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

Cholelithiasis is rarely recognized in children, especially in infants. Hemolytic disorders, long-term total parenteral nutrition (TPN), congenital anomalies of the biliary tree leading to stasis of bile flow, congenital IgA-deficiency, furosemide treatment, and prolonged fasting have been reported as predisposing factors for cholelithiasis in childhood. Hemolytic disease of the newborn due to anti-E has rarely been reported as a risk factor for cholelithiasis. We report a case of gallbladder stones in a neonate associated with anti-E antibody hemolytic disease.
Bile ; Biliary Tract ; Child ; Cholelithiasis ; Fasting ; Furosemide ; Gallbladder ; Humans ; Infant ; Infant, Newborn ; Parenteral Nutrition, Total ; Risk Factors

Oral allergy syndrome (OAS) is a subtype of food allergy composing of itching sense and edema in the oral cavity, lips, throat, pharynx, and larynx following ingestion of some fresh fruits or vegetables. Although the major pathogenic mechanism of OAS is known to be IgE-mediated response, here we experienced a case of OAS due to crown daisy (CD) and sesame leaf (SL) mediated by a non-IgE antibody mediated mechanism. A 33-year-old female visited our clinic to evaluate numbness of the tongue and gingiva after eating fresh CD and SL for 2 years. The patient had suffered from allergic rhinitis and atopic dermatitis for 20 years and took medications intermittently. There had been a history of food allergy to crab and shrimp. The serum total IgE level was elevated (404 kU/mL). The skin prick test showed strong positive reactions to tree and weed pollens, but not to CD and SL extracts. Enzyme-linked immunosorbant assay for detecting serum specific IgE to crude extracts of CD and SL showed negative results. The basophil activation test performed with crude extracts of CD or SL showed significant up-regulation of CD63-positive basophils by both CD and SL. In conclusion, we report a case of OAS due to CD and SL, not associated with pollen allergy, which is shown to be mediated by a non-IgE mediated mechanism.
Adult ; Basophils ; Complex Mixtures ; Crowns* ; Dermatitis, Atopic ; Eating ; Edema ; Female ; Food Hypersensitivity ; Fruit ; Gingiva ; Humans ; Hypersensitivity* ; Hypesthesia ; Immunoglobulin E ; Larynx ; Lip ; Mouth ; Pharynx ; Pollen ; Pruritus ; Rhinitis ; Rhinitis, Allergic, Seasonal ; Sesamum* ; Skin ; Tongue ; Up-Regulation ; Vegetables

Allergen-specific immunotherapy (SIT) reduces allergen specific IgE (sIgE) levels and achieves clinical and immunological tolerance by modulating innate and adaptive immunological responses. Increased temperature and CO2 concentrations caused by climate changes contribute to an increase of pollen count and allergenicity that influences clinical SIT outcomes. In this study, we investigated the changes of IgE binding components to tree and weed pollens in pollinosis patients who showed a paradoxical increase of serum sIgE level during pollen-SIT. We enrolled nine patients who showed an increasing pattern of serum sIgE level to alder, birch, ragweed and mugwort pollens by enzyme-linked immunosorbant assay. IgE immunoblot analysis confirmed the intensification or new generation of major IgE binding components that could be induced by climate change. The findings suggest that the regular monitoring of sIgE levels and symptom changes is required to improve the clinical outcomes of SIT in patients undergoing SIT for tree and weed pollens.
Adult ; Climate Change ; *Desensitization, Immunologic ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin E/*blood ; Male ; Middle Aged ; Pollen/immunology ; Rhinitis, Allergic, Seasonal/*therapy ; Skin Tests ; Young Adult

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