A 6 year-old, spayed female, Maltese dog was presented with precordial thrill and mild coughing. Thoracic auscultation revealed a grade V/VI systolic murmur with maximal intensity over the left apex characterized by musical murmur. Echocardiography revealed mild myxomatous degeneration of mitral valve and ruptured chordae tendineae. Musical murmur was produced due to the vibration of ruptured piece of chordae tendineae along with regurgitant flow. After treatment with furosemide and ramipril, clinical signs resolved and precordial thrill reduced. This case report describes typical clinical signs and phonocardiogram of musical murmur in a dog with acute chordae tendineae rupture.
Animals ; Auscultation ; Child ; Chordae Tendineae* ; Cough ; Dogs* ; Echocardiography ; Female ; Furosemide ; Humans ; Mitral Valve ; Music* ; Ramipril ; Rupture* ; Systolic Murmurs ; Vibration

BACKGROUND: Prolotherapy is a therapeutic procedure used for chronic musculoskeletal and arthritic pain. It involves injecting an irritant solution to pain sites and causes patient discomfort, which can lead to treatment discontinuation. Remifentanil is an ultra short-acting micro-opiate receptor agonist that permits a rapid transition from intense analgesia to a minimal residual effect. Here, we evaluated the effect of remifentanil as a preparative medication for ambulatory prolotherapy. METHODS: Eighty patients taking prolotherapy were assigned into three groups for pre-therapeutic injections: remifentanil 0.1 microgram/kg/min alone (Group R), remifentanil 0.05 microgram/kg/min with midazolam 2 mg (Group M), and normal saline (Group C). Pain and sedation scores, blood pressure, pulse oxygen saturation, heart rate, satisfaction score, and time to discharge were measured. RESULTS: Pain scores in groups M and R were lower than group C during and after prolotherapy. The sedation score of group M was higher than groups R and C. Nine patients in group R experienced dizziness during prolotherapy. In group M, 8 patients experienced dizziness and 2 patients experienced nausea. There was no difference in time to discharge among all groups. Satisfaction scores in group M (7.3 +/- 0.8) and group R (7.0 +/- 0.8) were higher than that of group C (5.3 +/- 0.6). CONCLUSIONS: Remifentanil and remifentanil/midazolam effectively reduce the pain produced by prolotherapy.
Analgesia ; Anesthesia ; Blood Pressure ; Dizziness ; Heart Rate ; Humans ; Midazolam ; Nausea ; Outpatients ; Oxygen ; Piperidines

PURPOSE: Febrile seizure is a common neurological disorder in children and it has been reported that it may progress to epilepsy in a few cases. We have set forth to carry out a prospective study of patients who developed epilepsy after febrile seizures to determine their clinical characteristics. METHODS: The subjects of this research were 104 patients who met WHO's definition of epilepsy after at least 6 months had passed since their first seizure of the 612 patients admitted to the pediatrics department of Kyung-hee Medical Center during 5 years from January of 1993 to January of 1998 for their first febrile seizure. Epilepsy was categorized as epileptic seizure according to ILAE(1981). RESULTS: 1) The incidence of epilepsy was highest in children from 3 years to 5 years. 2) Of 104 children who developed epilepsy, 60 children were males and 44 were females. 3) Of children who eventually developed epilepsy, 37% of them had the family history of seizure. 4) Of 612 cases of first attack febile seizure, generalized tonic-clonic type was the most frequent type and at the time of diagnosis of epilepsy, generalized tonic-clonic type was also the most frequent type. 5) The abnormal EEG findings are found in 95% of children who developed epilepsy. CONCLUSIONS: We observed the clinical characteristics of patients who developed epilepsy after febrile seizures, but we feel that continuous research is necessary in establishing a correlation between the two disorders.
Child ; Diagnosis ; Electroencephalography ; Epilepsy* ; Epilepsy, Generalized ; Female ; Humans ; Incidence ; Male ; Nervous System Diseases ; Pediatrics ; Prospective Studies ; Seizures ; Seizures, Febrile*

