Prediction of individual outcome after cardiopulmonary resuscitation is of major medical, ethical, and socioeconomic interest but uncertain. We experienced the case thats the patient got complete neurologic recovery after the 123th day firm cardiac arrest, who had been suspected to go with poor prognosis because she got the findings of Glasgow Coma Scale 4, severe diffuse encephalopathy on encephalogram and generalized tonic-clonic seizure at the 4th day. Recently, a 29 year-old women who sustained from respiratory arrest induced presumably by sedative and anticonvulsant therapy for control of seizure that happened during local lidocaine anesthesia far mamoplasty was transfered to our emergency medical center from local private plastic office. Arrest time was about 20 minutes. On hospital arrival, she had a pulseless bradyasystole and no respiration, but spontaneous circulation was restored at 10 minutes artier CPR started. We started cerebral oriented resuscitation including mild hypothermia(34degrees C), hemodilution, calcium channel blocker infusion. On hospital day 4, patient's glasgow coma scale(GCS) was 4. On hospital clay 7, Brain Magnetic Resonance Imaging(MRI) showed high signal intensity on T2WI, involving the bilateral basal ganglia. After contrast administraton, marked enhancement can be seen at the lesion site. Patient's glasgow coma scale(GCS) increased step by step to 5 on 8th day, 7 on 14th day, 10 on 15th day, 13 on 17th day, 15 on 20th day. 40 days later the patient was discharged with minor neurologic abnormality including hand tremor, dysphonia, amenorrhea and Mini Mental State Examination(MMSE) score(26). Long-term Follow up revealed that all neurologic functional abnormality inducting hand tremor, dysphonia, amenorrhea and MMSE score(26) is completely recovered on 123th day after episode of cardiopulmonary arrest.
Adult ; Amenorrhea ; Anesthesia ; Basal Ganglia ; Brain ; Calcium Channels ; Cardiopulmonary Resuscitation ; Coma ; Dysphonia ; Emergencies ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Hand ; Heart Arrest* ; Hemodilution ; Humans ; Hypoxia-Ischemia, Brain* ; Lidocaine ; Plastics ; Prognosis ; Respiration ; Resuscitation ; Seizures ; Tremor

PURPOSE: This treatment planning study was undertaken to evaluate the impact of beam angle configuration of intensity-modulated radiotherapy (IMRT) on the dose of the normal liver in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: The computed tomography datasets of 25 patients treated with IMRT for HCC were selected. Two IMRT plans using five beams were made in each patient; beams with equidistance of 72degrees (Plan I), and beams with a 30degrees angle of separation entering the body near the tumor (Plan II). Both plans were generated using the same constraints in each patient. Conformity index (CI), homogeneity index (HI), gamma index, mean dose of the normal liver (Dmean_NL), Dmean_NL difference between the two plans, and percentage normal liver volumes receiving at least 10, 20, and 30 Gy (V10, V20, and V30) were evaluated and compared. RESULTS: Dmean_NL, V10, and V20 were significantly better for Plan II. The Dmean_NL was significantly lower for peripheral (p = 0.001) and central tumors (p = 0.034). Dmean_NL differences between the two plans increased in proportion to gross tumor volume to normal liver volume ratios (p = 0.002). CI, HI, and gamma indices were not significantly different for the two plans. CONCLUSION: The IMRT plan based on beams with narrow separations reduced the irradiated dose of the normal liver, which would allow radiation dose escalation for HCC.
Carcinoma, Hepatocellular ; Humans ; Liver ; Radiotherapy, Intensity-Modulated ; Tumor Burden

