No abstract available.
Scimitar Syndrome*

With the development of body sensor technology, wearable health monitoring systems have been an emerging information technology in the 'ubiquitous health care' system. Wearable sensors enable long-term continuous physiological monitoring important in health promotion and management of many chronic disorders. In this paper, we present several wearable health monitoring systems developed by different countries and discuss emerging opportunities, as well as, existing challenges such as standardization, administration, validation, and discrepancy issues between technology and clinical implication.
Health Promotion ; Monitoring, Physiologic ; Telemedicine

PURPOSE: Painful plantar callosities under the second, third or fourth metatarsal head have been controverted about its treatment mordalities. We performed the vertical chevron osteotomy in patients with painful callosities on the second and third metatarsal head, and evaluated the outcome clinically. MATERIALS AND METHODS: Fourteen cases from 10 patients who had plantar keratosis were operated by vertical chevron osteotomy from March 2005 to October 2008. We used K-wire fixation for all cases. We evaluated the clinical results by the patients' satisfaction and disappearance of plantar lesion. RESULTS: The plantar keratosis was completely disappeared in 8 cases and partially in 5 cases. In 2 cases, patients expresses their pain caused by constant metatarsalgia that was suspected to be dorsal incisional pain and joint capsulitis. Transmetatarsalgia was not appeared. CONCLUSION: We consider vertical chevron osteotomy as a good surgical method for treatment of plantar keratosis.
Callosities ; Head ; Humans ; Joints ; Keratosis ; Metatarsal Bones ; Metatarsalgia ; Osteotomy

PURPOSE: Painful plantar callosities under the second, third or fourth metatarsal head have been controverted about its treatment mordalities. We performed the vertical chevron osteotomy in patients with painful callosities on the second and third metatarsal head, and evaluated the outcome clinically. MATERIALS AND METHODS: Fourteen cases from 10 patients who had plantar keratosis were operated by vertical chevron osteotomy from March 2005 to October 2008. We used K-wire fixation for all cases. We evaluated the clinical results by the patients' satisfaction and disappearance of plantar lesion. RESULTS: The plantar keratosis was completely disappeared in 8 cases and partially in 5 cases. In 2 cases, patients expresses their pain caused by constant metatarsalgia that was suspected to be dorsal incisional pain and joint capsulitis. Transmetatarsalgia was not appeared. CONCLUSION: We consider vertical chevron osteotomy as a good surgical method for treatment of plantar keratosis.
Callosities ; Head ; Humans ; Joints ; Keratosis ; Metatarsal Bones ; Metatarsalgia ; Osteotomy

We report one case of Horner's syndrome, a rare complication of closed thoracostomy. A 17 year-old girl with a second attack of left side primary spontaneous pneumothorax visited an emergency room. After closed tube thoracostomy, she was admitted to a general ward for elective video-assisted thoracosopic bullectomy, which was delayed due to incidental right side acute otitis media. On the third day of admission, she presented with pain and discomfort in the left eye. Further examination revealed left side ptosis and miosis and led to a diagnosis of Horner's syndrome. The chest tube was pulled back 2 to 3 cm for repositioning. After two days she underwent video-assisted thoracoscopic bullectomy and mechanical pleurodesis and was discharged at postoperative day 7. Symptoms and signs of Horner's syndrome gradually resolved, and she had fully recovered at the 2 month postoperative outpatient follow-up.
Chest Tubes ; Emergencies ; Eye ; Follow-Up Studies ; Horner Syndrome ; Humans ; Miosis ; Otitis Media ; Outpatients ; Patients' Rooms ; Pleurodesis ; Pneumothorax ; Quaternary Ammonium Compounds ; Thoracostomy

PURPOSE: inhaled nitric oxide(iNO) is an excellent method for the postoperative pulmonary hypertension in congenital heart disease. But more detailed care is needed because of the development of rebound pulmonary hypertension after NO Withdrawal. We performed this study in order to discontinue the iNO successfully by way of presenting the adequate weaning and supplying methods. METHODS: Between January, 1998 and August, 1999 we sudied 10 patients who had rebound pulmonary hypertension(RPH) after iNO withdrawal. We completed the iNO in these patween the first the second trial of the weaning process. We tried to discover the differences between the first and second weaning process. We measured NO concentration at the start and just before NO withdrawal and during the period of weaning process. Moreover, to identify the iNO effects during the weaning of the iNO, we counted the degree of the change of PaO2/FiO2and mean PAP/SAP beween initial and at half of the initial NO concentration. RESULTS: Second weaning had a longer duration weaning process(11+/-0 cersus 5+/- hours, P<0.05), lower NO concentration just before NO withdrawal(2+/-.6 versus 4+/-ppm, P<0.05). In the change of the mean PAP/SAP and PaO2/FiO2as iNO was weaning from the initial iNO concentration to a half of the initial iNO concentration, the degree of increase in mean PAP/SAP(0.026+/-.07 versus 0.054+/-.07, P<0.05) and the degree of decrease in PaO2/FiO2(49+/-4 versus 65+/-2, P<0.05) were smaller in the second in the second weaning process than the first weaning process. CONCLUSION: A successful weaning of iNO can be performed with a low iNO concentration at the start and just before withdrawal and with the long duration iNO weaning process. Moreover, We speculate that the degree of change in the mean PAP/SAP and PaO2/FiO2at the half of the iNO weaning process are an indicator for the development of RPH.
Heart Defects, Congenital ; Humans ; Hypertension, Pulmonary ; Nitric Oxide* ; Weaning*

