Propofol is a short acting, rapidly metabolized intravenous anesthetic agent. It cause a decrease in arterial pressure after induction of anesthesia and a decrease in heart rate. Hypertension, tachycardia during induction of anesthesia or in response to tracheal intubation is undesirable in high-risk patients, Propofol might attenuate the pressor to tracheal intubation than thiopental. In this study we compared propofol with thiopental for induction of anesthesia. Forty patients of ASA class III scheduled to undergoing valvular replacements divided two groups. Twenty patients were induced with thiopental, twenty patients were induced with propofol and maintained using 50% nitrous oxide in oxygen. Cardiovascular parameters were checked before induction, after propofol or thiopental injection, after succinylcholine injection, after tracheal intubation, after isoflurane mixed inhalations. The aim of this study is to examine a camparison of hemodynamic effects between propofol and thiopental for valvular replacement. The results were as follows. 1) There is little change in heart rate with thiopental group, but heart rate was decreased in propofol group. 2) There is slightly deaeased in arterial pressure with thiopental group, but markedly decreased in propofol group. 3) There is no difference of central venous pressure between two groups.
Anesthesia ; Arterial Pressure ; Central Venous Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation ; Isoflurane ; Nitrous Oxide ; Oxygen ; Propofol* ; Succinylcholine ; Tachycardia ; Thiopental*

OBJECTIVE: The study was conducted by the Association of Korean College of Nursing in order to survey and analyze the current state of clinical practicum for adult health nursing at four-year nursing college in Korea and to suggest improvements in the contents and methods of clinical practicum and its future direction. METHOD: Data were collected using a survey by mail from July to November 2004 using a structured questionnaire on the general state of clinical practicum for adult health nursing. The questionnaires were sent to 53 nursing colleges throughout the country, and 47 recovered questionnaires were analyzed. RESULTS: The number of credits for adult health nursing practicum was 7~10(average range), and various nursing fields were used in clinical practicum. The number of students per team was 5~6 at general wards and 3~4 at intensive care units. Students also experienced practicum during daytime and in the evening. Clinical practicum for adult health nursing was led by full-time professors and field practicum directors. In clinical practicum for adult health nursing, almost every college evaluated students' attitude, skills, leadership, etc. in various forms. CONCLUSIONS: It is urgent to develope a standardized evaluation tool for clinical practicum.
Adult* ; Education, Nursing ; Humans ; Intensive Care Units ; Korea* ; Leadership ; Nursing* ; Patients' Rooms ; Physician's Practice Patterns ; Postal Service ; Surveys and Questionnaires

BACKGROUND: Epidural anesthesia is thought to be relatively indicated for cesarean section in patients with severe preeclampsia. In contrast, avoidance of spinal anesthesia is recommended, postulating excessive hypotensive risks. In addition, general anesthesia is often avoided in this population because malignant hypertension following tracheal intubation is common and risks for difficult airway management are excessive. METHODS: In this study, we compared hemodynamic changes in patients with severe preeclampsia and normal pregnant women during spinal anesthesia for elective cesarean section. Spinal anesthesia was performed with 10 mg of 0.5% heavy bupivacaine mixed with 25 microgram fentanyl in 18 patients with severe preeclampsia and 17 normal pregnant women. We compared MAP, CI, and SVRI changes before and after spinal anesthesia. RESULTS: MAP responses following induction of spinal anesthesia for elective cesarean section in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. CI responses following induction of spinal anesthesia in patients with severe preeclampsia showed a statistically significant increase from 8 min after and normal pregnant women also showed a statistically significant increase from 4 min after spinal anesthesia. SVRI responses from induction of spinal anesthesia in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. Incidence of hypotension before delivery and used total dose of ephedrine during operation were statically insignificant between severe preeclamptic and normal pregnant women. CONCLUSIONS: We conclude that changes of MAP, CI and SVRI following spinal anesthesia for elective cesarean section in the severely preeclamptic and normal pregnant women are clinically similar. We suggest that spinal anesthesia for cesarean section is not contraindicated in the severely preeclamptic patient.
Airway Management ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal* ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Female ; Fentanyl ; Hemodynamics* ; Humans ; Hypertension, Malignant ; Hypotension ; Incidence ; Intubation ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women

Cysticercosis is a parasitic disease which results when man serves as the intermediate host of Taenia Solium, the pork tape warm; the larvae, cysticercus, develop in various body tissue. We have recently experienced a case of cysticercosis in the scrotum diagnosed by excision & biopsy.
Biopsy ; Cysticercosis* ; Cysticercus ; Larva ; Parasitic Diseases ; Scrotum* ; Taenia solium

