BACKGROUND: Tracheal extubation causes hypertension and tachycardia. In susceptable patients, even this short period of hypertension and tachycardia can result in myocardial ischemia. The purpose of this study was to evaluate the effect of esmolol and diltiazem in attenuating cardiovascular responses to tracheal extubation. METHODS: Changes in heart rate, systolic and diastolic blood pressure were measured during extubation and emergence from anesthesia in 60 ASA physical status I patients to assess the effect of esmolol and diltiazem. The patients were randomly assigned to one of three groups (n=20 for each group) : saline 5 ml (as a control), 0.2 mg/kg diltiazem and 1.5 mg/kg esmolol. These medications were given 2 min before tracheal extubation. RESULTS: Both groups of diltiazem and esmolol were greater attenuating effect on changes of heart rate, systolic and diastolic blood pressure than control group. The inhibitory effect on changes of heart rate was greater with esmolol than diltiazem, but the attenuating effect on changes of systolic blood pressure was greater with diltiazem than esmolol. CONCLUSIONS: We concluded that a bolus dose of intravenous diltiazem 0.2 mg/kg or esmolol 1.5 mg/kg given at 2 min before extubation was of value in attenuating the cardiovascular changes occuring in association with tracheal extubation and emergence from anesthesia. Esmolol is more effective than diltiazem in attenuating the heart rate changes. Diltiazem is more effective than esmolol in attenuating the systolic blood pressures changes.
Airway Extubation* ; Anesthesia ; Blood Pressure ; Diltiazem* ; Heart Rate ; Humans ; Hypertension ; Myocardial Ischemia ; Tachycardia

PURPOSE: To study the MR findings to predict the site of dural attachment in meningiomas. MATERIALS AND METHODS: We retrospectively reviewed MR findings of 23 patients with surgically confirmed meningiomas and analysed the characteristics of dural attachment site of meningiomas and tumor growing vector against dura. RESULTS: In the 10 cases that tumor had a single dural base, the dural base was tumor bed. in the 2 cases that tumor had more than two dural bases, wider, irregular and thicker enhancing dura was tumor bed. In the 7 of the 11 cases of diffuse dural bases with tumor, we could predict tumor bed considering the degree of compression to the brain parenchyma and the tumor growing vector. CONCLUSIONS: In the case of tumor having more than two surfaces contacting the dura or with narrow attachment site, it is possible to predict the site of dural attachment if we consider the characteristrics of dural attachment site and tumor growing vector against dura.
Brain ; Humans ; Meningioma* ; Retrospective Studies

No abstract available.
Humans ; Nephritis, Interstitial* ; Nephrotic Syndrome*

PURPOSE: The purpose of the study was to describe the essential structure of the lived experience of clinical nurses' interpersonal relations among nurses, patients, and others in the ward setting of the hospital. METHOD: Six nurses who have experienced from 4 to 7 years on the same ward setting, were interviewed. The data were collected from September, 2000 to May, 2001 and analyzed using Colaizzi's (1978) method of phenomenology. RESULT: In this study, 7 themes were extracted: difficulty of interpersonal relations after being familiar with work, developing good relations with doctors, patients, and their significant others as experience increased, generation gap among individual nurses, evaluating other nursing colleagues on their past experience in ward settings, avoiding nurses with whom one was in conflict, sometimes, resolving conflict through getting together with colleagues informally, having a limited interpersonal network, experiencing becoming mature through struggling with the difficulty of interpersonal relations. CONCLUSION: Nurse managers need to provide resources, opportunities, and information to clinical nurses through fully understanding the characteristics of nurses' interpersonal relations. In addition, they should minimize the factors which intervene with good interpersonal relations among clinical nurses.
Humans ; Intergenerational Relations ; Interpersonal Relations* ; Nurse Administrators ; Nursing

Nonsteroidal antiinflammatory drugs(NSAIDs) are known as clinically effective agents for treatment of inflammatory diseases. Inhibition of cyclooxygenase has been thought to be a major facet of the pharmacological mechanism of NSAIDs. However, it is difficult to ascribe the antiinflammatory effects of NSAIDs solely to the inhibition of prostaglandin synthesis. Human neutrophil elastase (HNElastase; HNE, EC 3.4.21.37) has been known as a causative factor in inflammatory diseases. To investigate the specific relationship between HNElastase inhibition and specificity of molecular structure of several NSAIDs, HNElastase was purified by Ultrogel AcA54 gel filtration, CM-Sephadex ion exchange, and HPLC (with TSK 250 column) chromatography. HNElastase was inhibited by aspirin and salicylate in a competitive manner and by naproxen, ketoprofen, phenylbutazone, and oxyphenbutazone in a partial competative manner, but not by ibuprofen and tolmetin. HNElastase-phenylbutazone-complex showed strong Raman shifts at 200, 440, 1124, 1194, 1384, 1506, and 1768 cm(-1). The Raman bands 1194, 1384, and 1768 cm(-1) may represent evidences of the conformational change at -N=N-phi radical, pyrazol ring, and -C=O radical of the elastase-drug complex, respectively. Phenylbutazone might be bound to HNElastase by ionic and hydrophobic interaction, and masked the active site. Inhibition of HNElastase could be another mechanism of action of NSAIDs besides cyclooxygenase inhibition in the treatment of inflammatory diseases. Different inhibition characteristics of HNE-lastase by NSAIDs such as aspirin, phenylbutazone-like drugs and ineffective drugs could be important points for drawing the criteria for appropriate drugs in clinical application.
Anti-Inflammatory Agents, Non-Steroidal/pharmacology* ; Chromatography, Affinity ; Computer Simulation ; Enzyme Inhibitors/pharmacology ; Human ; Isoenzymes/isolation & purification ; Isoenzymes/antagonists & inhibitors ; Ketoprofen/pharmacology ; Leukocyte Elastase/isolation & purification ; Leukocyte Elastase/antagonists & inhibitors* ; Models, Molecular ; Naproxen/pharmacology ; Phenylbutazone/analogs & derivatives ; Salicylates/pharmacology ; Spectrum Analysis, Raman

