BACKGROUND: Fentanyl, which is a potent synthetic micron-opioid receptor agonist, is one of the most widely used opioids in anesthesia and pain control. However, the pharmacodynamics of fentanyl show wide inter-individual variability. Therefore, this study was conducted to evaluate the influence of the blood-brain barrier transporter protein, p-glycoprotein, and micron-opioid receptor genetic polymorphism on fentanyl pharmacodynamics. METHODS: Seventy-nine patients who underwent posterior lumbar interbody fusion (PLIF) were included in this study. Postoperatively, the patients received fentanyl via an intravenous patient controlled analgesia device. The cumulative fentanyl doses and other pharmacodynamic data were then recorded at 2 h, 6 h, 12 h, 24 h and 48 h after the operation. In addition, genomic DNA was isolated from the patient's peripheral leukocytes and then evaluated for the presence of OPRM1 A118G and ABCB1 C3435T genetic polymorphism using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The results of this study indicated that ABCB1 C3435T genetic polymorphism may be related to the cumulative fentanyl requirement for postoperative pain control. However, these findings were not statistically significant (P = 0.09). In addition, no relationship was observed between OPRM1 A118G and the cumulative postoperative fentanyl requirement. However, the cumulative postoperative fentanyl requirement was lower in the TTAA group (ABCB1 3435 TT, OPRM1 118 AA) than in the CCGG group (ABCB13435 CC, OPRM1 118 GG). CONCLUSIONS: The ABCB1 C3435T polymorphism may affect fentanyl pharmacodynamics. However, further studies are required to confirm the relationship between p-glycoprotein and fentanyl.
Analgesia, Patient-Controlled ; Analgesics, Opioid ; Anesthesia ; Blood-Brain Barrier ; DNA ; Fentanyl ; Humans ; Leukocytes ; P-Glycoprotein ; Pain, Postoperative ; Pharmacogenetics ; Polymorphism, Genetic

PURPOSE: We studied the incidence and clinical course of BCG lymphadenitis to investigate the BCG related problem. SUBJECT AND METHODS: Three hundred and eighty-six infants received BCG vaccine (Pasteur-1173p2) in the Well Baby Clinic, Dept. of Pediatrics, Chonnam University Hospital from May 1993 and April 1994. Among them, twenty three infants developed regional lymphadenitis. We investigated the clinical course in twenty six infants with BCG lymphadenitis (three infants were transferred from the Public Health Center and they also had taken same BCG preparations). According to the lymph node size, we divided them into three groups (A : below 1cm, 5 infants; B : 1 to 2cm, 10; C : above 2cm, 11), and evaluated the clinical outcome. RESULTS: 1) The incidence of BCG lymphadenitis was 6.0% (23/386), the differences according to sex or age at vaccination were not observed. 2) Twenty three of twenty six infants (88.5%) showed one lymph node (left axillary 19 infants, left cervical 3 infants, left supraclaviclar 1 infant), but three (11.5%) showed multiple lymph node involvement. 3) Eight (30.8%) showed spontaneous improvement, but eighteen (69.2%) received single or double antituberculous medication at the beginning or after a period of observation. Two infants were treated by incision and drainage. CONCLUSIONS: The incidence of BCG lymphadenitis was relatively higher (6.0%) than previous reports, and the two thirds of the cases received antituberculous medication and or surgical treatment. Further prospective study according to the recent recommendation by the Korean Health Administration should be needed.
BCG Vaccine ; Drainage ; Humans ; Incidence ; Infant ; Jeollanam-do ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases ; Mycobacterium bovis* ; Pediatrics ; Public Health ; Vaccination

Papillary and solid epithelial neoplasm is a rare pancreatic tumor of low-grade malignancy. We report a case of a 23 year old female having solid and papillary neoplasm of the pancreatic tail with mutiple omental and peritoneal metastases. Microscopically, the main tumor showed typical histologic findings including solid and papillary areas with cystic change. But the metastasizing nodules were largely solid and the tumor cells demonstrated increased nuclear pleomorphism, hyperchromasia and an increased mitotic rate. The tumor cells contained considerable amount of intracellular and extracellular eosinophilic inclusions which were ultrastructually zymogen-like granules. These inclusions were more frequently found in the metastatic nodules. By flow cytometric study, the tumor was hyperdiploid. The DNA index was not significant.
Female ; Humans ; Neoplasm Metastasis

