BACKGROUND: This study examined the efficacy of patient-controlled epidural analgesia (PCEA) for post-cesarean section pain control and compared the suitability of four different volumes of continuous background infusion (CBI). METHODS: Sixty patients were received 0.125% bupivacaine with 5 g/ml fentanyl by PCEA (2 ml of demand dose and 10 minutes of lockout interval) and CBI. Experimental groups were divided four groups according to the volumes of CBI; 1 ml/hr, 2 ml.hr, 3 ml/hr and 4 ml/hr of CBI during 48 hours postoperatively. RESULTS: Total amount of fentanyl and bupivacaine consumption was significantly higher in 1ml/hr of CBI group than 2 ml/hr of CBI group during first 24 hours, and in 4 ml/hr of CBI group than 1 ml/hr and 3 ml/hr of CBI group during second 24 hours. CBI/maximum hourly demand dose was 15~23%. There is no significant difference between the groups in pain score, side effects and patient's satisfaction. CONCLUSIONS: This study suggests that two or three ml/hr of CBI can provide the most effective postoperative analgesia and the optimal ratio of CBI/maximum hourly demand dose is about 20%.
Analgesia ; Analgesia, Epidural* ; Bupivacaine ; Fentanyl ; Humans

No abstract available.
Apnea* ; Doxapram*

We retrospectively evaluated datas on 61 cases of neonatal sepsis confirmed by clinical symptoms and blood cultures at the NICU of Gil general hospital From Mar. 1989, to Fed. 1992. The results obtained were as follows: 1) The mean gestational age was 32.7+/-2.6 Weeks in preterm infants, and 39+/-1.5 weels on term infants. The mean birth weight was 1,701.4+/-422.4 g in preterm infants, and 3,232+/-581.7 g in term infants. 2) There were 61 infants with neonatal sepsis identified among 13, 486 live births, resulting in an incidence of 0.45%. The sex ratio of male to female was 1.2:1. The incidencdence was higher in preterm infants (2.21%) than in term infants (0.27%). 3) The most commom presenting symptoms of neonatal sepsis were apnea and bradycardia (53.6%) in preterm infants, jaundice (33.3%) in term infants 4) The concurrent diseases in neonatal sepsis were urinary tract infection (UT)(25%), pneumonia (21%), hyaline membrane disease (21%) in the order of frequency. Hyaline membrane disease (33.3%) was the most frequently associated disease in preterm infants, UTI (41.4%) in term infants 5) Gram positive organisms were isolated in 33 casess (52%), gram negative organisms in 30 cases (48%). The most common ortanism isolated from blood cultures was CONS (28.6%). The more common organisms in preterm infants were CONS (26.7%), Enterococcus (23.3%) and Klebsiella (10%). CONS (30.3%), E. Coli (27.3%) and Staphylococcus aureus (12%) were more frequent in term infants. 6) The significant diagnostic laboratory findings for neonatal sepsis were leukopenia ( < or =5000), I:T 0.16, thrombocytopenia ( <150,000/mm3), CRP> or =1+.2 or more of abnormal hematologic values were significantly more frequent in preterm infants (P< 0.05). 7) The risk factors associated with neonatal sepsis were endotracheal intubation (57%), birth ashyxia (Apgar score< or =6 at 5 min.)(39%) and umbilical catheterization (35.7%) in preterm infants, while endotrachial intubation (12.1%), birth ashyxia (12.1%) and premature rupture of membrane ( > or =24hrs)(9.0%) in term infants. 8) Early onset neonatal sepsis (72< or =hr of age) was found in 40 cases (65.6%). 9) The overall mortality rate of neonatal sepsis was 26.0%(39,3% in preterm infants, 15.2% in term infants). The mortality rate was significantly high in pseudomonas infection. 10) In low birth weight infants, the susceptibility to neonatal sepsis was greatest in the infants of lowest birth weight (1,00-1,500 gm) and the mortality rate was inversely proportional to birth weight. 11) Sensitivity to antibiotics in gram postitive organisms were chlorampjenicol (37%), Erythromycin (29%), ampicillin (26%) and cephalothin (26%). It clearly showed that newer antibiotics such as vancomycin is neccessary. In cases of gram negative organisms, sensitivity to antibiotics were amikacin (85%), gentamicin (65%), tobramycin (58%) and cephalothin (54%).
Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Apnea ; Birth Weight ; Bradycardia ; Catheterization ; Catheters ; Cephalothin ; Enterococcus ; Erythromycin ; Female ; Gentamicins ; Gestational Age ; Hospitals, General ; Humans ; Hyaline Membrane Disease ; Incidence ; Infant* ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Intubation ; Intubation, Intratracheal ; Jaundice ; Klebsiella ; Leukopenia ; Live Birth ; Male ; Membranes ; Mortality ; Parturition ; Pneumonia ; Pseudomonas Infections ; Retrospective Studies ; Risk Factors ; Rupture ; Sepsis* ; Sex Ratio ; Staphylococcus aureus ; Thrombocytopenia ; Tobramycin ; Urinary Tract Infections ; Vancomycin

