We report a 72-year-old female patient with spontaneous rupture of the left external iliac vein. She visited our hospital for abdominal and back pain. She had the abnormal finding of hemoperitoneum. We performed an emergency operation with diagnosis of left ovarian cyst rupture though she suffered from spontaneous rupture of the left external iliac vein. This case provides insight to the experience of spontaneous rupture of the left external iliac vein.
Aged ; Back Pain ; Emergencies ; Female ; Hemoperitoneum ; Humans ; Iliac Vein ; Ovarian Cysts ; Rupture ; Rupture, Spontaneous

Chronic fatigue of the respiratory muscles has contributed to the decreased ventilatory capacity and reduced excercise tolerance of individuals with COPD, especially in kyphoscoliosis. Nasal mask BiPAP has been shown to be useful for the patient with nocturnal muscle fatigue and COPD. A 35-year-old man with severe kyphoscoliosis was admitted to ICU due to acute respiratory failure. He had been diagnosed of COPD and had been intubated with mechanical ventilatory support for 7 times. This time he was intubated with ventilatory support, too, in ICU and readmitted to the ICU for severe hypoxemia and hypercarbia from general ward. Thereafter he refused the intubation. Nasal mask BiPAP ventilatory support system was applied and IPAP, EPAP level being adjusted to the 12, 4 cmH2O under monitoring vital signs and arterial blood gas analysis. His condition was improved and discharged home with support of nasal mask BiPAP system after 33 day-stay in the ICU.
Adult ; Anoxia ; Blood Gas Analysis ; Fatigue ; Humans ; Intubation ; Masks* ; Muscle Fatigue ; Patients' Rooms ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Insufficiency ; Respiratory Muscles ; Vital Signs

BACKGROUND: The synthetic narcotic sufentanil has been used in clinical practice for anesthetic induction and maintenance. But there is little information concerning its direct effects on heart. The purpose of this study is to evaluate the direct effects of sufentanil on contracture of ventricular myocardium. METHODS: Isometric contraction of isolated right ventricular papillary muscle of rabbit was measured under 0.2 Hz electrical stimulation in Krebs solution. Peak developed force(F), maximum rate of rise of developed force(+dF/dt(max)), maximum rate of fall of developed force(-dF/dt(max)) were analyzed. RESULTS: There were no statistically significant differences in frequency of isometric contraction from the 100% baseline value in time-matched control group. Sufentanil, in concentration of 0.01-0.1 mM, increased F, and -dF/dt(max) was decreased especially in concentration of 0.1 mM but not +dF/dt(max) Fo +dF/dt(max) and -dF/dt(max) were statistically different from time-matched control group in concentration of 0.1 mM. CONCLUSIONS: We conclude that sufentanil has mild contracture effect on ventricular muscle of rabbit directly.
Analgesics ; Contracture ; Electric Stimulation ; Heart ; Isometric Contraction ; Myocardium ; Papillary Muscles ; Rabbits* ; Sufentanil*

Ketamine is well known for its analgesic, bronchodilating and sympathetic stimulating effect. Hence, it has been widely used for induction of patients with hypotension or asthma and also for analgesic and sedating purposes in the ICU. We presented a 62 year old female patient with ventilator support in septic shock with refractory asthma whom we managed successfully with continuous intravenous infusion of ketamine postoperatively in the ICU. The patient had a history of asthma but had been asymptomatic recently and was scheduled for an emergent explo-laparotomy under the diagnosis of acute panperitonitis. Before the induction of anesthesia, the patient was in septic shock but no wheezing could be auscultated. After the induction of general anesthesia and endotracheal intubation, wheezing was apparent in both lung fields with a high peak inspiratory pressure. Inotropics, vasopressors and bronchodilators were promptly instituted without any improvement of asthma and the patient had to be transferred to the ICU with intubated after the operation. Clinical symptoms of asthma continued throughout the first day despite using bronchodilators under mechanical ventilation but, after starting the IV infusion of ketamine, there were decrease in the peak inspiratory pressure and wheezing with a subsequent improvement in the arterial blood gas analysis findings. We could also achieve considerable analgesic and sedating effect without any decrease in the blood pressure. The patient's general physical status improved and weaning with extubation was successfully done on the 21st day and was transferred to the general ward on the 28th day.
Anesthesia ; Anesthesia, General ; Anesthetics ; Asthma ; Blood Gas Analysis ; Blood Pressure ; Bronchodilator Agents ; Diagnosis ; Female ; Humans ; Hypotension ; Infusions, Intravenous ; Critical Care ; Intubation, Intratracheal ; Ketamine* ; Lung ; Middle Aged ; Patients' Rooms ; Respiration, Artificial ; Respiratory Sounds ; Shock, Septic* ; Status Asthmaticus* ; Ventilators, Mechanical ; Weaning

