Complete consciousness may return Tery slowly following general anesthesia. Although most patiients appear to approach their preanesthetic state within minutes to tours, but there appears to be some changes in cognitive functions for the next 2 to 4 days after halothane anesthesia. For the evaluation of recovery time from halothane anesthesia, we studied 10 pediatric patients who received N2O-O2-halothane anesthesia, During the recovery after cessation of halothane inhalation, we administered N2O (2 l/min) and O2 (1 l/min) with Dameca anesth-esia machine. All the patients ware ventilated with Dameca ventilator. The minute ventil-ation was 145 ml/kg/min. Throughout the experiments, we measured inspired( l) and end-tidal (ET) O2, CO2, N2O, N2, and halothane concentrations with mass spectrometry. Control data were obtained just after cessation of halothane inhalation, and all the data after then were compared with control data and expressed as % response of control. The concentrations of O2, CO2, N2, and N2O were net changed significantly during the experiment. The inspired halothane concentration (C1 HAL) in control was 1.14+/-0.08 vol% and it sho- wed significant progreasive decrease by each minute, The most abrupt decrease in C1 HAL was noticed in 3 min and 6 min: 68.8% and 73.0% in 3 min and 6 min respectively. The endtidal halothane concentrations (CET HAL) were 1.06 vol%, 0.52 vo1%, 0.39 vol% and 0.32 vol% in control, 3 min, 6min and 9 min respectively. The end-tidal halothane concentrations were also significantly decreased progressively. CET HAL/C1 HAL ratio was 0.91+/-0.02 in centrol, but it wag alwayg more than 1.0 after cessation of halothane, which indicates continuous elimination of halothane from the body, The complete disappearance times of inspired and end-tidal halothane calculated from the linear regreasion equations were 60.26 min and 63.10 min, respectively.
Anesthesia* ; Anesthesia, General ; Consciousness ; Halothane* ; Humans ; Inhalation ; Mass Spectrometry ; Ventilators, Mechanical

PURPOSE: To make a histological study of a urethral plate using light and transmission electron microscopies to find evidence responsible for ventral curvature in hypospadias. MATERIALS AND METHODS: Full thickness biopsies of the urethral plate were obtained from 5 patients with proximal hypospadias; including 4 children and 1 adult. All specimens were examined with light and transmission electron microscopies. RESULTS: With the light microscope, all specimens demonstrated well vascularized connective tissue, comprised of smooth muscle and collagen. With the transmission electron microscope, all specimens demonstrated intact endothelial cells and fibroblasts, with dispersed chromatin distribution, intercellular loose collagen and a regular arrangement of collagen fibrils in intercellular spaces. No histological evidence of fibrous cord could be found in any of the specimens. CONCLUSIONS: No histological evidence of fibrous cord could be historically found that could be considered responsible for ventral penile curvature in hypospadias.
Adult ; Biopsy ; Child ; Chromatin ; Collagen ; Connective Tissue ; Endothelial Cells ; Extracellular Space ; Female ; Fibroblasts ; Humans ; Hypospadias ; Male ; Microscopy ; Microscopy, Electron ; Microscopy, Electron, Transmission* ; Muscle, Smooth ; Urethra

The survival rate and motility recovered after cryopreservation of testicular spermatozoa in testicular sperm extraction (TESE)-ICSl program is low. The purpose of this study was to assess the availability and efficiency of mouse empty zona pellucida in cryopreserving human TESE spermatozoa. Mouse empty zonae pellucidae were obtained by extraction of cytoplasm with or without cytochalasin B treatment. Motile sperm from proven-fertile donor and two azoospermic patients after TESE were individually inserted into empty zona pellucida and cryopreserved. Two to five days after cyropreservation, the frozen sperm were thawed and the rates of recovery and motility were observed. The ooplasmic extraction rates of control (N=80) and cytochalasin B treated oocytes (N=80) were 94.0% and 96.2%, respectively (p>0.05). The post-thaw recovery rates of spermatozoa and rates of motility recovery of ejaculate (N=70) and testicular (N=70) sperm were 97.1%, 97.1% and 95.7%, 94.3%, respectively (p>0.05). The results of this study showed that the mouse zone pellucida is useful for cryostorage of single testicular spermatozoa.
Animals ; Cryopreservation* ; Cytochalasin B ; Cytoplasm ; Herpes Zoster* ; Humans ; Mice* ; Oocytes ; Sperm Injections, Intracytoplasmic* ; Spermatozoa* ; Survival Rate ; Tissue Donors ; Zona Pellucida*

