The need for a short-acting non-depolarizing neuromuscular blocking agent to replace succinylcholine chloride(succinylcholine) is recognized widely and attempts to find such a drug have been numerous. Atracurium besylate(atracurium) is one of the new series of neuromuscular blocking agents with little cardiovascular effect and is not dependent on hepatic and renal function for terminating its action because of its self-destroying mechanism. Because succinylchline may occasionally be contraindieated for intubation in parturients we studied the use of atracurium in 23 patients having cesarean section. All patients received 0. 5 mg/kg atracurium for intubation and neuromuscular relaxation. Hemodynamic changes, the time from the injection of atracurium to maximal twitch suppression, the time between atracurium administration and the return to 10% of control twitch height were recorded and observed the degree of vocal cord relaxation and conditions of intubation and evaluated the Apgar scores. 1) Mean arterial pressure and heart rate increased significantly after intubation compared with that of control and just before intubation but there were no significant changes in 5 minutes after intubation. 2) The 90% twitch suppression following atracurium administration was 75.6+/-20.9 seconds. 3) The return of 10% of control twitch height was 2449.3+/-1114.0 seconds. 4) Intubation conditions were excellent for 19 patients. 5) The Apgar scores of 20 neonates were high. These data suggest that the use of atracurium may be a useful alternative for induction for Cesarean section when succinylcholine is contraindicated.
Arterial Pressure ; Atracurium* ; Cesarean Section* ; Female ; Heart Rate ; Hemodynamics ; Humans ; Infant, Newborn ; Intubation ; Intubation, Intratracheal* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pregnancy ; Relaxation ; Succinylcholine ; Vocal Cords

BACKGROUND: There is pressure difference depending on the height of hand position when blood pressure is taken, applying the oscillometric electronic digital BP(blood pressure) monitor. Authors have calculated the degree of BP differences, and evaluated the accuracy and effectiveness of the digital BP monitor comparing with the conventional Mercury Sphygmomanometer. METHOD: Randomized sixty cases consisting of in-patients and hospital workers were subjected for this study. BPs were taken at three different levels-nose level, heart level and knee level-on conventional sitting position applying OMRON Digital Automatic Blood Pressure Monitor and conventional Mercury Sphygmomanometer, and statistical analysis was made. RESULTS: At the nose level, systolic BP and diastolic BP were lower with 23.5mmHg and 18.9mmHg respectively, than at the heart level, while at the knee level, they were higher with 21mmHg and 17.5mmHg respectively, than at the heart level. No actual statistical difference of systolic and diastolic values between OMRON Digital Automatic Blood Pressure Monitoring method at the heart level and conventional Mercury Sphygmomanometeric method. CONCLUSION: Present study demonstrated significant discrepancy of BP values, in systolic and diastolic values, depending on the height of measured finger, when OMRON Digital Automatic Blood Pressure Monitor is applied in taking BP on conventional sitting position. However, no actual discrepancy of BP values was noted between two methods when BP is taken at heart level by OMRON Digital Automatic Blood Pressure Monitor and on brachial artery BP by conventional Mercury Sphygmomanometer. Thus OMRON Digital Automatic Blood Pressure Monitor could take the place of Mercury Sphygmomanometer in taking peripheral BP, which subsequently enable us to estimate central artery BP, which is believed to be better clinical index, through this much more handy electrical oscillometric device in the future.
Arteries ; Blood Pressure ; Blood Pressure Monitors ; Brachial Artery ; Electric Impedance ; Fingers ; Hand* ; Heart ; Hydrostatic Pressure ; Knee ; Nose ; Sphygmomanometers*

