BACKGROUND: Pulmonary tuberculosis with a remaining cavitary lesion is considered to be a problem with the course of treatment. In particular, re-treatment cases tend to respond poorly to current anti-tuberculosis agents. Therefore the factors that are related with the poor closure of a cavitary lesion in pulmonary tuberculosis during treatment were evaluated. METHODS: A retrospective review of the medical records and chest X-ray films of 68 patients who had chemotherapy for the pulmonary tuberculosis with cavitary lesions was made. All the patients had been followed up for more than 12 months at National Masan Tuberculosis Hospital as of Aug. 2000. RESULTS: The male to female ratio was 3.9:1. 72.4% of the patients were between 20 to 50 years of age. 66.2% of the cavitary lesions on the chest X-ray films were confined to the upper lung fields : 36.8% in the right upper lung field and 29.4% in the left upper lung field. 82.4% of the cavities were less than 40mm in their size, and 83.8% were less than 6mm thick. The cavitary lesions were closed in 48 cases and remained in 20 cases during a follow-up period of more than 12 months. The factors that are though to affect ot the outcomes of the cavities were age, past medication history, the number of unused drugs, and the number of sensitive drugs. CONCLUSION: In the treatment courses of pulmonary tuberculosis with cavitary lesions, the following factors are associated with less desirable outcome:an age over 45, a past medication history of more than 2 courses of treatment, The number of unused drugs not exceeding average 6 and the number of sensitive drugs not exceeding average 7.
Drug Therapy ; Female ; Follow-Up Studies ; Hospitals, Chronic Disease ; Humans ; Lung ; Male ; Medical Records ; Retrospective Studies ; Thorax ; Tuberculosis, Pulmonary* ; X-Ray Film

No abstract available.
Humans ; Thrombocytosis

PURPOSE:Carotid endarterectomy may benefit patients with bilateral carotid stenosis by improving cerebrovascular hemodynamics of ipsilateral as well as contralateral cerebral hemispheres. We investigated cerebrovascular hemodynamics after carotid endarterectomy in patients with contralateral carotid occlusion by acetazolamide stress brain SPECT. MATERIALS AND METHODS: Subjects were 14 symptomatic patients (all men, mean age 66 yrs) with carotid stenosis (> 50%) with contralateral carotid occlusion. Acetazolamide stress Tc-99m ECD brain SPECTs were performed within 2 weeks before and after carotid endarterectomy using one day protocol. Cerebral blood flow (CBF) and cerebrovascular reserve (CVR) were assessed visually. In 12 patients, correlation between the patency of proximal anterior cerebral or anterior communicating arteries (A1/A-comm) and the improvement of CBF or CVR after endarterectomy was assessed. RESULTS: Preoperative SPECT showed reduced CBF in 2 ipsilateral and 10 contralateral hemispheres. CVR was reduced in 4 ipsilateral and 9 contralateral hemispheres. Of 12 hemispheres with reduced CBF, 2 hemispheres (16.7%) showed improvement of CBF after endarterectomy. However, reduced CVR was improved in all 4 ipsilateral and 7 of 9 (78%) of contralateral hemispheres after endarterectomy. Three of 4 with stenotic A1/A-comm and 4 of 8 with patent A1/A-comm had reduced contralateral CVR. Reduced contralateral CVR improved in all 3 patients with stenotic A1/A-comm and 3 of 4 with patent A1/A-comm. CONCLUSION: Acetazolamide stress brain SPECT demonstrated improvement of compromised cerebrovascular reserve in not only ipsilateral but also contralateral hemispheres of patients with contralateral carotid occlusion after carotid endarterectomy, and may, therefore, be useful for evaluating cerebral blood flow and cerebrovascular reserve after carotid endarterectomy.
Acetazolamide* ; Arteries ; Brain Ischemia ; Brain* ; Carotid Stenosis* ; Cerebrum ; Endarterectomy ; Endarterectomy, Carotid* ; Hemodynamics ; Humans ; Male ; Tomography, Emission-Computed, Single-Photon*

