PURPOSE:Effects of IDDM on bone mineral metabolism are still in controversy. Some reported that bone mineral density in IDDM had inverse relationship with HbA1c, some reported that spine BMD was normal while femur BMD was decreased. Others reported that increased urinary calcium excretion in IDDM induced early trabecular bone mineral loss. We studied the correlation of BMD with diabetic control and body measurements. METHODS:In sixteen IDDM patients, using dual energy X-ray absorptiometry, BMD was measured in lumbar spine as trabecular bone and femur neck as cortical bone. Z-score of BMD was obtained by comparing age and sex matched control data. Correlations between BMD and diabetic control parameters (HbA1c, duration of IDDM) and body measurements were calculated. RESULTS:The body measurements were in normal range in all IDDM patients, the duration of IDDM was 38.4+/-24.0months, HbA1c was in good control state (7.69+/-1.53%), and urinary Ca/creatinine ratio was not increased. The Z-score of BMD was not decreased statistically (lumbar spine: -0.255, femur neck: -0.404), and the Z-score had no correlationship with body measurements and diabetic control parameters. CONCLUSIONS:In well controlled childhood IDDM, BMD was not decreased significantly.
Absorptiometry, Photon ; Bone Density* ; Calcium ; Diabetes Mellitus, Type 1* ; Femur ; Femur Neck ; Humans ; Metabolism ; Reference Values ; Spine

No abstract available.
Pruritus*

Mutant form of the p53 gene product is abnormally accumulated in the nuclei of the tumor cells due to prolonged half life, and readily detected by immunohisto- chemical methods. To determine the positivity rate of p53 in body cavity fluid according the primary site and histological types of tumors and the utility of p53 immunostaining as an adjunct in the diagnosis of malignancy, we reviewed 69 effusions, including pleural effusion, ascitic fluid, and pericardial fluid, that were diagnosed as overt malignancy and 21 effusions of suspicious malignancy. Immuno- histochemistry was performed on paraffin-embedded cell blocks using a monoclonal antibody to p53 supressor gene product(Clone DO7) and a standard avidin-biotin complex technique with a citrate buffer antigen retrieval solution. The results were as follows; of the 46 pleural effusions with overt malignancy, 22 were immunopositive for p53 protein; of the 21 ascitic fluids with overt malignancy, 5 were positive for p53. Positivity rates according to the primary sites of tumors were 18 of 34(52.9%), 8 of 21(38.1%), 1 of 9(11.1%) cases of the tumors of the lung, GI tract, and ovary, respectively. According to the histologic types of lung cancer, 11 cases(61.6%) were positive out of 18 adenocarcinomas, 2 of 5 large cell undifferentiated carcinomas, and 1 of 2 small cell undifferentiated carcinomas. Of 21 cases of suspicious malignancy, 6 were positive for p53 and all of them(6/6) were confirmed as adeno- carcinoma of the lung or GI tract. These findings indicate that p53 immunostaining using paraffin embedded cell block is useful diagnostic and prognostic marker in body fluid cytology although negative immunostaining does not exclude malignancy.
Adenocarcinoma ; Ascitic Fluid ; Body Fluids ; Carcinoma ; Citric Acid ; Diagnosis ; Female ; Gastrointestinal Tract ; Genes, p53 ; Half-Life ; Lung ; Lung Neoplasms ; Ovary ; Paraffin ; Pleural Effusion

Fiberoptic bronchoscopy is a valuable diagnostic and therapeutic procedure in many clinical situations and is relatively simple to perform with proper technique. Local anesthetic technique is often preferable to general anesthesia for bronchoscopies since these examinations are mostly undertaken as outpatient procedures. Inhaled topical lidocaine, used to produce anesthesia of the repiratory tract prior to bronchoscopy, may cause anaphylactoid reaction in patients. However lidocaine hypersensitivity reaction is uncommon. We report the case of death due to hypersensitivity to topical lidocaine spray given during routine premedication for this procedure. The possibility of bronchospasm secondary to an adverse reaction to premedication or anesthesia must also be considered.
Anaphylaxis* ; Anesthesia* ; Anesthesia, General ; Bronchial Spasm ; Bronchoscopy* ; Humans ; Hypersensitivity ; Lidocaine* ; Outpatients ; Premedication

