To evaluate the relationship between spontancous diuresis and improvement of pulmonary function in respiratory distress syndrome, 15 premature neonates requiring mechanical ventilation for RDS, who admitted in NICU of Wonkwang University Hospital from January 1990 to June 1992, were studied. The results were as follows (results are mean+/-SEM) 1) Mean birth weight of study infants was 1.82+/-0.08Kg, and mean gestational age was 32.80+/-0.54 weeks. 2) The onset of diuresis occured at a mean age of 29.1+/-2.48 hours with maximum diuresis at a mean age of 41.9+/-1.8 hours 3) Mean urine output increased from 2.25+/-0.43ml/Kg/hr at the stage of pre 12 hours-onset of diuresis (p<0.001), then decreased 3.5+/-0.2ml/Kg/hr at the stage of after maximum diuresis (p<0.05). 4) After maximum diuresis, inspired oxygen gradient, peak inflating pressure, peak end expiratory pressure, mean airway pressure, and respiratory rate were decreased significantly (p<0.05), and alveolar-arterial oxygen gradient was decreased more significantly (p<0,01). So, We conclude that the pulmonary function was rapidly improving after maximum diuresis and these changes reflect the general principle used in ventilatory management of infants with RDS.
Birth Weight ; Diuresis* ; Gestational Age ; Humans ; Infant* ; Infant, Newborn ; Oxygen ; Respiration, Artificial ; Respiratory Rate

From January 1988 to December 1994, endoscopic sphincterotomy with stone extraction was attempted in 395 patients with common duct stones at Yeungnam University Hospital. Endoscopic sphincterotomy was successful in 389 patients(98.5 %), and clearance of the duct was achieved in 364 patients with an overall success rate of 92.2%. After sphincterotomy, stone extraction by basket or balloon was undertaken in 298 patients without lithotripsy, and stones could be extracted after fragmentation of stones in 19 patients. In 47 patients, stones were passed into duo denum spontaneously. There were 6 cases of sphincterotomy failure due to large periampullary diverticulum or previous gastrojejunostomy. In patients with success ful sphincterotomy, endoscopic stone extraction was failed in 25 cases due to 14 large stones, 5 bile duct strictures, 4 impacted stones, and 2 cases of technical fail ure. Complications were developed in 13 patients(3.3%); 8 pancreatitis and 5 bleedings. All of them were improved with medical therapy only. Despite relatively high success rate and low complications of the endoscopic management of choledocholithiasis, there were significant difficulties in removing large stones. Developement of more effective and inexpensive methods of lithotripsy, and the search for rapidly effective solvent dissolving stones were needed.
Bile Ducts* ; Bile* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Constriction, Pathologic ; Diverticulum ; Gastric Bypass ; Humans ; Lithotripsy ; Pancreatitis ; Sphincterotomy, Endoscopic

The hepatopulmonary syndrome is defined as the triad of liver disease, an increased alveolar-arterial gradient while breathing room air, and evidence of intrapulmonary dilatation. Other cardiopulmonary abnormalities(such as pleural effusion or decreased lung volumes) are common and may coexist in patients with the hepatopulmonary syndrome. An abnormal dilatation of intrapulmonary capillaries is evidenced by Tc 99m-MAA perfusion scan, contrast-enhanced echocardiography, and pulmonary angiography. We have experienced a case of hepatopulmonary syndrome in a fi7 year old woman with liver cirrhosis who complained of severe dyspnea and cyanosis. Her arterial blood gas analysis (ABGA) showed severe hypoxemia(PaO2 59mmHg), suggesting the hepatopulmonary syndrome, which was confirmed with the contrast-enhanced echocardiography. It showed delayc4 opacification of left side chambers during agitated saline injection', thus, intrapulmonary shunt was confirmed. So we report a case of hepatopulmonary syndrome with a rewiew of literature.
Angiography ; Blood Gas Analysis ; Capillaries ; Cyanosis ; Dihydroergotamine ; Dilatation ; Dyspnea ; Echocardiography ; Female ; Hepatopulmonary Syndrome* ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Lung ; Perfusion ; Pleural Effusion ; Respiration