We report two cases of Wernicke encephalopathy presenting with convulsive seizures. The first patient had been supplied with total parenteral nutrition due to acute pancreatitis and presented with partial seizure evolving to generalized seizure. The second patient had been malnourished due to alcoholism and recent dyspepsia after a gastrectomy, who presented with generalized seizure. Brain MRI revealed high-signal lesions in the focal cerebral cortex on T2-weighted, FLAIR, and diffusion-weighted images. After a thiamine injection, the patients recovered and abnormalities on the MRIs disappeared.
Alcoholism ; Brain ; Cerebral Cortex ; Dyspepsia ; Gastrectomy ; Humans ; Magnetic Resonance Imaging ; Pancreatitis ; Parenteral Nutrition, Total ; Seizures* ; Thiamine ; Wernicke Encephalopathy*

The purpose of this study provides measurements of radiation dose from MDCT of head, chest, abdomen and pelvic examinations. A series of dose quantities that are measured of patient weight to compare the dose received during MDCT examinations. Data collected included: weight together with CT dose descriptors, volume CT dose index (CTDIvol) and dose length product (DLP). The effective dose was also estimated and served as collective dose estimation data. Data from 1,774 adult patients attending for a CT examination of the head (n=520) or chest (n=531) or abdomen (n=724) was obtained from spiral CT units using a same CT protocol. Mean values of CTDIvol was a range of 48.6 mGy for head and 6.9, 10.5 mGy for chest, abdomen examinations, respectively. And mean values of DLP was range of 1,604 mGy.cm for head, 250 mGy.cm for chest, 575 mGy.cm for abdomen examinations, respectively. Mean effective dose values for head, chest, abdominal CT were 3.6, 4.2, and 8.6 mSv, respectively. The degree of CTDIvol and DLP was a positive correlation with weight. And there was a positive correlation for weight versus CTDIvol (r2=0.62), DLP (r2=0.694) in chest. And head was also positive correlation with weight versus CTDIvol (r2=0.691), DLP (r2=0.741). We conclude that CTDIvol and DLP is an important determinant of weight within the CT examinations. The results for this study suggest that CT protocol should be tailored according to patient weight.
Abdomen ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; Cone-Beam Computed Tomography ; Cytarabine ; Gynecological Examination ; Head ; Humans ; Subject Headings ; Thioguanine ; Thorax ; Tomography, Spiral Computed

BACKGROUND: Combining adjunctive medications with patient-controlled analgesia (PCA) has been used to minimize opioid related side-effects. The aim of this study was to evaluate whether postoperative infusion of a sub-sedative dose of dexmedetomidine can reduce opioid consumption and opioid related side-effects. METHODS: We selected 60 patients from 18 to 60 years old with an American Society of Anesthesiologists physical status of 1–2 who were scheduled for elective surgery. The types of surgery were limited to thoracoscopic wedge resection of the lung and pulmonary wedge resection under a mini-thoracotomy. Patients received PCA with sufentanil upon arrival in the recovery room, along with a separate continuous infusion of dexmedetomidine that was not mixed in the PCA but started at the same time. Patients were randomly allocated to two groups: dexmedetomidine 0.15 μg/kg/h was administered to patients in group D and normal saline was administered to patients in group C. The visual analogue scale (VAS) pain score, blood pressure, pulse rate, and respiratory rate were measured at each assessment. PCA related side-effects were evaluated. RESULTS: The VAS pain score was significantly lower in the dexmedetomidine group. Patients in the dexmedetomidine group required significantly less PCA at postoperative 1–4, 4–8, and 8–24 h time intervals. The incidence of nausea was significantly less in the dexmedetomidine group, and levels of sedation and hemodynamic variables except for blood pressure at postoperative 8 h were similar between the groups. CONCLUSIONS: In conclusion, a postoperatively administered sub-sedative dose of dexmedetomidine reduces PCA sufentanil consumption and decreases nausea.
Analgesia, Patient-Controlled* ; Blood Pressure ; Dexmedetomidine* ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Lung ; Nausea ; Passive Cutaneous Anaphylaxis ; Recovery Room ; Respiratory Rate ; Sufentanil*

