BACKGROUND: The purpose of this article was to identify the risk factors related to development of hemodynamically significant cardiac arrythmias in patients with mechanical ventilation. METHODS AND RESULTS: Holter recording and echocardiogram were performed after 30 minutes of ventilator initiation in patients on mechanical ventilation(MV) owing to respiratory failure(RF) from various reasons. From 68 patients, hemodynamically significant cardiac arrythmias were detected in 18 patients(26.5%). Initial mean arterial pressure, maximal heart rate, and initial pH were identified as risk factors for hemodynamically significant cardiac arrythmias. Additionally, the patients with pressure-controlled ventilation as an initial ventilatory mode developed hemodynamically significant cardiac arrythmias less frequently than the patients with other modes(15.8% vs. 40%, p=0.03). In multivariate analysis, initial mean arterial pressure(<70mmHg, odds ratio[OR]:5.5;95% confidence interval[CI]:1.2 to 24.2, p=0.026), maximal heart rate(>120/min, OR:19.7;95% CI:2.0 to 190.0, p=0.01), and pressure-controlled ventilation(OR:0.13,95% CI:0.03 to 0.55, p=0.006) were associated with the development of hemodynamically significant cardiac arrhythmias. CONCLUSION: Theses findings suggest that during the early stages of mechanical ventilation with acute respiratory failure, hemodynamically significant cardiac arrhythmias are directly associated with tachycardia(>120/min), initial MAP(<70mmHg), and, inversely, the initial use of pressure-controlled ventilation.
Arrhythmias, Cardiac* ; Arterial Pressure ; Heart ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Multivariate Analysis ; Respiration, Artificial* ; Respiratory Insufficiency* ; Risk Factors* ; Ventilation ; Ventilators, Mechanical

A schwannoma is a benign soft tissue tumor derived from Schwann cells of the nerve sheath. The lateral femoral cutaneous nerve is a sensory nerve originating from the second and third lumbar vertebra nerve roots, passing under the inguinal ligament and dividing into anterior and posterior branches. The anterior branch which is a major division and the main nerve that causes meralgia paresthetica supplies the knee joint from the anterior thigh. In addition, the posterior branch supplies the lateral thigh at the greater trochanter level.This paper reports the case of a 52-year-old woman with a very rare schwannoma in the terminal twig of posterior branch of the lateral femoral cutaneous nerve of right thigh protruded through the fascia lata with literatures review.

A schwannoma is a benign soft tissue tumor derived from Schwann cells of the nerve sheath. The lateral femoral cutaneous nerve is a sensory nerve originating from the second and third lumbar vertebra nerve roots, passing under the inguinal ligament and dividing into anterior and posterior branches. The anterior branch which is a major division and the main nerve that causes meralgia paresthetica supplies the knee joint from the anterior thigh. In addition, the posterior branch supplies the lateral thigh at the greater trochanter level.This paper reports the case of a 52-year-old woman with a very rare schwannoma in the terminal twig of posterior branch of the lateral femoral cutaneous nerve of right thigh protruded through the fascia lata with literatures review.

A schwannoma is a benign soft tissue tumor derived from Schwann cells of the nerve sheath. The lateral femoral cutaneous nerve is a sensory nerve originating from the second and third lumbar vertebra nerve roots, passing under the inguinal ligament and dividing into anterior and posterior branches. The anterior branch which is a major division and the main nerve that causes meralgia paresthetica supplies the knee joint from the anterior thigh. In addition, the posterior branch supplies the lateral thigh at the greater trochanter level.This paper reports the case of a 52-year-old woman with a very rare schwannoma in the terminal twig of posterior branch of the lateral femoral cutaneous nerve of right thigh protruded through the fascia lata with literatures review.

Amylase-producing multiple myeloma is a rare disorder and has poor prognosis. Its characteristics are elevation of salivary type amylase, extensive extramedullary spread, extensive bone destruction, shorter survival time, and abnormal karyotype. Recently, we have experienced a case of amylase-producing IgG kappa type multiple myeloma in a 63-year-old woman. On admission, serum and urine amylase was 8,450U/L and 169,710U/L, 85% and 86% of which was determined to be the salivary type, respectively. The other cause of hyperamylasemia had not been detected. The presence of immunoglobulin and amylase in the myeloma cells was demonstrated immunohistochemically. Bone marrow aspiration smear revealed 59.1% plasma cells. The cytogenetic study of bone marrow cell showed normal karyotype. The patient died 3 months after chemotherapy with melphalan and prednisolone.
Abnormal Karyotype ; Amylases ; Bone Marrow ; Bone Marrow Cells ; Cytogenetics ; Drug Therapy ; Female ; Humans ; Hyperamylasemia ; Immunoglobulin G* ; Immunoglobulins ; Karyotype ; Melphalan ; Middle Aged ; Multiple Myeloma* ; Plasma Cells ; Prednisolone ; Prognosis

