Adenosine deaminase(ADA) is an enzyme capable of catalysing the pathway from adenosine to inosine. Previous studies have shown that this enzyme may be useful in recognition of a tubeculous etiology of pleural, peritoneal, or meningeal effusions. ADA activity was studied in 42 patients with large amount of pericardial effusion. Patients were subdivided into the following four group : (A) 15 cases of tuberculous effusions : (B) 4 with pyogenic effusions : (C) 15 with idiopathic effusions : (D) 9 with malignant effusions. The results were as follows ; 1) The mean ADA activities assessed in pericardial effusions were 134.0+/-77.6U/L in group A : 93.8+/-43.8 in group B : 38.3+/-23.2 in group C : 27.3+/-20.8 in group D. Comparing the level achieved in group A with all others, the difference is significant at the P<0.001 level. 2) The mean ADA activities assessed in sera were 50.7+/-57.2 U/L in group A : 63.5+/-24.1 in group B : 25.9+/-12.0 in group C : 14.0+/-7.5 in group D. Comparing the level achieved in group A with all others, there is no significant difference. 3) Specificity(0.87) and sensitivity(0.93) of the test for the differential diagnosis of patients with tuberculous effusion from those with idiopathic effusion is high, when a value of more than 50 U/L is considered. In conclusion, the assessment of ADA in pericardial effusions is of great value in the diagnosis of tuberculous pericarditis.
Adenosine Deaminase* ; Adenosine* ; Diagnosis ; Diagnosis, Differential ; Humans ; Inosine ; Pericardial Effusion* ; Pericarditis, Tuberculous

Since the introduction of percutaneous mitral valvotomy(PMV) in 1984, PMV was an effecive alternative to surgical commissurotomy in selected patients with severe mitral stenosis. Also PMV was an excellent palliative strategy in such patients who were high risk for operative management or longterm anticoagulation was not feasible. We performed PMV in a patient with very tight mitral stenosis and severe pulmonary hypertension under the general anesthesia because the patient was anticipated to be uncooperative due to mental problem, who was diagnosed as schizophrenia 16 years ago. Robinol was used for premedication and i.v fentanyl was used for maintenance of anesthesia. Inoue balloon was introduced into the LV and gradual ballooning was performed with favorable results. Total anesthesia time and interval from internal jugular vein puncture to the completion of valvuloplasty were 1 hour 45 min and 40 minutes respectively. Hemodynamic variables were improved immediately after intervention and mitral valve area was increased from 0.5cm2 to 1.3cm2.
Anesthesia ; Anesthesia, General* ; Fentanyl ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Jugular Veins ; Mitral Valve ; Mitral Valve Stenosis* ; Premedication ; Punctures ; Schizophrenia*

Percutaneous balloon mitral valvuloplasty(PMV) was comparable to surgical commissurotomy in initial and long term follow-up results in selected patients with symptomatic severe mitral stenosis. Transseptal puncture was necessary for antegrade introduction of balloon. In patient with kyphoscoliosis, PMV was relatively contraindicatied due to difficulty and risk of septal puncture. We performed the PMV in a patient with kyphoscoliosis and severe mitral stenosis. The patient was presented with NYHA class III. Echocardiographic evaluation revealed mitral valve area of 0.8cm2 and mean diastolic pressure gradient of 12mmHg. X-ray film of T-L spine showed severe kyphoscoliosis. Transseptal puncture was possible with modification of angle of Brockenbrough needle at the site of 15cm from the needle tip. After transseptal puncture, Inoue balloon was introduced into the LV and gradual ballooning was performed with optimal results. Hemodynamic variable were improved immediately after intervention and mitral valve area was increased from 0.7cm2 to 1.8cm2. Patient was discharged with NYHA class I.
Blood Pressure ; Echocardiography ; Follow-Up Studies ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Needles ; Punctures ; Spine ; X-Ray Film

