No Abstract available.
Chungcheongnam-do* ; Infection Control*

There are many reports that d-tubocurarine has marked species and individual variations in the matter of muscle relaxation. Therefore the dose-related neuromuscular blocking effect of d-tubocurarine was studied in anesthetized patients. Eighty adult patients were studied during halothane-N2O-O2 anesthesia for various kinds of surgery. These patients were in good physical shape, without known or suspected liver, kidney, neuromuscular or hormonal disease, and were not taking medication known to influence the action of relaxants. Preanesthetic medication consisted of atropine 0.01mg/kg and valium 0.18 mg/kg intramuscularly 60 minutes before anesthesia. Anesthesia was induced with thiopental 4~5mg/kg. Succinylcholine 1mg/kg was used to faciliate tracheal intubation. Moderate hyperventilation was maintained throughout by a mechanical ventilator and patient temperature was maintained at 35~36 degrees C during the study. Forty patients received a single intravenous d-tubocurarine 0.1mg/kg(group A) after the succinylcholine effect had worn off and the other forty patients received a single intravenous d-tubocurarine 0.2mg/kg(group B) after the succinylcholine effect had disappered. Prior to the administration of d-tubocurarine, the patient's forearm and hand were firmly fixed to a specially constructed metal armboard. The thumb was abducted, fixed and connected to a electrical kymograph, Harvard apparatus. The ulnar nerve was stimulated at the wrist subcutaneous needle electrodes by means of supramaximal stimull from a peripheral nerve stimulator(model 91-M3, Emerson, USA). Square wave of "Train of Four" stimuli of 0.2msec duration were delivered at a frequency of 0.1Hz. The evoked twitch and tracing of the adductor muscle of the thumb was recorded continuously on a electrical kymograph. Upon recovery from the initial dose of succinylcholine, a stable baseline twitch tension was recorded for 15 minuts. At this point a single intravenous injection of d-tubocurarine, either 0.1mg/kg or 0.2mg/kg, was given. The data were plotted as onset time of twitch depression and percentage depression of twitch height and the recovery time of "Train of four" response were analysed in each group. The results were as follows: 1) In d-tubocurarine 0.1mg/kg group: the effect of d-tubocurarine was variable, ranging from no effect on twitch tension to abolition of the twitch response. Mean maximal twitch depression was 59.4%. Recovery index which showed more than 75% twitch depression was 39.9minutes. 2) In d-tubocurarine 0.2mg/kg group: the effect of d-tubocurarine obtained consistent and solid neuromuscular relaxation. Mean maximal twitch depression was 95.2%. Recovery index was 58.1 minutes.
Adult ; Male ; Female ; Humans

No abstract available.

OBJECTIVE: Interhemispheric subdural hematoma (IHSDH) is uncommon, because of their unusual location. However, it is a distinct lesion with its unique characteristics. We investigated clinical features and outcomes of consecutive 42 patients with IHSDH, retrospectively. METHODS: From 2006 to 2015, we treated 105 patients with IHSDH. All patients were diagnosed by computed tomography (CT) or magnetic resonance imaging. We selected 42 patients with thick (3 mm or more) IHSDH. We retrospectively reviewed the clinical and radiological findings, management and outcomes. RESULTS: The male to female ratio was 2:1. Two thirds of the patients were over 60 years old. Slip or fall was the most common cause of trauma. The level of consciousness on admission was Glasgow Coma Scale (GCS) 13 to 15 in 25 patients. The most common symptom was headache. All IHSDH was hyperdense in CT at the time of diagnosis. IHSDH frequently accompanied convexity subdural hematoma. The outcome was favorable in 27 patients, however, six patients were expired. Twenty-two patients were managed conservatively. Surgery was performed in ten patients to remove the concurrent lesion. The outcome was poor in spontaneous one, patients with low GCS, and patients with conservative treatment. CONCLUSION: IHSDH is rare especially the isolated one. The outcome was dependent to the severity of injury. Surgery may be helpful to remove the concurrent mass lesion, however, conservative treatment is generally preferred.
Consciousness ; Craniocerebral Trauma ; Diagnosis ; Female ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Headache ; Hematoma, Subdural* ; Humans ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Symptom Assessment