BACKGROUND: Significant improvements in the treatment of acute myelogenous leukemia (AML) has been contributed by the development of remission induction and consolidation chemotherapy. But the infection is one of the most important and fatal complications in patients with AML. Therefore the effective treatment and preventive strategies of these infections are essential in order that more patients may achieve a complete remission and long-term disease free-survival. The purpose of this study was to determine the recent incidence of infections and to evaluate response for the empiric antibiotic treatment during chemotherapy. METHODS: The records of 102 patients from a consecutive series of 206 admission episodes between April 1985 to December 1997 were reviewed retrospectively. When fever was developed, samples for microbiologic cultures and radiologic studies were done. Fine needle aspiration and/or biopsy from suspected lesions were done, if the studies mentioned above are unrevealing. RESULTS: Febrile episodes were developed in 123 of 206 admission session. The microbiologically defined infection (MDI) and clinically defined infection (CDI) were developed in 51.2% and 37.4% of episodes, respectively. Fever was developed in 80.7%, 30.2%, and 77.8% in cases receiving remission induction chemotherapy, standard dose-consolidation therapy, and intensified consolidation therapy, respectively. The most frequent sites of infections were lung (27.8%) and blood (27.8%). Staphylococcus epidermidis was the most common causative organism of bacteremia. The initial antimicrobial therapy was not modified in 8 of 123 febrile episodes. The rate of overall response to antimicrobial therapy was 65%. The rate of overall response to antimicrobial therapy during remission induction chemotherapy, standard dose-consolidation therapy, and intensified consolidation therapy was 70.4%, 89.4%, 71.4%, respectively. CONCLUSION: Infection has been a major cause of morbidity and mortality in acute myelogenous leukemia. Thus, intensive treatment needs for infection. More effective approaches should be evaluated by using more effective prophylactic and treatment modalities including new antimicrobials and by considering the changing spectrum of microbials.
Adult* ; Bacteremia ; Biopsy ; Biopsy, Fine-Needle ; Consolidation Chemotherapy ; Drug Therapy ; Fever ; Humans ; Incidence ; Leukemia, Myeloid, Acute* ; Lung ; Mortality ; Remission Induction ; Retrospective Studies ; Staphylococcus epidermidis

BACKGROUND: The goal of acute myelogenous leukemia(AML) therapy is to obtain the complete remission(CR) and to improve disease-free survival. Advances in chemotherapy and supportive care provided significant improvement in CR rate up to 60~85% patients with AML. METHODS: Forty two patients with previously untreated AML at Yeung Nam University Hospital from April 1985 through November 1996 were treated with AD(7-3) regimen for induction chemotherapy and followed by two courses of consolidation with AD(5-2) regimen. And the authors analyzed clinical factors related to the CR and overall survival. RESULTS: Twenty-four of the 42 patients achieved CR, and median duration of remission in 24 patients achieved CR was 56 weeks(4~ 305 +weeks). Median duration of survival in all 42 cases was 46 weeks(2~340 + weeks), and in 24 cases achieved CR was 73 weeks(12~340 +weeks). Causes of induction failure included infection in 9 cases, bleeding in 3 cases and drug resistance in 6 cases. Among the potential prognostic variables including age, initial WBC count, performance status, and presence of Auer rods and infection at the time of diagnosis, none was statistically significantly related to the prognosis. CONCLUSION: Further clinical trials for effective remission induction and postremission chemotherapy are necessary to overcome drug resistance and to increase the CR rate and duration.
Adult* ; Diagnosis ; Disease-Free Survival ; Drug Resistance ; Drug Therapy* ; Hemorrhage ; Humans ; Induction Chemotherapy ; Leukemia, Myeloid, Acute* ; Prognosis ; Remission Induction* ; Survival Rate