To determine how closely end- tidal PCO2 measured by capnometer(Datex, Finland), a kind of infrared gas analyzer, reflects arterial PCO2(measured by Corning 175: U.S.A.) during general anesthegia, peak- tidal PCO2 and arterial were measured simultaneously. Thirty patients ranging between the age of 18 and 49, having no apparent abnomalities and having physical status class I by American Society of Anesthesiologist's classification-were seleted for the study. The anesthesia was induced with 2.5% pentothal sodium 4~5 mg/kg, succinylcholine 1mg/kg and incubated. The anesthesia was maintained with each 2 L/min gas flow of nitrous oxide, oxygenand 1 halothne. The patients were ventilated br anesthetic ventilator with tidal volume 8~10 ml/kg and ramie of 15 Per minute. The measurement of CO2 gas tension was performed 20 minutes after the induction when the patient's anesthetic conditions were stabilized. The CO2 gas ganlples were taken from mouth piece inserted between endotracheal adapter and circle breathing circuit, The arterial blood tramples were taken from the radial artery. There was a significant correlation between the end-tidol PCO2 and the arterial PCO2 in this series. The mean arterial PCO2 was 37.57+/-4.59 mmHg and the mean end tidal PCO2 was 23.73+/-5.78 mmHg. The mean difference between the arterial and the end tidal PCO2 was 6.53+/-2.23 mmHg. The correlation index between the two measurement was 0.8. In conclusion, the measurement of the end-tidal PCO2 by Datex Capnometer reflected the blood PCO2 and is convenient method of clinical use for its non invasiveness and continuous measurement of ventilatory status of patients under general anesthesia.
Anesthesia ; Anesthesia, General* ; Boehmeria ; Carbon Dioxide* ; Carbon* ; Humans ; Mouth ; Nitrous Oxide ; Radial Artery ; Respiration ; Sodium ; Succinylcholine ; Thiopental ; Tidal Volume ; Ventilators, Mechanical ; Zea mays

Influenza-associated encephalopathy is regarded as one of the major neurologic disease entities along with those of Reye syndrome, acute necrotizing encephalopathy, and myelitis which are known to be related to influenza virus, mostly type A. And it is being actively researched in Japan as it has caused a tremendous increase in the number of deaths from 1997 to 2002, but it has not been yet reported in the Korean pediatric medical community. It attacks those previously healthy children, who have not been vaccinated. Patients start with such symptoms as fever and common respiratory problems, but within 24 to 48 hours they suffer from seizures with acute mental deterioration, become worse, and suffer multiple organ failures including marked elevated transaminase levels as well as coagulopathy. It induces deaths in a couple of days after the symptoms appear or remains a serious neurologic sequelae. Confirmative diagnosis is used to demonstrate influenza viral infection. We report here a 37 month aged boy who was admitted to our hospital during the last influenza season under the diagnosis of influenza associated encephalopathy on the basis of serologic testing by hemagglutinin inhibition(HI). This is the first report confirmed by increased antibody titer of the influenza A virus in Korea.
Child ; Diagnosis ; Fever ; Hemagglutinins ; Humans ; Influenza A virus ; Influenza, Human ; Japan ; Korea ; Male ; Multiple Organ Failure ; Myelitis ; Orthomyxoviridae ; Reye Syndrome ; Seasons ; Seizures ; Serologic Tests