OBJECTIVE: From November 30, 2016, the Korean Government carried the revised Medical Dispute Mediation and Arbitration Act into effect. Mediation will start automatically without agreements of the defendant, when the outcome of the patient was death, coma more than a month or severe disability. Cerebral aneurysm has a definite risk of bad outcome, especially in the worst condition. Any surgical intervention to this lesion has its own high risk of complications. Recently, Seoul central district court decided 50% responsibility of the doctors who made a rupture of the aneurysm during coiling (2015Ga-Dan5243104). We reviewed judicial precedents related to cerebral aneurysms in lawsuit using a web search.METHODS: We searched judicial precedents at a web search of the Supreme Court, using the key words, "cerebral aneurysm".RESULTS: There were 15 precedents, six from the Supreme Court, seven from the High Court, and two from district courts. Seven precedents were related to the causation analysis, such as work-relationship. Five precedents were malpractice suits related bad results or complications. Remaining three precedents were related to the insurance payment. In five malpractice precedents, two precedents of the Supreme Court reversed former two precedents of the High Court.CONCLUSION: Judicial precedents on the cerebral aneurysm included not only malpractice suits, but also causation analysis or insurance payment. Attention to these subjects is needed. We also need education of the independent medical examination. To avoid medical disputes, shared decision making seems to be useful, especially in cases of high risk condition or procedures.
Aneurysm ; Coma ; Decision Making ; Dissent and Disputes ; Education ; Expert Testimony ; Humans ; Insurance ; Intracranial Aneurysm ; Malpractice ; Negotiating ; Rupture ; Seoul

Since the national malaria eradication service (NMES) was implemented in 1959, extensive malariometric survey were conducted throughout the country. A total of 73,859 malaria cases of Plasmodium vivax were confirmed out of 268,259 blood smears through passive and active case detection (PCD and ACD) in 1960~1969 including chloroquine/ pyrimethamine combined tablets for the presumptive treatment of all of fever cases. The majority of the positive cases occurred in Gyeongsang buk-do, revealing 62,859 cases as of 85.2%, followed by Gyeonggi-do 5,844 cases (7.9%), Chungcheong buk-do 3,458 cases (4.7%), Gangwon-do 812 cases (1.1%), and 29 cases developed in Jeju-do. ACD was more sensitive and advantageous for detecting the malaria cases over PCD in the pilot study area. The high endemic area was located in the north Gyeongsang buk-do and north east Gyeonggi-do. The malaria incidence was high in the age group under 14 years in malaria foci, and that was low in non-malarious area. High parous rate (77.7%) and survival rate (91.4%) of the vector mosquitoes were shown in malaria foci, which were hilly or mountainous area. On the other hand, low parous rate (50.6%) and survival rate (42.7%) were found in non-malarious area, the rice field of south western part of the country even in abundance of vector mosquitoes. NMES had contributed the control of the malaria by carring out the residual DDT focal spray, mass drug administration, radical treatment of the positive cases, and mass blood survey in the heavy malarious area. Since then malaria disappeared rapidly, and no indigenous case was reported after 1984. In order to ascertain whether this country was malaria-free or not, mass blood survey was carried out for the juveniles, adolescents and adults in Yeongju-gun Gyeongsangbuk-do in 1986 where the highest incidence of malaria was recorded during the 1960s. The result showed no positive case at all. However vivax malaria reemerged, and made a dramatic resurgence since 1993 in the demilitarized zone (DMZ) bordering North Korea, and expanded toward eastern and southern part of the country year after year, totaling 14,089 cases including U.S. army by the end of 2000 in spite of the strong activities of antimalaria in the Republic of Korea. So vector control including the encouragement of the livestock farming in the malaria endemic area must be more sensitive and effective measure to reduce the risk of malaria transmission by the eliminating the dangerous age of mosquitoes in the points of characteristics of the Korean strain of parasites such as the mild symptoms, long-term incubation period and asymptomatic parasitaemia. Focal application of thermal fogging and mist spray of insecticides would be certainly effective in preventing the vector mosquitoes from infecting the gametocytes of malaria for the first peak of multi malaria cases in the early season of the year. All of the civilians who are in the high risk area for malaria should be forced to sleep under the permethrin impregnated mosquito nets. All of the soldiers near the DMZ are strongly recommended to take the combined tablets of chloroquine/ pyrimethamine instead of the single base of chloroquine at present to prevent the action of source of infection of the reservoirs and the completion of the sporogonic stages of the vector mosquitoes because the vector control activities are not allowed in the DMZ. The experts of entomologists and malariologist of the South and North Korea should discuss the antimalaria programme to eradicate the malaria from the Korean peninsular near future.
Adolescent ; Adult ; Chloroquine ; Culicidae ; DDT ; Democratic People's Republic of Korea ; Epidemiology ; Fever ; Gangwon-do ; Gyeonggi-do ; Gyeongsangbuk-do ; Hand ; Humans ; Incidence ; Insecticides ; Jeju-do ; Korea* ; Livestock ; Malaria* ; Malaria, Vivax ; Military Personnel ; Mosquito Nets ; Parasites ; Permethrin ; Pilot Projects ; Plasmodium vivax ; Pyrimethamine ; Republic of Korea ; Seasons ; Survival Rate ; Tablets ; Weather

