BACKGROUND: Malpositioning of the endotracheal tube within airway after intubation may results in serious complications, such as accidental extubation and inadvertent endobronchial intubation. Therefore, early detection of malposioning of the endotracheal tube is very impotant for deciding patient's prognosis. METHODS: We assessed the distance from the tip of the endotracheal tube to the carina according to the patient's age, sex, and the time, the location, and the route of intubation. The chest x-ray was taken for 333 patients (men, 226: women, 107) who were admitted to the intensive care unit of Wonju Christian Hospital from march 1, 1995 to February 28, 1996. Chest x-ray was obtained after intubation to verify endotracheal tube position. Appropriate endotracheal tube position on chest x-ray was defined as between 2 and 6 cm above the carina. RESULTS: Of the 333 intubations, 106 (31.8%) endotracheal tubes were inappropriately placed according to the chest x-ray. The percentage of malpositioned endotracheal tubes (<2 cm) was higher in women than in men (11.2% vs. 5.3%, p<0.05), with higher in night (7 PM to 7 AM) than in day (7 AM to 7 PM) (42% vs. 24%, p<0.05). Distance from the carina to the tip of endotracheal tube is 4.34 +/- 1.77cm in women and 5.23 +/- 1.64cm in men. Thus, position of the endotracheal tube in women is deeper than men (p<0.001). CONCLUSIONS: We conclude that the chest x-ray for confirmation of endotracheal tube position after endotracheal intubation may remain the standard of practice. And endotracheal tube position should be carefully assessed immediately after tracheal intubation, particularly in women and at night.
Female ; Gangwon-do ; Humans ; Incidence* ; Intensive Care Units ; Intubation ; Intubation, Intratracheal* ; Male ; Prognosis ; Thorax*

The Bcl-2 protein has been shown to block apoptosis induced by a variety of stimuli. We have performed the experiments which cell death can be blocked by the bcl-2 proto-oncogene under moderate(50-100mM) or high ethanol treatment(400-600mM). As a result of morphological changes, and MTT assay, cell death was blocked by Bcl-2 under 100mM ethanol. However, the results of DNA fragmentation and RT-PCR(ICE, and CPP32), immunoblotting(CPP32, and PARP) for SK-pcDNA3 cells(vector only) and SK-Bcl-2 cells(stably expressed bcl-2 gene) were showen to be no significant differences between two cell lines. These result suggested that cell death induced by ethanol was not followed by apoptosis mechanism, and was blocked by the bcl-2 proto-oncogene with moderate ethanol.
Apoptosis ; Cell Death* ; Cell Line ; DNA Fragmentation ; Ethanol* ; Ice ; Proto-Oncogenes*

PURPOSE: To analyse complications and to review usefulness of large needle(18G) in percutaneous transhepatic biliary drainage(PTBD). MATERIALS AND METHODS: 46 patients underwent PTBD in 52 occassions using large needle. 44 of 46 patients had either definite or suspicious malignant biliary obstruction, and most patients were poor in general dondition. Complications were classified as acute type if developed within 30 days and as delayed type if developed after 30 days. Acute type was subdivided into severe and mild forms. RESULTS: Severe forms of complications were death(5.8%), septicemia(3.8%), and bile peritonitis(1.9%). There were not different from the rate of complication in PTBD using fine needle but the procedure was much more simple. CONCLUSION: We PTBD using large neddie is a simple and safe procedure for prompt bile decompression.
Bile ; Decompression ; Drainage* ; Humans ; Needles*

Real-time ultrasound-guided fine-needle aspiration biopsy in 137 solid breast masses was performed. Sonographic findings were categorized into three group and aspirates were categorized into three cytologic groups. The cytologic result was reported benign masses (cytologic group 1) in 71 cases (52%), malignant masses (cytologic group 2 and 3) in 44 cases (32%) and insufficient specimens in 22 cases (16%). Insufficient specimens were treated as benign masses. Excisional biopsy in 44 malignant masses and 3 benigh masses according to cytologic results, clinical findings and follow up study was performed. The result was reported 41 malignant masses and 6 benign masses. Based on cytologic criteria, sensitivity for detection of malignancy was 93% and specificity was 94%. In conclusion, the high specificity provided by ultrasound-guided fine-needle aspiration biopsy could markedly reduce unnecessary surgical excisions for benign masses and it should be routinely performed, since it can give physical and emotional benefits to patients and lead to earlier and cost effective diagnosis of breast cancer.
Biopsy ; Biopsy, Fine-Needle* ; Breast Neoplasms ; Breast* ; Diagnosis ; Follow-Up Studies ; Humans ; Sensitivity and Specificity ; Ultrasonography

