BACKGROUND: It has long been suggested that neutrophils and their products are implicated as the central mediators of the acute lung injuries. Contrary to the dominant role of neutrophils in ARDS, many cases of ARDS has occurred in the setting of severe neutropenia without pufrnonary neutrophil infiltration. Therefore it is certain that effector cell(s) other than neutrophil play an important role in the pathogenesis of ARDS. This experiment was performed to define the mechanism of ARDS in the setting of neutiopenia, 1) by comparing the severity of endotoxin-induced lung injury, 2) by measurement of hydrogen peroxide production and cytokine concentration in the bronchoalveolar lavage cells and fluids obtained from different rats with and without cyclophosphamide-pretreatment. METHOD: The male Sprague-Dawleys were divided into the normal control (NC)-, endotoxin (ETX)-, and cyclophosphamide (CPA)-group in which neutropenia was induced by injecting cyclophosphamide intraperitoneally. Acute lung injury was evoked by injecting lipopolysaccharide (LPS) into a tail vein. The bronchoalveolar lavage (BAL) was performed at 3 and 6 hour after administration of LPS to measure the change of cell counts and concentrations of protein and cytokines, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). Hydrogen peroxide (HPO) production from BAL cel]s was measured at 6 hour after LPS administration by phenol red microassay with and without zymosan stimulation. RESULTS: The results were as follows. A change of leukocyte counts in the peripheral blood after treatment with CPA More than 95% of total leukocytes and neutrophils were reduced after CPA administration, resulting in severe neutropenia. A change of BAL cells In the ETX-group, the number of total cells (p<0.01) and of macrophage and neutrophll (p<0.05) were increased at 3 and 6 hour after LPS administration compared to those of NC- group. In the CPA-group, the number of total leukocyte and macrophage were not changed after LPS administration, but neutrophil counts were significantly reduced and jt took part in less than 0.1% of total BAL cells (p<0.01 vs NC-group). BAL cells in this group were almost all macrophages (99.7%). A change of protein concentration in the BALF In the ETX-group, protein concentration was increased at 3 hour and was more increased at 6 hour after LPS administration (p<0.05 and <0.01 vs NC-group, respectively). In the CPA-group, it was also significantly elevated at 3 hour after LPS administration (p<0.05 vs NC-group) , but the value was statistically not different from that of ETh-group. The value measured at 6 hour after LPS administration in the CPA-group became lower than that of ETX-group (p<0.05), but showed still a higher value compared to that of NC-group (p<0.05). A change of cytokine concentration in the BALF TNF-alpha and IL-6 were elevated in the ETX- and CPA-group compared to those of NC-group at both time intervals. There was no statistical difference in the values of both cytokines between the ETX- and CPA-groups. Measurement of hydrogen peroxide production from BAL cells There was no intergroup difference of HPO production from resting cells. HPO production after incubation with opsonized zymosan was significantly elevated in all groups. The percent increment of HPO production was highest in the ETX-group (89.0%, p<0.0008 vs NC-group ), and was 42.85 in the CPA-group (p = 0.003 vs NC-group ). Conclusion Acute lung injury in the setting of neutropenia might be caused by functional activation of resident alveola r macrophages.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Cell Count ; Cyclophosphamide ; Cytokines ; Humans ; Hydrogen Peroxide ; Interleukin-6 ; Leukocyte Count ; Leukocytes ; Lung Injury ; Macrophages* ; Male ; Neutropenia ; Neutrophil Infiltration ; Neutrophils ; Phenolsulfonphthalein ; Rats* ; Tumor Necrosis Factor-alpha ; Veins ; Zymosan

Diverticular disease of the colon is frequently involved in Western countries, which in korea, it is regarding as rare disease. In Western the diverticulosis is mainly affected on left side and increasing in according to age and false type is more frequent than ture type. While in oriental countries, the diverticulosis of the colon is mainly affected on right side and it is more frequent in younger patients. Cecal diverticulitis is known to a very rare disease and very difficult to be differenciated from acute scopy has purnished another useful tool in the differential diagnosis of diverticular disease. We experienced a case of cecal diverticultitis which had been diagnosed by colonofiberscopy and reviewed literatures briefly.
Colon ; Diagnosis, Differential ; Diverticulitis* ; Diverticulum ; Humans ; Korea ; Rare Diseases