PURPOSE: This study was to identify behaviors preventing the recurrence of breast cancer and the level of quality of life. METHODS: This descriptive study was conducted using a structured questionnaire from November 1, 2006 to December 25, 2006 . One hundred and twenty two women breast cancer survivors were recruited by convenience sampling. RESULTS: The most frequent behavior for preventing recurrence of the breast cancer was dietary treatment (90.9%) and exercise (86.8%) was the second behavior. In addition, most of them perceived these behaviors as 'very effective' (82.8%). The degree of the quality of life of a breast cancer survivor was 5.34 point indicating a 'medium level'. CONCLUSION: Breast cancer survivors pursued various behaviors for preventing recurrence of breast cancer. Therefore, the nursing interventions should be focused on a systematic educational approach considering healthy behaviors to prevent breast cancer recurrence for breast cancer survivors.
Adaptation, Psychological ; Adult ; Aged ; Breast Neoplasms/prevention & control/*psychology/therapy ; Data Interpretation, Statistical ; Demography ; Dietary Supplements ; Exercise Therapy ; Female ; *Health Behavior ; Humans ; Life Style ; Middle Aged ; Neoplasm Recurrence, Local/*prevention & control ; *Quality of Life ; Questionnaires ; Recurrence ; Survivors/*psychology

PURPOSE: To report a rare case of an angioleiomyoma involving the orbit. CASE SUMMARY: A 32-year-old male visited our clinic with pain and decreased visual acuity in the left eye, which had developed 1 month prior to admission. Best corrected visual acuity of the left eye had decreased to 0.7, and 3 mm of proptosis was observed. A 1x1 cm sized soft orbital mass was palpated on the lateral area of the left lower eyelid. Funduscopic examination of the left eye revealed multiple horizontal choroidal folds. On magnetic resonance imaging, a well-demarcated tumor was identified that showed hypointense signal intensity on a T1-weighted scan and hyperintense signal intensity on a T2-weighted scan. We performed anterior orbitotomy with an inferior conjunctival forniceal incision. The tumor was well encapsulated and easily dissected and could be completely removed. Histopathologic examination showed many vascular elements and intervascular fibrous stromas composed of spindle cells. The tumor was classified as angioleiomyoma. CONCLUSIONS: Angioleiomyoma should be considered in the differential diagnosis of a well-circumscribed mass lesion involving the orbit.
Adult ; Angiomyoma ; Choroid ; Diagnosis, Differential ; Exophthalmos ; Eye ; Eyelids ; Humans ; Magnetic Resonance Imaging ; Male ; Orbit ; Visual Acuity

BACKGROUND: The human papillomavirus (HPV) is the most common etiologic factor of cervical cancer. It was reported that the incidence of cervical intraepithelial neoplasia and cervical carcinoma was increased when normal women was infected with HPV. To date, for detection and classification of HPV, it were used by hybridization method using the DNA probe specific for HPV and in situ hybridization method for fixed paraffinized tissue, but reported that these methods were inadequate for detection of HPV DNA because of low sensitivity and complex procedure. Compared with these methods, polymerase chain reaction (PCR) was reported as a highly sensitive molecular biologic technique which could detect the HPV DNA in the cervical epithelial cell of women. Thus we used PCR for the investigation of detection rate of HPV 16 and 18, and its relationship with Pap smear class in normal women. METHODS: In 86 normal women, we had extracted the HPV DNA from cervical swab samples and then detected the presence of HPV DNA by nested PCR. RESULTS: In the cases of 86 normal women, the detection rate for HPV DNA was about 7.0%. In the cases of 26 women with Pap smear class I, the HPV DNA was not detected. And in the cases of 60 women with Pap smear class II, the detection rate for HPV DNA was about 10.0%; HPV subtype 16 about 6.7%; HPV subtype 18 about 1.7%; and the coinfection rate of HPV subtype 16 and 18 about 1.7%. CONCLUSIONS: We think that women who was previously infected with high-risk HPV should be examined for Pap smear test in regular time interval, and if the result of Pap smear was abnormal, then should be examined for the presence of the HPV DNA.
Cervical Intraepithelial Neoplasia ; Classification ; Coinfection ; DNA ; Epithelial Cells ; Female ; Human papillomavirus 16 ; Humans* ; In Situ Hybridization ; Incidence ; Papillomavirus Infections* ; Paraffin ; Polymerase Chain Reaction* ; Uterine Cervical Neoplasms

