3.Status Epilepticus in Adult Hospitalizde Patients: Cause and Clinical Outcome.
Hwi Chul CHOI ; Hong Ki SONG ; Byung Chul LEE
Journal of Korean Epilepsy Society 1999;3(2):174-179
Background AND PURPOSE: Status epilepticus (SE) is one of the major neurological emergency that requires immediate treatment to avoid significant morbidity and mortality. Thus, understanding the cause, features and prognosis of SE is important for the evaluation and treatment of this condition. We retrospectively reviewed the possible cause and clinical outcome of adult patients treated for SE at the Hallym Univrsity Hospital from 1994 to 1998. METHODS: For the identification of patients, we searched the data bank for patients meetinf criteria of SE who were 18 year or older, and their medical records were reviewed. We also investigated the relationships between cause, response to anticonvulsant therapy and short-term clinical outcome. RESULTS: The selected 127 patients wer 84 males and 43 females, aged 18 to 85 yeats (meen age: 49.5 years). The possible etiologies of SE were withdrawal of AED (n=27, 21.3%), anoxia (n=22, 17.3%), CNS infection (n=20, 15.7%), stroke (n=16, 12.6%), alcohol-related (n=15, 11.8%), metabolic (n=8, 6.3%), unknown (n=7, 5.5%), drug inroxicatio (n=5, 3.9%), trauma (n=4, 3.2%) and cerebral tumor (n=3, 2.4%). in 77 patients (n=77, 60.6%), SE was successfully aborted with first-line therapy, which usually included diazepam with or without phenytoin. The food responders to AEDs occurred in patients with AED withdrawal, alcohol-related, stroke, unknown, and trauma, The poor response related to anoxia, drug intoxication and CNS infection. Seventy nine patients (62.2%) had food outcome, but nineteen patients (14.9) were died. Anoxia, drug intoxication, CNS infection and metabolic abnormalities were associated with particularly poor outcome compared with other etiologies. CONCLUSION: This study indicates that the etiology of SE may help predict both the intial response to drug therapy and short-term clinical outcome.
Adult*
;
Anoxia
;
Diazepam
;
Drug Therapy
;
Emergencies
;
Female
;
Humans
;
Male
;
Medical Records
;
Mortality
;
Phenytoin
;
Prognosis
;
Retrospective Studies
;
Status Epilepticus*
;
Stroke
4.Plasma Hemoglobin in Recta1 or Intravenous Hydrogen Peroxide for Extrapulmonary Oxygenation.
Yonsei Medical Journal 1979;20(1):1-7
To study plasma hemoglobin cats were given serial enemas of 0.5 and 0.25% H2O2 with human who1e blood, single enemas of 0.5% H2O2 and single intravenous administration of 0.5% H2O2. Plasma hemoglobin levels were abnormally high in both the serial enema group and the intravenous group, while the plasma hemoglobin level was within normal range in the single enema group. Therefore a single enema of 0.5% H2O2 with human whole blood can be utilized with safety clinically for 60 to 75 minutes to relieve hypoxia.
Animal
;
Anoxia/drug therapy*
;
Blood*
;
Cats
;
Comparative Study
;
Enema
;
Female
;
Hemoglobins/analysis*
;
Hydrogen Peroxide/administration & dosage*
;
Hydrogen Peroxide/therapeutic use
;
Injections, Intravenous
;
Male
5.The Effects of Midazolam or Propofol Combined with Remifentanil Infusion for Central Venous Catheterization in Children.
Sang Hun RYU ; Jae Young KWON ; Hyeon Jeong LEE
Korean Journal of Anesthesiology 2007;52(6):669-674
BACKGROUND: Midazolam or propofol has been used for the procedural sedation in children. However, the combined use of remifentanil have not been widely investigated. The purpose of this study was to evaluate the effectiveness and safety of remifentanil infusion with intravenous anesthetics during the central venous catheterization in children. METHODS: After institutional review board approval and written informed consent from patients' parent, 20 children planned central venous catheterization for chemotherapy were randomly assigned into two groups. All patients were infused with remifentanil 0.1microng/kg/min. In M group, 0.3 mg/kg of midazolam bolus was injected and 0.1 mg/kg bolus were injected intermittently if the sedation was inadequate. In P group, 1.0 mg/kg of propofol bolus and 150microng/kg/min were infused. 0.5 mg/kg of propofol was given intermittently if the sedation was inadequate. Hemodynamic variables, end-tidal CO2 (EtCO2), bispectral index score (BIS) were monitored throughout the procedure. RESULTS: There were no significant differences in hemodynamic variables, sedation and recovery times. Oxygen saturation (SpO2) in P group was significantly lower than that of M group at 15 min after the start of infusion. EtCO2 in P group was significantly higher than that of M group at 10 min after the start of infusion. Hypoxemia (SpO2< 90%) were occurred in three patients of P group. There was no significant difference in BIS among the groups. CONCLUSIONS: The combined infusion of remifentanil 0.1microng/kg/min with midazolam provided successful sedation without airway assistance during the central venous catheterization in children.