Sunitinib, a multi-targeted tyrosine kinase inhibitor, is used for the treatment of renal cell carcinoma and gastrointestinal stromal tumors. Many adverse effects associated with sunitinib, including hypertension, proteinuria, and thrombotic microangiopathy, have been reported; however, the other forms of glomerulonephritis are very rare. We report a case of biopsy-confirmed immune complex glomerulonephritis in a patient with a gastrointestinal tumor who received sunitinib treatment. The proteinuria subsided partially after sunitinib was discontinued, but when the drug was reintroduced, it recurred.
Antigen-Antibody Complex ; Carcinoma, Renal Cell ; Gastrointestinal Stromal Tumors ; Glomerulonephritis ; Humans ; Hypertension ; Indoles ; Protein-Tyrosine Kinases ; Proteinuria ; Pyrroles ; Thrombotic Microangiopathies

p27Kip1 has been recognized as a negative regulator of cell cycle. Reduced level of p27 expression is associated with development and aggressiveness of several human tumors. To investigate the role of p27Kip1 on progression of colorectal adenocarcinoma, we studied 40 cases of human colorectal adenocarcinomas for expression of p27Kip1 protein using an immunohistochemical method, and compared these results with known prognostic parameters of colorectal adenocarcinoma. Among 40 cases of colorectal adenocarcinomas, p27Kip1 expression was detected in the nuclei of tumor cells in 14 cases (35%). The expression rate of p27Kip1 protein was significantly lower in the cases with lymph node metastasis (25.8%) than in those without lymph node metastasis (66.6%) (p<0.05). But it did not correlate with other parameters such as tumor size, histologic grade, vascular invasion, and Ki-67 labeling index. The results suggest that reduced expression of p27Kip1 protein plays a role in biologically aggressive behavior of colorectal adenocarcinoma.
Adenocarcinoma* ; Cell Cycle ; Cyclin-Dependent Kinase Inhibitor p27* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.

Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.

BACKGROUND: The purpose of this study was to investigate the prevalence of Stap hylococcus aureus with decreased susceptibility to glycopeptides in Korea and to evaluate the methods for detection. METHODS: From March to May 1998, 106 clinical isolates of S. aureus were collected from patients of the Kosin Medical Center . Antimicrobial susceptibilities for vancomycin and teicoplanin were determined by NCCLS disc diffusion method and the MICs were determined by agar dilution method. Correlation between both results was evaluated. RESULTS: MICs of vancomycin and teicoplanin against S. aureus isolates were 0.5 ~2 microgram/mL and 0.25 ~8 microgram/mL. Some S. aureus isolates showed decreased susceptibility to teicoplanin (MIC 4 microgram/mL, 33 strains; MIC 8 microgram/mL, 1 strain), but none showed decreased susceptibility to vancomycin. A positive correlation was observed between the inhibitory zone diameters of teicoplanin disc and the MICs of teicoplanin(P< 0.0 1). Inhibitory zone diameter differences between vancomycin and teicoplanin discs also showed a positive correlation with the MICs of teicoplanin (P< 0.01). Strains whose inhibitory zone diameters of teicoplanin disc were less than 16 mm, the sensitivity and positive predictive value for the detection of strains with MICs more than 4 microgram/mL were 100 % (34/ 34) and 43% (34/ 79), respectively. In strains with inhibitory zone diameter difference of more than 4 mm, the sensitivity and positive predictive value of detection in MICs of more than 4 microgram/mL were 94 % (32/ 34) and 70 % (32/46), respectively. CONCLUSION: Although S. aureus with intermediate or full resistance to glycopeptides was not isolated in this study, few strains had decreased susceptibility to teicoplanin. We conclude that when the inhibitory zone diameters of teicoplanin disc are less than 16 mm or inhibitory zone diameter difference between vancomycin and teicoplanin discs is more than 4 mm, the presence of S. aureus isolates with decreased susceptibility to teicoplanin should be suspected.
Agar ; Diffusion ; Glycopeptides ; Humans ; Korea ; Prevalence ; Staphylococcus aureus* ; Staphylococcus* ; Teicoplanin* ; Vancomycin

BACKGROUND: The measurement of perfusion is very important to understanding the physiology in the ischemic and reperfused tissue. However, no studies have been reported using a beating heart with a real time-continuous perfusion measurement system (QFlow(TM)400) to check local tissue perfusion so far. In this study, the changes in hemodynamics and local myocardial perfusion (LMP) after coronary reperfusion with nicardipine (a calcium channel blocker) administration were evaluated. METHODS: A total of 10 mongrel dogs were divided into two groups; group I (control group, n = 5), group II (nicardipine group, n = 5). After femoral arterial, pulmonary arterial and left ventricular catheterization, a left thoracotomy was performed. Next, the left anterior descending coronary artery (LAD) was exposed, and a thermal diffusion microprobe was inserted in the myocardium to measure LMP. RESULTS: In group II, blood pressure and systemic vascular resistance after LAD reperfusion were significantly decreased compared to group I. Cardiac output and stroke volume were more rapidly increased in group II, while left ventricular stroke work was decreased in group II. In group I, the LMP after LAD reperfusion did not recover to the baseline level, but the LMP did recover 20 minutes after LAD reperfusion and was increased more compared to the baseline level at 30 minutes after LAD reperfusion in group II. There were no significant differences in dP/dt between the two groups. CONCLUSIONS: We found that the LMP did not recover to the baseline level in the early state of LAD reperfusion; however, nicardipine administration increased the LMP after the early reperfusion period. Cardiac output and stroke volume were also more rapidly increased when nicardipine was administrated.
Animals ; Blood Pressure ; Calcium Channels ; Cardiac Output ; Catheterization ; Catheters ; Coronary Vessels ; Dogs* ; Heart ; Hemodynamics* ; Myocardial Reperfusion* ; Myocardium ; Nicardipine* ; Perfusion* ; Physiology ; Reperfusion ; Stroke ; Stroke Volume ; Thermal Diffusion ; Thoracotomy ; Vascular Resistance