PURPOSE: Usually papillary microcarcinoma (PMC) grows very slowly with a good prognosis, although it frequently metastasizes to regional lymph nodes and shows multiple tumor formation in the thyroid. Therefore, how to treat papillary microcarcinoma has been controversial. Recently several studies reported that some ultrasonographic features may potentially reflect the biological aggressiveness of a lesion. We investigated which ultrasonographic findings can reflect aggressive characteristics and whether US can helpful in selecting the appropriate surgical treatment of PMC. METHODS: We retrospectively reviewed the preoperative ultrasonographic findings and pathologic risk factors of 68 patients who had undergone surgical treatment for PMC at the Wallace Memorial Baptist Hospital from January 2004 to December 2005. RESULTS: The incidences of multifocality, extrathyroidal extension, and lymph node metastasis of PMC were 42.6%, 48.5% and 20.6%, respectively. The Mean sizes of PMC were no significant differences according to age, multifocality, extrathyroidal extension, lymph node metastasis, stage and AMES risk group, and tumor size more than 5 mm was not linked to pathologic prognostic factors. Cases demonstrating multiple nodules in the unilateral or bilateral lobes, as well as those with fine strong calcifications in the tumor on US, were directly linked to multifocality on pathologic finding. US is insensitive technique for detecting lymph node metastasis and it's sensitivity was only 14.3%, but it's positive predictive value and specificity were high (100%). CONCLUSION: The date suggested that complete surgery with appropriate nodal dissection should be performed in patients with PMC which their US demonstrating multiple nodules in the unilateral or bilateral lobes, fine strong calcifications echoes in tumor and US-detected node metastasis.
Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Protestantism ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Thyroid Gland* ; Ultrasonography*

Hypertrophic cardiomyopathy (HCM) is recognized as the most common feline cardiac disease. Several studies have evaluated the population characteristics and survival time of cats with HCM; however, these reports included large numbers of asymptomatic HCM. The purpose of this study was to evaluate the characteristics and survival time of cats with symptomatic HCM admitted to emergency service. Medical records were examined to verify clinical diagnosis of HCM. Asymptomatic cats diagnosed with HCM were also excluded from the study. From a total of 13 cats, eight were classified in the arterial thromboembolism (ATE) group while the other five were in the congestive heart failure (CHF) group. Middle-aged (6 years, range 1.4~7 years) male cats (53.8%) were included in this study. Pelvic limb paralysis, depression, and respiratory distress were common clinical signs found in symptomatic HCM cats. Hematologic evaluation found that enzymes related to muscle damage and tissue necrosis were elevated in both groups and highly elevated in the ATE group. Left atrium was remarkably enlarged in ATE group cats. The median survival time of cats in the ATE group was significantly shorter than that of cats in the CHF group (P=0.002). Prospective investigation based on a large population would be required to clarify the effects of various factors on prognosis of HCM cats.
Animals ; Cardiomyopathy, Hypertrophic* ; Cats* ; Depression ; Diagnosis ; Emergencies ; Extremities ; Heart Atria ; Heart Diseases ; Heart Failure ; Humans ; Male ; Medical Records ; Necrosis ; Paralysis ; Population Characteristics ; Prognosis ; Prospective Studies ; Thromboembolism

Achalasia is a motility disorder of the esophagus characterized by aperistalsis, incomplete lower esophageal sphincter (LES) relaxation, and increased LES tension. Obstruction at the esophageal hiatus results in dilatation of the thoracic esophagus, which can cause coughing and dyspnea by compression of the trachea and main-stem bronchi, and predisposes the patient to regurgitation and pulmonary aspiration of stagnant esophageal contents. We report a case of slight aspiration pneumonia during anesthesia in a pregnant woman who had achalasia of the esophagus. Epidural anesthesia was performed for a cesarian section uneventfully. She had a regurgitation of the gastroesophageal contents after a thiopental 225 mg IV because she wanted to sleep due to anxiety. We performed endotracheal intubation with Sellick's maneuver immediately followed by suction. We regret not to have recognized that she had achalasia of the esophagus. Therefore, we did not remove the esophageal contents with a nasogastric tube. The result was that she had slight aspiration pneumonia.
Anesthesia* ; Anesthesia, Epidural ; Anxiety ; Bronchi ; Cough ; Dilatation ; Dyspnea ; Esophageal Achalasia* ; Esophageal Sphincter, Lower ; Esophagus ; Female ; Humans ; Intubation, Intratracheal ; Pneumonia, Aspiration* ; Pregnant Women ; Relaxation ; Suction ; Thiopental ; Trachea

BACKGROUND: The studies on cryopreserved arterial allograft have been focused on cooling methods, pre-treatment, cryoprotectant agents, and preservation temperature. But recently, several studies have reported that thawing methods also play an important role in the occurrence of macroscopic and microscopic cracks. This study was designed to investigate the cell injury after thawing, using a rabbit model to clarify the effect of thawing methods on cryopreserved arteries. MATERIAL AND METHOD: Segments of the rabbit aorta were obtained and divided into 3 groups (n=60) according to whether the specimens were fresh (control, n=20), cryopreserved and rapidly thawed (RT) at 37oC (n=20), or cryopreserved and subjected to controlled, automated slow thawing (ST)(n=20). Cell damage was established using the TUNEL method and the morphological changes were also evaluated. RESULT: In the group that was rapidly thawed, the expression of TUNEL (+) cells increased significantly more than in the slowly thawed group. In addition, the endothelial denudation, microvesicles and edema were significant in the rapidly thawed group compared with those changes in the slowly thawed group. CONCLUSION: Our study suggests that the rapid thawing method may be one of the major causes of cellular damage and delayed rupture in cryopreserved arterial allografts. The expression of TUNEL (+) cells and structural changes were significantly low in the slowly thawed group, which might have contributed to the improvement of graft failure after transplantation.
Allografts ; Aorta* ; Arteries ; Cryopreservation ; Edema ; In Situ Nick-End Labeling ; Rupture ; Transplants

