The effects of epidural bupivacaine with and without epinephrine and morphine on mat-ernal blood pressure, newborn Apgar scores, and duration of analgesia were compared in 40 parturients during Cesarean section and post operative periods. Patients in group 1(n= 16) received 0.5% bupivacaine 27cc and group 2(n=10) recelved bupivacaine with epinephrine, group 3 (n= 10) received bupivacaine with morphine 3mg, and those in group 4(n= 10) received bupivacaine with epinephrine and morphine 3mg. Maternal hypotension occured less frequently in group 2 than in group 1 (p<0.001). Apgar scores were equally good (more than 8) all four groups. Duration of analgesia was longer in group 2(199.50+/-70.73min) than in group 1(133.50+/-50. 11min) but significantly longer in group 3(471.50+/-174.90) and in group 4(684.00+/-276. 92min) . It is concluded that adding epinephrine and morphine to bupivacaine during epidural anesthesia in the normal parturient has no adverse effects on either mother or neonate; and that it significantly prolongs the duration of analgesia and decreases the incidence of maternal hypotension.
Analgesia ; Anesthesia, Epidural* ; Blood Pressure ; Bupivacaine* ; Cesarean Section ; Epinephrine* ; Female ; Humans ; Hypotension ; Incidence ; Infant, Newborn ; Morphine* ; Mothers ; Obstetrics* ; Pregnancy

BACKGROUND: There is increasing evidence about inflammatory processes in the development of dementia. Therefore, inflammation has been believed to play a pivot role in cognitive decline, Alzheimer's disease (AD), and vascular dementia. High-sensitivity C-reactive protein (hs-CRP) is a sensitive systemic marker of inflammation, and increased levels of hs-CRP are associated with inflammatory reactions. It is important to identify modifiable risk factors, which could be used in preventing or delaying the onset of dementia. Therefore, we studied to clarify a clinical role of hs-CRP in AD and VaD. METHODS: This study population consisted of a sample of 102 patients with dementia (54 patients of AD and 48 patients of VaD) and 91 controls. We have investigated hs-CRP levels and cognitive function of each group. Cognitive function was evaluated with Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDS), Clinical Dementia Rating (CDR) with Sum of Box and Activities of Daily Living (ADL). RESULTS: All subjects with dementia showed higher hs-CRP levels than subjects without dementia. But, there was no significant difference of hs-CRP levels between patients with AD and those with VaD. The odds ratio of patients with AD and VaD by hs-CRP is 2.250 (95% Cl 1.670-3.032) for Alzheimer's disease and 4.0 (95% Cl 2.451-6.529) for vascular dementia. CONCLUSIONS: The result of our study suggests the presence of inflammatory activity is related with dementia, not only AD known to degenerative disease but also VaD associated with cerebrovascular disease. However, we could suggest that dementia with cerebrovascular lesions is more related with inflammatory activity than AD.
Activities of Daily Living ; Alzheimer Disease ; C-Reactive Protein ; Dementia ; Dementia, Vascular ; Humans ; Inflammation ; Odds Ratio ; Risk Factors

The pathogenesis of thrombocytopenia in the gestational thrombocytopenia is not understood.This syndrome may represent either the de novo development of ITP or an accelerationof the physiologic pattern of increased platelet destruction that occurs during gestation. Thisdisorder is not easily distinguishable from classical ITP. However, the recognition and diagnosisof this syndrome is important because infants born to individuals with gestational thrombocytopeniaappear to have a markedly reduced risk of developing thrombocytopenia when comparedto infants born to patients with a history of ITP antedating pregnancy. We represent a caseof delivery in severe gestational thrombocytopenia with brief review of the literature.
Blood Platelets ; Humans ; Infant ; Pregnancy ; Thrombocytopenia*

OBJECTIVE: The purpose of this study is to verify the usefulness of the rabbit model for disc degeneration study. MATERIALS: The L1-L2, L2-L3, L3-L4, or L4-L5 lumbar intervertebral disc (IVD) of 9 mature male New Zealand White rabbits were injured by inserting a 16-gauge needle to a depth of 5 mm in the left anterolateral annulus fibrosus while leaving L5-L6 IVD uninjured. Three other rabbits also received intradiscal injections of rabbit disc cells transfected with adenovirus and bone morphogenetic protein-2 (ad-BMP-2) at L4-L5 in addition to injury by 16-gauge needle at the L1-L2 level. Using digitized radiographs, measurements of IVD height were made and analyzed by using the disc height index (DHI). Magnetic resonance imaging (MRI) scans of the injured discs, injected discs, and uninjured L5-L6 discs were performed at 15 weeks post surgery and compared with preoperative MRI scans. RESULTS: All twelve rabbits showed consistent results of disc degeneration within 15 weeks following annular puncture. DHIs of injured discs were significantly lower than that of the uninjured L5-L6 discs (p<0.05). The mean value of disc degeneration grade of injured discs was significantly higher than that of uninjured discs (p<0.05). The injection of disc cell transfected with ad-BMP-2 did not induce disc regeneration at 15 weeks after injection. CONCLUSION: This study showed that the injured disc had a significant change in DHI on simple lateral radiograph and disc degeneration grade on MRI scans within 15 weeks in all rabbits. Rabbit annular puncture model can be useful as a disc degeneration model in vivo.
Adenoviridae ; Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Magnetic Resonance Imaging ; Male ; Models, Animal ; Needles ; Punctures ; Rabbits ; Regeneration

