No abstract available.
Fatty Liver* ; Obesity*

The central venous catheter(Quinton) was replaced in the right atrium for chemotherapy and blood sampling to a eight-year old girl with acute lymphoblastic leukemia. The catheter was flushed with heparin two times daily and the chemotherapeutic drug regimens by CCSG-105 protocol were vincristine, prednisone, L-asparaginase, daunomycin, methotrexate, cyclophosphamide, cytosine arabinoside, 6-mercaptopurine and adriamycin. On day 31 of catheterization, the lumen for blood sampling was blocked. From day 60 of catheterization, anorexia, nausea, vomiting, abdominal distension and tachypnea were developed. Echocardiogram, lung scan, pulmonary function test(PFT), arterial blood gas analysis (ABGA) were done. Two cemtimeters in diameter of thrombosis was found in the right atrium on echocardiogram. The lung scan showed slight decrease in uptake of Tc-99m on the whole lung fields. Restrictive ventratory impairment on PFT and decreased PaO2(48 mmHg) on ABGA were found. To lysis of thromboembolism, urokinase(4,400 IU/kg for initial 10 minutes and the 4,400 IU/kg for 12 hours) was injected intravenously and aspirin(30 mg/kg/d, po) was given. The thrombosis was disappeared from the atrium on echocardiogram and PaO2 was increased up to 97 mmHg temporary. The catheter was removed but total haziness on the right middle and lower lobes were developed after 5 days. The same dose of urokinase was injected just infront of the embolism through Pitfall catheter for 8 days intermittently as results of pulmonary angiography. Symptoms and PaO2 were alleviated and the lung was expanded with mild atelectasis on day 55 of the first fibrinolytic enzyme therapy. Although the frequent complications of central venous catheter are catheter occlusion and infection, we have to check the development of thromboembolism with echocardiogram periodically or in case of unexplained respiratory symptoms.
6-Mercaptopurine ; Angiography ; Anorexia ; Blood Gas Analysis ; Catheterization ; Catheters ; Central Venous Catheters* ; Cyclophosphamide ; Cytarabine ; Daunorubicin ; Doxorubicin ; Drug Therapy ; Embolism ; Enzyme Therapy ; Female ; Heart Atria ; Heparin ; Humans ; Lung ; Methotrexate ; Nausea ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prednisone ; Pulmonary Atelectasis ; Tachypnea ; Thromboembolism* ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Vincristine ; Vomiting

BACKGROUND: thermotherapy has been shown to be effective in the treatment of some fungal infections. Dermatophyte are well grown at 25degrees C rather than 37degrees C or high temperature. OBJECTIVE: An vitro test was done to assess the complemental effect and optimal conditions of local heating on the susceptability of t. rubrum to systemic antifungal agents. METHODS: Microdilution susceptability test to ketoconazole and itraconazole was done using 96 well microplate. Eight strains of T. rubrum were isolated from patients withtinea pedis and were cultured at 25degrees C, 37degrees C and 42degrees C for 1, 8 or 24 hours per day. MIC were checked at 4th, 7th, 9th day after inoculution. RESULTS: The growth without antifungal agents at 37degrees C and 42degrees C were decreased by 805 and 50% of the growth at 25degrees C respectively. Seven day after inoculation was the proper time to check the MIC. MIC50 of ketoconazole was the lowest at 42degrees C for 24hours per day in value of 0.006microgram/ml, and 0.09microgram/ml at 37degrees C for 24hours per day, 0.37microgram/mlat 42degrees C, for 8hours per day and 37degrees C for 8hours per day. MIC at 42degrees C for 1 hours er day, 37degrees C for 1 hyours and 25degrees C for 24hours per ady MIC were the same in value of 0.05microgram/ml. MIC50 of itraconazole was the lowest at 42degrees C for 24hours per day in value of 0.006microgram/ml, 0.01microgram/ml at 37degrees C for 24hours per day, 0.02microgram/ml at 37degrees C for 8hours per day. MIC at 42degrees C for 8hours per day, 42degrees C for 1hours per day, 37degrees C for 24hours per day MIC were the same in value of 0.05microgram/ml. CONCLUSION: Incubation at 37degrees C for 24 hours per day or 42degrees C for 24 hours per day increased the susceptability of T. rubrum to ketoconazole and itraconazole.
Antifungal Agents* ; Arthrodermataceae* ; Complement System Proteins ; Heating ; Hot Temperature ; Humans ; Hyperthermia, Induced ; Itraconazole ; Ketoconazole

PURPOSE: To assess the safety and efficacy of intracorneal ring segment (Intacs ring) implantation in managing keratoconus. METHODS: This retrospective case series comprised of 11 keratoconic eyes (11 patients) had Intacs ring (Addition Technology, Inc, California, USA) implantation. The main outcome measures were best corrected visual acuity, refraction, keratometry, topography, and pachymetry. Patients were examined before Intacs ring implantation as well as one week, one, three, and six months postoperatively. RESULTS: The mean best corrected visual acuity improved from 0.60+/-0.33 logMAR preoperatively to 0.39+/-0.23 logMAR six months postoperatively (p>0.05) and the mean corneal thickness, from 432.82+/-41.17 micrometer preoperatively to 448.00+/-62.27 micrometer at six months (p>0.05). The mean cylinder improved from -5.36+/-2.70D preoperatively to -2.50+/-1.66D six months postoperatively (p<0.05) and the mean keratometry, from 47.99+/-2.38D to 42.83+/-1.72D at six months (p<0.05). In addition, the mean spherical equivalent improved from -6.64+/-3.49D preoperatively to -3.66+/-3.37D six months postoperatively (p<0.05). One eye had a risk of ring exposure, but the others had no significant complications. CONCLUSIONS: Intacs ring implantation appears to be effective in improving cylinder, spherical equivalent, and keratometry in patients with keratoconus.
California ; Eye ; Humans ; Keratoconus ; Outcome Assessment (Health Care) ; Retrospective Studies ; Visual Acuity