Thrombotic thrombocytopenic purpura(TTP) is a clinical syndrome of unknown etiology and characterized by microangiopathic hemolytic anemia, thrombocytopenia, fluctuating neurological status, renal dysfunction and fever. Systemic lupus erythromatosus(SLE) is also multisystemic disease that some of clinical features may mimic TTP. Therefore both diseases have led to diagnostic confusion. We experienced two cases with SLE who subsequently or initially developed TTP. In case 1, a 44-year old woman had 1-year previous history of SLE and presented with dyspnea. After diagnosis of thrombotic microangiopathy by renal biopsy, she was managed with steroid, cyclophosphamide pulse therapy, fresh frozen plasma infusion and plasmapheresis. She was treated by aggressive treatment; nevertheless, she died on 15th admission day. In case 2, a 22-year old man was admitted because of nausea and vomiting. SLE with TTP was diagnosed by ARA criteria and the finding of microangiopathic hemolytic anemia. He was treated with plasmapheresis, fresh frozen plasma infusion and steroid therapy. He showed clinical response to the therapy, and has shown no recurrence of disease until now on. In conclusion, we suggest that early diagnosis and prompt therapy such as plasmapheresis and plasma infusion are very important in SLE with TTP.
Adult ; Anemia, Hemolytic ; Biopsy ; Cyclophosphamide ; Diagnosis ; Dyspnea ; Early Diagnosis ; Female ; Fever ; Humans ; Nausea ; Plasma ; Plasmapheresis ; Purpura, Thrombocytopenic* ; Purpura, Thrombotic Thrombocytopenic ; Recurrence ; Thrombocytopenia ; Thrombotic Microangiopathies ; Vomiting ; Young Adult

Infliximab is a chimeric anti-tumor necrosis factor-alpha monoclonal antibody. Infusion related reactions and infection are well known side effects of infliximab; however, renal complications have not been well recognized. We report on a patient with late onset-acute tubulointerstitial nephritis (ATIN) after treatment with infliximab and mesalazine for Crohn's disease. A 25-year-old woman was admitted with a purpuric rash on both lower extremities and arthralgia. She had been diagnosed with Crohn's disease 5.6 years previously and had been treated with mesalazine and infliximab. Serum creatinine level, last measured one year ago, was elevated from 0.6 mg/dL to 1.9 mg/dL. Results of urinalysis, ultrasound, and serologic examinations were normal. With a tentative diagnosis of Henoch-Schonlein purpura, oral prednisolone was given, and serum creatinine decreased to 1.46 mg/dL, but was elevated to 2.6 mg/dL again at two months after discontinuation of prednisolone. Renal biopsy indicated that ATIN was probably induced by drug, considering significant infiltration of eosinophils. Concomitant use of infliximab with mesalazine was supposed to trigger ATIN. Oral prednisolone was administered, and serum creatinine level showed partial recovery. Thus, ATIN should be suspected as a cause of renal impairment in Crohn's disease even after a long period of maintenance treatment with infliximab and mesalazine.
Adalimumab/therapeutic use ; Anti-Inflammatory Agents/therapeutic use ; Creatine/blood ; Crohn Disease/*drug therapy ; Drug Therapy, Combination ; Eosinophils/immunology ; Female ; Humans ; Infliximab/*adverse effects/*therapeutic use ; Kidney/pathology ; Mesalamine/*adverse effects/*therapeutic use ; Nephritis, Interstitial/*diagnosis/drug therapy/*etiology ; Prednisolone/therapeutic use

OBJECTIVES: IgA nephropathy is a common type of primary glomerulonephritis and may present with a wide variety of histologic patterns on renal biopsy. IgA nephropathy may progress to end stage renal disease. But it is difficult to predict the prognosis of IgA nephropathy. METHODS: In an attempt to identify prognostic indicators in this disease, the clinical data from 158 patients with IgA nephropathy were analyzed and compared to the pathologic subclassification proposed by Haas. RESULTS: 1)The mean age of 158 patients with IgA nephropathy was 31.5 yrs(M:F=1:1.04) and there were 17 patients in subclass I, 5 patients in subclass II, 80 patients in subclass III, 34 patients in subclass IV, 22 patients in subclass V. 2)The significant correlation between renal survival rate and histologic subclass in 114 patients who were followed-up for more than 12 months was showed in order of I, II>III, IV>V. 3)Active crescents were a significant negative prognostic indicator in renal survival in subclass III, but not in subclass IV. 4) The presence of immune complex deposits in the glomerular capillary loops in addition to the deposits in mesangial areas was associated with poor prognosis in progression to end stage renal disease of IgA nephropathy 5)With a respect to clinical presentation, hypertension, serum creatinine of>=1.5mg/dL, and proteinuria of>=2.0g/day were significant negative prognostic indicators for renal survival but the presense of gross hematuria was not associated with increased renal survival rate by an univariate analysis. CONCLUSION: These results suggest that histologic subclassification proposed by Haas may be a useful prognostic indicator for the clinical outcome of IgA nephropathy, as well as the amount of proteinuria, serum creatinine level and hypertension at the time of initial renal biopsy
Antigen-Antibody Complex ; Biopsy ; Capillaries ; Creatinine ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Hypertension ; Immunoglobulin A* ; Kidney Failure, Chronic ; Prognosis ; Proteinuria ; Survival Rate