BACKGROUND: The end-tidal carbon dioxide (ETCO2) is defined as a partial pressure of carbon dioxide at the end of an exhaled breath. And it has been found to correlate with cardiac output during cardiopulmonary resuscitation (CPR) in animal model. The purpose of this study is to determine that the assessment of ETCO2 could provide a highly sensitive predictor of return of spontaneous circulation (ROSC) during CPR. METHODS: Prospective, observational study was performed from Oct 1996 to Mar 1997 at the Severance hospital. All patients were endotracheally intubated and connected immediately to mainstream capnography sensor. We measured ETCO2 with Escort II model 20100 monitor(Medical Data Electronics, Inc, USA). It works on the principle of nondispersed infrared absorption with radiometric single beam optics. RESULTS: This study included 70 patients (52 were men) with a mean age of 54+/-15 years. ROSC was obtained in 43 patients. The initial ETCO2 averaged 15.5 +/-8.2 mmHg in survivors and 6.5+/-5.3 mmHg in nonsurvivors (p<0.01), and during the first 20 minutes of CPR, the maximal ETCO2 averaged 29.7+/-10.3 mmHg in survivors and 10.2+/-8.9 mmHg in nonsurvivors (p<0.01). ETCO2 was not significantly different in relation to initial rhythm, survival time after ROSC and possible cause of arrest. There is no cutoff value of ETCO2 satisfying greater than 90% of both sensitivity and specificity in predict ROSC. When maximal ETCO2 was less than 12 mmHg, we observed sensivity of 100% in predicting ROSC. CONCLUSION: Our results demonstrate that ETCO2 measurement represents a valuable, noninvasive, and clinical tool for monitoring patients during CPR.
Absorption ; Capnography ; Carbon Dioxide* ; Carbon* ; Cardiac Output ; Cardiopulmonary Resuscitation* ; Humans ; Models, Animal ; Observational Study ; Partial Pressure ; Prospective Studies ; Sensitivity and Specificity ; Survivors

OBJECTIVE: Detection of focal non-hemorrhagic lesion (NHL) has become more efficient in diffuse axonal injury (DAI) patients using an MRI. The aims of this study are to find out the radiological distribution, progress of NHL and its clinical significance. METHODS: Between September 2005 and October 2011, 32 individuals with NHLs on brain MRI were enrolled. NHLs were classified by brain location into 4 major districts and 13 detailed locations including cortical and subcortical, corpus callosum, deep nuclei and adjacent area, and brainstem. The severity of NHL was scored from grades 1 to 4, according to the number of districts involved. Fourteen patients with NHL were available for MRI follow-up and an investigation of the changes was conducted. RESULTS: Thirty-two patients had 59 NHLs. The most common district of NHL was cortical and subcortical area; 15 patients had 20 NHSs. However the most common specific location was the splenium of the corpus callosum; 14 patients had 14 lesions. The more lesions patients had, the lower the GCS, however, this was not a statistically meaningful difference. On follow-up MRI in 14 patients, out of 24 lesions, 13 NHLs resolved, 5 showed cystic change, and 6 showed atrophic changes. CONCLUSION: NHLs were located most commonly in the splenium and occur frequently in the thalamus and the mesial temporal lobe. Because most NHS occur concomitantly with hemorrhagic lesions, it was difficult to determine their effects on prognosis. Since most NHLs resolve completely, they are probably less significant to prognosis than hemorrhagic lesions.
Brain ; Brain Injuries ; Brain Stem ; Corpus Callosum ; Diffuse Axonal Injury ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Temporal Lobe ; Thalamus

