No Abstract available.
Infection Control*

Fungi* ; Hypersensitivity*

No abstract available.
Vibrio vulnificus* ; Vibrio*

No abstract available.
Vibrio vulnificus* ; Vibrio*

Immunosuppressive therapy based on the use of antilymphocyte globulin (ALG) has become standard therapy for patients with splastic anemia who are not eligible for bone marrow transplantation. In this study, T cell subsets before and after ALG therapy, hematologic responses, complications and prognostic factors were analysed. Eleven (42%) out of twenty-six patients treated with ALG showed response, but two patients showed relapse. Most of the response (9 cases) was noticed within 6 months after the initiation of ALG therapy (median: 3 months). The main complications of ALG therapy were fever (91%), thrombocytopenia (86%), neutropenia (63%), and serum sickness (56%). Four patients were died just ALG therapy because of serum sickness (2 cases), intracranial hemorrhage (1 case), and shock (1 case). Short interval from diagnosis to treatment suggested to show good response (P=0.0575), but it was not significant statistically. Lymphocyte subsets were measured in the blood of 23 patients. Helper T/suppressor T cell ratio (T4/T8 ratio) at the initiation of ALG therapy (day 0) was higher significantly in patients who were responded (P=0.0299). The patients who showed above 1.0 of T4/T8 ratio on day 0 might be speculated good response (P=0.032). More difference of T4/T8 ratio between day 14 after ALG therapy and day 0 might show good response (P=0.0673). Then the actuarial probability of survival at 3 years in patients treated with ALG was 77%. Our data suggest that ALG therapy may be used as an alternative treatment to bone marrow transplantation, and T4/T8 ration of peripheral blood at the initiation of therapy may be used as one of the prognostic factors.
Anemia ; Anemia, Aplastic* ; Antilymphocyte Serum* ; Bone Marrow Transplantation ; Child* ; Diagnosis ; Fever ; Humans ; Intracranial Hemorrhages ; Lymphocyte Subsets ; Neutropenia ; Recurrence ; Serum Sickness ; Shock ; T-Lymphocyte Subsets ; Thrombocytopenia

Vibrio vulnificus infection is one of the most fatal diseases in Korea. This study was undertaken to determine the cellular fatty acid (CFA) compositions of ninety-five clinical strains of V. vulnificus isolated from Korea during 1985-1995. We compared these results with the CFA profile of V. vulnificus in the Microbial Identification System (MIS) (CLIN library version 3.9; Microbial ID Inc., Newark, Del.), and also evaluated the MIS ability to identify V. vulnificus. Subgrouping of V. vulnificus by CFA analysis was performed and its results were compared with those of serotyping. Most of the CFAs in V. vulnificus strains were similar to the CFA profile of V. vulnificus in the MIS, but some distinctive differences were observed. First, means of two major CFAs, 16:0 and 16:1w7c, were 22.16% and 18.26% in this study, but 23.52% and 25.44% in the MIS respectively. Second, all isolates had 11:Oiso3OH, which was not present in the MIS. Eighty-five strains (89.5%) disclosed the first choice identification of V. vulnificus by the MIS, but only two strains (2.1%) were identified with SI values of 0.6. Remaining ten strains (10.5%) showed 'NO MATCH' results. Cluster analysis of CFA could separate V. vulnificus into nine subgroups, and predominant subgroups were subgroup VII (45 strains) and V (36 strains). There was heterogeny between subgroups by CFA and serotypes of V. vulnificus. The strains of 04 serotype which accounted for 80% (76/95) of the isolates were distributed into six different subgroups such as VII (40 strains), V (27 strains), III (4 strains), I (2 strains) and VI (1 strain). These showed that V. vulnificus strains isolated from Korea had different characteristics in the CFA composition in comparison with the MIS V. vulnificus library. Subgrouping by the CFA analysis might be a useful tool for the epidemiological study of V. vulnificus infection in Korea.
Korea* ; Serotyping ; Vibrio vulnificus* ; Vibrio*

