BACKGROUND: Although a personal interview with the patient during the preoperative visit decreases anesthesia-related anxiety, few efforts have been directed at identifying the patients' greatest concerns. The present study was undertaken to assess patients' anxiety regarding anesthetic management and their specific concerns about anesthesia. METHODS: Before any premedication or explanation of proposed anesthetic technique was given, two hundred and ninety five people (family members and patients) scheduled to undergo elective surgical procedures under general or regional anesthesia, were asked the question of what worried them about the anesthesia and what patients really want to know about their anesthesia. RESULTS: The vast majority of patients and their families want to know comprehensive information concerning their general or regional anesthesia including information about all possible complications related to anesthesia. The most common preoperative anxiety and concern regarding the anesthetic procedure relates to complications. In addition, frequent anxiety and curiosity were about recovery time after anesthesia, anesthetic method and pain. Parents and families of children undergoing general anesthesia most worried about brain damage including decline of memory and learning ability. CONCLUSIONS: Reassurance and satisfactory explanations about preanesthetic anxiety and curiosity are required for the patient and their family preoperatively in an attempt to reduce the patient's anxiety.The information from this study could help anesthetists communicate more effectively with the patient and their family during preoperative visits.
Anesthesia* ; Anesthesia, Conduction ; Anesthesia, General ; Anxiety* ; Brain ; Child ; Exploratory Behavior ; Humans ; Learning ; Memory ; Parents ; Premedication ; Surgical Procedures, Elective

Patterns of brain-stem compression and secondary brain-stem evoked postentials were investigated to correlate with expanding mass volume and location in mass-induced supratentorial brain compression in cats in which the subjects were divided into four experimental group i.e., frontal, temporal, parietal, and occipital brain-compressed groups. Postmortem insepection of the brain-stem showed either unilateral or bilateral dorsal herniation of the brain in frontal and temporal brain-compressed groups and dorsolateral herniation in parietal and occipital brain-compressed groups, respectively. Microscopic examination revealed that the secondary brain-stem hemorrhages were mostly caused by venous bleeding secondary to venous congestion, the bleeding being more severe in occipital brain-compressed group. As the intracranial pressure was raised by expansion of a supratentorial balloon, the late components of the BSEP were suppressed first, followed by the suppression of the early components. In BSEP recording a significant change was observed in Vth wave with prolongation of latency and decrease in amplitude. This finding suggests that the midbrain is the most vulnerable to compression ischemia. In parietal group, the Vth wave started to be prolonged at 0.4ml of balloon expansion and totally disappeared at 1.8ml of expansion.
Animals ; Brain Stem* ; Brain* ; Cats ; Hemorrhage ; Hyperemia ; Intracranial Hypertension ; Intracranial Pressure ; Ischemia ; Mesencephalon ; Rabeprazole

Bovine viral diarrhea virus (BVDV) of the genus Pestivirus is known as a common contaminant of cell culture-derived vaccines. Hog cholera virus (HCV), which is also of the genus Pestivirus and an important livestock disease in Korea, is recognized as a potential contaminant of vaccines produced in porcine cells. However, it is difficult for the National Biological Assays of korea to adequately detect contamination of these agents in biological products. For these reasons, we established rapid and sensitive methods for the detection of BVDV and HCV contamination in cell cultures and veterinary biologicals by using RT-PCR and nested PCR assays. We designed a Pestivirus primer amplifying 152 bp to detect both BVDV and HCV and a common primer amplifying 237 bp to detect only BVDV. Also, for the differentiation between BVDV type 1 and type 2, nested PCR was conducted using the amplified 237 bp PCR product, to amplify 179 bp in BVDV type 2 genome. The sensitivity of the PCR using common primer for the detection of BVDV was 400 TCID50/ml. All 6 strains of Korean BVDV isolates, 5 vaccines strains and the standard strain NADL could be detected. No reactions were observed when testing 5 types of viruses infecting pigs (HCV, TGEV, PEDV, JEV, PRRSV), 4 types infecting cattle (Akabane virus, BEFV, BCV, BRV) and 4 types infecting cats (FIP, FPL, FCV, FVR). Using this RT-PCR assay, commercial vaccines were tested and, 55 lots from 12 vaccine companies, were negative for BVDV contaminations. Same results were obtained by the immunoflourescence assay. The newly developed PCR or RT-PCR assays can be used as rapid, reliable, sensitive, and simple methods for the detection of BVDV (Pestivirus) in cell cultures, master seeds, and live viral vaccines.
Animals* ; Biological Assay ; Biological Products ; Cats ; Cattle ; Cell Culture Techniques ; Classical swine fever virus ; Diarrhea Virus 1, Bovine Viral ; Diarrhea Virus 2, Bovine Viral ; Diarrhea* ; Genome ; Korea ; Livestock ; Pestivirus ; Polymerase Chain Reaction* ; Swine ; Vaccines ; Viral Vaccines*

