Recently, the bcl-2 and p53 protein have been recognized as important factors that is contributed to programmed cell death. The objective of this study was to evaluate the prognostic significance of bcl-2 and p53 protein expression in uterine cervical carcinoma. The expression of bcl-2 and p53 in 59 cases of uterine cervical carcinoma (stage IB to IIB) were surgically treated from January 1993 to June 1994. The expression of bcl-2 and p53 was examined by immunohistochemical method using formalin fixed paraffin embedded tissue specimens. The 48 cases were squamous cell carcinoma and 11 cases were adenocarcinoma. The results were as follows: 1. The expression rate of bcl-2 protein was 28.8%(17/59) and there was no significant correlaltion between the expression of bcl-2 protein and the clinicopathologic parameters (histologic type, grade, FIGO stage, cervical invasion depth, lymph node metastasis, parametrial invasion, tumor size, neoadjuvant chemotherapy response, recurrence, survival). 2. The expression rate of p53 protein was 32.2%(19/59) and there was no significant correlation between expression of p53 protein and the clinicopathologic parameters. 3. There was significant correlation between and expression of bcl-2 and p53 protein (P 0.05). In conclusion, bcl-2 and p53 protein are thought to be possible factors in the carcinogenesis of uterine cervical carcinoma and correlate with progression of it. But further study will be required to clarify the role of bcl-2 and p53 in carcinogenesis of the uterine cervix.
Adenocarcinoma ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cell Death ; Cervix Uteri ; Drug Therapy ; Female ; Formaldehyde ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin ; Recurrence ; Uterine Cervical Neoplasms*

BACKGROUND: Ondansetron is a specific 5-hydroxytrypamine (HT3) receptor antagonist, sodium channel blocker and mu-opioid receptor agonist. Prophylactic intravenous administration of ondansetron has an antiemetic effect in general and epidural anesthesia. This study is designed to evaluate the antiemetic effect of intravenous ondansetron in patient-controlled epidural analgesia (PCEA) patients. METHODS: Sixty ASA physical status I-II patients undergoing elective cesarean section under epidural anesthesia using 0.75% ropivacaine and fentanyl 50microgram were received intravenous fentanyl 50microgram plus ondansetron 2 mg (group 2 mg: n = 20), 4 mg (group 4 mg: n = 20) or 8 mg (group 8 mg: n = 20) after delivery of baby. PCEA was started using 0.15% ropivacaine and 50microgram/ml butorphanol (total volume: 300 ml, 4 ml of bolus dose, and 10 min of lockout interval). The intraoperative and postoperative incidence and severity of nausea and vomiting were recorded using 4 point scale (0: none, 1: mild, 2: moderate, 3: severe) for postoperative 24 hours. RESULTS: There were no significantly lower incidence and severity of nausea and vomiting in group 8 mg (10%, 5%) than group 2 mg (25%, 10%), and group 4 mg (20%, 10%) during postoperative 24 hours. CONCLUSIONS: Prophylactic intravenous ondansetron 8 mg injection with PCEA drug has no superior antiemitic effect than 2 mg or 4 mg in cesarean section patients under PCEA without significant side effects.
Administration, Intravenous ; Analgesia, Epidural* ; Anesthesia, Epidural ; Antiemetics ; Butorphanol ; Cesarean Section* ; Female ; Fentanyl ; Humans ; Incidence ; Nausea ; Ondansetron* ; Postoperative Nausea and Vomiting* ; Pregnancy ; Sodium Channels ; Vomiting

No abstract available.
Common Variable Immunodeficiency* ; Humans

BACKGROUND: We compared the dose requirement, analgesic effect and side effects of fentanyl with those of meperidine when administered by patient controlled analgesia(PCA) with ketorolac after total abdominal hysterectomy. METHODS: Patients received ketorolac(bolus dose 1.5 mg, lockout interval 10 min) with either fentanyl(bolus dose 5 mcg) or meperidine(bolus dose 5 mg) using PCA pump postoperatively. RESULTS: During 48hrs, patients receiving fentanyl used significantly more drug(51.2 mg of morphine) than those receiving meperidine(25.4 mg of morphine) when results were expressed as morphine(mg) equivalents using the putative potency ratios of 1:10:0.01(morphine:meperidine:fentanyl). There were no significant differences in incidences of side effects, but analgesic effect of fentanyl was superior to that of meperidine at 12 and 48 hours after operation. CONCLUSIONS: Although both fentanyl and meperidine were useful and safe drugs for PCA for postoperative pain control, combinations of meperidine and ketorolac provided more effective analgesia.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics ; Fentanyl* ; Humans ; Hysterectomy* ; Incidence ; Ketorolac ; Meperidine* ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis

