PURPOSE: Intratracheal pulmonary ventilation (ITPV) is developed to decrease dead space ventilation. A reverse thrust catheter (RTC) is introduced into an endotracheal tube through an adapter. Bias gas through the RTC exits from the catheter tip. The flow of gas is redirected outward away from the lung. Gas is intermittently introduced into the lung as tidal volume (VT) by an expiratory valve. ITPV can be combined with pressure control mode, resulting in hybrid ventilation (HV). We hypothesized that HV might decrease VT, compared with volume controlled ventilation (VCV) or pressure controlled ventilation (PCV) alone. METHODS: HV was compared with VCV and PCV in 7 tracheostomized rabbits. We aimed at maintaining PaCO2 levels normal as the respiratory rates (RR) were set at 20, 40, 80, and 120/min. Blood pressure and airway pressures were monitored and dead space ratio was calculated. RESULTS: The dead spaces (VD) of VCV are 30+/-4 mL, 18+/-4 mL, 14+/-4 mL, and 12+/-5 mL and the VD of PCV are 24+/-6 mL, 16+/-3 mL, 15+/-4 mL and 12+/-4 mL at the respiratory rates of 20/min, 40/min, 80/min, and 120/min, respectively. The VD of HV are 13+/-6 mL, 9+/-3 mL, 7+/-2 mL, and 5+/-1 mL, respectively. The VT and PIP of HV are significantly lower than those of VCV and PCV at the same RR. CONCLUSION: It can be concluded that HV can be applied to minimize the airway pressures and dead space ventilation of VCV and PCV.
Bias (Epidemiology) ; Blood Pressure ; Catheters ; Lung ; Pulmonary Ventilation ; Rabbits* ; Respiratory Rate ; Tidal Volume ; Ventilation*

A case of Cushing's syndrome due to bilateral pigmented nodular adrenal disease in a 35-year-old male is presented. The adrenals showed multiple, black, variable sized nodules. Histologically the cells contained lipofuscin and either had a clear cytoplasm or an eosinophilic cytoplasm with a prominent nucleus. Lymphocytic infiltration and fatty metaplasia within the nodules are two of the prominent histological features. There is extreme internodular atrophy which suggests that primary pigmented nodular adrenocortical disease is a non-adrenocorticotropic hormone dependent condition. Since the disorder appears to involve primarily the cortex of both adrenals, the treatment of choice is bilateral adrenalectomy followed by steroid replacement. The characteristic clinicopathological manifestations that separate this diagnosis from other types of adrenal disease are also discussed. This is the first reported case in Korea to be documented with the pertinent clinicopathological findings.
Adipose Tissue/pathology ; Adrenal Cortex/chemistry/*pathology/radiography/secretion/ultrasonography ; Adrenalectomy ; Adult ; Atrophy ; Case Report ; Cushing Syndrome/*etiology/surgery ; Dexamethasone/diagnostic use ; Furosemide/diagnostic use ; Human ; Hydrocortisone/secretion ; Inflammation ; Lipofuscin/*analysis ; Male ; Metaplasia ; Organelles/ultrastructure

BACKGROUND: To decrease homologuous transfusion and bleeding, Acute Normovolemic Hemodilution (ANH) may be combined with induced hypotension. Tissue oxygen balance may be in danger because of decreased tissue perfusion pressure by induced hypotension and reduced arterial oxygen content by ANH. Thus it is necessary to evaluate effects of induced hypotension combined with ANH on hemodynamics and systemic oxygen balance. METHODS: In 6 mongrel dogs anesthetized with N2O-O2-enflurane and paralyzed with vecuronium, ANH was performed up to half of initial level of hemoglobin with isovolemic pentastarch infusion, and then mean arterial pressure (MAP) was lowered by 30% of the initial value by intravenous administration of Sodium Nitroprusside (SNP). Various hemodynamic parameters were measured before and after ANH and 15, 30, 45 and 60 minutes after induction of hypotension and 15 minutes after the end of hypotension. RESULTS: Heart rate was not changed significantly throughout the study. Central venous pressure increased significantly after ANH but decreased to the initial value after induced hypotension. Systemic vascular resistance showed significant decrease after ANH, more significant decrease after induced hypotension and slight increase after discontinuation of SNP. Cardiac output increased markedly by ANH and maintained during induced hypotension. Oxygen flux decreased significantly after ANH but slightly increased after induced hypotension. Oxygen consumption and Oxygen extraction ratio were maintained throughout the study. There were no acidemia and hypoxemia throughout the study. CONCLUSION: The combined use of ANH and induced hypotension with SNP is safe in the aspect of cardiovascular system and systemic oxygen balance.
Administration, Intravenous ; Animals ; Anoxia ; Arterial Pressure ; Cardiac Output ; Cardiovascular System* ; Central Venous Pressure ; Dogs* ; Heart Rate ; Hemodilution* ; Hemodynamics ; Hemorrhage ; Hydroxyethyl Starch Derivatives ; Hypotension* ; Nitroprusside ; Oxygen Consumption ; Oxygen* ; Perfusion ; Sodium* ; Vascular Resistance ; Vecuronium Bromide

