Granulocytic sarcoma is an uncommon extramedullary localized tumor composed of granulocytic precursor cells. The majority of cases have been reported in association with acute myeloid leukemia(AML) especially in children, but infrequently may occur in patients with myeloproliferative disorders or myelodysplastic syndromes. Most common sites of involvement were bone, soft tissue, lymph nodes and skin, but gastrointestinal tract, testis, central nervous system are also involved rarely. We present an unusual case of granulocytic sarcoma of the intracranium and the retro-orbital soft tissue occurring in a patient with concurrent myelodysplastic syndrome, diagnosed by brain magnetic resonance images and ultrasound guided needle biopsy.
Biopsy, Needle ; Brain ; Central Nervous System ; Child ; Gastrointestinal Tract ; Granulocyte Precursor Cells ; Humans ; Lymph Nodes ; Myelodysplastic Syndromes* ; Myeloproliferative Disorders ; Sarcoma, Myeloid* ; Skin ; Testis ; Ultrasonography

No abstract available.
Cholesterol*

No abstract available.
Compliance* ; Early Detection of Cancer* ; Family Practice* ; Humans

BACKGROUND: Glidescope(R) is a video-assisted intubation device.It offers a clear view and is easy to use, giving it several advantages over conventional intubation devises.This study was designed to compare the hemodynamic effects and POGO scores between conventional and video laryngoscopic intubation. METHODS: Sixty adult patients with ASA 1 or 2 were randomly allocated into two groups; Glidescope(R) (group G) or Macintosh (group M).Anesthesia was induced with propofol and remifentanil.Blood pressure and heart rate were recorded just prior to intubation and 1, 3, and 5 minutes after intubation.POGO scores, intubation time and the severity of sore throat were also recorded. RESULTS: There were no significant differences in SBP, MBP, DBP, HR, POGO score, intubation time and the severity of sore throat between two groups. CONCLUSIONS: The POGO scores and hemodynamic changes associated with tracheal intubation using the Glidescope(R) were almost the same as that of the Macintosh group.
Adult ; Blood Pressure ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Pharyngitis ; Propofol

Cholinesterase (ChE) is one of the most ubiquitous enzymes and in addition to its well characterized catalytic function, the morphogenetic involvement of ChE has also been demonstrated in neuronal tissues and in non-neuronal tissues such as bone and cartilage. We have previously reported that during mouse tooth development, acetylcholinesterase (AChE) activity is dynamically localized in the dental epithelium and its derivatives whereas butyrylcholinesterase (BuChE) activity is localized in the dental follicles. To test the functional conservation of ChE in tooth morphogenesis among different species, we performed cholinesterase histochemistry following the use of specific inhibitors of developing molar and incisors in the hamster from embryonic day 11 (E11) to postnatal day 1 (P1). In the developing molar in hamster, the localization of ChE activity was found to be very similar to that of the mouse. At the bud stage, no ChE activity was found in the tooth buds, but was first detectable in the dental epithelium and dental follicles at the cap and bell stages. AChE activity was found to be principally localized in the dental epithelium whereas BuChE activity was observed in the dental follicle. In contrast to the ChE activity in the molars, BuChE activity was specifically observed in the secretory ameloblasts of the incisors, whilst no AChE activity was found in the dental epithelium of incisors. The subtype and localization of ChE activity in the dental epithelium of the incisor thus differed from those of the molar in hamster. In addition, these patterns also differed from the ChE activity in the mouse incisor. These results strongly suggest that ChE may play roles in the differentiation of the dental epithelium and dental follicle in hamster, and that morphogenetic subtypes of ChE may be variable among species and tooth types.
Acetylcholinesterase ; Ameloblasts ; Animals ; Butyrylcholinesterase ; Cartilage ; Cholinesterases ; Cricetinae ; Dental Sac ; Epithelium ; Incisor ; Mice ; Molar ; Morphogenesis ; Neurons ; Tooth ; Tooth Germ

PURPOSE: This study was conducted to survey children's health status and need of customized visiting health care services in one province. METHODS: The participants in this study were 237 caregivers of infants and preschoolers. Data were collected at the participant's home or public health center. RESULTS: Many of the children did not receive developmental screening tests or dental examinations. In the beneficiary group, the prenatal checkup rate and children's vaccination rate were lower, and caregivers had more health problems than the other groups. On the assessment of home safety, unsafe conditions were more frequently found in the beneficiary group. The caregivers in the beneficiary group showed lower child rearing confidence than the other groups, and wanted customized visiting health care services most in the areas of developmental screening, regular health check-up and counseling, nutritional supplementation, and oral health care. CONCLUSION: These results indicate that it is necessary for children and parents in poverty to be provided with professional home visiting interventions for the promotion of child health and prevention of developmental problems and diseases. These findings can be used for developing future customized visiting health care service programs for infants and children in this community area.
Caregivers ; Child Rearing ; Child Health ; Child* ; Counseling ; Delivery of Health Care* ; House Calls ; Humans ; Infant ; Mass Screening ; Oral Health ; Parents ; Poverty ; Public Health ; Social Class* ; Vaccination