PURPOSE: To describe a series of patients with lower eyelid epiblepharon associated with lower eyelid retraction. METHODS: We retrospectively reviewed the medical records of patients who underwent surgery for lower eyelid retraction, epiblepharon, or thyroid-associated ophthalmopathy (TAO) between October 1999 and March 2007. Patients with both lower eyelid retraction and epiblepharon on preoperative examination were included in this study. RESULTS: Twenty-seven eyelids of 20 patients with both lower eyelid retraction and epiblepharon were enrolled. The underlying causes of lower eyelid retraction included congenital retraction (seven eyelids), congenital fibrosis of the extraocular muscles (CFEOM; seven eyelids), TAO (seven eyelids), post-operative cicatricial retraction (five eyelids), and facial nerve palsy (one eyelid). Eight of 27 eyelids were successfully corrected after the repair of retraction without the repair of epiblepharon, regardless of the cause of lower eyelid retraction. Another four eyelids with epiblepharon associated with TAO resolved after only orbital decompression. Cilia-everting sutures were additionally applied for epiblepharon in another 14 eyelids, 12 of which did not require the excision of a skin fold or the orbicularis muscles. Only one eyelid with mild retraction and epiblepharon underwent simple epiblepharon repair. Recurrence of retraction or epiblepharon developed in three eyelids during follow-up. CONCLUSIONS: In cases with both lower eyelid retraction and epiblepharon, the retraction should be repaired first, and then the epiblepharon can be corrected selectively according to the severity of the case.
Adolescent ; Adult ; Child ; Child, Preschool ; Eye Abnormalities/*complications/surgery ; Eyelid Diseases/*complications/surgery ; Eyelids/*abnormalities/surgery ; Graves Ophthalmopathy/surgery ; Humans ; Middle Aged ; Ophthalmologic Surgical Procedures/*methods ; Retrospective Studies ; Young Adult

PURPOSE: Hemodialysis remains the most important support for patients with end stage renal disease, and vascular access is an essential component for their life. Since 1966, internal arteriovenous fistula (AVF) has been used widely today. If vessels were not available for AVF, the alternative would be used such as prosthetic graft. But in 1997, the National Kidney Foundation-Dialysis Outcome and Quality Initiative (DOQI) recommended increased use of native arteriovenous fistula to improve overall patency and curtail angioaccess costs. This retrospective study is to review our experience and to evaluate the overall patency rate and the influencing factors on the patency of the AVF. METHOD: From March 1995 through October 2000, 111 fistulas were created of 111 patients in Eulji university hospital. Among them, 106 cases were able to follow up survey. The statistical analysis used by SPSS package. RESULT: The male versus female ratio was 1.22:1 and the age distribution was occurred on from 3rd decade to 9th decade. the common causes of renal failure was hypertension, glomerulonephritis and diabetes (62.1%). the autogenous graft fistulas were performed in 101 cases (wrist/antecubital fossa. 101/3), Goretex graft fistula were 7 cases. The early graft failures were 12 cases (11.4%) and the causes was thrombosis or stricture, and immaturation, psudoaneurysm, venous hypertension in order of frequency. At 12, 24, 36 months, the assisted patency rates of AVF were 80.4, 76.5, 71.3%, respectively. CONCLUSION: We could get higher patency rate of AVF due to liberal use of native veins and aggressive intervention of the failing AVF as recommendation of DOQI.
Age Distribution ; Arteriovenous Fistula* ; Constriction, Pathologic ; Female ; Fistula ; Follow-Up Studies ; Glomerulonephritis ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Male ; Polytetrafluoroethylene ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Thrombosis ; Transplants ; Veins

PURPOSE: To report a rare case of conjunctival myxoma. CASE SUMMARY: A 40-year-old man presented with a nasal bulbar conjunctival mass in his left eye. The mass was a 12 mmx7 mm pinkish movable mass in the subconjunctival space. There was no pain and no tenderness. We diagnosed the case as lymphoma, and we performed excisional biopsy of the mass. Histopathologic examination revealed the tumor to be a myxoma. CONCLUSIONS: When a patient presents with a pinkish, less vessel-appearing, non-pigmented and movable mass of the conjunctiva, conjunctival myxoma should be considered as a possible diagnosis.
Adult ; Biopsy ; Conjunctiva ; Eye ; Humans ; Lymphoma ; Myxoma

