A controlled study was carried out in 50 patients with perennial bronchial asthma to assess the efficacy and safety of budesonide turbuhaler. Subjects have suffered from cough, wheezing, dyspnea and chest tightness and showed either 15% of reversibility in FEV after bronchodilator inhalation or airway hyperresponsiveness to methacholine(PC20 < or = 25mg/ml.) Patients were randomized to treatment with budesonide turbuhaler or terbutaline turbuhaler for 8 weeks after 2 weeks of run-in period. Budesonide turbuhaler was effective for cough, wheezing, dyspnea and chest tightness. It improved peak expiratory flow rate and FEV1. Budesonide turbuhaler was tolerated well and the laboratory tests showed no abnormality. It is suggested that budesonide turbuhaler is effective and safe in the management of bronchial asthma.
Asthma ; Budesonide* ; Cough ; Dyspnea ; Humans ; Inhalation ; Peak Expiratory Flow Rate ; Respiratory Sounds ; Terbutaline ; Thorax

IgE-mediated sensitization to natural rubber latex can induce immediate hypersensitivity reactions ranging from contact urticaria to life threatening anaphylaxis. Recent reports suggest that asthma is also relatively frequent manifestation of latex allergy. In this case report, lat,ex induced asthma is described in an operat.ing room nurse regularly exposed t,o latex gloves. Her latex sensitivity was detected by skin prick testing. Specific bronchial provocation test with latex extract showed an early asthmatic reaction. Her symptoms had been much improved after avoidance. Occupational asthma induced by latex may be not uncommon among health care workers.
Anaphylaxis ; Asthma ; Asthma, Occupational* ; Bronchial Provocation Tests ; Delivery of Health Care ; Humans ; Hypersensitivity, Immediate ; Latex ; Latex Hypersensitivity ; Personnel, Hospital* ; Rubber ; Skin ; Urticaria

No abstract available.
Thioctic Acid*

The most important prognostic factor of breast cancer is the status of lymph node or distant metastasis, which is resisted by basement membrane and stromal matrix. MMP (matrix metalloproteinase)-2 is a 72-kilodalton type IV collagenase/ gelatinase and degrades the type IV collagen which is a main component of the basement membrane. Therefore, MMP-2 is believed to be one of the key molecule for cancer invasion and metastasis. Enzymatic activity of MMP is inhibited by TIMPs (tissue inhibitors of metalloproteinase). TIMP-2 forms a complex with latent pro-MMP-2 and inhibits the active forms of MMP-2. The balance of MMPs and TIMPs is suspected as the important factor of invasion and metastasis of the tumor cells. We studied the association between the expression of MMP-2/TIMP-2 and growth pattern of tumor border, lymph node metastasis, and estrogen receptor expression in the 57 cases of invasive ductal carcinoma of the breast using immunohistochemical staining methods. The results revealed increased expression of MMP-2 in the infiltrating tumor border and tumors with positive lymph node metastasis and negative estrogen receptor with no statistical significance (p>0.05). But the expression of TIMP-2 was increased in expanding tumor border and tumors with positive lymph node metastasis and negative estrogen receptor without statistical significance (p>0.05).
Basement Membrane ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Collagen Type IV ; Estrogens* ; Gelatinases ; Lymph Nodes* ; Matrix Metalloproteinases ; Neoplasm Metastasis* ; Tissue Inhibitor of Metalloproteinase-2*

BACKGROUND: During pediatric general anesthesia with Mapleson D-circuit, we used large amount of FGF(fresh gas flow) for avoidance of rebreathing of expired gas but low FGF are employed, the amount of anesthetic consumption and air contamination can be reduced. The aim of this study was to evaluate the fact that FGF of 220 ml/kg/min is clinically acceptable. METHODS: We selected sixty children weighing < or =20 kg who were scheduled for inguinal hernia repair under general anesthesia. The study was performed by 2 steps; In the step 1, the patients were divided into two groups according to weight(less than or greater than 8 kg) and end-tidal Pco2 were compared with simultaneous arterial Pco2 measurements. In the step 2, the patients were divided into two groups according to FGF(2MV or 220 ml/kg) and arterial Pco2, end tidal Pco2 and PminCO2(minimum inspired Pco2) were measured. RESULTS: In the step 1 study, arterial Pco2 was significantly higher than end-tidal Pco2 in the group 1 and there was slight difference in arterial Pco2 and end-tidal Pco2 in the group 2. In the step 2 study, PaCO2, PetCO2, PminCO2 were significantly increased in the group 3 than group 2 but there were no clinical hypoxemia in all patients. CONCLUSIONS: We consider that FGF of 220 ml/kg/min is appropriate during controlled ventilation with Mapleson D circuit in children weighing > or =8 kg because of economic and ecological advantages. Also, we consider FGF can be reduced in children weighing <8 kg under accurate respiratory gas monitoring.
Anesthesia, General* ; Anesthetics ; Anoxia ; Blood Pressure ; Child ; Heart Rate ; Hernia, Inguinal ; Humans ; Lidocaine ; Ventilation