BACKGROUND: Irbersatan, an orally active antihypertensive agent, effectively reduce blood pressure by directly blocking angiotensin II receptors without any significant adverse effects. The purpose of this study is to evaluate the efficacy and safety of irbesartan in patients with mild to moderate hypertension. METHODS: This study enrolled 83 patients who had diastolic pressure above 95 mmHg and below 110 mmHg on two measurements. Sixty eight patients were administered 150mg of irbesartan, an angiotensin II receptor blocker, daily for four weeks as an initial dosage. If the sitting diastolic pressure was equal to or greater than 90 mmHg after a 4 week treatment period, the dosage was doubled until the end of 8 weeks. Baseline pressures, antihypertensive effect, side effects, laboratory findings were compared before and after treatment. RESULTS: Fourty two patients out of 53 patients having completed this study showed decreased blood pressure equal to or more than 5 mmHg of the sitting diastolic pressure (response rate=79%). Twenty one patients out of 53 patients showed normalized blood pressure below 90 mmHg of the sitting diastolic pressure (normalization rate=40%). The extent of decrease in diastolic and systolic blood pressure after eight week treatment was an average 11.7+/-10.1 mmHg and 16.3+/-18.9 mmHg, respectively (p<0.05). Nineteen ontoward side effects was observed in 17 patients out of 68 patients with medication (frequency of ontoward effects=25%). Only one case with headache was considered to be related to the medication. Abnormal laboratory findings were observed in eight patients, and only one case with elevation of bilirubin and ALT levels was considered to be related to the medication. CONCLUSION: In conclusion, irbesartan is a safe and effective antihypertensive drug in patients with mild to moderate hypertension with tolerable side effects.
Bilirubin ; Blood Pressure ; Headache ; Humans ; Hypertension* ; Receptors, Angiotensin

Total intravenous anesthesia(TIVA) is desirable technique for a number of reasons. The first is that it implies all the components of general anesthesia : hypnosis, amnesia, analgesia, and muscle relaxation by combination of several drugs and the lungs are ventilated with oxygen-enriched air. A combination of fentanyl-propofol were used as TIVA for laryngomicrosurgery (LMS) with high frequency jet ventilation(HFJV). 41 patients were studied. Glycopyrrolate was given 1 hour before anesthetic induction. Propofol 2 mg/kg was intravenously administered 1 minute after fentanyl 1.5 ug/kg intravenously injection for induction. Endotracheal intubation was performed after succinylcholine administration with internal diameter 4.0-6.0 mm LASER tube through oral cavity or 8 fr. polyethylene catheter through nasal airway. After then, HFJV was started with frequency 108-120 cycles/minute and driving pressure 2.0-2.5 kg/cm(2). The adequacy of ventilation was evaluated with arterial blood gas analysis. For maintenance a continuous propafol infusion of 10 mg/kg/hour was used for the first 10 minutes, followed by 8 mg/kg/hour for the next 10 minutes and 6 mg/kg/hour, thereafter. Continuous dripping of succinylcholine was used for muscle relaxation. The patients showed relatively stable hemodynamic status during procedure (Fig. 1). Two recovery times were as followed: the interval from cessation of infusion until opening eyes on command(4.90+/-3.41 min), and that until correct response to simple question (5.50+/-3.49 min). There was a correlation between total amount of propofol given to patients and recovery times(P<0.05)(Table 1). Interestingly. a group of patients weighed over 70 kg showed carbon dioxide retension on arterial blood gas analysis(Fig. 2). In conclusion, fentanyl-propofol cobination with muscle relaxant is proper regimen for TIVA in LMS with HFJV. More stable and better recovery are the main reasons. However, carbon dioxide retension should be consider to the patients weighed over 70 kg with the HFJV.
Amnesia ; Analgesia ; Anesthesia, General ; Anesthesia, Intravenous* ; Blood Gas Analysis ; Carbon Dioxide ; Catheters ; Fentanyl ; Glycopyrrolate ; Hemodynamics ; High-Frequency Jet Ventilation* ; Humans ; Hypnosis ; Intubation, Intratracheal ; Lung ; Mouth ; Muscle Relaxation ; Polyethylene ; Propofol ; Succinylcholine ; Ventilation

