Succinylcholine(SCC) is well known to elevate the serum potassium level and to threaten life in some cases. In order to minimize the elevation of serum potassium following SCC, several attempts have been made such as SCC tamming and pretreatment with pancuronium or lidocaine or diazepam. Our study was undertaken to evaluate the change of serum potassium following induction in 60 patients divided into 7 different groups; group l. SCC 1mg/kg; group ll. SCC 2 mg/kg, grouplll, SCC 1mg/kg after SCC 10mg; group IV, SCC 1mg/kg after pancuronium 0.015mg/kg, group V. Pnacuronium 0.1mg/kg; group VI, SCC 1mg/kg after Lidocaine 1mg/kg; grou VII, SCC 1mg/kg after Diazepam 0.2mg/kg. The results were as follows: 1) Serum potassium were increased 0.14mEq/L in group l and 0.17 mEq/L in group ll. 2) Serum potassium were decreased in group lll, VI and VII than their control values but they were not statistically significant. 3) The decrease in serum potassium was most significant in group IV and V.
Calcium ; Diazepam ; Humans ; Lidocaine ; Pancuronium ; Potassium ; Succinylcholine

The present study was attempted to investigate whether polyphenolic compounds isolated from wine, which is brewed from Rubus coreanum Miquel (PCRC), may affect the release of catecholamines (CA) from the isolated perfused adrenal medulla of the spontaneously hypertensive rats (SHRs), and to establish its mechanism of action. PCRC (20~180 microgram/ml) perfused into an adrenal vein for 90 min relatively dose-dependently inhibited the CA secretory responses to ACh (5.32 mM), high K+ (56 mM), DMPP (100 micrometer) and McN-A-343 (100 micrometer). PCRC itself did not affect basal CA secretion (data not shown). Also, in the presence of PCRC (60 microgram/ml), the CA secretory responses to veratridine (a selective Na+ channel activator (10 micrometer), Bay-K-8644 (a L-type dihydropyridine Ca2+ channel activator, 10 micrometer), and cyclopiazonic acid (a cytoplasmic Ca2+ -ATPase inhibitor, 10 micrometer) were significantly reduced, respectively. In the simultaneous presence of PCRC (60 microgram/ml) and L-NAME (an inhibitor of NO synthase, 30 micrometer), the inhibitory responses of PCRC on the CA secretion evoked by ACh, high K+, DMPP, and Bay-K-8644 were considerably recovered to the extent of the corresponding control secretion compared with that of PCRC-treatment alone. The level of NO released from adrenal medulla after the treatment of PCRC (60 microgram/ml) was greatly elevated compared with the corresponding basal level. Taken together, these results demonstrate that PCRC inhibits the CA secretion from the isolated perfused adrenal medulla of the SHRs evoked by stimulation of cholinergic receptors as well as by direct membrane-depolarization. It seems that this inhibitory effect of PCRC is mediated by blocking the influx of calcium and sodium into the adrenal medullary chromaffin cells of the SHRs as well as by inhibition of Ca2+ release from the cytoplasmic calcium store at least partly through the increased NO production due to the activation of NO synthase.
(4-(m-Chlorophenylcarbamoyloxy)-2-butynyl)trimethylammonium Chloride ; 3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Adrenal Medulla ; Calcium ; Catecholamines ; Chromaffin Cells ; Cytoplasm ; Dihydropyridines ; Dimethylphenylpiperazinium Iodide ; Indoles ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Polyphenols ; Rats, Inbred SHR ; Receptors, Cholinergic ; Sodium ; Veins ; Veratridine ; Wine

