BACKGROUND: The afferent and efferent pathways of fentanyl cough response (FCR) and central organization are poorly understood at present. The aim of this study was to investigate the pretreatment effects of morphine, propofol, atropine, and midazolam on FCR. METHOD: The 120 healthy patients were randomly assigned to six equal pretreatment groups. They received 2ug/kg fentanyl rapidly through a peripheral venous catheter. The patients in each group were pretreated before the time necessary for peak plasma levels with different drugs as follows: group 1, no premedication; group 2, morphine 0.05 mg/kg iv; group 3, morphine 0.05 mg/kg iv naloxone 0.01mg/kg iv; group 4, propofol 0.5 mg/kg iv; group 5, atropine 0.01 mg/kg iv; group 6, midazolam 0.05 mg/kg iv. The patients were observed for any coughing or side effects, including oxygen desaturation, bronchoconstriction, chest wall rigidity and seizure. RESULT: 40% of patients in group 1 (control) had a cough response to fentanyl. Group 2 (morphine) and group 3 (morphine naloxone) showed a reduced FCR of 10%. The incidence of coughing was 60% of the patients in group 4 (propofol), 30% in group 5 (atropine), and 40% in group 6 (midazolam). These were not statistically significant. CONCLUSION: FCR is not altered by pretreatment with propofol, atropine, or midazolam, but morphine inhibits cough response and this antitussive effect was not antagonized by naloxone.
Atropine* ; Bronchoconstriction ; Catheters ; Cough* ; Efferent Pathways ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Morphine* ; Naloxone ; Oxygen ; Plasma ; Premedication ; Propofol* ; Seizures ; Thoracic Wall

BACKGROUND: Autoimmune hemolytic anemias are characterized by autoantibodies recognizing antigens on the Individual's own red blood cells, resulting in immune- mediated hemolysis. Blood transfusions have been regarded as hazardous in patients with autoimmune hemolytic anemia (AIHA) because of potential intensification of hemolysis and a presumed high incidence of alloimmunization. METHODS: We examined the pretransfusion and posttransfusion hemoglobin levels in 6 patients with autoantibodies in their sera, which showed panagglutinations with all bloods tested in the compatibility testing. They received 'least' incompatible blood because of inability to find compatible blood. RESULTS: When we compared pretransfusion hemoglobin level with posttransfusion hemoglobin level, in 5 of 6 patients with AIHA, the hemoglobin levels were increased after red cell transfusion. 4 patient who did not respond to transfusion therapy initially had an increase in hemoglobin level after steroid treatment. Any signs or symptoms indicating hemolytic transfusion reaction were not observed ducting the transfusion period in all patients. CONCLUSIONS: The decision to transfuse in AIHA should consider multiple factors including the patient's clinical status, the potential benefit of transfusion, the potential response to other therapeutic modalities, but must never be regarded as contraindicated, even though the compatibility test may be strongly incompatible.
Anemia, Hemolytic* ; Anemia, Hemolytic, Autoimmune ; Autoantibodies ; Blood Group Incompatibility ; Blood Transfusion ; Erythrocyte Transfusion* ; Erythrocytes* ; Hemolysis ; Humans ; Incidence

BACKGROUND: Autoimmune hemolytic anemias are characterized by autoantibodies recognizing antigens on the Individual's own red blood cells, resulting in immune- mediated hemolysis. Blood transfusions have been regarded as hazardous in patients with autoimmune hemolytic anemia (AIHA) because of potential intensification of hemolysis and a presumed high incidence of alloimmunization. METHODS: We examined the pretransfusion and posttransfusion hemoglobin levels in 6 patients with autoantibodies in their sera, which showed panagglutinations with all bloods tested in the compatibility testing. They received 'least' incompatible blood because of inability to find compatible blood. RESULTS: When we compared pretransfusion hemoglobin level with posttransfusion hemoglobin level, in 5 of 6 patients with AIHA, the hemoglobin levels were increased after red cell transfusion. 4 patient who did not respond to transfusion therapy initially had an increase in hemoglobin level after steroid treatment. Any signs or symptoms indicating hemolytic transfusion reaction were not observed ducting the transfusion period in all patients. CONCLUSIONS: The decision to transfuse in AIHA should consider multiple factors including the patient's clinical status, the potential benefit of transfusion, the potential response to other therapeutic modalities, but must never be regarded as contraindicated, even though the compatibility test may be strongly incompatible.
Anemia, Hemolytic* ; Anemia, Hemolytic, Autoimmune ; Autoantibodies ; Blood Group Incompatibility ; Blood Transfusion ; Erythrocyte Transfusion* ; Erythrocytes* ; Hemolysis ; Humans ; Incidence

