BACKGROUND: Intravenous patient-controlled analgesia (IV-PCA) has been widely used for pain relief after cesarean delivery under epidural anesthesia. However, IV-PCA alone has a limited effect on early postoperative pain relief. Epidural morphine injected intraoperatively could alleviate the early postcesarean pain. We evaluated the effects and side effects of intraoperative epidural morphine on postoperative IV-PCA. METHODS: Forty patients scheduled for cesarean section under epidural anesthesia were randomly assigned to one of two groups. The patients in the intravenous group (IV group, n = 20) received intravenous morphine 3 5 mg after the operation in the recovery room when patients complain of pain, and the patients in the epidural group (EPI group, n = 20) received intraoperative epidural morphine 3 mg after fetus delivery. After that, both groups received morphine IV-PCA (no basal infusion, bolus 1.0 mg, lock-out time 6 min). Analgesic efficacy, degree of patient satisfaction, drug consumption and side effects were compared at 4 and 24 hours after surgery. RESULTS: The EPI group had significantly lower VAS for pain at 4h after surgery on movement and resting than the IV group, whereas no significant difference was observed at 24h after surgery. The cumulative morphine consumptions at 4h and 24h after surgery were more in the IV group (each, P < 0.001). Fewer patients in the EPI group had drowsiness at 24h after surgery, but there were no significant differences in other side effects and degree of satisfaction between the two groups. CONCLUSIONS: We conclude that intraoperative epidural morphine was effective with less side effects for postoperative IV-PCA in the cesarean patients under epidural anesthesia.
Analgesia, Patient-Controlled* ; Anesthesia, Epidural ; Cesarean Section ; Female ; Fetus ; Humans ; Morphine* ; Pain, Postoperative ; Patient Satisfaction ; Pregnancy ; Recovery Room ; Sleep Stages

No abstract available.
Burn Units ; Burns ; Humans ; Nurse Clinicians

BACKGROUNDS: As the elderly population in-creases the health problem, especially dementia, becomes the clinically important problem. So in the part of primary care medicine it becomes so important that family physician make a focus on the detection, evaluation, and management of demented patient. Until nowadays there is few cohort study about the dementia and few nursing home in Korea. So author performed the MMSE-K in the elderly who are over 65 to get the cognitive function for early diagnosis, management and rehabilitation of psychosocial problem. METHODS: One hundred three persons who included in community society in Seoul and nursing home of Kyunggido were tested. The survey was done twice on september 1997 and September 1998. Author used the MMSE-K to the elderly by same doctors. The analysis was done by SAS 6.12 and t-test, one-way ANOVA and two-way ANOVA with linear trend test. RESULTS: The mean of first MMSE-K score in the community is 26.1 and in the nursing home is 24.4. And the mean of second MMSE-K score in the community is 25.5 and in the nursing home is 22.0. The MMSE-K score is elevated with male and longer duration of education and is decreased with the advanced age in two groups. According to the classification by MMSE-K score the number of people who have normal cognitive function is 45(43.7%), mild impaired cognitive function is 45(43.7%), moderately impaired cognitive function is 13(12.6%) and none has severely impaired cognitive function in both groups. The follow up MMSE-K score shows that the difference of two MMSE-K scores increases as the age increases. CONCLUSION: Until todays there is few study that designed in the form of cohort study about the elderly cognitive function in Korea. So family physicians must perform the prospective cohort study with the consistent concern and effort to get the research data about the dementia for earthy detection, management and rehabilitation for elderly.
Aged* ; Classification ; Cohort Studies ; Dementia ; Early Diagnosis ; Education ; Follow-Up Studies* ; Gyeonggi-do ; Humans ; Korea ; Male ; Nursing Homes ; Physicians, Family ; Primary Health Care ; Rehabilitation ; Seoul

