BACKGROUND: Laryngoscopy and tracheal intubation for general anesthesia are potent stimuli to the cardiovascular system due to sympathetic stimulation. The aim of this study was to compare the hemodynamic responses with different administration routes of lidocaine on blood pressure and heart rate changes associated with tracheal intubation. METHODS: Sixty patients were randomly assigned to spray group (Group 1, n=20) received 10% lidocaine 1.5 mg/kg spray to intratracheally immediately before tracheal intubation, IV group (Group 2, n=20) received 2% lidocaine 1.5 mg/kg intravenously before 90 sec tracheal intubation and control group (Group 3, n=20). Anesthesia was induced with thiopental 5 mg/kg IV, vecuronium 0.1 mg/kg and 50% N2O-O2- 2vol % enflurane. After 5 minutes, tracheal intubation was performed. Mean arterial pressure and heart rate were measured at preintubation and immediately postintubation, 1, 3, 5 mins after tracheal intubation. RESULTS:The differences of mean arterial pressure which were measured at preintubation and immediately postintubation and 1 minute after intubation in group 1 were significantly lower than those in other group (p<0.05). The differences of heart rate which measured at preintubation and 1 minute after intubation were lower than those in group 3 (p<0.05). CONCLUSIONS: For the suppression of sympathetic stimulation following tracheal intubation, 10% lidocaine spray to the laryngotrachea is an effective method to suppress cardiovascular response.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiovascular System ; Enflurane ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intubation* ; Laryngoscopy ; Lidocaine* ; Thiopental ; Vecuronium Bromide

BACKGROUND: Tracheal intubation by direct laryngoscopy induces frequently transient hypertension, tachycardia and arrhythmia. The purpose of this study was to examine the effect of esmolol and clonidine in attenuating the changes of blood pressure and heart rate by tracheal intubation. METHODS: Eighty patients were randomly divided into four groups: Group 1 (control , n=20), Group 2 (esmolol 0.5 mg/kg IV, n=20), Group 3 (clonidine 4 mcg/kg PO, n=20) and Group 4 (clonidine 4 mcg/kg PO and esmolol 0.5 mg/kg IV, n=20). The clonidine premedication were given orally with a sip of water 90 minutes before induction of anesthesia. Anesthesia was induced with thiopental 5 mg/kg, vecuronium 0.1 mg/kg, 50% nitrous oxide in oxygen and 2 vol % enflurane. After 5 minutes, tracheal intubation was performed. Patients in the group 2 and group 4 were given esmolol 0.5 mg/kg 90 seconds prior to tracheal intubation. Blood pressure and heart rate were measured at ward, preinduction, preintubation, immediately after intubation, 1, 3 and 5 minutes after intubation. RESULTS: After tracheal intubation, the increase in systolic blood pressure was supressed significantly in the clonidine-treated patients (Group 3, Group 4) compared with control group (p<0.05). The attenuating effect on increase of mean arterial pressure(MAP) was sustained longer in group 4 than group 3. Heart rate increased after tracheal intubation in all groups, but were markedly increased in the control group (p<0.05). The differences of MAP which measured at preinduction and immediately postintubation were smaller in group 4 than control group (p<0.05). The differences of heart rate which measured at preinduction and immediately postintubation were smaller in group 4 than group 1 or group 3 (p<0.05). CONCLUSIONS: Esmolol 0.5 mg/kg given as bolus, is effective for controlling the increase of heart rate but not in attenuating increase of blood pressure. Oral clonidine is effective for controlling the increase of blood pressure but not in attenuating increase of heart rate. Therefore esmolol combined with oral clonidine results in effective control of both heart rate and blood pressure.
Anesthesia ; Arrhythmias, Cardiac ; Blood Pressure ; Clonidine* ; Enflurane ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation* ; Laryngoscopy ; Nitrous Oxide ; Oxygen ; Premedication* ; Tachycardia ; Thiopental ; Vecuronium Bromide ; Water

