No abstract available.
Aeromonas* ; Enterotoxins*

BACKGREOUND: Tetracaine has been the most commonly used spinal anesthetic agent. Recently bupivacaine has been found to be a useful agent, and has been reported not to cause neurologic complications as well as being a better quality anesthetic. The purpose of this study was to compare the anesthetic effects of bupivacaine with that of tetracaine. METHODS: Forty patients undergoing lower abdomen and lower limb operation were randomly allocated to two groups. Group I (n=20) received 15mg, 0.5% tetracaine in 10% dextrose, while Group II (n=20) received 15mg, 0.5% bupivacaine in 8% dextrose. After intrathecal injection of the agent at the level of L3-4 intervertebral space, the changes in sensory and motor block, blood pressure and heart rate were measured in two groups. RESULTS: The onset time of sensory block was more rapid in Group I than in Group II. Two segment regression time of sensory block was significantly longer in Group II than in Group I (p<0.05). The time for maximum motor block was shorter in group I than in Group II (p<0.05), but the duration of decreased motor block was significantly longer in Group I. The change of systolic blood pressure in Group II was less than the change in Group I. CONCLUSIONS: Bupivacaine has a longer sensory block duration, a weaker, shorter motor block duration and yields a less change in systolic blood pressure than tetracaine in spinal anesthesia.
Abdomen ; Anesthesia, Spinal* ; Anesthetics ; Blood Pressure ; Bupivacaine* ; Glucose ; Heart Rate ; Humans ; Injections, Spinal ; Lower Extremity ; Tetracaine*

Consideration of the nutritional status of patients with acute respiratory failure and mechanical ventilation is important for effective patient assessment and management. Patients with acute respiratory failure are at a high risk for developing malnutrition. High glucose intakes given during the administration of total parenteral nutrition (TPN) have been demonstrated to increase CO2 production. The workload imposed by the high CO2 production may precipitate respiratory distress in patients experiencing compromised pulmonary function. The authors report a case of successful weaning from mechanical ventilation in patient with post-operative ARDS by proper nutritional support and by changing the proportion of calories derived from carbohydrates and fats. Substitution of fat calories for carbohydrate in TNA solutions can reduce CO2 production and help wean patients from mechanical ventilation. Conclusively, the TNA (total nutrients admixture) system is more beneficial to patients with acute respiratory failure due to less CO2 production and surfactant production than TPN. For patients with hypercapnia, providing 25% to 30% of calories as carbohydrate and 50% to 55% of calories from fat may be beneficial.
Carbohydrates ; Fats ; Glucose ; Humans ; Hypercapnia ; Malnutrition ; Nutritional Status ; Nutritional Support* ; Parenteral Nutrition, Total ; Respiration, Artificial ; Respiratory Insufficiency* ; Ventilator Weaning* ; Ventilators, Mechanical* ; Weaning

BACKGROUND: The National Committee for Clinical Laboratory Standards (NCCLS) recommends that the analytical variability must not exceed 25% of the biological variability in automated blood cell analysis. This study was conducted to determine whether routine automated blood cell analysis by Coulter STKS (Coulter Corp., Miami, FL, U.S.A) comforms with the NCCLS's recommendations. METHODS: Routine CBC analysis with STKS was performed on 22 healthy volunteers. The tests included calculating WBC, RBC, hemoglobin, MCV, platelet, MPV, and percentages of the granulocytes, lymphocytes, and monocytes. Blood samples were collected twice in one week interval to study the total variability. For the analytical variability, blood samples from 12 subjects were tested twice immediately after venipuncture for within-run variability, and samples from 10 subjects were tested immediately and 6 hours after venipuncture for within-day variability. The analytical variability was calculated as the sum of within-run and within-day variabilities. The biological variability was calculated by subtracting the analytical variability from total variability. The ratios of analytical and biological variabilities were calculated by dividing the analytical variability by the biological variability. RESULTS: Ratios of analytical and biological variabilities were as follows: 0.22 for WBC, 0.20 for RBC, 0.21 for hemoglobin, 0.39 for platelet, 1.98 for MPV, 0.07 for %granulocyte, 0.11 for %lymphocyte, and 1.81 for %monocyte. The ratio for MCV was not obtained because the analytical variability exceeded total variability. CONCLUSIONS: The analytical variability did not exceed 25% of the biological variability in all test categories except platelet, MPV and the percentage of monocyte. Thus, it is recommended that the analytic variability of all test categories be reduced so as to be in conformity with the NCCLS' recommendations.
Blood Cells* ; Blood Platelets ; Granulocytes ; Healthy Volunteers ; Lymphocytes ; Monocytes ; Phlebotomy