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

PURPOSE: Unilateral ureteral obstruction results in tubulointerstitial fibrosis of the affected kidney which is driven by increased levels of angiotensin II. In this study, we examed the fibrotic changes in un inephrectomized rats with incomplete urteral obstruction and explored the effect of an angiotensin converting enzyme(ACE)inhibitor, enalapril on the tubulointerstitial fibrosis of obstructive uropathy. MATERIALS AND METHODS: 130 Rats were sacrificed at 1, 2, 4 weeks after nephrectomy or obstruction. Collagen type I, II, and III were localized by immunohistochemical staining. And the distribution of each collagen type was analyzed using differences of their staining densities. RESULTS: There is no difference in total collagen amount and immunohistochemical staining between control and uninephrectomized group. After 2weeks in incomplete ureteral obstruction in uninephretomized rat, the total amount of collagen in affected kidney was significantly increased compared to control (p<0.05), and immunohistochemical staining for all type of collagen was gradually increased by increased duration of incomplete ureteral obstruction. Enalapril did not affect the total collagen amount and immunohistochemical staining in the kidney of uninephrectomized rat. Enalapril significantly decreased the collagen amount in affected kidneys of collagen was not significantly changed compaired to control group. CONCLUSIONS: the incomplete ureteral obstruction in uninephrectomized rat induces progressive increase of amount of collagen according to the duration of obstruction, especially 2 weeks, and enalapril administration after incomplete unilateral obstruction of tubulointerstitial fibrosis of obstructive uropathy.
Angiotensin II ; Angiotensins ; Animals ; Collagen Type I ; Collagen* ; Enalapril* ; Fibrosis ; Kidney ; Nephrectomy ; Rats* ; United Nations ; Ureter* ; Ureteral Obstruction*

BACKGROUND: The signal pathways and their precise roles for acute respiratory distress syndrome caused by endotoxin (ETX) has not been established. Since there has been several in vitro experiments suggesting that activation of protein kinase C (PKC) pathway may be responsible for endotoxin-induced inflammatory reaction, we performed in vivo experiments in the rats with the hypothesis that PKC-inhibition can effectively prevent endotoxin-induced acute lung injury. METHODS: We studied the role of PKC in ETX-induced ALl using PKC inhibitor (staurosporine, 5Th) in the rat. Specific pathogen free male Sprague-Dawley weighted from 165 to 270g were used for the study. Animals were divided into the normal control (NC)-, vehicle control (VC)-, ETX-, PMA (phorbolmyristateacetate)-, STP+PMA-, and STP+ETX-group. PMA (50mg/kg) or ETX (7mg/kg) was instilled through polyethylen catheter after aseptic tracheostomy with and without STP (0.2mg/kg) pretreatment. STP was injected via tail vein 30mm before intratracheal injection (IT) of PMA or ETX. Bronchoalveolar lavage (BAL) was done 3- or 6-hrs after IT of PMA or FTX respectively, to measure protein concentration, total and differential cell counts. RESULTS The results were as follows. The protein concentrations in BALF in the PMA- and ETX-group were very higher than that of VC-group (p<0.001). When animals were pretreated with STP, the %reduction of the protein concentration in BALF was 64.8 8.5 and 30.4 2.5% in the STP+PMA- and STP+ETX-group, respectively (p=0.028). There was no difference in the total cell counts between the PMA-and VC-group (p = 0.26). However the ETX-group showed markedly increased total cell counts as compared to the VC- (p=0.003) and PMA group (p=0.0027), respectively. The total cell counts in BALF were not changed after pretreatment with STP compared to the PMA- (p=0.22) and ETX-group (p=0.46). The percentage of PMN, but not alveolar macrophage, was significantly elevated in the PMA-, and ETX-group. Especially in the ETX-group, the percentage of PMN was 17 times higher than that of PMA (p<0.001). The differential cell counts was not different between the PMA and STP+PMA. On the contrary the STP+ETX-group showed decreased percentage of PMN (p = 0.016). There was no significant relationship between the protein concentration and the total or differential cell counts in each group. CONCLUSION: Pretreatment with PKC-inhibitor (staurosporine) partially but significantly inhibited ETX-in-duced ALI.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Catheters ; Cell Count ; Humans ; Macrophages, Alveolar ; Male ; Protein Kinase C* ; Protein Kinases* ; Rats ; Rats, Sprague-Dawley ; Respiratory Distress Syndrome, Adult ; Signal Transduction ; Specific Pathogen-Free Organisms ; Staurosporine ; Tracheostomy ; Veins

