BACKGROUND: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). METHODS: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (P(limit)). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (P(peak)) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a P(peak) of < or = 50 cmH2O. RESULTS: In Model 1, Vt and P(peak) were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and P(peak) levels were 17%, and the P(peak) adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and P(peak) levels were 85%; the P(peak) adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of P(limit). CONCLUSIONS: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.
Cardiopulmonary Resuscitation* ; Manikins* ; Models, Theoretical ; Positive-Pressure Respiration ; Thorax ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical*

Sarcopenia, which is defined as a decrease in skeletal muscle mass and strength with aging, is an important risk factor in clinical medicine that is associated with mortality, and poor surgical and nonsurgical outcomes. Sarcopenia is now recognized as a multifactorial geriatric syndrome. Cachexia is defined as a metabolic syndrome with inflammation as the key feature, so cachexia can be an underlying condition of sarcopenia. Recently, cachexia has been defined as a complex metabolic syndrome associated with an underlying illness and characterized by the loss of muscle mass with or without a loss of fat mass. These two conditions overlap but are not the same. In clinical practice, many factors related to sarcopenia (decreased food intake, inactivity, and decreased hormones) are reported frequently in patients with cachexia. On the contrary, systemic inflammation, the core feature of cachexia, can also be present in apparently healthy older sarcopenic patients. This suggests that new therapeutic approaches, alone or in combination, may be appropriate in both conditions.
Aging ; Cachexia* ; Clinical Medicine ; Eating ; Humans ; Inflammation ; Mortality ; Muscle, Skeletal ; Nutrition Therapy ; Risk Factors ; Sarcopenia*

Bariatric surgery is considered the only effective method of achieving long-term weight loss and ameliorating obesity-associated comorbidities in morbidly obese patients. However bariatric surgery is associated with risks of nutritional deficiencies and malnutrition. Therefore, postoperative nutritional follow-up and supplementation of vitamins and trace elements should be recommended. In this review, we provide essential information on nutritional complications and nutritional management after bariatric surgery.
Bariatric Surgery ; Comorbidity ; Follow-Up Studies ; Humans ; Malnutrition ; Methods ; Postoperative Care ; Trace Elements ; Vitamins ; Weight Loss

Osteotomy around the knee is a widely considered surgical procedure for osteoarthritis with lower extremity malalignment. High tibial osteotomy (HTO) is performed for varus deformity, while distal femur osteotomy (DFO) is performed for valgus deformity. However, if the correction is insufficient, double osteotomy can also be considered. This report included the basic principles and current concepts of patient selection and preoperative planning in osteotomy around the knee.
Congenital Abnormalities ; Femur ; Knee Joint ; Knee* ; Lower Extremity ; Osteoarthritis ; Osteotomy* ; Patient Selection

PURPOSE: To review the radiological findings of retroanastomotic hernia and to derive the useful US and CT criteria to assist in the diagnosis of the condition in patients who had previously undergone gastrojejunostomy. METHODS: During a recent period, 8 consecutive cases of retroanastomotic hernia were encountered. Of the patients involved, seven underwent US and CT imaging. The US and CT scans were reviewed retrospectively to determine the abnormal findings. Surgical confirmation was available in all cases. RESULTS: The efferent loop was herniated through the defect created behind the anastomosis in seven cases, and the afferent loop in one case. Retroanastomotic hernia was suggested prospectively in all cases. Among the seven cases of efferent loop herniation, the US and CT signs of retroanastomotic hernia included whirling of the mesenteric vessels, jejunal loops, and mesentery in the periumbilical abdomen (7/7); mural thickening of the herniated bowel loops (5/7); dilatation of the herniated bowel loops (2/7); and US showed decreased peristalsis of the herniated bowel loops (2/6). In one case, the US and CT signs of retroanastomotic hernia of the afferent loop included dilatation and whirling of a short length of the afferent loop behind the anastomosis. One out of the eight patients had reVersible bowel ischemia, and one had bowel necrosis. CONCLUSION: Retroanastomoic hernia is an important condition, and the US and CT findings might be used for its diagnosis.
Abdomen ; Diagnosis ; Dilatation ; Gastric Bypass* ; Hernia* ; Humans ; Intestines ; Ischemia ; Mesentery ; Necrosis ; Peristalsis ; Retrospective Studies ; Tomography, X-Ray Computed

It has been known that O-linked beta-N-acetylglucosamine (O-GlcNAc) modification of proteins plays an important role in transcription, translation, nuclear transport and signal transduction. The increased flux of glucose through the hexosamine biosynthetic pathway (HBP) and increased O-GlcNAc modification of protein have been suggested as one of the causes in the development of insulin resistance. However, it is not clear at the molecular level, how O-GlcNAc protein modification results in substantial impairment of insulin signaling. To clarify the association of O-GlcNAc protein modification and insulin resistance in rat primary adipocytes, we treated the adipocytes with O-(2-acetamido-2deoxy-D-glucopyranosylidene)amino-N-phenylcarbamate (PUGNAc), a potent inhibitor of O-GlcNAcase that catalyzes removal of O-GlcNAc from proteins. Prolonged treatment of PUGNAc (100 micrometer for 12 h) increased O-GlcNAc modification on proteins in adipocytes. PUGNAc also drastically decreased insulin-stimulated 2-deoxyglucose (2DG) uptake and GLUT4 translocation in adipocytes, indicating that PUGNAc developed impaired glucose utilization and insulin resistance in adipocytes. Interestingly, the O-GlcNAc modification of IRS-1 and Akt2 was increased by PUGNAc, accompanied by a partial reduction of insulin-stimulated phosphorylations of IRS-1 and Akt2. The PUGNAc treatment has no effect on the expression level of GLUT4, whereas O-GlcNAc modification of GLUT4 was increased. These results suggest that the increase of O-GlcNAc modification on insulin signal pathway intermediates, such as IRS-1 and Akt2, reduces the insulin-stimulated phosphorylation of IRS-1 and Akt2, subsequently leading to insulin resistance in rat primary adipocytes.
Acetylglucosamine/*analogs & derivatives/metabolism/pharmacology ; Adipocytes/*metabolism ; Animals ; Deoxyglucose/pharmacokinetics ; Glycosylation ; Immunoprecipitation ; *Insulin Resistance ; Male ; Monosaccharide Transport Proteins/metabolism ; Oximes/*pharmacology ; Phenylcarbamates/*pharmacology ; Phosphoproteins/*metabolism ; Phosphorylation ; Protein-Serine-Threonine Kinases/*metabolism ; Proto-Oncogene Proteins/*metabolism ; Rats ; Rats, Sprague-Dawley ; Research Support, Non-U.S. Gov't ; Subcellular Fractions/metabolism ; beta-N-Acetylhexosaminidase/antagonists & inhibitors

