BACKGROUND: The mechanically ventilated patient's stay in the emergency department (ED) is brief but ventilatory management and intervention must be optimal. Agitation, anxiety, distress, and discomfort are common complications far the ventilated patient. So, sedation is necessary to reduce these complications. METHODS: Patients were monitored and mechanically ventilated. Midazolam was intravenously administered as loading dose(3-5mg), followed by continuous infusion at a rate of 0.06mg/kg/hr, titrated to achieve a predetermined sedation level (Ramsay's sedation score: 2-5 points, Glasgow coma score scathe : 8-11 points). RESULTS: After onset of predetermined sedation, systolic and diastolic blood pressure and heart rate remained stable during continuous infusion when compared with those of the initial state. Arterial blood gas and peak inspiratory pressure remained unchanged but respiratory rate was decreased to allowable ranges. CONCLUSION: A short-term continuous infusion of midazolam was a safe and erective method for sedation of ventilated patients in ED.
Anxiety ; Blood Pressure ; Coma ; Dihydroergotamine ; Emergency Service, Hospital ; Heart Rate ; Humans ; Midazolam* ; Respiratory Rate

OBJECTIVE: This study was done to evaluate the risk factors and prevalence of symptom-giving pelvic girdle relaxation in pregnant women. METHODS: Three hundreds thirty-two postpartum women were asked to fill out a questionnaire within one week after their parturition. The diagnostic criteria of this lesion were adopted from the Norwegian Medical Association's and Larsen's criteria. The questionnaire were included age, parity, BMI(kg/cm2), weight gain during the pregnancy, history of symptom giving pelvic girdle relaxation in previous pregnancy, level of exercise and vocational status during and before the pregnancy and baby's birth weight. The answers were evaluated to determine the risk factors. The correlation was tested by student t-test and logistic regression. RESULTS: The prevalence of symptom-giving pelvic girdle relaxation during pregnancy was 18.9%. The history of symptom-giving pelvic girdle relaxation in previous pregnancy, multiparity and the absence of regular exercise before and during pregnancy showed correlation with symptom-giving pelvic girdle relaxation in pregnancy (p<0.05). CONCLUSION: It is suggested that women who experienced symptom-giving pelvic girdle relaxation in previous pregnancy should be checked for this lesion before pregnancy. Regular exercise is required to lower the incidence and lessen the severity of this lesion in pregnancy.
Birth Weight ; Female ; Humans ; Incidence ; Logistic Models ; Parity ; Parturition ; Postpartum Period ; Pregnancy ; Pregnant Women* ; Prevalence* ; Surveys and Questionnaire ; Relaxation* ; Risk Factors* ; Weight Gain

Sciatic nerve palsy after total knee arthroplasty, accompanied by motor power weakness and electromyographic evidence, is a rare occurrence. In a 78-year-old female, pneumatic tourniquet was used for 72 minutes, with a pressure of 300 mmHg. The time and pressure are generally accepted values. We noticed sciatic nerve palsy showing motor power weakness and electromyographic evidence. One year after the operation, she recovered full motor power, but complained about a tingling sensation below the knee. Given that the nerve injury after using tourniquet was due to neural ischemia, and since our patient had vascular circulation problems such as atrial fibrillation and clip insertion due to internal carotid artery aneurysm, our patient can be considered as a high-risk patient with weakness to neural ischemic damage, even with the use of conventional tourniquet. Therefore, surgeons should be cautious when using tourniquet in patients with vascular circulation problems.
Aged ; Aneurysm ; Arthroplasty, Replacement, Knee* ; Atrial Fibrillation ; Carotid Artery, Internal ; Female ; Humans ; Ischemia ; Knee ; Sciatic Nerve* ; Sciatic Neuropathy ; Sensation ; Surgeons ; Tourniquets

One of the purposes of this experiment is to observe the structure of crystalline lens with cataract, which is formed artificially, using the light microscope and electron microscope. The other is to observe the differences of structural variations in the cataract developed inside body. Twelve eyes of six pigs were used for this experiment. Two of them are normal crystalline lens, five are cystalline lens in distilled water, and the rest are in balanced salt solution through intact or ruptured capsule. We examined the time of cataract formation and compared the ultrastructural changes. Ruptured capsule and high osmotic pressure difference induced more rapid opacity. In case of distilled water, the capsule is maintained but it is very difficult to distinguish between epithelium and lens fibers. Also, there is a severe crack in the lens fibers. In electron microscopic, as the cataract progresses, the osmotic swelling becomes more prominent. One of the striking changes was a marked intercellular cyst formation. Lens cells became irregular in size and density and were extensively vacuolated. The swelling of the lens cells continuously induced large intracellular vacuoles and liquefied the cytoplasmic protein. In conclusion, the structural change of cataract, which was seen by an electron microscope, resulted from change in osmolarity from previously announced in vivo experiment and structural change resulted from this experiment are similar.
Cataract* ; Crystallins* ; Cytoplasm ; Epithelium ; Lens, Crystalline* ; Microscopy, Electron ; Osmolar Concentration ; Osmotic Pressure ; Strikes, Employee ; Swine ; Vacuoles ; Water

A fibroma of the tendon sheath (FTS) is a rare and less well-known benign soft-tissue tumor. FTS infrequently develop in the knee region. Especially intraarticular FTS of the knee was found in a few case reports. We present a rare case of FTS arising from the infrapatellar plica of the knee in 12-year-old man without a history of specific trauma. Magnetic Resonance Imaging (MRI) and an arthroscopic examination revealed an encapsulated soft tissue mass arising from the infrapatellar plica anterior to the anterior cruciate ligament. The histological diagnosis is FTS in the intraarticular of the knee. To the best of our knowledge, this report is the first reported case of FTS involving the infrapatellar plica of the knee.
Anterior Cruciate Ligament ; Child ; Diagnosis ; Fibroma* ; Humans ; Knee Joint ; Knee* ; Magnetic Resonance Imaging ; Tendons*