PURPOSE: About 20% to 30% of patients with node-negative breast cancer die of systemic metastases in 10 years after surgery. This may be due to either early occult systemic spread before node metastasis or occult lymph node metastasis (OLNM) which is undectected by routine pathologic evaluation. The purpose of this study was to assess the incidence and its prognostic significance of OLNM in breast cancer. MATERIALS AND METHODS: Paraffin blocks of axillary lymph nodes from 50 patients with invasive breast carcinoma initially diagnosed as node-negative by routine histological examination were evaluated. All nodes were serially sectioned by 40 pm thickness interval, followed by hematoxylin-eosin (H-E) staining and cytokeratin immunohistochemical staining. RESULTS: OLNM were detected in 6 patients (12%) by immunohistochemical method; in 3 of these 6 patients, it were also detectable by serial sectioning and H-E staining. OLNM correlated with the primary tumor size (r=0.43, p <0.05). During mean follow- up of 57 months, there were 4 systemic recurrences and one death. Of 6 patients with OLNM, 2 had multiple systemic recurrences (33.3%). Of 44 patients without OLNM, in contrast, only 3 had systemic recurrences (6.8%). Five year disease-free survival rates of patients with and without OLNM were 66.7% and 93.0%, respectively (p=0.087). CONCLUSION: These results suggest that about 10% of patients with "node-negative" breast cancer have OLNM, and the presence of OLNM may have marginal prognostic significance. Serial sectioning and cytokeratin immunohistochemical staining of axillary lymph nodes should be considered as a part of the routine histologic examination especially in the patients with a large primary tumor.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Humans ; Immunohistochemistry ; Incidence ; Keratins ; Lymph Nodes* ; Neoplasm Metastasis* ; Paraffin ; Recurrence

OBJECTIVES: This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. METHODS: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). RESULTS: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI=0.43-0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb> or =11 g/dL, blood pressure within the range of 100-140/60-90 mmHg, calcium x phosphate< or =55 g2/dL2 and albumin> or =4 g/dL were not significantly different between the groups. CONCLUSIONS: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.
Aged ; Female ; Humans ; Insurance, Health/*classification ; Male ; Medical Audit ; Middle Aged ; *Quality Indicators, Health Care ; *Quality of Health Care ; Renal Dialysis/*standards ; Republic of Korea

Color Doppler echocardiographic examination was performed to detect and evaluate semiquantitatively the severity of mitral regurgitation in 38 patients who underwent left ventriculography. The sensitivity and specificity of the technique in the detection of mitral regurgitation was 84% and 100% as compared with left ventriculography.Mitral regurgitation in the false negative cases was mostly mild. On the bases of the farthest distance reached by the regurgitation flow signal from the mitral value orifice, the severity of regurgitation was graded on a four point scale and these results were compared with those of angiography. A significant correlation(r=0.87) was found between Doppler imaging and angiography in the evaluation of the severity of mitral regurgitation.Also results was obtained for the evaluation based on the area covered by the regurgitant signals in the left atrial cavity & the regurgitant jet area(RJA) experssed as a percentage of the left atrial are(LLA) obtained in the same plane(RJA/LLA%). In conclusion, Color Doppler echocardiography is a useful noninvasvive thechique that is not only sensitive and specific in the identification of mitral regurgitation but also provides accurate estimation og its severity.
Angiography ; Echocardiography ; Echocardiography, Doppler, Color ; Humans ; Mitral Valve Insufficiency* ; Sensitivity and Specificity

Primary Pulmonary leiomyosarcomas are rare tumors. These tumors may arise at any level of the lung in which smooth muscle fibers are found. The highest incidence of sarcoma is during the fourth decade whereas for bronchogenic carcinoma the maximum incidence is during the sixth and seventh decades. Leiomyosarcomas are aggressive and progressive. Treatment is mainly surgical. The chemotherapy is ineffective and the effectiveness of radiotherapy depends on the total dose of irradiation. Prognosis and significant survival rate are related to the size of the lesion. We report one patient with primary pulmonary leiomyosarcoma involving the right lower lung.
Carcinoma, Bronchogenic ; Drug Therapy ; Humans ; Incidence ; Leiomyosarcoma* ; Lung ; Muscle, Smooth ; Prognosis ; Radiotherapy ; Sarcoma ; Survival Rate

To see the usefulness of CT in evaluation of response to treatment in patients with mediastinal tuberculous lymphadenitis (MTL), we analyzed the initial CT patterns and follow-up CTs or serial plain radiographs during 18 months antituberculous chemotheraphy in 58 consecutive patients. CT patterns of MTL at the beginning of treatment were categorized into solid type (n=8), low density with peripheral rim enhancement type (n=36), extranodal extension type (n=9) and calcified type (n=5). According to the response to treatment, each patients was categorized into prompt response group (response within the first three months and no residual lymph node after one year), slow response group (response after three months but residual lesion after one year), no response group (no change in size during 18 months treatment) and temporal increase group (temporal increase in size during the treatment but ultimately improved with chemotheraphy). Among 29 cases of prompt response group, 20 cases had large low-density areas, 6 cases had diffuse or extensive node involvement with extranodal extension or tracheal compression. Two patients with acquired immune derfciency syndrome belonged to this group. Fifteen cases of slow response group had low-density nedes in 7 patients and small solid or extranodal-extension nodes in 6 patients. They were associated with disseminated pulmonary tuberculosis, generalized lymphadenopathy or other organ(pericardium, brain, bone or abdomen) involvement. In 5 cases of no response group, there were 3 cases of calcified node and 2 cases of small solid nodes. Nine cases of temporal increase group included low density type of MTL only. And they were associated with disseminated pulmonary of endobronchial tuberculosis. In conclusion, response to antituberculous chemotherapy could be predicted in patients with MTL on the basis of CT findings before treatment.
Brain ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Tuberculosis ; Tuberculosis, Lymph Node* ; Tuberculosis, Pulmonary