Most acinic cell carcinomas arise within the parotid gland: extraparotid origin is rare. We encountered three cases of extraparotid acinic cell carcinoma arising in the buccal or palatal region, or the submandibular gland. All three tumors presented as a painless, slow-growing mass. CT imaging indicated that they were well defined, homogeneously enhanced, round masses. In one case, sonography demonstrated relatively homogeneous low echogenicity.
Acinar Cells* ; Carcinoma, Acinar Cell* ; Parotid Gland ; Salivary Glands ; Submandibular Gland

This study examined the relationship between anger expression or alexithymia and coronary artery stenosis in patients with coronary artery diseases. 143 patients with coronary artery diseases (104 males and 39 females) were enrolled in this study. The severity of their coronary artery stenosis was measured by angiography. The Anger Expression Scale and the Toronto Alexithymia Scale were used to assess the level of anger expression and alexithymia. The more stenotic group (occluded by 75% or more) exhibited a significantly higher level of alexithymia than the less stenotic group (occluded by less than 25%). Multiple regression anaylsis on the extent of stenosis also revealed that regardless of gender and age, the coronary artery disease patients with higher alexithymia were likely to show a greater level of stenosis. However, no significant differences were found on either the anger-in or anger-out subscale scores between the two groups. These results suggest that alexithymia is associated with the severity of coronary artery stenosis in patients with coronary artery disease. However, both anger expression and anger suppression were not shown to be associated with the severity of coronary artery stenosis.
Adult ; Affective Symptoms/*epidemiology ; Aged ; *Anger ; Coronary Stenosis/*epidemiology/*psychology ; Female ; Human ; Male ; Middle Aged ; Risk Factors ; Severity of Illness Index

PURPOSE: To report a case of uveitis in both eyes caused by Sweet's syndrome. CASE SUMMARY: A 66-year-old male presented with decreased visual acuity in his left eye. Three years prior he was diagnosed with Sweet's syndrome, with symptoms such as chill, fever and, maculopapular rash on the chest. At initial physical examination, he had 3 or 4+ inflammatory cells and flare in the anterior chambers of both eyes, as well as hypopyon in his left eye. Under the suspicion of uveitis caused by Sweet's syndrome, he was rescribed an IV steroid injection and topical steroid agent. Three days later, his visual acuity improved to 0.3 in the right eye and 0.2 in the left eye. Hypopyon in the left eye disappeared and inflammatory cells decreased to 1~2+. He showed signs of recurrence in both eyes after 5 months and was treated with posterior subtenon triamcinolone injection in each eye. The patient showed no signs of recurrence for 10 months after injection. CONCLUSIONS: We report a case of uveitis caused by Sweet's syndrome treated with a steroid agent resulting in good prognosis. To the best of our knowledge, this is first case of uveitis caused by Sweet's syndrome reported in Korea.
Aged ; Anterior Chamber ; Exanthema ; Fever ; Humans ; Korea ; Male ; Physical Examination ; Prognosis ; Recurrence ; Sweet Syndrome* ; Thorax ; Triamcinolone ; Uveitis* ; Visual Acuity