BACKGROUND: Tracheal extubation can be performed while patients are deeply anesthetized or when they are awake. Each technique has its own advantages and disadvantages. But necessity for deep extubating conditions, and what level of anesthesia is adequately deep, is still controversial. Clinical conditions of patients or the preference of the anesthesiologist has dictated the choice of extubation technique. METHOD: Anesthesia was induced and maintained as usual manners. The 49 healthy children between 3 and 12 year of age undergoing tonsillectomy and adenoidectomy were randomly assigned to group 1(extubation at 1 MAC of enflurane) and group 2(awake extubation). SpO2 and airway-related complications(cough, breath-holding, airway obstruction, and laryngospasm) were observed for 5 minutes after extubation with 100% O2 by mask, and SpO2 and heart rate were measured for 90 seconds during transportation to the recovery room with room air breathing. RESULTS: The total incidence of airway-related complications in group 2 were higher than in group 1. However, group 1 showed severer complications than in group 2 such as airway obstruction and laryngospasm. There was no differences between the two groups in SpO2 and heart rate changes with 100% O2 mask just after extubation and during transportation. Group 1 showed higher SpO2 than group 2 upon arrival in the recovery room. CONCLUSION: We concluded that in healthy children undergoing elective oral surgery, airway-related complications are likely to be influenced more by the skill, experience and preference of the anesthesiologist than by the method alone.
Adenoidectomy ; Airway Extubation ; Airway Obstruction ; Anesthesia ; Child* ; Heart Rate ; Humans ; Incidence ; Laryngismus ; Masks ; Recovery Room ; Respiration ; Surgery, Oral ; Tonsillectomy ; Transportation

Bacterial infection and smoking are an important risk factors involved in the development and progression of periodontitis. However, the signaling mechanism underlying the host immune response is not fully understood in periodontal lesions. In this study, we determined the expression of janus kinase (JAK)/signal transducer and activator of transcription (STAT) on Porphyromonas gingivalis lipopolysaccharide (LPS)- and nicotine-induced cytotoxicity and the production of inflammatory mediators, using osteoblasts. The cells were cultured with 5 mM nicotine in the presence of 1 µg/ml LPS. Cell viability was determined using MTT assay. The role of JAK on inflammatory mediator expression and production, and the regulatory mechanisms involved were assessed via enzyme-linked immunosorbent assay, reverse transcription-polymerase chain reaction, and Western blot analysis. LPS- and nicotine synergistically induced the production of cyclooxgenase-2 (COX-2) and prostaglandin E₂ (PGE₂) and increased the protein expression of JAK/STAT. Treatment with an JAK inhibitor blocked the production of COX-2 and PGE₂ as well as the expression of pro-inflammatory cytokines, such as tumor necrosis factor-α, interleukin-1β (IL-1β), and IL-6 in LPS- and nicotine-stimulated osteoblasts. These results suggest that JAK/STAT is closely related to the LPS- and nicotine-induced inflammatory effects and is likely to regulate the immune response in periodontal disease associated with dental plaque and smoking.
Bacterial Infections ; Blotting, Western ; Cell Survival ; Cytokines ; Dental Plaque ; Enzyme-Linked Immunosorbent Assay ; Inflammation* ; Interleukin-6 ; Necrosis ; Nicotine ; Osteoblasts* ; Periodontal Diseases ; Periodontitis ; Phosphotransferases ; Porphyromonas gingivalis* ; Porphyromonas* ; Risk Factors ; Smoke ; Smoking ; Transducers

