BACKGROUND: Laparoscopic appendectomy (LA) is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. We expected that dexmedetomidine would compensate for the problems arising from spinal anesthesia alone. Thus, we performed a feasibility study of spinal anesthesia with intravenous dexmedetomidine infusion. METHODS: Twenty-six patients undergoing LA received spinal anesthesia with intravenous dexmedetomidine infusion. During surgery, the patient's pain or discomfort was controlled by supplemental fentanyl or ketamine injection, and all adverse effects were evaluated. RESULTS: No patient required conversion to general anesthesia, and all operations were completed laparoscopically without conversion to open surgery. Seventeen (65.4%) patients required supplemental injection of fentanyl or ketamine. Bradycardia occurred in seven (26.9%) patients. CONCLUSIONS: Spinal anesthesia with dexmedetomidine infusion may be feasible for LA. However, additional analgesia, sedation, and careful attention to the potential development of bradycardia are needed for a successful anesthetic outcome.
Analgesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Appendectomy* ; Bradycardia ; Conversion to Open Surgery ; Dexmedetomidine* ; Feasibility Studies ; Fentanyl ; Humans ; Ketamine

BACKGROUND: Laparoscopic appendectomy (LA) is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. We expected that dexmedetomidine would compensate for the problems arising from spinal anesthesia alone. Thus, we performed a feasibility study of spinal anesthesia with intravenous dexmedetomidine infusion. METHODS: Twenty-six patients undergoing LA received spinal anesthesia with intravenous dexmedetomidine infusion. During surgery, the patient's pain or discomfort was controlled by supplemental fentanyl or ketamine injection, and all adverse effects were evaluated. RESULTS: No patient required conversion to general anesthesia, and all operations were completed laparoscopically without conversion to open surgery. Seventeen (65.4%) patients required supplemental injection of fentanyl or ketamine. Bradycardia occurred in seven (26.9%) patients. CONCLUSIONS: Spinal anesthesia with dexmedetomidine infusion may be feasible for LA. However, additional analgesia, sedation, and careful attention to the potential development of bradycardia are needed for a successful anesthetic outcome.
Analgesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Appendectomy* ; Bradycardia ; Conversion to Open Surgery ; Dexmedetomidine* ; Feasibility Studies ; Fentanyl ; Humans ; Ketamine

Polymorphous low-grade adenocarcinoma (PLGA) is a distinctive salivary gland neoplasm with a propensity to arise from minor salivary glands, particularly of the palate. Reports of PLGA have increased with the establishment of specific histopathological criteria characterizing the PLGA, but there are only a few reports of major salivary gland origin. PLGA shares histological features with adenoid cystic carcinoma, so histopathologic diagnosis is essential and immunohistochemistry is an important tool when making differential diagnosis. The treatment of choice is wide surgical excision, and long-term follow up is necessary to evaluate local recurrences. We herein report a case of PLGA arising in a submandibular gland with a review of the relevant literature.
Adenocarcinoma* ; Carcinoma, Adenoid Cystic ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Immunohistochemistry ; Palate ; Recurrence ; Salivary Gland Neoplasms ; Salivary Glands ; Salivary Glands, Minor ; Submandibular Gland*

Hypertrophy of salivary gland was developed by sialadenitis, sialolithiasis, autoimmune diasease and other tumorous conditions. Mikulicz's disease has been used to describe symptomless hypertrophy of the salivary gland and lacrimal gland. In the past, it was thought that Mikulicz's disease is included within the diagnosis of Sjogren's syndrome. However, Mikulicz's disease represents Immunoglobulin G4 (IgG4)-related hypertrophy of salivary gland and lacrimal gland by an elevated level of IgG4 in the serum of the patient and good responsiveness to glucocorticoid, eventually leading to recovery of gland function. We have experienced a case of IgG4-related sialadenitis and dacryoadenitis with bilateral hypertrophy of parotid, submandibular and lacrimal glands. We report this case with a brief review of the literature.
Dacryocystitis ; Humans ; Hypertrophy ; Immunoglobulin G ; Immunoglobulins ; Lacrimal Apparatus ; Salivary Gland Calculi ; Salivary Glands ; Sialadenitis ; Sjogren's Syndrome

