Control of tuberculosis is threatened by widesread emergence of drug resistant Mycobacterium tuberculosis. Rifampin is a key component among therapeutic regimens for the tuberculosis; therefore patients in whom resistance to this drug develop have a poor outlook, particularly if rifampin resistance is associated with resistance to other tuberculosis drugs. The purpose of this study was to detect the mutation in rpoB gene of rifampin resistant M. tuberculosis in Korea and to evaluate the usefulness of the method in clinical aspects. A sample of 80 M. tuberculosis was studied, and it included 40 rifampin resistance isolates and 40 rifampin sensitive isolates by conventional methods. The detection method involved the amplification by polymerase chain reaction (PCR) of the Rif' region and the identification of mutations by single-strand DNA conformation polymorphism analysis (SSCP) of the amplification products (157 bp). Mutation were identified in 39 of 40 rifampin resistant isolates, and in 1 of 40 rifampin sensitive isolates.
Humans ; Korea ; Mycobacterium tuberculosis* ; Mycobacterium* ; Nucleic Acid Conformation ; Polymerase Chain Reaction* ; Rifampin ; Tuberculosis

Control of tuberculosis is threatened by widespread emergence of drug resistance in Mycobacterium tuberculosis. Understanding the molecular basis of resistance might lead to development of novel rapid methods for diagnosing drug resistance. Rifampin is a key component among therapeutic regimens for the tuberculosis; therefore, patients who have drug resistance do not convalesce satisfactorily. The molecular mechanism of resistance to rifampin in M. tuberulosis has been elucidated. Substitutions of a limited number of highly conserved amino acids encoded by the rpoB gene are responsible for the ""single-step"" high-level resistance of M. tuberculosis to rifampin. Currently, two genotype-based protocols allow drug test from minimally grown cultured materials: (i)mutation identification by direct sequencing of PCR-amplified material. and (ii)mutation screening by PCR-SSCP. The purpose of this study is to evaluate the usefulness of the both methods. A sample of 75 isolates of M. tuberculosis was studied, and it inculded 36 rifampin-resistant strains and 39 rifampin-sensitive strains by conventional methods. Mutaions were identified in 36 rifampin-resistant isolates but in none of 39 sensitive isolates. All mutations were clustered within a region of 23 amino acids. Both methods allow detection of rifampin resistance in 2 to 3 days and will thus help in the early management of infection by M. tuberculosis.
Amino Acids ; Drug Resistance ; Humans ; Mass Screening ; Mycobacterium tuberculosis* ; Mycobacterium* ; Rifampin ; Tuberculosis

Mondor's disease is also called thrombophlebitis and it is not a common condition. The characteristics finding of Mondor's disease is a subcutaneous cord that is tender and tense. This disease commonly occurs in the breast and abdomen. The etiology of Mondor's disease is unknown, but the generally agreed on causes are trauma, excessive exercise and breast surgery. On rare occasions, this disease is related to malignancy, pregnancy, filariasis and so on. This disease is self limiting and it is usually treated conservatively and symptomatically. We treated one woman who had Mondor's disease on the anterior side of the left elbow. This is a very rare location for Mondor's disease and so clinicians need to be aware about the possibility of this unusual presentation for this disease.
Abdomen ; Breast ; Elbow ; Female ; Filariasis ; Humans ; Pregnancy ; Thrombophlebitis ; Transcutaneous Electric Nerve Stimulation

PURPOSE: Conventional laparoscopic appendectomy (LA) is a widely used treatment for appendicitis. Nowadays, single incision laparoscopic appendectomy (SILA) is increasingly used as an alternative treatment for appendicitis. The purpose of this study is to evaluate the clinical significance and differences between LA and SILA. METHODS: A total of 519 patients undergoing LA or SILA between January 2011 and December 2012 were identified in a retrospectively collected database. Patients' characteristics and peri-operative variables were analyzed. RESULTS: LA was performed in 485 patients and SILA was performed in 34 patients. Mean operation time for the LA group was 62.7 minutes (range 23.3~68.1) and that for the SILA group was 62.7 minutes (range 50.9~74.5). This difference of operation time was statistically significant. In the learning curve of SILA, operation time was gradually decreased. No significant differences in hospital stay and peri-operative complications were observed between groups. CONCLUSION: Although operation time for SILA was longer than that for LA, SILA was safe. Therefore, a prospective study should be conducted in order to confirm the possibility of application to most appendicitis patients.
Appendectomy ; Appendicitis ; Humans ; Laparoscopy ; Learning Curve ; Length of Stay ; Retrospective Studies

An intussusception was first reported by Barbette in 1674, but an intussusception of the appendix was first reported in London, in 1858. Of all intussusceptions, 5% occur in adults, and of these 90% are as a result of a primary cause. Therefore, treatment is usually based on the primary cause. An intussusception of the appendix can be treated by barium or air reduction, or by an appendectomy, with manual reduction in pediatrics, but these are very uncommon in adult, and can be treated by various methods, according to the underlying cause. A 74 years old woman was preoperatively diagnosed, by radiological examination, to have an intussusception of the appendix. An exploratory laparotomy was performed, and the lesion confirmed as an intussusception caused by an appendix mass, which was cystic and filled with mucin. Therefore, a right hemicolectomy was performed, with the pathological results confirming a mucinous cystadenocarcinoma of the appendix. Here, we report a case of an adult intussusception of the appendix in a 74 years old woman.
Adult ; Aged ; Appendectomy ; Appendix ; Barium ; Cystadenocarcinoma, Mucinous* ; Female ; Humans ; Intussusception* ; Laparotomy ; Mucins* ; Pediatrics

