No abstract available.

No Abstract Available.
X-Ray Film*

PURPOSE: High flow rate (FR) and pressure limit (PL) strategy with time-cycled pressure-limited (TCPL) ventilator is employed routinely in the neonates. Theoretical basis of this strategy is the two-compartment theory that the lung with acute respiratory failure consists of units with different compliance and resistance. But such constant pressure strategy has the risk of ventilator induced lung injury. We compared the ventilatory indices and clinical outcomes of two different strategies, high FR-constant pressure and low FR-constant FR in the ventilator care of the neonates with acute respiratory failure. METHODS: For the neonates born in our hospital and treated with mechanical ventilation from March to August in 1997, two different ventilator strategies were employed randomly with flow control ventilator. In the high-FR group, the FR was fixed at 10 L/ min and the PL was adjusted according to the arterial blood gas analysis (ABGA) results. In the low-FR group, the FR was adjusted to 10 mL/kg of tidal volume. Sixty neonates were enrolled, 32 in high-FR and 28 in low-FR group. Ventilatory indices and clinical outcomes were statistically cornpared in the two groups. RESULTS: Perinatal factors were not different in the two groups. Initial ventilator settings, ABGA results and ventilatory indices were not different. The tidal volume, fraction of inspired oxygen, peak inspired pressure and oxygenation index were higher and dynamic compliance was lower in the high-FR group compared to the low-FR group after 3 to 72 hours of ventilator care. In clinical outcomes, incidences of pulmonary interstitial emphysema, pneumothorax and chronic lung disease were significantly lower in the low-FR group. CONCLUSION: Low-FR with constant FR strategy resulted in better clinical outcomes in the ventilator care of neonates. We conclude that constant FR strategy prevents damage of the better compliant lung units and decreases the incidence of acute and chronic complications of ventilator care.
Blood Gas Analysis ; Compliance ; Emphysema ; Humans ; Incidence ; Infant, Newborn* ; Lung ; Lung Diseases ; Oxygen ; Pneumothorax ; Respiration, Artificial ; Respiratory Insufficiency* ; Tidal Volume ; Ventilator-Induced Lung Injury ; Ventilators, Mechanical

No abstract available.
Child* ; Endoscopy* ; Humans

A 32-year-old housewife who resides in Taegu was admitted in Yeungman University Hospital due to right upper quadrant abdminal pain of 2 mounths'duration. An abdomical CT and ultrasonography revealed a relatively well demarcated low density mass in the right lobe of liver. Right hepatic lobectomy was performed on the clinical impression of hepatoma. On the light microscopic study, the lobulated liver mass showed extensive central necrosis and fibrosis, with large numbers of pseudotubercles therein. The pseudotubercles have distorted helminthic eggs frequently. The submitted common bile duct lymph node also showed a few pseudotubercles. The eggs recovered from the tissue homogenate measured 140~152 micrometer by 75~85 micrometer in size and were unembryonated and light yellow to brown. The eggs were determined as those of Fasciola species. We reported the present case as 11th one of human fascioliasis in korea.
Humans

The present study was performed to compare maternal and perinatal outcomes in triplet and twin pregnancies with the result of ART(Assisted Reproductive Technology). Each pregnancy of 18 triplet pregnancies with 18 weeks or more was matched for maternal age, EDC(estimated date of confinement), parity, history of preterm delivery, indication of ART with two sets of twin pregnancies. Triplet pregnancies had a significantly shorter gestational age at delivery than twin pregnancies(30.4 versus 34.6 weeks), and a significantly lower mean birth weight(1,514 versus 2,286g). The mean hospital stay was significantly longer in triplets(22.3 versus 10.1 days). The incidences of 5 min Apgar score less than 7, neonatal deaths were significantly more often in triplets than twins; 18(33.3%) vs 6(8.3%), 15(27.8%) vs 7(9.72%), respectively. There were significant differences in the incidence of neonatal complications such as respiratory distress syndrome; 14(25.9%) vs 7(9.72%), ventilatory support; 18(33.3%) vs 5(6.9%), neonatal seizure; 9(16.7%) vs 0, btween the two groups. However, there were no significant differences between the groups in maternal complications or neonatal morbidity such as congenital malformations or hyperbilirubinemia, intraventricular hemorrhage, or bronchopulmonary dysplasia. We suggest that counseling patient regarding the anticipated perinatal outcomes of triplet pregnancies with the result of ART should be conducted with our data.
Apgar Score ; Bronchopulmonary Dysplasia ; Counseling ; Female ; Gestational Age ; Hemorrhage ; Humans ; Hyperbilirubinemia ; Incidence ; Infant, Newborn ; Length of Stay ; Maternal Age ; Parity ; Parturition ; Pregnancy ; Pregnancy, Triplet ; Pregnancy, Twin* ; Reproductive Techniques, Assisted* ; Seizures ; Triplets*