PURPOSE: To compare the precise roles of high-resolution computed tomography (HRCT) and fiberoptic bronchoscopy (FOB) in the evaluation of patients presenting with hemoptysis and to determine the optimal timing for HRCT. MATERIALS AND METHODS: The results of HRCT and FOB were compared in 23 patients (15 men, 8 women) presenting with hemoptysis. Etiologies included bronchietasis (n=4), parenchymal pulmonary tuberculosis (n=4), lung cancer (n=4), endobronchial tuberculosis (n=2), and broncholithiasis (n=2). Hemoptysis was proved to be due to miscellaneous causes in an additional three cases and to be cryptogenic in four. The diagnostic results of FOB performed before and after HRCT were compared as were those of HRCT performed within and after the first 48 hours of active bleeding. RESULTS: FOB and HRCT offered a correct diagnosis in 39% and 65% of cases, respectively (p=0.005). HRCT demonstrated three cases of bronchiectasis and three of parenchymal pulmonary tuberculosis which were beyond the range of a bronchoscope. In two of five cases in which HRCT findings were nonspecific, chondromatous hamartoma and lung cancer were confirmed by FOB. In cases where HRCT was performed prior to FOB, the latter demonstrated the location and diagnosis in 82% and 47% of cases, respectively (p=0.303) ; when HRCT was performed after FOB, HRCT was correct in 67% and 17% of cases, respectively (p=0.178). In none of three cases (0%) in which HRCT was performed during the first 48 hours of active bleeding did the procedure allow a specific diagnosis. In 15 of 20 (75%) cases in which HRCT was performed after the first 48 hours, however, the diagnosis provided by CT was correct. CONCLUSION: The results of this study suggest that in patients presenting with hemoptysis, both HRCT and FOB should be used for evaluation, since they are diagnostically complementary. FOB is more useful for the diagnosis of endobronchial lesion, and HRCT for bronchiectasis and parenchymal pulmonary tuberculosis. If, in cases of hemoptysis, initial diagnosis is attempted within the first 48 hours of active bleeding, FOB should be the initial step, and HRCT images should not be obtained until active bleeding has been shown on plain chest radiograph to have abated. If this initial approach takes place after the first 48 hours of active bleeding, FOB and HRCT are equally suitable.
Bronchiectasis ; Bronchoscopes ; Bronchoscopy* ; Diagnosis ; Hamartoma ; Hemoptysis* ; Hemorrhage ; Humans ; Lung Neoplasms ; Male ; Radiography, Thoracic ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: The purpose of this study was to evaluate the preemptive analgesic effect of a single intravenous infusion of low dose ketamine-clonidine. We compared the placebo with low dose ketamine and low dose ketamine-clonidine in patients undergoing an appendectomy. METHODS: Sixty ASA class 1 or 2 patients who received general anesthesia for an appendectomy were allocated randomly to three groups. Group 1 received intravenous normal saline 6 ml and group 2 received ketamine 0.15 mg/kg in normal saline 6 ml and group 3 received ketamine 0.15 mg/kg and clonidine 1microgram/kg in normal saline 6 ml 5 minutes before surgical incision. In the recovery room postoperative analgesia was assessed by the verbal numerical rating scale (VNRS) at 0 min, 15 min, 30 min, 60 min, 90 min and 120 min. Vital signs, sedation score and side effects were also checked. For postoperative analgesia, morphine 2 mg was given intravenously whenever a patient complained of pain, or the VNRS score was above 7. RESULTS: There were no intergroup differences of individual morphine requirements for postoperative pain control among the three groups. VNRS score, blood pressure, heart rate, sedation score and side effects were not significantly different among the three groups. CONCLUSIONS: A single low dose of ketamine-clonidine may not produce a postoperative analgesic effect in the recovery room, and a single low dose of ketamine also may not produce the preemptive effect for at least 2 hours.
Analgesia ; Anesthesia, General ; Appendectomy ; Blood Pressure ; Clonidine ; Heart Rate ; Humans ; Infusions, Intravenous ; Ketamine* ; Morphine ; Pain, Postoperative ; Recovery Room ; Vital Signs

AIMTo evaluate the effects of 60 Hz extremely low frequency (ELF) elelctromagnetic field (EMF) exposure on germ cell apoptosis in the testis of mice.

METHODSAdult male BALB/c mice (7 weeks of age) were exposed to a 60 Hz EMF of 0.1 mT or 0.5 mT for 24 h/day. A sham-exposed group served as the control. After 8 weeks of exposure, the mice were sacrificed. Germ cell apoptosis in the testis was assessed by histopathological examination, the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay (TUNEL) and flow cytometric examination of isolated spermatogenic cells stained with 7 aminoactinomycin D (7-AAD).

