Microvillous inclusion disease (MID) or congenital microvillous atrophy is a rare cause of intractable, persistent secretory diarrhea shortly after birth or at birth. The prognosis of MID is very poor and most of the reported patients have died within 6.5 years. Diagnosis is based on the ultrastructural demonstration of intracytoplasmic inclusion of microvilli. There have been several cases reported in the literature. To evaluate the clinicopathologic features of MID, we have reviewed 4 cases of MID which was confirmed by the ultrastructural study of the duodenal biopsy. All patients suffered from life-threatening diarrhea since birth. Many other radiologic or laboratory findings were of no value in the evaluation of causative agents. One of the patients died of the disease and remaining patients have been alive on intravenous fluids or total parenteral nutrition. Histological findings of all cases were similar and characterized by varying degrees of mucosal atrophy and chronic inflammatory cell infiltration in the duodenal mucosa. PAS stain revealed a discontinuous brush border over the atrophic villous surface with or without small vacuoles in the cytoplasm of the surface epithelium. Ultrastructural changes were found mainly in the surface epithelium of the duodenal mucosa and characterized by the presence of membrane bound inclusions lined by intact or degenerating microvilli, as well as degeneration of surface epithelial cells with loss of microvilli, or with sparse, short microvilli.
Atrophy ; Biopsy ; Child ; Cytomegalovirus Infections* ; Cytoplasm ; Diagnosis ; Diarrhea ; Epithelial Cells ; Epithelium ; Humans ; Membranes ; Microvilli ; Mucous Membrane ; Parenteral Nutrition, Total ; Parturition ; Prognosis ; Vacuoles

Void-free impression taking is important for the fabrication of accurate dental restorations.One of the essential properties of an impression material used for indirect fabrication of precision castings is the reproduction of the fine detail. The objective in this study was to determine the influence of mixing methods on the number of voids and surface detail reproduction.The number of voids and surface detail reproduction were evaluated with the stereomicroscope SZ-PT and photographed. The results were as follows; 1.In comparison of the void formation according to mixing methods of all impression materials,mechanical mixing was better than hand mixing and there was significant difference(P<0.05). 2.In comparison of the void formation according to hand mixing of alginate impression materials(TOKUSO A-1 alpha ,CAVEX IMPRESSIONAL ,AROMA FINE DF III), there was no significant difference among alginate groups.But the number of void was increased in the order of Panasil contact,TOKUSO A-1alpha , Permlastic light bodied and there was significant difference(P<0.05). 3.In comparison of the void formation according to mechanical mixing of alginate impression materials(TOKUSO A-1 alpha, CAVEX IMPRESSIONAL, AROMA FINE DF III), there was no significant different among alginate groups.But the number of void was decreased in order of TOKUSO A-1 alpha, Permlastic light bodied,Panasil contact and there was significant difference(P<0.05). 4.In comparison of the surface detail reproduction according to mixing methods of 3 types of impression materials(TOKUSO A-1 alpha, Permlastic light bodied,Panasil contact), there was no significant difference between hand mixing and mechanical mixing method 5.The surface detail reproduction was only influenced by impression materials,and produced better in order of TOKUSO A-1alpha, Panasil contact,Permlastic light bodied.There was significat difference among 3 type of impression materials(P<0.05). From the above results,void formation is influenced by mixing methods and surface detail reproduction is influenced by impression materials than mixing methods.Therefore,to fabricate accurate restorations,proper impression material and mechanical mixing method are more effective and available clinically.
Hand ; Reproduction*

