PURPOSE: Vascular endothelial growth factor (VEGF) is highly expressed in the airways of asthmatic patients. Asthmatic children are commonly exposed to parental smoking. We investigated the effect of environmental tobacco smoking (ETS) on VEGF levels in induced sputum of asthmatic children. METHODS: Sixty-nine asthmatic children were enrolled, who were hospitalized in the Pediatric Department of Korea University Hospital for acute asthma exacerbation. We interviewed their parents to assess ETS history with a questionnaire. We measured VEGF levels in induced sputum from asthmatic children by enzyme-linked immunosorbent assay, and we also measured the concentrations of sputum ECP by radioimmunoassay. We compared sputum levels of VEGF and ECP between an ETS group and a non-ETS group. RESULTS: Of the 69 cases, 45 were in the non-ETS group and 24 were in the ETS group. The ETS group showed higher sputum VEGF levels than did the non-ETS group (P=0.001). Serum IgE levels were not related to the sputum levels of VEGF in the ETS group, and there was no association between serum levels of ECP and sputum levels of VEGF. CONCLUSION: When asthmatic children were exposed to family smoking, higher levels of VEGF were measured in their sputum. It seems that environmental smoking aggravates allergic airway inflammation. We suggest that parents of asthmatic children should make all efforts to stop smoking.
Asthma ; Child* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin E ; Inflammation ; Korea ; Parents ; Surveys and Questionnaires ; Radioimmunoassay ; Smoke* ; Smoking* ; Sputum* ; Vascular Endothelial Growth Factor A*

BACKGROUND: Intravenous patient controlled analgesia (IV-PCA) is a very popular and relatively safe technique due to its innate negative feedback mechanism. Morphine, the most commonly used analgesic, however, has its own drawbacks due to troublesome side effects. Narcotic agonist-antagonists are known to have ceiling effects not only to their analgesic potency, but also to their side effects. The authors studied the efficacy and incidence of side effects of Butorphanol IV-PCA for postoperative analgesia and compared these to morphine. METHODS: 38 ASA class I or II patients, undergoing gynecological surgery were randomly assigned into two groups, respectively Butorphanol and Morphine and examined hemodynamic changes, overall pain relief, patients satisfaction and the frequency of side effects. After general anesthesia, each patient randomly received loading dose of butorphanol or morphine in the recovery room and discharged to the floor with the PCA module. Upon arrival, individual patient was evaluated at predetermined time interval for 24 hours. RESULTS: The percentage of patient satisfaction was very high in both groups. The incidence of nausea was less in butorphanol group. The incidence of other side effects was statistically insignificant. CONCLUSIONS: Butorphanol has less incidence of side effects and comparable level of analgesia when compared to morphine. We conclude that butorphanol may be considered as a part of routine IV-PCA regimen, in postoperative pain management.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia, General ; Butorphanol* ; Female ; Gynecologic Surgical Procedures* ; Hemodynamics ; Humans ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Recovery Room

To investigate the relationship of the density, thickness of lens nucleus and cortex with phacoemulsification time, we measured the preoperative density and length of lens nucleus and cortex of 100 eyes with a Scheimpflug camera. We performed phacoemulsification on the same phacoemulsification technique using a phacoemulsifier aspirator by the same surgeon. The preoperative mean values of the density of lens nucleus and cortex were 127. 09+/-57.44 and 30. 33+/-15. 24, respectively. The mean values of the thickness for both were 3.05+/-0.42mm and 0.65+/-0.17mm, respectively. The mean value of phacoemulsification time was 92.68+/-56.98 seconds. The phacoemulsification time was increased significantly as the density of lens nucleus was increased (P<0.0001). However, the thickness of the lens nucleus and cortex and the density of cortex had no significant effect on the phacoemulsification time (p=0. 235, p=0.811). Preoperative evaluation with a Scheimpflug camera is particularly valuable for cataractous patients with corneal endothelial disease deciding on phacoemulsification.
Cataract ; Humans ; Phacoemulsification*

Background: Conventional laryngoscopy with Macintosh blade requires a movement of the head, neck and cervical spine. The Bullard laryngoscope is an anatomically shaped, potentially eliminating the need for cervical spine extension. Bullard and Macintosh laryngoscopes were compared by measuring the degree of cervical spine extension by radiological measurement. Methods: Eighteen patients requiring endotracheal intubation were studied. Anesthesia was induced in neutral head position followed by laryngoscopy. Each patients was intubated two times by Macintosh and Bullard laryngoscope in random order. Radiographic evaluation was performed to determine the degree of cervical spine extension on four occasions; before induction, during facial mask ventilation, and during Bullard and Macintosh laryngoscopy. Results: The extension of cervical spine was significantly less following Bullard laryngoscopy than Macintosh laryngoscopy for best view (p<0.05). Conclusions: The Bullard laryngoscope can be used with less cervical spine extension than Macintosh laryngoscope. It may be useful in patients in whom cervical spine movement is limited or undesirable.
Anesthesia ; Head ; Humans ; Intubation, Intratracheal ; Laryngoscopes ; Laryngoscopy* ; Masks ; Neck ; Spine* ; Ventilation

