Patients with human immunodeficiency virus (HIV) infection have a higher burden of seizures, but few studies have examined seizures in HIV-infected individuals in Korea. A retrospective study was conducted to determine the epidemiology and clinical characteristics of seizures in patients with HIV infection. Among a total of 1,141 patients, 34 (3%) had seizures or epilepsy; 4 of these individuals had epilepsy before HIV infection, and the others showed new-onset seizures. Most patients exhibited moderate (200 to 500, n = 13) or low (below 200, n = 16) CD4 counts. The most common seizure etiology was progressive multifocal leukoencephalopathy (n = 14), followed by other HIV-associated central nervous system (CNS) complications (n = 6). Imaging studies revealed brain lesions in 21 patients. A total of 9 patients experienced only one seizure during the follow-up period, and 25 patients experienced multiple seizures or status epilepticus (n = 2). Multiple seizures were more common in patients with brain etiologies (P = 0.019) or epileptiform discharges on EEG (P = 0.032). Most seizures were controlled without anticonvulsants (n = 12) or with a single anticonvulsant (n = 12). Among patients with HIV infection, seizures are significantly more prevalent than in the general population. Most seizures, with the exception of status epilepticus, have a benign clinical course and few complications.
Adult ; Aged ; Anticonvulsants/therapeutic use ; Causality ; Comorbidity ; Electroencephalography/*statistics & numerical data ; Female ; HIV Infections/diagnosis/*epidemiology ; Humans ; Incidence ; Longitudinal Studies ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Risk Factors ; Seizures/*diagnosis/*epidemiology/prevention & control ; Treatment Outcome

OBJECTIVES: This study examined how ethanolamines (EAs) with the same functional alcohol group (HOCH2CH2), such as mono-EA (MEA), di-EA (DEA), and tri-EA (TEA), in water-based metalworking fluids (wbMWFs) are vaporized, condensed, and transformed by heat generated during metalworking. METHODS: Two types of experimental apparatus were manufactured to achieve these objectives. RESULTS: Vaporization tests using a water bath showed that the vaporization rate increased markedly from 0.19 mg/m2.min at 23.5degrees C to 8.04 mg/m2.min at 60degrees C. Chamber tests with a heat bulb revealed that "spiked" MEA was fully recovered, while only 13.32% of DEA and no TEA were recovered. Interestingly, non-spiked types of EAs were detected, indicating that heat could convert EAs with more alcohol groups (TEA or DEA) into other EAs with fewer group(s) (DEA or MEA). The EA composition in fresh fluid was 4% DEA, 66% TEA, and 30% MEA, and in used fluids (n = 5) was 12.4% DEA, 68% TEA, and 23% MEA. Conversion from TEA into DEA may therefore contribute to the DEA increment. Airborne TEA was not detected in 13 samples taken from the central coolant system and near a conveyor belt where no machining work was performed. The DEA concentration was 0.45 mg/m3 in the only two samples from those locations. In contrast, airborne MEA was found in all samples (n = 53) regardless of the operation type. CONCLUSION: MEAs easily evaporated even when MWFs were applied, cleaned, refilled, and when they were in fluid storage tanks without any metalworking being performed. The conversion of TEA to DEA and MEA was found in the machining operations.
Baths ; Ethanolamines ; Hot Temperature ; Tea ; Volatilization ; Water

OBJECTIVE: To study the erectile response to intracavernosal injection of prostaglandin E1 in 33 spinal cord injured men with neurogenic erectile dysfunction. METHOD: The erectile response was assessed by the penile palpation. Thirty three subjects (mean age, 35.5 years) were studied. They received a testing dosage starting from 2.5 microgram with increasing dosage (maximum 40 microgram) to achieve an erection. The positive response accounts for the sufficient erection lasting for more than 30 minutes. RESULTS: After the injection, 30 subjects (90.9%) achieved the positive response and the mean duration of erection was 59.2 minutes. Of the 30 positive responders, the mean dosage needed to induce positive response was 5.8 microgram in the patients with cervical cord injury (12 subjects), 13.1 microgram in the patients with thoracic cord injury (12 subjects), and 33.3 microgram in the patients with lumbar cord injury (6 subjects). The mean dosage required for the positive response was different according to the pre-injection erectile function of the subjects. For the positive response, it required 7.7 microgram in a full erection with short duration group (14 subjects), 9.4 microgram in a partial erection group (8 subjects), and 30.6 microgram in no erection group (8 subjects). No systemic side effect or complication was noted except for the prolonged erection in 1 subject. CONCLUSION: The intracavernosal injection of prostaglandin E1 appears to be a safe and effective treatment for the treatment of erectile dysfunction in spinal cord injured men. The dosage depends on the level of spinal cord injury and pre-injection erectile function.
Alprostadil* ; Erectile Dysfunction ; Humans ; Male ; Palpation ; Spinal Cord Injuries ; Spinal Cord*

