Inhalation induction of anesthesia is seldom used in a routine adult practice because of the long induction time and the prolonged excitement phase with the risk of laryngospasm and vomiting. So in modern practice, anesthesia is usually administered intravenously and produces unconsclousness pleasantly. However there are situaions where intravenous induction may not be ideal, and where rapid induction is still desired. The author wanted to evaluate the clinical application of inhalation induction of halothane using a vital capacity breath as a substitute for intravenous induction of anesthesia. The patients in this study had an ASA physical status of l or ll and presented no cardiopulmonary disease or abnormal laboratory data. The patients were divided into two group: a control group(n=30) and an experimental group(n=30). Control group: Intravenous induction with thiopental sodium. Experimental group: Inhalation induction with halothane using a vital capacity breath. The results are as follows: 1) The control group consisted of 14 males and 16 females. The mean age was 37.8+/-11.5years, and the ages ranged from 16 to 65 years. The mean body weight was 59.8+/-8.0kg, and body weights ranged from 44 to 75kg. in the experimental group, there were 17 males and 13 females. The mean age was 28.9+/-13.7 years, and the ages ranged from 18 to 65 years. The mean body weight was 57.4+/-8.1 kg, and body weight ranged from 43+/-75kg. 2) In the experimental group, the apnea time ranged from 20 to 105 sec, with a mean of 44.5+/-20.4 sec. The mean induction time was 76.7+/-32.1sec. and induction time ranged from 20 to 150 sec. There was no relationship between apnea time and induction time. 3) The hemodynamic changes were as follows: a. There were significantly greater changes in blood pressure and pulse rate during intubation and postintubation in the control group than in the experimental group(p<0.05). b. There were significant changes in blood pressure and pulse rate in the control group(p<0.05), but seemed not to be hazardous clinically. 4) Induction was impossible in two patients in the experimental group due to profuse secretion or excitement. 5) The side effects in the experimental group included coughs(5 cases), arrythmias(4), excitements(4) and secretion(1), respectively. 6) Postanesthetic comments in the experimental group:27 of the 28 patients remembered the anesthetic smells: 3 pleasantly, 20 moderately and 4 unpleasantly. In conclusion, inhalation induction of halothane using a vital capacity breath is a safe, acceptable and practical alternative to intravenous induction in cooperative adult patients.
Adult ; Anesthesia ; Apnea ; Blood Pressure ; Body Weight ; Female ; Halothane* ; Heart Rate ; Hemodynamics ; Humans ; Inhalation* ; Intubation ; Laryngismus ; Male ; Smell ; Thiopental ; Vital Capacity* ; Vomiting

The retrograde microorganismal colonization in the pharynx from stomach may cause the nosocomial pneumonia and that may be more likely when the gastric pH is relatively high. We tried to find out the relationships between the gastric pH and the incidence of nosocomial pneumonia with twenty patients intubated for longer than 48 hours at ICU. We achieved following results: 1) The incidence of the nosocomial pneumonia was twenty percent. 2) All the patients developed nosocomial pneumonia showed the gastric pH above 4.0. 3) In the patients intubated for longer than 5 days, the incidence of nosocomial pneumonia was 33.3% in contrast to 9.0% for less than 5 days. 4) With the sputum culture, the incidence of colonization was higher in the patients with gastric pH above 4.0 than that in the patients with gastric pH below 4.0(84.6% vs 58.1%). 5) With regard to the duration of intubation, the incidence of colonization was higher in the patients intubated for longer than 4 days than that in the patients intubated for less than 4 days(90% vs 50%). 6) The most common pathognomic organisms were astreptoccus and Pseudomonas aeroginosa. It is conculded that the nosocmial pneumonia might develop more frequently in the patients with gastric pH above 4.0 than in the patients with gastric pH below establishment of the relationship between the treatment of the stress ulcer and the nosocomial pneumonia.
Colon ; Humans ; Hydrogen-Ion Concentration* ; Incidence ; Intubation ; Pharynx ; Pneumonia* ; Pseudomonas ; Sputum ; Stomach ; Ulcer

