Intrathecal injection of a small amount of morphine was used to provide obstetric analgesia in 20 primiparous women in labor. When the cervix was 3~4cm dilated approximately, 0.25mg or 0.5mg of morphine was injected intrathecally in each patient. In all parturients, labor pains were completery relieved after 10~60 min and analgesia lasted 8 to 15 hours. The vital signs of all parturients after intrathecal morphine injection were stable. The analgesia was well achieved but there was no alteration of motor power or pinprick sensation. The maternal side effects such as itching, nausea, vomiting, somnolence and urinary retention occured in a high proportion of parturients, but severity of these side effects were mild in most cases. Urinary retention was most severe side effect in our cases. All newborns were scored as having 8~10 on Apgar scores at 1 min after birth.
Analgesia ; Analgesia, Obstetrical* ; Cervix Uteri ; Female ; Humans ; Infant, Newborn ; Injections, Spinal ; Labor Pain ; Morphine* ; Nausea ; Parturition ; Pregnancy ; Pruritus ; Sensation ; Urinary Retention ; Vital Signs ; Vomiting

BACKGROUND: Previous studies indicated that there was important correlation between early patency of infarct-related artery, preservation of ventricular function, and improved survival after thrombolytic therapy for acute myocardial infarction. An increased infusion rate of rt-PA has been shown to result in faster thrombolysis and a high patency rate of occluded vessel in myocardial infarction. Therefore, we evaluated the effect of simplified triple bolus injection of rt-PA on early patency of infarct-related artery and evaluated safety and efficacy of triple bolus injection. METHOD: Patients with acute myocardial infarction presenting up to 6 hour from the onset of chest pain were recruited for the study. Aspring(100-200mg) was given immediately. Total dose for 1.5mg/kg of rt-PA(minimum 75mg, maximum 100mg) was administered as triple bolus intravenous injections. The half of total dose was injected initially, the quarter of total dose was injected at 10 minutes after 1st injection and the remainder was injected at 40 minutes after 1st injection. Five thousand units of heparin was given and 1,000-1,500unit/hr was given continuously. Coronary angiogram was performed at 60 minutes and 7-10 days after the first bolus injection. RESULTS: At 60 minutes, eleven of fourteen patients (78.6%) showed TMI grade-3 of patency in infarct-related coronary artery. There were two patients of hemorrhagic complications. One patient developed cerebellar hemorrhage at third day after rt-PA injection, and the other developed bleeding at femoral sheath site. There was no in-hospital mortality and reinfarction. CONCLUSION: In patients with acute myocardial infarction, the simplified triple bolus injection of rt-PA is associated with high early patency(TMI grade-3) in infarct-related coronary artery, with low risk of major bleeding comlications comparable to other studies.
Arteries ; Chest Pain ; Coronary Vessels ; Hemorrhage ; Heparin ; Hospital Mortality ; Humans ; Injections, Intravenous ; Myocardial Infarction* ; Thrombolytic Therapy ; Tissue Plasminogen Activator* ; Ventricular Function

Purpose: This study aimed to comprehensively examine middle-aged male taxi drivers' perceptions of the risk of cardiovascular disease. Methods: A qualitative method was used, with focus group interviews. The participants were middle-aged male taxi drivers who had been driving for more than ten years and for more than six hours daily. Results: The data were analyzed using qualitative thematic analysis. Middle-aged male taxi drivers' perceptions of the risk of cardiovascular disease were categorized into three main themes:　 “individual perceptions of cardiovascular disease”, “possibility of behaviors for cardiovascular disease” and “motivations of behaviors for cardiovascular disease”. Six sub-themes were extracted as follows: “perception of vulnerability”, “perception of seriousness”, “perception of profitability”, “perception of disability”, “self-awareness” and “advancing toward health care”. Conclusion It is necessary to invigorate support systems through measures including education, counseling, and web-based programs to prevent cardiovascular disease in middle-aged male taxi drivers.

