BACKGROUND: Oropharyngeal manipulation is problematic when patients have a gag reflex. Sedation can suppress gag reflex, but can cause serious airway problems. We compared remifentanil (Group R) and propofol (Group P) in terms of cooperation and loss of gag reflex, while drugs were administered incrementally using target controlled infusion (TCI). METHODS: Fifty seven patients who required awake fiberoptic intubation were randomized to Group R or Group P. After measurement of baseline gag trigger point index (GTPI), TCI was set to effect-site concentration (Ce) of 1 ng/ml (Group R) or 1 microg/ml (Group P), then titrated by 0.5 increment until GTPI score reached 0. The incidence of drop-out and decreased cooperation, Ramsay sedation scale (RSS) and Ce at loss of GR, and complications were assessed. RESULTS: Seven patients were dropped out in Group P due to deep sedation and disobedient behavior, but none in Group R (P = 0.015). Gag reflex suppressed as RSS increased in both groups (P < 0.001), however, the incidence of elimination of gag reflex clustered at RSS 2 in Group R (P < 0.001), whereas it was evenly distributed in Group P (P = 0.20). The incidence of patients who were spontaneously roused (gag reflex elimination at RSS 1 and 2) were higher in Group R than in Group P (P = 0.002). CONCLUSIONS: Deep sedation and impaired cooperation were observed only in Group P and spontaneously roused patients were higher in Group R, suggesting that remifentanil is more suitable for cooperative elimination of GR.
Conscious Sedation ; Deep Sedation ; Humans ; Incidence ; Intubation ; Piperidines ; Propofol ; Reflex ; Trigger Points

To evaluate in vitro anti-HIV efficacies of nucleoside derivatives, MT-4 cell line was infected with HIV-1 and HIV-2 respectively and treated with various compounds and the formerly approved drugs such as AZT, d4T, ddC and ddI. CPE method was used to evaluate their antiviral activity Most dideoxynucleosides, AZT, d4T, ddC and ddI, showed anti-HIV activities against both viruses but no other compounds including anti-herpesvirus drugs did any. Further experiments were carried out to study their inhibitory mechanism of viral adsorption. The results showed no inhibition of syncytium formation due to an interaction between the gp120 expressed in HIV-infected cell surface and CD4 receptor on the uninfected cell surface in the presence of AZT. AZT showed no activity up to 100 microgram/ml. Inhibition of reverse transcriptase (RT) in the presence of AZT-triphosphate was tested by using RT expressed in E. coli and purified and its IC50 was 4.5 nM.
Adsorption ; Cell Line ; Dideoxynucleosides ; Giant Cells ; HIV-1 ; HIV-2 ; Inhibitory Concentration 50 ; RNA-Directed DNA Polymerase ; Stavudine

No abstract available.
Acrodermatitis*

No abstract available.
Histiocytic Necrotizing Lymphadenitis* ; Lymphohistiocytosis, Hemophagocytic*

Generalized pustular psoriasis is the most servere form of psoriasis. This disorder is characterized by pustular skin lesions general symptoms such as high fever, weakness and peripheral blood leukocytosis. We have experienced a case of generalized pustular psoriasis after suffering from chickenpox which was diagnosed by clinical symptoms and pathologic features from a skin biopsy. This 4-year-old male patient was managed by local and oral corticosteroid therapy with excellent outcome. A brief review of the related literature is also included.
Biopsy ; Chickenpox* ; Child, Preschool ; Fever ; Humans ; Leukocytosis ; Male ; Psoriasis* ; Skin

PURPOSE: The purpose of this study was to describe the essence of the experiences of patients in an ICU, and to understand them from the patients' point of view. METHODS: Participants in this study were six patients in P hospital. Data collection consisted of in-depth interviews and an observation method done from January to April in 2005. The method was analysis using the phenomenological method proposed by Colaizzi(1978). RESULTS: The themes were classified into eight theme clusters. The eight theme clusters were finally grouped into four categories, 'shock', 'pain', 'gratefulness' and 'pleasure of revival'. CONCLUSION: The ICU patients had negative experiences in physical.mental critical situations, but also positive experiences in consolation and nurses and families' encouragement. Therefore, ICU nurses must support patients and their families to minimize the negative experiences and maximize the positive experiences.
Adult ; Aged ; Attitude to Health ; Critical Illness/psychology ; Female ; Humans ; Inpatients/*psychology ; *Intensive Care Units ; Interviews as Topic ; Male ; Middle Aged ; Nursing Methodology Research ; Patient Transfer ; Qualitative Research

PURPOSE: The purpose of this study was to understand the experiences of mental health hospital workers. METHODS: Participants in the study were a total of 8 mental health hospital workers who consisted of nurses, social welfare workers and health managers. To prevent them from being omitted, the interviews were all recorded under the participants prior agreement. The method was analysis using the phenomenological method proposed by Colaizzi(1978). RESULTS: The experiences of the participants of this study were classified into 15 significant areas, from which 10 subjects hard work, conflicts, heavy feeling, irritability, getting familiar, changes of recognition, aptitude determination, feeling of achievement and sense of pride were drawn out. These subjects were then grouped into 5 themes. These five themes were finally grouped into 5 categories, negative emotion, depressive emotion, changes of thinking, delight and value discovery. CONCLUSIONS: The study tried to analyze the experiences of key informants like nurses, social welfare workers and health managers all of whom were serving at mental health hospitals, contribute to social recognition about the special medical establishment, promote qualitative mental health nursing and further provide educational information necessary for understanding mental health hospital workers.
Health Personnel/*psychology ; Helping Behavior ; Hospitals, Psychiatric ; Humans ; Interviews as Topic ; *Mental Health ; Models, Nursing ; Nursing Staff, Hospital/*psychology ; Workplace/psychology