BACKGROUND: Angiogenesis is an essential component of tumor growth and metastasis, and the vascular endothelial growth factor (VEGF) is one of the most important angiogenic factors. Several solid tumors produce substantial amounts of VEGF, which stimulates proliferation and the migration of ednothelial cells, therby inducing neovasculization by a paracrine mechanism. To evaluate the prognostic roles of angiogenesis and VEGF expression in patients with non-small cell lung cancer, the relationship between VEGF expression in tumor tissues, the clinicopathologic features and the overall survival rate were analysed. METHODS: Sixty-nine resected primary non-small cell lung cancer specimens were evaluated. The pareffinembedded tumor tissues were stained by anti-VEGF polyclonal antibodies using an immunohistochemical method to assess VEGF expression. RESULTS: In Forty-one patients (59%), the VEGF antigen was expressed weakly in their tumor tissue, whereas in twenty-eight patients (41%) the VEGF antigen was expressed strongly. The median survival time of the weak VEGF expression group was 24 months, and that of the strong VEGF expression group was 19 months. The three year-survival rates were 35%, 33%, respectively. The survival difference between both groups was not statistically significnat. CONCLUSION: Although results were not statistically significant, the strong expression group tended to poorer prognosis than weak expression group.
Angiogenesis Inducing Agents ; Antibodies ; Carcinoma, Non-Small-Cell Lung* ; Humans ; Neoplasm Metastasis ; Prognosis ; Survival Rate ; Vascular Endothelial Growth Factor A