Reviewing the results of the blood cultures performed at Yeungnam University Hospital during 4-year-period through January, 1, 1984 to December 31, 1987, the following results were obtained. 1) Out of 8083 blood specimens cultured microorganisms grew in 582 specimens with positivity rate of 7.20%. Polymicrobial bacteremia was found in 16 patients. 2) Among 582 positive specimens, Gram-positive cocci grew in 189 specimens, and Gram-negative bacilli, in 393 specimens. Clinically significant microorganisms consisted of 82 Staphylococcus aureus, and 20 Streptococcus species in Gram-positive cocci group, 80 Salmonella typhi, 72 Escherichia coli, 72 Salmonella paratyphi A in Enterobacteriaceae, and 46 Pseudomonas cepacia, and 16 Pseudomonas aeruginosa in glucose non-fermenting microorganisms. 3) Increasing incidence of Serratia, Acinetobacter and Pseudomonas species as major nosocomial infection source is noteworthy. They showed increased tendency from 6.3% of 1984 to 17.7% of 1987 of total positive blood cultures. 4) High isolation rate of Pseudomonas species and Aeromonas hydrophila was noted in summer, while Salmonella typhi showed high prevalence from May to September and in January. 5) In susceptibility tests of isolated organisms, staphylococcus aureus was sensitive to basic antimicrobial agents except for ampicillin. The glucose non-fermenting microorganisms showed high resistance to basic antimicrobial agents in 32.2%. In conclusion, considering the relatively higher incidence of growth of Staphylococcus epidermidis than ideal level indicates that sampling technique should be improved. Secondly, all the hospital staffs in cooperation with Hospital Infection Committee are desirable to pay efforts to decrease the nosocomial infection.
Acinetobacter ; Aeromonas hydrophila ; Ampicillin ; Anti-Infective Agents ; Bacteremia ; Burkholderia cepacia ; Cross Infection ; Enterobacteriaceae ; Escherichia coli ; Glucose ; Gram-Positive Cocci ; Humans ; Incidence ; Prevalence ; Pseudomonas ; Pseudomonas aeruginosa ; Salmonella paratyphi A ; Salmonella typhi ; Serratia ; Staphylococcus aureus ; Staphylococcus epidermidis ; Streptococcus

Buerger's disease (thromboangiitis obliterans) is an inflammatory, nonatherosclerotic, occlusive disease of small- and medium-sized arteries and veins that involves distal vessels of the extremities. Patients show symptoms related to ischemia of distal lower extremities and upper extremities (claudication, gangrene, rest pain, distal cyanosis). We report a case of progressive ascending motor weakness of the lower extremities in a Buerger's disease patient due to a metastatic bone tumor on the T3 level after lumbar epidural block and continuous cervical epidural block.
Arteries ; Extremities ; Gangrene ; Humans ; Ischemia ; Lower Extremity ; Spinal Cord Compression* ; Spinal Cord* ; Thromboangiitis Obliterans* ; Upper Extremity ; Veins

Schonlein-Henoch purpura is a generalized small vessel vasculitis characterized by nonthrombocytopenic purpura, arthritis, abdominal pain and nephritis. In 1914 Osler described an allergic purpura associated with hemiplegia. After then Lewis et al. reported the cases of Schonlein-Henoch purpura associated with convulsion, coma, confusion, intracranial hemorrhage, and chorea, CNS complication has been reported in 1-8% of children and subsided spontaneously in most cases. Headache is a remarkable sympton and appears nonspecific nature. In 1991 Ostergaard and Storm reported that headache occured during the first week following skin rash and frequently showed abnormal EEG findings. We investigated prospectively the presence of a possible cerebral and renal involvement in the case of Schonlein-Henoch purpura. EEG abnormality demonstrated in 52.6% of all cases, and headache or irritability in 47.4% of all cases. A significant association was found between abnormal EEG finding and presence of headache, but was not found between EEG findings and presence of renal involvement and hypertension. Patients with abnormal EEG had no Past or famity history of febrile convulsion or ididopathic epilepsy.
Abdominal Pain ; Arthritis ; Child ; Chorea ; Coma ; Electroencephalography* ; Epilepsy ; Exanthema ; Headache ; Hemiplegia ; Humans ; Hypertension ; Intracranial Hemorrhages ; Nephritis ; Prospective Studies ; Purpura, Schoenlein-Henoch* ; Seizures ; Seizures, Febrile ; Vasculitis

