No abstract available.

BACKGROUND: Pressure support ventilation(PSV) is a new form of mechanical ventilatory support that assists spontaneous inspiratory effort of an intubated patient with a clinician-selected amount of positive airway pressure. Low level pressure support during inspiration can overcome the resistive component of inspiratory work imposed by ah endotracheal tube. However the clinical efficacy of PSV as a weaning method has not been established yet. Object : The aim of study was to evaluate the efficacy of PSV when it is added to intermittent mandatory ventilation (IMV) in facilitating weaning process compared to IMV mode alone. METHOD: When the subject patients became clinically stable with their arterial blood gas analysis in acceptable range, they underwent weaning process either by IMV alone or by IMV plus PSV. The level of pressure support was held constant through the weaning period. For the patients who required mechanical ventilation for less than 72hr, 2h weaning trial was performed with IMV rate starting from 6/min. For the patients who required mechanical ventilation more than 72 hr, 7 hr weaning retrial was performed with IMV rate starting from 8/min. For the patients who failed three consecutive trials of weaning, retrial of weaning was attempted over 3 days with IMV rate starting from 8/min. Clinical characteristics, APACHE II score and nutritional status were compared. For all patients, heart rate, mean blood pressure and respiratory rate were mornitored for 48 hrs after weaning trial started. RESULTS: The total number of weaning trial was 37 in 23 patients(18 by IMV, 19 by IMV+PSV). Total ventilation time, APACHE II score and nutritional status were not statistically different between the two groups. The weaning success rate were not statistically different(38.3% by IMV, 42.1% by IMV+PSV) and the changes of mean blood pressure, heart rate, respiratory rate during first 48 hours were not different between the two groups. CONCLUSION: Low level PSV when added to IMV for weaning trial does not seem to improve the success rate of weaning from mechanical ventilation. PSV at 10cm H2O did not induce significant physiologic changes during weaning process.
APACHE ; Blood Gas Analysis ; Blood Pressure ; Heart Rate ; Humans ; Nutritional Status ; Respiration, Artificial ; Respiratory Rate ; Ventilation* ; Weaning*

PURPOSE: One of the most important adverse effects of long-term cyclosporine therapy is nephrotoxicity, the morphologic changes of which include interstitial fibrosis and arteriolar hyalinization. Recently, several authors have shown that osteopontin plays an important role in the development of interstitial fibrosis by acting as a macrophage chemoattractant and stimulating the production of TGF-beta in experimental cyclosporine nephrotoxicity. However, the relationship between osteopontin and TGF-beta in humans has not been clearly documented so far. We studied the expression of osteopontin and TGF-beta in children with minimal change nephrotic syndrome treated with cyclosporine to demonstrate whether there is a relationship between cyclosporine toxicity and osteopontin expression as previously shown in animal models. MATERIALS AND METHODS: Nineteen children (15 males and 4 females) were the subject of this study. Renal biopsies had been performed before and after the cyclosporine therapy (mean duration: 15.9 months). In 5 patients, additional biopsies were performed after completing the cyclosporine treatment (mean: 26 months). The expressions of osteopontin and TGF-beta were evaluated by immunohistochemistry in the glomeruli and tubulointerstitium. RESULTS: Osteopontin expression was significantly increased in the glomerular mesangium and tubules after cyclosporine treatment. But there was no statistically significant increase of TGF-beta in the interstitium. There was no significant increase in tubular osteopontin and interstitial TGF-beta expression in those cases developing interstitial fibrosis after cyclosporine treatment compared with cases those not developing interstitial fibrosis. No significant changes in osteopontin or TGF-beta expression were observed in subsequent 5 biopsy samples after discontinuation of cyclosporine compared with the first follow up biopsies. CONCLUSION: These results suggest that osteopontin is a nonspecific marker of renal injury rather than a mediator of interstitial fibrosis in cyclosporine nephrotoxicity of human.
Biopsy ; Child ; Cyclosporine* ; Fibrosis ; Follow-Up Studies ; Glomerular Mesangium ; Humans ; Hyalin ; Immunohistochemistry ; Macrophages ; Male ; Models, Animal ; Nephrosis, Lipoid* ; Osteopontin* ; Transforming Growth Factor beta