PURPOSE: Among the several transcatheter devices of PDA occlusion, Rashikind device was the most extensively experienced, but it had risk of occluder embolism and incomplete occlusion of PDA, approximately 27%. The authors used Duct-Occlud , made of 0.028 inch stainless steel coil. The coil is double cone-shape in released state, and used in streched condition through 4F implantation catheter for ductus occlusion. We are to report the short-term result of PDA occlusion using Duct-Occlud. METHODS: Six patients with internal ductal diameter of less than 3.5mm were selected for ductus occlusion. The Duct-Occlud was selected as follows : the diameter of aortic end was same as aortic ampulla, and the length was slightly shorter than that of ductus. The streched coil was introduced into descending aorta through implantation catheter, and the remaining coil was released in ductus and pulmonary artery subsequently. Postprocedure aortic angiogram was obtained and echocardiography was performed at 1day, 1 week, 1 month and 3 month after the procedure. RESULTS: Except one hourglass type, all the other PDA were tunnel shaped. The range of internal diameter of ductus was 0.83-2.4mm, the length 5.36-P12.4mm, and Qp/Qs 1.04-1.67. Three cases required repositioniong of coils, while the others were successful in one procedure. The residual shunts were resolved at 1 day in most cases, but two cases in 1 month after the procedure. There were no complications, such as coil embolism, migration, or pulmonary stenosis. CONCLUSIONS: In small PDA with internal diameter of less than 3.5mm, transcatheter occlusion using Duct-Occlud is easy, safe and accurate, except with high cost.
Aorta, Thoracic ; Catheters ; Echocardiography ; Embolism ; Humans ; Pulmonary Artery ; Pulmonary Valve Stenosis ; Stainless Steel

This study was intended to enhance the level of hospital personnel management through analysing job satisfaction of hospital employees in terms of structural, personal and environmental variables. The sample of this study consist of a total of 790 persons including doctors, residents, interns, pharmacists, nurses, medical engineers, office workers and manual workers who have worked for general hospitals with 200 beds, 300 beds and 800 beds respectively. The Likert's 5 scales were used for the measurement of satisfaction. The results can be summarized as follows: 1. Structural variables. The level of satisfaction on the job itself was generally low 2.8 in Likert`s 5 scales, with the order of role ambiguity(3.87), routinization(2.6), work overload (2.45) and autonomy(2 37). Hospital employees are aware of their responsibility and they regarded their work as heavy one. The compensatory satisfaction degree was 2.5 which was also low: There were in the order stability(3.l), distributive justice(2.57), pay(2.3) and promotion(l.9). Usually hospital employees showed high degree of stability, while, their satisfaction on promotion possibility is quite low due to specially differentiated structures of hospitals. The degree of satisfaction on the internal conditions of organizational culture was relatively higher as 2.92: They were co-worker's support(3.69), supervisory support(3.15), role conflict(2.64) and welfare(2.17) in order. The satisfaction on welfare as an economic condition was the lowest. 2. Personal Variables. The level of satisfaction on personal variables was 3.27 which seemed to be quite high: contribution to the hospital(3.38), attitude on job performance(3.28) and pride as a member of the, hospital(3.07). They seem to believe that their work has been helpful to the performance of hospitals. 3. Environmental Variables. The degree of satisfaction on these variables was 3.07 the average which was derived from environmental factors such as family-role conflict and community support related to hospital employees' environment. The order of satisfaction for each variable is community support(3.2) and family-role conflict(2.94). They turned out to be fairly satisfied with their job in community and yet, they wanted more spare time to spend with their family.
Hospitals, General* ; Humans ; Job Satisfaction* ; Organizational Culture ; Personnel Administration, Hospital ; Pharmacists ; Weights and Measures