PURPOSE: A new quantitative tumor marker, based on the combined measurement of urinary fragments of cytokeratins 8 and 18, namely the urinary bladder cancer antigen(UBC(TM)) test, has been proposed for the detection of bladder transitional cell carcinoma(TCC). We evaluated the diagnostic efficacy of UBC(TM) test in comparison with that of urinary cytology to establish UBC(TM) test for the diagnosis of TCC. MATERIALS AND METHODS: One-hundred ninety-six patients with hematuria were included in this study. Forty patients were diagnosed histologically as TCC by transurethral resection or radical cystectomy(group A), while the others had various benign urinary tract conditions(group B). RESULTS: UBC(TM) levels were significantly different between groups A (1851.39+/-4627microgram/l) and B (19.28+/-107.03microgram/l) (p<0.001). Sensitivity for diagnosis of TCC was 89.7%(36/40) in UBC(TM) test and 45%(18/40) in cytology(p<0.05). Specificity for diagnosis of TCC was 84.6%(132/156) in UBC(TM) test and 100%(156/156) in cytology. UBC(TM) test was significantly more sensitive than cytology in stage Ta(85.7% vs. 0%, p<0.05), T1 tumors(89.4% vs. 31.5%, p<0.05), and in Grades 1(83.3% vs. 25%, p<0.05) and 2(90.4% vs. 52.3%, p<0.05) tumors. UBC(TM) test was more sensitive in higher Grade(83.3% in Grade 1, 90.4% in Grade 2 and 100% in Grade 3). CONCLUSIONS: In comparison with urinary cytology, UBC(TM) test could be a valuable marker for diagnosis of TCC in patients with early stage and low grade TCC. Therefore, UBC(TM) test in association with cytology may be useful as a screening test for TCC of the bladder.
Carcinoma, Transitional Cell* ; Diagnosis ; Hematuria* ; Humans ; Keratins ; Mass Screening* ; Sensitivity and Specificity ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Tract

BACKGROUND: Although postmenopausal estrogen replacement therapy is known to reduce cardiovascular mortality, the mechanism is not clear yet. Furthermore, the effect of estrogen on vascular tonus is reportedly variable according to the animal models, vascular beds and agonists used. MATERIALS AND METHOD: Bilateral ovariectomies were performed in 12 week-old, 18 spontaneously hypertensive rats (SHR) and 18 normotensive Wistar-Kyoto rats (WKY). Rats were divided into three groups according to the dose of 17beta-estradiol (E 2 ) pellets implanted subcutaneously two weeks after ovariectomy: control (no implantation), low-dose (0.5 mg) and high-dose (5 mg) E 2 replacement group. Two weeks after pellet implantation, organ bath experiments were performed using descending thoracic aortae. For endothelium-dependent relaxation, acetylcholine (10(-9) -3x10(-6) M) was cumulatively added into the vessels precontracted with 10(-7) M norepinephrine (NE). For vasoconstrictor responses, cumulative concentration-contraction curves were constructed in quiescent vessels using NE (10(-9) -10(-5) M), U46619 (10(-9) -3x10(-6) M), endothelin-1 (10(-10) -10(-7) M). In addition, contraction to angiotensin II (10(-7) M) was also obtained. Serum 17beta-estradiol levels were measured by radioimmunoassay. Blood pressure was measured by tail-cuff method in some SHRs before ovariectomy and after placebo/E 2 replacement. RESULTS: Endothelium-dependent relaxation to acetylcholine was impaired in WKY treated with 5 mg E 2 (pIC 50 : control vs 5mg E 2 : 7.75+/-0.13 vs 7.27+/-0.16: n=6: p<0.05). No significant effect was noted in SHR. Contraction to angiotensin II was inhibited by low-dose E 2 in WKY and high-dose E 2 in SHR (% of the contraction to 60 mM KCl: WKY: control vs 0.5 mg E 2 : 39+/-5 vs 25+/-2: SHR: control vs 5 mg E 2 : 34+/-4 vs 22+/-2: n=6 and p<0.05 in WKY and SHR). In contrast, NE-induced contraction was enhanced by E 2 replacement (both low- and high-dose) in WKY and SHR (WKY: control vs 0.5 mg E 2 vs 5 mg E 2 : AUC: 280+/-24 vs 387+/-26 vs 374+/-25: maximal contraction: 137+/-8 vs 166+/-8 vs 162+/-3: pD 2 : 7.63+/-0.11 vs 8.17+/-0.13 vs 8.13+/-0.13: SHR: control vs 0.5 mg E 2 vs 5 mg E 2 : AUC: 265+/-17 vs 349+/-16 vs 406+/-19: maximal contraction: 152+/-6 vs 181+/-9 vs 203+/-16: pD 2 : 7.45+/-0.13 vs 7.91+/-0.08 vs 8.04+/-0.04: n=6 and p<0.05 between control and treated groups in WKY and SHR for all parameters). Contraction to U46619 was enhanced by E 2 replacement in SHR (control vs 0.5 mg E 2 : AUC: 478+/-30 vs 574+/-23: maximal contraction: 181+/-9 vs 230+/-10: n=6: p<0.05 for both parameters). Maximal contractile response to endothelin-1 was also enhanced in SHR (control vs 0.5 mg E 2 vs 5 mg E 2 : maximal contraction: 165+/-7 vs 189+/-7 vs 199+/-8: n=6 and p<0.05 between control and treated groups) but not in WKY. Blood pressure was not different between placebo and E 2- treated SHR (171+/-2 vs 174+/-4 mmHg). CONCLUSION: In WKY, chronic high-dose estrogen replacement impairs endothelium-dependent relaxation to acetylcholine.: low-dose estrogen replacement does not affect endothelium-dependent relaxation in SHR and WKY. Estrogen replacement enhances the contraction to most of the contractile agonists tested except angiotensin II in both WKY and SHR. These results suggest that estrogen replacement affect the vascular tonus differently according to the vasoactive substances and/or hormones without significant effect on blood pressure.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid ; Acetylcholine ; Angiotensin II ; Animals ; Aorta, Thoracic ; Area Under Curve ; Baths ; Blood Pressure ; Endothelin-1 ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Models, Animal ; Mortality ; Norepinephrine ; Ovariectomy ; Radioimmunoassay ; Rats ; Rats, Inbred SHR* ; Relaxation