BACKGROUND: The aim of this study was to investigate the suitability of a dose conversion table from oral morphine to transdermal fentanyl patch (TDFP) and to evaluate the efficacy and safety of TDFP in the treatment of cancer pain. METHODS: Sixty cancer patients whose pain had been stabilized with oral morphine for at least 48 hours (morphine phase) were switched to TDFP using standard conversion chart for fentanyl dosage. TDFP were replaced every 72 hours for 9 days (fentanyl phase). Assessment of pain, nausea, vomiting, pruritus and somnolence were recorded as visual analogue scale (VAS). RESULTS: Patients' pain assessment and side effects were not significantly different during both phases. But ten patients reported some skin reactions to the patch, such as erythema, itching, and papules. CONCLUSIONS: TDFP were well tolerated and provided pain relief in cancer patients equivalent to that achieved with oral morphine.
Erythema ; Fentanyl* ; Humans ; Morphine ; Nausea ; Pain Measurement ; Pruritus ; Skin ; Vomiting

BACKGROUND: Opioids are frequently used to relieve pain or to induce sedation during monitored anesthesia care and regional anesthesia. Infusion rates for alfentanil range from 0.25-0.72 microgram/kg/min. This study was performed to define the optimal range of blood concentration of alfentanil to produce a conscious sedation without significant vital sign changes and side effects in spinal anesthesia patients. METHODS: One hundred patients were administered spinal anesthesia with 0.5% hyperbaric bupivacaine 12-18 mg and then a target controlled infusion (TCI) of alfentanil using a syringe pump equiped with a stelpump program. The target concentrations of alfentanil were 20 ng/ml (n = 20, group A20), 25 ng/ml (n = 20, group A25), 30 ng/ml (n = 20, group A30), 35 ng/ml (n = 20, group A35) and 40 ng/ml (n = 20, group A40). Sedation scale, bispectral index (BIS), systolic and diastolic blood pressure, heart rate, SpO2, and anxiety score were checked during the operation and postoperatively one hour later in the recovery room. RESULTS: The sedation scale was significantly higher in groups A30, A35, and A40 than in the other two groups (P < 0.05), but there were no significant difference in BIS among the groups. Mean infusion rates of alfentanil were 0.27-0.46 microgram/kg/min. Time from end of alfentanil infusion to response to a verbal command was significant delayed in groups A30, A35, and A40 than in the other two groups. Recall of operative procedure occurred in 50 65%. Intraoperative hypotension, bradycardia, and respiratory depression occurred more frequently in groups A35, and A40 than in the other three groups (P < 0.05). Incidences of postoperative nausea and vomiting were significantly higher in groups A35, and A40 than in the other three groups (P < 0.05). Heart rate and systolic and diastolic pressures were more significantly lowered during the operation in groups A35, and A40 than in the other three groups (P < 0.05). CONCLUSIONS: Alfentanil has an effective sedation effect at 40% of the analgesic dosage during spinal anesthesia. But, incidences of side effects, like hypotension, bradycardia, and nausea and vomiting increased with alfentanil target concentrations. TCI of alfentanil at 30 ng/ml produces effective sedation, antianxiety effect, and fewer side effects during spinal anesthesia.
Alfentanil* ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Conduction ; Anesthesia, Spinal ; Anti-Anxiety Agents ; Anxiety ; Blood Pressure ; Bradycardia ; Bupivacaine ; Conscious Sedation* ; Heart Rate ; Humans ; Hypotension ; Incidence ; Nausea ; Postoperative Nausea and Vomiting ; Recovery Room ; Respiratory Insufficiency ; Surgical Procedures, Operative ; Syringes ; Vital Signs ; Vomiting

BACKGROUND: The technique using target-controlled infusion (TCI) with propofol produces safe intraoperative sedation during regional anesthesia with rapid recovery and high patient satisfaction. The objective of this study was to define the blood propofol concentration necessary for conscious sedation in regional anesthesia patients according to age. METHODS: Sixty patients scheduled to undergo regional anesthesia were allocated into one of three groups according to age, such as group 1 (n = 20): 16 24 yr, group 2 (n = 20): 30 39 yr, group 3 (n = 20): 40 55 yr. Thirty minutes after performing regional anesthesia, TCI of propofol started at a target plasma level of 1 microgram/ml adjusted in steps of 0.2 microgram/ml to maintain a sedation level 3 on a 5-point sedation scale. RESULTS: The mean target concentration was 0.9 microgram/ml (group 1), 0.8 microgram/ml (group 2), 0.7 microgram/ml (group 3). The mean propofol consumption was 38.5 microgram/kg/min (group 1), 34.3 microgram/kg/min (group 2), and 30.8 microgram/kg/min (group 3). The recovery time was significantly delayed in group 3 (2.8 min) compared to group 1 (1.5 min) and group 2 (1.8 min). CONCLUSIONS: TCI of propofol within at 0.7 0.9 microgram/ml blood concentration range produces safe intraoperative sedation during regional anesthesia with rapid induction, rapid recovery and high patient satisfaction without severe complications in 16 55 yr old patients.
Anesthesia, Conduction* ; Conscious Sedation* ; Humans ; Patient Satisfaction ; Plasma ; Propofol*