BACKGROUND: Smoking is a high risk factor for various chronic diseases. Therefore, physicians are expected to play a critical role in patients smoking cessation. There have been a number of studies which show that cessation recommendation by physicians is effective for patients to stop smoking. The purpose of this study is to assess physicians smoking status and its effect on physicians attitude for their advice to patients to quit smoking. METHODS: During August and September in 1995, self-report questionnaire was distributed to doctors in Jin-Gu, Pusan. It consisted of inquiries on their demographic features, their smoking status, whether physicians ask patients their smoking status or not, whether physicians advise patients to quit smoking or not, and whether physicians confirm patients smoking cessation. Among 203 responses returned, 193 cases was analyzed. RESULTS: Among the total 193 persons, 60 persons are smoking now(31.4%, Men 34.5%, women 0%), and 88 persons(67.2%) are ex-smoker. 84.1% of smokers have tried to quit smoking, and stress was the most common reason for failure. Smoking rate and experience rate were higher in men than in women(P<0.001), but there were no significant differences in smoking rate and experience rate according to ages, religions, specialties, hospital types, and positions. Among responders 144 cases(75.0%) asked smoking status of patients. 21.4% of them asked smoking status of all patients who may smoke, and 25.0% of them hardly ask smoking status of patients. For question about patients' smoking status, the younger physicians were more active in asking smoking status of patients(p=0.038), and the physicians in hospital did much more than physicians in university hospital and private clinics(p=0.015). Among responders, 161 persons(84.7%) advised patients to quit smoking, and 19.5% of them advised to quit smoking for all patients who smoked. However, 15.3% of them hardly gave patients such suggestion. It was found that there was no significant relationship between physicians smoking status and attitudes toward giving patients suggestion to quit smoking. CONCLUSIONS: This study revealed that there was no significant relationship between physicians smoking status and their attitudes toward giving patients suggestion to quit smoking, and physicians smoking status did not have any effect on smoking cessation advice. However, this study does not exclude the possibility that the results might be reversed, if the census would be extended to broader area. Physicians should take an active role against smoking.
Busan ; Censuses ; Chronic Disease ; Female ; Humans ; Male ; Risk Factors ; Smoke* ; Smoking Cessation* ; Smoking* ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Cisplatin is an ototoxic agent commonly used for the treatment of solid tumors. Recently, it has been recognized to cause apoptosis in tumor cells, kidney and cochlea. The Bcl-2 family are specific proteins which are a well-known group of death modulating factors. The aims of this study was to analyze the expression of Bcl-2 family for the time course after cisplatin injection. MATERIALS AND METHODS: Sprague-Dawley (SD) rats were injected intraperitoneally wtih either 20 mg/kg of cisplatin, or the same amount of saline water to be used as control. Cochleae were harvested 6, 12 and 24 hours after injection and compared to those of the control ones. TUNEL staining was performed to observe apoptotic cells. Immunohistochemistry and Western blotting were performed to investigate the expression of Bax and Bcl-2. RESULTS: Positively TUNEL-labeled nuclei were observed mainly in the outer hair cells (OHCs), inner hair cells (IHCs), supporting cells and marginal cells. Bax and Bcl-2 immunoreactivity was observed in stria vascularis, OHCs, IHCs and Deiter's cells in the groups harvested at 6 h and 12 h. Bax was expressed most highly at 6 h and Bcl-2 at 12 h. The western blotting method showed that in the group harvested at 24 h, the intensity of Bax and Bcl-2 expression showed no difference compared with those of the control group. CONCLUSION: The present results suggest that apoptotic mechanism in which Bax and Bcl-2 play an important role begins before 6 h and terminates within 24 h after a single injection of high dose cisplatin.
Animals ; Apoptosis* ; Blotting, Western ; Cisplatin* ; Cochlea* ; Hair ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Kidney ; Rats* ; Rats, Sprague-Dawley ; Stria Vascularis ; Water

OBJECTIVE: Ureaplasma urealyticum colonization is a significant cause of fetal and neonatal pneumonia and is associated with the prevalence of bronchopulmonary dysplasia (BPD) in preterm infants. This study was aimed to evaluate the relationship between U. urealyticum colonization and neonatal morbidity. METHODS: We tested 476 infants for U. urealyticum on the first day of life among infants admitted to the neonatal intensive care unit of Bun-dang Seoul National University Hospital from June 2003 to July 2006. Urine and endotracheal aspirates were processed by PCR (polymerase chain reaction) or culture for U. urealyticum colonization. We compared the morbidity in the colonized group with the non-colonized group. RESULTS: The study group consisted ot 136 infants less than 32 weeks of gestational age and 340 infants more than 32 weeks of gestational age. In infants less than 32 weeks of gestational age, 18 (13%) of 136 infants had 1 or more positive specimens by culture or PCR. BPD occurred more in the colonized group than in the non-colonized group (p=0.058) and respiratory distress syndrome (RDS) occurred significantly less in the colonized group (p=0.043). Total WBC counts on the third day of life was significantly increased in the colonized group (p=0.003) and this significance was prominent in the neutrophil fraction (p=0.001). There was no significant relation between U. urealyticum colonization and IgM levels nor C-reactive protein (CRP) level nor U. urealyticum colonization of the mother. Twenty-three(7%) of 340 infants more than 32 weeks of gestational age had 1 or more positive specimens by culture or PCR. BPD didn't occur and RDS didn't decrease significantly in the colonized group (p=0.605). Total IgM levels didn't increase significantly in the colonized group (p < 0.006) but total WBC counts and CRP levels didn't increase significantly in the colonized group. There was no significant relation between U. urealyticum colonization and U. urealyticum colonization of the mother (p=0.21). CONCLUSION: U. urealyticum colonization in infants less than 32 weeks of gestational age was associated with an increased prevalence of BPD and a decreased prevalence of RDS.
Bronchopulmonary Dysplasia ; C-Reactive Protein ; Colon* ; Gestational Age ; Humans ; Immunoglobulin M ; Infant* ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Mothers ; Neutrophils ; Pneumonia ; Polymerase Chain Reaction ; Prevalence ; Seoul ; Ureaplasma urealyticum* ; Ureaplasma*