No abstract available.
Antibodies ; Immunoglobulin E

BACKGROUND: Maternal serum triple marker screening (alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol) can detect 60-70% of Down syndrome and 60% of Edwards syndrome. Previous studies have reported that positive serum screening is related to other fetal chromosomal abnormalities, pregnancy complications, and adverse outcomes. We determined the incidence and karyotype of chromosomal abnormalities in screen positive women and evaluated a relationship between chromosomal and ultrasonographic abnormalities. METHODS: Of the 49,806 pregnant women between 15 and 23 weeks' gestational age who received prenatal serum screening with a cut-off value (a risk of 1:270 for Down and 1:100 for Edwards syndrome), 2,116 (4.2%) and 196 (0.4%) were screen positive for Down syndrome and for Edwards syndrome, respectively. Chromosomal analysis in amniotic fluid was performed for 1,893 (89.5%) of the Down positive and 140 (71.4%) of the Edwards positive pregnant women. Ultrasonographic examination was performed to detect fetal abnormalities. RESULTS: Eighty-three cases of chromosomal abnormalities including 40 trisomy 21 (2.1%) and 43 other chromosomal abnormalities (2.3%) were identified in the Down screen positive. Other chromosomal abnormalities included 9 numerical and 34 structural abnormalities. Ten cases of chromosomal abnormalities (9 trisomy 18 and 1 trisomy 9) were detected in the Edwards screen positive. Ultrasonographic abnormalities were found more frequently in the women who had chromosomal aberrations. CONCLUSIONS: These data suggest that 4.4% of the Down screen and 7.1% of the Edwards screen positive pregnancy have fetal chromosomal abnormalities. Positive Down screening results reflect a relatively high probability of other abnormalities except trisomy 21. Edwards screen positive group show a low frequency of other chromosomal abnormalities except trisomy 18. A simultaneous use of maternal serum screening and ultrasonograms could be useful for the diagnosis of fetal abnormalities.
Amniotic Fluid ; Chorionic Gonadotropin ; Chromosome Aberrations ; Diagnosis ; Down Syndrome ; Female ; Gestational Age ; Humans ; Incidence ; Karyotype ; Mass Screening ; Pregnancy ; Pregnancy Complications ; Pregnant Women* ; Trisomy ; Ultrasonography

Baker's asthma is the most prevalent occupational asthma, and IgE-mediated response is known as a major pathogenesis. However, recent studies have suggested the involvement of innate immune response because wheat flour contains bacterial endotoxins or lipopolysaccharides. To further understand a role of innate immune response in the development of work-related respiratory symptoms (WRS) in bakery workers, we investigated mannose-binding lectin (MBL), one of the initiating components of the complement cascade in a single cohort of bakery workers. A total of 373 bakery workers completed a questionnaire regarding WRS. The bakery workers were divided into 2 groups according to previous history of allergic rhinitis (AR)/bronchial asthma (BA): those with history of AR/BA (group I) and those without (group II). We measured serum MBL levels by using enzyme-linked immunosorbant assay and genotyped 4 single nucleotide polymorphisms of the MBL2 gene (226G>A in exon 1, -554G>C, -431A>C, and -225G>C in the promoter) by using TaqMan assays. Fifty-nine subjects (15.5%) were previously diagnosed with AR/BA, and 64 subjects (16.8%) complained of WRS. No significant differences were found in serum MBL levels between groups I and II. However, in group II subjects, but not in group I subjects, the serum MBL levels were significantly higher in bakery workers with WRS than in those without. In addition, the serum MBL levels were significantly different according to genetic polymorphisms of the MBL2 gene and its haplotypes. In conclusion, serum MBL, affected by genetic polymorphisms, may be associated with WRS in bakery workers with no previous history of AR/BA.
Asthma ; Asthma, Occupational ; Cohort Studies ; Complement System Proteins ; Endotoxins ; Exons ; Flour ; Haplotypes ; Immunity, Innate ; Lipopolysaccharides ; Mannose-Binding Lectin ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Rhinitis, Allergic ; Triticum

PURPOSE: Pollinosis is one of the major allergic diseases caused by airborne pollens. Alder and birch pollens are the major sensitizing tree pollens in this country. The immunoglobulin E (IgE) reactivity to each pollen allergen is known to be variable according to the region. We determined the major IgE binding components of these tree pollens in sera of adult patients with allergic rhinitis. METHODS: Allergic rhinitis patients, of whom specific IgE level to birch and/or alder pollens (>10 kU/L by ImmunoCAP) were included. The protein bands of two pollen extracts were determined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis, and their IgE-binding components were identified by IgE immunoblot analysis. The binding specificity and cross-reactivity between two pollens were evaluated by IgE enzyme linked immunosorbent assay (ELISA) inhibition test. RESULTS: Six IgE binding components were found in birch pollens in which two (14 kDa and 17 kDa) were major components. Two IgE binding components were found in alder pollens in which the 17 kDa was a major component. The IgE binding component to the major allergen component of 17 kDa was observed in 90.3% of the study subjects sensitive to alder pollens and 72.7% of them sensitive to birch pollens. The ELISA inhibition tests showed significant inhibitions with additions of birch/alder pollen extracts. CONCLUSION: We identified two major IgE binding components (17 kDa and 14 kDa) from birch pollens and one component (17 kDa) from alder pollens. Significant cross reactivity was noted between these two pollens.
Adult ; Allergens ; Alnus ; Betula ; Cross Reactions ; Electrophoresis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoblotting ; Immunoglobulin E ; Immunoglobulins ; Pollen ; Rhinitis ; Rhinitis, Allergic, Perennial ; Rhinitis, Allergic, Seasonal ; Sodium