PURPOSE: Medical direction is an integral part of proper prehospital care, which is performed by EMS providers. In Gyunggi province, a number of measures have been implemented to improve the direct medical direction system. We aimed to report on the process and results of the newly implemented medical direction system. METHODS: This is a descriptive analysis of the newly implemented medical direction system for community EMS providers from June 2014 to October 2014. Direct medical direction was requested by emergency medical technicians (EMTs) during the study period, as follows: when a destination hospital was selected, EMTs requested medical direction from the physicians at the destination hospital. During the study period specially-trained advanced EMTs were permitted to perform intravenous (IV) access for fluid or glucose infusion without direct medical direction. EMTs were asked to complete records when they requested direct medical direction and performed IV access without medical direction. These records were collected and used in the analysis. RESULTS: Of 5949 direct medical direction requests, 5527 were analyzed; 2958 (53.5%) cases were requested to the destination hospitals, 2569 (46.5%) were requested to the centralized dispatch center. 'Patient evaluation' was the most common reason for EMTs to request medical direction to the destination hospitals (1680, 54.4%) and centralized dispatch center (980, 38.1%). EMTs' degree of satisfaction did not differ significantly between destination hospitals and the centralized dispatch center (4.12+/-0.82 and 4.09+/-0.84, p=0.053). IV access rate for hypotensive patients increased 6.1% during the study period compared to the same period of 2013 (17.6% and 11.5%, p<0.01). CONCLUSION: We found that it is feasible to request direct medical direction to the destination hospitals and perform IV access for fluid or glucose infusion without direct medical direction for specially-trained advanced EMTs. Continuing efforts to establish an optimized medical direction system would be required for proper pre-hospital care.
Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Medical Technicians ; Glucose ; Humans ; Korea

OBJECTIVE: The incidence of leptomeningeal dissemination from malignant glioma is rare, so the clinical features of this are not well documented yet. We attempted to determine the clinical features of leptomeningeal dissemination from malignant gliomas. METHODS: We retrospectively analyzed 11 cases of leptomeningeal dissemination of malignant glioma, who were treated at our institution between 2006 and 2009. We investigated the clinical features of these patients by considering the following factors : tumor locations, the events of ventricular opening during surgery and the cerebrospinal fluid (CSF) profiles, including the cytology. RESULTS: The group was composed of 9 males and 2 females. The histological diagnosis of their initial intracranial tumors were 4 primary glioblastoma, 3 anaplastic astrocytoma, 1 anaplastic oligoastrocytoma, 2 ganglioglioma and 1 pleomorphic xanthoastrocyotma with anaplastic features. The mean age of the patients at the time of the initial presentation was 42.8+/-10.3 years. The mean time between surgery and the diagnosis of spinal dissemination was 12.3+/-7.9 (3-28) months. The mean overall survival after dissemination was 2.7+/-1.3 months. All our patients revealed a history of surgical opening of the ventricles. Elevated protein in the CSF was reported for eight patients who had their CSF profiles checked. CONCLUSION: We propose that in the malignant gliomas, the surgical opening of ventricles can cause the spinal leptomeningeal dissemination and the elevated protein content of CSF may be a candidate marker of leptomeningeal dissemination.
Astrocytoma ; Female ; Ganglioglioma ; Glioblastoma ; Glioma ; Humans ; Incidence ; Male ; Retrospective Studies