PURPOSE: The 2005 guidelines for cardiopulmonary resuscitation (CPR) caution that effective compression is essential (Class I) and chest compression (CC) by rescuers should be switched every 2 minutes to avoid rescuer's fatigue. It is controversial how long effective CC by a single individual can be provided. There are few reports about CPR quality, especially when rescuers perform CC for more than 10 minutes. The mean CPR period was about 30 minutes in Korea. We investigated the quality of CC and rescuer's fatigue after about 30 minutes. METHODS: From April 2009 to July 2009, health care providers (HCPs) were recruited into this study. The study simulated 2 person, in-hospital CPR. On the test day, which had been randomly assigned, each participant performed 7 CCs for about 30 minutes. The period of each CC was 2 minutes, and the period of each circulation check was 5 seconds. Participants' heart rates (HR) and visual analogue scale (VAS) scores for fatigue were obtained before and after each CC. Data for each 2 minutes CC was obtained with the use of Resusci Anne(R) with the Laerdal(R) PC skill reporting system. We used one-way repeated measures ANOVA for comparison of quality and fatigue of each CC and multiple linear regression for finding the predictors for correct CC. SPSS 17.0 was used for analysis. RESULTS: Among a total of 30 HCPs, data from 27 were analyzed. All participants were certified as a BLS provider and some were certified as BLS instructors. The rate of effective compression was 83.8+/-24.3%. Despite 2 min CC tasks were repeated alternatively for about 30 minutes, there were no differences in the number of correct CCs, depth and velocity of compression, and the number of incorrect CCs. CONCLUSION: During in-hospital CPR, HCPs may provide effective chest compressions on shifts with minimal effect of fatigue, even if they provide CC for 30 minutes.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Heart Rate ; Humans ; Korea ; Linear Models ; Manikins ; Thorax

Inducible nitric oxide synthase (iNOS) expression of several organs on the lipopolysaccharides (LPS)-injected rats and on excisional wound was observed by immunohistochemical methods to investigate iNOS-positive cells during inflammation. iNOS expression was induced in response to LPS in the brain and these reactions were observed in the choroidal epithelium, ependymal cells and a few of nerve cells and fiber. A more intensive reaction of nerve cell and fiber was mainly observed in the corpus callosum and hypothalamus. Induction of iNOS of the lung was observed in alveolar macrophage, smooth muscle, pneumocytes and inflammatory cells infilterated in the alveolar septum. iNOS expression of the liver was detected in Kupffer cells, hepatocytes, bile duct and inflammatory cells of spotty necrosis. The cardiac muscle and endothelial cell of the heart showed positive iNOS expression. In the excisional wound, inflammatory cells including macrophages, neutrophil and fibrobast showed iNOS expression and mainly detected necrobiotic layer. Collectively, iNOS expression was induced in the several cell types during inflammatory process. So for better understanding the function of iNOS, more research should be done in relation to each cell type of organ.
Animals ; Bile Ducts ; Brain ; Choroid ; Corpus Callosum ; Endothelial Cells ; Epithelium ; Heart ; Hepatocytes ; Hypothalamus ; Inflammation ; Kupffer Cells ; Lipopolysaccharides ; Liver ; Lung ; Macrophages ; Macrophages, Alveolar ; Muscle, Smooth ; Myocardium ; Necrosis ; Neurons ; Neutrophils ; Nitric Oxide Synthase Type II* ; Pneumocytes ; Rats* ; Shock* ; Wound Healing* ; Wounds and Injuries*

Primary care is an essential part of a whole health system. It is the first contact point for medical care in the community, where many people are likely to obtain their own impression of the health system. Primary care has its own attributes, such as first contact, continuity, comprehensiveness, and coordination, which are yardsticks for measuring its excellence. Regarding the value of primary care, many studies have reported extensive evidence of the advantages of primary care at individual and societal levels. Health systems with strong bases of primary care are better than those with weak ones in terms of cost, health outcomes, and quality of care. However, primary care in South Korea has continuously shrunk or been weakened for several decades. As people age and chronic illnesses become prevalent, more attention is being paid to primary care than ever before, and several policy options have been proposed. Therefore, if the medical community wishes to invigorate primary care, it should play a pivotal role in formulating and implementing primary care policies by envisioning primary care, establishing related data infrastructure, and continuing the discussion on long term goals like training primary care physicians.
Chronic Disease ; Health Care Costs ; Humans ; Korea ; Physicians, Primary Care ; Primary Health Care ; Republic of Korea

Ischemic colitis has a relatively high prevalence in the elderly population with underlying vascular disorders such as hypertension and usually occurs on the left side of the colon. However, ischemic colitis also rarely occurs in healthy young adults with no risk factors. Herbal medication use is increasing, particularly for weight loss. Ischemic colitis associated with herbal medication use has been rarely reported. Here, we describe a case of right-sided ischemic colitis in a young woman that was potentially linked to the use of herbal medication. An 18-year-old woman was admitted to our emergency department with abdominal pain and bloody diarrhea for 1 day. Her medical history was unremarkable for bowel ischemia risk factors. However, she had taken herbal medication for weight loss for the past 2 weeks. Abdominopelvic CT showed diffuse wall thickening with decreased mucosal enhancement from the ascending to the transverse colon. A colonoscopic biopsy specimen showed coagulative necrosis of the mucosa, hemorrhage, and inflammatory cell infiltration. The abdominopelvic CT, colonoscopy, and biopsy findings were compatible with ischemic colitis. Her abdominal pain and bloody diarrhea improved completely with conservative management, and she was advised to discontinue the use of herbal medications.
Abdominal Pain ; Adolescent ; Aged ; Biopsy ; Colitis, Ischemic ; Colon ; Colon, Transverse ; Colonoscopy ; Diarrhea ; Emergencies ; Female ; Hemorrhage ; Humans ; Hypertension ; Ischemia ; Mucous Membrane ; Necrosis ; Prevalence ; Risk Factors ; Weight Loss ; Young Adult

