Cimetidine, and H2-receptor blocker, is associated with a direct inhibition of liver microsomal enzymes and a decrease in liver blood flow which results in a variety of clinically significant drug interactions, but its effects on the action of muscle relaxants have not been established. Recently, Kambam et al(1987) reported that the duraion of action of succinylcholine was prolonged 2~2.5 times by cimetidine. The effects of cimetidine, ranitidine, and famotidine, on duration of action of succinylcholine and vecuronium were studied. Sixty ASA class 1 or 2 patients scheduled for elective exploratory laprotomies were randomly divided into two groups as follows: Succinylcholine Group(n=40, 1mg/kg) control group(n=10), cimetidine group(n=10): 300mg ph hs & 1 hour before induction, ranitidine group(n=10): 150mg po hs & 1 hour before induction, famotidine group(n=10) : 40mg po hs only. Vecuronimu Group(n=20, 0.08mg/kg) control group(n=10), famotidine group(n=10): 40 mg po hs only. All patients were premedicated with hydroxyzine(1.5mg/kg) and Robinul 0.2mg IM, 1 hour before anesthesia. Anesthesia was induced with thiopental sodium 5~6mg/kg and succinylcholine 1mg/kg or vecuronium 0.08mg/kg. Tracheal intubation was performed at 75~!00% block as monitored by train-of-four stimulation of the ulnar nerve at 2Hz, 20 seconds apart(ABM, Datex). Anesthesis was maintained with 50% nitrous oxide, oxygen, and 2% enflurane. The duration of action of the muscle relaxants was measured from injection of muscle relaxant to the time of 25% recovery of first twitch height on train-of-four stimulation. The results were as follows: 1) The duration of succinylcholine was prolonged significantly by the H2-receptor blockers, 8.3+/-1.49 minutes with cimetidine, 9.8+/-1.98 minutes with ranitidine, and 10.3+/-2.48 minutes in the famotidine group as compared to 6.9+/-1.43 minutes in the control(p<0.05). 2) The duration of action of vecuronium was not affected significantly by the H2-receptor blocker, 26.5+/-4.72 minutes in the famotidine group as compared to 23.6+/-4.52 minutes in the control(p>0.05).
Anesthesia ; Cimetidine ; Drug Interactions ; Enflurane ; Famotidine ; Humans ; Hydrogen-Ion Concentration ; Intubation ; Liver ; Nitrous Oxide ; Oxygen ; Ranitidine ; Succinylcholine* ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide*

Nephrotic syndrome occurs infrequentiy prior to the second year of life. When nephrotic syndrome does develop during the first year, the course differs from that of older children with nephrotic sydrome, being characterized by an extremely poor prognosis and an almost complete refractoriness to therapy. Despite its low incidence congenital nephrotic syndrome is important, not only because of the severity and the disorder itself but also because the occurrence of nephrotic syndrome in this age group rasies question regarding the etiology of the disease. We experienced one case of congenital nephrotic syndrome which was confirmed by autopsy. The patient was born as a premature infant with body weight 1,400gm and 37weeks of gestational age, to a toxemic mother, gravida 3 and parity 3 in Obsteric Department of Seoul Red Cross Hospital. The patient had an uncomplicated nursery staying even though routine weekly urinalysis did show up various degree of proteinuria and microscopic hematuria without any obvious edema till the age of 50 days with body weight 2,400gm on the discharge. He was lost to be followed at Out Patient Department untill the age of 4months when he was brought to admission because of respiratory distress in generalized edematous state. He died at 7 months of age following progressive down-hill cours, despite treatment with prednisolone and cyclophosphamide for 2 months. At autopsy, almost all of the glomeruli (99%) were sclerotic with occassional creascent formation and tubules showed mircocystic dilataions. It is considered that this case was the first one which was presented on literature in Korea.
Autopsy ; Body Weight ; Child ; Cyclophosphamide ; Edema ; Female ; Gestational Age ; Hematuria ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Korea ; Mothers ; Nephrotic Syndrome* ; Nurseries ; Parity ; Prednisolone ; Prognosis ; Proteinuria ; Red Cross ; Seoul ; Urinalysis