Despite the substantial amount of asthma-related information available on the internet, little is known about the quality of such information. We assessed asthma-related information on the Korean internet intended as an educational material for asthma patients. By entering the key word, 'asthma', into 4 popular search engines, 32 web sites were identified and categorized with respect to authorship. The core asthma educational concepts and Health On the Net Code of Conduct principles were used to evaluate informational value and justifiability of unreliable information. Eight of 32 web sites were categorized as western physician, seventeen as oriental physician, four as commercial, and three as others. The mean number of core asthma educational concepts on the whole web sites was 2.7 out of 8. By type of authorship, 1.7 on the commercial sites, 2.1 on the oriental physician sites, 3.5 on the western physician sites, and 5.0 on the others sites in decreasing order. One of the western physician sites, two of the commercial sites, and all of the oriental physician and others sites contained unreliable information. However all of them except one site failed to satisfy our criteria of justifiability. Asthma-related information currently available on the Korean internet is highly variable in quality and lacks core asthma educational concepts and justifiability.
Asthma/*diagnosis/*therapy ; Health Education ; Human ; Internet ; Korea ; Medical Informatics ; Patient Education/*methods ; Quality Control

BACKGROUND: It is well known that when macrophages are stimulated with endotoxin, they produce a wide variety of cytokine mediators, including TNF-α and IL-1β. However, there is an alterationnin the macrophages responsiveness when they are challenged with repeated bouts of endotoxin, termed 'endotoxin tolerance' which is regarded as a self-protective phenomenon from continuous stimulation. In this study, endotoxin tolerance in the peripheral blood monocytes of sepsis patients was evaluated. METHODS: Fourteen patients with organism-documented sepsis were included. The severity of illness was evaluated by APACHE IIscore. Peripheral blood monocytes were isolated from the patients and diluted to 1×105/well. After stimulation with endotoxin(LPS of E. coli O114:B4, 100 ng/ml), they were incubated at 37℃ in 5% CO2 incubator for 24 hours. Supernatant was collected for the measurement of TNF-αand IL-1β with ELISA method. Peripheral blood monocytes of seven healthy volunteers were used as control. RESULTS: The APACHE IIscore(mean±SD) of the patients at the time of blood sampling was 12.2±5.7. The primary infection foci were urinary tract infection, pneumonia, subacute bacterial endocarditis, and catheter related infection, etc. The causative organisms were gram negative rods(10 cases), gram positive cocci(6 cases) with two cases of mixed infection. Serum TNF-α could be measured in 4 cases with 29.9±27.7 pg/ml. Serum IL-1β was measureable in only one patient. The TNF-α level of supernatant of cultured peripheral blood monocytes was 2,703±2,066 pg/ml in patients and 2,102±1,914 pg/ml in controls. The IL-1β level of supernatant was 884±1,050 pg/ml in patients and 575±558 pg/ml in controls. There was no difference of TNF-α and IL-1β level between patients and controls. CONCLUSION: We cannot prove the phenomenon of endotoxin tolerance in this study. Future study needs to be focused on the more severe sepsis patients who were taken for sampling earlier. Addition of serum to the culture medium could be an another valuable option for the success of this study.
APACHE ; Catheters ; Coinfection ; Endocarditis, Subacute Bacterial ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Humans ; Incubators ; Macrophages ; Monocytes ; Pneumonia ; Sepsis* ; Tumor Necrosis Factor-alpha* ; Urinary Tract Infections

BACKGROUND: Bronchial asthma is a complex genetic disorder. Although serum IgE level and bronchial hyperresponsiveness are well known to be under genetic control, the influence of genetic factors on basophil releasability has been seldom studied. OBJECTIVE: The present study was carried out to investigate whether genetic factors may influence the basophil histamine releasability. MATERIALS AND METHODS: We studied 50 children, 32 with atopic asthma (AA) and 18 normal control (NC), and their parents. Suspensions of leukocytes were isolated and stimulated with Ca ionophore and anti-IgE antibody. Then, histamine in the supernatant was as-sayed by an automated fluorometric analyzer. RESULTS: Among the probands, AA children had a significantly higher anti-IgE induced histamine release than NC children. In contrast, Ca ionophore-induced histamine release was similar between the two groups. Ca ionophore-induced or anti-IgE-induced histamine release was not significantly different between parents of AA children and those of NC children. However, the maximal histamine release by Ca ionophore in parents had a significant correlation with that of probands, whereas the values by anti-IgE were not correlated between probands and their parents. CONCLUSION: We confirmed that basophils from patients with atopic asthma are characterized by a specific increase in IgE-mediated histamine release. The significant correlation of Ca ionophore-induced maximal histamine release between children and their parents suggests that genetic factors may play an important role in the control of non-IgE-mediated relessability from basophils.
Asthma ; Basophils* ; Child ; Genetics ; Histamine Release ; Histamine* ; Humans ; Immunoglobulin E ; Leukocytes ; Parents ; Suspensions