BACKGROUND: Pressure support(PS) is becomimg a widely accepted method of mechanical ventilation either for total unloading or for partial unloading of respiratory muscle. The aim of the study was to find out if PS exert different effects on respiratory mechanics in synchronized intermittent mandatory ventilation(SIMV) and continuous positive airway pressure (CPAP) modes. METHODS: 5, 10 and 15 cm H2O of PS were sequentially applied in 14 patients(69+/-12 yrs, M:F=9:5) and respiratory rate (RR), tidal volume(VT), work of breathing(WOB), pressure time product(PTP), P(0.1), and T(1)/T(TOT) were measured using the CP-100 pulmonary monitor(Bicore, USA) in SIMV and CPAP modes respectively. RESULTS: 1) Common effects of PS on respiratory mechanics in both CPAP and SIMV modes As the level of PS was increased(0, 5, 10, 15 cm H2O), VT was increased in CPAP mode(0.28+/-0.09, 0.29+/-0.09, 0.31+/-0.11, 0.34+/-0.12 L, respectively, p=0.001), and also in SIMV mode(0.31+/-0.15, 0.32+/-0.09, 0.34+/-0.16, 0.36+/-0.15 L, respectively, p=0.0215). WOB was decreased in CPAP mode(1.40+/-1.02, 1.01+/-0.80, 0.80+/-0.85, 0.68+/-0.76 joule/L, respectively, p=0.0001), and in SIMV mode(0.97+/-0.77, 0.76+/-0.64, 0.57+/-0.55, 0.49+/-0.49 joule/L, respectively, p=0.0001). PTP was also decreased in CPAP mode(300+/-216, 217+/-165, 179+/-187, 122+/-114cm H2O * sec/min, respectively, p=0.0001), and in SIMV mode(218+/-181, 178+/-157, 130+/-147, 108+/-129cm H2O.sec/min, respectively, p=0.0017). 2) Different effects of PS on respiratory mechanics in CPAP and SIMV modes By application of PS (0, 5, 10, 15 cm H2O), RR was not changed in CPAP mode(27.9+/-6.7, 30.0+/-6.6, 26.1+/-9.1, 27.5+/-5.7/min, respectively, p=0.505), but it was decreased in SIMV mode (27.4+/-5.1, 27.8+/-6.5, 27.6+/-6.2, 25.1+/-5.4/min, respectively, p=0.0001). P(0.1) was reduced in CPAP mode(6.2+/-3.5, 4.8+/-2.8, 4.8+/-3.8, 3.9+/-2.5 cm H2O, respectively, p=0.0061), but not in SIMV mode(4.3+/-2.1, 4.0+/-1.8, 3.5+/-1.6, 3.5+/-1.9 cm H2O, respectively, p=0.054). T(1)/T(TOT) was decreased in CPAP mode(0.40+/-0.05, 0.39+/-0.04, 0.37+/-0.04, 0.35+/-0.04, respectively, p=0.0004), but not in SIMV mode(0.40+/-0.08, 0.35+/-0.07, 0.38+/-0.10, 0.37+/-0.10, respectively, p=0.287). 3) Comparison of respiratory mechanics between CPAP+PS and SIMV alone at same tidal volume. The tidal volume in CPAP+PS 10 cm H2O was comparable to that of SIMV alone. Under this condition, the RR(26.1+/-9.1, 27.4+/-5.1/min, respectively, p=0.516), WOB(0.80+/-0.85, 0.97+0.77 joule/L, respectively, p=0.485), P0.1(3.9+/-2.5, 4.3+/-2.1 cm H2O, respectively, p=0.481) were not different between the two methods, but PTP(179+/-187, 218+/-181 cmH2O.sec/min, respectively, p=0.042) and T(1)/T(TOT)(0.37+/-0.04, 0.40+/-0.08, respectively, p=0.026) were significantly lower in CPAP+PS than in SIMV alone. CONCLUSION: PS up to 15 cm H2O increased tidal volume, decreased work of breathing and pressure time product in both SIMV and CPAP modes. PS decreased respiration rate in SIMV mode but not in CPAP mode, while it reduced central respiratory drive(P(0.1)) and shortened duty cycle (T(1)/T(TOT)) in CPAP mode but not in SIMV mode. By 10 cm H2O of PS in CPAP mode, same tidal volume was obtained as in SIMV mode, and both methods were comparable in respect to RR, WOB, P(0.1), but CPAP+PS was superior in respect to the efficiency of the respiratory muscle work (PTP) and duty cycle(T(1)/T(TOT)).
Continuous Positive Airway Pressure ; Respiration, Artificial ; Respiratory Mechanics* ; Respiratory Muscles ; Respiratory Rate ; Tidal Volume ; Work of Breathing