Microscopic polyangiitis (MPA) is a necrotizing vasculitis involving the small vessels without granulomatous inflammation. Most MPA initially presents with renal involvement without pulmonary involvement. Isolated and initially presenting alveolar hemorrhage is very rare. The patient was a 39-year-old female with a progressive cough, dyspnea, and blood-tinged sputum for the previous 5 days. We determined that her condition was MPA though VATS lung biopsy and renal biopsy. After 2 months of steroid therapy, the chest lesions had improved. We report here a rare case of MPA with isolated and initial involvement of the lung with a review of the literature.
Adult ; Biopsy ; Cough ; Dyspnea ; Female ; Hemoptysis ; Hemorrhage ; Humans ; Inflammation ; Lung ; Microscopic Polyangiitis ; Sputum ; Thoracic Surgery, Video-Assisted ; Thorax ; Vascular Diseases ; Vasculitis

BACKGROUND/AIMS: Chronic obstructive pulmonary disease (COPD) often coexists with co-morbid conditions that significantly affect the prognosis. Although depression frequently coexists with COPD, little about how to screen for depression in COPD patients is known. We report the effectiveness of depression screening in patients with COPD and of the instruments used for this purpose. METHODS: We performed a systematic literature review of the domestic (Research Information Sharing Service, KoreaMed, and Kmbase) and international (Medline, Embase, Cochrane library) databases using "COPD AND depression AND screening tools" as key words. RESULTS: No study directly evaluated the effectiveness of screening for depression in COPD patients. However, depression was present more frequently in patients with COPD. COPD patients with depression were also more likely to be in poor health. A total of eight screening instruments for depression were translated into Korean. All had similar reliabilities and internal consistencies. CONCLUSIONS: Screening of COPD patients for depression is necessary because individuals with this condition are more likely to suffer from depression, which has a negative impact on health. The choice of depression screening instruments may need to be based on considerations of simplicity.
Depression ; Humans ; Information Dissemination ; Mass Screening ; Prognosis ; Pulmonary Disease, Chronic Obstructive

To investigate the incidence and pattern of occurrence of primary brain tumors in Koreans, 2,616 cases of histologically confirmed primary intracranial tumors, which were operated on in our department between 1976 and 1995, were reviewed. In all cases, age, sex, tumor type, location and date of diagnosis were recorded, and tumors were pathologically classified according to the WHO Histological Type of CNS tumors, revised in 1993. The tumors studied included all those within the intracranial region, except for vascular or infectious masses and epidermoid or dermoid cysts associated with congenital dermal sinus. The total number of adult patients was 2,232(85.3%), while the number of pediatric cases(below 16 years of age) was 384(14.7%). The mean age of the patients was 36.4 years, and the male : female ratio(M:F ratio) was 1 : 1.06. Common tumors were those involving neuroepithelial tissue(874 cases ; 33.4%), the sellar region(787 cases ; 30.1%), the meninges(572 cases ; 21.9%), cranial and spinal nerves(232 cases ; 8.9%), and germ cell tumors(GCT)(59 cases ; 2.3%). Meningiomas, pituitary adenomas, and schwannomas occurred at a higher rate in females(M:F ratio : 1:1.92,1:1.21,1:1.19, respectively). GCT, medulloblastomas, craniopharyngiomas, and hemangioblastomas, on the other hand, occurred more often in males (M:F ratio : 1:0.44, 1:0.46, 1:0.67, 1:0.72, respectively). Common pediatric tumors were astrocytic tumors (23.2%), medulloblastomas(19.3%), and craniopharyngiomas(11.2%). The age distribution of tumors was similar to that found in other epidemiologic studies. Between 1976 and 1993, with the introduction of computerized tomography(CT), the reported incidence of primary intracranial tumors has increased by an average of 13% annually. The relative incidences of pituitary adenoma, glioma, hemangioblastoma and primitive neuroecrodermal tumors(PNET) have increased since 1988, when magnetic resonance imaging(MRI) was installed in our hospital.
Adult ; Age Distribution ; Brain Neoplasms ; Craniopharyngioma ; Dermoid Cyst ; Diagnosis ; Epidemiologic Studies ; Epidemiology ; Female ; Germ Cells ; Glioma ; Hand ; Hemangioblastoma ; Humans ; Incidence ; Male ; Medulloblastoma ; Meningioma ; Neurilemmoma ; Pituitary Neoplasms ; Spina Bifida Occulta