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.
Histiocytic Necrotizing Lymphadenitis* ; Lymphohistiocytosis, Hemophagocytic*

No abstract available.
Acrodermatitis*

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

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

Several conditions such as nipple eczema, erosive adenomatosis of the nipple, mammary Paget's disease and hyperkeratosis of the nipple and areola occur exclusively in the region of the areola and nipple. Seborrheic keratosis is a benign epidermal lesion that can appear on any part of the body but reported cases appearing on the areola are very rare. Cutaneous horn generally presents as an asymptomatic, conical keratotic mass, which commonly occurs on sun-exposed skin, and has an underlying condition that may be benign, premalignant, or malignant. Seborrheic keratosis is a well known benign underlying condition of the cutaneous horn. We herein present a 49-year-old male with a conical hyperkeratotic mass on his right areola, which, upon microscopic examination was revealed to be seborrheic keratosis.
Animals ; Eczema ; Horns* ; Humans ; Keratosis, Seborrheic* ; Male ; Middle Aged ; Nipples ; Paget's Disease, Mammary ; Skin

The trans-sphenoidal resection of a recurred pituitary tumor was performed in a 42 years old man under general anesthesia with propofol and remifentanil. Neither massive bleeding nor hypotension was observed intraoperatively, but bradycardia was sustained over five hours. The patient did not suffer from hypertriglyceridemia and there was no evidence of drug toxicity or vigorous intervention during the surgery, however hyperamylasemia was observed one day after the surgery. It is presumed that vagal stimulation by propofol and remifentanil infusion might induce bradycardia and abnormal pancreatic enzyme secretion consequently.
Anesthesia, General ; Bradycardia ; Drug Toxicity ; Hemorrhage ; Humans ; Hyperamylasemia ; Hypertriglyceridemia ; Hypotension ; Piperidines ; Pituitary Neoplasms ; Propofol