BACKGROUND: Olfactory dysfunction, including anosmia and hyposmia is difficult to treat. Although the mechanism is not well known, stellate ganglion block (SGB) is used to treat olfactory dysfunction. There are no prior studies on the long-term effects of SGB on olfactory dysfunction. The purpose of this study was to evaluate the continuity of therapeutic effects and patient satisfaction with SGB treatment. METHODS: This was a follow-up study carried out via a telephonic survey. The olfactory function of the patient was evaluated using a visual analog scale (VAS). We checked VAS three times: VAS-I (pre-treatment VAS), VAS-A (post-treatment VAS), and VAS-C (VAS at follow up telephone survey). We divided the subjects into 2 groups according to their responsiveness to SGB: the responsive (R group) and the unresponsive groups (UR group). Patient satisfaction was evaluated using a Likert scale. RESULTS: Out of the 40 subjects, 37 responded to the telephone survey. In the UR group, there was difference in the olfactory function. However, in the R group, there were significant VAS differences; VAS-I was 9.6 +/- 0.7, VAS-A was 5.1 +/- 4.2, and VAS-C was 2.7 +/- 2.7 (P < 0.05). On the Likert scale, patient satisfaction was as follows: grade 1, 17 patients (45.9%); grade 2, 6 patients (16.2%); grade 3, 6 patients (16.2%); and grade 4, 8 patients (21.6%). CONCLUSIONS: SGB is a safe, long-lasting, and effective therapeutic modality for olfactory dysfunction treatment.
Arginine Vasopressin ; Follow-Up Studies ; Humans ; Olfaction Disorders ; Patient Satisfaction ; Smell ; Stellate Ganglion ; Telephone

BACKGROUND: Ulinastatin, a urinary trypsin inhibitor, is widely used to treat acute systemic inflammatory disorders. However, the effects of ulinastatin, especially on the potential for hemostasis, have not been fully elucidated. This study examined whether ulinastatin had any beneficial effects on blood loss and blood transfusion requirements in patients undergoing major orthopedic surgery. METHODS: Eighty patients, aged 18 to 75 years, scheduled for major orthopedic surgery were enrolled in this study and were divided into the ulinastatin (n = 40) and control (n = 40) groups. Following the induction of general anesthesia, and immediately before the surgical incision, the patients in the ulinastatin group were given 5,000 units/kg of ulinastatin, which were mixed in 100 ml normal saline intravenously over 30 min, while those in the control group received the same volume of normal saline. The amounts of blood loss, infused fluid, and transfused blood products were measured throughout the study period. Blood samples for coagulation parameters were obtained before inducing anesthesia (T1), at the end of surgery (T2), and 12 h after surgery (T3). RESULTS: The amounts of blood loss and infused fluid during surgery were not significantly different between the two groups. However, 12 h postoperative blood loss was significantly less in the ulinastatin group than in the control group (255.0 +/- 133.2 ml VS. 395.4 +/- 338.4 ml, P < 0.05). CONCLUSIONS: Our data suggest that a single infusion of ulinastatin in major orthopedic surgery is associated with decreased blood loss in the early postoperative period.
Aged ; Anesthesia ; Anesthesia, General ; Blood Transfusion ; Glycoproteins ; Hemostasis ; Humans ; Orthopedics ; Postoperative Hemorrhage ; Postoperative Period ; Trypsin