Peritonesl insufflation of CO2 to creste the pneumoperitoneum necessary far laparoscopy in- duces intraoperative cardiovascular and ventilatory changes that complicste anesthetic management of laparoscopy. We investigated cardiovascular and ventilstory changes during laparoscopic cholecystectomy under general anesthesia in 11 healthy patients. During operation, intraabdominal pressure was maintained automatically at 14 mmHg by a CO2 insufflator and controlled ventilation setting was adjusted at the values of PaCO2 about 30 mmHg before peritoneal insufflation, and this ventilatory setting was not changed throughout the operation. We measured peak inspiratory pressure(Ppi), mean arterial pressure(MAP), pulse rate(PR), arterial blood gas and end tidal carbon dioxide(PEtCO2) before and during peritoneal insufflation, snd after peritoneal exsufflation. Peritoneal insufflation of CO2 resulted in a significant increase of Ppi, MAP, PaCO2 and PEtCO2, a significant decrease of pH. And PaCO2 and pH were not restored until 15 minutes after CO2 exsufflation. PR and PaO2 were not changed significantly throughout the operation. Conclusively, during general anesthesia for laparoscopic choleeystectomy, hyperventilation was needed under the monitoring of PEtCO2 or PEt,CO2 and special care and monitoring was mendatory for the patients with impaired cardiopulmonary function and increased intracranial pressure.
Anesthesia, General* ; Carbon ; Cholecystectomy, Laparoscopic* ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation ; Insufflation ; Intracranial Pressure ; Laparoscopy ; Pneumoperitoneum ; Ventilation

We report I case of diabetes insipidus associated with suprasellar germinoma, obstructive hydrocephalus and both optic nerve atrophy. In this patient, symptoms of increased intracranial pressure was preceded by characteristic polyuria and polydipsia. The water restriction and pitressin test resulted in central originated diabetes insipidus. Computerized tomography in the brain revealed smooth marginated rounded mass density measuring 3.9 cm obliterating 3rd ventricle and extending to suprasellar region. On neurosurgical operation, egg sized tumor mass was noted in suprasellar area with complete obstruction of 3rd ventricle. The cytological and histopathological findings revealed malignant atypical teratoma(Ectopic pinealoma) which is extremely rare in pediatric age. The patient was received partial excision of tumor mass and ventriculo-peritoneal shunt. After operation, the patient was exhibited progressive renal failure and discharged against doctors order without improvement. We also briefly reviewed with related literatures.
Atrophy ; Brain ; Diabetes Insipidus* ; Germinoma* ; Humans ; Hydrocephalus ; Intracranial Pressure ; Optic Nerve ; Ovum ; Polydipsia ; Polyuria ; Renal Insufficiency ; Vasopressins ; Ventriculoperitoneal Shunt ; Water

Perforation after foreign body ingestion is rare. We report a 25-month-old girl who was diagnosed with a stomach perforation with secondary localized peritonitis caused by long, sharp bamboo. On admission, she had abdominal pain and fever. Simple abdominal erect & supine X-ray, abdominal ultrasonogram and computed tomography scan were normal. On the 6 th hospital day, gastrofiberoscopy was performed because a sharp mass was palpated by doctor on abdominal examination. Endoscopic findings revealed a 8 cm-long sharp bamboo tip was pierced to the posterior wall of antrum. This foreign body was removed with Olympus FG-8L alligator forcep. She was managed with NPO and prompt intravenous antibiotics and discharged with clinical improvement.
Abdominal Pain ; Alligators and Crocodiles ; Anti-Bacterial Agents ; Child, Preschool ; Eating ; Female ; Fever ; Foreign Bodies ; Humans ; Peritonitis* ; Stomach* ; Surgical Instruments ; Ultrasonography

