BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

No abstract available.
Animals ; Intercellular Signaling Peptides and Proteins* ; Rats* ; Urinary Bladder Neck Obstruction* ; Urinary Bladder*

Varicocele is considered as one of common etiology for subfertility in men and recently it is acknowledged that varicocele first developed in puberty exert more severe damage to testicular structure than that in adulthood, but its ultimate effect on the fertility is not well known. We used animal model to compare the effect of varicocele on the fertility and histology in the adolescent with that in adulthood. Sprague-Dawley rats were treated to create varicocele at 7 weeks and 12 weeks of age by partial ligation of left renal vein. After 4 weeks of sexual maturation period passed, each male rat was mated with two female rats for 21days and then scarified to examine the testicular volume loss and histologic change. All female rats were also sacrificed for the evaluation of pregnancy rate, litter side and fetal weight. Pregnancy rate in adolescent rats were 47.1% and there was significant difference in fertility between control rats and rats with varicocele. Interestingly the impregnating ability of adolescent rats was correlated with the mean diameter of seminiferous tubules of both testicles. ipsilateral testicular volume loss and histologic changes were more severe in adolescent rats than in adult rate. In summary, varicocele created in adolescent Sprague-Dawley rats is considered to be implicated. in their adulthood fertility, probably due to its more severe damage to testicular volume and histologic change(especially tubular narrowing) than in adult rats.
Adolescent* ; Adult ; Animals ; Female ; Fertility* ; Fetal Weight ; Humans ; Infertility ; Ligation ; Male ; Models, Animal ; Pregnancy Rate ; Puberty ; Rats* ; Rats, Sprague-Dawley ; Renal Veins ; Seminiferous Tubules ; Sexual Maturation ; Testis ; Varicocele*

No abstract available.

No abstract available.
Myocardial Infarction*

No abstract available.
Intercellular Signaling Peptides and Proteins*

No abstract available.
Animals ; Rats* ; Urinary Bladder*

We describe a case metastatic alveolar soft part sarcoma of the brain in a 20-year old man. Alveolar soft part sarcoma is slowly growing tumor which almost shows conspicuous vascular invasion and have a high incidence of blood-borne metastasis. The principal metastatic sites are the lungs, followed by the skeleton and brain. Cerebral metastases may be the first manifestation of the disease and are more common with alveolar soft part sarcoma than with any other type of soft tissue sarcoma. The light-and electron-microscopic and immunohistochemical findings are described. Periodic acid-Schiff-positive, diastase resistant, intracytoplasmic crystals, pathognomonic for alveolar soft part sarcoma, are present. The cells expressed immunoreactivity for vimentin, desmin, neuron-specific enolase, S-100 protein and renin. The results of our own immunohistochemical examinations is suggestive of myoendocrine origin.
Incidence ; Neoplasm Metastasis

The melanotic neuroectodermal tumor of infancy(MNTl) is a rare, usually benign, pigmented lesion which most frequently involves the maxilla. Skull, brain, and mandible are other craniofacial sites; this anatomic region accounts for 87% of all cases. The vast majority of MNTl, nearly 95%, present in infants of both sexes within the first year of life. Most cases of MNTl follow a benign course, with a 15% propensity for local recurrence. MNTl is regarded as a primitive neuroectodermal tumor with polyphenotypic differentiation. We report a classical MNTl which occurred in left lower maxilla in 6-month old female infant. She developed an ill defined, firm swelling on the left alveolar ridge and gum during 3 weeks. Mass excision reveals ill defined, grayish-tan hard mass, measuring 2.0x1.6 cm. Microscopically, the tumor reveals irregular alveolar pattern of melanin-containing cuboidal cells and nests of small round cells. The immunohistochemical staining for melanoma-associated antigen, neuron-specific enolase and cytokeratin show positive reactions. Ultrastructural examination showed intracytoplasmic melanosome, tonofilament and desmosome.
Infant ; Male ; Female ; Humans

As regard to the treatment modality and its prognosis following the treatment, there are some differences between the thoracolumbar compression fracture and bursting fracture. If bursting fracture is accompanied by nerve injury, especially if the fracture fragment is compressing the spinal cord, it is reported that decompression with early surgical intervention would achieve a much better prognosis. Therefore, the authors tried to suggest an overall statistics on the patient's age, mechanism of injury and injured site and to compare the sensitivity of tools used in diagnosing bursting fracture radiologically, as well as the sensitivity of posterior vertebral body angle, which is used in diagnosing subtle bursting fracture. Three hundred forty three patients admitted to emergency center of Yongdong Severance Hospital with a thoracolumbar fracture from 1992. Jan. to 1994. Dec. Of the 343 patients, minor fracture and those with insufficient X-ray films and clinical notes were excluded from the study. The study was done with 199 patients in retrospective method. All the 199 patients had plain X-ray and computed tomography taken. the results were as follows 1. The male to female ratio was 114 to 85 with average age being 47.1 years old(14-93 years old). 2. The mechanisms of injury were falling down, traffic accident, slipped down, sprain and confusional injury in the order written. 3. There were 67 cases of compression fracture and 132 cases of bursting fracture. 157 cases had I level injury in the order of Ll, T12, and L2, 33 cases had 2 level injury, and 8 cases were injured in 3 level of the spine. 4. Of the factors determining the radiological diagnosis of bursting fracture, the disruption of posterior cortical line had the highest sensitivity. 5. Of the 45 cases of 1 level injured subtle bursting fracture, those with posterior vertebral body angle of more than 100 degree radiographically had a sensitivity of 82%. Of the thoracolumbar fractured patient admitted to the emergency room, searching for disruption of posterior cortical line in plain film helped in diagnosing bursting fracture, and calculating the posterior vertebral body angle helped in determining whether further computed topography was needed in subtle bursting fracture.
Accidents, Traffic ; Decompression ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Female ; Fractures, Compression ; Humans ; Male ; Prognosis ; Retrospective Studies ; Spinal Cord ; Spine ; Sprains and Strains ; X-Ray Film