Pulmonary embolism is a common clinical problem in patients with immobilization, cancer, indwelling central venous catheter and surgery. However, although rare, it may occur in patients with inherited thrombophilia. Protein S deficiency is known to increase the risk of venous thrombosis and pulmonary embolism. There are many reports of venous thrombosis with protein S deficiency, but there are few reports of arterial thrombosis, especially recurrent acute pulmonary embolism. Here, we report a case of recurrent pulmonary embolism associated with type II protein S deficiency.
Blood Coagulation Disorders, Inherited ; Central Venous Catheters ; Humans ; Immobilization ; Protein S ; Protein S Deficiency ; Pulmonary Embolism ; Thrombophilia ; Thrombosis ; Venous Thrombosis

The korean society of otolaryngology has had and experience on intraining examination since 1992. We also had the fortieth annual board examination for specialist in 1997. But we have no evidence on the validity of these tests yet. The aim of this study is to examine the validity of the intraining examinations as a tool of formative evaluation, to present a personal progress index demonstrating constructive validity, and to examine the validity of the board examination as a tool of summative evaluation. We did statistic analysis on the consecutive personal scores of 1995 and 1996 intraining examinations, and 1997 written and oral board examinations. Analysis of the averages, standard deviations, distribution curves, and Wilcoxon singed rank test on the scores of 1995 and 1996 intraining examinations demonstrated the constructive validity. Chi-square test revealed that those who had low scores in intraining examinations of two consecutive years had low scores in 1997 board examinations and personal progress index demonstrated the predictive validity. Correlation and linear regression analysis demonstrated a strong correlation between 1997 written and oral board examination. Analysis of the averages, standard deviations, distribution curves, and Spearman rank correlation coefficient revealed that 1997 written board examination had higher concurrent validity than the that of oral examination.
Diagnosis, Oral ; Humans ; Linear Models ; Otolaryngology* ; Specialization

BACKGROUND: Type 2 diabetes develops because of defects in both insulin secretion and action. The half-life of insulin in uremia is prolonged because the metabolic clearance rate of insulin in diabetic end stage renal disease (ESRD) patients is reduced with consequence that the dose of insulin and/or oral hypoglycemic agent (OHA) administered in normal renal function make them increase the risk of hypoglycemia. Therefore, we should usually reduce the dose of insulin and/or OHA, or stop administration of insulin and/or OHA if type 2 diabetic patients are progressed to ESRD. But in some patients, that is not true. The aim of this study was to test the hypothesis that insulin resistance plays an important role in (re)evaluation of optimal insulin and/or OHA dose for glycemic control after type 2 diabetic patients are progressed to ESRD. METHODS: Insulin resistance was examined in 23 type 2 diabetic ESRD patients with tight control of glycemia using the K index of the insulin tolerance test (Kitt). We divided 23 patients into three groups. Group 1 (n=10) was defined as patients who were administered neither insulin nor OHA after ESRD. Group 2 (n=9) was defined as patients who were changed from insulin to OHA as drug for glycemic control after ESRD. Group 3 (n=4) was defined as patients in whom insulin or OHA was continuously administered after ESRD without a change of them for glycemic control. We compared the degree of insulin resistance among these three groups. RESULTS: Insulin resistance determined by Kitt was significantly different between group 1 (Kitt, 2.1422/0.94-4.01%/min), group 2 (Kitt, 1.3811/0.79- 3.90%/min) and group 3 (Kitt, 0.8550/0.44-1.81%/min) by using Kruskal-Wallis test (p=0.048). Kitt in group 3 was significantly lower than in group 1 by using Mann-Whitney test (p=0.016). CONCLUSION: Although metabolic clearance of insulin is reduced by renal failure, demand of insulin/ OHA for optimal glycemic control is not reduced in higher insulin-resistant type 2 diabetic ESRD patients on hemodialysis. Insulin resistance plays an important role in determination of optimal insulin/ OHA dose for glycemic control after type 2 diabetic patients are progressed to ESRD.
Half-Life ; Humans ; Hypoglycemia ; Insulin Resistance* ; Insulin* ; Kidney Failure, Chronic* ; Metabolic Clearance Rate ; Renal Dialysis* ; Renal Insufficiency ; Uremia