PURPOSE: The aim of this study was to determine the epidemiology of Kawasaki disease in the Kyung Nam area and to evaluate whether the results of this epidemiological study could support infectious etiology. METHODS: We sent a questionnaire to three training hospitals in the Kyung Nam area and retrospectively reviewed their medical records of Kawasaki disease from Jun. 1995 to Dec. 1999. RESULTS: The total number of patients was 717 cases, with little differences of annual prevalence during the five years. In all cases, the monthly prevalence of Kawasaki disease was high in Apr. and Jul. At the eastern of Kyung Nam, the monthly prevalence was high in Apr. and Jul. in 1995 and 1996, Jul. in 1997, Apr. in 1998 and Apr. and Jul. in 1999. In the central area of Kyung Nam, the monthly prevalence was high in Apr. in 1995 and 1996, Apr. and Jul. in 1997 and Jul. in 1998 and 1999. In the western Kyung Nam, the monthly prevalence was high in Nov. in 1995, Aug. in 1996, Oct. in 1997, Dec. in 1998 and Nov. in 1999. CONCLUSION: In the eastern and central areas of Kyung Nam, the monthly prevalence of Kawasaki disease was similarly high in Apr. and Jul. However, in the western district, the prevalence was high in late fall and winter. We could not prove the hypothesis that Kawasaki disease occurred with the spread of single infectious agent, but the a nnually similar prevalence in eastern and central Kyung Nam supported the infection theory for the etiology of the disease.
Epidemiologic Studies* ; Epidemiology ; Humans ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Prevalence ; Surveys and Questionnaires ; Retrospective Studies

PURPOSE: Acute pyogenic osteomyelitis is uncommon in children. Delayed diagnosis and inappropriate treatment are leading to growth failure and deformation. We review the clinical manifestations and treatment of acute osteomyelitis in children according to age. METHODS: A retrospective analysis was made of 32 patients who underwent antibiotic management or operation between Aug 1989 and Dec 2003 for acute pyogenic osteomyelitis in age from 0 to 15 years old. RESULTS: The study group was composed of 21 boys and 11 girls. The subjects were divided into four groups according to age: 0-1 yr (n=6), 1-5 yr (n=11), 6-10 yr (n=8), and 11-15 yr (n=7). Nineteen cases were diagnosed in Winter. Femur was the most common infected site (37.5%). There were no predisposing factor in 17 patients, and 7 of 15 patients had trauma history. Sepsis was important predisposing factor in neonates. The chief complaints were pain, swelling and fever. S. aureus (61%) is the most common organism. Twenty-nine patients were treated with operation and concomitant antibiotics. Two cases had sequelae in follow-up period: One is avascular necrosis of femur and the other is discrepancy of leg length. CONCLUSION: In our review, because of poor prognosis in septic neonates, we recommend to treat actively neonatal sepsis and prevent or detect osteomyelitis early. Because most of patients were diagnosed and treated in orthopedic surgery, the rate of operation was too high. So, protocol for further evaluation and management of acute osteomyelitis in pediatric patients were needed.
Adolescent ; Anti-Bacterial Agents ; Causality ; Child* ; Delayed Diagnosis ; Female ; Femur ; Fever ; Follow-Up Studies ; Humans ; Infant, Newborn ; Leg ; Necrosis ; Orthopedics ; Osteomyelitis* ; Prognosis ; Retrospective Studies ; Sepsis

Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a genetically heterogeneous mitochondrial disorder with variable clinical symptoms. Here, from the sequencing of the entire mitochondrial genome, we report a Korean MELAS family harboring two homoplasmic missense mutations, which were reported 9957T>C (Phe251Leu) transition mutation in the cytochrome c oxidase subunit 3 (COX3) gene and a novel 13849A>C (Asn505His) transversion mutation in the NADH dehydrogenase subunit 5 (ND5) gene. Neither of these mutations was found in 205 normal controls. Both mutations were identified from the proband and his mother, but not his father. The patients showed cataract symptom in addition to MELAS phenotype. We believe that the 9957T>C mutation is pathogenic, however, the 13849A>C mutation is of unclear significance. It is likely that the 13849A>C mutation might function as the secondary mutation which increase the expressivity of overlapping phenotypes of MELAS and cataract. This study also demonstrates the importance of full sequencing of mtDNA for the molecular genetic understanding of mitochondrial disorders.
Adult ; Asian Continental Ancestry Group ; DNA Mutational Analysis ; DNA, Mitochondrial/analysis/*genetics ; Electron Transport Complex I/*genetics ; Electron Transport Complex IV/*genetics ; Female ; Humans ; Korea ; MELAS Syndrome/*genetics ; Male ; Middle Aged ; Mitochondrial Proteins/*genetics ; *Mutation, Missense ; Pedigree ; Polymorphism, Genetic

