Midazolam, a new water-soluble benzodiazepine, has a few important advantages over diazepam which are lack of vascular irritation and rapid onset and short duration of action. So it has been used for an induction agent for anesthesia. But there were many different reports about the effective dose of midazolam as an induction agent for anesthesia, and which showed intersubject variability. Therefore, this study was aimed to verify the effective induction dose of midazolam comparing with thiopental 5 mg/kg for general anesthesia. The patients were divided into 6 groups. The patients of group 1, 2, 3, 4, and 5 were injected midazolam 0.15, 0.20, 0.25, 0.30, and 0.35 mg/kg, respectively, and, of group 6, thiopental 5 mg/kg for induction of anesthesia. Induction of anesthesia was defined as complete with loss of eyealsh reflex and failure to verbal commands. Unless induction was attained within 3 minutes, it was considered as failure of induction, and further steps of study were discontinued. After anesthesia was induced, stimulus to trapezius muscle relevant to endotracheal intubation was applied. The blood pressure, heart rate and arterial oxygen saturation were recorded before induction, at induction, and 1, 2, and 3 minutes after a stimulus to trapezius muscle. The incidences of pain on injection, venous irritations and antegrade amnesia were evaluated. The results were as follows; 1) Induction fractions of group 1, 2, 3, 4, 5, and 6 were 21.5, 57.2, 81.9, 100, and 100%, respectively. Induction times of group 1 to 5(midazolam groups) were 74.7-87.9 sec.(raanges, 40 -150 sec.) and, of group 6, 39.5 sec.(ranges, 33-55 sec.). But there was no relationship between midazolam doses and induction times. 2) At induction, systolic blood pressures of patients in group 3, 4, 5, and 6 decreased 6.1%, 5.8%, 10.5%, and 8.8%, respectively, and remained so after stimulus to trapezius muscle, but in group 6, which returned to preinduction value. Changes in sytoiic blood pressure were statistically insignificant among groups. 3) At induction, diastolic blood pressures of patients in group 5 and 6 decreased 11.0% and 11.3%, respectively, and, after stimulus to trapezius muscle, diastolic blood pressures did not change in group 3, 4, and 5, but, in group 6, returned to preinductuin value. Changes in diastolic blood pressure were statistically insignificant among groups. 4) At induction, heart rates of patients in group 3, 4, 5, and 6 increased 10.0%, 13.8%, 7.5%, and 25.8%, respectively. Changes in heart rate were significantly different between group 6 and other groups. 5) Arterial oxygen saturations decreased 0.25%, 0.3%, and 0.35% in group 3, 4, and 5 at induction, respectively, but, in group 6, decreased 3.4% after stimulus to trapezius muscle. Changes in arterial oxygen saturation were statistically insignificant among groups. 6) There were no differences in incidences of pain on injection, venous irritations, and antegrade amnesia among groups. In summary, midazolam can be used to induce general anesthesia safely with dose of 0.25 mg/ kg to 0.35 mg/kg, although there remains intersubject variability.
Amnesia ; Anesthesia ; Anesthesia, General* ; Benzodiazepines ; Blood Pressure ; Diazepam ; Heart Rate ; Humans ; Incidence ; Intubation, Intratracheal ; Midazolam* ; Oxygen ; Reflex ; Superficial Back Muscles ; Thiopental

Diabetes mellitus is a systemic disease with profound effects on oral health and periodontal wound healing. Uncontrolled diabetes adversely affects surgical wound healing and is often associated with abnormal proliferation of fibroblasts. Human gingival fibroblasts and PDL cells were chosen because they are intimately involved in periodontal therapy and are important for the success of surgical procedure such as guided tissue regeneration. The aim of the present study was to elucidate whether cellular activity and collagen synthesis by glucose pre-treated human gingival fibroblasts and PDL cells are influenced by insulin, and whether healthy cells differ from glucose treated cells. Cells were cultured with DMEM at 37degrees C, 5% CO2, 100% humidified incubator. To evaluate the effect of glucose on gingival fibroblasts and periodontal ligament cells, the cells were seeded at a cell density of 1x10(4) cells/well culture plates and treated with 20 and 50mM of glucose for 5 days. Then MTT assay was carried out. To evaluate the effect of insulin on glucose-pretreated cells, the cells were seeded at a cell density of 1x10(4) cells/well culture plates and treated with 20 and 50mM of glucose for 5 days. After incubation, 10(3), 10(4) and 10(5)mU/l of insulin were also added to the each well and incubated for 2 days, respectively. Then, MTT assay and collagen synthesis assay were carried out. The results indicate that cellular activity of gingival fibroblasts significantly increased by glucose while periodontal ligament cells were unaffected and cellular activity of gingival fibroblasts and periodontal ligament cells were unaffected by insulin. Collagen synthesis of gingival fibroblast with 20mM glucose and insulin unaffected, but 50mM glucose and insulin increased than control. Collagen synthesis of periodontal ligament cell with 20mM glucose and 10(5)mU/l insulin significantly increased than other groups and 50mM glucose pretreated PDL cells significantly increased at 10(3)mU/l insulin but decreased at 10(4)mU/l insulin. Our findings indicated that these cell types differed in their growth response to glucose, and the increase in collagen synthesis was significantly raised at insulin level of 10(3)mU/l in gingival fibroblasts and periodontal ligament cells except 20mM glucose pretreated periodontal ligament cells.
Cell Count ; Collagen ; Diabetes Mellitus ; Fibroblasts* ; Glucose* ; Guided Tissue Regeneration ; Humans* ; Incubators ; Insulin* ; Oral Health ; Periodontal Ligament* ; Wound Healing