Shiitake (Lentinus edodes) is a kind of mushroom which is cooked and eaten as a food in Chinese, Japanese and Korean meals. It is nowadays the second most commonly produced edible mushroom in the world. In 1985, a case characterized by itchy skin eruptions after the ingestion of raw shiitake mushrooms was reported and was termed as toxicodermia. Here we report five cases of shiitake dermatitis which developed after ingestion of raw or cooked shiitake mushrooms. All patients complained of severe itching and showed linear grouped erythematous papules after scratching(Kobner phenomenon). To our knowledge, this is the first report of shiitake dermatitis in the Korean literature.
Agaricales ; Asian Continental Ancestry Group ; Dermatitis* ; Eating ; Humans ; Meals ; Pruritus ; Shiitake Mushrooms ; Skin

OBJECTIVES: The definition of a hidden youth is a young person who has completely withdrawn from society and shut himself or herself away for more than 3 months. Those pathologically-withdrawn youths have become a burden not only to society but also to the family. However, screening of these hidden youths cannot be done easily. This study focused on developing a primary effective screening tool for these hidden youths. METHODS: The 42 participants of this study were parents of hidden youths that are between 8 to 25 years old. They were selected from from mental health centers and psychiatric clinics around Seoul and Gyeonggi Province. We also recruited 239 parents of middle and high school students in the Seoul metropolitan area for a control group. In order to decide the concurrent validity of this questionnaire, we used the Symptom Checklist-90-Revision, Children's Depression Inventory, Beck Depression Inven-tory, Social Anxiety Scale for Children-Revised, Social Anxiety and Distress Scale, Avoidant Personality Disorder Scale, and State-Trait Anxiety Inventory for Children. SPSS version 12.0 was used for statistical analysis. RESULTS: Cronbach's alpha values, the reliability coefficient to represent internal consistency, were between 0.396 and 0.935, which showed relatively high internal consistency for this questionnaire. The test-retest coefficient was between 0.68 and 0.78, which was a statistically significant result. In a factor analysis, 4 factors such as avoidance, withdrawal, isolation, and apathy were extracted. In a concurrent validity test with SCL-90-R, the isolation factor showed a statistically-significant relationship with a phobic-anxiety sub-scale, and avoidance and withdrawal sub-scales were remarkably correlated with the interpersonal sensitivity sub-scale. CONCLUSION: Since the questionnaire for socially withdrawn youths has achieved statistically-satisfactory reliability and validity, it will be a useful method to screen for hidden youths in educational, community, and clinical settings.
Adolescent ; Anxiety ; Apathy ; Child ; Depression ; Humans ; Mass Screening ; Mental Health ; Parents ; Personality Disorders ; Reproducibility of Results ; Surveys and Questionnaires

OBJECTIVES: The definition of a hidden youth is a young person who has completely withdrawn from society and shut himself or herself away for more than 3 months. Those pathologically-withdrawn youths have become a burden not only to society but also to the family. However, screening of these hidden youths cannot be done easily. This study focused on developing a primary effective screening tool for these hidden youths. METHODS: The 42 participants of this study were parents of hidden youths that are between 8 to 25 years old. They were selected from from mental health centers and psychiatric clinics around Seoul and Gyeonggi Province. We also recruited 239 parents of middle and high school students in the Seoul metropolitan area for a control group. In order to decide the concurrent validity of this questionnaire, we used the Symptom Checklist-90-Revision, Children's Depression Inventory, Beck Depression Inven-tory, Social Anxiety Scale for Children-Revised, Social Anxiety and Distress Scale, Avoidant Personality Disorder Scale, and State-Trait Anxiety Inventory for Children. SPSS version 12.0 was used for statistical analysis. RESULTS: Cronbach's alpha values, the reliability coefficient to represent internal consistency, were between 0.396 and 0.935, which showed relatively high internal consistency for this questionnaire. The test-retest coefficient was between 0.68 and 0.78, which was a statistically significant result. In a factor analysis, 4 factors such as avoidance, withdrawal, isolation, and apathy were extracted. In a concurrent validity test with SCL-90-R, the isolation factor showed a statistically-significant relationship with a phobic-anxiety sub-scale, and avoidance and withdrawal sub-scales were remarkably correlated with the interpersonal sensitivity sub-scale. CONCLUSION: Since the questionnaire for socially withdrawn youths has achieved statistically-satisfactory reliability and validity, it will be a useful method to screen for hidden youths in educational, community, and clinical settings.
Adolescent ; Anxiety ; Apathy ; Child ; Depression ; Humans ; Mass Screening ; Mental Health ; Parents ; Personality Disorders ; Reproducibility of Results ; Surveys and Questionnaires