INTRODUCTION: Protamine reversal of heparin anticoagulation often produces profound hypotension. However, the precise mechanisms of its hypotensive effect have not been fully elucidated. Using a canine model, we explored the effects of cyclo-oxygenase inhibitor, indomethacin (INDO), and nitric oxide synthetase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME) either alone or both on the cardiopulmonary responses to protamine. METHODS: Fifty-four mongrel dogs in five groups were studied during 1.5% halothane anesthesia. GroupI (n=17) received heparin (300 IU/kg iv) followed by protamine (3 mg/kg iv over 30 s) 5 min after the heparin. The same protocol were used in groups II (n=11), III (n=12), and IV (n=7), except that L-NAME (20 mg/kg), INDO (10 mg/kg), and INDO (10 mg/kg) plus L-NAME (10 mg/kg) were infused over 10 min beginning 30 min before the protamine injection, respectively. Animals in group V (n=7) were given protamine (3 mg/kg) alone. Mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), left ventricular end-diastolic pressure (LVEDP), LVdP/dt and cardiac output and left circumflex coronary flow (LCX flow) via Doppler flowmeter and heart rate were continuously recorded in baseline conditions and up to 15 min. Plasma NOx (NO2-, NO3-) levels were also measured before (baseline) and 3, 5, 10, and 15 min after protamine injection. RESULTS: In group I, protamine caused immediate but transient decreases of MAP (41%), cardiac index (CI, 58%), dP/dt (28%), and LVEDP (62%) and increases of MPAP (38%) and systemic and pulmonary vascular resistance indices (SVRI, 30%; PVRI, 316%). INDO significantly attenuated the hemodynamic responses to protamine, whereas L-NAME did not affect them at all. INDO plus L-NAME prevented protamine-induced hypotension, but CI (-24%) and LVEDP (-30%) showed similar changes as those in group II. Protamine increased MPAP but inconsistently, meanwhile no correlation was found between the magnitude of increase of MPAP and decrease of MAP at peak responses in groups I-IV. LCX flow increased significantly (124~188%) immediately after protamine infusion without any changes in plasma NOx levels in groups I-IV. Neither significant hemodynamic effects nor NOx release was found in animals given protamine alone. CONCLUSION: Protamine in the presence of heparin induces profound hypotension which may be mediated by a prostanoid and other potent vasodilators. In addition, increase of PAP and NO release may not play a significant role in the protamine-induced hypotension.
Anesthesia ; Animals ; Arterial Pressure ; Cardiac Output ; Dogs* ; Flowmeters ; Halothane ; Heart Rate ; Hemodynamics ; Heparin ; Hypotension* ; Indomethacin ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Plasma ; Prostaglandin-Endoperoxide Synthases ; Protamines* ; Vascular Resistance ; Vasodilator Agents

PURPOSE: Dendritic cells (DCs) are the most potent antigen presenting cells and should be differentiated to mature form to induce primary T cell response. In this study, we intended to generate mature DCs from peripheral blood mononuclear cells (PBMCs), so that develope the basis for immunotherapy using DCs. METHODS: PBMCs were isolated from 25 mL of normal adults' peripheral blood and evenly distributed in 5 wells of a 6-well plate. Nonadherent cells were gently aspirated after 2 hour-incubation under humidified 5% CO2 at 37degrees C. Adherent monocytes were cultured in 3 mL of 10% fetal bovine serum plus RPMI-1640 media containing granulocyte/macrophage-colony stimulating factor (GM-CSF) 200 ng/mL and interleukin (IL)-4 20 ng/mL. To assess the effect of tumor necrosis factor (TNF)-alpha and interferon (IFN)-alpha on DC maturation, either or both were added on day 4 of culture. Cells were harvested on day 4 and 7 to calculate the cell counts, CD83 /HLA-DR cells, and CD86 /HLA-DR cells. RESULTS: On day 4, large amounts of DCs were observed. CD83 /HLA-DR cells and CD86 / HLA-DR cells were 11.6% and 16.6% of total cells counted and yields were 1.3% and 2.0%, respectively. On day 7, DCs were more frequently observed in all instances and purity ranged from 24.0% to 31.0% as a mean value. The final yields of matue DCs were 2.9~3.4% of PBMCs inoculated. Adding TNF-alpha plus IFN-alpha led to the best yield. But, IFN-alpha alone did not increase the mature DCs compared to the control. CONCLUSION: We successfully cultured large quantities of mature DCs from PBMCs using GM-CSF and IL-4. IFN-alpha seems to have a synergistic effect when added with TNF-alpha, but further studies are required to prove the clinical significance.
Antigen-Presenting Cells ; Cell Count ; Dendritic Cells* ; Granulocyte-Macrophage Colony-Stimulating Factor ; HLA-DR Antigens ; Immunotherapy ; Interferon-alpha ; Interferons ; Interleukin-4 ; Interleukins ; Monocytes ; Tumor Necrosis Factor-alpha