BACKGROUND: Infectious complications commonly occur in the survivors of out-of-hospital cardiac arrest. The aim of our study was to describe the incidence, associated factors and outcome of infectious complications of the survivors of out-of-hospital cardiac arrest. METHODS: We conducted a retrospective analysis of 75 patients who survived out-of-hospital cardiac arrest. We collected the data on the demographics, the modes of cardiac arrest, the duration of CPR, the dose of epinephrine, the use of hypothermia, new infections, the duration of mechanical ventilation, the length of stay in the intensive care unit (ICU), recovery of consciousness and the mortality. RESULTS: New infections developed in 46.7% of the patients. Asystole was the most common rhythm (70.7%). The most common infectious complication was pneumonia (40.0%) urinary tract infection developed in 10 cases, vascular catheter local infection developed in 6 cases, primary blood stream infection developed in 3 cases, wound infection developed in 2 cases and pseudomembranous colitis developed in 1 case. The most common pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus. Blood cultures were obtained in 36 patients during the first 24 hr and the pathogen was isolated in three. The patients with infection had a longer duration of mechanical ventilation and a longer stay in the ICU (p < 0.001, p = 0.001). CONCLUSIONS: Infectious complications are common in survivors of out-of-hospital cardiac arrest and these infections are associated with a longer duration of mechanical ventilation and a longer stay in the ICU. The most common infectious complication was pneumonia and the pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus.
Cardiopulmonary Resuscitation ; Consciousness ; Demography ; Enterocolitis, Pseudomembranous ; Epinephrine ; Heart Arrest ; Humans ; Hypothermia ; Incidence ; Intensive Care Units ; Length of Stay ; Out-of-Hospital Cardiac Arrest ; Pneumonia ; Pseudomonas aeruginosa ; Respiration, Artificial ; Retrospective Studies ; Rivers ; Staphylococcus ; Staphylococcus aureus ; Survivors ; Urinary Tract Infections ; Vascular Access Devices ; Wound Infection

PURPOSE: In this study, we analyzed clinical manifestations of and ways to manage malaria. METHODS: The medical records of the patients confirmed as malaria by using peripheral blood smear at Ui jungbu St. Mary's hospital from April 1997 to November 2001 were reviewed retrospectively. RESULTS: Of the 170 patients, there were 111 males and 59 females, and their mean ages were 32.3+/-14.5, 34.9+/-18.1 years, respectively. Malaria occurred throughout the year and peaked during the sixth to ninth months (84.1%). All cases were vivax malaria. All 170 patients had fever, but tertian fever was seen in only 81 (48%) patients. Laboratory abnormalities were hemoglobin below 12 g/dL in 70 (41.2%) patients, WBC below 4000/mm3 in 49 (28.9%), platelet count below 120,000/mm3 in 142(83.5%). Of the 92 patients who underwent ultrasonography of the abdomen, splenomegaly was seen in 81 (89%)patients. The time from onset of symptoms to admission ranged from 2 to 30 days with a mean 8.1+/-5.5 days. All patients responded promptly to drug therapy. One patient developed recurrent malaria 120 days after the first attack. Another patient experienced multifocal splenic infarction. CONCLUSION: All patients with malaria had fever and chills. The most common laboratory findings were thrombocytopenia and anemia. All patients responded promptly to drug therapy. As cases of malaria in Korea are increasing, early diagnosis and treatment, as well as prevention, are important.
Abdomen ; Anemia ; Chills ; Drug Therapy ; Early Diagnosis ; Female ; Fever ; Humans ; Korea ; Malaria ; Malaria, Vivax* ; Male ; Medical Records ; Platelet Count ; Retrospective Studies ; Splenic Infarction ; Splenomegaly ; Thrombocytopenia ; Ultrasonography

PURPOSE: Dermatofibroma is a lesion several millimeters to several centimeters in size, arising from dermis or subcutaneous tissue, mostly at extremities of a middle aged female. It is a benign fibrous tumor that to our knowledge metastasis have not been reported and may recur only locally. Here we report a rare case of 36-year-old female with dermatofibroma arising from back and metastasized to both lungs. METHODS: We performed an en-block elliptical mass excision for skin lesion and metastatectomy for multiple nodules of both lungs. RESULTS: Histologically, the tumors of both lungs and skin lesion showed dilated cystic airspaces which were lined by respiratory epithelium with underlying layers of tumor cells. The tumor cells were composed of plump to spindled fibrohistiocytic cells arranged in storiform growth pattern. There were no cellular pleomorphism, atypical mitosis, and necrosis. These are the specific features of a dermatofibroma and we could examined the histologic findings of skin and lungs identical. Thus, this indicates that dermatofibroma of back was metastasized to both lungs. CONCLUSION: We report this case to notice that dermatofibroma is a benign tumor but it rarely metastasizes.
Adult ; Dermis ; Extremities ; Female ; Histiocytoma, Benign Fibrous* ; Humans ; Lung* ; Middle Aged ; Mitosis ; Necrosis ; Neoplasm Metastasis ; Respiratory Mucosa ; Skin ; Subcutaneous Tissue