Hepatoblastoma (HB) is a rare embryonic malignant tumor of the liver. Most morphological studies on HB have limited to the histological characteristics and only 3 cases of HB have been described in the cytology literature. We present 2 cases of HB occurring in children aged 1 year and 3 years, respectively. The distinctive cytologic features of fine needle aspiration of HB were clusters of tumor cells showing acinar and trabecular pattern, smaller tumor cells with a high nuclear-cytopalsmic ratio and hyperchromatic nuclei having prominent nucleoli, and the presence of extramedullary hematopoiesis and osteoid material. These features were also found in the cell block and the biopsy specimen, and appeared very useful in the differentiation of HB from hepatocellular carcinoma.
Acute Kidney Injury* ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Hepatocellular ; Child* ; Hematopoiesis, Extramedullary ; Hepatoblastoma ; Humans ; Liver ; Nephrosis, Lipoid*

No abstract available.
Child* ; Humans ; Killer Cells, Natural* ; Nephrosis, Lipoid*

Leiomyoma of the female urethra is a very rare entity. A case of leiomyoma of the female urethra in a 47year-old female, who had presenting symptoms with a protruded large mass outside the vaginal introitus, was presented. The mass was enucleated surgically and confirmed as a leiomyoma pathologically.
Female* ; Humans ; Leiomyoma* ; Urethra*

Among the causes of pure red cell aplasia, human parvovirus B19 has been shown to be cytotoxic to erythroid progenitor cells in the bone marrow associated with chronic hemolytic anemia with rapidly dividing erythroids and persistently to be suppression of erythropoiesis in immunocompromised individuals related with failure to produce neutralizing antibody to the virus. In a patient with hereditary spherocytosis presenting acute onset of reticulocytopenia during hospitalization, who had shown severe anemia and prodromal symptoms including fever, fatigue and dizziness, infection of parvovirus Bl9 was proven by the presence of IgM and IgG antibodies to parvovirus Bl9, the detection of viral DNA using PCR technique in her serum and the decreased erythroid cells, especially late normoblasts in bone marrow, Also in the other who was diagnosed as hereditary elliptocytosis and complained of fever, headache, abdominal pain and diarrhea, an episode of reticulocytopenia and the nearly absence of late normoblasts in the bone marrow were observed. IgM antibodies to parvovirus Bl9 and the viral DNA were detected in her serum, too.
Abdominal Pain ; Anemia ; Anemia, Hemolytic ; Antibodies ; Antibodies, Neutralizing ; Bone Marrow ; Diarrhea ; Dizziness ; DNA, Viral ; Elliptocytosis, Hereditary* ; Erythroblasts ; Erythroid Cells ; Erythroid Precursor Cells ; Erythropoiesis ; Fatigue ; Fever ; Headache ; Hospitalization ; Humans* ; Immunoglobulin G ; Immunoglobulin M ; Parvovirus B19, Human ; Parvovirus* ; Polymerase Chain Reaction ; Prodromal Symptoms ; Red-Cell Aplasia, Pure

Among the causes of pure red cell aplasia, human parvovirus B19 has been shown to be cytotoxic to erythroid progenitor cells in the bone marrow associated with chronic hemolytic anemia with rapidly dividing erythroids and persistently to be suppression of erythropoiesis in immunocompromised individuals related with failure to produce neutralizing antibody to the virus. In a patient with hereditary spherocytosis presenting acute onset of reticulocytopenia during hospitalization, who had shown severe anemia and prodromal symptoms including fever, fatigue and dizziness, infection of parvovirus Bl9 was proven by the presence of IgM and IgG antibodies to parvovirus Bl9, the detection of viral DNA using PCR technique in her serum and the decreased erythroid cells, especially late normoblasts in bone marrow, Also in the other who was diagnosed as hereditary elliptocytosis and complained of fever, headache, abdominal pain and diarrhea, an episode of reticulocytopenia and the nearly absence of late normoblasts in the bone marrow were observed. IgM antibodies to parvovirus Bl9 and the viral DNA were detected in her serum, too.
Abdominal Pain ; Anemia ; Anemia, Hemolytic ; Antibodies ; Antibodies, Neutralizing ; Bone Marrow ; Diarrhea ; Dizziness ; DNA, Viral ; Elliptocytosis, Hereditary* ; Erythroblasts ; Erythroid Cells ; Erythroid Precursor Cells ; Erythropoiesis ; Fatigue ; Fever ; Headache ; Hospitalization ; Humans* ; Immunoglobulin G ; Immunoglobulin M ; Parvovirus B19, Human ; Parvovirus* ; Polymerase Chain Reaction ; Prodromal Symptoms ; Red-Cell Aplasia, Pure