BACKGROUND: Vitamin C has been reported to have a role in the decrease of airway hyperresponsiveness in animal models. This data is based on some metabolic actions of vitamin C, such as promotion of histamine degradation, producing mote PGE2 than PGE2 alpha in cyclooxygenase pathway, decrease of smooth muscle contraction, and acting as reducing agent of oxidant. It has been also known that heavy smokers have lower blood levels of vitamin C than nonsmokers and this deficiency in heavy smokers have been explained by several mechanisms, such as increased oxidation by oxidants and free radicals, increased biosynthesis of catecholamine and serotorim released by nicotine, and inadequate dietary intake. In this study, We attempted to assess effect of vitamin C on bronchial hyperresponsiveness in heavy smokers who have bronchial hyerresponsiveness and role of vitamin C on bronchial hyperresponsiveness. METHOD: To assess acute effect of vitamin C on airway hyperresponsiveness, blood sample for vitamin C level and spirometry, methacholine challenge test were done in 17 smokers and 8 nonsmokers, and one hour after oral administration of vitamin C 3 g, blood sample for vitamin C level and spirometry, metliacholine challenge test were repeated. To assess chronic effect of vitamin C on airway hyperreeponsiveness after daily administration of vitamin C 1 g for one week in 17 smokers, blood sample for vitamin C level and spirometry, methacholirie challenge test were done. To assess role of vitamin C, after oral administration of vitamin C 3 g plus indomethacin 100 mg in 12 of 15 smokers who were reactive to methacholine challenge test, spirometry and methacholine challenge test were done and after oral intake of indomethacin 100 mg in 12 smokers who were reactive to methacholine challenge test, spirometry and metbachoine challenge test were repeated. RESULT: There were no significant differences in whole blood vitamin C levels between smokers(1.17+/-0.22mg/dL) and nonsinokers(1.14+/-0.19 mg/dL) (p>0.05). Fifteen of the 17 smokers(88.2%) were reactive to metbacholine chaflenge test amd 10 of the 15 smokers who were reactive to methacholine challenge test were less than 8 mg/dL in PC20FEV1, and 7 of the 8 nonsmokers(87.5%) were nonreactive to methacltoline challenge test There were significant decrease in bronchial responsiveness after oral administration of xitamin C 3 g in 13 of the 15 smokers who were reactive to methachoine challenge test. This significant decrease persisted with maintenance daily administration of 1 g for one week. PC20FEV1 were not correlated to vitamin C levels in smokers. After oral administration of indomethacin 100 mg, significant reduction of bronchial responsiveness that occured after oral administration of xdtamin C 3 g in smokers were attenuated. CONCLUISON: Although there were no significant differences in whole blood vitamin C levels between smokers and nonsmokers, heavy smokers have significant increase in bronchial responsiveness than nonsmokers. This bronchial hyperresponsiveness of heavy smokers can be attenuated by vitamin C supplement Disappearance of vitamin C effect by indcrnethaein supplement may suggest that vitamin C exert its effect via alteration of arachidonic acid metabolism.
Administration, Oral ; Arachidonic Acid ; Ascorbic Acid* ; Dinoprostone ; Free Radicals ; Histamine ; Indomethacin ; Metabolism ; Methacholine Chloride ; Models, Animal ; Muscle, Smooth ; Nicotine ; Oxidants ; Prostaglandin-Endoperoxide Synthases ; Spirometry ; Vitamins*

Glycogenic acanthosis(GA) of the esophagus,is often found in routine endoscopic examination of the upper GI tract but has not drawn much attention. However, there is controversy concerning the nature, clinical significance and prevalence of this candition. An endoscopic study, performed in 1041 patients, showed that the incidence of GA was 32,9%. Its incidence was found to be significantly higher in male than in female(40.0% vs. 22.1%; p<0.0001) and frequency of high grade(II+III) GA was higher in male than in female(58.1% vs. 45.3~%; p<0.0D01). An increasing tendency was observed with respect to age(X 36~343, p~<0,0001). The frequency of GA was higher in smoker than in non-smoker(49.2% vs. 20.8%; p<0.0001). GA did not have a clear relationship with alcohol intake, dietary habit, condiments, and diet temperature. The frequency of GA was higher in the patient with reflux esophagitis than without reflux esophagitis(3.8% vs. 1.7%; p~<0.05). Therefore, age, sex and smoking appear to be risk factors of GA, as in esophageal carcinoma.
Condiments ; Diet ; Esophagitis, Peptic ; Esophagus ; Food Habits ; Glycogen* ; Humans ; Incidence ; Male ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Upper Gastrointestinal Tract