Symptoms of deep cerebral vein thrombosis (DCVT) are variable and nonspecific. Radiologic findings are essential for the diagnoses. In the majority of cases of deep internal cerebral venous thrombosis, the thalamus is affected bilaterally, and venous hypertension by thrombosis causes parenchymal edema or venous infarction and may sometimes cause venous hemorrhage. Intravenous injections of mannitol can be administered or decompressive craniectomy can be performed for reduction of intracranial pressure. The objectives of antithrombotic treatment in DCVT include recanalization of the sinus or vein, and prevention of propagation of the thrombus. Herein, the authors report DCVT which was successfully treated by low molecular weight heparin.
Brain Edema ; Cerebral Infarction ; Cerebral Veins ; Decompressive Craniectomy ; Edema ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Hypertension ; Infarction ; Injections, Intravenous ; Intracranial Pressure ; Intracranial Thrombosis ; Mannitol ; Thalamus ; Thrombosis ; Veins ; Venous Thrombosis

BACKGROUND: Postoperative pain control in children is a difficult problem for management. Fentanyl is one of the most commonly used narcotics in infants and children due to its rapid onset and brief duration. Infants older than 3 months had a lower incidence of apnea than adults given fentanyl; however, the dosage of fentanyl varies a great deal depending on the purpose and plan for the postoperative management. This study is designed to evaluate the effective dose of intraoperative intravenous fentanyl for pain control following inguinal herniorrhaphy in pediatric patients. METHODS: Sixty children for inguinal herniorrhaphy under general anesthesia were divided into four groups. Group I received no analgesics as a control. Group II, III and IV received intravenous fentanyl 0.5 microgram/kg, 1 microgram/kg and 1.5 microgram/kg respectively. Fentanyl was injected intravenously at the beginning of fascia closure. Extubation time and the degree of pain was evaluated. RESULTS: Our result showed that group III and IV had a lower pain score than that of the control group during the first 30 min in the recovery room (p<0.05), but no significant differences were found between the group III and group IV. The time interval from fascia closure to extubation was prolonged in the group II, III and IV compared to the control group (p<0.05). But no significant differences were found between the three groups. CONCLUSION: We suggest that intravenous administration of fentanyl 1 microgram/kg at the closure of fascia would be an easy, simple and effective means for relieving postinguinal herniorrhaphy pain in recovery room.
Administration, Intravenous ; Adult ; Analgesics ; Anesthesia, General ; Apnea ; Child* ; Fascia ; Fentanyl* ; Herniorrhaphy* ; Humans ; Incidence ; Infant ; Narcotics ; Pain, Postoperative ; Recovery Room

BACKGROUND: Post-operative shivering is one of the potential complications for any surgical patient. Its incidence varies from 5% to 65%, and many preventive and treatment modalities have been reported. For the effective prevention of post-anesthetic shivering by using intravenous clonidine or meperidine, randomized controlled studies were reviewed. The overall incidence of shivering after clonidine or meperidine administration, and the anti-shivering effect of clonidine and meperidine were evaluated. METHODS: DATA SOURCES: Medline search from 1978 to March 1998. DATA SELECTION: We selected studies that had investigated the preventive anti-shivering effect of intravenous clonidine or meperidine by randomized controlled trials. Ten clinical trials were evaluated. RESULTS: The pooled odd ratio of the patients who received clonidine was 0.32 (95% confidence interval, 0.22~0.47) and it seemed to be effective. But these studies showed little evidence of significant homogeneity (P=0.01). In the subgroup analysis, the pooled odd ratio of group A (early administration or intra-operative infusion group) was 0.47 (95% CI 0.31~0.72) evidenced effectiveness but failed to prove homogeneity (P=0.047). But group B (the late intra-operative administration group) had a pooled odd ratio of 0.10 (95% CI 0.05~0.22) and showed homogeneity (P=0.98). In meperidine trials, the pooled odd ratio was 0.20 (95% CI 0.07~0.55). CONCLUSION: We present quantitative evidence based on a meta-analysis of pooled effect size from randomized trials that clonidine is more beneficial for the prevention of post-anesthetic shivering and more effective than meperidine when it is administrated during later period of surgery.
Clonidine* ; Information Storage and Retrieval ; Humans ; Incidence ; Meperidine* ; Shivering*