PURPOSE: During the night time decision making on patients suspicious of appendicitis is often difficult because diagnosis and timing for operation are frequently delayed. Therefore, we analyzed above cases and solution is suggested. METHODS: This retrospective study included 360 patients who underwent laparotomies for suspected appendicitis at Hanil Hospital during one year, from March 1998 to Feb. 1999. They were divided into two groups according to presenting time to physician (Day time: 6 a.m. to 6 p.m., Night time: 6 p.m. to 6 a.m.). Sex & age distribution, time of presentation to physician, duration of symptoms, symptoms & physical findings, white blood cell counts, interval from presentation to operation, hospital stay, and pathologic diagnosis were compared. RESULTS: There were no significant differences in sex & age distribution, duration of symptoms, symptoms & physical findings, white blood cell counts, pathologic diagnosis between the two groups. However, during the night time, the interval from presentation to operation was longer than that of the day time (9.15 hours versus 4.83 hours, p<0.001), the rate of delayed appendectomy during the night was 58.0%, the rate of negative laparotomy increased when appendectomy was delayed for more than 12 hours compared with less than 12 hours (28.1% vs 11.7%, p<0.01), and in the cases with perforated appendicitis, delayed appendectomy for more than 12 hours had longer hospital stay compared with less than 12 hours (12 days vs 9.44 days, p<0.01). Factors causing delayed appendectomy were related to the physician (42.5%), lack of anesthetic & nursing supports (19.5%), failure to structure the operation team (20.7%), and patient itself (17.3%). When white blood cell counts were rechecked in the next morning, levels above 10,000 cells/mm3 were highly associated with appendicitis in contrast to that below 10,000 cells/mm3 (91.7% vs 43.5%, p<0.002).
Age Distribution ; Appendectomy ; Appendicitis* ; Decision Making ; Diagnosis ; Humans ; Laparotomy ; Length of Stay ; Leukocyte Count ; Nursing ; Retrospective Studies

BACKGROUND: Pregabalin is an anticonvulsant and analgesic agent that interacts selectively with the voltage-sensitive-Ca(2+)-channel alpha-2-delta subunit. The aim of this study was to evaluate whether the analgesic action of intrathecal (IT) pregabalin is associated with KATP channels in the rat formalin test. METHODS: IT PE-10 catheters were implanted in male Sprague-Dawley rats (250-300 g) under inhalation anesthesia using enflurane. Nociceptive behavior was defined as the number of hind paw flinches during 60 min after formalin injection. Ten min before formalin injection, IT drug treatments were divided into 3 groups: normal saline (NS) 20 microl (CON group); pregabalin 0.3, 1, 3 and 10 microg in NS 10 microl (PGB group); glibenclamide 100 microg in DMSO 5 microl with pregabalin 0.3, 1, 3 and 10 microg in NS 5 microl (GBC group). All the drugs were flushed with NS 10 microl. Immunohistochemistry for the KATP channel was done with a different set of rats divided into naive, NS and PGB groups. RESULTS: IT pregabalin dose-dependently decreased the flinching number only in phase 2 of formalin test. The log dose response curve of the GBC group shifted to the right with respect to that of the PGB group. Immunohistochemistry for the KATP channel expression on the spinal cord dorsal horn showed no difference among the groups 1 hr after the formalin test. CONCLUSIONS: The antinociceptive effect of pregabalin in the rat formalin test was associated with the activation of the KATP channel. However, pregabalin did not induce KATP channel expression in the spinal cord dorsal horn.
Anesthesia, Inhalation ; Animals ; Catheters ; Dimethyl Sulfoxide ; Enflurane ; Formaldehyde ; gamma-Aminobutyric Acid ; Glyburide ; Horns ; Humans ; Immunohistochemistry ; KATP Channels ; Male ; Pain Measurement ; Prostaglandins B ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; Thienamycins ; Pregabalin