Anesthetics, Intravenous
;
Anoxia
;
Catheterization, Central Venous*
;
Central Venous Catheters*
;
Child*
;
Drug Therapy
;
Ethics Committees, Research
;
Hemodynamics
;
Humans
;
Informed Consent
;
Midazolam*
;
Oxygen
;
Parents
;
Propofol*
6.Anesthetic Experience of Acquired Distal Tracheoesophageal Fistula: A case report.
Youn Suk SON ; Kyu Don CHUNG ; Hyun Sook CHO ; Sang Mook LEE ; Kuhn PARK ; Jong Ho LEE ; Ji Hyun CHUNG
Korean Journal of Anesthesiology 2006;50(3):346-350
A tracheoesophageal fistula (TEF) was detected in a woman who received chemotherapy for acute lymphoblastic leukemia. The fistula biopsy confirmed the aspergillus infection. A large fistula was located at the lateral wall of the carina involving the proximal left main bronchus, and the orifice of left main bronchus was almost completely obstructed by white mass-like plaque. Primary repair was planned using the right thoracotomy approach. We originally planned to selectively intubate the left lung with the aid of fiberoptic bronchoscope without success. Therefore, we selectively intubated the right lung. Hypoxemia developed during surgery and the level of oxygenation was improved by selectively intubating the left bronchus from the surgical field once the defect had been exposed. We review the ventilation technique and anesthetic problems encountered in patients with a large distal TEF.
Anoxia
;
Aspergillus
;
Biopsy
;
Bronchi
;
Bronchoscopes
;
Drug Therapy
;
Female
;
Fistula
;
Humans
;
Lung
;
Oxygen
;
Precursor Cell Lymphoblastic Leukemia-Lymphoma
;
Thoracotomy
;
Tracheoesophageal Fistula*
;
Ventilation
7.Expression of Hypoxia Inducible Factor-1alpha in Invasive Squamous Cell Carcinoma of Uterine Cervix Treated by Radiotherapy.
Kyung Ja LEE ; Min Sun CHO ; Seung Cheol KIM ; Hae Sung MOON ; Hyesook PARK ; Shi Nae LEE ; Sun Hee SUNG ; Ki Nam SHIM ; Kyung Eun LEE ; Sung Ae JUNG ; Kwon YOO ; Hae Young PARK ; Soo Yeun PARK ; Eun Sun YOO ; Hyun Suk SUH
Korean Journal of Pathology 2005;39(5):307-312
BACKGROUND: Hypoxia-inducible factor-1alpha (HIF-1alpha) is an intrinsic marker of tumor hypoxia, and this is associated with reduced radiosensitivity. Furthermore, HIF-1alpha can increase a tumor's aggressiveness by promoting neoangiogenesis, cell proliferation and survival, and invasion. METHODS: The expression of HIF-1alpha was was investigated by performing immunohistochemistry on the cervical tissue specimens obtained from 57 patients who had received radiotherapy combined with or without chemotherapy for stages I-III cervical squamous cell carcinoma. The staining results were compared with anemia, the stage, the radiotherapy response and patient survival by univariate and multivariate analysis. RESULTS: In 57 patients, the expression of HIF-1alpha was seen in the tissue specimens of 46 patients (81.7%). Among them, 25 (54.3%), 14 (30.4%), and 7 (15.2%) of the patients' tissue specimens showed weak, moderate and strong expressions, respectively. Six patients had a partial response after radiotherapy. Twelve patients (21.1%) died of cervical cancer. The increased expression of HIF-1alpha was significantly associated (p<0.05) with the disease stage and anemia. There were significant positive correlations between the increased expression of HIF-1alpha and the poor response after radiotherapy and the patients' survival. CONCLUSIONS: The present result suggests that the overexpression of HIF-1alpha in the uterine cervix could be used as a prognostic indicator for the patients treated with radiotherapy.
Anemia
;
Anoxia*
;
Carcinoma, Squamous Cell*
;
Cell Proliferation
;
Cervix Uteri*
;
Drug Therapy
;
Female
;
Humans
;
Hypoxia-Inducible Factor 1
;
Immunohistochemistry
;
Multivariate Analysis
;
Radiation Tolerance
;
Radiotherapy*
;
Uterine Cervical Neoplasms
8.Changes of SGOT and SGPT after Halothane, Enflurane and Thalamonal Anesthesia.