BACKGROUND: Patients with centrally recurred bronchogenic carcinoma make a complaint of many symptoms like hemoptysis, cough & dyspnea. At these conditions, the goal of treatment is only to relieve their symptoms. High dose rate brachytherapy(HDR-BT) is the palliative treatment modality of centrally located endobronchial tumor regardless of previous external irradiation(XRT) on the same site in symptomatic patients. METHOD: We studied the effects of HDR-BT in 26 patients with symptomatic recurrent lung cancer. Patients(male: 24, mean age: 54yrs)were treated with HDR-BT underwent bronchoscopic placement of 192Ir HDR after loading unit(Gammamed(R), Germany) to deliver 500cGY intraluminal irradiation at a depth of 1cm every 1wk on 3 occasions. Evaluation at base line and 4wks after HDR brachytherapy included chest X-ray, bronchscopy, symptoms (Standadized Scale for dyspnea, cough, hemoptysis), and Karnofsky performance scale. RESULTS: Endobronchial obstruction was improved in 11/26 patients(37%). Atelectasis in chest X-ray was improved in 5/15 patients(33%). Hemoptysis, dyspnea & cough were improved in 5/10 patients (50%), 5/8 patients (62%) & 10/18 patients (56%) respectively. Karnofsky performance status was changed from 76.4 scores in pretreatment to 77.6 scores after treatment. During HDR-BT, massive hemoptysis (2 patients) and pneumothorax(1 patient) were occurred as complications. CONCLUSION: We concluded that HDR-BT gave additional benefits for the control of symptoms and general performance and endobronchial obstruction & atelectasis. And HDR-BT will be an additional treatment for the recurrent and endobronchial obstructive lung cancer.
Brachytherapy* ; Carcinoma, Bronchogenic ; Cough ; Dyspnea ; Hemoptysis ; Humans ; Karnofsky Performance Status ; Lung Neoplasms ; Palliative Care ; Pulmonary Atelectasis ; Thorax

Central venous catheterization is commonly used for supplying large amounts of fluids, total parenteral nutrition and for monitoring central venous pressure. Numerous complications exist with the technique, including pneumothorax, arterial puncture with vessel injury, catheter embolus, mediastinal hematoma, hydrothorax, and the thrombus of the vein. We reported an uncommon case of pleural effusion, due to catheter tip migration and penetration, which occurred 4 days after central venous catheterization.
Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Central Venous Pressure ; Embolism ; Glycosaminoglycans ; Hematoma ; Hydrothorax ; Parenteral Nutrition, Total ; Pleural Effusion ; Pneumothorax ; Punctures ; Subclavian Vein ; Thrombosis ; Veins

Central venous stenosis or occlusion occurs in 11-50% of hemodialysis patients with prior subclavian vein cannulation and ipsilateral fistula or shunt. Most patients are asymptomatic but some require treatment to reduce the risk of thrombosis and improve inadequate hemodialysis pressure. In these cases, endovascular intervention, including ballooning and stenting, is a feasible strategy for selected patents. We report an unusual case of a 40-year-old man on hemodialysis that underwent endovascular stenting to treat right subclavian vein stenosis and experienced stent migration to the right ventricle, requiring surgical removal.
Adult ; Catheterization ; Constriction, Pathologic ; Fistula ; Heart Ventricles ; Humans ; Renal Dialysis ; Stents ; Subclavian Vein ; Thrombosis

Stenotrophomonas maltophilia is an ubiquitous aerobic Gram-negative bacillus. Hospitalization and prior antibiotic therapy are risk factors for S. maltophilia infection. This organism is isolated with increasing frequency from hospitalized patients and may cause therapeutic problems because of its intrinsic resistance to common antibiotics and the immunodeficiency status of the affected host. S. maltophilia has been reported to be commonly associated with pneumonia and urinary tract infection. However, biliary infection caused by S. maltophilia is very rare. Herein, we report on a case of acute cholecystitis that developed secondary to S. maltophilia bacteremia in a patient with hepatitis-B related liver cirrhosis and gallbladder stone.
Anti-Bacterial Agents ; Bacillus ; Bacteremia* ; Cholecystitis, Acute* ; Gallbladder ; Hospitalization ; Humans ; Liver Cirrhosis ; Pneumonia ; Risk Factors ; Stenotrophomonas maltophilia* ; Urinary Tract Infections