PURPOSE: The purpose of this study was to determine the proton MR spectroscopic features of liver cirrhosis and the different proton MR spectroscopic features between liver cirrhosis and the normal human liver by comparing the two different conditions. MATERIALS AND METHODS: The investigation involved 30 cases of in-vivo proton MR spectra obtained from 15 patients with liver cirrhosis demonstrated on the basis of radiologic and clinical findings, and from 15 normal volunteers without a past or current history of liver disease. MR spectroscopy involved the use of a 1.5T GE Signa Horizon system (GE Medical Systems, Milwaukee, U.S.A.) with body coil. STEAM (STimulated Echo-Aquisition Mode) with 3000/30 msec of TR/TE was used for signal acquisition; patients were in the prone position and respiration was not interrupted. Cases were assigned to either the cirrhosis or normal group, and using the proton MR spectra of cases of in each group, peak changes occurring in lipids (at 1.3ppm), glutamate and glutamine (at 2.4 -2 .5ppm), phosphomonoesters (at 3.0 -3 .1ppm), and glycogen and glucose (at 3.4 -3 .9ppm) were evaluated. Mean and standard deviation of the ratio of glutamate + glutamine/lipids, phospho-monoesters/lipids, glycogen + glucose/lipids were calculated from the area of their peaks. The ratio of various metabolites to lipid content was compared between the normal and cirrhosis group. RESULTS: The main characteristic change in proton MR spectra in cases of liver cirrhosis compared with normal liver was decreased relative intensity of lipid peak. Mean and standard deviation of ratio of glutamate + g-lutamine/ lipids, phosphomonoesters/lipids, glycogen + glucose/lipids calculated from the area of their peaks of normal and cirrhotic liver were 0.0204 +/-0.0067 and 0.0693 +/-0.0371 (p<0.05), 0.0146 +/-0.0090 and 0.0881 +/-0.0276 (p<0.05), 0.0403 +/-0.0267 and 0.2325 +/-0.1071 (p<0.05), respectively. The other character-istic feature of proton MR spectra of liver cirrhosis was the peak detected at 3.9 - 4.1 ppm with unknown nature. Mean and standard deviation of area ratio of the unknown peak to lipid peak in proton MR spectra of liver cirrhosis was 0.1504 +/-0 . 0 3 5 5 . CONCLUSION: Proton MR spectra of liver cirrhosis revealed decreased intensity of lipid with statistical signifi-cance compared with that of normal liver, and peak at 3.9 -4.1 ppm with unknown nature. In conclusion, liver cirrhosis can be diagnosed non-invasively by the analysis of observed proton MR spectroscopic features.
Fibrosis ; Glucose ; Glutamic Acid ; Glutamine ; Glycogen ; Healthy Volunteers ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Magnetic Resonance Spectroscopy ; Prone Position ; Protons* ; Respiration ; Steam

This report describes a rare case of postoperative hyperventilation attack after an endoscopic third ventriculostomy in a 46-year-old woman. About 60 min after the termination of the operation, an intractable hyperventilation started with respiratory rate of 65 breaths/min and EtCO2, 16.3 mm Hg. Sedation with benzodiazepine, thiopental sodium, fentanyl, and propofol/remifentanil infusion was tried under a rebreathing mask at a 4 L/min of oxygen. With aggressive sedative challenges, ventilation pattern was gradually returned to normal during the 22 hrs of time after the surgery. A central neurogenic hyperventilation was suspected due to the stimulating central respiratory center by cold acidic irrigation solution during the neuroendoscopic procedure.
Benzodiazepines ; Cold Temperature ; Female ; Fentanyl ; Humans ; Hyperventilation ; Masks ; Middle Aged ; Oxygen ; Respiratory Center ; Respiratory Rate ; Thiopental ; Ventilation ; Ventriculostomy

Verrucous hyperplasia of the distal stump skin is a rare condition which shows multiple, irregular warty papules and plaques but histologically no evidence of viral warts. It has been suggested that verrucous hyperplasia results from persistent stump edema, usually when the distal stump is unsupported in the prosthesis socket. We present a 53-year-old male who showed verrucous plaques on the distal stump skin and also showed edematous change with oozing. He has been wearing a below-the-knee prosthesis for 35 years since a traumatic amputation and has not changed the prosthesis for 30 years. Histopathological findings showed hyperkeratosis, parakeratosis, acanthosis, papillomatosis, dermal edema, fibrosis, dermal vessel proliferation and dilatation. He was diagnosed as having verrucous hyperplasia with lymphedema by clinical and histopathological findings.
Amputation ; Amputation, Traumatic ; Amputees* ; Dilatation ; Edema ; Fibrosis ; Humans ; Hyperplasia* ; Lymphedema* ; Male ; Middle Aged ; Papilloma ; Parakeratosis ; Prostheses and Implants ; Skin ; Warts