This erratum is being published to correct of affiliation and add an acknowledgement.

BACKGROUND: The cell mediated immunity has an important role in the pathogenesis of tuberculosis. sIL-2R has been known as a sensitive marker of T lymphocyte activation. Elevated serum levels of sIL-2R have been found in patients with lymphoproliferative disorders, organ transplantation, autoimmune diseases, and various granulomatous diseases. Elevated levels of sIL-2R have been also found in the seam and pleural fluid of the patients with tuberculosis. To evaluate the diagnostic value of sIL-2R in the differentiation of tuberculous pleurisy and. nontuberculous pleurisy. We measured the level of sIL-2R in the sera and pleural fluids of 12 patients with tuberculous pleurisy and 32 patients with nontuberculous pleurisy. METHOD: Samples of pleural fluid and serum were centrifuged at 2500 rpm for 10 min to remove cell pellets. Soluble R-2R was measured with a sandwitch enzyme immunoassay using the Cellfree r Interleukin-2 Receptor Test kit( T-cell science, Inc. Cambridge, MA). RESULTS: The results obtained were as follows: 1) The sIL-2R level in pleural fluid of the patients with tuberculous pleurisy was higher than that of patients with nontuberculous pleurisy(P<0.005). 2) When the sIL-2R level above 5,000 u/ml in pleural fluid was used as the cut-off value to diagnose tuberculous pleurisy, it had a sensitivity of 84.6% and a specificity of 90.9%. 3) The sIL-2R level in the sera of the patients with tuberculous pleurisy was higher than that of patients with bacterial pleural effusions and normal control group(P<0.05) and there was no difference of levels compared with malignant pleural effusions and transudative pleural effusions(P>0.05). 4) In patients with tuberculous pleurisy, the mean concentration of sIL-2R in pleural fluid was higher than that in serum(P<0.005). CONCLUSION: These findings suggest that the measurement of elevated levels of pleural fluid sIL-2R in tuberculous pleurisy may be useful in the differential diagnosis between patients with tuberculous pleurisy and nontuberculous pleurisy.
Autoimmune Diseases ; Diagnosis, Differential ; Humans ; Immunity, Cellular ; Immunoenzyme Techniques ; Interleukin-2* ; Lymphocyte Activation ; Lymphoproliferative Disorders ; Organ Transplantation ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy* ; Sensitivity and Specificity ; T-Lymphocytes ; Transplants ; Tuberculosis ; Tuberculosis, Pleural*

BACKGROUND: Lidocaine's sedative effect has not been known well. The purpose of this study was to evaluate its sedative and cardiovascular effects during induction of anesthesia. METHODS: Twenty patients were randomly allocated to group I or II, with or without lidocaine 1.5 mg/kg intravenously (IV) before induction, respectively. The BIS, blood pressure and heart rate were measured at before and 2 minutes after lidocaine IV injection, preintubation, and 1, 2, 3 and 5 minutes after tracheal intubation. The enflurane concentrations were continuously maintained at 2 volume%. RESULTS: The BIS of group I was more decreased at 1 and 2 minutes after intubation than those of group II. The systolic blood pressures of group I were less increased at 1 and 2 minutes after intubation than those of group II. The diastolic blood pressures and heart rates of group I were not different from those of group II at each stage of the procedure. CONCLUSIONS: Lidocaine reduced BIS and blunted the intubation-induced systolic hypertensive response. In addition it is thought that it has a sedative effect and is effective to maintain cardiovascular stability after tracheal intubation.
Anesthesia ; Blood Pressure ; Enflurane ; Heart Rate ; Humans ; Hypnotics and Sedatives* ; Intubation ; Intubation, Intratracheal* ; Lidocaine*

