A massive pulmonary embolism occurring during surgery is a fatal complication. Therefore, early detection and subsequent treatment of pulmonary emboli are important clinical challenges. In this report, an acute pulmonary embolism associated with cardiac arrest occurred during the surgical reduction of a femur fracture. It was diagnosed by echocardiography and treated with urokinase successfully. Therefore, we recommend the use of urokinase for the treatment of a intraoperative massive pulmonary embolism.
Echocardiography ; Femur* ; Heart Arrest ; Pulmonary Embolism* ; Urokinase-Type Plasminogen Activator*

The nfa1 gene was cloned from a cDNA library of pathogenic Naegleria fowleri by immunoscreening; it consisted of 360 bp and produced a 13.1 kDa recombinant protein (rNfa1) that showed the pseudopodia-specific localization by immunocytochemistry in the previous study. Based on the idea that the pseudopodia-specific Nfa1 protein mentioned above seems to be involved in the pathogenicity of N. fowleri, we observed the effect of an anti-Nfa1 antibody on the proliferation of N. fowleri trophozoites and the cytotoxicity of N. fowleri trophozoites on the target cells. The proliferation of N. fowleri trophozoites was inhibited after being treated with an anti-Nfa1 polyclonal antibody in a dose-dependent manner for 48 hrs. By a light microscope, CHO cells co-cultured with N. fowleri trophozoites (group I) for 48 hrs showed severe morphological destruction. On the contrary, CHO cells co-cultured with N. fowleri trophozoites and anti-Nfa1 polyclonal antibody (1: 100 dilution) (group II) showed less destruction. In the LDH release assay results, group I showed 50.6% cytotoxicity, and group II showed 39.3%. Consequently, addition of an anti-Nfa1 polyclonal antibody produced a decreasing effect of in vitro cytotoxicity of N. fowleri in a dosedependent manner.
Animals ; Antibodies, Protozoan/*immunology ; Antigens, Protozoan/genetics/*immunology ; CHO Cells ; Dose-Response Relationship, Immunologic ; Female ; Hamsters ; Mice ; Mice, Inbred BALB C ; Naegleria fowleri/growth & development/immunology/*pathogenicity ; Protozoan Proteins/genetics/*immunology ; Recombinant Proteins/immunology ; Support, Non-U.S. Gov't

Relapsing polychondritis (RP) is an uncommon disorder of unknown etiology characterized by inflammation and destruction of the cartilaginous structures of many organs, including the tracheobronchial tree. We experienced a rare case of RP diagnosed after stellate ganglion block. A 56-year-old female has been treated under impression of rheumatoid arthritis and bronchial asthma for several years, but her symptoms were not markedly relieved. We performed right stellate ganglion block with 8 mL of 1% mepivacaine for the relief of the right shoulder pain. About 5 minutes later, she complained severe dyspnea and became cyanotic. Bronchoscopic finding was diffuse bronchoconstriction during expiration. We confirmed the diagnosis of relapsing polychondritis by bronchoscopic biopsy finding. Unfortunately, she died 3 months later due to recurrent pneumonia and acute respiratory distress syndrome.
Arthritis, Rheumatoid ; Asthma ; Biopsy ; Bronchoconstriction ; Diagnosis ; Dyspnea ; Female ; Humans ; Inflammation ; Mepivacaine ; Middle Aged ; Pneumonia ; Polychondritis, Relapsing* ; Respiratory Distress Syndrome, Adult ; Shoulder Pain ; Stellate Ganglion*

OBJECTIVES: This 3-year longitudinal study was conducted to evaluate the influence of self-rating health perception on health care utilization and all cause-death risk. METHODS: The hypothesis was tested using a community-based samples, among which subjects 3,414 were interviewed in 1995. Self-rating health perception was assessed by single-item question. Three components of health care utilization amount(number of visits, number of medications, yearly health care expenses) per year were measured using medical insurance data during 3-year follow-up period among subjects in district health care insurance. There were 123 deaths from all causes among 3,085 subjects interviewed. RESULTS: The results showed that those who had poor health perception revealed more increases in the amount of health care utilization than good health perception group (p<0.05). After adjusting for age and sex, the poor health perception group had higher death risk over 3 years than good health perception group(hazard ratio=1.88). but, after adjusting health care utility, supplementary, was not significant. CONCLUSION: These results suggest that self-rating health percep-tion was associated with difference in health care utilization and all cause-death risk.
Delivery of Health Care* ; Follow-Up Studies ; Insurance ; Longitudinal Studies

