No abstract available.

The isolation arm test at upper limb for the study of muscle relaxants sensitivity of human muscle is described. In the healthy adults, succinylcholine 100ug/kg or vecuronium 5~6ug/kg combined with 20ml saline is given intravenously at various sites of injection while the circulation to the arm is occluded with upper arm pneumatic tournique. After injection of muscle relaxants, neuromuscular transmission is then studied by TOF stimulation to ulnar nerve with EMG monitor(ABM, Dates) and changes of twitch response in evoked muscle action potential amplitude from hypothenar muscle are recorded. In the results, twitch height is depressed weakly and slowly but incompletely after muscle relaxant is injected intravenously at cubital fossa, and declines further depression following recovery after the release of upper arm tourniquet occiuded systemic circulation(two stage response). There are not any changes of twitch response while muscle relaxants are given intravenously between upper arm and forearm pneumatic tourniquet. But twitch height is depressed rapidely and completely after muscle relaxants are given intravenously at doris hand under the upper arm or forearm pneumatic tourniquet. Conclusively, twitch response under the isolation arm test is influenced from the site of injection, and in order to obtain the correct assessment of neuromuscular blockade, muscle relaxants will be given intravenously at dorsi hand with forearm pneumatic tourniquet.
Action Potentials ; Adult ; Arm* ; Depression ; Forearm ; Hand ; Humans ; Neuromuscular Blockade ; Succinylcholine ; Tourniquets ; Ulnar Nerve ; Upper Extremity ; Vecuronium Bromide

This technique in the conscious volunteers to study the neuromuscular blockade was described in which two different muscle relaxants of ED95X10(-1) in 20ml 0.9% saline were injected simultaneously into one arm and the contralateral arm below the occlusion site of circulation with tourniquet, and then two different neuromuscular blockades were compared following tourniquet released after 80% twitch depression. The benefits of this technique were obtained as following; 1) Simplicity, saving and safety from easily to set up and using low dose of muscle relaxant. 2) Expected results from pure effects of muscle relaxant without any drug interactions. 3) Time shortening of experimental study. 4) Saving time and experiments from simultaneously comparison of control with study group in one experiment. 5) The study of pure receptor binding with muscle relaxant, since a presumed plasma concentration of muscle relaxants is near or actually zero after release of the tourniquet when fresh blood had flushed the limb. Conclusively bilateral isolated forearm technique is elegant method to study the biophase binding interacted of relaxants and cholinerceptor.
Arm ; Depression ; Drug Interactions ; Extremities ; Forearm* ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents ; Plasma ; Tourniquets ; Volunteers

No abstract available.
Arteriovenous Fistula* ; Laminectomy*

BACKGROUND: Although amphotericin B (AMB) has a wide spectrum of activity that encompasses the majority of yeast isolates, there have been recent reports suggesting that some yeast isolates exhibit decreased susceptibility to AMB. However, in vitro AMB susceptibility of yeast species isolates from blood cultures in Korea has not been fully surveyed. METHODS: A total of 92 bloodstream yeast isolates from four Korean hospitals, representing 10 Candida species (69 isolates) and 4 non-Candida yeast species (23 isolates) were evaluated. AMB minimum inhibitory concentrations (MICs) were determined by two methods: the CLSI method and Etest. AMB minimum fungicidal concentrations (MFCs) were also determined. RESULTS: For all 92 yeast isolates, the CLSI method generated a restricted range of MICs (0.125 to 4 microgram/mL) with 3.3% exhibiting MICs > or =2 microgram/mL, and the corresponding MFC values ranged from 0.25 to 8 microgram/mL with 26.1% showing MFCs > or =2 microgram/mL. Etest produced the widest distribution of MICs, ranging from 0.03 to 32 microgram/mL. High AMB MICs (> or =0.38 microgram/mL) by Etest was observed in 34.8% of the isolates: Candida krusei (100%), Candida rugosa (100%), Trichosporon asashii (100%), Candida glabrata (82%), and Yarrowia lipolytica (75%). Etest disclosed that all isolates of Candida guilliermondii, Candida lusitaniae, Candida pelliculosa and Kodamaea ohmeri were highly susceptible to AMB (MIC < or =0.19 microgram/mL). CONCLUSIONS: Our study showed that Etest may be more useful to discriminate yeast isolates with reduced susceptibility to AMB, and some isolates of less common yeast species from Korea may have decreased AMB susceptibilities.
Amphotericin B/*pharmacology ; Antifungal Agents/*pharmacology ; Candida/drug effects/isolation & purification ; Candidiasis/microbiology ; Culture Media ; Humans ; Korea ; Microbial Sensitivity Tests ; Reagent Kits, Diagnostic ; Yeasts/*drug effects/isolation & purification