A Sengstaken-Blakemore (S-B) tube, when used approximately, still has a place in the management of acute variceal bleeding, and controls bleeding in 40~90% of the cases. However its use is accompanied by number of complications such as esophageal ulcer, pulmonary aspiration, and malfunction of the tube, which requires replacement. We recently observed a very unusual complication: the remaining gastric balloon of a S-B tube was broken off in the fundus of stomach by the patient's traction. The gastric balloon was easily and safely removed using an endoscopic snare after deflating the gastric balloon with a needle puncture.
Gastric Balloon ; Hemorrhage ; Hypogonadism ; Mitochondrial Diseases ; Needles ; Ophthalmoplegia ; Punctures ; SNARE Proteins ; Stomach ; Traction ; Ulcer

Gastritis cystica polyposa (GCP) is a rare lesion characterized by hyperplastic and cystic dilatation of the gastric mucosal glands infiltrating into the underlying submucosa. In most cases, it develops in patients who have undergone a gastroenterectomy, but can occasionally be found in an unoperated stomach. GCP may present as a submucosal tumor or polyp, and rarely as a giant gastric mucosal fold. We experienced a case of GCP that presented as a hyperplastic polyp, and it was unrelated to any gastric surgery. Upper endoscopy revealed the presence of a subpedunculated polyp in the posterior wall of the antrum. The lesion was successfully removed by endoscopic mucosal resection and diagnosed as a GCP.
Dilatation ; Endoscopy ; Gastritis ; Humans ; Polyps ; Stomach

Malignant duodenocolic fistula is a rare complication of colon cancer, and this usually develops as the right-side colon cancer that invades the duodenal bulb. The fistula often results in watery diarrhea, weight loss and feculent vomiting. A barium enema or duodenography have been the most useful diagnostic procedures, and the fistula is directly confirmed by an endoscopic examination. Curative resection is not possible in many cases due to metastasis or local invasion, so a palliative operation can be performed to relieve symptoms, but it cannot completely prevent the vomiting or diarrhea. Seven Korean cases of malignant duodenocolic fistula have been previously reported on, and an operation was performed in six cases. We report here on a case of duodenocolic fistula with intestinal obstruction that arouse from a right-side colon cancer, and this was successfully managed by placing covered metallic stents at the duodenum and hepatic flexure.
Barium ; Colonic Neoplasms ; Diarrhea ; Duodenum ; Enema ; Fistula ; Intestinal Obstruction ; Neoplasm Metastasis ; Stents ; Vomiting ; Weight Loss

Malignant rhabdoid tumors were first described in 1978 by Beckwith and Palmer as a rare variant of Wilms' tumors with a "rhabdomyosarcomatoid" pattern and a particularly poor prognosis. Week reclassified this disease as a distinct disease in 1989 and thereafter, there have been several reports about malignant rhabdoid tumor that occurred in various organs, including the colon. The histologic characteristics of rhabdoid tumor are noncohesive or loosely cohesive cells with high cellularity, an eccentric large nucleus and eosinophilic cytoplasm, and the cytoplasm is usually positive for vimentin and it contain hyaline inclusions. On immunohistochemical staining, the cells are usually positive for vimentin and cytokeratin and they are negative for desmin. This tumor progresses rapidly and it has a very poor prognosis, but survival is better if there is no lymphatic or distant metastasis. We experienced a patient who suffered with undifferentiated adenocarcinoma with rhabdoid features in the ascending colon.
Adenocarcinoma ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Cytoplasm ; Desmin ; Eosinophils ; Humans ; Hyalin ; Keratins ; Neoplasm Metastasis ; Prognosis ; Rhabdoid Tumor ; Vimentin ; Wilms Tumor