BACKGROUND: Determination of left ventricular(LV) myocardial mass with echocardioraphy is feasible and validated. American society of echocardiography(ASE) issued recommendations for the quantitation of the left ventricle by M-mode and 2-dimensional echocardiography in 1978 and 1989, respectively. Although some controversies exist regarding the relative accuracy of M-mode and 2-dimensional techniques, many workers now agree that 2-dimensional methods are more accurate and can be applied to a higher percentage of patients. But sometimes the validated methods are not optimal when parasternal short axis view is difficult to obtain, when the ventricle is distorted, or when scar tissue constitutes a portion of the myocardial volume. METHODS: We measured left ventricular mass in 72 normal subjects using three different methods-ASE cube method with correction in M-mode(method A), area-length method from parasternal short axis view and apical four chamber view(method B), and the method using Simpson's rule from apical four chamber view(method C). RESULTS: 1) LV mass(index) was 161.8+/-30.3g(98.7+/-15.6g/m2) by method A, 166.2+/-32.8g(101.2+/-16.5g/m2) by method B, and 161.2+/-31.8g(98.2+/-15.5g/m2) by method C. 2) LV mass or index by method B was significantly different from that by method A(p<0.001) and from that by method C(p<0.001). However there was no significant difference in LV mass or index between by method A and C(p>0.05). 3) There was a strong correlation between LV mass or index by the method A and B(r=0.873, p<0.001), by the method B and C(r=0.923, p<0.001), and by the A and C(r=0.945, p<0.001). CONCLUSIONS: It is suggested that the method using Simpson's rule can reliably assess LV mass, although it results in smaller value that that by area-length method.
Axis, Cervical Vertebra ; Cicatrix ; Echocardiography* ; Heart Ventricles ; Humans

BACKGROUND: Blunted perception of dyspnea, which may be related to the increased mortality, has been demonstrated in patients with a history of near-fatal asthma and in the elderly. OBJECTIVE: The purpose of this study was to evaluate the relationship between the perception of dyspnea and the severity of asthma. METHOD: Baseline spirometry and Borg score change(A Borg score) during breathing through an inspiratory muscle trainer were measured in 27 consecutive asthma patients and 11 normal subjects. RESULTS: The baseline Borg score was negatively related to FEV1 A Borg score was significantly lower in asthmatics than in controls at high level of loads. A Borg score was lower in severe asthma than in mild asthma. A Borg score was positively related to the baseline FEV1. Seventy-five percent of severe asthma, 62.5% of moderate one, and 9.1% of mild one showed impaired dyspnea perception. Dyspnea perception was related to age(r, = -0.49, p<0.001). CONCLUSION: Three quarters of patients with severe asthma showed impaired dyspnea perception to inspiratory resistive load. Dyspnea perception was related to asthma severity and age.
Aged ; Asthma ; Dyspnea* ; Humans ; Mortality ; Respiration ; Spirometry

Immune responses associated with bacterial infection involve various inflammatory cells. Clinical symptoms and pathologic features are particularly influenced by the predominant cells. Among inflammatory cells, T cells have the heterogenity. T cells may develop into the mature cells expressing the cell surface markers with different functions and T helper cells are categorized into Th1 and Th2 cells based on their different patterns of cytokine production. The objective of this study was to investigate the change of expression of surface markers on T cells and the Th1/Th2 immune response in pulpal inflammation associated with specific bacteria. We experimentally induced pulpal inflammation in rat incisors by drilling without coolant and innoculated with Streptococcus mutans (S.M. group), Porphyromonas endodontalis (P.E. group), or only sterile cotton (control group). After 1, 2, and 5 days, mandibular incisors were extracted and the pulp tissues were extirpated. The expressions of IL-2 recepters (CD25) and ICAM-1 (CD54) on CD4+ and CD8+ cells in the pulps were determined using a flow cytometer, and the concentration of IL-2, IFN-gamma and IL-4 was measured by enzyme-linked immunosorbent assay. The results were as follows; 1. In the S.M. group, CD4+ cells were more increased at 2nd day than 1st day and in the P.E. group, CD8+ cells were more increased at 2nd day than 1st day. 2. The percentages of CD4+, CD4+25+ and CD4+54+ cells were decreased in the pulp tissues at 5th day after irritation in all groups. 3. The ratios of CD4+/CD8+, CD4+/CD4+25+ and CD4+/CD4+54+ in the pulps at 2nd day after irritation by P. endodontalis were significantly lower than the other groups. 4. The higher concentrations of IFN-gamma than IL-4 in the pulps at 2nd day after irritation by P. endodontalis showed that T helper 1 reaction were predominant in the early stage of the pulpal inflammation induced by P. endodontalis. 5. The higher concentrations of IL-4 than IFN-gamma in the pulps at 1st day and 5th day after irritation by S. mutans were measured but the differences were not significant.
Animals ; Bacteria ; Bacterial Infections ; Incisor ; Inflammation ; Intercellular Adhesion Molecule-1 ; Interferon-gamma ; Interleukin-2 ; Interleukin-4 ; Lymphocyte Subsets ; Lymphocytes ; Mandrillus ; Porphyromonas endodontalis ; Rats ; Streptococcus mutans ; T-Lymphocytes ; T-Lymphocytes, Helper-Inducer ; Th2 Cells

