OBJECTIVES: Over the last 30 years, despite the increasing sophistication in medical care, the mortality of acute renal failure(ARF) has remained virtually unchanged at 40-50%, but the reasons remain unknown. This study intend to identify prognostic risk factors influencing survival and predict the mortality in ARF patients. METHODS: We retrospectively analyzed 152 patients with ARF who required renal replacement therapy, or whose serum creatinine level above 5 mg/dl, from Jan. 1988 to May. 1995. Multiple factors which may influence mortality were evaluated by univariate and multivariate analysis. RESULTS: 1) Of the 152 patients, 97 were male and 55 were female. The mean age was 47 years and the overall mortality was 36.8%. 2) Based on the univariate analysis, age>60 years, cause of ARF, APACHE II score, number of failing organs, peak serum creatinine level, PaO2, coma, hypotension, ARDS, GI bleeding, ventilatory support, need for antiarrhythmics, DIC, cardiovascular failure, pulmonary failure, neurological failure, and gastrointestinal failure were all significant factors discriminating between survivors and nonsurvivors(p<0.05) 3) By multivariate analysis, hypotension, coma, ventilatory support, and age over 60 years were significant independent predictors influencing survival in ARF patients and logistic equation and logit score were as follows : z=-2.04+1.32(age over 60)+2.18(hypotension)+2.88 (ventilatory support) + 3.28(coma) P=ez/(1+ ez) 4) In ROC(receiver-operating characteristic)curve, when the cutoff point was 0.2, maximum sensitivity was 75% and maximum specificity was 82%. CONCLUSION: In ARF, prognostic risk factors for mortality were age over 60 years, hypotension, assisted ventilation and coma. The logit score by multiple analysis is a reliable predictor of mortality in ARF patients, however the further studies are required to confirm these results.
Acute Kidney Injury* ; APACHE ; Coma ; Creatinine ; Dacarbazine ; Female ; Hemorrhage ; Humans ; Hypotension ; Male ; Mortality* ; Multivariate Analysis ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors* ; Sensitivity and Specificity ; Survivors ; Ventilation

No abstract available.
Polycystic Kidney Diseases* ; Tuberous Sclerosis*

No abstract available.
Lymphadenitis*

Monitoring fetal movement serves as an indirect rneasure of fetal well-being, especially for central nervous system integrity and function. Methods to monitor fetal movement vary from the simple approach of having the mother chart perceived movement to highly specialized methods. However there were no reliable objective monitoring methods in Korea. For development of objective method for evaluating fetal movement, during pregnancy, one-hundred and two pregnant patients were entered to this study. All patients were divided into following 3 groups and each type of monitoring methods were applied. Group 1(N=20): Type I using portable FHR Doppler unit(IFD-100 model, Intermed, Korea). Group 2(N=20): Type II using FHR Microphone(Prenatal Listening Kit, Model FS002, Unisar Inc., US). Group 3(N=62): Type III using conventional ultrasound transducer(Corometric 115 Model, US). In this study, accurate counting of the fetal movementutus were best performed using Type III, because of monitoring fetal movements has its greatest efficiency when using conventional ultrasound transducer of fetal monitor. It was also attractive to doctors and nurses as a convenient methods because it needed only single transducer when compared to Type I and II. Although monitoring fetal body movement permits a general assessment of well-being, no perfect technique is still reliable. Futher techniques would be developed using the results of this study for improvement of several factors such as accuracy and objectiveness
Central Nervous System ; Fetal Monitoring ; Fetal Movement* ; Humans ; Korea ; Mothers ; Pregnancy* ; Transducers ; Ultrasonography

Preeclampsia is defined as the development of hypertension with proteinuria, edema induced by pregnancy after 20th week of gestation. Eclampsia implies the occurrence of convulsions unrelated to any coexisting neurologic disease in a preeclamptic. The leading cause of maternal death in preeclampsia-eclampsia is intracranial hemorrhage. Other causes of morbidity include congestive heart failure with pulmonary edema, pulmonary aspiration of gastric contents, disseminated intravascular coagulation, acute renal failure, and septic shock. We experienced a case of death from intracranial hemorrhage in eclamptic patient undergoing cesarean section.
Acute Kidney Injury ; Cesarean Section* ; Disseminated Intravascular Coagulation ; Eclampsia ; Edema ; Female ; Heart Failure ; Humans ; Hypertension ; Intracranial Hemorrhages* ; Maternal Death ; Pre-Eclampsia ; Pregnancy ; Proteinuria ; Pulmonary Edema ; Seizures ; Shock, Septic

So-called, the double channel pylorus has been, relatively rarely, reported through out the world. All reported cases were almostly those of gastroduodenal fistula as a complication of peptic ulcer disease. The congenital forms of double pylorus were reported even more rarely. We found three cases of double channel pylorus in 25,000 cases endoscopy done at our unit. All those three cases were thought to be acqired form endoscopically, radiographically and histologically. One of those was undergone to operative resection because of uncontrollable bleeding and the others were on medical theraphy with satisfaction.
Endoscopy ; Fistula ; Hemorrhage ; Peptic Ulcer ; Pylorus*

This clinical trial was undertaken on 32 infants and chhildren who had G-I symptoms caused by a few diseases, such as meningitis, parenteral infection and intestinal infection. Out of 32 patients, six had vomiting only, caused by meingitis and habitual vomiting, eighteen had vomiting and diarrhea both which caused by parenteral infection and rest of them (8) had diarrhea only, caused by intestinal infection. Polybutine syrup, which 5.0 ml contain 24 mg of trimebutine, was given to these patients as follows; 2.5 ml twice a day at 6 months of age, 5.0 ml twice a day at 6 months to one year and 10 ml three times a day at 1-5 years of age. In ten of 24 patients, who had vomiting only (6), vomiting and diarrhea (18), the symptoms were improved within 48 hours, and rest of them (10) was also shown the improvement of their symptoms within 5 days after medication. In comparison of polybutine treated group and not treated group, the effectiveness of polybutine treatment for the symptoms was statistically meaningful.
Diarrhea ; Humans ; Infant ; Meningitis ; Trimebutine ; Vomiting