RESULTSEMF exposure did not significantly affect the body and testis weights, but significantly increased the incidence of germ cell death. The distinguishing morphological feature of EMF exposure was a decrement in the number of well organized seminiferous tubules. Quantitative analysis of TUNEL-positive germ cells showed a significantly higher apoptotic rate in the 0.5 mT exposed mice than that in the sham controls (P<0.05), while the difference between the two exposed groups was insignificant. The TUNEL-positive cells were mainly spermatogonia. In flow cytometry analysis, the percentage of live cells [forward scatter count (FSC)(high)7-AAD(-)] was lower in the exposed groups than that in the controls (Figure 5A), but the decrease in viability was not statistically significant.

CONCLUSIONContinuous exposure to ELF EMF may induce testicular germ cell apoptosis in mice.

Animals ; Apoptosis ; Body Weight ; Electromagnetic Fields ; adverse effects ; Flow Cytometry ; In Situ Nick-End Labeling ; Male ; Mice ; Mice, Inbred BALB C ; Organ Size ; Spermatozoa ; cytology ; Testis ; cytology

PURPOSE: To compare 3D ultrasound (3D-US) with 2D ultrasound (2D-US) in terms of their usefulness and limitations in the diagnosis of breast masses. MATERIALS AND METHODS: We obtained 2D and 3D US images of 37 breast lesions present in 20 cases of fibroadenoma, nine of cancer, and eight of fibrocystic disease proven in a total of 26 cases [fibroadenoma (n=13), breast cancer (n=9), fibrocystic disease (n=4)] by histologic examination, and by clinical evaluation and clinical evaluation with sonographic imaging in eleven. When comparing 3D and 2D-US images we had no prior information regarding detection rate according to the size of lesions, whether or not internal and boundary echo patterns could be interpreted, accurate differentiation between tumorous and non-tumorous lesions, or the accuracy with which benign and malignant tumors could be differentiated. RESULTS: For lesions of 1 cm or less in diameter the detection rate of 3D-US was lower than that of 2D-US, but for lesions over 1 cm there was no difference between the two modalities. In fibroadenoma and breast cancer, 3D-US was more useful than 2D-US for the evaluation of both internal and boundary echo, but with fibrocystic disease and in the diagnosis of tumor/non-tumor, there was no significant difference. In breast cancer, however, 3D-US more accurately determined malignancy, and in fibroadenoma, because of the pseudospicule revealed by 3D-US, this modality was less exact in determining benignancy. CONCLUSION: In the evaluation of internal and boundary echo in breast mass diagnosis, 3D-US was more useful than its 2D counterpart. For lesions of 1 cm or less in diameter, however, the detection rate of 3D-US was low, and since in some benign cases a pseudospicule was apparent, the possibiliy of confusion with malignancy arose. For these reasons, the usefulness of 3D-US was limited.
Breast Neoplasms ; Breast* ; Diagnosis* ; Fibroadenoma ; Ultrasonography

The aim of this study was to evaluate the role of demineralized and particulate autogenous tooth, and interleukin-6 in bone regeneration. A demineralized and particulate autogenous tooth was prepared and human osteoblast-like cells (MG63) and human osteosarcoma cells were inoculated into the culture. The rate of cell adhesion, proliferation and mineralization were examined, and the appearance of cellular attachment was observed. An 8 mm critical size defect was created in the cranium of rabbits. Nine rabbits were divided into three groups including: An experimental group A (3 rabbits), in which a demineralised and particulate autogenous tooth was grafted; an experimental group B (3 rabbits), in which a demineralized, particulate autogenous tooth was grafted in addition to interleukin-6 (20 ng/mL); and a control group. The rabbits were sacrificed at 1, 2, 4 and 6 weeks for histopathological examination with H-E and Masson's Trichrome, and immunohistochemistry with osteocalcin. The cell-based assay showed a higher rate of cell adhesion, mineralization and cellular attachment in the experimental group A compared with the control group. The animal study revealed an increased number of osteoclasts, newly formed and mature bones in the experimental group A compared with the control group. Eventually, a higher number of osteoclasts were observed in the experimental group B. However, the emergence of newly formed and mature bone was lower than in the experimental group A. The current results suggest that treatment with demineralized and particulate autogenous tooth and interleukin-6 is not effective in stimulating bone regeneration during the bone grafting procedure.
Animals ; Bone Regeneration* ; Bone Transplantation ; Cell Adhesion ; Dentin* ; Humans ; Immunohistochemistry ; Interleukin-6* ; Miners ; Osteocalcin ; Osteoclasts ; Osteosarcoma ; Rabbits ; Skull ; Tooth ; Transplants