Mishaps related to valve malfunction in a self-inflating bag-valve unit can lead to fatal complications. We report a case of severe hypotension that resulted from the locking of the Laerdal valve in the inspiratory position during transport in the operating room. A 36 year old man had undergone an off-pump coronary artery bypass graft. Immediately before leaving the operating room, severe hypotension developed abruptly. But an EKG showed only a reduction of heart rate. We started closed cardiac massage with an intravenous bolus injection of epinephrine 0.5 microgram and reconnected the anesthesia breathing circuit. The patient was manually ventilated using the anesthesia reservoir bag. Vital signs immediately recovered. At that time, the patient's abdomen was distended and we suspected an expiratory abnormality. The self-inflating bag-valve unit was tested with an anesthesia reservoir bag as a test lung. Expiration did not occur. Another self-inflating bag-valve unit was substituted and normal ventilation was restored. It is essential that before use, a self-inflating bag-valve unit should be tested for proper function during both expiration and inspiration using a test lung such as, an anesthesia reservoir bag.
Abdomen ; Adult ; Anesthesia ; Coronary Artery Bypass, Off-Pump ; Electrocardiography ; Epinephrine ; Heart Massage ; Heart Rate ; Humans ; Hypotension* ; Lung ; Operating Rooms ; Respiration ; Resuscitation ; Transplants ; Ventilation ; Vital Signs

It is important to consider the fetal, uteroplacental, and maternal issues when choosing anesthetic technique for fetal surgery. The twin reversed arterial perfusion (TRAP) sequence, or the acardiac anomaly, occurs in 1:100 monozygous multiple pregnancies and in 1:35,000 births. The TRAP sequence is characterized by placental vascular arterio-arterial anastomosis between twin fetuses, one an acardiac/acephalic twin that receives its blood flow from the normal pumping twin, thereby endangering the normal twin by high output cardiac failure. The acardiac twin is nonviable, and perinatal mortality in the pump cotwin exceeds 50% because of cardiac failure and prematurity. This can be managed by fetal surgery. We report on a patient with a 26-wk gestation complicated by an acardiac/acephalic fetus anesthetized for surgical umbilical cord ligation.
Anesthesia* ; Female ; Fetus ; Heart Failure ; Humans ; Ligation ; Parturition ; Perfusion* ; Perinatal Mortality ; Pregnancy ; Pregnancy, Multiple ; Umbilical Cord

PURPOSE: The aim of this study was to determine the usefulness of ultrasonography for lumbar anatomical structure measurement. MATERIALS AND METHODS: From January 2011 to April 2011, 41 patients (22 males, 19 females) with back pain who visited the outpatient department and underwent lumbar magnetic resonance imaging (MRI) were selected. In each level of L4 and L5, we measured the longest distance and horizontal distance between each inferior articular process based off a spinous process. We also measured the distance between the spinous process tip and the vertebral body posterior surface and the thickness and width of the multifidus muscle. All distances were measured with ultrasonography and MRI and the two measurement results were compared. RESULTS: Using ultrasonography and MRI, we measured the distance between the spinous process tip and the posterior surface of the body. The distances were 39.16+/-8.71 mm/39.53+/-6.01 mm at L4 and 38.32+/-9.66 mm/37.74+/-10.54 mm at L5. The right multifidus muscle thickness measurements were 32.13+/-10.79 mm/33.84+/-9 mm at L4 and 31.32+/-10.04 mm/32.84+/-12.28 mm at L5. The measuring distance between the spinous process center to the posterior vertebral body surface and thickness of multifidus muscles by ultrasonography and MRI had significant correlations (p<0.05). CONCLUSION: Limitations still exist in measuring the structure of lumbar anatomy with ultrasonography. However, measuring the distance between the spinous process center to the vertebral body posterior surface and multifidus muscle thickness was effective.
Back Pain ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Male ; Muscles ; Outpatients ; Spine