PURPOSE: The clinical significance of Y. pseudotuberculosis infection has recently recognizd in various part of the world, because it can cause a wide range of clinical problems such as mesenteric lymphadenitis, septicemia, reactive arthritis, terminal ileitis, erythema nodosum, and a cute renal failure. We have experienced 19 children with Y. pseudotuberculosis infection confirmed by stool culture. Our aim in this study was to evaluate clinical charactieristics, age and sex distribution, and source of infection. METHODS: Stools were inoculated on CIN(Cefsulodin-Irgasan-Novobiosin) agar (Difco, USA) and incubated for 48hr at 22 degrees C for isolation of Y. pseudotuberculosis. API 20E and VITEC were used for identification of the isolates. The antimicrobial sensitivity tests were performed by GN S(gram negative sensitive) card. Clinical characteristics were analyzed retrospectively. RESULTS: Retrospective analysis of 19 children with Y. pseudotuberculosis infection who visited our hospital between Jun.1993 and Dec.1993 was performed. The most prevalent age group was 6 to 8 years(42%) and monthly distribution showed November, December, June, and July in order of frequency, respectively. The common symptoms and signs were fever(100%), abdominal pain(100%), rash(74%), s trawberry tongue(53%), vomiting(53%), diarrhea(37%), and desquamation(32%), respectively. Four cases among 9 cases showed multiple mesenteric lymph node enlargements on the abdominal ultrasonogaphy. Serogroups of the isolates from stool specimens were type 5(15/19, 79%), and type 4(4/19, 21%), respectively. Y. pseudotuberculosis was also isolated from 3 samples of untreated drinking water which was thought to be the source of infection. There were no resistance strains against Amikacin, Carbenidlin, Gentamicin, and Trimethoprim/Sulfamethoxazole in the antibiotic susceptibility tests. CONCLUSIONS: In this study, the antibiotic susceptibility against Y. pseudotuberculosis was excellent, although the clinical characteristics were various. We have found that untreated drinking water was an important source of this infection. Further epidemiologic study for this infection should be needed.
Agar ; Amikacin ; Arthritis, Reactive ; Child* ; Crohn Disease ; Drinking Water ; Epidemiologic Studies ; Erythema Nodosum ; Gentamicins ; Humans ; Lymph Nodes ; Mesenteric Lymphadenitis ; Renal Insufficiency ; Retrospective Studies ; Sepsis ; Sex Distribution ; Yersinia pseudotuberculosis* ; Yersinia*

This study was aimed to elucidate the endothelium-dependent vascular effects of halothane and sevoflurane on rabbit aortic rings at two conventional concentrations(high induction and low maintenance concentration in human). Isometric tenslon was recorded in isolated aortic rings. Preparations of rabbit thoracic aorta were suspended in Krebs' buffer and aerated with 95% O2 and 5% CO2. One set of the rings had intact endothelium and the other set of the rings had endothelium mechanically denuded. In the first experiments, the rings were precontracted with norepinephrine(NE) of 10-7 M. After tension was stabilized in 10~15 minutes following NE, halothane(1, 2%) or sevoflurane(2, 4%) was bubbled with O2/CO2 gas mixture at increasing concentrations. In the second experiment, O2/CO2 gas mixture only(control rings), halothane 2% or sevoflurane 4 % with O2/CO2, gas mixture was bubbled for 10(-7) minutes prior to and during contraction with NE of 10M. After tension was stabilized following NE, acetylcholine(10(-8)-10(-6) M) was added cumulatively. In the third experiment, the procedure was as same as the second experiment except for that acetylcholine(10(-8)-10(-6) M) was substitued for nitroglycerin (10(-9)-10(-6) M) . The present study demonstated that both of halothane and sevoflurane at high concentration caused a vasoconstriction to 110.7+/-4.2% and 122.4+/-8.4% in vascular rings with intact endothelium, and 106.1+/-1.9% and 118.3+/-3.5% in vascular rings with denuded endothelium, respectively, compared to each control value of 100%. Furthermore, halothane and sevoflurane attenuated the acetylcholine induced relaxing response in NE-precontracted vascular rings with intact endothelium, but did not affect any change of tension in vascular rings with denuded endothelium. Halothane and sevoflurane did not attenuate the nitroglycerin induced relaxing response in NE-precontracted vascular rings with both intact and denuded endothelium. In conclusion, halothane and sevoflurane at high concentration has vasoconstrictory effects on vascular smooth muscles in rabbit aortic rings regardless of presence of endothelium and also attenuated the endothelium-dependent relaxation.
Acetylcholine ; Aorta, Thoracic ; Endothelium* ; Halothane* ; Muscle, Smooth, Vascular ; Nitroglycerin ; Norepinephrine ; Relaxation ; Vasoconstriction