No abstract available.
Angiography ; Arterial Occlusive Diseases ; Lower Extremity

BACKGROUND: Rabies is an acute fatal viral disease generally transmitted from infected animals to humans through bites. It is distributed worldwide. The number of Korean people traveling to rabies-endemic countries and being bitten by infected animals has been increasing recently. Therefore, we investigated international travelers who received rabies post-exposure prophylaxis (PEP) at the National Medical Center (NMC) and compared the data with those of other clinics. MATERIALS AND METHODS: This study was a retrospective review of 106 patients who visited the International Travel Clinic of the NMC and received rabies PEP between July 2006 and December 2012. During that period, we used the Essen intramuscular regimen protocol. Complete rabies PEP was defined as 5 doses of rabies vaccination with or without rabies immunoglobulin (RIG) administration according to the World Health Organization guidelines. RESULTS: A total 106 cases documented within the period of 6 years were selected, including 10 children younger than 15 years and 96 older than 15 years. The mean age of the patients who received PEP was 33.4 years. Of the patients, 53 were male and another 53 were female. Most of the exposures occurred in Southeast Asia, predominantly from dog bites (71, 66.9%). The lower extremities were the most frequent site of exposure (37, 34.9%). All the patients began receiving rabies vaccination for prophylaxis after exposure, and 51 received rabies vaccination with RIG. Meanwhile, 74 cases (69.8%) initiated rabies vaccination overseas, but only 10 of them received RIG while overseas; the remaining 32 (30.2%) initiated rabies vaccination after returning to Korea. Within 7 days, all the children and 74 adults received their first rabies vaccination. Six adults initiated first rabies vaccination after 1 week. Eleven of the 106 patients stopped PEP before 5 doses, among whom 4 (1 child and 3 adults) discontinued vaccination after confirming that the biting animal remained healthy throughout 10 days of observation. None of the patients had been previously vaccinated against rabies. CONCLUSIONS: Most of the overseas travelers who visited our clinic after being bitten by suspected rabid animals received appropriate rabies PEP. However, the interval between exposure and first rabies vaccination was often delayed. Tourists who plan to travel in rabies enzootic regions need to be aware that prompt initiation of PEP is important to reduce the risk for developing human rabies.
Adult ; Animals ; Asia, Southeastern ; Child ; Dogs ; Female ; Humans ; Immunoglobulins ; Korea* ; Lower Extremity ; Male ; Post-Exposure Prophylaxis* ; Rabies* ; Retrospective Studies ; Vaccination ; Virus Diseases ; World Health Organization

BACKGROUND: The opportunistic imperfect fungus Candida albicans causing life-threatening infections in immunocompromised patients is recognized to be one of important nosocomial pathogens. Recently, an outbreak of septicemia caused by C. albicans was occured in neonatal intensive care unit (NICU) of Chungbuk university hospital. To investigate the molecular epidemiology of these infections, we analyzed genotypes of C. albicans isolates from NICU and non-NICU. METHODS: Fourteen isolates of C. albicans were used for intraspecies genotyping, which were composed of 9 isolates from NICU and 5 isolates from non-NICU from January to April 1998. Each three isolates of C. albicans, C. parapsilosis and C. tropicalis were used for interspecies genotyping. The genotyping were analyzed by RAPD with four random primers. RESULTS: The genotypes of C. albicans isolates from immature neonates in NICU were identical with those from medical persons in NICU but different with those from patients in non-NICU. Interspecies RAPD profiles were more distinctive than intraspecies RAPD profiles. The reproducibility of RAPD showed good result. CONCLUSION: These results show that C. albicans isolated from NICU disclose the same RAPD genotype, which suggests the clonal origin, and RAPD can be the useful method for the epidemiological study of nosocomial infection caused by C.albicans.
Candida albicans* ; Candida* ; Chungcheongbuk-do ; Cross Infection ; DNA* ; Epidemiologic Studies* ; Fungi ; Genotype ; Humans ; Immunocompromised Host ; Infant, Newborn ; Intensive Care Units, Neonatal* ; Intensive Care, Neonatal* ; Molecular Epidemiology ; Sepsis*