PURPOSE: Electrophysiologically assess conduction pathways of the pyramidal and extrapyramidal systems in rats and predict the pathways involved in spinal cord injuries. METHOD: The motor area of the cerebral cortex, medullary reticular nucleus, lateral vestibular nucleus, and red nucleus of adult Sprague-Dawley rats were stimulated with microelectrodes. Laminectomies were performed at the C6, T10 and L2 cord level. Field potentials evoked by stimulation of the cerebral cortex and the three motor nuclei were recorded with a glass microelectrode of 1.5~2.5 Mohm filled with 0.2M NaCl. To construct a cross-sectional map of field potentials, recording was made in 7 tracks equally spaced across the spinal cord. In each track, field potentials were recorded at seven equally spaced points from the ventral to dorsal cord. RESULT: Stimulation of the cerebral motor cortex evoked 5 wanes, such as P1, P2, P3, P4, P5. P1 was monitored mainly in the bilateral dorsal half of the spinal cord and other wades mainly in the ventral half of the spinal cord. With lateral vestibular nucleus stimulation, 1 or 2 short duration biphasic waves followed by a longer duration positive wave were monitored mainly in the ipsilateral ventrolateral funiculus of the cord. Field potentials produced by stimulating the medullary reticular nucleus were shown mainly in the ventromedial funiculus, and their latencies were longer than those from the vestibular nucleus stimulation. Field potentials generated by the stimulation of the red nucleus were monitored mainly in the dorsolateral funiculus. CONCLUSION: motor evoked potential is clinically useful to evaluate the descending pathways of the spinal cord.
Adult ; Animals ; Cerebral Cortex ; Evoked Potentials, Motor* ; Glass ; Humans ; Laminectomy ; Microelectrodes ; Motor Cortex ; Rats* ; Rats, Sprague-Dawley ; Red Nucleus ; Spinal Cord ; Spinal Cord Injuries ; Vestibular Nucleus, Lateral

BACKGROUND: In a gynecologic cone biopsy, fentanyl is commonly used with propofol for its analgesic effect, but it has many side effects, such as bradycardia, respiratory depression and hypotension. A subanesthetic dose of ketamine has an analgesic effect and minimal cardiovascular effects. We wanted to know whether ketamine can be safely used with propofol in a gynecologic cone biopsy instead of fentanyl. METHODS: Forty woman patients were randomly allocated to two groups. All patients were anesthesized with a propofol infusion. Fentanyl 1mug/kg IV was injected 2 minutes before LMA (laryngeal mask airway) insertion in group I, ketamine 0.25 mg/kg IV was injected also in group II. Blood pressure and heart rate were measured before fentanyl or ketamine injection, 1 minute, 3 minutes and 5 minutes after LMA insertion, and during the operation. A numerical rating scale (NRS) for pain and other side effects were checked for 24 hours after the operation. RESULTS: There were no significant differences between the two groups in blood pressure, heart rate, NRS and side effects, but a more stable systolic blood pressure in the ketamine group occured. CONCLUSIONS: For a gynecologic cone biopsy, propofol anesthesia combined with fentanyl or ketamine was not different for stable cardiovascular results, postoperative pain relief and side effects. Therefore, ketamine as an analgesic combined with propofol could replace fentanyl in gynecologic cone biopsy anesthesia.
Anesthesia* ; Biopsy* ; Blood Pressure ; Bradycardia ; Female ; Fentanyl* ; Heart Rate ; Humans ; Hypotension ; Ketamine* ; Masks ; Pain, Postoperative ; Propofol ; Respiratory Insufficiency