Newborn premature babies have lwo levels of transplacentally acquired maternal immunoglobulin which is mostly transferred after 32~34 weeks gestaton, therefore they may have IgG deficiencies that increase their susceptibility to bacterial infection. We performed this study to determine whether intravenous immunoglobulin (IVIG) therapy improves mortality or infection occurrance rate. From 1 october 1991 to 31 July 1992, 73premature newborn infants with gestational age< or =34weeks were enrolled: the theatment group, consisting of 43infants who received prophylactic intravenous immunoglobulin therapy (500mg/kg/week) and the control group, consisting of 30infants who did not receive. prophylactic intravenous administration of immunoglobulin to preterm infants with a gestational ageage< or =34week, at a dose of 500mg/kg/week, results in maintenance of a satisfactory serum IgG level throughout the high-risk period for infection. But the incidence rates of proven or very probable sepsis, mortality for sepsis and total mortality in the infants receiving intravenous immunoglobulin were not significant differences when compared with those in the control infants. No adverse effects were noted after immunoglobulin transfusions in our subjects. In conclusion, our study does not show any decrease in bacterial infection rate or in mortality rate, and no study in the literature has shown absolute proof of the prophylactic efficacy of IVIG in premature newborns. Larger studies are necessary to confirm these observations and to determine more effective dosing schedules and the optimal levels of orhanism-spectific antibodies. And specific hyperimmnue of monoclonal antibody preparations may be required to provide reliable sources of effective prophylactic to premature neonate with high risk in bacterial sepsis.
Administration, Intravenous ; Antibodies ; Appointments and Schedules ; Bacterial Infections ; Humans ; IgG Deficiency ; Immunization, Passive ; Immunoglobulin G ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Mortality ; Sepsis*

During the period from 1964 to 1958, chemical analyses of urinary calculi were performed on 88 cases treated in the Department of Urology, Seoul National University Hospital. The chemical composition of the calculi analysed is recorded in the following table. COMPOSITION NUMBER OF CASES % OF TOTAL Calcium oxalate 27 30.7 Calcium phosphate 25 28.5 Oxalate & phosphate 17 19.3 Uric acid & phosphate 8 9.1 Uric acid & Oxalate 6 6.8 Uric acid 3 3.4 Carbonate 1 1.1 Carbonate & phosphate 1 1.1 Total 88 100
Calcium ; Calcium Oxalate ; Calculi ; Carbon ; Seoul ; Uric Acid ; Urinary Calculi* ; Urology

Pulmonary artery sling is an uncommon and potentially lethal vascular anomaly that can produce airway obstruction. Despite the availibility of a corrective operation, the mortality rate remains very high due to the high incidence of associated obstructive anomalies of the tracheobronchial tree. We experienced a 70-day-old male infant who was admitted to our unit because of sudden dyspnea, cyanosis, coarse expiratory wheezing and inspiratory stridor. At first, he was treated with bronchodilator and steroid under the impression of infantile asthma, but the symptoms went on without interval change. We performed magnetic resonance imaging study followed esophagography and two dimensional echocardiography. Finally he was diagnosed as a vascular sling. We report this with a brief review and related literatures.
Airway Obstruction ; Asthma ; Cyanosis ; Dyspnea ; Echocardiography ; Humans ; Incidence ; Infant ; Magnetic Resonance Imaging ; Male ; Mortality ; Pulmonary Artery ; Respiratory Sounds