Guillain-Barre syndrom(GBS) is not a single entity, but may arise from a variety of pathogenic mechanisms. In GBS, abnormally increased autoantibody levels to GM, constitute a group with motor neuropathy predominantly and substantial axonal damage, particularly those following Campylobacter enteritis. We report a patient, 43 years old male, who presented with 3 days history of rapidly progressive weakness of all extremities. Electreophysiologic studies were suggestive of axonal form of motor dominant polyneuropathy, Using ELISA, autoantibody of MAG(myelin associated glycoprtein) and SGPG(sulfoglucuronyl paraglobiside) showed normal ranges, but IgG GM. Autoantibodies abnormally elevated. Additionally antibody titer of Campylobacter jejuni increased. We reported the axonal form of Guillain, Barr syndrome associated with IgG GM,, Ab and antiCampylobacter jejuni antibody.
Adult ; Autoantibodies ; Axons* ; Campylobacter jejuni* ; Campylobacter* ; Enteritis ; Enzyme-Linked Immunosorbent Assay ; Extremities ; Humans ; Immunoglobulin G* ; Male ; Polyneuropathies ; Reference Values

The purpose of study is to investigate whether glass rod detector (GRD) would be suitable for dosimeter of radiotherapy units. A GRD is used for the measurement of the output factors and x-axis beam profiles from Gamma Knife. The output factors measured with GRD from the 14, 8 and 4 mm collimators relative to the 18 mm collimator are 0.980+/-0.013, 0.949+/-0.013 and 0.872+/-0.012, respectively. The output factors obtained with a GRD are within 1.0% in good agreement with the values recommended by the manufacture. The full width at half maximum (FWHM) of x-axis beam profiles measured with GRD are 5.9 mm at a 4 mm collimator.
Glass* ; Radiotherapy

Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication.
Barotrauma ; Catheters ; Constriction, Pathologic ; Emergencies ; Epidural Space ; Female ; Hemiplegia ; Humans ; Intervertebral Disc ; Leg ; Lower Extremity* ; Sensation ; Spinal Stenosis ; Young Adult

We report a case of intussusception of the cecum and appendix arising in pericecal endometriosis that are mistaken as a cecal tumor preoperatively. At the other OBGY clinic, the 1st lapalotomy was performed for management of leiomyoma but pelvic organs were adhesion severely and palpation mass in the cecum and appendix. The patient was transfer to our hospital for evaluation and treatment of mass. We investigated to intestine closely and diagnosis was cecal tumor colonoscopically. Total hystrectomy and iliocecectomy was performed successfully and discovered intussusception of the cecum and appendix due to endometriosis mistaken as a cecal tumor in operative field. Postoperatively, this case was diagnosed in pericecal endometriosis histologically.
Appendix* ; Cecum* ; Diagnosis ; Endometriosis* ; Female ; Humans ; Intestines ; Intussusception* ; Leiomyoma ; Palpation