BACKGROUND: Spinal anesthesia for cesarean section is widely used technique for rapid induction, high success rate and excellent intraoperative and postoperative analgesia. Potentiating the effect of intrathecal local anesthetics by addition of opioid for cesarean section is well known. In this study, we compared the clinical effects when different doses of fentanyl were combined with intrathecal hyperbaric bupivacaine. METHODS: Ninety six healthy term parturients were randomly divided into four groups: Group C (control), : Group F10 (fentanyl 10 microg), : Group F15 (fentanyl 15 microg), F: Group F20 (fentanyl 20 microg). In every group, 0.5% heavy bupivacaine was added according to the adjusted dose regimen. We observed the maximal level of the sensory block and motor block, the quality of intraoperative analgesia, the duration of effective analgesia and the side effects. RESULTS: There were no significant differences between four groups in maximal level and recovery rate of sensory and motor block. Quality of intraopertive analgesia and muscle relaxation was increasing by increasing dosage of intrathecal opioids. Duration of effective analgesia was significantly prolonged in Group F15 and F20 than Group C and F10, but there were no differences between Group F15 and F20. And the frequencies of side effects such as hypotension, max sedation level were increasing by increasing dosage of intrathecal opioids. The Apgar scores were normal, and there were no differences between the four groups. CONCLUSIONS: The addition of fentanyl 15 microg for spinal anesthesia provides adequate intraoperative analgesia and good postoperative analgesia without significant adverse effects.
Analgesia ; Analgesics, Opioid ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Cesarean Section ; Female ; Fentanyl ; Humans ; Hypotension ; Muscle Relaxation ; Pregnancy

OBJECTIVES: Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated the influence of injection speed of local anesthetic to subarachnoid space on maternal hypotension and level of sensory block. METHODS: Bupivacaine (0.5%) 9 mg with fentanyl 10 microg was injected to subarachnoid space either quickly (during 20 seconds, 0.1 mL/sec, n=20) or slowly (during 100 seconds, 0.02 mL/sec, n=20) in parturients scheduled for elective cesarean section. The onset and level of sensory block was checked and heart rate and blood pressure was checked by 2.5 minutes during 20 minutes. Hypotension (systolic blood pressure <100 mmHg or <70% of baseline) was treated with ephedrine. RESULTS: Hypotension occurred 70% of parturients with spinal anesthesia. Slow injection didn't influence on the onset and level of sensory block and didn't reduce the incidence of hypotension. But onset of hypotension was delayed. CONCLUSION: Slow injection (during 100 seconds, 0.02 mL/sec) of local anesthetic delayed onset of hypotension and required less amount of ephedrine. Slow injection of local anesthetic was one of the effective methods for the cardiovascular stability during cesarean section under spinal anesthesia.
Anesthesia ; Anesthesia, Spinal ; Blood Pressure ; Bupivacaine ; Cesarean Section ; Ephedrine ; Female ; Fentanyl ; Heart Rate ; Hypotension ; Incidence ; Injections, Spinal ; Pregnancy ; Subarachnoid Space

No abstract available.
Acute Kidney Injury* ; Hemoglobinuria, Paroxysmal*

BACKGROUND: Although upper gastrointestinal (UGI) endoscopy is highly sensitive for the detection of esophago-gastroduodenal lesions, pain and discomfort during the procedure cause examinees to experience stress and anxiety. Moreover, there have been only a few studies on relief of pain and discomfort during UGI endoscopy through preparatory interventions. Therefore, the aim of this study was to investigate the relationship between a preparatory education program and the discomfort and retching experienced by examinees during endoscopy. METHODS: A total of 306 examinees who visited a health promotion center and underwent non-sedated endoscopy from May 13 to July 3, 2009 were included in this study. After they were assigned to experimental (n = 154) and control groups (n = 152), their discomfort and retching were measured with a visual analogue scale. The preparatory education program consisted of cognitive intervention, behavioral intervention and information. RESULTS: The preparatory education program relieved discomfort during endoscopy in male subjects, in subjects aged 60 and over, or in subjects with previous endoscopic experience with statistical significance (P < 0.05). It also relieved retching during endoscopy in subjects aged 60 and over with statistical significance (P = 0.023). Multiple logistic regression analysis showed that the preparatory education program significantly relieved the discomfort of examinees during endoscopy (P = 0.028). CONCLUSION: We found that the preparatory education program used in this study could significantly relieve the discomfort caused by endoscopy, particularly in subjects aged 60 and over, or in male subjects with a high incidence of stomach cancer in Korea.
Aged ; Anxiety ; Endoscopy ; Endoscopy, Gastrointestinal ; Health Promotion ; Humans ; Incidence ; Korea ; Logistic Models ; Male ; Stomach Neoplasms