OBJECTIVE: This study was undertaken to review the disease course, clinical and laboratory manifestations, prognosis and treatment of adult onset Still s disease (AOSD) in Korea. METHODS: Thirty-two patients with AOSD were enrolled from 1986 to 1997 in Hanyang University Hospital. Diagnosis of AOSD was based on the criteria proposed by Yamaguchi. We classified the disease course into self-limited, inter mittent, or chronic disease course. RESULTS: Twenty-four (75%) patients were female. Skin rash occurred in 28 (88%) patients, lymphadenopathy in 8 (25%), hepatomegaly in 4 (13%), and pericarditis in 2 (6%) out of 32 patients. The most commonly affected joints were knee joints (88%). Elevated LDH was seen in 18 (60%) patients and decreased CK in 17 (61%) patients. Rheumatoid factor was detected in 4 (13%) patients and ANA in 12 (38%) patients. Anemia (Hb < 10 g/dL) was seen in 13 (41%) patients and hypoalbuminemia (<3. 5 g/dL) in 14 (52%) patients. Elevated ferritin (300 ng/mL) level was seen in 23 (79%) patients. Twenty-five (78%) patients had elevated serum transaminase. Bone marrow studies were performed in 16 patients. Nine out of 16 patients showed hyperplasia of the myeloid series and 2 patients displayed the features of a hemophagocytic syndrome. The mean duration of follow up of 32 patients was 32 months (range 3- 108). Eight (27%) patients had a self-limited, 9 (30%) an intermittent, and 13 (43%) a chronic disease course. The hypoalbuminemia was significantly associated with an "intermittent or chronic disease group" (p<0. 05). Thirty-two patients received systemic corticosteroids and 21 patients received single or combination of disease modifying antirheumatic drugs. CONCLUSION: We found that hypoalbuminemia at presentation was significantly associated with an unfavorable outcome, intermittent or chronic disease group. The clinical manifestations and disease course of AOSD in Korea were similar to those previously reported in other countries except significantly lower incidence of lymphadenopathy, hepatomegaly, and pericarditis.
Adrenal Cortex Hormones ; Adult* ; Anemia ; Antirheumatic Agents ; Bone Marrow ; Chronic Disease ; Diagnosis ; Exanthema ; Female ; Ferritins ; Follow-Up Studies ; Hepatomegaly ; Humans ; Hyperplasia ; Hypoalbuminemia ; Incidence ; Joints ; Knee Joint ; Korea* ; Lymphatic Diseases ; Lymphohistiocytosis, Hemophagocytic ; Pericarditis ; Prognosis ; Rheumatoid Factor ; Still's Disease, Adult-Onset*

BACKGROUND: The aging of the patient population is one of rhe most important factirs influencing health care delivery. Currently 5% of the Korean population is elderly, defined as older than 65years of age, with this group projected to increase to 13.1% by the year 2021. Cardiovascular disease is the leading cause of death and of disability in the elderly age group. mong them, coronary heart disease is the most importane. METHOD: Study population composed of 216 patients who were admittied to the hospital with first acute myocardial infarction and they were divided into two groups according to the age(older than 65 years of age vs younger). Clonical features, risk factors of coronary heart disease, in-hospital outcome and complication were compared in elderly patients and others group. Results : 1) The risk factors of coronary heart disease is similar to younger patients but pattern of chest pain is less typical than younger patients. 2) Clinical presentation of elderly patients is similar to younger patients except Killip class on admission.(1.66vs 1.91,P=0.04) 3) In-hospital mortality of elderly patients in higher than younger patients. In addition to an increased incidence of death, recurrent ischemia, stroke, AV block, ventricular arrythmia, pulmonary edema occured more frequently with advanced age. 4) Especially in the thrombolytic therapy group, in-hospital death, reinfarction and recurrent ischemia is higher than primary PTCA group in elderly patients. CONCLUSIONS: Diagnosis of acute chest pain is difficult in elderly patients and in-hospital mortality and morbidity is higher than in younger patients. Thus more accurate diagnosis and discriminative therapeutic modality is needed.
Aged ; Aging ; Arrhythmias, Cardiac ; Atrioventricular Block ; Cardiovascular Diseases ; Cause of Death ; Chest Pain ; Coronary Disease ; Delivery of Health Care ; Diagnosis ; Hospital Mortality ; Humans ; Incidence ; Ischemia ; Myocardial Infarction* ; Pulmonary Edema ; Risk Factors ; Stroke ; Thrombolytic Therapy