PURPOSE: Parotid gland can be considered as a risk organ in whole brain radiotherapy (WBRT). The purpose of this study is to evaluate the parotid gland sparing effect of computed tomography (CT)-based WBRT compared to 2-dimensional plan with conventional field margin. MATERIALS AND METHODS: From January 2008 to April 2011, 53 patients underwent WBRT using CT-based simulation. Bilateral two-field arrangement was used and the prescribed dose was 30 Gy in 10 fractions. We compared the parotid dose between 2 radiotherapy plans using different lower field margins: conventional field to the lower level of the atlas (CF) and modified field fitted to the brain tissue (MF). RESULTS: Averages of mean parotid dose of the 2 protocols with CF and MF were 17.4 Gy and 8.7 Gy, respectively (p < 0.001). Mean parotid dose of both glands > or =20 Gy were observed in 15 (28.3%) for CF and in 0 (0.0%) for MF. The whole brain percentage volumes receiving >98% of prescribed dose were 99.7% for CF and 99.5% for MF. CONCLUSION: Compared to WBRT with CF, CT-based lower field margin modification is a simple and effective technique for sparing the parotid gland, while providing similar dose coverage of the whole brain.
Brain ; Humans ; Parotid Gland ; Xerostomia

BACKGROUND: Suspension ligamentoplasty using abductor pollicis longus (APL) tendon without bone tunneling, was introduced as one of the techniques for treatment of advanced first carpometacarpal (CMC) arthritis. The purpose of this study was to evaluate the radiologic and clinical results of APL suspension ligamentoplasty. METHODS: The medical records of 19 patients who underwent APL suspension ligamentoplasty for advanced first CMC arthritis between January 2008 and May 2012 were reviewed retrospectively. The study included 13 female and 6 male patients, whose mean age was 62 years (range, 43 to 82 years). For clinical evaluation, we assessed the grip and pinch power, radial and volar abduction angle, thumb adduction (modified Kapandji index), including visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiologic evaluation was performed using simple radiographs. RESULTS: The mean follow-up was 36 months (range, 19 to 73.7 months). Mean power improved from 18.3 to 27 kg for grip power, from 2.8 to 3.5 kg for tip pinch, and from 4.3 to 5.4 kg for power pinch. All patients showed decreased VAS from 7.2 to 1.7. Radial abduction improved from 71degrees preoperatively to 82degrees postoperatively. The modified Kapandji index showed improvement from 6 to 7.3, and mean DASH was improved from 41 to 17.8. The height of the space decreased from 10.8 to 7.1 mm. Only one case had a complication involving temporary sensory loss of the first dorsal web space, which resolved spontaneously. CONCLUSIONS: The APL suspension ligamentoplasty for treatment of advanced first CMC arthritis yielded satisfactory functional results.
Adult ; Aged ; Aged, 80 and over ; Carpometacarpal Joints/*surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Osteoarthritis/*surgery ; Postoperative Complications ; Retrospective Studies ; Tendons/*surgery ; Thumb/*surgery