BACKGROUND: The survival benefit of combination chemotherapy comparing supportive care to patients with advanced non-small cell lung cancer, especially stage IV non-small cell lung cancer patients with metastatic disease, is controversial. The main goal of this study was to evaluate the difference in survival between patients treated with chemotherapy and those who were not and to identify prognostic factors in the patients with stage IV non-small cell lung cancer. METHODS: From January 1989 to December 1994, total 67 patients including 20 patients treated with combination chemotherapy and 47 patients treated with only supportive care in stage IV non-small cell lung cancer patients with metastatic disease were enrolled in this study. Combination chemotherapy consisted of etoposide 120mg/m2 iv for 3 days and cis-platin iv day 1 every 4 weeks. The treatment groups were retrospectively analyzed by age, sex, histologic cell type, weight loss, serum LDH level, ECOG performance status and major organ metastasis. RESULTS: The significant prognostic factors influencing survival on this study were ECOG performance status and histologic subtype. Overall response rate by combination chemo-therapy was 30%(complete response 0%, partial response 30%). Median survival of overall patients was 13.6 weeks and median survival of chemotherapy group, 20 weeks, was significantly longer than that of supportive care group, 11.7 week(p<0.01). Median survival of responder in patients receiving chemotherapy, 45.5 weeks, was significantly longer than that of non-responder, 17.3 weeks(p<0.05). 1 year-survival rate of chemotherapy group and supportive care group was 15% and 8%, respectively. Nausea or vomiting, alopecia and anemia were seen in nearly most cases after this combination chemotherapy. Toxicities above grade 3 included neutropenia, anemia, thrombocytopenia, infection, fever, nausea, vomiting and alopecia. But this combination chemotherapy was relatively well tolerated except one treatment-related death from sepsis associated with severe granulocytopenia. CONCLUSION: These results suggest that systemic chemotherapy might be helpful to the stage IV non-small cell lung cancer patients with good performance status and large scale randomized prospective trials should be performed.
Agranulocytosis ; Alopecia ; Anemia ; Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide ; Fever ; Humans ; Nausea ; Neoplasm Metastasis ; Neutropenia ; Retrospective Studies ; Sepsis ; Thrombocytopenia ; Vomiting ; Weight Loss

BACKGROUND: To achieve tight glycemic control in the poorly controlled type 2 diabetic patients with oral hypoglycemic agent, it maybe beneficial to initiate insulin treatment at the early stage. Many patients with type 2 diabetes are often reluctant to begin insulin therapy despite poor glycemic control with oral hypoglycemic agents, this little known phenomenon, often termed 'psychological insulin resistance (PIR)'. This study investigates psychological insulin resistance in Korean patients with type 2 diabetes. METHOD: This study examined a total of 76 type 2 diabetic patients with poor glycemic control during period of April to July 2006. Through questionnaire and telephone survey, total 24 questions were asked about various attitudes on insulin therapy including psychological barriers and patients' acceptance of this treatment. Subjects were asked to allocate points in 5-point scale (from 5 points for 'very true' to 1 point for 'very untrue'). RESULTS: The means of psychological rejection, injection-related anxiety and fear of insulin side effects such as hypoglycemia and weight gain were 3.65 +/- 0.92, 3.17 +/- 0.98 and 2.8 +/- 1.02, respectively. Unwillingness was common in insulin therapy, 67% of patient rejected or was unwilling to take insulin. Main reasons of patients most frequently endorsed beginning insulin indicate that disease is worsening, permanence (once you start insulin you can never quit) and sense of personal failure. Furthermore, study indicates that patients' reasons for avoiding insulin therapy were mainly psychological rejection, which extended far beyond a simple injection related anxiety. CONCLUSION: PIR was psychological reluctance rather than injection related anxiety. To overcome these psychological barriers to insulin treatment, it is necessary to address appropriate diabetes education including training and counseling with excellent interactive communications between patients and clinicians.
Anxiety ; Counseling ; Humans ; Hypoglycemia ; Hypoglycemic Agents ; Insulin ; Insulin Resistance ; Rejection (Psychology) ; Telephone ; Weight Gain ; Surveys and Questionnaires