BACKGROUND: Body fat distribution, rather than the level of obesity per se, appears to be a strong predictor of abnormalities in metabolic complication. Visceral fat accumulation is significantly correlated with glucose intolerance and constitutes as an independent risk factor for the diabetes mellitus. METHODS: We investigated the impact of body fat distribution on the glucose, lipid metabolism and growth hormone secretion in obese subjects with varying glucose tolerance and lean controls matched with sex and age. 69 obese Koreans (34 men, 35 women; 43.8 yrs) and 21 lean Koreans (10 men, 11 women; 40.8 yrs) were recruited. Anthropometric measurement and impedence for measurement of total body fat, and computed tomography for visceral and subcutaneous fat area at umbilicus level were performed. All subjects underwent a standard oral glucose tolerance test and GH stimulation test by L-dopa. RESULTS: The results are summarized as follows. 1. Obese patients had greater ideal body weight (%, IBW) and lean body mass (LBM) than lean controls. But no significant differences were found in IBW and LBM between 3 obese groups. 2. The 25 obese NIDDM had the highest FFA-AUC during OGTI and the lowest GH-AUC to L-Dopa stimulation test. The insulin-AUC during OGTT was the highest in 24 obese subjects with normal glucose tolerance. 3. All male groups have VSR of more than 0.4, which has been designated visceral fat obesity. In contrast all female groups have VSR of lesser than 0.4 but obese DM subjects have the highest VSR. Visceral fat area per body weight ratio(VWR) showed increasing tendency in obese, IGT, and DM group. 4. Waist circumference and VWR showed strong correlation with metabolic parameters among anthropometric parameters. They were positively correlated with FFA-AUC during OGTT and negatively correlated with GH-AUC to L-dopa stimulation. CONCLUSION: Visceral fat accumulation are associated with insulin resistance, dyslipidemia and impairment of growth hormone secretion via increase of free fatty acid. The simple waist circumference may provide a more practical indicator that correlated with aMominal fat distribution and metabolic complications associated with obesity.
Adipose Tissue* ; Body Fat Distribution ; Body Weight ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Female ; Glucose Intolerance ; Glucose Tolerance Test ; Glucose* ; Growth Hormone ; Humans ; Ideal Body Weight ; Insulin Resistance ; Intra-Abdominal Fat ; Levodopa ; Lipid Metabolism* ; Male ; Obesity* ; Risk Factors ; Subcutaneous Fat ; Umbilicus ; Waist Circumference

BACKGROUND: Hyperprolactinemia has been linked with hyperandrogenism and hirsutism in some women. High plasma Dihydroandrosterone and DHA-S levels were reported in patients with hyperprolactinemia and a dissociation of adrenal androgen and cortisol secretion occurs in normal subjects. The mechanism has not been elucidated, but it has been suggested that pituitary factors other than ACTH modulate adrenal androgen synthesis, One candidate hormone is prolactin. Adrenal tissue has been found to possess prolactin receptors and prolactin has been shown to act synergistically with ACTH and lowers the activity of the enzyme 5a-reductase or 3B-hydroxysteroid dehydrogenase (3B-HSD). The aim of this study was to investigate the secretion of adrenal androgen metabolites in patients with idiopathic hyperprolactinemia and prolactinoma and to deterrnine the relationship with prolactin and androgens. METHODS: We measured 24 hour-urinary DHEA, androstenedione, androsterone, pregnenolone, tetrahydrocorticoid and cortisol in 16 normal controls and 5 patients with idiopathic hyperprolac-tinemia (HP) and 12 patients with prolactonoma in the early follicular phase. RESULTS: Urinary DHEA, AD (androsteredione), and androsterone, the metabolites of adrenal androgen, were significantly higher in both patients with idiopathic HP and prolactinoma compared with those in normal controls (p<0.05), whereas they were not different in both disease groups. Urinary pregnenolone levels, early metabolite of adrenal steroid synthesis, were lower in patients. In contrast, urinary tetrahydorcortisol and cortisol were higher in patients compared to controls. There was no difference in DHEA:androsterone ratio between patients and controls. And there were no correlation between prolactin levels and the levels of androgenic metabolites or clinical symptoms. CONCLUSION: Prolactin has a tropic effct on the secretion of androgens and steroids by the adrenal cortex. But prolactin levels were not correlated with androgen levels or clinical symptoms (amenorrhea), and it might have little effect on lowering the activity of 3B-HSD.
Adrenal Cortex ; Adrenocorticotropic Hormone ; Androgens ; Androstenedione ; Androsterone ; Dehydroepiandrosterone ; Female ; Follicular Phase ; Hirsutism ; Humans ; Hydrocortisone ; Hyperandrogenism ; Hyperprolactinemia* ; Oxidoreductases ; Plasma ; Pregnenolone ; Prolactin ; Prolactinoma ; Receptors, Prolactin ; Steroids