BACKGROUND: Mivacurium is a non-depolarizing neuromuscular blocking agent which has short duration of action. The goal of this study was to describe a technique which could shorten the onset time of mivacurium for rapid endotracheal intubation by using priming principle. METHODS: Thirty-one patients were randomly allocated into four groups. Patients in group I(n=8) received a single dose of 0.12 mg/kg mivacurium. Those in group II(n=10), III(n=6), and IV(n=7) received 0.015 mg/kg pancuronium, 0.012 mg/kg vecuronium, and 0.008 mg/kg mivacurium 4 minutes before the intubating dose of 0.12 mg/kg mivacurium was given respectively. Accelerographic response to train-of-four(TOF) stimulation of ulnar nerve at 15 seconds interval was used for neuromuscular monitoring. The onset time, the duration and recovery indices were compared between groups. RESULTS: The onset time in group II (2.9 0.49 min) and III (2.33 0.4 min) were significantly faster than that in group I (5.19 0.47 min). In the group II, the duration (26.3 1.9 min) and recovery index (12.35 2.45 min) were significantly prolonged than those in group I (9.12 1.21 and 4.75 0.52 min), respectively. CONCLUSION: The onset time is more rapid when pancuronium or vecuronium is used as priming agent than when mivacurium as single bolus injection or priming agent.
Humans ; Intubation, Intratracheal* ; Neuromuscular Blockade* ; Neuromuscular Monitoring ; Pancuronium* ; Pharmacology ; Ulnar Nerve ; Vecuronium Bromide*

BACKGROUND: Some of elective surgical procedures may be postponed or cancelled due to inadequate preoperative assessment and preparation. To minimize this problem, our preadmission anesthesia consultation clinic had been designed and managed at the outpatient department. The case referral pattern and efficacy of the clinic were evaluated for 1 year. METHODS: The study was done collected prospectively on 881 patients referred to the clinic from January to December 1997, 1 year. The age, sex, departmental distribution of consultation, ASA physical status of patients, the clinical department and reasons of consultation, and satisfaction of the patients or their parents were analized prospectively. The preoperative hospital stay periods before and after the opening of the clinic were compared. RESULTS: The sex ratio(M/F) were 6/4. Thirty-seven percent of the patients were under 10 years old and 11.8% were twenties. ENT(48.4%), ophthalmology(15.6%), general surgery(12.6%) were mainly referral departments. Reasons for consultation were related to chest X-ray abnormality(28.9% of the cases) and EKG abnormality(17.9%). The majority of consultation had pediatric(30%) and cardiologic problem(26%). URI(54.2%) and liver disease(12.6%) were major disease entities to postpone their surgery. In 2.7% of the patients, their admission or operation were postponed by the anesthesiologists in the clinic. Ninety-one percent of the patients were satisfied to visit the clinic. CONCLUSION: We conclude that reduction in preoperative hospital stay and shortening in delay of surgery are provided, and most patients are satisfied to the preadmission anesthesia consultation clinic.
Anesthesia* ; Child ; Electrocardiography ; Humans ; Length of Stay ; Liver ; Outpatients ; Parents ; Prospective Studies ; Referral and Consultation ; Surgical Procedures, Elective ; Thorax

Primary mucosa-associated with a lymphoid tissue (MALT) lymphoma is a rare distinct subtype of non-Hodgkin’s lymphoma that occurs in approximately 8% of all non-Hodgkin lymphomas. Primary gastrointestinal MALT lymphoma usually occurs in the stomach, but duodenal involvement is extremely rare. Therefore, the clinical manifestations, treatment, and prognosis of primary duodenal MALT lymphoma have not yet been validated because of its rarity. This paper reports a case of a 40-year-old male with primary duodenal MALT lymphoma who was treated successfully with radiation therapy alone. A 40-year-old male visited for a medical check-up.Esophagogastroduodenoscopy revealed whitish multi-nodular mucosal lesions in the second and third portions of the duodenum. Biopsy specimens from mucosal lesions in the duodenum were reported to be suspicious for MALT lymphoma of the duodenum. He received a total dose of 3,000 cGy in 15 fractions with external beam radiation therapy for three weeks. Three months after radiation therapy, an endoscopic examination revealed complete resolution of the duodenal lesions. The follow-up 12 months after radiation therapy showed no evidence of tumor recurrence.