PURPOSE: The purpose of this article was to announce the establishment of the multicenter Korean Prostate Cancer Database (K-CaP) and to provide urologists with details about K-CaP's methodology. MATERIALS AND METHODS: The initial participating K-CaP institutions include five medical centers in Korea. First, we registered prostate cancer patients who underwent radical prostatectomy as the basic background data. K-CaP is poised to combine these initial observational longitudinal studies with those of other eligible institutions as the database grows. All current prostate cancer patients in Korea are able to be registered into the Web-based database system and thereby have a role in several observational studies. The structure of the database for K-CaP was developed by matching it with the respective data from different studies. The operability of the K-CaP database system was verified by using the existing databases from three participating institutions. RESULTS: The analysis of clinicopathologic characteristics of patients with the use of the Web-based database was successfully conducted. We confirmed the accurate operation of the Web-based database system without any difficulties. CONCLUSIONS: We are announcing the establishment of K-CaP the first database of comprehensive observational longitudinal studies about prostate cancer in Korea. The database will be successfully maintained by sufficiently and continuously updating all patient data covering several treatments. Complete statistical results for registered prostate cancer patients are forthcoming for the basic background data to establish the database. Even though much trial and error are expected during the development process, we expect that K-CaP will eventually become one of the most powerful longitudinal observation databases.
Humans ; Korea ; Longitudinal Studies ; Prostate ; Prostatectomy ; Prostatic Neoplasms

BACKGROUND/AIMS: There has been no standard treatment for advanced hepatocellular carcinoma (HCC) until now. The aim of this study was to evaluate the efficacy of hepatic arterial infusion therapy (HAIT) using 5-fluorouracil (5-FU) and cisplatin (CDDP) for advanced HCC. METHODS: Twenty patients received repeated HAIT using an implanted drug delivery system. Of the 20 patients, eight patients had HCC with portal vein tumor thrombosis (PVTT), eleven patients had residual tumor despite transcatheter arterial chemoembolization (TACE) or percutaneous ethanol injection therapy (PEIT), and one patient had multiple recurrent HCC nodules after surgical resection. The patients were repeatedly treated with an arterial infusion of 5-FU (250 mg/5 hours on day 1-5) and CDDP (10 mg/1 hour on day 1-5) via the drug delivery system at three weekly intervals. RESULTS: Of the 20 patients, three patients were excluded from the study due to death within the first 1 week of treatment or during follow-up before evaluation. The response rate according to tumor size on abdominal CT was 29.4% (5 patients). One of the five patients showed a complete response (CR, 5.9%), three patients showed partial responses (PR, 17.6%), and one patient showed a minor response (MR, 5.9%). Chemotherapy- related side effect, such as grade I-II nausea (n=2), grade II vomiting (n=1), fever (n=1), drug eruption (n=1) and catheter-related complication such as dislodgement of the catheter (n=2), occurred in six patients. CONCLUSIONS: HAIT using the FP regimen is another option for patients having advanced HCC with PVTT or for patients showing an ineffective response to other therapies.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Carcinoma, Hepatocellular/*drug therapy/radiography ; Cisplatin/administration & dosage ; English Abstract ; Fluorouracil/administration & dosage ; *Hepatic Artery ; Humans ; Infusion Pumps, Implantable ; *Infusions, Intra-Arterial ; Liver Neoplasms/*drug therapy/radiography ; Male ; Middle Aged

BACKGROUND/AIMS: Prognosis of advanced hepatocellular carcinoma (HCC) treated by conventional therapies has been considered to be poor. The aim of this study was to evaluate the efficacy of hepatic arterial infusion therapy (HAIT) using FEM (5-fluorouracil, epirubicin, mitomycin-C) regimen for advanced HCC. METHODS: Eighteen patients received repeated HAIT using an implanted drug delivery system. Of the 18 patients, 8 patients had HCC with portal vein tumor thrombosis, 9 patients had recurrent HCC after transarterial chemoembolization (TACE) and 1 patient after surgical resection. The patients received 5-fluorouracil (330 mg/m2, every week), epirubicin (30 mg/m2, every 4 weeks) and mitomycin-C (2.7 mg/m2, every 2 weeks). RESULTS: Mean age was 51 years. The response rate (complete response+partial response) by tumor size on abdominal CT was 38.9%. Survival ranged from 2 to 24 months and the median survival time was 8 months. The cumulative survival rate of responders group was significantly higher than non-responders group (p=0.0385). The mean levels of serum alpha-FP and PIVKA-II in responders group decreased after HAIT (3,179 ng/mL and 2,850 ng/mL) than before (11,218 ng/mL and 4,396 ng/mL), but not significantly. Chemotherapy-related side effects were nausea, vomiting and alopecia. Three patients had catheter-related complications. One patient developed gastric ulcer. CONCLUSIONS: HAIT using FEM regimen is a useful therapeutic option for patients with advanced HCC with portal vein tumor thrombosis or ineffective response to other therapies.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*administration & dosage ; Carcinoma, Hepatocellular/*drug therapy/mortality/pathology ; Epirubicin/administration & dosage ; Female ; Fluorouracil/administration & dosage ; Humans ; Infusion Pumps, Implantable ; Infusions, Intra-Arterial ; Liver Neoplasms/*drug therapy/mortality/pathology ; Male ; Middle Aged ; Mitomycin/administration & dosage ; Survival Rate