BACKGROUND: Avoparcin has been banned in Korea since 8 years ago, but vancomycin-resistant enterococci (VRE) has not been proven to be eradicated from the domestic livestock. This study was purposed to investigate the prevalence of VRE and perform an epidemiologic survey in chicken farms located in Seoul and Kyunggi Province. METHODS: Feces were collected freshly from chickens and workers and their families in three free-range chicken farms and three cage-raising chicken farms. All swabs were inoculated on enterococcosel agar containing 6 microgram/mL of vancomycin. Minimum inhibitory concentrations of teicoplanin and vancomycin were determined using the agar dilution method. Vancomycin resistance were genotyped with multiplex PCR using primers specific for vanA, vanB, and vanC1. Epidemiolgic survey was carried out using a uniform questionnaire to obtain information about the number and variety of livestock, feeding protocols, physical farming conditions, maintenance protocols, hygiene, and employment conditions. RESULTS: vanA Enterococcus facium was isolated from 37 (2.9%) of 1280 chickens. There were no VRE carriers found among the workers and their families. The prevalence of VRE among cage-raising chickens was 4.8% compared to 0.6% for free-range chickens. The difference between the two groups was highly significant (P<0.001). CONCLUSION: There still was a significant rate of VRE colonization in chicken livestock in Seoul and Kyunggi Province. Physical farming conditions of cage-raising chicken farms seemed to be associated with a high VRE colonization rate.
Agar ; Chickens* ; Colon ; Employment ; Enterococcus ; Feces ; Gyeonggi-do* ; Humans ; Hygiene ; Korea ; Livestock ; Microbial Sensitivity Tests ; Multiplex Polymerase Chain Reaction ; Prevalence* ; Seoul* ; Teicoplanin ; Vancomycin ; Vancomycin Resistance ; Surveys and Questionnaires

BACKGROUND: Avoparcin has been banned in Korea since 8 years ago, but vancomycin-resistant enterococci (VRE) has not been proven to be eradicated from the domestic livestock. This study was purposed to investigate the prevalence of VRE and perform an epidemiologic survey in chicken farms located in Seoul and Kyunggi Province. METHODS: Feces were collected freshly from chickens and workers and their families in three free-range chicken farms and three cage-raising chicken farms. All swabs were inoculated on enterococcosel agar containing 6 microgram/mL of vancomycin. Minimum inhibitory concentrations of teicoplanin and vancomycin were determined using the agar dilution method. Vancomycin resistance were genotyped with multiplex PCR using primers specific for vanA, vanB, and vanC1. Epidemiolgic survey was carried out using a uniform questionnaire to obtain information about the number and variety of livestock, feeding protocols, physical farming conditions, maintenance protocols, hygiene, and employment conditions. RESULTS: vanA Enterococcus facium was isolated from 37 (2.9%) of 1280 chickens. There were no VRE carriers found among the workers and their families. The prevalence of VRE among cage-raising chickens was 4.8% compared to 0.6% for free-range chickens. The difference between the two groups was highly significant (P<0.001). CONCLUSION: There still was a significant rate of VRE colonization in chicken livestock in Seoul and Kyunggi Province. Physical farming conditions of cage-raising chicken farms seemed to be associated with a high VRE colonization rate.
Agar ; Chickens* ; Colon ; Employment ; Enterococcus ; Feces ; Gyeonggi-do* ; Humans ; Hygiene ; Korea ; Livestock ; Microbial Sensitivity Tests ; Multiplex Polymerase Chain Reaction ; Prevalence* ; Seoul* ; Teicoplanin ; Vancomycin ; Vancomycin Resistance ; Surveys and Questionnaires

Quantitative measurement of BK virus DNA (Q-BKDNA) has been used for the early diagnosis and monitoring of BK virus-associated nephropathy (BKVAN). This study was designed to determine the BKDNA cutoff for the diagnosis of BKVAN. Between June 2005 and February 2007, 64 renal transplant recipients taken renal biopsies due to renal impairment submitted plasma and urine for Q-BKDNA. Eight BKVAN patients (12.5%) had median viral loads of 6.0 log(10) copies/mL in plasma and 7.3 log(10) copies/mL in urine. Among 56 non-BKVAN patients, 45 were negative for Q-BKDNA; 4 were positive in plasma with a median viral load of 4.8 log(10) copies/ mL, and 10 were positive in urine with a median viral load of 4.8 log(10) copies/mL. Receiver operating characteristic curve analysis showed that a cutoff of 4.5 log(10) copies/mL in plasma and a cutoff of 5.9 log(10) copies/mL in urine had a sensitivity of 100% and a specificity of 96.4%, respectively. A combined cutoffs of 4 log(10) copies/ mL in plasma and 6 log(10) copies/mL in urine had better performance with a sensitivity of 100% and a specificity of 98.2% than each cutoff of urine or plasma. QBKDNA with the combined cutoffs could reliably diagnose BKVAN in renal transplant recipients.
Adolescent ; Adult ; BK Virus/*genetics ; Biopsy ; Calibration ; DNA, Viral/*genetics ; Female ; Humans ; Kidney Diseases/*virology ; Kidney Transplantation/*methods ; Male ; Middle Aged ; Polymerase Chain Reaction ; Polyomavirus Infections/diagnosis ; Treatment Outcome