BACKGROUND: Action of mivacurium varies in condition with reduced plasma cholinesterase activity. The aim of this study is to evaluate the pharmacodynamics of mivacurium and to obtain the infusion rate of mivacurium in patients with liver cirrhosis or cholestasis. METHOD: We allocated into three groups. Healthy subjects without hepatobiliary disease(Group I, n=10), patients with liver cirrhosis(Group II, n=5), and patients with cholestasis(Group III, n=9) received 5 mg/kg thiopental sodium and 1~2g/kg fentanyl. They were ventilated by mask with 2.5~3% enflurane(in O2/N2O 50%) until I/E ratio of enfurane concentration gt; or = 0.8, and then received 3 ED95 mivacurium(0.18 mg/kg). Accelerographic responses to train-of-four(TOF) stimulation of ulnar nerve at 15 seconds interval were used for neuromuscular monitoring. The onset time, the duration, recovery indices and infusion rate of mivacurium were compared among groups. RESULT: The durations from the injection of mivacurium to 10% single twitch recovered (Dur10) in group II(16.5+/-4.3 min) and III(17.1+/-0.6 min) were longer significantly than that in group I(10.7+/-5.3 min). The infusion rates to maintain a steady twitch height at 5~10% for 20 min in group II(1.9+/-1.5 microgram/kg/min) and III(1.6+/-0.7g/kg/min) were lower than that in group I(3.5+/-1.3 g/kg/min). However, there was no significant difference between group II and III. CONCLUSION: Clinical duration of relaxation with 3 ED95 mivacurium is prolonged significantly and infusion rate to maintain the steady twitch height at 5~10% is lower in patient with liver cirrhosis or cholestasis than in patient without hepatobiliary disease.
Cholestasis* ; Cholinesterases ; Fentanyl ; Humans ; Liver Cirrhosis* ; Liver* ; Masks ; Neuromuscular Monitoring ; Plasma ; Relaxation ; Thiopental ; Ulnar Nerve

BACKGROUND: Atracurium, a nondepolarizing muscle relaxant, is eliminated by Hofmann elimination and not affected by pseudocholinesterase(pChe). Many reports show fall in pChe activity during pregnancy and our measurement failed to prove it. However, the authors found previously the infusion rate of mivacurium, which is metabolized by pChe, to achieve surgical relaxation is decreased. So, we compared the difference in the infusion rate of atracurium between full-term pregnant and nonpregnant women. METHODS: Muscle relaxation of full-term pregnant women(C group, n=10) and nonpregnant women (Non-C group, n=10) was maintained by continuous infusion of atracurium to keep 1st response of TOF at 5 1%. After discontinuance of infusion, recovery index was measured without reversals using the accelerograph. RESULTS: There was no significant difference in infusion rate of atracurium to maintain 1st twitch response of TOF at 5 1% and recovery index between two groups. There was little correlation between the total infusion time and infusion rate, or between the total infusion time and recovery index. CONCLUSION: The atracurium infusion rate in parturients to maintain muscle relaxation was not different from that in non-parturients. For Cesarean section, the usual infusion rate of atracurium is recommended to achieve the adequate surgical relaxation.
Atracurium* ; Cesarean Section* ; Female ; Humans ; Muscle Relaxation ; Obstetrics ; Pregnancy ; Relaxation

PURPOSE: The purpose of this study was to understand the principle of percutaneous nephrolithotomy(PNL), toincrease its success rate, and to base the radiologic approach on preoperative interventional tract dilatation. MATERIALS AND METHODS: Twenty-six patients(male, 19, female, 7) with staghorn or pelviocalyceal calculi who hadundergone PNL were included in this study. After percutaneous nephrostomy(PCN) was performed in each patient, thetract was dilated to 30F with Amplatz dilators using coaxial techniques or a 30F, 10cm high-pressure tractdilatation balloon. One day before the calculi were fragmented and removed by PNL, a 30F Amplatz sheath wasinserted under local anesthesia. The time required for tract dilatation, complications, and surgery was analyzed. RESULTS: Percutaneous tract dilatation were successful in all patients, and forceps, a nephrolithotome and anephroscope were successfully introduced into the pelvocalyceal system. The average procedure time was 19.5minutes ; a double J stent was replaced in the pelvocalyceal system of 13 of 26 patients (50%) ; because ofimproper catheter direction or/and bleeding, the Amplatz sheath was replaced in three. After PNL, complicationsinvolving renal hematoma occurred in one patient. This did not affect the patient's prognosis, however. CONCLUSION:Owing to its short procedure time and low complication rate, interventional preoperative tract dilatation forPNL is thought to be an effective technique for patients with staghorn or pelvocalceal calculi.
Anesthesia, Local ; Calculi ; Catheters ; Dilatation* ; Female ; Hematoma ; Hemorrhage ; Humans ; Nephrostomy, Percutaneous* ; Prognosis ; Stents ; Surgical Instruments

Ureteral fistula is a serious complication of abdomino-pelvic surgeries, often resulting in poor outcomes owing to lack of proper treatment. We report the case of a 49-year-old woman who underwent placement of a silicone-covered ureteral occlusion stent in her right ureter for the management of ureteral leakage after pelvic surgery. A ureterogram obtained 18 months following the stent placement confirmed that there was no stent migration or additional urine leakage. We propose that the silicone-covered ureteral occlusion stent is practical, fast, and safe for the management of ureteral leakage.
Female ; Fistula ; Humans ; Middle Aged ; Stents* ; Therapeutic Occlusion ; Ureter* ; Urinary Diversion ; Urinary Fistula