Yong Woo CHOI ; Seung Oh REW ; Ou Kyoung KWON ; Se Ung CHON
Korean Journal of Anesthesiology 1984;17(1):12-16
There are many factors which cause postoperative hepatic dysfunction or necrosis: chronic liver disease, viral infection, septicemia, severe burn, nutritional deficiency, previous or concommitant drug therapy, hypoxia, hypercarbia, hypotension and surgical procedures. Anesthetic agents are not the most common cause of postoperative hepatic dysfunction. But too frequently halothane is blamed for postoperative hepatic dysfunction, while other more likely causes are ignord. So, in order to in vestigate the effects of halothane, enflurane and thalamonal anesthesia on hepatic function, we compared with serum GOT, GPT level at preoperatively and postoperatively in 60 patients who had no liver disease previously and had no experience of general anesthesia. We divided them randomly in 3 groups: halothane administered group, enflurane administered group and thalamonal administered group. And serum GOT, GPT were checked preoperatively, postop, 24 hrs, and on postop, 6th day. Blood transfusion were not performed during this study. The result of this study reveals that there is no statistically significant difference in changes of SGOT, SGPT between halothane, enflurane and thalamonal group during postoperative period(p>0.05). This result show that the effect of halothane on hepatic function was not significantly different from those of enflurane and thalamonal.
Alanine Transaminase*
;
Anesthesia*
;
Anesthesia, General
;
Anesthetics
;
Anoxia
;
Aspartate Aminotransferases*
;
Blood Transfusion
;
Burns
;
Drug Therapy
;
Enflurane*
;
Halothane*
;
Humans
;
Hypotension
;
Liver Diseases
;
Malnutrition
;
Necrosis
;
Sepsis
9.Microenvironments and Cellular Proliferation Affected by Oxygen Concentration in Non-Small Cell Lung Cancer Cell Line.
Jong Wook SHIN ; Eun Ju JEON ; Hee Won KWAK ; Ju Han SONG ; Young Woo LEE ; Jae Woo JEONG ; Jae Cheol CHOI ; Jae Yeol KIM ; In Won PARK ; Byoung Whui CHOI
Tuberculosis and Respiratory Diseases 2007;63(3):242-250
BACKGROUND: Abnormal angiogenesis can induce hypoxia within a highly proliferating tumor mass, and these hypoxic conditions can in turn create clinical problems, such as resistance to chemotherapy. However, the mechanism by which hypoxia induces these changes has not yet been determined. Therefore, this study was conducted to determine how hypoxia induces changes in cell viability and extracellular microenvironments in an in vitro culture system using non-small cell lung cancer cells. METHODS: The non-small cell lung cancer cell line, A549 was cultured in DMEM or RPMI-1640 media that contained fetal bovine serum. A decrease in the oxygen tension of the media that contained the culture was then induced in a hypoxia microchamber using a CO2-N2 gas mixture. A gas analysis and an MTT assay were then conducted. RESULTS: (1) The decrease in oxygen tension was checked the anaerobic gas mixture for 30 min and then reoxygenation was induced by adding a 5% CO2-room air gas mixture to the chamber. (2) Purging with the anaerobic gas mixture was found to decrease the further oxygen tension of cell culture media. (3) The low oxygen tension resulted in a low pH, lactic acidosis and a decreased glucose concentration in the media. (4) The decrease in glucose concentration that was observed as a result of hypoxia was markedly different when different types of media were evaluated. (5) The decrease in oxygen tension inhibited proliferation of A549 cells. CONCLUSION: These data suggests that tumor hypoxia is associated with acidosis and hypoglycemia, which have been implicated in the development of resistance to chemotherapy and radiotherapy.
Acidosis
;
Acidosis, Lactic
;
Anoxia
;
Carcinoma, Non-Small-Cell Lung*
;
Cell Culture Techniques
;
Cell Line*
;
Cell Proliferation*
;
Cell Survival
;
Drug Therapy
;
Glucose
;
Hydrogen-Ion Concentration
;
Hypoglycemia
;
Oxygen*
;
Radiotherapy
10.Rituximab-induced Interstitial Pneumonitis in a Young Patient: A Case Report and Review of the Literature.
Dong Mee LEE ; Sung Yong OH ; Hyun Ah YOON ; Suee LEE ; Sung Hyun KIM ; Hyuk Chan KWON ; Soo Keol LEE ; Hyo Jin KIM
Korean Journal of Hematology 2007;42(4):423-427
Side effects of rituximab are mild in most cases, but there have been a few cases of severe pulmonary toxicity reported in elderly patients. Here we report a case of interstitial pneumonitis following rituximab treatment in a young patient. A 35-year-old woman with diffuse large B-cell lymphoma was admitted complaining of dry cough and dyspnea without fever after the 3 treatments with rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. Her chest CT with high-resolution CT scanning confirmed the presence of bilateral diffuse ground-glass opacities. The analysis of arterial blood gases indicated hypoxemia. The pulmonary function testing showed a restrictive pattern. There were no other findings suggesting an infection. The findings were compatible with a rituximab-induced interstitial pneumonitis. After the patient was treated with prednisolone, the symptoms resolved. Cases with rituximab-induced interstitial pneumonitis develop principally in elderly patients. However, the condition also can occur in young patients.
Adult
;
Aged
;
Anoxia
;
Cough
;
Doxorubicin
;
Drug Therapy
;
Dyspnea
;
Female
;
Fever
;
Gases
;
Humans
;
Lung Diseases, Interstitial*
;
Lymphoma, B-Cell
;
Prednisolone
;
Respiratory Function Tests
;
Tomography, X-Ray Computed
;
Vincristine
;
Rituximab