Patients with cardiogenic embolic stroke may experience an early, recurrent cerebral embolism. Fortunately, limited evidence suggests that anticoagulatory agents or thrombolytic agents may prevent recurrent cardiogenic emboli and halt progression of so-called "progressing stroke" However, because of the possibility of the intracerebral hemorrhage, use of such agents has generally been considered cautiously with timing, dosage and patient selection. Serious complications of anticoagulation for presumed embolic stroke are hemorrhage in the area of infarction. We experienced two patients with nonseptic cerebral embolism of cardiac origin. They were managed with anticoagulant or thrombolytic therapy, but resulted in clinical deterioration or death from spontaneous subdural hemorrhage. In each patient, an initial CT scan excluded the presence of hemorrhage but a second CT scan after clinical deterioration, documented subdural hemorrhage.
Cerebral Hemorrhage ; Cerebral Infarction* ; Fibrinolytic Agents ; Hematoma, Subdural ; Hematoma, Subdural, Acute* ; Hemorrhage ; Humans ; Infarction ; Intracranial Embolism ; Patient Selection ; Stroke ; Thrombolytic Therapy* ; Tomography, X-Ray Computed

BACKGROUND: Correct transfusion of blood product to the right patient requires multiple processes. Errors occurring in the pre-transfusion checking step can result in a serious incident. The role of patients in the safe blood transfusion practice has been investigated. METHODS: We have adopted patient involvement in bedside checking using patient's signature since 2010. We conducted a retrospective review of transfusion medical records during January 2013. The signatures of doctors, nurses, and patients were audited and the reasons for omitting patient's signature were examined. RESULTS: The practice of patient's signature was performed after the problems of procedures were improved. A total of 4697 blood products for 576 patients were issued. The first transfused products were 426 units of RBC (74.0%), 56 units of platelet (9.7%), and 34 units of fresh frozen plasma (5.9%). Completion of patient's signature was observed in 336 patients (63.5%). The reason for omitting patient's signature was operation (104, 18.1%), unclear consciousness or sedation (75, 13.0%), and neonate or infancy (7, 1.2%). CONCLUSION: Patient involvement in the pre-transfusion checking process by writing down the patient's own signature could be achievable. In case of no patient's signature as with an operation, sedation, and neonate or infancy, specific attention is required to ensure a safe transfusion practice.
Blood Platelets ; Blood Transfusion ; Consciousness ; Humans ; Infant, Newborn ; Medical Records ; Plasma ; Retrospective Studies ; Writing

Twenty eight patients with negative but technically satisfactory four-vessel angiography-admitted to our department from 1985 to 1995 were followed for long term evaluation. The aim of this retrospective study of patients with SAH of unknown etiology was to evaluate the clinical features, long-term prognosis in mortality rate and risk of rebleeding, and the daily functional capacity. Twenty eight out of 1035(2.7%) spontaneous subarachnoid hemorrhage patients were found to have subarachnoid hemorrhage(SAH) of unknown etiology. Twenty eight patients were confirmed as SAH, by computed tomography or lumbar puncture. CT scan was undertaken in all cases(in 28 cases within 5 days of hemorrhage). SAH of unknown etiology classified as Hunt and Hess grade I was 60.7% of cases, but there were no patients with Grade V. Arterial hypertension was present on admission in 35.7% of cases. We only performed the angiogram once in 16 of 28 patients, but there were no rebleedings caused by aneurysm. The period of follow-up ranged from 2 to 11 years, with the mean of 4.3 years. Only one of 28 patients(3.6%) experienced late rebleeding, and again had normal cerebral panangiography. Two patients(7.1%) showed a moderate disability in activities of daily living, one patient(3.6%) was mild disabled, and two(7.1%) had died of pneumonia. Based on the ADL grade, Grade I was 28.6% at the time of discharge however, during follow-up, increased up to 81.5%.
Activities of Daily Living ; Aneurysm ; Follow-Up Studies* ; Humans ; Hypertension ; Mortality ; Pneumonia ; Prognosis ; Retrospective Studies ; Spinal Puncture ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

Recently, various studies evaluating percutaneous cervical nucleoplasty have reported good results. Percutaneous cervical nucleoplasty has been commonly used for treating contained herniated disc or protrusion, but a posterolateral extruded disc has not been considered to be an indication. The tip of the L'DISQ(R) wand can be curved to the desired angles by the rotation of the control wheel. Therefore, L'DISQ(R) can directly access the extruded disc. We report the application of percutaneous cervical nucleoplasty by using the L'DISQ(R) in three patients with an extruded disc. Decompression was successfully performed, and the symptoms improved immediately. In one patient, a 6-month follow-up magnetic resonance imaging study showed disappearance of the extruded cervical disc. Percutaneous cervical nucleoplasty using the L'DISQ(R) can be an effective, low complication, minimally invasive procedure for treating cervical disc herniation.
Decompression ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging