Postoperative pain control is one of the main concern for the anesthesiologist. Intermittent narcotic injections caused inadequate pain relief in many patients. Periodic injections could improve analgesia with increased incidence of undesirable side effects including respiratory depression, nausea, vomiting, and urinary retenion. Balanced analgesia may lessen these complications without reducing analgesic effect. I assessed the effect of balanced analgesia using morphine, ketorolac and droperidol. Each 20 gynecological patients were allocated to one of four groups Morphine(initial bolus 2mg followed by 48mg continousi.v. for 2 days) or ketorolac(initial bolus 30mg, follwed by 120mg continousi.v. for 2 days) was continously injected in group 1 and group 2, respectively. In group 3, half doses of morphine and ketorolac in group 1, 2 was used in combinstion. 5mg of droperidol was added to group 3 drugs in group 4. There were no significant changes in blood pressure and heart rate in all groups. Onset time of analgesic effect was faster in morphine containing groups 1, and 4, and the effect was better in all three morphine containing group 1, 3 and 4 than ketorolac group 2. Untoward effects were least in ketorolac group 2. Droperidol could prevent nausea and vomiting, however led to increased incidence of somnolence. It could be concluded that balanced analgesia with morphine, ketorolac and droperidol with fine titration would be better than intravenous morphine or ketorolac alone.
Analgesia* ; Blood Pressure ; Droperidol* ; Heart Rate ; Humans ; Incidence ; Ketorolac* ; Morphine* ; Nausea ; Pain, Postoperative* ; Respiratory Insufficiency ; Vomiting

PURPOSE: This study investigated the influence of patent ductus arteriosus (PDA) and its treatment on incidence and progression of retinopathy of prematurity (ROP). METHODS: The authors retrospectively reviewed the medical records of 408 infants who underwent screening examinations for ROP at the Neonatal Intensive Care Unit of our hospital. RESULTS: The total incidence of ROP was 23.5% (96 out of 408) and the patients that needed treatment were 7.4% (30 out of 408). The mean birth weight and gestational age was 1406.1 grams and 30.67 weeks in patients without ROP, and 979.8 grams and 27.46 weeks in patients with ROP, respectively. In both total and very low birth weight (VLBW) patients, the incidence of ROP was higher in the PDA group than the non-PDA group, but the PDA group was an independent risk factor only in the VLBW group (p = 0.033). The incidence of threshold disease was not significantly different between the PDA and control groups (p = 0.757). There was no significant difference of incidence of ROP and threshold disease among the 3 treatment groups for PDA. CONCLUSIONS: In VLBW patients, the presence of PDA increased the risk of ROP and its progression, thus more attention is needed for PDA patients. However, there was no significant difference in ROP incidence and progression according to different PDA treatment methods.
Birth Weight ; Diterpenes ; Ductus Arteriosus, Patent ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Mass Screening ; Medical Records ; Retinopathy of Prematurity ; Retrospective Studies ; Risk Factors

BACKGROUND: There has been a concern about the incidence of the cutaneous premalignant and malignant tumors. It has increased recently and has varied according to social and environmental influence. OBJECTIVE: The purpose of our study was to clarify the recent trends in cutaneous premalignant and malignant tumors, and to compare them with other reports. METHODS: The 175 cases out of the total number of 34,333 new outpatients were diagnosed cutaneous premalignant and malignant tumors from January, 1990 to December, 2000 at the Department of Dermatology, Yeungnam University Hospital. Incidence and its change, age and sex distribution, and anatomical site were investigated. RESULT: 1. The incidence of cutaneous premalignant and malignant tumors was 0.51%, and increased lately. 2. Among the 175 cases of premalignant and malignant tumors, basal cell carcinoma(30.9%) was the most common, followed by squamous cell carcinoma(22.9%), actinic keratosis(12.6%), Bowen's disease(10.9%). 3. The premalignant lesions were increased and outnumbered squamous cell carcinoma since 1996. 4. Basal cell carcinoma was the most common skin cancer that had markedly increased in comparison with squamous cell carcinoma. 5. Actinic keratosis, Bowen's disease, basal cell carcinoma, squamous cell carcinoma, malignant melanoma on sun exposed areas were much more increased than on non exposed areas. 6. The mean age of patients was 65.3+/-15.0 years, and the age of the majority of cases(94.3%) was over 40 years. 7. The ratio of male to female was 1.01 : 1. The number of females increased relatively in comparison with previous reports. 8. The most common site was the face(55.4%), followed by scalp(12.0%), trunk (12.0%).
Actins ; Bowen's Disease ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Dermatology ; Female ; Humans ; Incidence ; Keratosis, Actinic ; Male ; Melanoma ; Outpatients ; Sex Distribution ; Skin Neoplasms ; Solar System

BACKGROUND: Pontine infarction extending to the basal surface has been reported to possess different characteristics from deep pontine infarction without extending to the basal surface. METHODS AND RESULTS: We studied 54 patients ; 30 patients with pontine infarction extending to the basal surface (group SE) and 24 patients with deep pontine infarction without extension (group DL) based on the site of the infarcts on precontrast sagittal T2WI. We assessed angiographic findings(MRA, 54; DSA, 31), risk factors, clinical features and the effectiveness of the intraluminal signal changes on spin-echo MRI in the diagnosis of occlusion or stenosis of the basilar artery. The incidence of basilar artery stenosis or occlusion in MRA or DSA in group SE(60%) was significantly more frequent than group DL(12.5%), whereas the incidence of vertebral artery stenosis or occlusion was not different between two groups. A noteworthy finding was that five patients (17%) of the group SE had not been extended to the basal surface on axial T2WI. The risk factors were similarly distributed between the two groups. The effectiveness of abnormal signal void of axial MRI was poor in the diagnosis of basilar artery occlusion or stenosis. CONCLUSIONS: Our results suggest that the two types of pontine infarction may be caused by different arterial pathology. Although the presence of abnormal flow void on MRI cannot predict the stenosis or occlusion of basilar artery, sagittal T2WI and angiographic study help to evaluate the patients with pontine infarction.
Basilar Artery* ; Constriction, Pathologic ; Diagnosis ; Humans ; Incidence ; Infarction* ; Magnetic Resonance Imaging ; Pathology ; Risk Factors ; Vertebrobasilar Insufficiency

Tight junction (TJ) is recognized as a second barrier of the skin. Altered expression of TJ proteins in various skin diseases characterized by the abnormal permeability barrier such as psoriasis suggests that TJ could be affected by stratum corneum (SC) barrier status. However, the physiological relationship between SC and TJ barrier remains to be investigated. Therefore, we examined the effect of SC barrier disruption on the expression of TJ proteins, claudin (Cldn)-1 and Cldn-4, and TJ barrier function in hairless mouse skin. We also investigated whether the alterations in epidermal Ca2+ affected TJ proteins expression in vivo. Repeated tape-stripping induced a sequential change of the expression and function of TJ. As early as 15-30 minutes after tape-stripping, downregulation of Cldn-1 and Cldn-4 immunoreactivity and protein level without change in mRNA level was found. This was accompanied by the abnormal leakage of lanthanum. However, by 1 hour Cldn-1 and Cldn-4 immunolocalization recovered along with normalized lanthanum permeation pattern. Moreover, the mRNA and protein levels of Cldn-1 and Cldn-4 were increased by 1 to 6 hours after tape-stripping. Inhibition of calcium loss by immersion of barrier-disrupted skin into a high Ca2+ solution prevented the dislocation of Cldn-1 and Cldn-4. Occlusion of barrier-disrupted skin delayed the restoration of Cldn-1 and Cldn-4. Our results suggest that the alteration of epidermal Ca2+ gradient caused by SC barrier perturbation affects the TJ structure and function and the faster recovery of TJ as compared to the SC barrier may imply the protective homeostatic mechanism of skin barrier.
Animals ; Calcium/*metabolism ; Claudin-1/genetics/*metabolism ; Claudin-4/genetics/*metabolism ; Epidermis/metabolism/*physiology ; Female ; Gene Expression Regulation ; Mice ; Mice, Hairless ; Permeability ; RNA, Messenger/metabolism ; Tight Junctions/metabolism/*physiology

During the recent epidemic period (1995~1996), seven strains of rubella virus were isolated in Korea. To analyze phylogenetic relationship between seven Korean strains and rubella virus strains from other different geographical areas, structural genes (E1, E2 and C) of Korean strains were enzymatically amplified and automatically sequenced. The sequence similarities of the E1, E2 and C genes of the cosmopolitan types were 95.8~98.1%, 92.6~99.2% and 96.4~99.3% based on 1,441, 122 and 139 nucleotides and 96.9~98.5%, 90~100% and 97.8~100% based on 480, 40 and 46 amino acids compared to the sequences of strain RA27/3, respectively. In contrast, the sequence similarities of the E1, E2 and C genes of the Asian types were 91.5~92.1%, 83.6~88.5% and 91.4% based on nucleotides ad 96.9~97.7%, 85.5% and 97.8% based on amino acids compared to the sequences of strain RA27/3. respectively. However, immunodominent epitopes of the E1 gene of the cosmopolitan and Asian types were well conserved, and the growth patterns in cell culture and immunofluorescent antibody titers in cross-reaction test showed no differences between two different types. In phylogenetic analysis based on nucleotide sequences of each gene regions, the comopolitan and Asian types formed tow distinct phylogenetic lineages. These data showed two distinct genotypes of rubella viruses cocirculated in Korea, but no significant differences in the antigenicity of two different rubella virus strains were found.
Amino Acids ; Asian Continental Ancestry Group ; Base Sequence ; Cell Culture Techniques ; Epitopes ; Genotype ; Humans ; Korea ; Nucleotides ; Rubella virus* ; Rubella* ; Sequence Analysis*

Hantaan (HTN) and Seoul (SEO) viruses, murid rodent-borne hantaviruses, are known to causes hemorrhagic fever with renal syndrome (HFRS) in Korea. To determine the genomic diversity and molecular phylogeny of HTN and SEO viruses found in Korea, we amplified for part of M and S genomic segments of hantaviruses from sera of HFRS patients and lung tissues of hantavirus seropositive striped-field mice. Both M and S segment of 16 HTN and 2 SEO viruses were amplified by nested reverse transcripton-polymerase chain reaction. Based on 324 nucleotides in the M genomic segment, the HTN and SEO strains showed 93.8~100% and 99.1~99.4% homologies, respectively. Similarly, based on 230 nucleotides in the S genomic segment, HTN and SEO strains showed 90.9~100% and 100% homologies, respectively. Phylogenetic analysis of M and S segments indicated that HTN strains could be divided into at least two main groups in M and S trees and the sequence differences detected among the S and M genomic segments of HTN viruses are consistent with reassortment having taken place between HTN virus strains.
Animals ; Hantavirus ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Korea ; Lung ; Mice ; Muridae ; Nucleotides ; Phylogeny ; Seoul virus* ; Seoul*

BACKGROUND: Viral myocarditis is considered as a cause of dilated cardiomyopathy. At present, two pathogenic mechanisms may be involved in the pathogenesis of viral myocarditis and subsequent cardiomyopathy. First, the virus infection of myocyte may directly lead to either cell death or persistent metabolic dysfunction. Second, virus-induced immune or autoimmune mechanism may play a role. METHODS: To test the therapeutic efficacy of immunosuppression with cyclophophamide(CYP) on coxsackievirus B3(CB3) myocarditis, 10-14 week-old Balb/c mice were inoculated with 4000 plaque-forming units of CB3. In experiment 1, CYP (100mg/kg/day subcutaneous injection, s.c) was administrated daily on days 1-7(group 2, n=16). In experiment 2, CYP 30mg/kg/day s.c(group 3, n=32) or CYP 100mg/kg/day s.c(group 4, n=32) were administrated on days 8-14. The animals of infected controls(group 1, n=26) and group 2, 3, 4 were dissected at days 4, 7, 15, 22 and spleen, heart, thymus and body weights were measured. RESULTS: In experiment 1. survival rate in group 2 on day 7, 15 were low compared with group 1(85%, 0% vs 100%, p<0.05). and myocardial virus titers in group 2 on day 4 was 50 times, and on day 7, 1000 times higher compared with group 1, Histologically, on day 7, focal cellular infiltrations were prominent findings in group 1, but diffuse myocardial necrosis without cellular infiltration were observed in group 2. In experiment 2, survival rate, cardiac histopathology myocardial virus titer and serum neutralizing antibody titers did not differ among groups 1, 3 and 4. In experiment 1 and 2, the spleen-to-body-weight and thymus-to-body-weight ratios were significantly lower in CYP treated groups than those in controls and marked cellular depletions in spleens and thymus were observed in CYP treated groups. CONCLUSIONS: As the results of above, it can be concluded that the immunosuppression during viremic phase of murine viral myocarditis aggravated the myocardial necrosis, and during aviremic phase, the administration of CYP didnot affect the process of viral myocarditis. Thus, direct viral mechanisms in the production of cardiomyocyte injury in CB3-infected mice appear to bo more important than cell mediated immune mechanism. To understand relevant pathogenic mechanisms of clinical myocarditis and dilated cardiomyopathy resulting from viral infection, the experimental study expanding into nonmurine animals and into various models using other infectious agents may be required.
Animals ; Antibodies, Neutralizing ; Body Weight ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cell Death ; Cyclophosphamide* ; Heart ; Immunosuppression ; Injections, Subcutaneous ; Mice ; Muscle Cells ; Myocarditis* ; Myocytes, Cardiac ; Necrosis ; Spleen ; Survival Rate ; Thymus Gland ; Viral Load

PURPOSE: We analyzed the clinical and radiologic results after arthroscopic reconstruction of the posterior cruciate ligament and posterolateral rotatory instability using fresh frozen Achilles tendon allograft. MATERIALS AND METHODS: Nine patients (10 cases) were evaluated. Male was 8 and female 1. Mean age was 38.4 years (23~59) and interval after trauma was 12.4 months (3~25 mo). Mean follow-up period was 14 months (12~21 mo). Posterior cruciate ligament was reconstructed with arthroscopic transtibial, single bundle technique and posterolateral rotatory instability with figure of "8" method using fibular tunnel. Clinical evaluation was done using posterior drawer test, posterolateral drawer test, varus stress test, prone external rotation (dial) test and range of motion. Functional evaluation was done by Lysholm knee score and Tegner activity scale. RESULTS: 90% of cases showed improvement to grade I by posterior drawer and to normal by posterolateral drawer, varus stress and dial test. One case showed flexion limitation more than 10degrees compared to opposite knee. Lysholm knee score and Tegner activity scale have been improved from mean 48.5 and 2.1 preoperatively to mean 80.2 and 4.5 postoperatively (p<0.05). Posterior drawer stress radiographs showed the improvement from mean 17 mm to 4.2 mm(p<0.05). CONCLUSION: Successful results were obtained by combined reconstruction of the posterior cruciate ligament and posterolateral rotatory instability with fresh frozen Achilles allograft.
Achilles Tendon* ; Allografts* ; Exercise Test ; Female ; Follow-Up Studies ; Humans ; Knee ; Male ; Posterior Cruciate Ligament* ; Range of Motion, Articular

The coronary sinus (CS) is the venous drainage system of the heart. CS ostium atresia is a rarely seen cardiac malformation. Congenital atresia of the CS is usually found together with persistent left superior vena cava (LSVC) and other cardiac malformations. However, isolated congenital atresia of the CS is very rare. We present a rare case of isolated congenital atresia of the CS connecting the left atrium and coronary veins without persistent LSVC in a 58-year-old female.