The hypoglycemic effects of four edible plants (Angelicae tenuissimae (A. ten.), Pleurospermum kamtschaticum (P. kam.), Adenophora remotiflora (A. rem.) and Zanthoxylum schinifolium (Z. sch.)) in streptozotocin (STZ)-induced diabetic rats were investigated. Sprague-Dawley male rats weighing 190-230 g were induced diabetes mellitus by the STZ injection (45 mg/kg) into the tail vein and were divided into six groups ; normal, STZ-control and four edible plant groups (A. ten., P kam., A. rem. and Z. sch. groups). Normal and STZ-control groups were fed a AIN-93 diet and four groups of STZ-induced diabetic rats were fed one of each experimental diets containing 10% of the edible plant powder for 4 weeks. Diabetic rats showed the lower weight gain compared to the normal rats. In experimental groups except P. kam., AST activities were close to normal. A. ten. group were lowered ALT activities slightly. The plasma glucose levels of the diabetic experimental groups were significantly decreased at 4th week. The plasma insulin levels in diabetic experimental groups were not significantly different compared to the STZ-control group. The liver glycogen levels in STZ injected rats were significantly lower in compared to the normal rats. However no significant differences were found in response experimental plants intake in diabetic rats. The muscle glycogen were not significantly different among all the groups.
Animals ; Blood Glucose* ; Campanulaceae ; Diabetes Mellitus ; Diet ; Glycogen* ; Humans ; Hypoglycemic Agents ; Insulin ; Liver Glycogen ; Male ; Plants, Edible ; Plants, Medicinal* ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Streptozocin* ; Veins ; Weight Gain ; Zanthoxylum

BACKGROUND/AIMS: Hepatic fibrosis in rat induced by thioacet amide shares similar morphological and biochemical characteristics with human liver cirrhosis. Thioacetamide (T AA) initially induces accumulation of collagen in Disse space and eventually leads to macro- and micronodular cirrhos is. Ito cell was believed to play a main role in hepatic fibrosis. And it s activity was known to be regulated by the expression of various genes. But little has been discovered about the upstream signal trans duction pathway of these genes in hepatic fibrosis. The expression of genesrelated to Ito cell activity was regulated by many transcription factors , the activity of which was regulated by protein kinase C( PKC) is oforms. So it is s upposed that PKC could be as s ociated with fibrosis in liver. METHODS: We investigated the correlation of PKC is oforms and It ocell activity in the course of hepatic fibrosis using TAA induced rat liver cirrhosis model. We used six week- old male rats , and administered 0.03% TAA in drinking water. The animals were sacrificed at 9, 20, and 30 weeks after TAA administration. The degree of hepatic fibrosis was evaluated by measuring the total amount of collagen.-SMA immunohist ochemical st aining of liver tissue was done to determine the Ito cell activity. The expression pattern of PKC isoforms was investigated by West ern blotting. RESULTS: In TAA- treated group, collagen cont ent and Ito cell activity did not increase until 30 weeks and 20 weeks of treatment , respectively, while in control group collagen cont ent and Ito cell activity were not detected. Collagen content showed linear correlation with Ito cell activity. This implied that the proliferation of activated Ito cells was prior to the increase of collagen content. In view of expression pattern of PKC is oforms, PKC alpha showed no difference in TAA- treated group and control group. In TAA-treated group, PKCbeta1 exhibited increased level of expression in both particulate and cytosolic forms at 9 weeks, while PKCdelta and PKC epsilon showed striking shift to particulated form. After 20 weeks, all of the PKC beta1, delta, and epsilon degenerated and showed remarkably decreased level of expression. This suggested PKC alpha had no relation to hepatic fibrosis,while PKC beta1, delta, and epsilon, showing activity at 9 weeks, were related to fibrosis og liver. In response to fibrogenic factors, molecules engaged in intracellular signal transduction pathway like PKC beta1, delta, and epsilon, began to change prior to the increase of Ito cell activity, morphologic changes and alterations of collagen content. CONCLUSION: Our results strongly suggest that the activity of PKC isoforms play an important role in early step of hepatic fibrosis, while accompanying Ito cell activity do in later step.
Animals ; Collagen ; Cytosol ; Drinking Water ; Fibrosis ; Hepatic Stellate Cells ; Humans ; Liver Cirrhosis* ; Liver* ; Male ; Protein Isoforms ; Protein Kinase C-epsilon ; Protein Kinases ; Rats ; Signal Transduction ; Strikes, Employee ; Thioacetamide ; Transcription Factors