BACKGROUND: Severe respiratory variations of systolic arterial and central venous pressure (CVP) may increase the risk of embolic event in orthopedic patient. As airway obstruction during sedation can cause this respiratory variation, we evaluated the degree of variations of systolic blood (SBP) and CVP during airway obstruction period. METHODS: Fifteen females who had obstructed airway during total knee replacement (TKR) were included for the study. After regional anesthesia were established, SBP and CVP variations were analyzed according to the three periods; baseline, obstruction, and airway, respectively. Calculated CVP variables were similar to SBP variables as below: DeltaSBP = Expmax (maximal value at expiration) - Inspnadir (minimal value at inspiration), %DeltaSBP = (DeltaSBP/ Exp(max)) x 100. The frequencies of pulsus paradoxus (PP) and negative inspiratory CVP (NIC) were also measured. RESULTS: At obstruction period, DeltaSBP was 21.7 mmHg and 93.3% of patient had PP. Also, DeltaCVP was 19.3 mmHg and 100% of patient showed NIC. %DeltaCVP (140%) was larger than %DeltaSBP (16%). And DeltaCVP was inversely correlated with baseline and obstruction SBP and %DeltaCVP was also inversely correlated with baseline CVP at obstruction period. CONCLUSIONS: During airway obstruction in sedated TKR patients, variations of CVP are larger than those of SBP. So we have to monitor CVP continuously as well as SBP so as not to increase the possible risk of respiratory of variation.
Airway Obstruction ; Anesthesia, Conduction ; Arthroplasty, Replacement, Knee ; Central Venous Pressure ; Female ; Humans ; Organothiophosphorus Compounds ; Orthopedics

PURPOSE: Various factors have been cited in the morbidity of small bowel resections, but their clinical importance is uncertain. We wanted to know what were the significant risk factors elevating the morbidity and how to reduce the morbidity of small bowel resections effectively. METHODS: A retrospective study was done for 107 patients who had undergone small bowel resections from Jan. 1992 to Jul. 1999. The patients were evaluated based on sex and age, the cause and site of resection, the presence of previous abdominal operations, the morbidity, the mortality, and the cause of death in order to determine their clinical significance for small bowel resections. Also the differences of morbidity were analyzed according to the risk factors of old age, pre-op hypotension and hypoalbuminemia, the cause of resection, emergency operation, the presence of a previous abdominal operation, the length of the resection, the presence of associated chronic illness, and spillage of the intestinal content. RESULTS: Complications after small bowel resections occurred in 41 cases (38.3%). The morbidity was significantly increased in the cases with associated chronic illness and spillage of intestinal content by perforation combined with strangulation (p<0.05). Factors such as old age, hypotension, hypoalbuminemia, cause of resection, emergency operation, the length of the resection and spillage of intestinal contents by simple perforation elevated the morbidity, but this result is not statistically significant (0.050.5). CONCLUSIONS: We concluded that intensive peri-operative care, a rapid and precise operative technique, and the surgeon's efforts can decrease the morbidity and the mortality after small bowel resections. The selection of the high risk patients should be done based on the surgeon's knowledge of the risk factors including associated chronic illness, and cumulative data obtained by using instituted surveillance for morbidity.
Cause of Death ; Chronic Disease ; Emergencies ; Gastrointestinal Contents ; Humans ; Hypoalbuminemia ; Hypotension ; Mortality ; Retrospective Studies ; Risk Factors*

Primary Pigmented Nodular Adrenal Dysplasia (PPNAD) is a rare cause of Cushing's syndrome in infants and young adults. The familial occurrence, it may be variably associated with a complex of other pathologic characteristics that manifests extraadrenal disorders (includes cardiac myxomas, lentigines, mammary myxoid lesions, testicular tumors, pituitary adenomas, and neuroectodermal tumors) was considered indicative of Carneys complex. This was based on the failure of cortisol suppression by high-dose dexamethasone, either normal or suppressed basal adrenocorticotropic hormone (ACTH) levels, and normal radiographic studies of the sellar turcica, and adrenals glands is almost normal or slightlg eulaged.. Bilateral adrenalectomy has thus the only effective means of cure. The disease may be a component of a rare, but potentially dangerous complex of abnormalities that follow an autosomal-dominant mode of inheritance. Recently we experienced a case of Carney's complex composed by Cushings syndrome due to PPNAD with familial purple colored lentigines on their lips and report it with reviews of the literatures.
Adrenalectomy ; Adrenocorticotropic Hormone ; Cushing Syndrome* ; Dexamethasone ; Humans ; Hydrocortisone ; Infant ; Lentigo ; Lip ; Myxoma ; Neural Plate ; Pituitary Neoplasms ; Testicular Neoplasms ; Wills ; Young Adult