This study's aim was to investigate their opinions to improve the educational system for dental hygienists on the basis of their duties as dental hygienists. The qualitative study was conducted among 19 dental hygienists at Daejeon, Korea from July to August 2016. Two researchers followed each subject for working hours in a day and recorded all the tasks and time to take for each task. After one day, the researchers met each subject and conducted face-to-face interviews to investigate the opinions about the dental hygiene curriculum and national board examination. The main duties recognized by more than half of the subjects were oral disease prevention including scaling and dental treatment assistance. The subjects' minority opinion about the main duties included radiography, impression taking, dental implant surgery assistance, orthodontic treatment, patient counseling, dental management and staff management, and oral health education. The most important tasks perceived by the subjects were prosthetic and implant impressions, scaling and implant surgery assistance. The subjects' minority opinion about the most important duties included patient counseling and making temporary crowns. The most difficult tasks answered by the subjects were prosthetic and implant impressions and dental implant surgery assistance. The subjects' minority opinion about it included patient counseling, scaling, and making temporary crowns. They mentioned that their curriculum in college was different from the actual work and the national board examination was not reflective of their real duties. We found out Korean dental hygienists had a lot of roles as dental assistants, dental business managers, and so on. We suggest that the law, curriculum and national board examination for dental hygienists should be revised to be able to reflect the reality of the clinical field.
Commerce ; Counseling ; Crowns ; Curriculum ; Dental Assistants ; Dental Hygienists* ; Dental Implants ; Education* ; Humans ; Jurisprudence ; Korea ; Licensure ; Oral Health ; Oral Hygiene* ; Radiography

Not infrequently, we meet urgent situations that emergency cardiac pacing is inevitable. Paricularly, in patients with impending brady-asystole cardiac arrest, we cannot but introduce pacing cartheter without fluroscopic guidance in emergency department if transcutaneous pacing is not available. There is little report about emergency transvenous cardiac pacing without fluoroscopic guidance in patients with impending cardiac arrest in korea. We report our experiences of temporary transvenous pacing by blind approach performed in patients with impending bradyasystolic cardiac arrest in emergency department. Among 10 patients who blind pacing were performed. 7 were successfully paced and 3 were not. 5 of 7 patients with successful pacing died of underlying diseases. 2 patients wiere alive. A hematoma around the puncture site was developed in a patient receiving thrombolytic therapy. We concluded that temporary transvenous pacing withoup fluoroscopy should be tried in the emergency situations if fluoroscopy or transcutaneous pacemaker is not avialable.
Emergencies* ; Emergency Service, Hospital ; Fluoroscopy* ; Heart Arrest* ; Hematoma ; Humans ; Korea ; Punctures ; Thrombolytic Therapy

BACKGROUND: In korea, significant proportion of victims with out-of-hospital cardiac arrest have no change to survive because some physicians regard the victim with cardiac arrest outside the hospital as the dead and they do not attempt cardiopulmonary resuscitation(CPR). And we cannot expect bystander-initiated CPR and emergency medical system in resuscitating the victims with cardiac arrest. We studies the outcome of resuscitation attempts and the factor associated with survival in patients with out-of-hospital cardiac arrest in current situation of emegency medical system. Method: We attempted cardiopulmonary resuscitation(by standard guidelines) in 74 consecutive victims with non-traumatic out-of-hospital cardiac arrest in emergency department. RESULTS: Of 74 victims with cardiac arrest 35(47%) had no any restoration of spotaneous circulation(ROSC), 26(35%) had transient ROSC but died within 24 hours,6(8%) survived over 24 hours but died in the hospital, and 7(10%) discharged alive. Factors associated with survival were cardiac origin as a cause of cardiac arrest, ventricular fibrillation as a initial ECG rhythm, and short circulatory arrest time. CONCLUSION: Survival rate of victims with non-traumatic out-of-hospital cardiac arrest was 10%. Considering the feasibility to survive, CPR should be attempted in patients with out-of-hospital cardiac arrest if do-no-resusciate(DNR) is not indicated.
Cardiopulmonary Resuscitation ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Korea ; Out-of-Hospital Cardiac Arrest* ; Resuscitation* ; Survival Rate ; Ventricular Fibrillation