OBJECTIVES: This study aimed to identify psychopathologies of sexually abused children and intervening variables of symptom severity. METHODS: Eighty-four school-aged children were identified for sexual abuse from a center for child sexual abuse by psychiatrists, clinical psychologists, and social workers. We analyzed correlations among symptom severity, types of sexual abuse, gender, age, relationship with the abuser, family system, and current and past psychopathologies. RESULTS: The percentage of victims with particular psychiatric disorders (current) were 79.8%. Children without identifiable disorders were 20.2%, but these children had significantly increased scores on self report scales of anxiety (RCMAS), depression (CDI), and withdrawal scores on parental reports of child behavior checklist (K-CBCL). Sixty nine percent of abused children had primary diagnosis related to sexual abuse in DSM-IV diagnositic system. PTSD was 41.7%, depressive disorder was 38.1%, and anxiety disorder was 21.4%. Psychopathologies were more severe if perpetrators were of acquaintance or if victims had previous psychopathologies or parent-child relational problems. Types of primary caregiver and older age were also related to the severity of psychopathologies. CONCLUSION: Present study suggests that most victims of childhood sexual abuse suffer from significant psychological distress. Intervening variables are relationship with the perpetrator, previous mental health status, age of the child, type of the primary care taker, and the quality of parent-child relationship.
Anxiety ; Anxiety Disorders ; Caregivers ; Checklist ; Child Abuse, Sexual ; Child Behavior ; Child* ; Depression ; Depressive Disorder ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea* ; Mental Health ; Parent-Child Relations ; Parents ; Primary Health Care ; Psychiatry ; Psychology ; Psychopathology* ; Self Report ; Sex Offenses ; Social Workers ; Stress Disorders, Post-Traumatic ; Weights and Measures

Accurate placernent of double-lumen endobronchial tube is essential for successful one lung anesthesia We studied 58 adult patients (38 males and 20 females) undergoing thoracic surgery under one lung anesthesia. We used the fiberoptic bronchoscope as an "introducer" over which the double lumen tube was advanced under direct vision. Correct position of the left side double-lumen endobronchial tube at supine position was determined by direct vision of cephalad surface of the bright blue bronchial cuff immediately below the carina. Correct position of the right side double lumen endobronchial tube at supine position was determined by direct vision of the right upper lobe bronchial orifice through the right upper labe ventilation slot. After the patient was repositioned, the position of the double lumen endobronchial tube was rechecked by fiberoptic bronchoscope. The results were as follows; 1) There was a significant correlation of correct depth of left and right double lumen endobronchial tube at supine position with height for both male and female patients. 2) Left side double lumen endobronchial tube: 58% of total cases (20 Case of 38 Case) were displaced by turning of the patient from supine to the lateral decubitus position. 3) Right side double lumen endobronchial tube: 65% of total cases (13 Case of 20 Case) were displaced by turning of the patient from supine to the lateral decubitus position.
Adult ; Anesthesia ; Bronchoscopes ; Female ; Humans ; Lung ; Male ; Supine Position ; Thoracic Surgery ; Ventilation

We investigated the pathobiological course of uranyl nitrate (UN) induced polyuric acute tubular necrosis (ATN) in male Sprague Dawley rats. UN (5mg/kg 15mg/kg and 3Omg/kg) in 5% NaHCO3 induced weight loss, polydipsia, and polyuria 24 hrs after injection when compared to the controls which were treated with 5% NaHCO3 only. Twenty four hours following the injection of UN, serum creatinine and blood urea nitrogen levels had increased. These changes continued for at least 72 hours, although the concentration of uranium had decreased. Light microscopic studies conducted 24 hours after injection, revealed partial degeneration and necrosis of the proximal tubules and many casts m the distal convoluted tubules. These changes progressed for 72 hours. Despite this tubular damage, the glomeruli were relatively intact. 5 days after injection, the epithelial cells lining the proximal tubules displayed regenerative activities; these findings were more prominent after 10 days. Through electron microscopic examination, we observed the destruction of mitochondria in the proximal tubular cells, a possible cause of polyuria. Ten days post injection regenerative activities in the proximal tubular cells showed that the maturation of intracellular organelles followed the proliferation of the premature cells.
Animal ; Kidney Failure, Acute/chemically induced* ; Kidney Function Tests ; Kidney Tubular Necrosis, Acute/chemically induced* ; Male ; Rats ; Rats, Inbred Strains ; Uranium/pharmacology* ; Uranyl Nitrate/pharmacology*

PURPOSE: Although asthma is generally understood as a disease of the the small airways, FEF25-75%, an index representing peripheral small airways, is a appropriately used in the diagnosis of asthma. The objectives of this study are to assess the usefulness of FEF25-75% in children with asthma for clinical application. METHODS: Five hundred sixty two 5- to 15-year-old children with symptoms suggestive of asthma were enrolled. Methacholine bronchial provocation tests were performed and the children were divided into two groups according to their test results. RESULTS: Forced expiratory flow between 25-75 percent of vital capacity (FEF25-75%) was significantly lower in asthma group (P< 0.001). A 25 percent fall of FEF25-75% of percentage predicted value was correlated with PC20FEV1 (provacation concentration of methacholine required to reduce FEV1 by 20 percent) (r=0.601, P< 0.001). The sensitivity of PC25FEF25-75% (provocation concentration of methacholine required to reduce FEF25-75% by 25 percent) was 94.11 percent when PC20FEV1 was a point of reference. Youden's index was 0.64. CONCLUSION: FEF25-75% is an useful and sensitive index that predicts the presence or absence and the degree of bronchial hyperresponsiveness and PC25FEF25-75% should be brought into clinical application in asthmatic children.
Adolescent ; Asthma* ; Bronchial Provocation Tests* ; Child* ; Diagnosis ; Humans ; Methacholine Chloride* ; Vital Capacity