BACKGROUND: In emergency rooms or intensive care units, we have shown delivery of higher fractions of oxygen promptly for respiratory or cardiac arrest patients by using resuscitating instruments, especially the resuscitator bag. Previously we studied the variables affecting the fraction of delivered oxygen (FDO2) under varying ventilating techniques and conditions. In this paper, using corrugated tubes as substitute for reservoir bag, we measured FDO2 and compared two. METHODS: We designed a special wooden box, which held the Laerdal resuscitator bag. We measured the FDO2 with or without reservoir bags and corrugated tubes at various tidal volumes, respiration rates and oxygen flows. RESULTS: With a 500 ml corrugated tube, FDO2 were higher than with a 250 ml corrugted tube but lower than with a reservoir bag. CONCLUSIONS: Corrugated tube is less effective to deliver high fractions of oxygen than the reservior bag, but it is acceptable to use corrugated tube as a substitute for a reservior bag than not to use it at all.
Emergency Service, Hospital ; Heart Arrest ; Humans ; Intensive Care Units ; Oxygen* ; Respiratory Rate ; Tidal Volume

The effects of the prone position on the improvement of oxygenation in patients with ARDS were reported already twenty years ago. Recent studies have shown that the prone position would improve the ventilation and perfusion relationship as it improves the ventilation in the local area without altering the pulmonary blood flow during the support of ventilation in the patients with ARDS. We have applied the prone position repeatly on the patient with ARDS which developed after the removal of a bilateral pulmonary empyema and decortication. The initial effect of the prone position on oxygenation improved the PaO2/FiO2 (arterial oxygen tension divided by inspired oxygen concentration) ratio, 104.3 to 132.9, at FiO2 0.7. Improvement of oxygenation was maintained with repeat position change, three times over 24 hours, from supine to prone position.
Empyema ; Humans ; Oxygen* ; Perfusion ; Prone Position* ; Respiratory Distress Syndrome, Adult* ; Ventilation

BACKGROUND: Protease-activated receptor 2 (PAR2) belongs to a family of G protein- coupled receptors activated by proteolytic cleavage. Trypsin-like serine proteases interact with PAR2 expressed by a variety of tissues and immune cells. The aim of our study was to investigate whether PAR2 stimulation can lead to the activation of human macrophages. METHODS: PAR2-mediated proliferation of human macrophage cell line THP-1 was measured with MTT assay. We also examined the extracellular regulated kinase (ERK) phosphorylation and cytokine production induced by trypsin and PAR2-agonist using western blot and enzyme-linked immunosorbent assay (ELISA), respectively. RESULTS: Treatment of trypsin or PAR2-activating peptide increased cell proliferation in a dose-dependent manner, and induced the activation of ERK1/2 in THP-1 cells. In addition, trypsin-induced cell proliferation was inhibited by pretreatment of an ERK inhibitor (PD98059) or trypsin inhibitor (SBTI). Moreover, PAR2 activation by trypsin increased the secretion of TNF-alpha in THP-1 cells. CONCLUSION: There results suggest that PAR2 activation by trypsin-like serine proteases can induce cell proliferation through the activation of ERK in human macrophage and that PAR2 may play a crucial role in the cell proliferation and cytokine secretion induced by trypsin-like serine proteases.
Blotting, Western ; Cell Line* ; Cell Proliferation ; Enzyme-Linked Immunosorbent Assay ; Humans* ; Macrophages* ; Phosphorylation ; Phosphotransferases ; Receptor, PAR-2* ; Serine Proteases ; Trypsin ; Tumor Necrosis Factor-alpha

Tuberculous spondylitis is a very rare disease, but it can result in bone destruction, kyphotic deformity, spinal instability, and neurologic complications unless early diagnosis and proper management are done. Because the most common symptom of tuberculous spondylitis is back pain, it can often be misdiagnosed. Atypical tuberculous spondylitis can be presented as a metastatic cancer or a primary vertebral tumor. We must make a differential diagnosis through adequate biopsy. A 30-year-old man visited our clinic due to back and chest pain after a recent traffic accident. About 1 year ago, he had successfully recovered from tuberculous pleurisy after taking anti-tuberculosis medication. We performed epidural and intercostal blocks but the pain was not relieved. For the further evaluation, several imaging and laboratory tests were done. Finally, we confirmed tuberculous spondylitis diagnosis with the biopsy results.
Accidents, Traffic ; Adult ; Back Pain ; Biopsy ; Chest Pain ; Diagnosis, Differential ; Early Diagnosis ; Humans ; Rare Diseases ; Spondylitis ; Tuberculosis, Spinal ; Tuberculosis, Pleural