Uterine scar dehiscence following laparoscopic myomectomy rarely occurs but can compromise both maternal and fetal well-being in subsequent pregnancy. We here present two cases of pregnancy complicated by preterm birth that resulted from uterine scar dehiscence following laparoscopic myomectomy. First case was a nulligravida who had scar dehiscence at 26 weeks of gestation after having a laparoscopic myomectomy 3 months prior to conception. Two weeks later, we observed her fetal leg protruding through the defect. The other case was a primigravida with a history of prior cesarean delivery, whose sonography revealed myomectomy scar dehiscence at 31 weeks of gestation. Within a few hours after observing, the patient complained of abdominal pain that was aggravating as fetal leg protruded through the defect. In both cases, babies were born by emergency cesarean section. Conservative management can be one of treatment options for myomectomy scar dehiscence in preterm pregnancy. However, clinicians should always be aware of the possibility of obstetric emergencies.
Abdominal Pain ; Cesarean Section ; Cicatrix* ; Emergencies ; Female ; Fertilization ; Humans ; Leg ; Pregnancy* ; Premature Birth ; Uterine Myomectomy ; Uterine Rupture

BACKGROUND: Irbersatan, an orally active antihypertensive agent, effectively reduce blood pressure by directly blocking angiotensin II receptors without any significant adverse effects. The purpose of this study is to evaluate the efficacy and safety of irbesartan in patients with mild to moderate hypertension. METHODS: This study enrolled 83 patients who had diastolic pressure above 95 mmHg and below 110 mmHg on two measurements. Sixty eight patients were administered 150mg of irbesartan, an angiotensin II receptor blocker, daily for four weeks as an initial dosage. If the sitting diastolic pressure was equal to or greater than 90 mmHg after a 4 week treatment period, the dosage was doubled until the end of 8 weeks. Baseline pressures, antihypertensive effect, side effects, laboratory findings were compared before and after treatment. RESULTS: Fourty two patients out of 53 patients having completed this study showed decreased blood pressure equal to or more than 5 mmHg of the sitting diastolic pressure (response rate=79%). Twenty one patients out of 53 patients showed normalized blood pressure below 90 mmHg of the sitting diastolic pressure (normalization rate=40%). The extent of decrease in diastolic and systolic blood pressure after eight week treatment was an average 11.7+/-10.1 mmHg and 16.3+/-18.9 mmHg, respectively (p<0.05). Nineteen ontoward side effects was observed in 17 patients out of 68 patients with medication (frequency of ontoward effects=25%). Only one case with headache was considered to be related to the medication. Abnormal laboratory findings were observed in eight patients, and only one case with elevation of bilirubin and ALT levels was considered to be related to the medication. CONCLUSION: In conclusion, irbesartan is a safe and effective antihypertensive drug in patients with mild to moderate hypertension with tolerable side effects.
Bilirubin ; Blood Pressure ; Headache ; Humans ; Hypertension* ; Receptors, Angiotensin

The diagnosis of neurocysticercosis is relatively easy with brain computed tomo-grarhy(CT) and/or magnetic resonance imaging(MRI) and ELISA test of serum and cerebrospinal fluid(CSF). The clinical manifestation of the disease are varied and correlated with the infection sites. The use of praziquantel and/or surgical excision are effective in treatment of the disease. The effect of treatment has been evaluated with imaging studies and changes of clinical manifestation. The authors reviewed 97 neurocysticercosis patients to evaluate the prognostic predictability of serum and CSF ELISA titers after treatment . We classified the patients into two groups. Rebound group was patients which showed higher ELISA titers after praziquantel medication than pretreatment. The responses to treatment were evaluated with the changes on brain CT or MRI. The Initial ELISA titers were lower in rebound group than those of nonrebound group, but three month after treatment, rebound group showed higher titers. The changes of ELISA titers in rebound group were greater in CSF than those in serum. The reduction of cyst on brain CT or MRI was more remarkable in rebound group than in nonrebound group and the prognosis of rebound group was better. Changes of ELISA titers was valuable in predicting the effect of treatment and prognosis.
Brain ; Diagnosis ; Enzyme-Linked Immunosorbent Assay* ; Humans ; Magnetic Resonance Imaging ; Neurocysticercosis* ; Praziquantel ; Prognosis*