No abstract available.
Respiratory Insufficiency* ; Ventilators, Mechanical* ; Weaning*

The birth of conjoined twins remains an extremely rare event. Most of such twins are stillborn and one third of the live births die within first day of life. In Korea, there are only three reports on the anesthesia for separation of different kinds of conjoined twins. In view of anesthesia for separation of such twins prematurity, low birth weight, and anomalous shared organ play the major role on the perioperative morbidity and mortality. Such anesthesia therefore is one of the exceedingly complex fields among the pediatric anesthesia and require mobilization of all possible methods and monitoring devices used for pediatric anesthesia. We performed careful preoperative evaluation of extent of joining, discussion and rehearsal of separation procedure between separation team, and anesthetic care such as all possible monitoring, preservation of body temperature, appropriate fluid therapy, awake intubation, avoid neuromuscular blockers, and thorough separation of duty. The separated twins showed normal weight gain postoperatively and discharged postoperative 31th day without any complications.
Anesthesia* ; Body Temperature ; Fluid Therapy ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Intubation ; Korea ; Live Birth ; Mortality ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Parturition ; Twins, Conjoined ; Weight Gain

BACKGROUNDS: This study was investigated for assessing of the sedative dose of midazolam and its influence on neonatal Apgar score that intravenously injected immediately before operation during epidural anesthesia for cesarean section. METHODS: Midazolam, 1 mg, was given into a freely running IV line every 30s 2 min after 2 mg of midazolam was initiately injected. Ten seconds prior to each injection patients were asked to open the eye. No response, as determined by the anesthesiologists, to three promptly repeated and increasingly louder commands was considered the end-point for the study and no further midazolam was given. RESULTS: The sedative dose of midazolam in our study was 3.3 1.1 mg and interindividual variation (range: 2~7 mg) were wide. Respiratory depression was occurred in one of pregnant women with midazolam. All of the Apgar scores of the newborn infants at 1 and 5 min in both groups were higher than seven. CONCLUSIONS: When the intravenous injection of midazolam for sedation immediately before operation is required in pregnant women during epidural anesthesia for cesarean section, we would like to suggest that one should initiately administer the small dose and then inject the incremental dose with careful observation of the respiratory status.
Anesthesia, Epidural* ; Apgar Score ; Cesarean Section* ; Female ; Humans ; Infant, Newborn ; Injections, Intravenous ; Midazolam* ; Pregnancy ; Pregnant Women* ; Respiratory Insufficiency ; Running

The incidence of airway difficulty in the general surgical population varies greatly depending on the degree of airway difficulty. Much of the anesthesia related morbidity attributable to managing a difficult airway comes from an interurruption of gas exchange (hypoxia and hypercarbia) which may cause cardiovascular instability and brain damage. Most airway catastrophes ocurrs when possible difficulty with the airway was not recognized. Although fiberoptic intubation is reliable method in patients with difficult airways, there are many cases of difficulty in visualizing the structure of the larynx with conventional fiberoptic technique due to copious secretion, swelling and hemorrhage in the pharyngeal cavity. Recently, we experienced a success in difficult tracheal intubation with LMA in the 27 year old male patient diagnosed ankylosing spondylitis. We hope that using a #4 LMA as a conduit for 6.0 mm cuffed endotracheal tube with the aid of fiberscope attached to the video camera system would be an alternative method for difficult intubation.
Adult ; Anesthesia ; Anesthesia, General* ; Blood Pressure* ; Brain ; Clonidine* ; Epinephrine ; Heart Rate* ; Heart* ; Hemodynamics ; Hemorrhage ; Hope ; Humans ; Incidence ; Intubation* ; Larynx ; Male ; Norepinephrine ; Plasma* ; Skin ; Spondylitis, Ankylosing ; Succinylcholine ; Thiopental