Resveratrol (RSV) may provide numerous protective eff ects against chronic inflammatory diseases. Due to local hypoxia and hypertonicity, the renal medulla is subject to extreme oxidative stress, and aldehyde products formed during lipid peroxidation, such as 4-hydroxy-2-hexenal (HHE), might be responsible for tubular injury. This study aimed at investigating the eff ects of RSV on renal and its signaling mechanisms. While HHE treatment resulted in decreased expression of Sirt1, AQP2, and nuclear factor erythroid 2-related factor 2 (Nrf2), mouse cortical collecting duct cells (M1) cells treated with HHE exhibited increased activation of p38 MAPK, extracellular signal regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and increased expression of NOX4, p47(phox), Kelch ECH associating protein 1 (Keap1) and COX2. HHE treatment also induced NF-κB activation by promoting IκB-α degradation. Meanwhile, the observed increases in nuclear NF-κB, NOX4, p47(phox), and COX2 expression were attenuated by treatment with Bay 117082, N-acetyl-l-cysteine (NAC), or RSV. Our findings indicate that RSV inhibits the expression of inflammatory proteins and the production of reactive oxygen species in M1 cells by inhibiting NF-κB activation.
Acetylcysteine ; Animals ; Anoxia ; Bays ; JNK Mitogen-Activated Protein Kinases ; Lipid Peroxidation ; Mice* ; Oxidative Stress* ; p38 Mitogen-Activated Protein Kinases ; Phosphotransferases ; Reactive Oxygen Species ; Sirtuin 1

Iodinated contrast media (CM) can cause immediate and late reactions. We treated a patient with a recurrent generalized maculopapular rash and a fever that occurred within two days of exposure to iodinated CM, iopromide (Ultravist(R)), for chest computed tomography. We performed skin testing including prick tests, intradermal tests, and patch tests. Our findings indicated a late skin reaction to Ultravist(R) in addition to cross-reactions to other iodinated CM such as ioversol (Optiray(R)), iohexol (Iobrix(R)), and iobitridol (Xenetix(R)). In this study, we report the case of a patient diagnosed with a late adverse reaction to Ultravist(R) in addition to cross-reactions to other iodinated CM.
Contrast Media ; Exanthema ; Fever ; Humans ; Intradermal Tests ; Iohexol ; Patch Tests ; Skin ; Skin Tests ; Thorax ; Triiodobenzoic Acids

The occurrence of an abdominal wall hematoma caused by abdominal paracentesis in patients with liver cirrhosis is rare. This paper presents a case of an abdominal wall hematoma caused by abdominal paracentesis in a 67-year-old woman with liver cirrhosis with a review of the relevant literature. Two days prior, the patient underwent abdominal paracentesis for symptom relief for refractory ascites at a local clinic. Upon admission, a physical examination revealed purpuric patches with swelling and mild tenderness in the left lower quadrant of the abdominal wall. Abdominal computed tomography revealed advanced liver cirrhosis with splenomegaly, tortuous dilatation of the para-umbilical vein, a large volume of ascites, and a large acute hematoma at the left lower quadrant of the abdominal wall. An external iliac artery angiogram showed the extravasation of contrast media from the left deep circumflex iliac artery. Embolization of the target arterial branches using N-butyl-2-cyanoacrylate was then performed, and the bleeding was stopped. The final diagnosis was an abdominal wall hematoma from the left deep circumflex iliac artery after abdominal paracentesis in a patient with liver cirrhosis.