BACKGROUND: The fact that only 10-20% of chronic cigarette smokers develop chronic obstructive pulmonary disease (COPD) reflects the presence of genetic factors associated with the susceptibility to COPD. Recently, it was reported that the surfactant protein A increases the secretion of matrix metalloprotease 9, which degrades extracellular matrices of the lung, through a Toll-like receptor 2 (TLR2). In this context, possible role of TLR2 in the pathogenesis of COPD was postulated, and a functional dinucleotide repeat polymorphism in intron II of TLR2 was evaluated for any association with COPD. METHOD: Male patients with COPD and male smokers with a normal pulmonary function were enrolled in this study. The number of Guanine-Thymine repeats in intron II of the TLR2 gene were counted. Because the distributions of the repeats were trimodal, the alleles were classified into three subclasses, 12-16 repeats: short (S) alleles; 17-22 repeats: medium length (M) alleles; and 23-27 repeats: long (L) alleles. RESULT: 125 male patients with COPD and 144 age- and gender-matched blood donors with a normal lung function were enrolled. There were no differences in the distribution of each allele subclass (S, M and L) between the COPD and control group (p=0.75). The frequencies of the genotypes with and without each allele subclass in the COPD and control group were similar. CONCLUSION: A microsatellite polymorphism in intron II of TLR2 gene was not associated with the development of COPD in Koreans.
Alleles ; Blood Donors ; Dinucleotide Repeats ; Extracellular Matrix ; Genetic Predisposition to Disease ; Genotype ; Humans ; Introns ; Lung ; Male ; Microsatellite Repeats* ; Pulmonary Disease, Chronic Obstructive* ; Pulmonary Surfactant-Associated Protein A ; Tobacco Products ; Toll-Like Receptor 2* ; Toll-Like Receptors*

BACKGROUND: A pleural effusion is a common medical problem. Despite several diagnostic tests, 15-20% of pleural effusions go undiagnosed. The aim of this study was to evaluate the clinical characteristics and prognosis of a lymphocyte dominant exudative pleural effusion with a low adenosine deaminase (ADA), low carcinoembryonic antigen (CEA), negative cytology and negative acid fast bacilli (AFB) smear. METHOD: From Jan 2000 to Aug 2001, 43 patients with lymphocyte dominant exudative pleural effusions whose AFB smear and cytologic exam were negative, their pleural fluid ADA level was < 40 IU/L, and their CEA level was < 10 ng/mL were enrolled in this study. A retrospective analysis of the patients' medical records was carried out. RESULT: Among 31 of the 43 cases (72%), probable underlying diseases causing the pleural effusion were identified: 21cases of malignant diseases, 4 cases of liver cirrhosis, 2 cases of pulmonary tuberculosis, 1 case of end stage renal disease, 1 case of a chylothorax, 1 case of a post?CABG (coronary artery bypass graft) state, 1 case of a pulmonary embolism. No clinically suspected etiology was identified in the remaining 12 cases (28%). Of these 12 pleural effusions, 7 cases spontaneously resolved, 2 effusions resolved with antibiotics, and the other 2 cases were persistent. CONCLUSION: Lymphocyte dominant exudative pleural effusions with a low ADA, low CEA, negative cytological exam, and negative AFB smear, but without a definite cause might have a benign course and clinicians can observe them with attention.
Adenosine Deaminase ; Anti-Bacterial Agents ; Arteries ; Carcinoembryonic Antigen ; Chylothorax ; Diagnostic Tests, Routine ; Humans ; Kidney Failure, Chronic ; Liver Cirrhosis ; Lymphocytes* ; Medical Records ; Pleural Effusion* ; Prognosis* ; Pulmonary Embolism ; Retrospective Studies ; Tuberculosis, Pulmonary

BACKGROUND/AIMS: The identification of significant coronary arterial disease (CAD) is important to reduce perioperative ischemic insult and the possibility of repeated open-chest surgery in patients scheduled to undergo valvular surgery. However, there are no published data on the incidence of significant CAD in these patients. Thus, we examined the prevalence of significant CAD in patients scheduled to undergo valvular surgery. METHODS: From January 2005 to June 2011, all consecutive adult patients diagnosed with significant valvular disease and scheduled for an elective open valvular operation were retrospectively investigated at Chungnam National University Hospital and Chonbuk National University Hospital. Patients who underwent emergent valvular operations due to acute aortic dissection or trauma and concomitant valvular operations at the time of coronary artery bypass graft (CABG) surgery were excluded. RESULTS: During the study period, a total of 431 patients (58 +/- 13 years old, 204 males) were included. The distributions of mitral (241 patients) and aortic valvular disease (230 patients) were similar. Coronary angiography was performed in 297 patients (68.9%). Of these, 36 (12.1%) showed significant CAD and 32 underwent concomitant CABG operations. Based on a multivariate analysis, the presence of CAD was significantly associated with old age (> or = 65 years old) [odds ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372-6.921, p = 0.006], more cardiovascular risk factors (> or = 3) (OR = 3.002, 95% CI = 1.386-6.503, p = 0.005), and the presence of aortic stenosis (OR = 2.763, 95% CI = 1.269-6.013, p = 0.010). CONCLUSIONS: The incidence of significant CAD was 12.1% in adult patients who underwent valvular operations in Korea. CAD was more common in patients with old age, aortic stenosis, and multiple cardiovascular risk factors.
Adult ; Aortic Valve Stenosis ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Heart Valve Diseases ; Humans ; Incidence ; Korea ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Risk Factors ; Transplants