Surfactant replacement therapy in neonates with respiratory distress syndrome (RDS) has been introduced in our country since May 1990. The purpose of this study was to assess the effect and short-term outcome of surfactant replacement for neonatal RDS using collective data of uncontrolled trials from different hospitals in Korea. For the period May 1990 to Dec. 1991, a total of 68 RDS neonates were treated with a reconstituted bovine surfactant (Surfactant-TA) at 17 hospitals. Data on 60 neonates were collected from 16 hospitals and were analyzed in this study. In order to examine the factors that might influence the mortality, we performed a stepwise discriminant analysis. RDS was diagnosed according to accepted clinical and radiographic criteria at each hospital. The mean gestational age of 60 neonates was 31+/-3 weeks (1 SD, range, 24~40 wk) and the mean birth weight was 1549+/-566 grams (range, 590~3300 gm). Surfactant treatment resulted in a significant improvement in ventilatory requirement during the subsequent clinical course. However, there were large variations in the instillation procedure (single vs repeated instillations), dose of surfactant, and respirator settings after surfactant treatment. The neonatal mortality was 40% in this group. When the effect of surfactant treatment was compared between survival and death group, the magnitude of improvement was significantly less in death group than that in survival group. Factors affecting the neonatal mortality include a poor response to surfactant, sepsis and/or DIC, decreasing gestational age and weight, acidosis before treatment and air-leaks. We conclude that treatment with Surfactant-TA has an impact on the clinical course of RDS. To optimize the effects of surfactant therapy, the following refinement will be needed: better initial stabilization with respect to blood pressure, blood gases and pH, instillation techniquse including pre-and post-surfactant ventilation, weaning guidelines, dose, dose schedule, as well as timing of treatment, management of infection, and prevention of severe birth asphyxia.
Acidosis ; Appointments and Schedules ; Asphyxia ; Birth Weight ; Blood Pressure ; Dacarbazine ; Gases ; Gestational Age ; Humans ; Hydrogen-Ion Concentration ; Infant ; Infant Mortality ; Infant, Newborn* ; Korea ; Mortality ; Parturition ; Sepsis ; Ventilation ; Ventilators, Mechanical ; Weaning

Autoimmune hepatitis in children is a rare and severe inflammatory disease of unknown etiology, and progress to cirrohosis and liver failure, generally is responsive to immunosuppressive therapy. It is more prevalent in women than men, and characterized by the presence of circulating autoantibodies, a high serum globulin. Extrahepatic manifestations such as thyroiditis, ulcerative colitis, glomerulonephritis and autoimmune hemolytic anemia, are associated. We report, to our knowledge, the first case of autoimmune hepatitis in conjunction with choledochal cyst and pancreatitis in 11-year-old female patient. At the time of diagnosis, she suffered from acute upper abdominal pain, jaundice, and pallor. Laboratory findings showed Cooms positive hemolytic anemia, hypergammaglobulinemia, hyperbilirubinemia, and high serum transaminases. Antinuclear antibody was of homogeneous type. In liver biopsy, cellular infiltrates largely lymphocytes were noted. Treatment with corticosteroids induced clinical, biochemical remission, but subsequent withdrawal leaded to relapse. Incidentally choledochal cyst were found and then acute pancreatitis developed. After management for acute pancreatitis, surgical resection of cyst with hepatojejunostomy was performed.
Abdominal Pain ; Adrenal Cortex Hormones ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune ; Antibodies, Antinuclear ; Autoantibodies ; Biopsy ; Child ; Choledochal Cyst* ; Colitis, Ulcerative ; Diagnosis ; Female ; Glomerulonephritis ; Hepatitis, Autoimmune* ; Humans ; Hyperbilirubinemia ; Hypergammaglobulinemia ; Jaundice ; Liver ; Liver Failure ; Lymphocytes ; Male ; Pallor ; Pancreatitis* ; Recurrence ; Thyroid Gland ; Thyroiditis ; Transaminases