BACKGROUND: Escherichia coli and Klebsiella pneumoniae resistant to 3rd generation cephalosporin have been reported with increasing frequency in tertiary-care hospital in Korea. MicroScan Neg Combo Panel Type 21 (Type 21) contains a 1 microgram/mL cepfodoxime (POD) in addition to other screen wells containing ceftazidime, cefotaxime, ceftriaxone, and aztreonam, which are designed for detecting extended-spectrum beta-lactamase (ESBL)-producing E. coli and Klebsiella species. We evaluated the Type 21 panel for its ability to detect ESBL. METHODS: From November to December in 1998, 496 E. coli and 326 K. pneumoniae strains isolated from clinical specimens were tested with Type 21 panel The isolates flagged as ESBL producers by the panel were confirmed by the double disk synergy test (DDS). To evaluate the specificity of POD, n-lactamases of 54 E, coli and 20 K. pneumoniae strains that were flagged by, POD only from January to May 1999 were analyzed by isoelectric focusing(IEF). RESULTS: 75/496(15%) E. coli and 68/326(21%) K. pneumoniae were flagged as ESBL producers by Type 21 panel. Of those, 94 isolates including 38/75 (51%) of E. coli and 56/68 (82%) of K. pneumoniae were positive for DDS. Among the 94 ESBL producers, all were detected by POD, 84% by cefotaxime, 85% by ceftazidime, 84% by ceftriaxone, and 86% by aztreonam. The 74 strains that were flagged as ESBL producers by POD screen well only were mostly DDS-negative, cefoxitin- resistant and showed beta-lactamases with pls of 5.4 and 7.6 or no band, which could be interpreted as the presence of TEM-1 or SHV-1 type beta-lactamases and/or basal AmpC beta-lactamases, not ESBL. CONCLUSION: MicroScan Neg Combo Panel Type 21 was able to detect a greater number of ESBL producers by inclusion of POD in its screening well. However, the specificity of POD was compromised by flagging a significant number of DDS negative strains. We conclude that the isolates with reduced susceptibility to 3rd generation cephalosporins as well as POD can be reported as ESBL-producers and those resistant to POD only should be confirmed by DDS.
Aztreonam ; beta-Lactamases ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins ; Escherichia coli ; Klebsiella ; Klebsiella pneumoniae ; Korea ; Mass Screening ; Pneumonia ; Sensitivity and Specificity

Purpose: The Korea Medical Licensing Exam (KMLE) typically contains a large number of items. The purpose of this study was to investigate whether there is a difference in the cut score between evaluating all items of the exam and evaluating only some items when conducting standard-setting. Methods: We divided the item sets that appeared on 3 recent KMLEs for the past 3 years into 4 subsets of each year of 25% each based on their item content categories, discrimination index, and difficulty index. The entire panel of 15 members assessed all the items (360 items, 100%) of the year 2017. In split-half set 1, each item set contained 184 (51%) items of year 2018 and each set from split-half set 2 contained 182 (51%) items of the year 2019 using the same method. We used the modified Angoff, modified Ebel, and Hofstee methods in the standard-setting process. Results: Less than a 1% cut score difference was observed when the same method was used to stratify item subsets containing 25%, 51%, or 100% of the entire set. When rating fewer items, higher rater reliability was observed. Conclusion When the entire item set was divided into equivalent subsets, assessing the exam using a portion of the item set (90 out of 360 items) yielded similar cut scores to those derived using the entire item set. There was a higher correlation between panelists’ individual assessments and the overall assessments.

