BACKGROUND: This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33degrees C target temperature management. METHODS: A retrospective study was conducted on patients who underwent 33degrees C target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia. RESULTS: A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 +/- 0.15 microg/kg/h. Decisions of charged doctor's were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole. CONCLUSIONS: Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33degrees C target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33degrees C targeted temperature management.
Atropine ; Body Weight ; Bradycardia* ; Carbon Monoxide Poisoning ; Dexmedetomidine* ; Diagnosis ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Hypothermia, Induced ; Logistic Models ; Odds Ratio ; Retrospective Studies

BACKGROUND: There are many rating scales for assessment of geriatrics. But each of these scales were not sufficient to evaluate comprehensive geriatric assessment, physical and psychologic efforts for care. METHODS: We developed new scales to comprehensive geriatric assessment for care of geriatric patients. The Geriatrics Physical Support Scale(GPSS) evaluates physical effort consists of 10 areas and the Geriatrics Global Support Scale(GGSS) evaluates general condition of patients consist of 6 areas. Eighty probable and possible AD patients received the Clinical Dementia Rating Rating Scale(CDR), Korearn version of Mini-Mental State Examination(K-MMSE), Barthel Activity of Daily Living Index(B-ADL) GPSS, GGSS. We tested internal consistency, correlation among dementia rating scales. RESULTS: The GPSS correlated to CDR -0.63(p<0.01), B-ADL -0.90(p<0.01) and the GGSS correlated to CDR -0.60(p<0.01), B-ADL -0.75(p<0.01). The internal consistency were 0.69(GGSS), 0.92(GPSS). CONCLUSION: The Geriatrics Global Support Scale evaluate general condition of patients and the Geriatrics Physical Support Scale evaluate physical efforts needed for care of geriatric patients. These scales an also brief and easy rating scales to grade degree of caregiver`s burden.
Dementia ; Geriatric Assessment ; Geriatrics* ; Humans ; Physical Exertion ; Reproducibility of Results* ; Weights and Measures

No abstract available.
Female ; HELLP Syndrome* ; Pregnancy

BACKGROUND: The purpose of this study was to determine the tibial fixation strength provided by different intraosseous soft tissue graft lengths within the tibial tunnel. METHODS: Porcine tibial bones and digital flexor tendons were used for testing. Bone mineral densities of proximal tibial medial condyles were measured, and two-strand tendon bundles of 8 mm diameter were used. An intraosseous graft length of 2 cm was used in group 1 (n = 10), and a graft length of 4 cm was used in group 2 (n = 10). Tunnels were 4 cm in length and 8 mm in diameter. Tibial fixation was performed using a suture tied around a screw post with a washer and an additionally inserted 7 x 20 mm bioabsorbable screw. After applying preconditioning loading of 10 cycles, 1,000 cycles between 70-220 N were applied at a frequency of 1 Hz. Graft slippage and total graft movement were recorded. Ultimate tensile strength was measured by pull-out testing at an Instron crosshead speed of 1,000 mm/min. RESULTS: No significant intergroup difference was found for total graft movement after cyclic loading (slippage in group 1, 1.2 mm and group 2, 1.2 mm, respectively, p = 0.917; and total graft movement in group 1, 3.3 mm and group 2, 2.7 mm, respectively, p = 0.199). However, mean ultimate tensile strength in group 2 was significantly higher than that in group 1 (group 1, 649.9 N; group 2, 938 N; p = 0.008). CONCLUSIONS: In a porcine model, ultimate tensile strength was greater for a 4 cm long intraosseous flexor tendon in the tibial tunnel. However, no intergroup difference in graft slippage or total graft movement was observed. The results show that a 2 cm intraosseous graft length in the tibial tunnel is safe and has sufficient strength (> 450 N) for adequate rehabilitation after anterior cruciate ligament reconstruction.
Animals ; Anterior Cruciate Ligament/injuries/*physiopathology/surgery ; *Anterior Cruciate Ligament Reconstruction ; Biomechanical Phenomena ; Bone Density ; Models, Animal ; Swine ; Tendons/*transplantation ; Tensile Strength ; Tibia/*surgery