No abstract available.
Colorectal Neoplasms*

BACKGROUND: Intradermal test is a useful diagnostic method for acute anaphylactoid or anaphylactic reactions induced by anesthetic drugs. We analyzed the responses of intradermal test for anesthetic drugs in patients who did not show anaphylactoid or anaphylactic reactions. METHODS: The authors performed intradermal test for anesthetic drugs (thiopental, midazolam, fentanyl, atracurium and vecuronium) in 224 adult patients one hour before induction of anesthesia. The responses were interpreted as measuring the size of wheal and flare. We also did history taking for past allergic history. RESULTS: There were no patient that showed positive reaction. The rate of false positive reaction for atracurium (12.5%) was significantly higher than other anesthetic drugs (p<0.05). And the rate of false positive reaction for atracurium in patients under the age of 40 (20%) was significantly higher than those above the age of 40 (3.8%) (p<0.05). But the difference of the rate of false positive reaction for atracurium between male (8%) and female (15.3%) was not significant statistically. The differences of the rates of false positive reaction for anesthetic drugs between past allergic history group and no past allergic history group were not statistically significant. CONCLUSIONS: In intradermal test for anesthetic drugs, the rate of false positive reaction for atracurium was significantly higher than thiopental, vecuronium, fentanyl and midazolam. Especially, it was significantly higher in patients under the age of 40. So in performing intradermal test to search for causative anesthetic drug, we have to consider the high rate of false positive reaction for atracurium.
Adult ; Anaphylaxis ; Anesthesia ; Anesthetics* ; Atracurium ; False Positive Reactions ; Female ; Fentanyl ; Humans ; Intradermal Tests* ; Male ; Midazolam ; Thiopental ; Vecuronium Bromide

No abstract available.
Cervix Uteri* ; Female ; Hysterectomy*

Intraspinal morphine anesthesis for open heart surgery was first publicized by Jeon early in 1986. We came to the conclusion that the anesthesia induced by an intraspinal morphine injection was satisfactory in anesthesia practice for open heart surgery and we have called this procedure, "Intraspinal Morphine Anesthesia". However, respiratory depression seemed to be most serious between 12~16hrs, after an intraspinal injection of morphine so that this technique is recommended only in patients who need controlled respiration for more than 12 hours because respiratory arrest occurs more commonly at that time. In other words intraspinal morphine anesthesia is absolutely not recommended in patients for simple operations. This study was undertaken to evaluate the effects of demerol injected in the subarachnoid space and to compare them with the effects of intraspinal morphine anesthesia. This attempt was made to take advantage of the rapid onset and short duration of demerol action for simple and short procedures. We had 32 cases scheduled for open heart surgery but those were all simple cases such as ASD and VSD in which controlled respiration was not expected to be needed. They were anesthetized mainly by intraspinal demerol and intravenous tranquilizers with 100% oxygen throughout the surgery. 1) The dosage of intraspinal demerol which ranged between 1~2 mg/kg did not seem to be proportional to the duration and potency of the drug. 2) Valium was administered intravenously to eliminate intraoperative awareness. Valium was preferred to Activan for simple cases. 3) The main action of demerol seemed to last 3~4 hours and no respiratory problems were observed 4 hours after the injection of demerol. 4) The onset of an anlgesic effect appeared at 5~7 minutes and the respiratory depression or arrest occuresd around10 minutes after the injection. 5) Cardiovascular dynamics appeared stable throughout the surgery except for transient bradycardia with mild hypotension whcih was seem occasionally. 6) Respiratory depression seemed to be no problem in the recovery room and ICU periods. 7)Somnolence lasts around 2~4 hours with no inadvertent resctions. 8) documented complications such as pruritus and voiding difficulty were not problems with the use of demerol for open heart surgery. 9) The aneshtesia induced by intraspinal demerol injection was satisfactory in anesthesia practice for simple cases. Therefore, we have called this procedure "Intraspinal Demerol Anesthesia". However, this technique sometimes is inconvenient in clinical practice because of its short action.
Anesthesia* ; Bradycardia ; Diazepam ; Humans ; Hypotension ; Injections, Spinal ; Intraoperative Awareness ; Meperidine* ; Morphine ; Oxygen ; Pruritus ; Recovery Room ; Respiration ; Respiratory Insufficiency ; Subarachnoid Space ; Thoracic Surgery

Balanced anesthesia is being equilibrated with the maintenance of light planes of anesthesia and the relatively free utilization of muscle relaxants to prevent untoward movement of the patient in response to surgical stimuli. However, muscle relaxants per se do not contributes to the state of hypnosis or analgesia. Therfore, awareness during modern anesthesia must be seriously taken. We have given anesthesia in 175 cases for cesarean section in order to investigate intraoperative awareness. Among the 175 anesthetic cases, 13 cases had awareness of pain and 19 cases had auditor awareness. Accordingly the total incidence of awareness in our investigation was 16% which was significantly high and should be considered in clinical anesthesia practice.
Analgesia ; Anesthesia* ; Balanced Anesthesia ; Cesarean Section* ; Female ; Humans ; Hypnosis ; Incidence ; Intraoperative Awareness ; Pregnancy