PTC is the single most valuable diagnostic method available to evaluate the size, shape and site of the causesof obstuctive jaundice among various radiological procedures. The authors reviewed and radiologically classifiedthe PTC films of 203 cases of obstructive jaundice from July 1977 to June 1983 at Presbyterian Medical Center,Jeon-ju confirmed clinically, operatively and pathologically. The resuls are as follows; 1. The most common causeof obstructive jaundice was bile duct stoen (64/203:31.53%) and the other causes were bile duct cancer(43/203:21.18%), pancreas cancer(41/203:20.19%), biliary ascariasis &/or clonorchiasis(20/203:9.85%), ampulla andduodenal cancer (7/203:3.45%), fibrotic stenosis of sphincter of Oddi(6/203: 2.96%) etc. in that order. Of theseprimary involvement with cancer was more frequent (91/203:44.33%) than stone. 2. 88.33%(179/203) of patients wasover 40-year-of- age and the sex ratio between male and female was about 2:1. 3. The average maximal diameter ofextrahepatic bile duct just proximal to the site of obstruction or stenosis by stones or by cancers was nearlyequal(2.36cm:2.38cm). 4. Cancers caused complete bile duct obstruction in about 75%(68/91) of cases and also wereassociated with intrahepatic duct dilatation about 92%(84/91) of cases. But in contrast biliary calculi showedgood drainage of contrast medium in 75%(48/64) of cases and 92%(59/64) showed normal diameter of intrahepaticduct. 5. The differential PTC findings between bile duct cancer and pancreas cancer were not so distinct but inbiel duct cancer the obstruction site of the bile duct was more irregular and serrated than pancreas cancer, whilethe latter showed a more downward convexity and a smoother end. Moreover annular filling defect with overhangingedges was seen only in bile duct cancer.
Ascariasis ; Bile Duct Neoplasms ; Bile Ducts ; Cholestasis ; Constriction, Pathologic ; Dilatation ; Drainage ; Female ; Gallstones ; Humans ; Jaundice ; Jaundice, Obstructive ; Male ; Methods ; Pancreas ; Pancreatic Neoplasms ; Protestantism ; Sex Ratio

No abstract available.
Epidermolysis Bullosa Dystrophica* ; Epidermolysis Bullosa*

The observation of eosinophilic ascites is uncommon. They can be noted in parasitic disease, malignant condition, vasculitis, idiopathic hypereosinophilic syndrome or allergic disorders including eosinophilic gastroenteritis, which is a rare disease of unknown etiology characterized by massive tissue infiltration of eosinophils in the layers of any area of gastrointestinal[GI] tract. Clinical manifestations are related to the level of the histologic infiltration in the wall, and the segment of the GI tract involved. Mucosal involvement may result in abdominal pain, nausea, vomiting, diarrhea and weight loss. Muscle layer involvements have obstructive symptoms. Subserosal eosinophilic infiltration may result in the development of eosinophilic ascites. We experienced a case of eosinophilic ascites as manifestation of eosinophilic gastroenteritis in a 43-year old man who also had jejunal obstruction. High proportion of eosinophil count was noted in the ascites, however peripheral blood eosinophilia was not noted. Parasitologic studies were negative. Histologic examination of segment of jejunum showed heavy transmural infiltration of eosinophils which were extended to subserosal layer. Eosinophilic ascites noted in eosinophilic gastroenteritis, though not a common disease entity, had not been described in the laboratory medicine related papers in Korea. Therefore we report this case as an example of eosinophilic ascites.
Abdominal Pain ; Adult ; Ascites* ; Diarrhea ; Eosinophilia ; Eosinophils* ; Gastroenteritis* ; Gastrointestinal Tract ; Humans ; Hypereosinophilic Syndrome ; Jejunum ; Korea ; Nausea ; Parasitic Diseases ; Rare Diseases ; Vasculitis ; Vomiting ; Weight Loss

In this study, we are to produce the single chain variable fragment (scFv) antibodies against surface protein of hepatitis B virus (HBV) using antibody phage display technique. Balb/c mice were immunized with preS1 and cDNAs of heavy and light chains of splenic B cells from immunized mice were prepared using RT-PCR. Two cDNAs were linked with (64S) linker DNA under recombination PCR to produce single chain Fv DNA. After digestion of scFv DNA with Sp 1 and Not 1, the digested DNA was ligated into pCANTAB 5E and electroporated into E. coli XL1-Blue to prepare scFv-library. The size of library was 1 * 10' pfu/ml. Phage antibodies (phabs) against preS1 were rescued with M13K07 helper phages, and preS1-binders were selected through 3 times of panning using 96 well microtitre plates. Phage antibody clones were assayed directly for the ability to bind preS1 by ELISA. And then 7 phage antibody clones had high ELISA signals against preS1. Phabs from preS1-specific pMsc-17 had the strongest ELISA signal to preS1. Phabs from pMsc-17 were used for Western blot to preS1 and the results revealed that it was specific to preS1. To prepare the soluble scFv antibody, phabs from pMsc-17 were transfected into non-suppressor E. coli HB2151, and grown under 1 mM IPTG. Soluble scFv antibody was mainly accumulated in the periplasmic space, but small amount of antibody was secreted into culture media.
Animals ; Antibodies ; B-Lymphocytes ; Bacteriophages* ; Blotting, Western ; Cell Surface Display Techniques ; Clone Cells ; Culture Media ; Digestion ; DNA ; DNA, Complementary ; Enzyme-Linked Immunosorbent Assay ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Isopropyl Thiogalactoside ; Mice* ; Periplasm ; Polymerase Chain Reaction ; Recombination, Genetic ; Single-Chain Antibodies*