No abstract available.
Beckwith-Wiedemann Syndrome*

PURPOSE: It is known that single umbilical artery is frequently associated with gastrointestinal or urogenital anomaly, however, routine renal sonography has been debated in healthy neonate with isolated single umbilical artery. This study is designed to determine the usefulness of routine renal sonography in apparently healthy infants with an isolated single umbilical artery. METHODS: Thirty healthy neonates with a single umbilical artery without a major anomaly from January 1995 to July 2002 were enrolled. The authors investigated the clinical background of babies and their mothers after renal sonography after 72 hours of age. When the abnormalities were found at the first renal sonography, the severity of hydronephrosis and degree of obstruction and renal function were analyzed by follow up renal sonography, voiding cystourethrography(VCUG) and technetium-99m-dimercaptosuccinic acid(DMSA) scan or technetium-99m-mercaptoacetyl-triglycerine (MAG3) scan. RESULTS: Among the 30 healthy patients with isolated single umbilical artery, five patients(16.7%) showed abnormalities on first renal sonography with one major(3.3%) and four(13.4%) minor renal anomaly(minimal or mild hydroneohrosis). One major renal anomaly(severe hydronephrosis) showed severe decreased renal function on MAG3 scan without reflux, and the other four minor regressed spontaneously on follow up study. CONCLUSION: The value of routine early renal sonograpy for detecting renal anomaly in healthy infants with an isolated single umbilical artery remained unclear because most of the anomalies would regress spontaneously in the follow up study.
Follow-Up Studies ; Humans ; Hydronephrosis ; Infant* ; Infant, Newborn ; Mass Screening* ; Mothers ; Single Umbilical Artery*

BACKGROUND/AIMS: Entecavir is a synthetic nucleoside analogue, cyclopentyl guanine nucleoside, which has a potent antiviral effect and the least viral breakthrough in hepatitis B virus (HBV) replication. Entecavir has been available in Korea since 2007 but there are few reports on its effects. The aim of this study was to evaluate the virological response (VR) and biochemical response (BR) to entecavir in HBV patients at 3, 6 and 9 months after treatment with entecavir. MATERIALS AND METHODS: Thirty-three chronic hepatitis B patients who took entecavir for at least 9 months were enrolled. We investigated VR and BR by retrospectively reviewing medical records. Patients who satisfied the following criteria were chosen: 1) initial alanine aminotransferase (ALT) levels = 1.5upper limit of normal (ULN) and 2) initial HBV DNA levels = 5 log10 copies/ml. We measured ALT levels every 3 months until month 9. HBV DNA was measured every 2 or 3 months by polymerase chain reaction (PCR) method. RESULTS: Most patients taking entecavir showed good BR (ALT < 40 IU/L). The BR rates were 61%, 73% and 67% at months 3, 6 and 9, respectively. VR (HBV DNA < 5 log(10) copies/ml or 2 log lower than initial HBV DNA) rates were 82%, 91% and 91% at months 3, 6 and 9, respectively. Undetectable HBV DNA (HBV DNA < 4 log(10) copies/ml) rates were 49%, 73% and 85% at months 3, 6 and 9, respectively. Two patients presented with virological breakthrough without adverse effects until month 9. CONCLUSIONS: Entecavir showed good BR and VR from month 3 and these effects continued through the 9-month observation period. This suggests that entecavir is also a good choice for the first line treatment of chronic hepatitis B (CHB). Further studies are needed to determine the long-term efficacy and drug resistance of entecavir in Korean CHB patients.
Alanine Transaminase ; DNA ; Drug Resistance ; Guanine ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Korea ; Medical Records ; Polymerase Chain Reaction ; Retrospective Studies