Eosinophilia is usually accompanied by parasite infestation, allergic condition, drug, collagen disease, and idiopathic hypereosinophilic syndrome. In about 10 to 40% of rheumatoid arthritis patients, peripheral blood reveals eosinophilia. Of the rheumatic disease, eosinophilia may occur in rheumatoid arthritis, sarcoidosis, polyarteritis nodosa and other vascultis. Patient with eosinophilia must be carefully followed up due to possibility of progression to eosinophilic leukemia or myeloproliferatire disease. We experienced a case of rheumatoid arthritis with severe eosinophilia for a period of more than one year in a 53 year-old female patient, eosinophil more than 85% in the peripheral blood, but in spite of careful laboratory study, there was no evidence of parasite infestation, allergic disease and malignant condition that may cause eosinophilia. Therefore we concluded that her severe eosinophilia was associated with rheumatoid arthritis itself, and now she is intensively followed up at the outpatient department. We have to look for any malignant transformation during her clinical course. Marked eosinophilia associated with rheumatoid arthritis is very rare, so we report this case with a review of literatures.
Arthritis, Rheumatoid* ; Collagen Diseases ; Eosinophilia* ; Eosinophils ; Female ; Humans ; Hypereosinophilic Syndrome ; Middle Aged ; Outpatients ; Parasites ; Polyarteritis Nodosa ; Rheumatic Diseases ; Sarcoidosis

No abstract available.
Chorea ; Creutzfeldt-Jakob Syndrome

Cyclosporine (CsA) has been one of the main immunosuppressants after kidney transplantation since its introduction in Korea. There was remarkable improvement of graft survival in kidney transplantation with CsA, compared with azathioprine. Cipol-N(R)(Chong Kun Dang, Korea), microemulsion gelatin capsule formulation of CsA, is a new generic drug. This pure domestic brand of CsA was tested for bioequivalence in healthy adults compared with the reference drug of the same formulation, Sandimmun-Neoral(R)(Novartis, Switzerland) in 1997. This open-label, multi-center study is designed to evaluate the efficacy of Cipol-N(R) in primary kidney transplant recipients for 6 months after transplantation. A total of 59 patients from 4 medical centers were enrolled in the study. Maintenance immunosuppressive protocol was based on CsA and steroid dual therapy, which was induced 2 days prior to the operation. Acute rejection was diagnosed with clinical or pathological clue. Clinical criteria for the diagnosis of acute rejection were oliguria, graft swelling and tenderness, rising serum creatinine, fever, and papillary swelling and increased vascular resistant index on Doppler ultrasonography. Steroid pulse therapy was used as primary treatment. Steroid resistant acute rejection was treated with anti-lymphocyte agents such as OKT3, ATG, or ALG. The primary efficacy endpoint was onset of acute rejection or treatment failure, defined as graft loss, death, or premature termination from the study for any reason. Incidence and severity of acute rejection, actual survival rate of patient and graft, function of the graft, pharmacokinetics of the Cipol-N(R), and the primary efficacy variables were evaluated 6 months after transplantation. All enrolled patients were included in the primary analyses of efficacy on the basis of intent to treat. Mean age of the patients was 37.1 10.4 years old. Male and female ratio was 42:17. There were 38 related pairs, which included 5 HLA identical and 33 HLA haplo-identical matches, and 21 unrelated pairs. A total of 10 patients were withdrawn from the study before post- transplant 6 months. The causes for premature withdrawal were patient's request without specific reason (6), partially rescued acute rejection (3), and patient's death (1). There were 27 episodes of acute rejection in 25 patients, which were diagnosed clinically (11) and pathologically (16). Steroid pulse therapy and anti-lymphocyte agent were used in 24 and 3 cases respectively. There were 4 patients, who showed partial rescue but no graft loss due to acute rejection. Patient and graft survival was 98.3% at post-transplant 6 months. Serum creatinine concentration showed 1.3-1.7 mg/dl all through the study period, which meant relatively stable graft function. Mean daily doses of Cipol-N(R) at post-transplant 1 and 6 months were 325 and 300 mg respectively. With this short term study, we can report that Cipol-N(R) showed relatively good efficacy in primary living donor kidney transplantation. Further study is needed for the evaluation of long term efficacy and safety.
Adult ; Azathioprine ; Creatinine ; Cyclosporine ; Diagnosis ; Female ; Fever ; Gelatin ; Graft Survival ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation ; Kidney* ; Korea ; Living Donors* ; Male ; Muromonab-CD3 ; Oliguria ; Pharmacokinetics ; Survival Rate ; Therapeutic Equivalency ; Transplantation ; Transplants ; Treatment Failure ; Ultrasonography, Doppler