Somatostatinoma is a rare form of neuroendocrine tumor that was first described in 1977. Most tumors have involved the pancreas, and gastrointestinal tract involvement is rare. Somatostatinomas of the ampulla of Vater are extremely rare and present distinct clinical and pathologic differences. Pancreatic somatostatinoma has been associated with a clinical syndrome of dyspepsia, mild diabetes, cholelithiasis, steatorrhea, and hypochlorhydria, but duodenal somatostatinoma, in general, has been clinically silent. A further contrast is that duodenal carcinoid tumors, mainly gastrinoma, tended to be benign, whereas ampullary carcinoid tumors, mainly somatostatinoma, exhibited malignant behavior. Therefore, definite diagnosis is important for treatment and prognosis, and is performed by image study, immunohistochemistry and electron microscopic examination. We report a case of somatostatinoma of the ampulla of Vater in a 51-year-old male. He complained of generalized abdominal pain for a few days. Gastrofiberscopically, a 1.2 cm sized bulging mass was observed on the ampulla of Vater. Radiologically, on abdomen CT, a protruding enhancing mass was revealed in the duodenum. In octreoscan, there was an abnormal focus off increased radiouptake in the infrahepatic area. He underwent a pancreatoduodenectomy. Grossly, the mass was an intraluminary protruding polypoid submucosal mass with focal ulceration in the ampulla of Vater. Histologically, it showed well-differentiated nonpleomorphic tubular cell nest and psammoma bodies. Immunohistochemically, the tumor cells showed a neuroendocrine nature with synaptophysin immunostain and intense staining only for somatostatin.
Abdomen ; Abdominal Pain ; Achlorhydria ; Ampulla of Vater* ; Carcinoid Tumor ; Cholelithiasis ; Diagnosis ; Duodenum ; Dyspepsia ; Gastrinoma ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Neuroendocrine Tumors ; Pancreas ; Pancreaticoduodenectomy ; Prognosis ; Somatostatin ; Somatostatinoma* ; Steatorrhea ; Synaptophysin ; Ulcer

A 28 year-old male who had received Konno procedure twelve years ago with 23mm mechanical aortic valve and bovine pericardium with which his small aortic annulus, ventricular septum and right ventricular outflow tract had been enlarged was transferred due to sudden congestive heart failure. There were perforations on aortic and interventricular portion of bovine pericardial patch above and below the aortic valve, respectively, which was calcified and denaturated severely. The perforations seemed to be attributed to the cracks, resulting from mobility of mechanical aortic valve itself and stiffness of calcified and denaturated bovine patch. We performed a redo Konno procedure applying PTFE patch.
Adult ; Aortic Valve ; Heart Failure ; Humans ; Male ; Pericardium ; Polytetrafluoroethylene ; Reoperation ; Ventricular Septum