There have been very few reports on reflex seizures induced by writing. Complex precipitating behaviors such as calculation, writing, copying of complicated figure, and spatial construction have been recognized as triggering factor of epileptic seizures. We report a case of a patient with a very unusual form of complex reflex epilepsy in which seizures are usually induced by writing or spatial construction. Neurological examination was normal and brain magnetic resonance imaging showed mild brain atrophy without focal lesion. During long-term video-EEG monitoring, she was instructed to write a letter with the right hand. About 20 minutes after writing, she experienced similar aura and motion arrest and then showed an elevation of bilateral upper extremities like myoclonic jerk followed by generalized tonic clonic seizure. On ictal EEG, spike and wave complexes appeared from both centroparietal region followed by 10 Hz rhythmic activities for 20 seconds. Interictal EEG was normal. Ictal-interictal subtraction image of brain SPECT (99mTc-HMPAO) showed hyperperfusion in the middle frontal gyrus and precentral gyrus of left frontal lobe and superior and inferior frontal gyrus of right frontal lobe. We suggest that this reflex epilepsy might be originated from both central areas with maximum on the left side. Oxcarbazepine was effective in controlling this reflex epileptic seizure.
Atrophy ; Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Reflex* ; Frontal Lobe ; Hand* ; Humans ; Magnetic Resonance Imaging ; Myoclonus ; Neurologic Examination ; Reflex* ; Seizures ; Tomography, Emission-Computed, Single-Photon ; Upper Extremity ; Writing

PURPOSE: To evaluate incidentally observed thickened mucosa of paranasal sinuses on brain MRI of patients without evidence of sinusitis. MATERIALS AND METHODS: We reviewed brain MRI of 82 adults aged over 20 ; 45 were males and 37 were females. Brain axial MRI was obtained from the hard palate with 8mm thickness and 2mm gap. The mucosal thickness of incidentally observed paranasal sinuses seen on brain MRI was measured at the mostly thickened portion by T2- and T1-weighted images. RESULTS: The mean mucosal thickness at the most thickened portion of paranasal sinuses, regardless of their location was 3.5mm with S.D. of 1.5mm. The mucosal thickening was observed more commonly in maxillary (79 patients, mean 3.0mm, S.D. 1.4mm) and ethmoid sinuses (80 patients,mean 2.7mm, S.D. 1.1mm) than in sphenoid (39 patients, mean 1.6mm, S.D. 1.4mm) or frontal sinuses (38 patients, mean 1.9mm, S.D. 1.4mm). CONCLUSION: Mucosal thickening of up to 6.5mm was a common finding on brain MRI of patients without evidence of sinusitis ; accuracy was 95%.
Adult ; Brain* ; Ethmoid Sinus ; Female ; Frontal Sinus ; Humans ; Magnetic Resonance Imaging ; Male ; Mucous Membrane ; Palate, Hard ; Paranasal Sinuses* ; Reference Values* ; Sinusitis

We investigated the synergistic apoptotic effects of co-treatments with Chios gum mastic (CGM) and eugenol on G361 human melanoma cells. An MTT assay was conducted to investigate whether this co-treatment efficiently reduces the viability of G361 cells compared with each single treatment. The induction and augmentation of apoptosis were confirmed by DNA electrophoresis, Hoechst staining, and analyses of DNA hypoploidy. Western blot analysis and immunofluorescent staining were also performed to evaluate expression and translocation of apoptosis-related proteins following CGM and eugenol co-treatment. Proteasome activity and mitochondrial membrane potential (MMP) changes were also assayed.The results indicated that the co-treatment of CGM and eugenol induces multiple pathways and processes associated with an apoptotic response in G361 cells. These include nuclear condensation, DNA fragmentation, a reduction in MMP and proteasome activity, an increase of Bax and decrease of Bcl-2, a decreased DNA content, cytochrome c release into the cytosol, the translocation of AIF and DFF40 (CAD) into the nucleus, and the activation of caspase-9, caspase-7, caspase-3, PARP and DFF45 (ICAD). In contrast, separate treatments of 40 microg/ml CGM or 300 microM eugenol for 24 hours did not induce apoptosis. Our present data thus suggest that a combination therapy of CGM and eugenol is a potential treatment strategy for human melanoma.
Apoptosis ; Blotting, Western ; Caspase 3 ; Caspase 7 ; Caspase 9 ; Cytochromes c ; Cytosol ; DNA ; DNA Fragmentation ; Electrophoresis ; Eugenol ; Gingiva ; Humans ; Melanoma ; Membrane Potential, Mitochondrial ; Proteasome Endopeptidase Complex ; Proteins ; Resins, Plant

