIS concentration and gestational age (r=-0.777, p<0.001), and birth weight(r=-0.728, p<0.001) in normal rnale neonates. 4) There were significant negative relationships between MIS concentration and gestational age (r=-0.726, p<0.001), and birth weight(r=-0.725, p<0.001) in male neonates with RDS. 5) After adjusting the value of gestational age, the MIS level of male neonates with RDS was significantly higher than that of normal male neonates(p<0.001). 6) After adjusting the value of body weight, the MIS level of male neonates with RDS was significantly higher than that of normal male neonates(p<0.001). CONCLUSION: Male neonates with RDS had higher MIS levels than normal male neonates of the same body weight or same calculated gestational age. The results of this study suggest that MIS may play a causative or important ancillary role in the sexual dimorphism that characterizes the neonatal RDS and may be used as a predictive marker of RDS in male neonates.
Anti-Mullerian Hormone* ; Body Weight ; Enzyme-Linked Immunosorbent Assay ; Female ; Gestational Age ; Humans ; Infant, Newborn* ; Male ; Parturition ; Prevalence

PURPOSE: Unilateral ureteral obstruction results in tubulointerstitial fibrosis of the affected kidney which is driven by increased levels of angiotensin II. In this study, we examed the fibrotic changes in un inephrectomized rats with incomplete urteral obstruction and explored the effect of an angiotensin converting enzyme(ACE)inhibitor, enalapril on the tubulointerstitial fibrosis of obstructive uropathy. MATERIALS AND METHODS: 130 Rats were sacrificed at 1, 2, 4 weeks after nephrectomy or obstruction. Collagen type I, II, and III were localized by immunohistochemical staining. And the distribution of each collagen type was analyzed using differences of their staining densities. RESULTS: There is no difference in total collagen amount and immunohistochemical staining between control and uninephrectomized group. After 2weeks in incomplete ureteral obstruction in uninephretomized rat, the total amount of collagen in affected kidney was significantly increased compared to control (p<0.05), and immunohistochemical staining for all type of collagen was gradually increased by increased duration of incomplete ureteral obstruction. Enalapril did not affect the total collagen amount and immunohistochemical staining in the kidney of uninephrectomized rat. Enalapril significantly decreased the collagen amount in affected kidneys of collagen was not significantly changed compaired to control group. CONCLUSIONS: the incomplete ureteral obstruction in uninephrectomized rat induces progressive increase of amount of collagen according to the duration of obstruction, especially 2 weeks, and enalapril administration after incomplete unilateral obstruction of tubulointerstitial fibrosis of obstructive uropathy.
Angiotensin II ; Angiotensins ; Animals ; Collagen Type I ; Collagen* ; Enalapril* ; Fibrosis ; Kidney ; Nephrectomy ; Rats* ; United Nations ; Ureter* ; Ureteral Obstruction*

The principles determining the primary localization of lesions in fixed drug eruption (FDE) are still unknown. Studies investigating the predilection areas in FDE have indicated drug-related, trauma-related, or inflammation-related specific site involvement, as well as visceracutaneous reflex-related specific site involvement. The importance of viscerocutaneous reflexes for the location of dermatoses was first recognized in the 1960s. Head's zones are viscerocutaneous reflex projection fields on the skin that extend over certain dermatomes and possess a reflex-associated maximal point. Recently, in a Turkish collective of patients, three women with the primary location of FDE lesions on the maximal points of Head's zones were presented. We also experienced 3 cases with FDE where the lesions were located at specific sites (buttocks), the so-called maximal points of Head's zones, which are known to be the most active dermatomal areas of an underlying visceral pathology. An underlying internal disturbance (ureter stone, pyelonephritis and chronic pelvic inflammatory disease) was found in all 3 patients, corresponding to the organ-related maximal point of Head's zones in each case. In conclusion, the primary location of FDE lesions on the maximal points of Head's zones revealed relevant organ disorders with corresponding projection fields.
Drug Eruptions ; Female ; Humans ; Pyelonephritis ; Reflex ; Skin ; Skin Diseases

BACKGROUND: Moisturizers are commonly used for the management of many skin problems and sometimes they are used to maintain healthy skin. Previous studies on the short-term treatment with moisturizers have shown that moisturizers can weaken or strengthen the skin barrier function. OBJECTIVE: We evaluated the effect of long-term treatment with a physiologic lipid-containing moisturizer on the barrier function of normal skin. METHODS: 39 healthy volunteers applied the moisturizer on one forearm 3 times daily for 8 weeks and then they were followed-up for the next 2 weeks (the regression period). No moisturizer was used on the other forearm as a control. The TEWL, skin capacitance and skin lipid content were evaluated weekly during the 8 weeks treatment period and then daily during 2 weeks of the regression period. RESULTS: During the treatment period, the skin capacitance and lipid content values of the treated side were significantly higher than that of the control side, and the TEWL values of the treated side were significantly lower than that of the control side. During the regression period, all the values of the treated side steadily became closer to those of the control side. These results suggest that long term treatment with moisturizer does not deteriorate the skin barrier function. CONCLUSION: Long-term treatment with moisturizer containing physiologic lipid not only enhances the normal skin barrier, it does not suppress the endogenous lipid synthesis of the skin.
Forearm ; Skin