For the assessment the effect of succinylcholine (SCh) on atracurium, 59 adult patients undergoing elective surgery under general anesthesia were subjected to this study in which the nEMG response (twitch height) of the hand to TOF stimulation (0.2 Hz) of ulnar nerve was monitored and recorded with Datex Relaxograph. According to the amount and mode of the drugs administered, the patients were divided into four experimental groups;1) Group I, a bolus injection of atracurium in dose of 0.5 mg/kg 2) Group II, atracurium 1.0 mg/kg, a double dose of group I 3) Group III, atracurium 0.5 mg/kg after 25 to 50% recovery of initial twitch height from twitch height depression induced by SCh (1 mg/kg) 4) Group IV, mixed injection of SCh (1 mg/kg) and atracurium (0.5 mg/kg) Followings were the results. 1. Mean onset time of the atracurium, which was 4.5+/-0.6 minutes in group I and 4.00.7 minutes in group II, changed to 2.7+/-0.6 and 4.0+0.8 minutes in group III and IV respectively, showing no significance. 2. Mean action duration of atracurium was 49.1+/-3.4 minutes in group I and 72.0+/-3.7 minutes in group II, the latter being significant (p<0.001). It was, however, 49.0+/-3.6 minutes in group III, indicating that SCh shnwed a little effect, while it was 38.1+/-1.8 minutes in group IV, being significantly shorter than those of group I and IlI (p<0.01). 3. Mean potency of atracurium expressed by the percentage change of initial twich height was 0.7+/-0.5% in group I and it was decreased to 0% in group II but it was not sinificant. In group III, it was increased to 0.9+/-0.6% but it was also no significance. In group IV, it was decreased to 0.4+/-0.2% which was not significant. 4. Presence of atracurium (0.5 mg/kg) in group IV did not have any effect on the intensity of fasciculation induced by SCh. These results indicate that succinylcholine did not attect the onset time and action potency of atracurium. However, in group of the mixed injection, SCh shortened only the duration of action of atracurium.
Adult ; Anesthesia, General ; Atracurium* ; Depression ; Fasciculation ; Hand ; Humans ; Succinylcholine* ; Ulnar Nerve

For the assessment the effect of succinylcholine (SCh) on atracurium, 59 adult patients undergoing elective surgery under general anesthesia were subjected to this study in which the nEMG response (twitch height) of the hand to TOF stimulation (0.2 Hz) of ulnar nerve was monitored and recorded with Datex Relaxograph. According to the amount and mode of the drugs administered, the patients were divided into four experimental groups;1) Group I, a bolus injection of atracurium in dose of 0.5 mg/kg 2) Group II, atracurium 1.0 mg/kg, a double dose of group I 3) Group III, atracurium 0.5 mg/kg after 25 to 50% recovery of initial twitch height from twitch height depression induced by SCh (1 mg/kg) 4) Group IV, mixed injection of SCh (1 mg/kg) and atracurium (0.5 mg/kg) Followings were the results. 1. Mean onset time of the atracurium, which was 4.5+/-0.6 minutes in group I and 4.00.7 minutes in group II, changed to 2.7+/-0.6 and 4.0+0.8 minutes in group III and IV respectively, showing no significance. 2. Mean action duration of atracurium was 49.1+/-3.4 minutes in group I and 72.0+/-3.7 minutes in group II, the latter being significant (p<0.001). It was, however, 49.0+/-3.6 minutes in group III, indicating that SCh shnwed a little effect, while it was 38.1+/-1.8 minutes in group IV, being significantly shorter than those of group I and IlI (p<0.01). 3. Mean potency of atracurium expressed by the percentage change of initial twich height was 0.7+/-0.5% in group I and it was decreased to 0% in group II but it was not sinificant. In group III, it was increased to 0.9+/-0.6% but it was also no significance. In group IV, it was decreased to 0.4+/-0.2% which was not significant. 4. Presence of atracurium (0.5 mg/kg) in group IV did not have any effect on the intensity of fasciculation induced by SCh. These results indicate that succinylcholine did not attect the onset time and action potency of atracurium. However, in group of the mixed injection, SCh shortened only the duration of action of atracurium.
Adult ; Anesthesia, General ; Atracurium* ; Depression ; Fasciculation ; Hand ; Humans ; Succinylcholine* ; Ulnar Nerve