Epidural injection of morphine is widely used for relief of postoperative pain. However urinary retention, the side effect, following epidural morphine is troublesome for patient. A 45 year old male patient was admitted due to avascular necrosis of right hip joint and received bipolar endoprosthesis under continuous epidural anesthesia with 2% lidocaine 15 ml. In recovery room after operation, we applied 2 day,s continuous drug infusor (Baxter Infusor(R), Baxter Healthcare Co., USA) with morphine 2 mg and fentanyl 300 g in saline through epidural catheter. At 2 hour after operation, morphine 2 mg was added to the continuous drug infusor due to severe surgical pain. In ward, at 5 hour, he complained of voiding difficulty and abdominal distension. At 6 hour, Nelaton catheter was inserted and 1000 ml of urine was voided. On the 1st postoperative day, the continuous drug infusor was removed and he received naloxone 0.1 mg, two times, intravenously. But voiding difficulty was persisted. Intermittent Nelaton catheter or indwelling Foley catheter was inserted alternatively. Bethanechol chloride (Besacholine(R)) 15~90 mg/day and prazosin hydrochloride (Minipress(R)) 2~3 mg/day were administered orally and hot bag was applied on lower abdomen. On the 25th postoperative day, he was ultimately released from voiding difficulty and discharged without any problems. We suggested that the causes of urinary retention were bladder atony by overdistention of the bladder and contraction of internal urethral sphincter following epidural anesthesia, surgical pain and immobilization.
Abdomen ; Anesthesia, Epidural ; Bethanechol ; Catheters ; Delivery of Health Care ; Fentanyl* ; Hip Joint ; Humans ; Immobilization ; Infusion Pumps* ; Injections, Epidural ; Lidocaine ; Male ; Middle Aged ; Morphine* ; Naloxone ; Necrosis ; Pain, Postoperative ; Prazosin ; Recovery Room ; Urethra ; Urinary Bladder ; Urinary Retention*

A 23-month-old male patient with treated bronchitis underwent a surgery for the repair of bilateral Hutch's diverticulum of bladder under general anesthesia. He treated bronchitis during 2 weeks since 3 weeks before operation. Arriving operating room, he had mild coughing with sputum. During anesthesia, he was well ventilated but endotracheal secretion was profuse. At ABGA of 2 hours after starting anesthesia, severe hypercapnea(PaCO2: 190.2 mmHg) and severe acidosis(PH: 6.746) were checked. Active treatment was done by suction of endotracheal secretion, hyperventilation, PEEP(5~10 cmH2O), increasing fresh gas flow rate(3.6 L/min --> 7 L/min), and administration of sodium bicarbonate, orciprenaline sulfate and methyl- prednisolone. After 3 hours of treatment, ABGA was normalized and symptoms including wheezing were relieved.
Anesthesia ; Anesthesia, General ; Bronchitis* ; Child* ; Cough ; Diverticulum* ; Humans ; Hypercapnia* ; Hyperventilation ; Infant ; Male ; Metaproterenol ; Operating Rooms ; Prednisolone ; Respiratory Sounds ; Sodium Bicarbonate ; Sputum ; Suction ; Urinary Bladder*