BACKGROUND: Desflurane is a new inhalation anesthetic with a low blood/gas solubility which should allow fast induction and emergence from anesthesia. This study was designed to compare the induction and recovery characteristics of gynecologic surgical patients receiving either desflurane or isoflurane with nitrous oxide for the maintenance of general anesthesia. METHODS: After standardized induction of anesthesia with fentanyl, propofol, succinylcholine and tracheal intubation, patients undergoing elective gynecologic surgery randomly divided into desflurane group (n=21) or isoflurane group (n=20). Induction and recovery time and the incidence of postoperative nausea and vomiting and recall were compared between the two groups. RESULTS: Although anesthetic conditions were similar during operation in the two groups, significant differences were noted in induction and recovery profiles from anesthesia. Induction time was 124+/-66 sec for desflurane vs. 422+/-257 sec for isoflurane (mean SD). The time required for the end-tidal concentration of anesthetics to decrease by 50% was 168.0+/-160.1sec for desflurane vs. 222.9+/-127.5sec for isoflurane. The time to response (eye opening follow simple command), orientation (recall of name and date of birth), reach 10 point of PAR (postanesthetic recovery) score and discharge from recovery room were significantly shorter after desflurane than after isoflurane (417.0+/-158.7 vs. 577.1+/-207.4sec, 591.0+/-193.0 vs. 800.0+/-326.0sec, 31.3+/-18.0 vs 41.8+/-15.0min, 66.9+/-27.2 vs. 80.1+/-11.8min, respectively). CONCLUSIONS: From the above study it can be concluded that a balanced anesthetic technique using desflurane as the main anesthetic has certain advantages compared with isoflurane in terms of faster emergence, however the frequency of side effects such as nausea, vomiting and recall during postoperative period were similar after both anesthetic drugs.
Anesthesia ; Anesthesia, General ; Anesthesia, Inhalation* ; Anesthetics ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Inhalation* ; Intubation ; Isoflurane ; Nausea ; Nitrous Oxide ; Postoperative Nausea and Vomiting ; Postoperative Period ; Propofol ; Recovery Room ; Solubility ; Succinylcholine ; Vomiting

PURPOSE: A decline in the circulating levels of estrogen impairs vaginal engorgement, which leads to histopathological changes in the vaginal tissues. The aim of this study was to evaluate the effect of delayed estrogen replacement on the vagina structure in castrated rabbits. Materials and Methods: New Zealand White female rabbits were randomly divided into three groups; two groups (the castration and castration estrogen replacement groups) were castrated: the control group underwent sham operations. Nine weeks after surgery, the estrogen replacement group received subcutaneous injections of estrogen (50microgram/kg/day) for 4 weeks. Vaginal tissue was processed for histology with Masson's trichome stain. The expressions of e-NOS and n-NOS were examined by immunohistochemistry and Western blot. RESULTS: From the histology, marked thinning of the vaginal epithelial layers, and decreased smooth muscle content and submucosal microvasculatures were evident, but with no increase in the collagen fibers in the castrated group was noted. The vaginal tissue of the estrogen replaced animal showed similar morphological features to those in the control rabbits. From the histomorphometry, the percentage of vaginal smooth muscle in the castrated group was significantly decreased compared to those in the control and estrogen replaced groups. The expression and signal intensity of e-NOS were decreased in the vagina of the castrated animals compare to those in the control group. In the estrogen replaced group, the expression of e-NOS was normalized. CONCLUSIONS: Delayed estrogen replacement showed structural restoration of vaginal tissues. These results suggest that delayed estrogen replacement therapy could improve the sexual function in menopausal women.
Animals ; Blotting, Western ; Castration ; Collagen ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Humans ; Immunohistochemistry ; Injections, Subcutaneous ; Menopause ; Muscle, Smooth ; New Zealand ; Rabbits ; Trichomes ; Vagina