Kimura's disease is a rare chronic inflammatory and proliferative condition of unknown etiology. It has been thought to be a part of large spectrum of the entity known as angiolymphoid hyperplasia with eosinophilia (ALHE). However, recently the difference is emphasized between the two entities by some authors. It usually presents subcutaneous or dermal mass in the head and neck region. This condition can be mistaken for a malignant tumor. It is defined pathologically as hyperplastic lymphoid follicles, eosinophilic infiltration and vascular proliferation. Authors have experienced three cases of Kimura's disease occurring in the submandibular, axillary and inguinal regions since 1993. There were two males and one female. Two patients presented peripheral eosinophilia. All patients underwent surgical excision. Two patients were managed with oral prednisone postoperatively.
Angiolymphoid Hyperplasia with Eosinophilia ; Eosinophilia ; Eosinophils ; Female ; Head ; Humans ; Male ; Neck ; Prednisone

OBJECTIVE: Recently the existence of a CD4+CD25+ regulatory (Treg) population has been described in rodents and humans. It is unclear how the immune response cells interact to tumor cells effectively, but the malignant tumor cell growth was suppressed by the main effect of T lymphocytes and natural killer cells in experimental studies using various biologic response modifier. This study was performed to investigate the proportion of CD4+CD25high Tregs and expression of Foxp3 in Peripheral blood (PBL)s in patients with cervical, ovarian or uterine cancers. METHODS: Blood samples were collected from 10 healthy women and a total of 40 patients with gynecologic cancer at department of Obstetrics and Gynecology, Asan Medical Center, Seoul, Korea, from March 2005 to September 2005, were enrolled in study group. Information regarding patient history and tumor stage was recorded. They were diagnosed at same center at first, and never been treated any therapy. The population of CD4+CD25+high Tregs as a percentage of total CD4+cells was evaluated by flow cytometric analysis. We measured the proportion of Treg cell that co-express CD4 and CD25 in the peripheral blood lymphocytes form patients with either cervical, ovarian uterine cancer or carcinoma in situ of cervix. Expression of Foxp3 in the CD4+subsets defined by electrophoresis. RESULTS: The following tumor entities were included cervical cancer (n=10. 7 in stage I, 1 in stage II, 1 in stage III, 1 in stage IV); ovarian cancer (n=10. 4 in stage I, 0 in stage II, 5 in stage III, 1 in stage IV), ; uterine cancer (n=10. 9 in stage I, 0 in stage II, 0 in stage III, 1 in stage IV). In cervical cancer patient, ovarian cancer patients, uterine cancer patients and healthy women, the proportion of CD4+CD25high Tregs was 4.53% (SD 2.30), 6.89% (SD 7.81), 4.37% (SD 2.43) and 0.87% (SD 0.57) of the total CD4+cells respectively. The proportion of CD4+CD25+high T cells was significantly higher in cervical cancer patients (p=0.016), ovarian cancer patients (p=0.001) and uterine cancer patients (p=0.038) when compared with healthy women. But there was no significant difference in proportion of CD4+CD25+ Tregs comparing with healthy women. Expression of Foxp3 was significantly thicker in tumor-associated lymphocytes than control T cells by electrophoresis. CONCLUSION: In conclusion, our data suggested that the increase in frequency of regulatory T cells might play a role in modulation of the immune response against cervical, ovarian, uterine cancer could be important in design of immunotherapeutic approaches.
Carcinoma in Situ ; Cervix Uteri ; Chungcheongnam-do ; Electrophoresis ; Female ; Gynecology ; Humans ; Killer Cells, Natural ; Korea ; Lymphocytes* ; Obstetrics ; Ovarian Neoplasms ; Rodentia ; Seoul ; T-Lymphocytes ; T-Lymphocytes, Regulatory ; Uterine Cervical Neoplasms ; Uterine Neoplasms

