Background: Conventional laryngoscopy with Macintosh blade requires a movement of the head, neck and cervical spine. The Bullard laryngoscope is an anatomically shaped, potentially eliminating the need for cervical spine extension. Bullard and Macintosh laryngoscopes were compared by measuring the degree of cervical spine extension by radiological measurement. Methods: Eighteen patients requiring endotracheal intubation were studied. Anesthesia was induced in neutral head position followed by laryngoscopy. Each patients was intubated two times by Macintosh and Bullard laryngoscope in random order. Radiographic evaluation was performed to determine the degree of cervical spine extension on four occasions; before induction, during facial mask ventilation, and during Bullard and Macintosh laryngoscopy. Results: The extension of cervical spine was significantly less following Bullard laryngoscopy than Macintosh laryngoscopy for best view (p<0.05). Conclusions: The Bullard laryngoscope can be used with less cervical spine extension than Macintosh laryngoscope. It may be useful in patients in whom cervical spine movement is limited or undesirable.
Anesthesia ; Head ; Humans ; Intubation, Intratracheal ; Laryngoscopes ; Laryngoscopy* ; Masks ; Neck ; Spine* ; Ventilation

Central venous catheters are useful for acute hemodynamic monitoring, fluid resuscitation, drug administration, the aspiration of air embolism and total parenteral nutrition. However, various complications may occur during central venous catheterization and the most common complication of the internal jugular approach is arterial puncture. Arterial puncture can be easily identified by a pulsatile blood flow and the bright red color of blood. It is usually confirmed by connecting catheter to a pressure transducer and observing venous waveforms and venous pressure. We experienced a patient in whom arterial cannulation was unrecognized by pressure recording, but was confirmed by blood gas analysis.
Blood Gas Analysis ; Catheterization ; Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Embolism, Air ; Hemodynamics ; Humans ; Parenteral Nutrition, Total ; Punctures* ; Resuscitation ; Transducers, Pressure ; Venous Pressure

PURPOSE: The purpose of this study was to describe the clinical and imaging features of metastatic bone tumors with sunburst periosteal reaction and to define the characteristic findings which would be helpful for differentiating metastatic bone tumors from primary malignant bone tumors. MATERIALS AND METHODS: The authors retrospectively reviewed the cases of nine patients with pathologically confirmed metastatic bone tumors with sunburst periosteal reaction, for which imaging studies (plain radiographs [n=9], radioisotope [RI] scans [n=4], magnetic resonance [MR] images [n=6], and computed tomographic [CT] scans [n=4]) were performed. The imaging studies of each lesion were analyzed by two musculoskeletal radiologists focusing on the metastatic site, patterns of bone response, signal intensity characteristics and pattern of contrast enhancement on MR. The clinical records of the patients were reviewed with regard to the age and sex of the subjects, the clinical presentation, and the origin of the primary tumors. RESULTS: The cases consisted of six men and three women, whose mean age was 62 years (age range, 50-88 years). The primary tumors were adenocarcinoma of the stomach [n=4], adenocarcinoma of the lung [n=2], adenocarcinoma of the prostate [n=1], hepatocellular carcinoma of the liver [n=1], and adenocarcinoma of unknown origin [n=1]. The sites of metastatic involvement exhibiting sunburst periosteal reaction were the scapula [n=2], proximal humerus [n=2], rib [n=1], iliac bone [n=1], tibia [n=1], spine [n=1], and proximal phalanx [n=1]. In all patients, the imaging findings showed osteolytic [n=3] or osteoblastic [n=6] lesions with sunburst periosteal reaction. In six cases, the lesions were iso-intense on the T1-weighted images and heterogeneously hyperintense on the T2-weighted images. The gadolinium-enhanced T1-weighted images showed a nearly homogenous enhancement of the lesions without any central necrotic portion. CONCLUSION: Although metastatic bone tumor exhibiting sunburst periosteal reaction is rare, it should be included along with primary malignant bone tumors in the differential diagnosis of bone lesions with sunburst periosteal reaction, especially in older patients with or without a known primary malignancy.
Adenocarcinoma ; Carcinoma, Hepatocellular ; Diagnosis, Differential ; Female ; Humans ; Humerus ; Liver ; Lung ; Male ; Osteoblasts ; Prostate ; Retrospective Studies ; Ribs ; Scapula ; Spine ; Stomach ; Tibia

BACKGROUND: There has been some reports demonstrating the geographic heterogeneity in frequency of specific cytogenetic aberrations, but little is known about the types, frequency and prognostic value of specific chromosomal abnormalities in Korean adults with acute myelogenous leukemia. To evaluate cytogenetic characteristics of Korean adults with acute myelogenous leukemia, following study was performed. METHODS: Cytogenetic studies using high-resolution banding technique were done on newly diagnosed 38 patients with de nono acute myelogenous leukemia (AML) admitted to Asan medical center from January 1995 to May 1996. RESULTS: 1) Sixteen patients (42.1%) had clonal chromosomal abnormalities. 2) The t (8;21) was detected in 8 patients (21.1%). The t (15;17) was detected in 2 patients. The inv (16), del (11)(q23) and 7q- were detected in 1 patient each. Trisomy 21 as a sole abnormality was detected in 1 patient and complex abnormalities were detected in 2 patients. risomy 8 was not detected. 3) Eight (50%) of the 16 patients with AML-M2 had t (8;21), 2 of the 3 patients with AML-M3 had t (15;17) and 1 patient with AML-M4Eo had inv (16). 4) The median age of patients with chromosomal abnormalities was significantly younger than that of patients with normal karyotype (34 vs. 48 years, P=0.003). Other clinical andlaboratory characteristics were not significantly different between abnormal and normal cytogenetic groups. 5) The complete remission rate of patients with chromosomal abnormalities was lower than that of patients with normal karyotype, but the difference of CR rates was not statistically significant (78.1 vs. 84.2%, P=NS). CONCLUSION: These results suggest that lower incidence of trisomy 8, higher incidence of t (8;21) and stronger association between t (8;21) and AML-M2 than usually described may be the cytogenetic characteristics of acute myelogenous leukemia in Korean adult.
Adult* ; Chromosome Aberrations ; Chungcheongnam-do ; Cytogenetics ; Down Syndrome ; Humans ; Incidence ; Karyotype ; Leukemia, Myeloid, Acute* ; Population Characteristics ; Trisomy