For extremity surgery, tourniquet is placed routinely. With deflation of the tourniquet, the metabolic product is flushed into the systemic circulation and theoretically poses a potential for toxic reactions. In actual fact, these are rare events with this technique. Vigilant monitoring will detect cardiovascular depression at this time. By the tourniquet application, lactic acidemia, abnormal coagulopathy, hypotention, hyperkalemia, increased PaCO2, and production of noxious oxygen free radicals were reported following the release of the tourniquet. But the serial changes of metabolic derangement, degree of lactic acidemia following the use of the tourniquet were not exactly known. To confirm the safety of the pneumatic tourniquet use for two hours, the serial changes of lactic acid levels, acid-base status, potassium concentration, concentration of respiratory gaaes (arterial and end-tidal CO2,) and also hypotension, dysrhythmias and respiratory pattern following release of the tourniquet were studied. Patients were anesthetized with 1% halothane, 50% nitrous oxide and 50% oxygen. Ventilation was maintained by the ventilator to keep the end-tidal CO2, to 4.0% just before the release, and then respiratory parameters (respiratory rate, tidal volume) were constantly maintained through the study. The data were measured from arterial samples or monitors with the following interval; just before tourniquet apply (BTA), before tourniquet release (BTR), at 1, 3, 5, 15 and 30 minutes after the tourniquet release (ATR 1 m, 3m, 5 m, 15 m 30 m). Data measured before the tourniquet apply were used as control values. All data were analyzed by the paired t-test with control. Changes of mean values of each time in one parameter were analyzed by one-way ANOVA. Correlationships between the parameters and duration of ischemia induced by the tourniquet were analyzed by simple regression. The results of this study were as follows; 1) The arterial concentration of lactic acid was maximally increased at 3 minutes after tourniquet release and not returned to control value until 30 minutes after tourniquet release. 2) End-tidal CO, was reached to maximal values of 5.3% at 5 minutes after release of tourniquet. Accompanying theses changes, spontaneous respiration was recovered from the controlled ventilation in 11 patients out of 13 and fought with mechanical ventilator due to asynchronism of respiratory cycles. 3) Mild metabolic acidosis showing the decreased arterial pH and increased PaCO2, in arterial blood gas analysis was maintained in 30 minutes following the release of tourniquet. 4) There were no significant changes of concentrations of potassium. 5) Three episodes of mild hypotension were observed out of 13 patients, but dysrhythmias and other significant clinical changes not observed through the study. The above results showed the possibility of lactic acidemia and changes of respiratory pattern by increased PaCO2, after release of the tourniquet may occur. More intent monitoring is needed to the patients who have had the metabolic derangement in acid-base balance and increased intracranial pressure in application of tourniquet on limbs.
Acid-Base Equilibrium ; Acidosis ; Blood Gas Analysis ; Depression ; Extremities ; Free Radicals ; Gases* ; Halothane ; Humans ; Hydrogen-Ion Concentration ; Hyperkalemia ; Hypotension ; Intracranial Pressure ; Ischemia ; Lactic Acid ; Lower Extremity* ; Nitrous Oxide ; Oxygen ; Potassium ; Respiration ; Tourniquets* ; Ventilation ; Ventilators, Mechanical