BACKGROUND: Epidural "top-up" has been known to enhance spinal anesthesia in combined spinal-epidural anesthesia. Saline and local anesthetics were reported to have a volume effect when infused as epidural "top-up". In cesarean deliveries where high sensory block has been achieved using a combined spinal-epidural technique, we evaluated the effects of epidural "top-up" on the underlying spinal block. METHODS: Sixty-six parturients were allocated randomly into group C (control, n = 21), S (saline, n = 21), or B (bupivacaine, n = 24). Ten minutes after they received 8 mg of 0.5% hyperbaric bupivacaine intrathecally, nothing, 10 ml saline, or 10 ml of 0.25% bupivacaine were infused, respectively. The sensory level at 10 min, the maximal level and the time to reach it, and degrees of motor block and muscle relaxation were compared. We also investigated intraoperative side effects and postoperative findings in the PACU. RESULTS: There were significant changes in sensory level after epidural top-ups in the group S and B, but no differences in maximal height of sensory block and degree of muscle relaxation among the groups. Intraoperative pain was complained in fewer patients in the group B. Times to sensory and motor recovery were longer in patients of the group B. CONCLUSIONS: Eight milligrams of hyperbaric bupivacaine using a combined spinal-epidural technique was not sufficient for cesarean section. Epidural saline top-up showed volume effect, which didn't improve the spinal block. Epidural "top-up" of 0.25% 10 ml bupivacaine enhanced the spinal block and sustained the block postoperatively.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Cesarean Section* ; Female ; Humans ; Muscle Relaxation ; Pregnancy

PURPOSE: Ragweed and mugwort pollens are the major weed allergens that cause pollinosis in Korea. The IgE-binding components to these 2 pollens and their cross-reactivity have not been reported in Korea, while several reports had been made in Western countries. We investigated IgE-binding components to ragweed and mugwort pollens and their allergenic relationship in patients sensitive to the 2 pollens. METHODS: We enrolled 33 allergic rhinitis patients with typical seasonal pollinosis symptoms in autumn and elevated serum specific IgE levels to ragweed and/or mugwort pollens (>10 kU/L by ImmunoCAP). The protein bands of the 2 pollen extracts were determined using sodium dodecyl sulphate-polyacrylamide gel electrophoresis, and IgE immunoblot analysis was performed to determine the IgE-binding components of each pollen extract. Enzyme-linked immunosorbent assay (ELISA) inhibition and immunoblot inhibition tests were performed to evaluate the cross-reactivity between ragweed and mugwort pollen extracts. RESULTS: Eight IgE-binding components (9, 10, 11, 12, 27, 30, 38, and 80 kDa) were found in ragweed pollen extracts, of which 4 (38, 11, 27, and 80 kDa) were major IgE-binding components. Eight IgE-binding components (10, 14, 16, 20-24, 26-30, 42, 60-66, and 80-90 kDa) were found in mugwort pollen extracts, of which 2 components (26-30 and 20-24 kDa) were major IgE-binding components. No significant inhibitions were noted between ragweed and mugwort pollen extracts by the ELISA inhibition test. No significant changes were noted in IgE immunoblot inhibition analysis. CONCLUSION: We identified 4 major IgE-binding components (38, 11, 35, 27, and 80 kDa) in ragweed pollens and 2 major IgE-binding components (26-30 and 20-24 kDa) in mugwort pollens. No cross-reactivity was found between ragweed and mugwort pollens.
Allergens ; Ambrosia* ; Artemisia* ; Cross Reactions ; Electrophoresis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin E* ; Korea ; Pollen* ; Rhinitis ; Rhinitis, Allergic, Seasonal ; Seasons ; Sodium

BACKGROUND: Aspirin/NSAIDs can release cysteinyl-leukotriene (cys-LTs) into airways and precipitate asthmatic symptoms in aspirin - induced asthma(AIA). It has been reported that there is profound overexpression of LTC4 synthase in their bronchial mucosa, compared to aspirin-tolerant asthma. Objective : We observed whether genetic polymorphism of LTC4 synthase may be predisposed to LTC4 synthase overexpression in AIA. Subject and METHOD: Forty - four AIA patients having positive responses on lysin aspirin bron choprovocation tests and 47 non - aspirin induced asthma ( non - AIA ) patients having negative challenges and 32 healthy controls were enrolled. The genotypes of the promoter LTC4 synthase gene ( A,C transversion ) were determined by polymerase chain reaction and restriction fragment length polymorphism ( RFLP ) method. RESULTS: LTC4 synthase promoter polymorphism ( A444C btransversion) was not significantly different between non - AIA and AIA patients (p>0.05). Conclusion These findings suggest that genetic polymorphism of LTC4 synthase promoter may not be predisposed to LTC, synthase overexpression in AIA.
Aspirin* ; Asthma* ; Asthma, Aspirin-Induced ; Genotype ; Humans ; Leukotriene C4* ; Mucous Membrane ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length