We report a case of pure red cell aplasia due to parvovirus B19 infection in a renal transplant recipient. The patient was a 32-year-old male with end stage renal disease due to chronic glomerulonephritis, who had been undergoing regular hemodialysis. He received a living nonrelated renal transplant and immumosuppressive therapy including prednisolone, tacrolimus, and mycophenolate mofetil. One week after kidney transplantation, severe anemia was persisted despite recombinant human erythropoietin administration and packed red blood cell transfusion. His bone marrow aspiration smear demonstrated erythroid hypoplasia and giant pronormoblasts with prominent intranuclear inclusions. Both serum and bone marrow were positive for parvovirus B19 DNA polymerase chain reaction and anti-parvovirus B19 IgM. He was treated with intravenous immunoglobulin and conversion of tacrolimus to cyclosporine. His hemoglobin level was completely recovered three months later.
Adult ; Anemia ; Bone Marrow ; Cyclosporine ; DNA ; Erythroblasts ; Erythrocyte Transfusion ; Erythropoietin ; Glomerulonephritis ; Humans ; Immunoglobulin M ; Immunoglobulins ; Intranuclear Inclusion Bodies ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Parvovirus* ; Polymerase Chain Reaction ; Prednisolone ; Red-Cell Aplasia, Pure* ; Renal Dialysis ; Tacrolimus ; Transplantation*

OBJECTIVES: The aim of this study was to analyze psychosocial factors associated with suicidal idea among Korean elderly. METHODS: The sociodemographic data and psychopathology were evaluated by questionnaire and psychiatric interview in community-dwelling elderly with age over 60 (N=100) and adults with age 30-49 (N=60). Suicidal idea was assessed by 9th item of Beck Depression Inventory (BDI). To analyze factors associated with suicidal idea in Korean elderly, we assessed family function (Family Adaptation Partnership Growth Affection Resolve, APGAR), alcohol problem (Cut Annoyed Guilty Eye-Opener, CAGE), depressive symptoms (HAM-D, BDI), cognitive function (CDR, MMSE-K, GDS), and functional activities (ADL, I-ADL). RESULTS: 1) The frequency of suicidal idea of the elderly with age over 60 (20.0%) was significantly higher than that of adult with age 30-49 (6.7%)(p<0.05). 2) The factors associated with suicidal idea were major depressive disorder (OR=42.17, 95% C.I. : 2.62-679.03), physical illness (OR=27.01, 95% C.I. : 1.18-616.50), depressive symptoms (OR=12.18, 95% C.I. : 2.91-49.98), poor economic status (OR=7.18, 95% C.I. : 1.05-48.86). 3) The means of variables in the elderly with suicidal idea were ADL 6.4+/-1.1, HAM-D 17.8+/-7.7, BDI 30.0+/-9.5, APGAR 4.8+/-2.6, which were significantly higher than those of the elderly without suicidal idea (p<0.05, respectively). 4) The HAM-D score in the Korean elderly had statistically significant correlation with APGAR (gamma=0.376, p<0.01), BDI (gamma=0.808, p<0.01), ADL (gamma=0.316, p<0.01), GDS (gamma=0.282, p<0.01), CDR (gamma=0.258, p<0.01) and education level (gamma=-0.208, p<0.05). The BDI score had statistically significant correlation with APGAR (gamma=0.341, p<0.01), HAM-D (gamma=0.808, p<0.01), GDS (gamma=0.340, p<0.01), CDR (gamma=0.301, p<0.01), ADL (gamma=0.325, p<0.05) and I-ADL (gamma=0.206, p<0.05). CONCLUSION: These results suggested early detection, psychogeriatric intervention of the elderly with high risk factors and active treatment of medical illness could reduce suicidal idea among them.
Activities of Daily Living ; Adult ; Aged* ; Depression ; Depressive Disorder, Major ; Education ; Humans ; Psychology* ; Psychopathology ; Surveys and Questionnaires ; Risk Factors

Von Hippel-Lindau disease (VHL) is a rare, autosomal dominantly transmitted familial, hereditary disease. This disease genetically predisposes affected people to the development of some types of tumor, such as cerebellar, spinal and medullary hemangioblastomas, and retinal angiomas, renal cell carcinomas and pheochromocytomas. Herein, a case of a cystic renal cell carcinoma, accompanied by Von Hippel-Lindau disease, treated by nephron sparing surgery, is reported. The VHL gene mutation of this case was also identified.
Carcinoma, Renal Cell* ; Genetic Diseases, Inborn ; Hemangioblastoma ; Hemangioma ; Nephrons* ; Pheochromocytoma ; Retinaldehyde ; von Hippel-Lindau Disease*