BACKGROUND: Moisturizers are commonly used for the management of many skin problems and sometimes they are used to maintain healthy skin. Previous studies on the short-term treatment with moisturizers have shown that moisturizers can weaken or strengthen the skin barrier function. OBJECTIVE: We evaluated the effect of long-term treatment with a physiologic lipid-containing moisturizer on the barrier function of normal skin. METHODS: 39 healthy volunteers applied the moisturizer on one forearm 3 times daily for 8 weeks and then they were followed-up for the next 2 weeks (the regression period). No moisturizer was used on the other forearm as a control. The TEWL, skin capacitance and skin lipid content were evaluated weekly during the 8 weeks treatment period and then daily during 2 weeks of the regression period. RESULTS: During the treatment period, the skin capacitance and lipid content values of the treated side were significantly higher than that of the control side, and the TEWL values of the treated side were significantly lower than that of the control side. During the regression period, all the values of the treated side steadily became closer to those of the control side. These results suggest that long term treatment with moisturizer does not deteriorate the skin barrier function. CONCLUSION: Long-term treatment with moisturizer containing physiologic lipid not only enhances the normal skin barrier, it does not suppress the endogenous lipid synthesis of the skin.
Forearm ; Skin

BACKGROUND: Postoperative nausea and vomiting is one of the main problems after mastoidectomy and tympanoplasty. There is a growing interest in the use of nonpharmacologic and nonintravenous approaches to the prevention of postoperative nausea and vomiting. The aim of this study was to investigate the effect of stimulating the P6 acupoint and of the use of metoclopramide intranasal spray on the prevention of postoperative nausea and vomiting after mastoidectomy and tympanoplasty. METHODS: We studied 60 patients who received mastoidectomy and tympanoplasty for chronic ottitis media. No antiemetic agent or device was provided in the C group (n = 20). Acupressure on the P6 acupoint was applied after surgery in the P6 group (n = 20). In the M group (n = 20), metoclopramide was sprayed intranasally before extubation. Severity values of postoperative nausea and vomiting were assessed using 5 scales at different postoperative times. RESULTS: The severity of postoperative nausea and vomiting was significantly lower in the P6 group than in the C and M groups. There was no difference in the severity of postoperative nausea and vomiting between the C and M groups. At a postoperative 8 and 16 hr, there was a statiscally significant decrease of the severity of postoperative nausea and vomiting in the P6 group. CONCLUSIONS: Acupressure on the P6 acupoint reduced the incidence and severity of postoperative nausea and vomiting after mastoidectiomy and tympanoplasty. This result suggests that acupressure at P6 may be a useful new nonpharmacologic approach to the reduction or prevention of postoperative nausea and vomiting after mastoidectomy and tympanoplasty.
Acupressure ; Acupuncture Points ; Humans ; Incidence ; Metoclopramide ; Nausea ; Postoperative Nausea and Vomiting* ; Tympanoplasty* ; Vomiting ; Weights and Measures

BACKGROUND: Pediatric cardiopulmonary bypass (CPB) often results in increased capillary permeability and accumulation of excess total body water, which can lead to multiple organ dysfunctions. Recently, modified ultrafiltration (MUF) has been used during pediatric cardiac surgery to limit various deleterious effects of CPB. We investigated the effects of MUF on lung compliance and gas exchange in pediatric open heart operations. METHODS: Fifteen pediatric open heart surgery patients were evaluated. Lung compliance (dynamic compliance), arterial oxygen tension (PaO2), arterial to end-tidal carbon dioxide tension difference (Pa-ETCO2), systolic blood pressure (SBP), heart rate, and hematocrit (Hct) were measured. Measurements were made after induction of anesthesia, after CPB, after MUF and after sternal closure. RESULTS: Lung compliance, PaO2, SBP and Hct increased significantly after MUF compared to after CPB. After sternal closure, lung compliance decreased significantly from the value following MUF. PaO2, SBP, Hct decreased significantly after CPB compared to the values obtained after induction of anesthesia. Pa-ETCO2 and heart rate did not change significantly. CONCLUSIONS: Modified ultrafiltration increases lung compliance, PaO2, SBP and Hct. MUF is an excellent option for improving cardiopulmonary function immediately following pediatric cardiopulmonary bypass.
Anesthesia ; Blood Pressure ; Body Water ; Capillary Permeability ; Carbon Dioxide ; Cardiopulmonary Bypass ; Heart ; Heart Rate ; Hematocrit ; Humans ; Lung Compliance* ; Lung* ; Oxygen ; Thoracic Surgery* ; Ultrafiltration*

Acanthosis nigricans is a symmetric eruption characterized by the presence of a hyperpigmented, velvety cutaneous thickening, that can develop on any part of the body, but characteristically affects the flexural areas of the body. The velvety hyperkeratotic lesions can be located on the dorsum of the hands and feet in dark-skinned people in the form of a variant of acanthosis nigricans called as acral acanthotic anomaly or acral type acanthosis nigricans. Although acanthosis nigricans is associated with malignant tumors, particularly gastric carcinoma, acral type acanthosis nigricans has never been reported to be associated with gastric adenocarcinoma. In our present study, we describe a case of 58-year-old man with acral type acanthosis nigricans and its association with carcinoma of the stomach; a marked improvement was seen in the skin condition of the patient with chemotherapy.
Acanthosis Nigricans ; Adenocarcinoma ; Foot ; Hand ; Humans ; Middle Aged ; Skin