OBJECTIVES: This study aimed to estimate the completeness of cancer registration with Capture-recapture method. METHODS: The study was conducted in the population based cancer registry of Kwangju, Korea, for which there are three main sources of notification: reports by Korean Central Cancer Registry, reports by pathology data, and the others reports by radiology data, death certificates, etc. The defined cases in three sources were matched by 13 digits Resident Register Number. To derive an estimates, log-linear models were applicated. RESULTS: Overall completeness was estimated to be around 93%. There was some variation with age(consistently high levels below age group 60-74 years, a minimum of 88.6% above 75 years). Among the most common cancer sites, estimates of completeness were highest for thyroid cancer(97.1%), while lower estimates of completeness were derived for stomach cancer(92.3%), liver cancer(92.6%). CONCLUSIONS: Careful application of Capture-recapture method may provide an alternative to traditional approaches for estimating the completeness of cancer registration in Kwangju city.
Death Certificates ; Gwangju ; Humans ; Korea ; Linear Models ; Liver ; Pathology ; Stomach ; Thyroid Gland

Radial artery is frequently chosen for cannulation. Although the method is safe and simple, it can infrequently lead to tissue necrosis. This is a report of one case of amputation due to thumb necrosis developed from the radial artery cannulation in a patient who had open heart surgery. This is a 65 years old female who received a graft interposition of ascending aorta due to dissecting aortic aneurysm. Left radial artery cannulation was carried out after modified Allen's test appeared to be positive. On the 11 th postoperative days, we found that the catheter of left hand was obstructed, and we removed the catheter. On the 9 hrs after removal of catheter, thumb of left hand became color change and edematous with blister. On the 14 th days after removal of catheter, thumb of left hand became worsened to dusky purple to dark color change and pulseless, coldness. On the 20 th days after removal of catheter, amputation of thumb of left hand was performed.
Aged ; Amputation ; Aorta ; Aortic Aneurysm ; Blister ; Catheterization* ; Catheters ; Female ; Hand ; Humans ; Necrosis* ; Radial Artery* ; Thoracic Surgery ; Thumb* ; Transplants

BACKGOUND: The purpose of this study was to evaluate characteristics and mortality rates of patients admitted to the post-anesthesia care unit (PACU) for obtaining the better clinical guidances and more advanced therapeutic plan in the future. METHODS: The medical records of total 425 patients admitted to the PACU from January to December 1998 were reviewed and analyzed according to age, sex, department, duration of stay, mechanical ventilator care, and mortality rates. RESULTS: Patients admitted PACU were 6% of total anesthesia patients. The ratio of male to female was 1.5:1. Patients of manhood aged from 45 to 64 were 37%, pediatric patients under 15 year-old were 23%. and elderly patients over 64 year-old were 18% of total PACU patients. The ratio of patients with ventilatory support was 42%. Mortality rate of neonate under 1 month of age was about 47%. Total mortality rate was 12%. CONCLUSIONS: To improve the outcome of the patients in PACU, continuous nutritional and medical support, cardiovascular and pulmonary monitoring, appropriate nursing care, and availability of medical staff were needed.
Adolescent ; Aged ; Anesthesia ; Female ; Humans ; Infant, Newborn ; Critical Care ; Male ; Medical Records ; Medical Staff ; Middle Aged ; Mortality ; Nursing Care ; Ventilators, Mechanical

Myoepithelioma is a rare benign tumor, most frequently located in the salivary gland. However, involvement of an extra-salivary gland is even rarer and very few cases involving the nasal cavity have been reported in the literature. A 51-year-old female patient presented with a complaint of progressive nasal obstruction and occurrence of recurrent epistaxis in the left nasal cavity over several months. A hemorrhagic and erythematous mass occupying the left nasal cavity was observed on physical examination using a nasal endoscope. A preoperative angiogram confirmed that he tumor was receiving blood supply from the sphenopalatine artery. We performed embolization to prevent hemorrhage during surgery; one day later, the lesion was successfully removed through endoscopic excision. Histopathological examination revealed that the tumor contained myoepithelial cells and myxoid stroma. Immunohistochemical studies showed that the tumor was positive for cytokeratin marker and S-100 protein, confirming the diagnosis of myoepithelioma. The patient recovered without any nasal symptoms or postoperative deficits.