The purpose of this study is to verify severity of asthma in asthmatic patients through through the arterial blood gas analysis. Subjects were consisted of 103 patients (74 boys and 29 girls), between 2~13 years of ages. Clinically, asthmatic patients were classified into 6 groups, i, e., group 0(no rhonchi), group 1(rhonchi only), group 2(mild attack), group 3(moderate attack), group 4(severe attack), group 5(respiratory failure with disturbance of consciousness). PH kept normal range in the group 0, group 1, group 1 and group 3,but began decrease in the group 4.There was linear fall in Po2 and began decrease in the group 3. HCO3- maintained normal level through the whole range. BE showed acidemia on the whole, and began distinctive decrease in the group 4 and group 5, especially. Hypoxemia, hypercapnia and acidemia were common in patients in severe attacks with disturbance of consciousness.
Anoxia ; Asthma ; Blood Gas Analysis* ; Child* ; Consciousness ; Humans ; Hydrogen-Ion Concentration ; Hypercapnia ; Reference Values

No abstract available.
Anemia, Hemolytic* ; Cholelithiasis* ; Hepatolenticular Degeneration*

The authors have intended to measure intrinsic dose distribution by Farmer dosimeter in irregularly shaped fields such as L.M. and T shape models in order to determine dose in homogeneity in those models. We made 2 off-xis points in each model and measured the depth dose at 1.5, 5 and 9cm below surface. The results showed 1~3% dose discrepancy between 2 points. We also measured the depth dose by geometric approximation and computer calculation in those models, and came to the conclusion that computer calculation using Clarkson's principle is simpler and the measurements are closer to the ideal data obtained by the experiment in three models of irregularly shaped fields than those of geometric approximation method.

BACKGROUND: Studies in animals suggest that pipecuronium dose not induce hemodynamic chan-ges related to histamine release or to an effect on the autonomic nervous system. Therefore the effects of bolus administration of large doses of pipecuronium, up to 0.20 mg/kg, on the intubation condition, onset and duration of neuromuscular blockade, heart rate and blood pressure were studied during fentanyl- nitrous oxide anesthesia. METHOD: Forty adults were randomly assigned to receive a bolus injection of either 0.05, 0.10, 0.15, 0.20 mg/kg of pipecuronium. Neuromuscular blockade was measured using mechanomyographic activity of the adductor pollicis muscle after supramaximal stimulation of the ulnar nerve. Four subgroups of 10 patients received pipecuronium doses of 0.05, 0.10, 0.15 and 0.20 mg/kg, respectively, as an intubating dose. RESULTS: The times of onset and clinical duration (mean sem) after each dose were as follows: 0.05 mg/kg, 2.98 0.42 and 41.5 2.42 min; 0.10 mg/kg, 1.54 0.06 and 82.9 7.48 min; 0.15 mg/kg, 1.41 0.14 and 124.8 13.1 min; 0.20 mg/kg, 1.12 0.05 and 187.1 12.8 min. The intubation condition, time of onset and duration after doses of 0.05 mg/kg were significantly different from values after the higer doses. The duration was increased with dose-increments. No dose-related changes in heart rate or blood pressure were observed. CONCLUSION: The authors conclude that dose of 0.10 mg/kg and over has good intubation condition clinically and large bolus dose of pipecuronium can be safely used with a significantly prolonged duration of action without hemodynamic change.
Adult* ; Anesthesia ; Animals ; Autonomic Nervous System ; Blood Pressure ; Heart Rate ; Hemodynamics ; Histamine Release ; Humans ; Intubation ; Intubation, Intratracheal* ; Neuromuscular Blockade ; Nitrous Oxide ; Pipecuronium* ; Ulnar Nerve