One of the central components of periodontal therapy is the improvement of esthetics. The presence and appearance of interdental papillae plays an important role of periodontal esthetics. The aim of the present study was to investigate how immediate provisional restoration preserve the shape of interdental papilla around the extraction socket and the width of bucco-lingual of gingiva. Another aim was to investigate the change in the interdental papilla and the amount of vertical bone fill of a extraction socket in relation to the interdental alveolar bone levels adjacent the alveolar socket. A total of 19 patients (11 male, 8 female, mean age of 50.57+/-8.16), who visited the Department of Periodontology, Pusan National University and had more than one anterior tooth scheduled to be extracted due to an advanced periodontal disease were included in the present study. After initial periodontal therapy, the extracted teeth were reshaped of the root and placed into the socket followed by splinting with adjacent teeth with self-curing resin. The width of bucco-lingual of gingiva and interdental papilla height were measured at baseline, 1, 3, 6, 9 and 12 month and the periapical radiographic examination were taken at baseline, 6 and 12month following the extraction. The amount of vertical bone fill in the extraction socket were calculated. At 12 months following the extraction, the changes in mesial and distal interdental papilla and the width of bucco-lingual showed -1.06+/-0.48mm, -0.84+/-0.50mm, -1.50+/-0.96mm, relatively. The positional change in the interproximal papillae was significantly associated with the interdental bone level adjacent to the extraction socket(p=0.028). The higher the interproximal bone level adjacent the extraction socket, the greater the amount of bone fill in the extraction socket(p<0.001). In conclusion, it was thought that immediate provisional restoration could minimize the loss of the width of bucco-lingual and interproximal papillae around the extraction socket. In addition, the higher the interproximal bone level adjacent the extraction socket, the greater the amount of bone fill and the smaller the reduction of papillary height around the extraction socket.
Busan ; Esthetics ; Female ; Gingiva ; Humans ; Male ; Periodontal Diseases ; Splints ; Tooth

Eosinophilic gastroenteritis (EGE) is known to have a low incidence among the pediatric population, but it can result in serious complications, such as gastric outlet obstruction. In previously published EGE cases with the obstruction in adults, surgeries were often performed. In this report, we present a 14-year-old girl who came to our facility with severe abdominal pain and vomiting. On the initial abdominal physical examination, diffuse tenderness and severe epigastric pain were noted. Computed tomography scan of the abdomen showed the findings of superior mesenteric artery (SMA) syndrome. However, she had no history of recent weight loss, and the medical history was inconsistent with SMA syndrome. We planned upper gastrointestinal series with barium, and then verified gastric outlet obstruction. We performed esophagogastroduodenoscopy and obtained a final diagnosis of EGE through mucosal biopsy specimen. Corticosteroids and anti-inflammatory medications were administered. Dietary modification and education were done as well. The symptoms resolved, and the follow-up esophagogastroduodenoscopy and ultrasonography showed improvements in the obstruction. Our case emphasizes that gastric outlet obstruction due to EGE must be carefully differentiated from SMA syndrome because of their similarities in clinical features and radiologic images. In doing so, we can avoid surgical intervention and perform medical/dietary treatment for gastric outlet obstruction.

PURPOSE: Nursing workplace spirituality (NWS) has received attention as a new and meaningful subject for nursing to consider, but little is known about the relation of NWS to nursing. The purpose of this study was to identify the effect of NWS on job satisfaction, burnout and turnover intention. METHODS: Participants were 145 clinical nurses, who had worked for over 6 months in one of four general hospitals in B city. Data were collected using self-reported questionnaires and analyzed using descriptive statistics, independent t-test, ANOVA, Pearson coefficient and hierarchical multiple regression. RESULTS: In the second hierarchy controlling general characteristics, significant predictors of job satisfaction were burnout and NWS, which explained 45.0% of the variance. NWS had more influence on job satisfaction than burn out, and the model was suitable. NWS showed no statistically significant effect on burnout and turnover intention, when general characteristics and job related factors were controlled. CONCLUSION: Findings indicate that nursing workplace spirituality has a positive influence on job satisfaction, but no direct influence on burnout or turnover intention, which may indicate an indirect influence. Nurse managers need to develop the NWS enhancement program and provide them to nurse to improve job satisfaction.
Burns ; Hospitals, General ; Humans ; Intention ; Job Satisfaction ; Nurse Administrators ; Nursing ; Spirituality