PURPOSE: Recurrent groin hernias are a significant problem with high recurrence rates. There is a great deal of controversy regarding their management. This study examined the outcome of patients who had undergone a repair of recurrent groin hernias. METHODS: This study examined retrospectively the medical records of all patients who underwent repairs of recurrent groin hernias (a total 239 cases) between January 1998 and December 2006. The repair was tailored to the previous operation and the patients' medical condition. The types of previous operations, present operation, complications and re-recurrence rate were analyzed. RESULTS: Of the 2,542 groin hernias operated on, 239 cases (9.4%) were treated for recurrent groin hernias. The types of previous surgery were conventional open tissue repair in 199 cases (83.3%), Lichtenstein repair in 28 cases (11.7%), open mesh repair (PHS, Perfix plug) in 6 cases (2.5%) and laparoscopic repair in 6 cases (2.5%). The recurrent groin hernias were repaired using a laparoscopic method in 123 cases (51.4%), open mesh repair in 92 cases (38.4%), Lichtenstein repair in 18 cases (7.5%) and a conventional open tissue repair in 6 cases (2.5%). Postoperative complications occurred in 40 cases (16.7%), which included 10 seromas, 4 wound infections, 3 hematomas, 2 wound swellings, 8 scrotal swelling, 5 dysurias, 2 chronic neuralgias. There were 6 cases of re-recurrence in the 239 cases of recurrent groin hernias (2.5%). CONCLUSION: A tailored approach based on the previous repair and the medical condition of the patients with recurrent groin hernias is associated with a decrease in the incidence of major postoperative complications and a low recurrence rate (2.5%).
Dysuria ; Groin ; Hematoma ; Hernia ; Humans ; Incidence ; Medical Records ; Neuralgia ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Seroma ; Wound Infection

BACKGROUND AND OBJECTIVE: Eosinophil is a major inflammatory cell in allergic diseases and parasitic infestations. Various cytokines such as GM-CSF, IL-3 and IL-5 are known to activate eosinophils and prolong their survival. Among them, IL-5 is the most potent stimulator of eosinophil survival. Recently, it was reported that increased expression of Bcl-2 is related to prolonged survival of IL-5 stimulated eosinophil. Theophylline is a useful drug in bronchial asthma, due not only to bronchial dilation but also to its anti-inflammatory effects. It has been suggested that anti inflammatory action of theophylline derives from the reduction of inflammatory cells in the airways which is mechated by stimulat on of apoptosis of inflammatory cells. In this study, we investigated, by measuring Bcl-2 expression of IL-5 stimulated eosinophil, the effect of theophylline on apoptosis as one of the anti-inflammatory action. MATERIAL AND METHOD: Peripheral eosinophils were isolated from atopic patients by using Perco- 11 discontinuous gradient and purified by negative selection technique using MACS. Eosinophil viability and apoptosis were measured by FACscan. Expression of Bcl-2 protein in eosinophils was detected by Western blot and ELISA. RESULTS: IL-5 increased the percentage of viable eosinophils and reduced the apoptosis of eosinophils in a dose dependent manner. The increased survival of IL-5 stimulated eosinophils was reduced by theophylline via activation of apoptosis. Bcl-2 was increased when eosinophils were cultured with IL-5 only, but when theophylline was cocultured, reduced Bcl-2 was seen with Western blot and ELISA. CONCLUSION: IL-5 increases the survival of eosinophil through the enhanced expression of Bcl- 2. Theophylline has counter action against IL-5 via inhibition of Bcl-2 induced by IL-5. Inhibiting the prolongation of eosinophil survival caused by IL-5 might be one possible mechanism of antiinflammatory effects of theophylline.
Apoptosis ; Asthma ; Blotting, Western ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Eosinophils* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Interleukin-3 ; Interleukin-5 ; Theophylline*

Primary melanoma of anorectum is a very rare, aggressive tumor with a reported 5-year survival rate of 6%. Over 90% of all anorectal melanomas arise at the dentate line, but primary lesions well above this line in the rectum or rectosigmoid have been reported. Surgical treatments of this virulent tumor have ranged from conservative approach, such as wide local excision to abdominoperineal resection (APR) with or without bilateral inguinal lymphadenectomy. When wide local excision was compared to APR in terms of survival, no significant difference was noted. However, five-year survivors had 2 mm thin lesion, and underwent radical surgery. We have experienced three cases of primary anorectal melanoma, two of which underwent radical surgery and survived 20 months and 6 months respectively. One patient had wide local excision, and survived 5 months. One of the three patient had von Recklinghausen disease with caf -au-lait spots and primary melanoma, which is probably one of the first reported case in the literature.
Humans ; Lymph Node Excision ; Melanoma* ; Neurofibromatosis 1 ; Rectum ; Survival Rate ; Survivors