BACKGROUND: Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 µg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]). METHODS: Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany) was used to assess cardiac output (CO) and systemic vascular resistance (SVR). Six minutes after intubation, baseline heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 µg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded. RESULTS: No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau. CONCLUSIONS: For patients under general anesthesia receiving dopamine at 10 µg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.
Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiac Output ; Dopamine* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Jugular Veins ; Saphenous Vein ; Vascular Resistance ; Veins*

A randomised trial was conducted in 13 patients to assess the circulatory response to endotracheal intubation. None of the patient suffered from heart or lung disease, all were premedicated with lorazepam 0.4 mg/kg, glycopyrrolate 0. 004 mg/kg intramuscularly 30-60 min. beforehand. Patients received vecuronium 0.01mg/kg intravenously for precrurarization and 2 min. later 6 patients received lidocaine 2 mg/kg intravenously and 7 patients received saline 1 ml/20 kg intravenously. Blood pressure and pulse rate were measured repeatedly by an automatic recording device (Datascope 2100A) and cardiac output was measured by noninvasive cardiac output monitor with suprasternal doppler ultrasound. After laryngoscopy and intubation, systolic arterial pressure increased 19.7% mean arterial pressure 18.8% from baseline values in lidocaine group (p<0.05), and systolic arterial pressure increased 21.4% mean artereal pressure 19.8% from baseline values in saline group (p<0. 05). Pulse rate increased 30.9% from baseline values in lidocaine group (p<0.05) and 32.5% from baseline in saline group (p<0.05). But there was no intergroup difference in systolic arterial pressure, mean arterial pressure and pulse rate. Diastolic pressure of both group did not increase significantly and did not show intergroup difference. Cardiac output increased 35.3% from baseline values in lidocaine group (p<0.05). We concluded that lidocaine 2 mg/kg infusion intravenously 2 min prior to laryngoscopy and intubation does not prevent hemodynamic reaction evoked by endotracheal intubation.
Arterial Pressure ; Blood Pressure ; Cardiac Output ; Glycopyrrolate ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy ; Lidocaine* ; Lorazepam ; Lung Diseases ; Ultrasonography ; Vecuronium Bromide

BACKGROUND: Methods to reduce the amount of blood transfusion include perioperative hemodilution, hypotensive anesthesia, the transfusion of previously deposited autologous blood, and intraoperative autotransfusion used the cell saver. The purpose of this study is to evaluate the effect of the use of the cell saver in orthopedic spinal surgery. METHODS: One hundred and one patients for orthopedic spinal surgery were involved in this study and divided into two groups: group 1 (no used cell saver, n=51) and group 2 (used cell saver, n=50). We checked transfusion amounts during operation and the changes of hematocrit after operation. RESULTS: The amount of blood obtained from cell saver apparatus was 1220 +/- 651 ml (mean SD). Hematocrit of the autologous blood from this apparatus was 48.5 +/- 2.5%. Amounts of blood transfusion during operation were 4.1 +/- 0.9 IU (400 ml/IU) in group 1 and 2.5 +/- 0.7 IU in group 2 (p<0.05). The hematocrit was markedly decreased at the postoperative 2 and 3 days in group 2 (p<0.05). CONCLUSIONS: This study suggested that intraoperative salvage technique with cell saver apparatus could decrease the use of bank blood by 40% in orthopedic spinal surgery. However, we should be prepare the blood for the decrease of the hematocrit at the postoperative 2 and 3 days.
Anesthesia ; Blood Transfusion ; Blood Transfusion, Autologous ; Hematocrit ; Hemodilution ; Humans ; Orthopedics*