Terminal cancer pain is always a challenge to pain doctors.If the focus of the cancer pain is located in the restricted area, it is easy to control the pain. However, if the focus of cancer pain is widespread, it is very difficult to control the pain and it makes pain doctors embarrassed.Nowadays, the ultrasound-guided nerve block become a popular method. It is easy to find the nerve and helps to insert the catheter around the nerve for the continuous nerve block. We encountered a patient who was 59 years old with a stomach cancer and vertebral metastasis. He complained about the pain in his abdomen, back and left thigh. His abdominal and back pain vanished with the use of continuous lumbar epidural injection. However, the patient still complained about the pain and numbness on the left thigh, because of this, he couldn't get any sleep.We tried a continuous femoral nerve block under the ultrasound guidance, after that his pain was gone.The ultrasound-guided nerve block will be very helpful to control the pain.
Abdomen ; Back Pain ; Catheters ; Femoral Nerve ; Humans ; Hypesthesia ; Injections, Epidural ; Neoplasm Metastasis ; Nerve Block ; Stomach Neoplasms ; Thigh

PURPOSE: To assess the metabolite ratios in gliomas to determine whether the metabolic information obtained by using by using in vivo single vexel 1H magnetic resonance spectroscopy(MRS) can be used as a marker for the grading of malignancy. MATERIALS AND METHODS: A total of 28 1H MR spectra from brain tumors in 27 patients with pathologically-proven gliomas were recorded. Seven patients had low grade gliomas (grade II astrocytoma in three, oligodendroglioma in three and mixed glioma in one), six had anaplastic gliomas (grade III astrocytoma in three and oligodendroglioma in three), and 14 had glioblastoma multiformes (grade IV), 1H MRS was performed on a 1.5T MRunit using PRESS sequence with a TR of 2000ms, a TE of 270 or 135ms and a voxel size of cm for all spectra. Relative lactate levels, NAA/Cho, NAA/Cr and Cho/Cr ratios were measured based on the peak heights of each resonance and compared among gliomas. RESULTS: Most tumors demonstrated decreased NAA, elevated Cho and lactate. Relatively high lactate and Cho levels and markedly decreased NAA level were more frequently observed in the high grade gliomas than in low grade gliomas. Marked elevation of lactate level in the solid component of the tumor was mostly observed in high grade gliomas. In a patient with gliomatosis cerebri, 1H MRS demonstrated a spectral pattern of tumor in filtration in an area that on MR images was apparently normal. However, NAA/Cr, NAA/Cho and Cho/Cr ratios did not significantly correlate, however, with the histologic grading of malignancy. Because of the partial volume effect, the heterogeneity of tumors containing solid and cystic or necrotic components within avoxel limited the interpretation of 1H MRS data for the grading of malignancy. CONCLUSION: The results suggest that in some patients in vivo single voxel 1H MRS may be useful for grading the malignancy of gliomas and evaluating the exact extent of tumors. In solid gliomas, the relative level of lactate appears to be a good markerfor the grading of malignancy.
Astrocytoma ; Brain Neoplasms ; Filtration ; Glioblastoma ; Glioma* ; Humans ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Neoplasms, Neuroepithelial ; Oligodendroglioma ; Population Characteristics

Cloacal anomalies are very rare congenital malformations with the incidence of 1/50,000-250,000 births. Hydrocolpos involves the dilatation of the vagina due to obstruction of the genital tract, leading to accumulation of secretions. Because of wide spectrum of abnormal anatomy involving urogenital and gastrointestinal systems, prenatal diagnosis is difficult. As ultrasound becomes more and more reliable, prenatal diagnosis is possible as early as in the second trimester. The presence of prenatally detected hydro (metro) colpos warrants a systematic evaluation of fetal and neonatal anatomy to rule out a large variety of possibly associated malformations or syndromes. We present a case of urogenital sinus maldevelopment which was initially presented as a fetal ascites.
Ascites ; Dilatation ; Female ; Humans ; Hydrocolpos ; Incidence ; Parturition ; Pregnancy ; Pregnancy Trimester, Second ; Prenatal Diagnosis ; Ultrasonography* ; Vagina