Pediatric airway management has been both an integral part of routine anesthesia practice and one of its greatest challenges. Traditionally, it has been thought that the pediatric larynx is funnel-shaped, with the narrowest portion being situated at the cricoid cartilage; the choice of endotracheal tube type, size and insertion depth has been based on this concept. Uncuffed endotracheal tubes have typically been advocated for children younger than 8 years. However, it has recently been determined that the pediatric larynx is conical-shaped, with the narrowest portion of the larynx being situated at the rima glottidis. Therefore, there has been a shift in pediatric airway management, and cuffed tubes have been used without significant differences in post-extubation complication rates. It is critical to use the appropriate type and size of endotracheal tube, as well as to ensure proper insertion depth and adequate visualization of airway structures. Here, we introduce and discuss the optimal type, size, and insertion depth of endotracheal tube, and compare direct and video laryngoscopy.
Airway Management ; Anesthesia* ; Child ; Cricoid Cartilage ; Glottis ; Humans ; Intubation, Intratracheal* ; Laryngoscopy ; Larynx ; Pediatrics

Background: Postoperative vomiting (POV) is one of the most serious complications in pediatric patients undergoing strabismus surgery. This study was conducted to test the hypothesis that gastric decompression (GD) could prevent POV caused by gastric distension after mask ventilation. Methods: A total of 60 pediatric patients (ASA PS I–II, aged one to 10 years) were randomly allocated to two groups; Group D (n = 30) and Group C (n = 30). Induction of anesthesia was performed with careful face mask ventilation with 100% O2 (3 L/min) and sevoflurane 3 vol% to limit airway pressure below 20 cmH2O. Endotracheal intubation was done after confirming adequate neuromuscular blockade. Then, the patients in Group D received GD, while patients in Group C did not. After the surgery, POV was assessed during the emergence from anesthesia in the operating room and postanesthetic care unit (30 min and 60 min). Results: During the emergence, POV was significantly decreased in Group D compared to Group C (Group D 3.3% vs. Group C 30.0%, P = 0.006). The odds ratio analysis showed a lower incidence of POV in Group D (odds ratio = 0.080; 95% confidence limit: 0.009–0.685) during the emergence period. There was no significant difference in the incidence of POV in the postanesthetic care unit (Group D 6.7% vs. Group C 4.3% at 30 min, P = 1.000; 0% in both groups at 60 min). Conclusions GD reduced the incidence of POV in pediatric patients undergoing strabismus surgery during emergence.

Atrial septal defect is one of the most common congenital heart diseases in adult, of which absolute causes is not confirmed, but explained by multifactorial inheritance. In Korea, there has been no case report of atrial septal defect in identical twins in spite of some reports of atrial septal defect in relatives and twins in other countries. We present a first case of atrial septal defect in identical twins whose mother had no infection or medication history during pregnancy.
Adult ; Heart Diseases ; Heart Septal Defects, Atrial* ; Humans ; Korea ; Mothers ; Multifactorial Inheritance ; Pregnancy ; Twins ; Twins, Monozygotic*

No abstract available.
Pregnancy*

BACKGROUND: The hemodynamic responses to tracheal intubation and placement of a suspension rigid laryngoscope are increases of the heart rate and blood pressure during laryngeal microscopic surgery (LMS).Therefore, several methods have been used to attenuate these responses. The aim of the present study was to compare the effects of three different infusion rate of remifentanil on the hemodynamic responses and recovery characteristics of patients who are under going LMS. METHODS: Forty-five patients (ASA class 1 and 2) who were scheduled for LMS were randomly allocated to three groups. The patients received propofol 3microgram/ml (the effective target concentration) with remifentanil 0.2microgram/kg/min (Group R0.2), 0.3microgram/kg/min (Group R0.3), or 0.4microgram/kg/min (Group R0.4), respectively.The patients' systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR) were measured at baseline, 1 minute before and after tracheal intubation and 1 minute after placement of a suspension rigid laryngoscope.The patients' recovery characteristics (spontaneous respiration and eye opening) were assessed at 15 to 30 seconds intervals after discontinuation of the anesthetics. RESULTS: The blood pressure and heart rate at the time of tracheal intubation and placement of the suspension rigid laryngoscope were unchanged in Group R0.3, yet they were increased in Group R0.2 and they were decreased in Group R0.4. The emergence time was significantly shorter for the R0.2 and R0.3 Groups than that for Group R0.4. CONCLUSIONS: We concluded that TIVA with using propofol and remifentanil (0.3microgram/kg/min) can provide a stable hemodynamic status during LMS.
Blood Pressure ; Eye ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Laryngoscopes ; Piperidines ; Propofol ; Respiration

No abstract available.
Gram-Positive Bacterial Infections* ; Teicoplanin*