BACKGROUND: This study evaluated the clinical characteristics and risk factors associated with community and hospital onset MRSA isolated from patients admitted to a tertiary care teaching hospital. METHODS: The study was carried out on MRSA isolated from clinical specimens of patients admitted into the wards and the intensive care unit in a 2,200-bed tertiary care teaching hospital from January 1st through December 31st, 2007. In order to identify the risk factors associated with MRSA acquisition, the medical records were reviewed. All statistics were computed using SPSS version 14.0. RESULTS: Of the 835 MRSA isolates, 179 (21.4%) were CO-MRSA and 656 (78.6%) were HO-MRSA. Of the 179 CO-MRSA isolates, 6 (3.4%) were CA-MRSA. Multiple logistic regression analysis showed that a history of using medical device or antibiotics within 1 year before the isolation of MRSA were significant risk factors for HO-MRSA, and a history of hospitalization within 1 year before the isolation of MRSA was a significant risk factor for CO-MRSA. Analysis on the antibiotics administered within 1 year before the isolation of MRSA showed that levofloxacin, macrolides, 1st generation cephalosporins, 3rd generation cephalosporins, 4th generation cephalosporins, vancomycin, metronidazole, and carbapenem were all significant risk factors for HO-MRSA and that TMP/SMX was a significant risk factor for CO-MRSA. Of the 6 (3.4%) CA-MRSA isolates, 1 (16.7%) was the pathogen responsible for soft tissue infection. No patients died from the CA-MRSA infection. CONCLUSION: MRSA isolated from clinical specimens of patients admitted into the wards and the ICU in a tertiary care teaching hospital was usually HO-MRSA, CO-MRSA and HO-MRSA usually had at least one of the risk factors associated with MRSA acquisition, and CO-MRSA was mainly HACO-MRSA.
Anti-Bacterial Agents ; Cephalosporins ; Hospitalization ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Logistic Models ; Macrolides ; Medical Records ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Metronidazole ; Ofloxacin ; Risk Factors ; Soft Tissue Infections ; Tertiary Healthcare ; Vancomycin

Stomatococcus mucilaginosus is a Gram-positive coccus normally found in the oropharynx and upper respiratory tract. Recently, S. mucilaginosus has been increasingly reported to cause seri-ous infections in immunocompromised patients. A 42-year-old male patient with chronic myeloge-nous leukemia developed the clinical signs and symptoms of septicemia in the state of neutropenia due to the failure of a bone marrow transplant. The blood cultures revealed Gram-positive cocci in three sets of aerobic blood culture bottles. The bacteria were identified as S. mucilaginosus by an API STAPH Identification Panel (bioMerieux SA, Marcy 1 'Etoile, France). The patient was cured bacteriologically with a vancomycin treatment for 20 days. Here we report the first case of S. mucilaginosus septicemia in Korea.
Adult ; Bacteria ; Bone Marrow ; Gram-Positive Cocci ; Humans ; Immunocompromised Host ; Korea ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Male ; Neutropenia ; Oropharynx ; Respiratory System ; Sepsis* ; Vancomycin

Hypokalemic periodic paralysis is an autosomal dominant disorder characterized by episodic weakness of skeletal muscle associated with hypokalemia. It may be presented as familial or sporadic. Familial hypokalemic periodic paralysis is caused by mutations in the muscle membrane dihydropyridine sensitive calcium channel alpha-1 subunit. The abnormal genes in most cases are located in the chromosome 1q31-32. We experienced 2 cases(a 14-year-old male, a 12-year old male) of familial hypokalemic periodic paralysis. Two cases presented with quadriplegia after eating salty foods. The diagnosis was made by demonstrating decreased plasma level of potassium. The patient responded dramatically to potassium replacement therapy. We report two cases of familial hypokalemic periodic paralysis caused by salty foods with a brief review of related literatures.
Adolescent ; Calcium Channels ; Child ; Diagnosis ; Eating ; Humans ; Hypokalemia ; Hypokalemic Periodic Paralysis* ; Male ; Membranes ; Muscle, Skeletal ; Plasma ; Potassium ; Quadriplegia