Some variables can influence the efficiency of leukocyte removal filter for red cell concentrates. We performed this study to evaluate whether the filtration efficiency for platelet concentrates(PCs) can be influenced by bedside filter(PXL8K, Pall Corporation, USA) used, platelet storage time and transient stopping of platelet agitation, and to measure the amount of cytokines released from donor leukocytes in PCs during the storage time. In addition, we examined the effect of leukocyte reduction by filtration before the storage of PCs on the subsequent generation of cytokines. Any of the above mentioned variables did not make significant differences. From day 1 to day 5, there were significant increases in IL-1 beta (<1 vs. 8.6 pg/mL, p<0.05), IL-8 (<10 vs. 455.3 pg/mL, p<0.05) and TNF-alpha (<4 vs. 16.6 pg/mL, p<0.05) in unflltered PCs, whereas no increased revels of cytokines were found in the cases of prestorage filtration.
Blood Platelets* ; Cytokines ; Dihydroergotamine ; Filtration* ; Humans ; Interleukin-1beta ; Interleukin-8 ; Leukocytes* ; Tissue Donors ; Tumor Necrosis Factor-alpha

PURPOSE: Asthma is prevalent in many countries. Few studies have investigated the association between asthma and concomitant diseases. We retrospectively analyzed the fourth Korean National Health and Nutrition Survey database, performed in 2008 using nationwide stratified random sampling to obtain a representative cohort of the Korean population. METHODS: We evaluated the association between both self-reported ever-asthmatics and wheezers and concomitant diseases such as arthritis, hypertension, gastrointestinal (GI) ulcers, dyslipidemia, diabetes mellitus, rhinitis, depression, stroke, and obesity in subjects aged > or =40 years. A multivariate analysis was performed to identify concomitant diseases independently associated with asthma, after adjustment for age, gender, income, cigarette smoking, and other chronic diseases. RESULTS: Of the total of 4,445 subjects, 2,596 (58.4%) were female and the mean age was 58.3 years. Of the 4,445 subjects, 195 (4.4%) had been diagnosed with asthma at some point, and 444 (10%) were wheezers. Multivariate analysis showed that arthritis (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.26-2.42), rhinitis (OR 1.78, 95% CI 1.14-2.78), depression (OR 1.45, 95% CI 1.05-2.07), and obesity (OR 1.61, 95% CI 1.08-2.40) were significantly associated with self-reported ever-asthma, and arthritis (OR 1.50, 95% CI 1.19-1.909), hypertension (OR 1.34, 95% CI 1.07-1.67), GI ulcers (OR 1.48, 95% CI 1.05-2.08), rhinitis (OR 1.60, 95% CI 1.16-2.19), depression (OR 1.94, 95% CI 1.51-2.48), and obesity (OR 1.56, 95% CI 1.17-2.09) were significantly associated with wheezers. CONCLUSIONS: These findings indicate that arthritis, rhinitis, depression, and obesity may be associated with both self-reported ever asthma and wheezers in the Korean population.
Aged ; Arthritis ; Asthma ; Cohort Studies ; Depression ; Diabetes Mellitus ; Dyslipidemias ; Female ; Humans ; Hypertension ; Multivariate Analysis ; Nutrition Surveys ; Obesity ; Retrospective Studies ; Rhinitis ; Smoking ; Stroke ; Ulcer

There are several mechanisms for the dissemination of lipid material from a mature teratoma into the subarachnoid space or ventricles, including iatrogenic or traumatic rupture, but spontaneous rupture of a mature teratoma is rare. We report the spontaneous rupture of a spinal mature teratoma into the subarachnoid space and ventricles. However, at surgery, there was no definite evidence of rupture into the perimedullary cerebrospinal fluid. We postulate that the central canal could be a migration pathway for ruptured material into the brain.
Brain ; Rupture ; Rupture, Spontaneous ; Subarachnoid Space ; Teratoma

Severe acute respiratory distress syndrome (ARDS) is a life-threatening disease with a high mortality rate. Although many therapeutic trials have been performed for improving the mortality of severe ARDS, limited strategies have demonstrated better outcomes. Recently, advanced rescue therapies such as extracorporeal membrane oxygenation (ECMO) made it possible to consider lung transplantation (LTPL) in patients with ARDS, but data is insufficient. We report a 62-year-old man who underwent LTPL due to ARDS with no underlying lung disease. He was admitted to the hospital due to influenza A pneumonia-induced ARDS. Although he was supported by ECMO, he progressively deteriorated. We judged that his lungs were irreversibly damaged and decided he needed to undergo LTPL. Finally, bilateral sequential double-lung transplantation was successfully performed. He has since been alive for three years. Conclusively, we demonstrate that LTPL can be a therapeutic option in patients with severe ARDS refractory to conventional therapies.
Extracorporeal Membrane Oxygenation ; Humans ; Influenza, Human* ; Lung Diseases ; Lung Transplantation* ; Lung* ; Middle Aged ; Mortality ; Pneumonia* ; Respiratory Distress Syndrome, Adult*

This report describes a case of a serpentine fusiform aneurysm of the internal carotid artery in a patient who presented with visual disturbances. The serpentine aneurysm was treated successfully by coil trapping and occlusion of the parent artery, accompanied by balloon dilation. Nine months post-operatively, the patient's visual acuity had improved considerably.
Aneurysm* ; Arteries ; Carotid Artery, Internal ; Humans ; Parents ; Visual Acuity