OBJECTIVES: Percutaneous renal biopsy may be carried out in several ways. Recently, the use of a spring-loaded biopsy gun has become popularized. There have been much controversies on the tissue adequacy and the incidence of complications when compared to the manual biopsy. The present study was performed to compare tissue adequacy and the incidence of complications between manual biopsy and automated biopsy. METHODS: We have studied 108 patients in whom the method of renal biopsy was assigned to one of the two methods[14G Tru-cut needle manual bx (group I) and 18G automated gun biopsy(group II)] according to their national resident's identification number in a randomized and prospective manner. RESULTS: There were 50 patients in group I and 58 patients in group II. There was no difference in gender, age, hemoglobin, prothrombin time, partial thromboplastin time, diastolic and systolic blood pressure pre-biopsy in group I and II. Indications for biopsies were proteinuria accompained by hematuria (37%), proteinuria(34.3%), acute renal failure (9.3%), SLE (8.3%), chronic renal failure (5.6%), hematuria only (5.6%). In Group I the number of passes was 2.4+/-0.8, the glomeruli obtained were 25.3+/-13.2 and the number of glomeruli per pass were 11.6+/-6.5, and in Group II 3.4+/-1.1, 19.4+/-10.8, and 6.8+/-4.0, respectively. These showed a significant difference (p<0.05). In all cases pathological diagnosis were possible. The histology showed IgA nephropathy in 27.8%, MCNS in 14.8%, lupus nephritis in 11.1, MGN in 11.1%, MPGN in 7.4%, and others. The incidence and area of perinephric hematoma demonstrated on ultrasound 24 hours post-biopsy was increased in group I (24%, 937.7+/-640.0mm2 compared to 10.3%, 372.4+/-327.4mm2 in group II) although no statistically significant difference existed. There was no significant difference in gender, age, prothrombin time, partial thromboplastin time, systolic and diastolic blood pressure between the group with and without hematomas. Hematocrit levels before and after biopsy showed a significant difference (34.5+/-8.2, 33.5+/-8.1, p<0.05) in group I, but no significant difference was observed in group II (34.7+/-6.4, 34.8+/-6.4). CONCLUSION: Both techniques rendered adequate tissue sampling, but the extent of bleeding seems to be more severe with manual 14G Tru-cut needle biopsy.
Acute Kidney Injury ; Biopsy* ; Biopsy, Needle ; Blood Pressure ; Diagnosis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Hematocrit ; Hematoma ; Hematuria ; Hemorrhage ; Humans ; Incidence ; Kidney Failure, Chronic ; Lupus Nephritis ; Needles ; Partial Thromboplastin Time ; Prospective Studies* ; Proteinuria ; Prothrombin Time ; Ultrasonography

Neuroendocrine carcinoma (NEC) arising from the extrahepatic bile duct is extremely rare and commonly mistaken for cholangiocarcinoma. Therefore, NEC of the bile duct is difficult to diagnose preoperatively. Previously reported cases were resected with a diagnosis of cholangiocarcinoma and diagnosed with NEC after surgery. This paper reports an 84-year-old female with small-cell NEC of the extrahepatic bile duct, confirmed by a biopsy from an ERCP, with a review of the relevant literature. Contrast-enhanced abdomen computed tomography and magnetic resonance cholangiopancreatography revealed an approximately 1.7 cm enhancing intraductal mass in the proximal common bile duct with dilatation of the upstream bile duct. ERCP showed a long strictured segment in the proximal common bile duct with bile duct dilatation. A biopsy was performed at the site of the stricture. Histological examinations and hematoxylin–eosin staining showed the solid proliferation of small tumor cells with irregularly shaped hyperchromatic nuclei.Immunohistochemical examinations showed that the tumor cells were positive for CD56 and synaptophysin. Small-cell NEC of the extrahepatic bile duct was confirmed based on the histology and immunohistochemistry findings. The patient and their family denied treatment because of the patient’s old age.