No abstract available.
Cardiopulmonary Bypass ; Models, Theoretical

BACKGROUND: Parenteral tetracycline is no longer available for pleural sclerosing agent for pleurodesis in Korea due to the discontinuation of the production. The purposes of this study were to determine whether oral doxycycline (ODC) could be used as an effective sclerosing agent for pleurodesis, and to compare the effectiveness of ODC to other agents, such as homologous blood and talc. MATERIAL AND METHOD: Twenty male rats were divided into four groups (A to D). Following agents were given to each group intrapleurally; 10 ml/kg of 0.9% saline to group A, 10 mg/kg of ODC to group B, 2 ml/kg of homologous blood to group C, and 70 mg/kg of talc slurry to group D. All animals were sacrificed 28 days after instillation. The pleural spaces were assessed grossly and microscopically and were graded from 0 to 3, and the thicknesses of the pleura were measured. RESULT: The gross score of group A was 0.0, group B was 1.4+/-0.9, group C was 1.0+/-0.7, and group D was 2.2+/-0.8. Significant adhesion were examined in group B and D grossly (p<0.05). The pleural thickness of group A was 0.7+/-0.2 /10(2) mm, group B was 1.2+/-0.4 /10(2) mm, group C was 1.4+/-0.4 /10(2) mm, and group D was 3.5+/-0.9 /10(2) mm. Group D showed pleural thickening significantly (p<0.05). The microscopic score of group A was 1.0, group B was 1.7+/-0.5, group C was 1.5+/-0.4, and group D was 2.8+/-0.4. Group B and D showed significant inflammations and depositions of collagen (p<0.05). CONCLUSION: ODC showed significant pleurodesis grossly and microscopically, and homologous blood did not show adhesion. Talc was a significant sclerosing agent for pleurodesis causing extensive inflammation and collagen depisotion.
Animals ; Collagen ; Doxycycline* ; Humans ; Inflammation ; Korea ; Male ; Pleura ; Pleurodesis ; Rats* ; Sclerosing Solutions* ; Talc* ; Tetracycline

Inflammatory bowel disease, such as ulcerative colitis and Crohn's disease, has a potential risk of developing into colorectal cancer. However, there is little relationship between intestinal tuberculosis and colon cancer because intestinal tuberculosis is a curable disease and has a relatively short disease course. Nevertheless, there have been a few case reports of intestinal tuberculosis associated with colon cancer. There was a case report in which the carcinoma facilitated entry of tubercle bacilli with development of a secondary infection, and ulcerative lesions of tuberculosis may be precursors of carcinomas. We experienced a 77-year-old woman who had intestinal tuberculosis combined with ascending colon cancer. She visited our hospital because of abdominal pain and constipation. Colonoscopy showed a luminal obstruction mass in the ascending colon. Histologic examination revealed an adenocarcinoma. After surgery, the surgical specimen disclosed an adenocarcinoma in the cecum and ascending colon and intestinal tuberculosis around the cancer site of the cecum. Herein, we report a rare case of colon cancer co-existing with colonic tuberculosis with a review of the literature.
Female ; Humans ; Adenocarcinoma

PURPOSE: Idiopathic granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology and the optimal treatment remains controversial. The aim of this study is to evaluate the efficacy of surgically complete excision in patients with idiopathic granulomatous mastitis. METHODS: Between March 2005 and November 2008, we treated 14 cases that were diagnosed with idiopathic granulomatous mastitis. Prospectively, we treated the cases with complete surgical excision with or without steroid therapy in all patients. RESULTS: The mean age of the patients was 36 years (range 30 to 53 years). All cases performed were complete excision with or without steroid therapy. The median follow up period was 26 months (range 5 to 50 months) and all cases had no recurrence. 13 patients out of the 14 were satisfied with the cosmesis of the treated breast. CONCLUSION: We conclude that the treatment of choice for idiopathic granulomatous mastitis is surgically complete excision.
Breast ; Breast Diseases ; Follow-Up Studies ; Granulomatous Mastitis ; Humans ; Prospective Studies ; Recurrence