Absorption ; Alveolar Process ; Animals ; Bone Regeneration ; Collagen ; Collagen Type I ; Giant Cells ; Lymphocytes ; Membranes ; Osteogenesis ; Rats ; Rats, Sprague-Dawley ; Transplants

Aged, 80 and over ; Comorbidity ; Deglutition Disorders ; physiopathology ; Diagnosis, Differential ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal ; physiopathology ; Male ; Pharyngeal Neoplasms ; diagnosis ; diagnostic imaging ; physiopathology ; Radiography

Aged, 80 and over ; Diagnosis, Differential ; Female ; Foreign Bodies ; complications ; diagnostic imaging ; Humans ; Radiography ; Sciatica ; diagnostic imaging ; Soft Tissue Injuries ; diagnostic imaging

<0.05). 4. Histologic examination revealed that AM protected leukocyte infiltration and epithelial migration was nearly completed at 4 weeks. Terudermis(R) group showed mild neutrophil infiltration until 2 weeks and completion of epithelization at 4 weeks. Control group showed massive leukocyte infiltration until 4 weeks. 5. Microvessels were increased sharply at 1 week and control group at 1 and 4 week showed significant differences with Terudermis(R) group of same interval(p<0.05) but no differences were found with AM group(p<0.05). CONCLUSION: EGF and EGF-R were well preserved in freeze-dried AM. AM attached to collagen acted as excellent biologic dressing which had similar effect with Terudermis(R). AM showed anti-inflammatory action and healing was completed at 4 weeks after full-thickness skin defect.
Amnion* ; Animals ; Bandages* ; Biological Dressings ; Collagen* ; Epidermal Growth Factor ; Leukocytes ; Microvessels ; Neutrophil Infiltration ; Rats* ; Skin ; Wound Healing* ; Wounds and Injuries*

Dentures ; Epithelium ; Fascia ; Keratinocytes ; Laminin ; Mastication ; Mouth Mucosa ; Mucous Membrane ; Oral Hygiene ; Proliferating Cell Nuclear Antigen ; Rabbits ; Rehabilitation ; Skin ; Transplants

BACKGROUND: The adhesion of polymorphonuclear neutrophils (PMNs) to the coronary endothelium is an crucial step in PMN-mediated reperfusion injury. The purpose of this study was to investigate whether thiopental inhibits the postischemic coronary vascular adhesion of PMNs, and results in reduced postischemic myocardial dysfunction in isolated guinea pig hearts. METHODS: Hearts (n = 6-8/group) were isolated from male-guinea pigs and perfused with modified Krebs-Henseleit solution. After isolation, hearts were stabilized for 10 minutes, perfused for 15 minutes, allowed an ischemic period for 30 minutes, and a reperfusion period of 60 minutes (C group). In the P group, a bolus of 1x10(6) PMNs was infused 2 minutes after reperfusion, and in the T group additional thiopental was infused 5 minutes after the start of reperfusion, and PMNs were infused on 2 minutes after reperfusion. PMN adhesion (%), LVDP, LVEDP, +/-dP/dt, HR, and CF were measured pre- and postischemia. RESULTS: The addition of thiopental (25 microM) to the perfusate reduced the postischemic coronary vascular adhesion of PMNs (72.5+/-4.5% vs 40.0+/-7.4%, P < 0.05) and prevented postischemic myocardial dysfunction compared with group P (73.5+/-6.9% vs 48.4+/-3.0%, P < 0.05). CONCLUSIONS: Postischemic myocardial dysfunction is significantly more pronounced after PMN infusion. Thiopental reduced the postischemic coronary vascular adhesion of PMNs and attenuated the myocardial dysfunction, which was responsible at least in part, for the cardioprotective effect.
Animals ; Endothelium ; Guinea Pigs* ; Guinea* ; Heart* ; Ischemia ; Neutrophils* ; Reperfusion ; Reperfusion Injury ; Swine ; Thiopental*