To evaluate the therapeutic effect of various drug combination in experimental pneumoconiosis, a total of 240 Spraque-Dawley was instilled intratracheally by 50 mg free silica or coal dust with 0.8 ml normal saline. In the control group, it was intratracheally instilled only dust at once, while from l1th week experimental groups were administered drug. Experimental groups were divided into 8 groups according to drug combination such as group treated with piperazine and aspirin, piperazine and allopurinol, piperazine and azathioprine, aspirin and allopurinol, aspirin and azathioprine, allopurinol and azathioprine, solumedrol, and solumedrol and cyclophosphamide. The duration of treatment was 10 weeks. All animals were killed at 20th week after dust instillation. We observed body weight at 20th week after dust instillation, the dry lung weight of left lung, total and differential cell count in bronchoalveolaT lavage (BAL) fluid. Leukotriene B4, tumor necrosis factor, and superoxide anion production from alveolar macrophage, amount of hydroxyproline in left lung, and the histopathologic examination in the right lung stained with hematoxylin-eosin and Masson's trichrome. The results were as follows 1. The dry weight of the left lung in groups of treated with piperazine combined with aspirin and piperazine combined with azathloprlne was significantly decreased compared to the control group in silica instilled group. 2. The total number of cells in BAL in all experimental groups of silica instilled group and group of pjperafine/azathioprine and aspirin/allopurinol of coal dust instilled group were significantly decreasea compared to each control group. 3. The silica instilled group, the percentage of macrophage in experimental group tended to be increased in comparison with the control group but neutrophil tended to be decreased. Among experimental group, in the group treated with solumedrol and solumedrol/cyclophosphamide, the percentage and number of Iymphocyte markedly increased compared to each control group 4. The amounts of Hydroxyproline in the group piperazine/allopurinol and piperazine/azathioprine of silica instilled group were markedly lower than in the control group. 5. The preduction of TNF from alveolar macrophage in experimental group tended to be decreased compared to each control group. 6. The pathologic score that quantified the pathologic finding in the right lung, in all exporimental groups except the treated with regimen contained solumedrol of silica instilled group was significantly decreased compared to control group. In coal dust instilled group, the pathologic score of the group treated with piperazine and allopurinol, aspirin and azathioprine, and allopurinol and azathioprine was markedly lower than control group. 7. We analyzed the indices for alveolitis and fibTosis. The most effective drug combination was treated with piperazine combined with azathioprine and piperazine combined with allopurinol.
Allopurinol ; Animals ; Aspirin ; Azathioprine ; Body Weight ; Cell Count ; Coal ; Cyclophosphamide ; Drug Combinations* ; Dust ; Hydroxyproline ; Leukotriene B4 ; Lung ; Macrophages ; Macrophages, Alveolar ; Methylprednisolone Hemisuccinate ; Neutrophils ; Pneumoconiosis* ; Silicon Dioxide ; Superoxides ; Therapeutic Irrigation ; Tumor Necrosis Factor-alpha

Elbow tuberculosis is a rare disease which accounts for 1-3% of all cases of osteoarticular tuberculosis. The diagnosis of tuberculous arthritis is very difficult in most clinical situations because of the insidious onset, indolent process, and mild and non-specific local or systemic symptoms. Thus, the confirmatory diagnosis and effective treatment for tuberculous arthritis are delayed until the disease progresses to an advanced stage in many clinical settings. Herein we report a case of septic arthritis of the elbow due to Mycobacterium tuberculosis as a result of misdiagnosis and delayed treatments.
Arthritis ; Arthritis, Infectious ; Diagnostic Errors ; Elbow ; Mycobacterium tuberculosis ; Rare Diseases ; Tuberculosis ; Tuberculosis, Osteoarticular

Elbow tuberculosis is a rare disease which accounts for 1-3% of all cases of osteoarticular tuberculosis. The diagnosis of tuberculous arthritis is very difficult in most clinical situations because of the insidious onset, indolent process, and mild and non-specific local or systemic symptoms. Thus, the confirmatory diagnosis and effective treatment for tuberculous arthritis are delayed until the disease progresses to an advanced stage in many clinical settings. Herein we report a case of septic arthritis of the elbow due to Mycobacterium tuberculosis as a result of misdiagnosis and delayed treatments.
Arthritis ; Arthritis, Infectious ; Diagnostic Errors ; Elbow ; Mycobacterium tuberculosis ; Rare Diseases ; Tuberculosis ; Tuberculosis, Osteoarticular