PURPOSE: We wanted to predict the high risk group that requires urgent airway intervention by using the parameters of the soft-tissue lateral neck radiographs of adult acute epiglottitis patients. METHODS: This retrospective study was conducted in two teaching hospitals. The patients who were diagnosed with acute epiglottitis from June, 2007 to May, 2009 were enrolled and their medical records and x-ray films were reviewed. The width of the epiglottis at the widest point (EW), the width of the arytenoid at the widest point (AW), the prevertebral soft tissue distance at the third cervical spine (PSTD), the shortest distance from the epiglottis to the hypopharyngeal wall (EHD) and the shortest distance from the epiglottic root to the arytenoids'tip (EAD) were investigated and we performed regression analyses of these parameters of the patients in the high risk group that required urgent airway intervention. RESULTS: A total of 42 patients were enrolled. Dyspnea and hoarseness were more frequent in the high risk group that required urgent airway intervention (p=0.008, 0.040, respectively). The EW was significantly longer (p=0.001) in the high risk group. The EHD and EAD were significantly shorter (p=0.012, <0.001, respectively) in the high risk group. Only the EAD showed significant correlation with the percent of airway patency on linear regression analysis (p=0.003) and the EAD was the only significant predictor for the high risk group on multivariate logistic regression analysis (p=0.043). The receiver operating characteristics curve of the EW/EAD for the high risk group was obtained and it showed the best predictive power (AUC: 0.977, p<0.001). CONCLUSION: The EAD noted on soft-tissue lateral neck radiography is an important predictor of high risk patients who require urgent airway intervention. The cut-off value of the EW/EAD for the predicting the high risk group is 2.44 (sensitivity 100%, specificity 85.7%).
Adult ; Airway Obstruction ; Dyspnea ; Epiglottis ; Epiglottitis ; Hoarseness ; Hospitals, Teaching ; Humans ; Linear Models ; Logistic Models ; Medical Records ; Neck ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Spine ; X-Ray Film

Low glycemic index (GI) foods have been reported to be very important in the control of blood glucose levels in diseases such as diabetes mellitus and obesity, which are becoming more prevalent in Korea. Bread consumption at breakfast and as a snack is also on the rise. To provide low GI alternatives, breads supplemented with dietary fibersfructooligosaccharide (FOS), ground whole rye, and 2 types of resistance starch (RS2 and RS4)-were developed. The GIs for these breads were evaluated with 13 healthy college students (M6, F7) and sensory tests were done. Four kinds of breads were made through the modification of a basic recipe for white bread (the control, B) as follows: for Bf, the entire amount of sugar was replaced with FOS. For Ryef, 50% of the white wheat flower was replaced with roughly ground wholerye (20 mesh: 12-20 mesh = 1 : 3) in addition to replacing sugar with FOS. For RS2f and RS4f, 20% of the white wheat flower was replaced with RS2 or RS4, in addition to replacing sugar with FOS. The overall preference score of Bf was similar to that of B, while those of Ryef, RS2f and RS4f were lower than that of B, but showed the acceptable degree of the overall preference. The glycemic indices of Ryef and RS2f were 46.1 and 45.9 respectively, which were significantly lower than the GI of B, 67.8. The GIs of Bf and RS4f were, however, 66.7 and 80.5 respectively, showing no significant difference compared to B. The glycemic loads for a 30 g serving were 9.5, 5.9, 6.2, 11.0 and 9.0 for B, Bf, Ryef, RS2f and RS4f, respectively. In conclusion, addition of RS2 or roughly ground whole rye to the dough formula significantly lowered the GI. Since the preferences shown for those two breads were acceptable, they may be recommended as a substitute for white bread for persons who need blood glucose management. More studies on the bread making process are required to improve preference and acceptance. Although GI lowering effects for F and RS4 were not found in this study, further studies are needed to verify their effects.
Blood Glucose ; Bread* ; Breakfast ; Edible Grain* ; Diabetes Mellitus ; Flowers ; Glycemic Index* ; Humans ; Korea ; Obesity ; Secale* ; Snacks ; Starch* ; Triticum