A choriocarcinoma is a rapidly invasive, widely metastatic, human chorionic gonadotropin (HCG)-producing neoplasm, which are usually intrauterine and gestational. A primary gastric choriocarcinoma is very rare, and its pathogenesis is still uncertain. A 56-year old man presented with gastrointestinal bleeding and a gastric mass, clinically suspicious of a gastric adenocarcinoma. Thus, a radical subtotal gastrectomy and lymph node dissection, with a reconstruction, was performed. The resected specimen was found to be a Borrmann type I tumor, and a histological examination showed it to be a primary gastric choriocarcinoma, with an associated adenocarcinoma and a syncytiotrophoblast, which was immunostained by human chorionic gonadotropin (HCG). The serum HCG level, on the 7th postoperative day, was found to be 2, 775 mIU/ml. Chemotherapy was administered two months after surgery, as the patient refused chemotherapy during the immediate post operative period. At that time, the tumor rapidly recurred and disseminated to the liver. The patient died three months after the initial diagnosis.
Adenocarcinoma ; Choriocarcinoma* ; Chorionic Gonadotropin ; Diagnosis ; Drug Therapy ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Liver ; Lymph Node Excision ; Pregnancy ; Trophoblasts

A choriocarcinoma is a rapidly invasive, widely metastatic, human chorionic gonadotropin (HCG)-producing neoplasm, which are usually intrauterine and gestational. A primary gastric choriocarcinoma is very rare, and its pathogenesis is still uncertain. A 56-year old man presented with gastrointestinal bleeding and a gastric mass, clinically suspicious of a gastric adenocarcinoma. Thus, a radical subtotal gastrectomy and lymph node dissection, with a reconstruction, was performed. The resected specimen was found to be a Borrmann type I tumor, and a histological examination showed it to be a primary gastric choriocarcinoma, with an associated adenocarcinoma and a syncytiotrophoblast, which was immunostained by human chorionic gonadotropin (HCG). The serum HCG level, on the 7th postoperative day, was found to be 2, 775 mIU/ml. Chemotherapy was administered two months after surgery, as the patient refused chemotherapy during the immediate post operative period. At that time, the tumor rapidly recurred and disseminated to the liver. The patient died three months after the initial diagnosis.
Adenocarcinoma ; Choriocarcinoma* ; Chorionic Gonadotropin ; Diagnosis ; Drug Therapy ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Liver ; Lymph Node Excision ; Pregnancy ; Trophoblasts

Splenosis is the autotransplantation of fragmented splenic tissue that occurs as a result of traumatic splenic rupture or a routine splenectomy. Generally, splenic implants are numerous and located within the peritoneal cavity; peritoneum, omentum and abdominal viscera, and occasionally on extra-abdominal surfaces. Splenic implants are rarely clinically significant and are incidental found during an abdominal operation, but occasionally mimics primary or metastatic tumors, as seen on radiological studies. Herein, the case of a patient in whom multiple abdominal masses were identified as splenosis, but the initial radiographic finding was that of carcinomatosis peritonei.
Autografts ; Carcinoma* ; Humans ; Omentum ; Peritoneal Cavity ; Peritoneum ; Splenectomy ; Splenic Rupture ; Splenosis* ; Stomach Neoplasms* ; Viscera

Detecting malignant cells in ascitic fluid from tumor patients is important since the existence of malignant cells in ascitic fluids is related to the prognosis of patients. Various laboratory methods are being used to obtain diagnosis in ascitic fluids, but some ascitic fluids can not be diagnosed reliably. Cytogenetic analysis of ascitic fluid is not used routinely as a laboratory tool. In this presentation a cytogenetic study of the ascitic fluids from 9 patients with malignant tumor was performed by a direct or short-term culture method. According to cytogenetic study, 5 cases had positive findings for malignant cells. One case had a inconclusive result. There were no malignant cells in the remaining 4 cases. On blind cytologic data, no informations could be obtained in 4 out of 9 cases and the remaining 5 cases had negative findings for detecting malignant cells. Among the 5 cases, cytogenetic findings were negative in 3 cases but in the remaining 2 cases, one was reported positive and the other inconclusive each other. In present study, even though the ascitic fluids from 5 patients were subjected to the comparison of the cytologic study with cytogenetic analysis, two different findings could be obtained. Therefore if further study of a large series of cancer patients with ascitic fluids is done, the value of cytogenetic analysis will be clearly shown. In addition, the cytogenetic study of cell present in ascitic fluids can be used as useful adjunct to cytologic study, and also it can indicate that more invasive diagnostic procedures are necessary.
Ascitic Fluid* ; Cytogenetic Analysis ; Cytogenetics ; Diagnosis ; Humans ; Prognosis