Typhoid fever is an acute systemic febrile disease caused by Salmonella Typhi, characterized by persistent fever, headache, abdominal pain, diarrhea and rose spots. Salmonella infection can lead to diffuse organ involvement including bone, lung, thyroid, kidney, liver, spleen, heart, intestine and skin. While a variety of complications may be seen in typhoid fever, sensorineural hearing loss or pancreatitis has been rarely observed. Recently, we experienced a case of typhoid fever complicated by sensorineural hearing loss, acute pancreatitis and hepatitis in a 21-year-old female patient, who was improved with ceftriaxone and ciprofloxacin administration and supportive care. We report this case with a review of the literature.
Abdominal Pain ; Ceftriaxone ; Ciprofloxacin ; Diarrhea ; Female ; Fever ; Headache ; Hearing Loss, Sensorineural* ; Heart ; Hepatitis* ; Humans ; Intestines ; Kidney ; Liver ; Lung ; Pancreatitis* ; Salmonella Infections ; Salmonella typhi ; Skin ; Spleen ; Thyroid Gland ; Typhoid Fever* ; Young Adult

BACKGROUND: Authors have undertaken this study to see if the choice of anesthesia can directly or indirectly provide immunomodulation for cytokines, to determine the relationship of cytokines and hypothalamo-pituitary-adrenal axis in stomach cancer surgery patients, and also to see whether the amount of morphine administration and choice of analgesia can influence cytokine release, and possibly immunity. METHODS: Total 19 gastric cancer surgery patients were randomly assigned in double-blind fashion into two groups. Group-G (n=9) was provided with general anesthesia plus morphine intravenous patient controlled analgesia (IV-PCA), whereas group-GE (n=10) with preemptive epidural and general anesthesia plus continuous epidural analgesia for control of postoperative pain. At predetermined time interval, proinflammatory cytokines and stress hormones were evaluated with visual analog pain scale. Simultaneous assessments of operating and anesthesia time, total morphine doses, the time to recovery of gastrointestinal function and incidences of complications were also made. RESULTS: Demographic data, the durations of operation and anesthesia and recovery of gastrointestinal function were similar in both groups. Total morphine doses were approximately four times greater in group-G. Secretions of interleukin-1 beta , TNF and epinephrine were blocked by preemptive epidural anesthesia, meanwhile, interleukin-6 as well as ACTH and cortisol were not. After 24 hours after skin incision, the differences of cytokines, ACTH and cortisol between two groups were dissipated. In spite of these hormonal findings, visual analog pain scale could not disclose any differences. Incidences of complications were statistically insignificant except that of itching in group-GE. CONCLUSION: Preemptive epidural anesthesia and analgesia can partially block only some of cytokines and stress hormones, and these effects do not have clinically relevant long term influences. The amounts and means of morphine administered by continuous epidural analgesia block or IV-PCA demonstrated no evidence of immunosuppression at clinical dose range.
Adrenocorticotropic Hormone ; Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Anesthesia and Analgesia* ; Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Axis, Cervical Vertebra ; Cytokines ; Epinephrine ; Humans ; Hydrocortisone ; Immunomodulation* ; Immunosuppression ; Incidence ; Interleukin-1beta ; Interleukin-6 ; Morphine ; Pain Measurement ; Pain, Postoperative ; Pruritus ; Skin ; Stomach Neoplasms* ; Stomach*

BACKGROUND: Although degree of motor blockade during high thoracic spinal anesthesia is difficult to determine, pulmonary function may reflect the level of motor blockade. So we checked pulmonary function during spinal anesthesia with two different local anesthetic agents. METHODS: 50 patients, ASA PS 1-2, were randomly divided into two groups. After basal pulmonary function test (FVC: forced vital capacity, FEV1: forced expiratory volume in one second, PEFR: peak expiratory flow rate, PEP: peak expiratory pressure, PIP: peak inspiratory pressure.), the patients received spinal anesthesia with either 0.5% hyperbaric bupivacaine or 0.5% hyperbaric tetracaine. Thirty minutes after injection, level of sensory blockade was checked by pinprick test and pulmonary function test was performed. RESULTS: Almost all the values of pulmonary function reduced after spinal anesthesia, but the degrees of reduction were not differ in two groups except PEP, which reduced more profoundly in tetracaine group than bupivacaine group. CONCLUSIONS: It is more desirable that we use bupivacaine rather than tetracaine as spinal anesthetic agent in the patient with poor pulmonary function.
Anesthesia, Spinal* ; Anesthetics ; Bupivacaine* ; Forced Expiratory Volume ; Humans ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Tetracaine* ; Vital Capacity