This study was performed to investigate the mechanism of the clozapine-induced seizures in partially restrained rats by concomitant treatment with drugs affecting monoaminergic systems. Partially restrained rats treated with acute single doses of 10mg/kg clozapine exhibited myoclonic jerks(MJs). Drugs affecting the monoaminergic systems, including 2mg/kg haloperidol, 5mg/kg propranolol, 2mg/kg ritanserin, 20mg/kg fluoxetine, and 20mg/kg imipramine, were concomitantly treated with clozapine to observe the effects of these drugs on the MJs. The drugs were given intraperitoneally either as acute single doses(haloperidol, propranolol, ritanserin, and fluoxetine) or as chronic doses for 21 days(haloperidol, imipramine, ritanserin, and fluoxetine). The effects of the concomitant treatment of other drugs on the clozapine-induced MJs were evaluated by comparison of the total numbers of the MJs between the clozapine-treated and concomitantly treated groups. The results were as follows. 1) Concomitant treatment with acute single doses of haloperidol, propranolol, and fluoxetine reduced the total numbers of the clozapine-induced MJs, while concomitant treatment with ritanserin did not. 2) Concomitant treatment with chronic doses of imipramine and ritanserin increased the total numbers of the MJs, while concomitant treatment with fluoxetine reduced them. Concomitant chronic treatment with haloperidol did not affect the numbers of the MJs. These results suggest that dopamine and serotonin, not noradrenalin may be involved in the clozapine-induced MJs in partially restrained rats. Future research needs to study the function of each subtype of monoaminergic receptors on the mechanism of the clozapine-induced seizure.
Animals ; Clozapine ; Dopamine ; Fluoxetine ; Haloperidol ; Imipramine ; Myoclonus* ; Propranolol ; Rats* ; Ritanserin ; Seizures ; Serotonin

Seven patients having midline granuloma received local irradiation from March 1983 to June 1986. Clinically, all of the 7 patients had pansinusitis with necrotic destruction of the involved sites and one case revealed colonic lesion. Each of the patients received a tumor dose of 4,000 ~ 5,000 cGy/5~6wks to the upper aerodingestive tract using a 6-MV linear accelerator. Complete and partial remission occurred in 3 patients each, and in one case, the disease progressed despite of the irradiation.
Colon ; Granuloma* ; Humans ; Particle Accelerators

Insertion of indwelling arterial catheter has become a valuable procedure for blood pressure monitoring and for measurement of blood gas tension during anesthesia. A 34-year-old man with chronic alcoholism and diabetes mellitus was admitted to the hospital because of hyperosm-olar coma. On the first hospital day, percutaneous left radial artery cannulation was carried out for hemodynamic monitoring and arterial blood gas analysis after a modified Allen's test appear-ed to be positive. On the eleventh hospital day, the catheter was removed because of fever and sign of infection at the insertion site. Treatment with vancomycin by sensitivity test was begun on day 13, after continued for 2 weeks. On day 34 a pulsatile mass was noted at the insertion site. During surgery, a pseudoaneurysm of 1X1.2 cm size was found, and liquified hematoma and necrotic material were noted. The aneurysm was removed and end to end anastomosis was successfully completed. We suggest that risk factors for pseudoaneurysm may include abnormal state of vessel wall, multiple attempts at cannulation, increased duration of catheterization, adva-nced age, prolonged hospitalization, hematoma and infection at cannulation site.
Adult ; Alcoholism ; Anesthesia ; Aneurysm ; Aneurysm, False* ; Blood Gas Analysis ; Blood Pressure Monitors ; Catheterization* ; Catheters ; Coma ; Diabetes Mellitus* ; Fever ; Hematoma ; Hemodynamics ; Hospitalization ; Humans ; Radial Artery* ; Risk Factors ; Vancomycin