BACKGROUND: Electroconvulsive therapy (ECT) can produce dangerous complications, such as arrhythmias, transient hypertension, and increases in intraocular pressure. This study was designed to whether propofol, in comparision with thiopental, would attenuate these hypertensive responses and increases in intraocular pressure. METHODS: Twenty patients were studied during courses of ECT administrations, each patient receiving propofol or thiopental on different occasions. The induction dose was 1.6 mg/kg of propofol and 3 mg/kg of thiopental sodium. Mean arterial pressure, heart rate, cardiac rhythm and intraocular pressure were checked before induction (control), after administration of succinylcholine, immediately, 5 min, and 10 min after ECT administration. Recovery time was also compared between two groups. RESULTS: Mean arterial pressure was lower following propofol than thiopental (p<0.05) immediately after ECT. Heart rate was lower following propofol than thiopental (p<0.05) immediately, 5 min, and 10 min after ECT. Cardiac rhythm abnormalities were infrequent and not serious. Intraocular pressure was lower following propofol than thiopental (p<0.05) immediately, 5 min, and 10 min after ECT. Recovery time of propofol (6.5+/-0.8 min) was shorter than thiopental (7.5+/-0.9 min). CONCLUSIONS: Propofol for ECT induction would seem to be an ideal drug, as it attenuates hypertensive responses and increases in intraocular pressure.
Anesthesia ; Anesthetics ; Arrhythmias, Cardiac ; Arterial Pressure ; Electroconvulsive Therapy* ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intraocular Pressure* ; Propofol* ; Succinylcholine ; Thiopental*

No abstract available.
Female ; Fetal Heart* ; Hearing* ; Heart Rate, Fetal* ; Pregnancy ; Pregnancy*

BACKGROUND: It has long been suggested that neutrophils and their products are implicated as the central mediators of the acute lung injuries. Contrary to the dominant role of neutrophils in ARDS, many cases of ARDS has occurred in the setting of severe neutropenia without pufrnonary neutrophil infiltration. Therefore it is certain that effector cell(s) other than neutrophil play an important role in the pathogenesis of ARDS. This experiment was performed to define the mechanism of ARDS in the setting of neutiopenia, 1) by comparing the severity of endotoxin-induced lung injury, 2) by measurement of hydrogen peroxide production and cytokine concentration in the bronchoalveolar lavage cells and fluids obtained from different rats with and without cyclophosphamide-pretreatment. METHOD: The male Sprague-Dawleys were divided into the normal control (NC)-, endotoxin (ETX)-, and cyclophosphamide (CPA)-group in which neutropenia was induced by injecting cyclophosphamide intraperitoneally. Acute lung injury was evoked by injecting lipopolysaccharide (LPS) into a tail vein. The bronchoalveolar lavage (BAL) was performed at 3 and 6 hour after administration of LPS to measure the change of cell counts and concentrations of protein and cytokines, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). Hydrogen peroxide (HPO) production from BAL cel]s was measured at 6 hour after LPS administration by phenol red microassay with and without zymosan stimulation. RESULTS: The results were as follows. A change of leukocyte counts in the peripheral blood after treatment with CPA More than 95% of total leukocytes and neutrophils were reduced after CPA administration, resulting in severe neutropenia. A change of BAL cells In the ETX-group, the number of total cells (p<0.01) and of macrophage and neutrophll (p<0.05) were increased at 3 and 6 hour after LPS administration compared to those of NC- group. In the CPA-group, the number of total leukocyte and macrophage were not changed after LPS administration, but neutrophil counts were significantly reduced and jt took part in less than 0.1% of total BAL cells (p<0.01 vs NC-group). BAL cells in this group were almost all macrophages (99.7%). A change of protein concentration in the BALF In the ETX-group, protein concentration was increased at 3 hour and was more increased at 6 hour after LPS administration (p<0.05 and <0.01 vs NC-group, respectively). In the CPA-group, it was also significantly elevated at 3 hour after LPS administration (p<0.05 vs NC-group) , but the value was statistically not different from that of ETh-group. The value measured at 6 hour after LPS administration in the CPA-group became lower than that of ETX-group (p<0.05), but showed still a higher value compared to that of NC-group (p<0.05). A change of cytokine concentration in the BALF TNF-alpha and IL-6 were elevated in the ETX- and CPA-group compared to those of NC-group at both time intervals. There was no statistical difference in the values of both cytokines between the ETX- and CPA-groups. Measurement of hydrogen peroxide production from BAL cells There was no intergroup difference of HPO production from resting cells. HPO production after incubation with opsonized zymosan was significantly elevated in all groups. The percent increment of HPO production was highest in the ETX-group (89.0%, p<0.0008 vs NC-group ), and was 42.85 in the CPA-group (p = 0.003 vs NC-group ). Conclusion Acute lung injury in the setting of neutropenia might be caused by functional activation of resident alveola r macrophages.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Cell Count ; Cyclophosphamide ; Cytokines ; Humans ; Hydrogen Peroxide ; Interleukin-6 ; Leukocyte Count ; Leukocytes ; Lung Injury ; Macrophages* ; Male ; Neutropenia ; Neutrophil Infiltration ; Neutrophils ; Phenolsulfonphthalein ; Rats* ; Tumor Necrosis Factor-alpha ; Veins ; Zymosan