More than 80% of cancer patients experience cancer pain. Among them, more than 50% experience moderate to severe pain. To control cancer pain, a variety of methods have been used, including medications and nerve blocks. In some patients, however, it is impossible to perform nerve blocks due to caner metastasis into the epidural space, while in other patients, opioid dose escalation is impossible due to opioid side effects; thus, cancer pain management is difficult. Scrambler therapy is a novel approach for pain control that uses EKG-like pads, which are applied above and below the site of pain. Scrambler therapy synthesizes 16 different types of nerve action potentials that provide "non-pain" information via cutaneous nerves. The advantages of this treatment are that it is non-invasive and safe and has no significant side effects. In this case series, we report the treatment results of using scrambler therapy in three cancer patients with intractable pain.
Action Potentials ; Epidural Space ; Humans ; Neoplasm Metastasis ; Nerve Block ; Pain Management ; Pain, Intractable

OBJECTIVE: The purpose of this study is to evaluate the surgical outcomes of bifrontal interhemispheric(BIH) approach and compare them to those of the pterional approach for the treatment of craniopharyngioma. METHODS: Seventeen patients had their first operation for the resection of craniopharyngiomas between 2000 and 2004 at our medical center. Eleven patients who had the pterional approach and 6 with the BIH approach were enrolled. The age range at the time of surgery was 5 to 80 years (mean age 35.6 years old). The presenting symptoms were visual disturbance in 12 patients and signs of increased intracranial pressure in 5 patients. RESULTS: The tumors were totally removed in 3(27 %) and subtotally in 8(73 %) patients with the pterional approach. Total tumor removal was achieved in 5 out of 6(83%) patients by the BIH approach, except 1 patient with a subchiasmatic lesion. Vision was improved in 4(36 %) patients treated with the pterional approach and in all patients treated by the BIH approach CONCLUSION: The BIH approach for craniopharyngioma surgery may be an effective and safe approach for tumors that extend outside of the sellar-suprasellar region with acceptable outcomes.
Craniopharyngioma* ; Humans ; Intracranial Pressure

PURPOSE: Recent reports suggest that many professionals, including emergency physicians, suffer from job stress and psychosocial stress. Emergency physicians also report a high premature attrition rate. Our goal was to investigate the levels of job and psychosocial stress and the relationship between these stresses and abandonment of their own specialty. METHODS: Data was collected using a cross-sectional mail survey with a self-administered questionnaire. The questionnaire included 49 questions in scales relating to job stress, job satisfaction and plans for their remaining years in their specialty. Three hundred and forty-two emergency physicians participated in this study and completed the questionnaire RESULTS: Among the 342 questionnaires, 132(48.4%) were returned. Multivariate analysis of variance revealed statistically significant differences in job stress and psychosocial stress between academic emergency physicians and clinical emergency physicians. The average scores for job stress, job satisfaction and psychosocial stress among emergency physicians were, respectively, 3.35+/-0.57, 2.93+/-0.50 and 2.33+/-0.78. Mean levels of job stress and psychosocial stress were higher among academic emergency physicians. Job satisfaction and occupational commitment were also higher among academic emergency physicians. Variables such as patient load, working hours per week, and night shifts proved unimportant. Of clinical emergency physicians, 54% planned on leaving their specialty within ten years. CONCLUSION: Job stress and psycosocial stress of academic emergency physicians were higher, but job satisfaction and occupational commitment were higher. Job stress and psycosocial stress of clinical emergency physicians were lower, but premature attrition rate were higher.
Emergencies ; Humans ; Job Satisfaction ; Multivariate Analysis ; Postal Service ; Surveys and Questionnaires ; Weights and Measures