In implant restorations, it is difficult for the patient to percept any symptoms. In addition, they are absent of shock absorbers, which can lead to mechanical failure if stress distribution is not considered. Since maxillary anterior multiple-implant restorations play a significant role in guiding the functional movement of the mandible by distributing lateral force, it is crucial to form appropriate occlusion. The use of the T-scan system is more advantageous in assessing ‘dynamic occlusion’, such as the change of occlusion over time, the amount of tooth contact during functional movement, and assessing the occlusion in the less-visible posterior teeth. The case is reported as it has satisfactory results in harmonious anterior guidance of a maxillary anterior multiple-implant restoration using T-scan analysis.
Humans ; Mandible ; Prostheses and Implants* ; Shock ; Tooth

Treatment by All-trans retinoic acid (ATRA) followed by anthracycline-AraC chemotherapy has improved the outcome of acute promyelocytic leukemia. ATRA is usually well tolerated, but a few major side effects can be observed. Retinoic acid syndrome (RAS) often occurs during the induction chemotherapy of acute promyelocytic leukemia. A pericardial effusion is a common cardiac manifestation but myocarditis has been rarely documented. Here we reports a very rare case of fully recovered myocarditis as a result of RAS related to ATRA administration during induction treatment of acute promyelocytic leukemia which documented by echocardiographic evidence.
Induction Chemotherapy ; Leukemia, Promyelocytic, Acute ; Myocarditis ; Pericardial Effusion ; Tretinoin

Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia caused by insulin autoantibodies in the absence of exogenous insulin administration. Some drugs containing sulfhydryl compounds are known to initiate the onset of IAS. A 67-year-old female who had diabetes for 5 years visited the outpatient clinic at our institution due to diabetic peripheral polyneuropathy. She was prescribed alpha-lipoic acid (ALA), which contains two sulfur atoms. Two weeks later, she complained of recurrent hypoglycemic symptoms. We detected a high level of insulin and high titers of insulin autoantibodies. Her human leukocyte antigen (HLA) genotype included the DRB1*0406 allele, which indicates a high level of susceptibility to IAS. She was treated with prednisolone. After this episode, she experienced two more hypoglycemic events after taking ALA for diabetic neuropathy in other hospitals. As ALA can be used to treat diabetic peripheral polyneuropathy, physician discretion is advised based on the possibility of IAS due to ALA in diabetic patients.
Aged ; Alleles ; Ambulatory Care Facilities ; Autoantibodies ; Diabetic Neuropathies ; Female ; Genotype ; Humans ; Hypoglycemia ; Insulin Antibodies ; Insulin* ; Leukocytes ; Polyneuropathies ; Prednisolone ; Sulfhydryl Compounds ; Sulfur ; Thioctic Acid*

Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia caused by insulin autoantibodies in the absence of exogenous insulin administration. Some drugs containing sulfhydryl compounds are known to initiate the onset of IAS. A 67-year-old female who had diabetes for 5 years visited the outpatient clinic at our institution due to diabetic peripheral polyneuropathy. She was prescribed alpha-lipoic acid (ALA), which contains two sulfur atoms. Two weeks later, she complained of recurrent hypoglycemic symptoms. We detected a high level of insulin and high titers of insulin autoantibodies. Her human leukocyte antigen (HLA) genotype included the DRB1*0406 allele, which indicates a high level of susceptibility to IAS. She was treated with prednisolone. After this episode, she experienced two more hypoglycemic events after taking ALA for diabetic neuropathy in other hospitals. As ALA can be used to treat diabetic peripheral polyneuropathy, physician discretion is advised based on the possibility of IAS due to ALA in diabetic patients.
Aged ; Alleles ; Ambulatory Care Facilities ; Autoantibodies ; Diabetic Neuropathies ; Female ; Genotype ; Humans ; Hypoglycemia ; Insulin Antibodies ; Insulin* ; Leukocytes ; Polyneuropathies ; Prednisolone ; Sulfhydryl Compounds ; Sulfur ; Thioctic Acid*

We cloned the full-length cDNA of O Manisa, the virus for vaccinating against foot-and-mouth disease. The antigenic properties of the virus recovered from the cDNA were similar to those of the parental virus. Pathogenesis did not appear in the pigs, dairy goats or suckling mice, but neutralizing antibodies were raised 5-6 days after the virus challenge. The utilization of O Manisa as a safe vaccine strain will increase if recombinant viruses can be manipulated by inserting or removing a marker gene for differential serology or replacing the protective gene from another serotype.
Animals ; Antibodies, Neutralizing ; Clone Cells* ; Cloning, Molecular ; DNA, Complementary* ; Foot-and-Mouth Disease ; Foot-and-Mouth Disease Virus* ; Goats ; Humans ; Mice ; Parents ; Swine ; Virulence*

Background: To investigate the efficacy and safety of moderate-intensity rosuvastatin/ezetimibe combination compared to highintensity rosuvastatin in high atherosclerotic cardiovascular disease (ASCVD) risk patients with type 2 diabetes mellitus (T2DM). Methods: This study was a randomized, multicenter, open, parallel phase 4 study, and enrolled T2DM subjects with an estimated 10-year ASCVD risk ≥7.5%. The primary endpoint was the low-density lipoprotein cholesterol (LDL-C) change rate after 24-week rosuvastatin 10 mg/ezetimibe 10 mg treatment was non-inferior to that of rosuvastatin 20 mg. The achievement proportion of 10-year ASCVD risk <7.5% or comprehensive lipid target (LDL-C <70 mg/dL, non-high-density lipoprotein cholesterol <100 mg/dL, and apolipoprotein B <80 mg/dL) without discontinuation, and several metabolic parameters were explored as secondary endpoints. Results: A hundred and six participants were assigned to each group. Both groups showed significant reduction in % change of LDL-C from baseline at week 24 (–63.90±6.89 vs. –55.44±6.85, combination vs. monotherapy, p=0.0378; respectively), but the combination treatment was superior to high-intensity monotherapy in LDL-C change (%) from baseline (least square [LS] mean difference, –8.47; 95% confidence interval, –16.44 to –0.49; p=0.0378). The combination treatment showed a higher proportion of achieved comprehensive lipid targets rather than monotherapy (85.36% vs. 62.22% in monotherapy, p=0.015). The ezetimibe combination significantly improved homeostasis model assessment of β-cell function even without A1c changes (LS mean difference, 17.13; p=0.0185). Conclusion In high ASCVD risk patients with T2DM, the combination of moderate-intensity rosuvastatin and ezetimibe was not only non-inferior but also superior to improving dyslipidemia with additional benefits compared to high-intensity rosuvastatin monotherapy.