Alpasia cutis congenita is an anomaly characterized by absence of localized areas of the integument. The most common type of aplasia cutis congenita is Aplasia cutis congenita limited to the scalp, although other areas of the body may also be involved. We experienced a case of aplasia cutis congenita in a male newborn infant. The skin defects were extensive with symmetrical involvement of lower extremities. The multiple bullae were found on the both fingers and toes. No similar conditions and other associated congeital anomalies were found in the family membes of this particular case. The light microscopic examinaton of the denuded skin areas how absence of epidemis and the demis contain atrophic and hypoplastic adnexa. The bullae have a split within the dermis below lamina densa on electron microscopy. The skin defects were healed by supportive therapy for 4weeks.
Dermis ; Ectodermal Dysplasia* ; Epidermolysis Bullosa* ; Fingers ; Humans ; Infant, Newborn ; Lower Extremity ; Male ; Microscopy, Electron ; Scalp ; Skin ; Toes

BACKGROUND: Routine management of postoperative pain have been changed as a result of technological advances in drug delivery systems. The purpose of this study was to compare the effect of continuous epidural analgesia(CEA) system and intravenous patient controlled analgesia (IV-PCA) system for pain relief after cesarean delivery. METHODS: Sixty adult women were randomly assigned to receive analgesics either IV-PCA or CEA after cesarean delivery with general anesthesia for operation. IV-PCA group was received 30 mg intramuscular injection of ketorolac after awakening, followed by IV-PCA. PCA unit was filled with 60 ml; mixed with morphine 10 mg, fentanyl 1000 microgram, ketorolac 180 mg, and normal saline. It had a flow rate of 0.5 ml/hr and lockout interval was 15minutes. CEA group was received a bolus of epidural morphine 3mg and 8ml of 0.25% bupivacaine before the end of operation, followed by CEA. CEA unit was filled with 100 ml; mixed with morphine 4 mg, fentanyl 500 microgram, 0.5% bupivacaine 20 ml, and normal saline. It had a flow rate of 2ml/hr. The degree of analgesia was subjectively evaluated by a visual analogue scale(VAS). Patients were evaluated 0, 1, 2, 6, 12, 24, and 48hours after operation for pain relief, sedation, nausea, vomiting, pruritus, and respiratory rate. RESULTS: VAS pain score were significantly lower in CEA group than IV-PCA group at 0(8.0+/-1.4 vs 3.9+/-0.7), 1(4.4+/-1.3 vs 3.3+/-0.9) and 2hours(3.9+/-1.2 vs 3.3+/-0.8)(p<0.05). There were no apparent cases of respiratory depression and motor weakness of lower extrimity. Nausea or vomiting occurred in 7 patients(23%) of IV-PCA group, and occurred in 3 patients(10%) of CEA group. Pruritus occurred in 6 patients(20%) of IV-PCA group, and occurred in 11 patients (37%) of CEA group. Sedation occurred in 9 patients(30%) of IV-PCA group. Conculsions: We conclude that the CEA with small dose of morphine, fentanyl and bupivacaine is an easy and effective method for pain control after cesarean delivery.
Adult ; Analgesia ; Analgesia, Epidural* ; Analgesia, Patient-Controlled* ; Analgesics ; Anesthesia, General ; Bupivacaine ; Drug Delivery Systems ; Female ; Fentanyl ; Humans ; Injections, Intramuscular ; Ketorolac ; Morphine ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pruritus ; Respiratory Insufficiency ; Respiratory Rate ; Vomiting