BACKGROUND: Long-term phenytoin therapy induces resistance to the neuromuscular blocking effects of metocurine, atracurium, doxacurium, and pipecuronium. This study examine neuromuscu-lar blocking effect and recovery of mivacurium in isolated rat phrenic-hemidiaphragm with two-weeks phenytoin pretreatment. METHOD: After the administration of 14 days of phenytoin 40 mg/kg, administered intraperitoneally twice daily (n=10), ED90, antagonism of neostigmine and 4-aminopyridine on the electrically evoked twitch response and train-of-four (TOF) stimulation were compared to control groups in isolated rat phrenic-hemidiaphragm preparation. RESULTS: ED90 was significantly greater in the phenytoin group than in the control group (319 +/- 39.5 g vs. 209.5 +/- 52.2 g, respectively). After the administration of neostigmine 0.75 M, the recovery of the single twitch and TOF ratio were significantly lesser in the phenytoin group than in the control group (single twitch; 19.6 +/- 6.6% vs. 69.2 +/- 9.4%, TOF ratio; 0.258 +/- 0.149 vs. 0.543 +/- 0.1, respectively). After the administration of 4-aminopyridine 40uM, the recovery of the single twitch and TOF ratio were no significant differrence between the phenytoin group and the control group (twitch; 118.1 +/- 25.3% vs. 122.6 +/- 24.8%, TOF ratio; 0.937 +/- 0.051 vs. 0.949 +/- 0.067, respectively). CONCLUSION: Long-term phenytoin therapy induces resistance to the neuromuscular blocking effects of mivacurium.
4-Aminopyridine ; Animals ; Atracurium ; Drug Interactions ; Neostigmine ; Neuromuscular Blockade* ; Phenytoin* ; Pipecuronium ; Rats*

PURPOSE: Triage in the emergency departmen (ED) is the preliminary clinical sorting process before full disclosure of patients' problems so that patients with the highest acuity are treated first in the setting of resource constraints. To overcome the inter-rater variability of existing triage tools, the Emergency Severity Index (ESI) was developed and was shown to be both valid and reliable in practice. Because of the disparity in practice patterns and some inappropriate criteria in the original ESI, the authors have modified the ESI and determined its inter-rater reliability. METHODS: We applied the modified ESI to a convenient sample of adults who visited an urban academic ED between July 24, 2001, and August 5, 2001. After completion of a short, 4-hour training course on the modified ESI, an intern and emergency medicine resident pair triaged the patients independently. The inter-rater reliability was measured using a weighted kappa analysis and was categorized as excellent (>or=0.8), good (0.60-0.79), or fair ( Adult ; Disclosure ; Emergencies* ; Emergency Medicine ; Humans ; Triage*

PURPOSE: This study quantitatively evaluated the apoptosis in human peripheral blood lymphocytes using flow cytometry, and investigated the possibility of using this method, with a small amount of blood, and the time and dose dependence of radiation-induced apoptosis. MATERIALS AND METHODS: Peripheral blood lymphocytes were isolated from the heparinized venous blood of 11 healthy volunteers, 8 men and 3 women, with each 10 ml of blood being divided into 15 samples. The blood lymphocytes were irradiated using a linear accelerator at a dose rate of 2.4 Gy/min, to deliver doses of 0.5, 1, 2 and 5 Gy. The control samples, and irradiated cells, were maintained in culture medium for 24, 48 and 72 hours following the irradiation. The number of apoptotic cells after the in vitro X-irradiation was measured by flow cytometry after incubation periods of 24, 48 and 72 hours. We also observed the apoptotic cells using a DNA fragmentation assay and electron microscopy. RESULTS: The rate of spontaneous apoptosis increased in relation to the time interval following irradiation (1.761+/-0.161, 3.563+/-0.564, 11.098+/-2.849, at 24, 48, and 72 hours). The apoptotic cells also increased in the samples irradiated with 0.5, 1, 2 and 5 Gy, in a radiation dose and time interval after irradiation manner, with the apoptosis being too great at 72 hours after irradiation. The dose-response curves were characterized by an initial steep increase in the number of apoptotic cells for irradiation doses below 2 Gy, with a flattening of the curves as the dose approached towards 5 Gy. CONCLUSION: The flow cytometric assay technique yielded adequate data, and required less than 1 mL of blood. The time and dose dependence of the radiation-induced apoptosis, was also shown. It is suggested that the adequate time interval required for the evaluation of apoptosis would be 24 to 48 hours after blood sampling.
Apoptosis* ; DNA Fragmentation ; Female ; Flow Cytometry ; Healthy Volunteers ; Heparin ; Humans ; Lymphocytes* ; Male ; Microscopy, Electron ; Particle Accelerators