BACKGROUND: Bronchial hbyperresponsiveness (BHR) is a key feature of asthma, and may precede the development of asthma. Genetically determined and acquired factors may contribute to development of BHR. OBJECTIVE: To evaluate expression of bronchial responsiveness to methacholine according to age, sex, smoking habit, and atopy in general population without bronchial asthma, a cross sectional study was performed. METHOD: A total of 1,190 general population who composed of 408 subjects with age less than 19 years (young age group), 621 subjects with age from 20 to 40 years (middle age group), and 161 subjects with age more than 41 years (old age group) were enrolled. Evaluations were made by a questionnaire, serum IgE level and skin prick test to common inhalant allergens, and methacholine bronchial provocation test (MBPT). Bronchial responsiveness were evaluated by positive rate of MBPT (PC,p-methacholine 4 25mg/ml), and slope of dose- response curve (slope, %fall of FEV, / log[last concentration of methacholine, mg/ml]). RESULT: Positive rate of MBPT was 11.0%, and slope (mean+SE) was 10.6+0.2 %/mg/ml. Postive rate of MBPT was more prevalent in the young age group than in middle and old age groups (19.6% vs. 6.6% vs. 6.2%, p<0.05), and slope was higher in young age group than in other groups (14.4+0.4 vs. 8.6+0.3 vs. 8.9+0.5 %/mg/ml, p<0.05). No significant differences in positive rate of MBPT and slope were noted according to sex in young and old age groups. However, in the middle age group, slope was higher in females than in males (9.5+0.4 vs. 7.9+ 0.3 %/mg/ml, p<0.05). No significant differences of slope was observed according to smoking habit in males of middle age group, but in males of old age group, the slope was higher in subjects with smoking habit than those without it (9.6+0.8 vs. 6.5+0.9 %/mg/ml, p<0.05). Significant relationship was observed between geometric value of serum IgE level and slope(r=0. 152, p=0.009). The postive rate of MBPT and slope were significantly higher in subjects with positive skin rea,ctivity to common inhalant allergens than those without it (14.3% vs. 8.6%, p ( 0.05; 11.8+0.4 vs. 9.8+0.3 %/mg/ml, p<0.05). The difference of bronchial responsiveness according to skin reactivity was observed in young and middle age groups, but not in old age group. CONCLUSION: Bronchial responsiveness to methacholine is significantly higher in children than in adults, in middle-aged females than in middle-aged males. Atopy and smoking may have a dif ferent role to determine the bronchial responsiveness depending upon age and sex.
Adult ; Allergens ; Asthma* ; Bronchial Provocation Tests ; Child ; Female ; Humans ; Immunoglobulin E ; Male ; Methacholine Chloride* ; Middle Aged ; Skin ; Smoke ; Smoking ; Surveys and Questionnaires

BACKGROUND: Rapid adrenocorticotropin (ACTH) stimulation test using 250ug of ACTH (1-24) has been used as a standard test in the initial assessment of adrenal function. However, it has recently been suggested that a rnaximal cortisol response can be achieved with a much lower ACTH dose, and reducing the dose might further enhance the sensitivity of the test in the detection of mild adrenal insufficiency. This study was performed to evaluate the role of low-dose (lug) ACTH stimulation test in the assessment of adrenal function and the diagnosis of subtle adrenal insufficiency. METHODS: Twenty-two subjects with suspected adrenal insufficiency due to long-term corticosteroid use were included in this study. The correlations between clinical features and the serum cortisol responses to low dose (lug) and high dose (250 ug) ACTH stimulation were evaluated. RESULTS: In high dose test, 10 (67%) out of 15 subjects with clinical features of adrenal insufficiency showed decreased serum cortisol response (peak cortisol level <18 ug/dL), but 5 (33%) subjects showed normal response (peak cortisol level > 18ug/dL). On the other hand, 14 (93%) subjects with clinical features of adrenal insufficiency showed decreased serum cortisol response in low dose test, while only one showed normal response. In 7 subjects without clinical features of adrenal insufficiency, 5 subject (71%) showed normal response, and 2 subjects (29%) showed decreased response in both low and high dose tests. CONCLUSION: These results suggest that the 1-ug low dose ACTH stimulation test might be more sensitive than conventional 250-ug test in the detection of mild adrenal insufficiency. Further studies are needed to determine the optimal dose of ACTH and the criteria for normal response to ACTH stimulation.
Adrenal Insufficiency* ; Adrenocorticotropic Hormone* ; Cosyntropin ; Diagnosis* ; Hand ; Hydrocortisone