Laryngoscopy and endotracheal intubation are potent stimuli that can induce increased sympathetic activity, tachycardia and hypertension. The authors studied the effects of intravenous clonidine pretreatment, a centrally acting a2-adrenoceptor agonist, on hemodynamic responses to laryngoscopy and tracheal intubation, and on anesthetic requirements during operation. Forty ASA I -II patients undergoing elective minor general surgery were allocated randomly to receive either 5ug/kg clonidine or 3 ml of 0.9% normal saline as control intravenously 10 minutes before induction of anesthesia. The results obtained were as follows. Compared to baseline values, blood pressure and heart rate at 1 minute after intubation were significantly increased in control group, but significantly decreased in clonidine group. They were maintained at lower values throughout the whole duration of operation in clonidine group than in control group. More doses of fentanyl were needed in the control group but not in the clonidine group during operation, and because of bradycardia and hypotension, atropine or ephedrine was needed in the clonidine group. In conclusion, the elevation of blood pressure and heart rate accompanying tracheal intubation were preventable with less requirement of supplemental fentanyl, but bradycardia and hypotention were infrequently seen as a side effects, when 5ug/kg intravenous injection of clonidine 10 minutes before induction.
Anesthesia ; Anesthesia, General* ; Atropine ; Blood Pressure* ; Bradycardia ; Clonidine* ; Ephedrine ; Fentanyl ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Tachycardia

BACKGROUND: Community-acquired pneumonia(CAP) remains a leading cause of morbidity and mortality worldwide. Recently, the evolution of drug-resistant microorganisms has become a serious problem in CAP management. Specific antimicrobial therapy is the cornerstone of CAP management. However, obtaining an accurate etiologic diagnosis clinically is not easy and empirical antimicrobial treatment is usually administered prior to the correct microbiologic diagnosis. In this study, the clinical usefulness of empirical CAP treatment was investigated. METHODS: A total 35 cases were studied prospectively over a 16-month period in Mokpo Catholic Hospital from Dec. 1995 to Mar. 1997. The microbiologic diagnosis was made by sputum, blood culture, a specific serum antibody test and an immunologic study. RESULTS: The causative organisms were isolated in 10 (30%) out of 33 cases: 8 cases and 1 case on the sputum culture and blood culture respectively, and 1 case by an indirect hemagglutinin test. 12 cases had underlying diseases: pulmonary tuberculosis 4, alcoholism 4, diabetes mellitus 3, and liver cirrhosis 1. Antimicrobial treatment was given empirically and all cases recovered. CONCLUSION: A definite microbiologic diagnosis before commencing the appropriate treatment in CAP is not straightforward. Empirical therapy according to a clinical assessment is important and helpful. However, every effort to make the correct etiologic diagnosis should be taken.
Alcoholism ; Diabetes Mellitus ; Diagnosis ; Hemagglutinins ; Jeollanam-do* ; Liver Cirrhosis ; Mortality ; Pneumonia* ; Prospective Studies ; Sputum ; Tuberculosis, Pulmonary

BACKGROUND: E-cadherin, one of the best known cell adhesion molecules plays an important role in embryonic cell development and architectural maintenance of adult tissues. This molecule is a calcium- dependent glycoprotein and is expressed in most normal epithelial tissues. Selective loss of E-cadherin has been observed in many carcinomas of various origins, and this phenomenon is thought to be an induction point for depression of cell adhesiveness and for metastasis. This study was conducted to evaluate the significance of E-cadherin expression as a prognostic factor in breast cancer and to examine the relationship between E-cadherin expression and clinicopathologic factors. METHODS: Surgical specimens were obtained from 73 patients with breast carcinoma from September 1993 to August 1996 in the Department of Surgery, Mok-Dong Hospital, Ewha Womans University. The immunohistochemical staining was performed by using the paraffin embedded tissues. These results were compared with previously known important clinicopathologic characteristics such as age, tumor location, chief complaint, mass size, tumor stage, lymph node invasion, mitosis, nuclear and histologic grades. RESULTS: The expression status of E-cadherin was normal in 41 cases (56%), reduced in 23 cases (32%), lost in 9 cases (12%). When compared with clinicopathologic variables, loss of E-cadherin expression was found in high nuclear and histologic grade, high stage, and severe lymph node invasion cases. However, there was no significant difference in survival rate according to E-cadherin expression. CONCLUSION: This study suggests that E-cadherin expression may be related with the histologic and nuclear grades, the stage and lymph node invasiveness, so it can be used as predictive factor for metastasis.
Adhesiveness ; Adult ; Breast Neoplasms* ; Breast* ; Cadherins* ; Cell Adhesion Molecules ; Depression ; Female ; Glycoproteins ; Humans ; Lymph Nodes ; Mitosis ; Neoplasm Metastasis ; Paraffin ; Survival Rate

No abstract available.
Humans ; Intracranial Aneurysm* ; Tomography, Emission-Computed, Single-Photon*