This analysis was performed to investigate the relationship between nutrition and anthropometric indices using the data from a cross-sectional survey of a large national sample, '98 Korean national health and nutrition examination survey. Subjects were selected by stratified multistage probability sampling design and completed dietary questionnares including food intakes for one day by 24-hour recall method. For this analysis, 6566 subjects were selected by age(over 20 years old). For anthropometry, height, weight, and waist- and hip- circumference were measured. They were classified by body mass index(BMI, weight(Kg)/height2(m2)) and waist-hip ratio(WHR, waist circumference(Cm)/hip circumference(Cm)). The nutrients intake of subjects were compared with the recommended daily allowances(RDA). Mean adequacy ratio(MAR) was calculated. Mean heights, weights, BMIs were higher in the groups with nutrient intake over 125% of RDA than the lower intake groups for most nutrients. However, Mean WHR was the highest in the groups with nutrient intake under 75% of RDA for most nutrients excluding iron intake of women aged 20~64 years. Among women aged 20~64 years, means of MAR were 0.71 for obese individuals(BMI>30), 0.72 for subjects with underweight(BMI<18.5), and 0.76 for subjects with normal weight(18.5< or = BMI<25). Normal subjects has statistically significantly higher MAR than those of other groups. However, among elderly people aged over 65 years, obese group had the highest MAR, 0.68. Women with abdominal obesity(WHR>0.9) had lower MAR, 0.71 than those with normal weight(MAR=0.76). From these results, obesity and abdominal obesity seems to be the results of malnutrition including both undernutrition and overnutrition rather than simple problem of excess energy intake. Obesity in elderly people needs to be handled differently from adults.
Adult ; Aged ; Anthropometry ; Cross-Sectional Studies ; Energy Intake ; Female ; Humans ; Iron ; Malnutrition ; Nutrition Surveys* ; Obesity ; Obesity, Abdominal ; Overnutrition ; Weights and Measures

This analysis was performed to investigate the relationship between nutrition and anthropometric indices using the data from a cross-sectional survey of a large national sample, '98 Korean national health and nutrition examination survey. Subjects were selected by stratified multistage probability sampling design and completed dietary questionnares including food intakes for one day by 24-hour recall method. For this analysis, 6566 subjects were selected by age(over 20 years old). For anthropometry, height, weight, and waist- and hip- circumference were measured. They were classified by body mass index(BMI, weight(Kg)/height2(m2)) and waist-hip ratio(WHR, waist circumference(Cm)/hip circumference(Cm)). The nutrients intake of subjects were compared with the recommended daily allowances(RDA). Mean adequacy ratio(MAR) was calculated. Mean heights, weights, BMIs were higher in the groups with nutrient intake over 125% of RDA than the lower intake groups for most nutrients. However, Mean WHR was the highest in the groups with nutrient intake under 75% of RDA for most nutrients excluding iron intake of women aged 20~64 years. Among women aged 20~64 years, means of MAR were 0.71 for obese individuals(BMI>30), 0.72 for subjects with underweight(BMI<18.5), and 0.76 for subjects with normal weight(18.5< or = BMI<25). Normal subjects has statistically significantly higher MAR than those of other groups. However, among elderly people aged over 65 years, obese group had the highest MAR, 0.68. Women with abdominal obesity(WHR>0.9) had lower MAR, 0.71 than those with normal weight(MAR=0.76). From these results, obesity and abdominal obesity seems to be the results of malnutrition including both undernutrition and overnutrition rather than simple problem of excess energy intake. Obesity in elderly people needs to be handled differently from adults.
Adult ; Aged ; Anthropometry ; Cross-Sectional Studies ; Energy Intake ; Female ; Humans ; Iron ; Malnutrition ; Nutrition Surveys* ; Obesity ; Obesity, Abdominal ; Overnutrition ; Weights and Measures

BACKGROUND: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying (one medial-row tie among 4 medial-row sutures) on the medial-row in double-row suture-bridge configuration (2x2 anchor with 4x4 suture stands). METHODS: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using 2x2 anchor double-row configuration. The mean age was 61.3 years (range, 31-81 years). Two double-loaded suture anchors were used for medial-row. Four medialrow stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre- and postoperative MRI. RESULTS: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. CONCLUSIONS: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears.
Arthroscopy ; Atrophy ; Classification ; Humans ; Magnetic Resonance Imaging ; Muscular Atrophy ; Rotator Cuff* ; Shoulder ; Suture Anchors ; Sutures ; Tears* ; Tendons