OBJECTIVES: This report describes the development process of a drug dosing database for ethical drugs approved by the Korea Food & Drug Administration (KFDA). The goal of this study was to develop a computerized system that supports physicians' prescribing decisions, particularly in regards to medication dosing. METHODS: The advisory committee, comprised of doctors, pharmacists, and nurses from the Seoul National University Bundang Hospital, pharmacists familiar with drug databases, KFDA officials, and software developers from the BIT Computer Co. Ltd. analyzed approved KFDA drug dosing information, defined the fields and properties of the information structure, and designed a management program used to enter dosing information. The management program was developed using a web based system that allows multiple researchers to input drug dosing information in an organized manner. The whole process was improved by adding additional input fields and eliminating the unnecessary existing fields used when the dosing information was entered, resulting in an improved field structure. RESULTS: A total of 16,994 drugs sold in the Korean market in July 2009, excluding the exclusion criteria (e.g., radioactivity drugs, X-ray contrast medium), usage and dosing information were made into a database. CONCLUSIONS: The drug dosing database was successfully developed and the dosing information for new drugs can be continually maintained through the management mode. This database will be used to develop the drug utilization review standards and to provide appropriate dosing information.
Advisory Committees ; Databases, Pharmaceutical ; Drug Utilization Review ; Humans ; Isothiocyanates ; Korea ; Pharmacists ; Radioactivity

BACKGROUND/AIMS: Vitamin E improves the biochemical profiles and liver histology in nonalcoholic steatohepatitis, but the role of vitamin E is not clearly defined in the management of nonalcoholic fatty liver disease (NAFLD) which includes both simple steatosis and steatohepatitis. Co-morbid metabolic syndrome increases the probability of steatohepatitis in NAFLD. In this study, we aimed to determine the short-term effects of vitamin E and off-treatment durability of response in a propensity-score matched cohort of NAFLD patients with metabolic syndrome. METHODS: A retrospective cohort was constructed by retrieving 526 consecutive NAFLD patients from the electronic medical record data warehouse of a tertiary referral hospital in South Korea. Among them, 335 patients (63.7%) had metabolic syndrome and were eligible for vitamin E therapy. In order to assess the effect of vitamin E, propensity score matching was used by matching covariates between control patients (n=250) and patients who received vitamin E (n=85). RESULTS: The PS-matched vitamin E group (n=58) and control group (n=58) exhibited similar baseline metabolic profiles. After 6 months of vitamin E therapy, the mean ALT levels decreased significantly compared to PS-matched control (P<0.01). The changes in metabolic profiles (body weight, lipid and glucose levels) did not differ between control and vitamin E groups during the study period. CONCLUSIONS: Short-term vitamin E treatment significantly reduces ALT levels in NAFLD patients with metabolic syndrome, but metabolic profiles are not affected by vitamin E.
Adult ; Aged ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Body Weight ; Cohort Studies ; Female ; Humans ; Lipoproteins, HDL/blood ; Lipoproteins, LDL/blood ; Liver/pathology ; Male ; Metabolic Syndrome X/*complications/diagnosis/drug therapy ; Middle Aged ; Non-alcoholic Fatty Liver Disease/*complications/diagnosis/*drug therapy ; Propensity Score ; Republic of Korea ; Retrospective Studies ; Vitamin E/*therapeutic use