BACKGROUND: The purpose of this study was to determine the optimal dose of remifentanil for minimizing hemodynamic changes during intubation and reducing propofol-induced pain in elderly patients. METHODS: In a randomized prospective study, 60 patients (ASA I-II, elder than 65 years) were enrolled to determine which of two target remifentanil blood concentrations (3 ng/ml, 5 ng/ml) was required to blunt hemodynamic changes during intubation and to reduce propofol-induced pain. After the target effect site concentration of remifentanil had been reached, the target controlled infusion of propofol was started and propofol-induced pain was recorded. Blood pressure and heart rate were recorded at baseline, just before intubation and 1, 3, 5 min after intubation. RESULTS: There were no significant differences in the hemodynamic parameters between two groups, but not in arterial pressure at just before intubation and 1 minute after intubation. However, the group R5 (5 ng/ml) showed significantly less intense pain induced by propofol than in the group R3 (3 ng/ml). CONCLUSIONS: The results suggest that the group R5 provide more relief in propofol induced pain than the group R3, but showed great possibility of hypotension and bradycardia in both groups, which means it should be used with cautions in the elderly patients.
Aged ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Intubation ; Piperidines ; Propofol ; Prospective Studies

PURPOSE: Assess the appropriate level of electrocardiography (EKG) education that should be incorporated into the curriculum of emergency medical technician (EMT) students. METHODS: Consensus by EMT professors and emergency medicine specialists was obtained using two rounds of the Delphi survey. The questionnaire consisted of 70 items; 12 related to demographic information, 8 related to general interpretation of EKG, 26 related to interpretation of arrhythmia, 20 related interpretations of structural anomaly, infarction and systemic disease, and 4 related to interpretation of EKG findings used for advanced cardiac life support. We considered consensus to be agreement of greater than 7 of 9 (66.7%). RESULTS: 59 and 24 subjects were included in the first and second rounds of the Delphi survey, respectively. The response rate was 59% for the first round and 40.7% for the second round. Of 70 items, 40 items came to a consensus by the panel. All items related to interpretation of EKG and advanced cardiac life support and most (10 of 12) items related to basic content were felt to be important by both EMT professors and emergency medicine specialists. However, for items related to arrhythmia and related to structural anomaly, infarction and systemic disease, less than half of the items examined were felt to be necessary in the curriculum of EMT students (12 of 26 and 6 of 20). CONCLUSION: We identified 40 items that should be included into the EKG curriculum of EMT students. These findings should be used to create more effective educational programs for EMT students.
Advanced Cardiac Life Support ; Arrhythmias, Cardiac ; Consensus ; Curriculum ; Delphi Technique ; Electrocardiography ; Emergencies ; Emergency Medical Technicians ; Emergency Medicine ; Humans ; Infarction ; Porphyrins ; Surveys and Questionnaires ; Specialization

BACKGROUND: Propofol produces anesthesia with rapid recovery but also causes pain on injection. This study was designed to evaluate the effects of two different concentrations of remifentanil for minimizing the pain caused by propofol and to compare the hemodynamic changes during propofol-remifentanil infusion. METHODS: In a randomized, double-blind study of 80 patients, we compared the severity of the injection pain of propofol between two groups of patients. The initial effect-site target concentration of remifentanil was set at 4 ng/ml (the R4 group, n = 40) or 8 ng/ml (the R8 group, n = 40). After the effect-site concentration of remifentanil was achieved, the infusion of propofol was started with the concentration of 4 microgram/ml. The remifentanil-related complications were evaluated and the severity of the pain caused by propofol was compared by using a four-point scale during the propofol infusion. The heart rate and arterial blood pressure were measured at pre-induction, just before intubation and at 1 minute after intubation. RESULTS: The severity of injection pain of propofol was significantly lower in the R8 group than in the R4. There was no significant difference in the incidence of remifentanil-related complications between the two groups. Compared with the pre-induction values, the heart rate and arterial blood pressure were significantly lower at pre-intubation and at 1 minute after intubation in the R4 and R8 groups. CONCLUSIONS: Pretreatment with an effect-site concentration of 8 ng/ml remifentanil may be useful for minimizing the propofol injection pain compared with 4 ng/ml remifentanil.
Anesthesia ; Arterial Pressure ; Double-Blind Method ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Intubation ; Piperidines ; Propofol

BACKGROUND: Tracheal intubation stimulates the sympathetic nervous system, resulting in hypertension, tachycardia and sometimes critical complications, especially in patients with underlying hypertension, cardiovascular disease or cerebrovascular disease. In this study, we sprayed 4% lidocaine into the trachea before intubation, and observed the hemodynamic changes after tracheal intubation. METHODS: We randomly allocated 87 patients, whose ASA physical status was I or II, into three groups. The 4% topical lidocaine was sprayed before intubation at the following specific times: just before intubation (group 0), or 1 minute (group 1) and 2 minutes before intubation (group 2). For maintenance of anesthesia, TIVA (total intravenous anesthesia; propofol-remifentanil infusion with orchestra(R)) was used. We observed hemodynamic changes between the groups just after the intubation, as well as 1, 3 and 5 minutes after the intubation. Hemodynamic changes were also monitored in the same group. RESULTS: When the patients arrived at the operating room, we found no significant difference in heart rate and arterial pressure between the groups. However, heart rate after intubation in group 1 was significantly lower than group 0. The diastolic and mean arterial pressure just after intubation were lower in group 1 and 2 than in group 0. CONCLUSIONS: Spraying lidocaine 1 or 2 minutes before intubation was more effective than spraying it just before intubation for reducing hypertensive responses after intubation.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Cardiovascular Diseases ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Lidocaine ; Operating Rooms ; Sympathetic Nervous System ; Tachycardia ; Trachea