The bleomycin is a chemotherapeutic agent useful in the treatment of selected neoplasms, including non-seminomatous testicular carcinoma. An increased incidence of respiratory failure postoperatively in patients previously treated with bleomycin has been reported. And an increase in the toxicity of high concentration of oxygen in oxygen therapy has been demonstrated in rodents after administration of bleomycin. However, the use of an enriched inspired oxygen concentration 41% was reported not hazardous in a testicular cancer population who were exposed to significant doses of bleomycin. The pulmonary toxicity of bleomycin therapy in combination with high oxygen exposure is still controversial. The aim of this study is to analyze the effect of exposure to 50% oxygen in the mice pretreated with bleomycin. Bleomycin were administered intraperitoneally to the mice, 4 mg/ kg twice a week for 5 weeks. After administeration of bleomycin to the mice, the half of the miee, the experimental group, were exposed to 50% oxygen for 24 hours. And the other control group were exposed to room air. Morphometric analysis with light microscopy was performed to the following parameters; number of total pulmonary cell count, percentage of consolidation of lung parenchyma and degree of intensity of fibrosis of lung parenchyma. The area of diseased lung was increased in mice given with bleomycin and hyperoxia compared with that of those treated with bleomycin only. The results were as follows, l) In the control group given 4 mg/kg bleomycin and room air, the number of total pulmo- nary cell count were 36.21+/-6.53/10(-8) m(2) and the percentage of consolidation was 1.2+/-0.4%. 2) In the experimental group given with 4 mg/kg bleomycin and 50% oxygen for 24 hrs, the number of total pulmonary cell count were 59.67+/-9.13/10(-8) m(2) and the percentage of area of consolidation of lung parenchyma was 5.8+/-2.3%, 3) Fibrosis of the lung parenchyma was seen only in the experimental group to which oxygen was given after administration of bleomycin. In conclusion, this study demonstrated that hyperoxia potentiated the pulmonary damage by bleomycin in the mice.
Animals ; Bleomycin* ; Cell Count ; Fibrosis ; Humans ; Hyperoxia* ; Incidence ; Lung ; Mice ; Microscopy ; Oxygen ; Respiratory Insufficiency ; Rodentia ; Testicular Neoplasms

The degree of hematopoietic depression and spontaneous recovery of depressed cells with 50% nitrous oxide inhalation for 6 or 12 hours were studied in 120 Sprague-Dawley rats. Immediately after, 1 day, 3 days and 1 week after nitrous oxide inhalation, precursor cells of granulocyte-monocyte and T lymphocyte in bone marrow and blood were sampled and cultured. After one week of culture period, the numbers of colony forming unit-granulocyte monocyte (CFU-GM) and colony forming unit-T lymphocyte (CFU-TL) were counted. There was no change in the number of colony immediately after inhalation of nitrous oxide, but was significant decrease in number of colony 1 day and 3 days after inhalation of nitrous oxide (p<0.001). One week after cessation of nitrous oxide inhalation, spontaneous recovery of number of colony developed without any treatment. To evaluate the protective effect of folinic acid (Rescuvolin) against hematopoietic depression, Rescuvolin 0.1 mg/0.3 ml were injected intraperitoneally at 12 hours and 1 hour before, 1 hour before and immediately after nitrous oxide inhalation, respectively. The data of each group were compared with that of the animals which have inhaled nitrous oxide for 6 hours without folinic acid. Folinic acid injected groups showed significant increase in numbers of colony (p<0.001) especially in 12 and 1 hour before nitrous oxide inhalation. In conclusion, the longer the duration of nitrous oxide inhalation, the faster and severer hematopoietic depression developed. The pretreatment of folinic acid may prevent the bone marrow depression by a long-term and repeated use of nitrous oxide. In clinical anesthesia, it is recommended to avoid to use nitrous oxide for the patients with bone marrow depressed disease such as leukemia and aplastic anemia.
Anemia, Aplastic ; Anesthesia ; Animals ; Bone Marrow ; Depression* ; Humans ; Inhalation ; Leucovorin* ; Leukemia ; Lymphocytes ; Monocytes ; Nitrous Oxide* ; Rats* ; Rats, Sprague-Dawley