The purpose of this study was to find out the effeet of midazolam and fentanyl on oxygcn saturation by pulse oximetry in surgical patients under spinal anesthesia. The subjects of this study were 83 patients who were operated on under spinal anesthesia, at a general hospital in Pusan. from December 1st, 1997 to March 31st, 1998. The subjects of Group 1 were 53 patients who did not receive either of midazolam and fentanyl. The subjects of Group 2 were 21 patients who received midazolam. The subjects of Group 3 were 9 patients who received both midazolam and fentanyl. Oxygen saturation was measured with a pulse oximeter by time series. The collected data were analyzed by the SPSS / PC~ program and the results of the study were as follows 1. There were no significant differences among the three experimental groups in terms of age or cardiopulmonary disease. 2. Among the three groups, there were statistically significant differences in Sp02 at 5 minutes after starting the operation or after intravenous injection of drugs. The SpO2 mean for Group 3 was 92.4%, for Group 2 it was 97.7%. and for Group 1 it was 98.2%. 3. Hypoxemia cases occurred in 88.9% of Group 3, 28.6% of Group 2, and 17.0% of Group 1, respectively. It is concluded that oxygen saturation mo4oring should be done routinely to all patients under ~spinal anesthesia, especially during operating tim4. and patients receiving midazolam and fentanyl should be monitored closely. After monitoring oxygen should be administered to all patients who developed hypoxemia.
Anesthesia ; Anesthesia, Spinal* ; Anoxia ; Busan ; Fentanyl* ; Hospitals, General ; Humans ; Injections, Intravenous ; Midazolam* ; Oximetry ; Oxygen*

No abstract available.
Humans ; Humerus* ; Neck* ; Shoulder Dislocation* ; Shoulder* ; Tears*

BACKGROUND: The measurement of carbon monoxide concentration in expired air is used as an objective method to analyze the smoking status. This method has been proven to be reliable and is used throughout the world but it has been only recently accepted in Korea. Therefore the purpose of this study was to examine if measuring the concentration in expired air accurately reflects the Korean's smoking status. METHODS: The subjects were from ages of 19 through 75 healthy people including smokers and nonsmokers. The smokers had their carbon monoxide measured after answering a questionnaire. This questionnaire was formed to obtain information concerning smoking status, smoking habit and factors that influence carbon monoxide measurement. Micro II smokerlyzer (Bedfont Instruments Ltd., England) was used to analyze CO concentration in expired air. The method used for measuring CO concentration was to deeply inhale and hold one's breath for 15 seconds and measure CO concentration while exhaling. RESULTS: The total number of subjects was 148(143 males, 5 females) consisting of 114 smokers, 34 non smokers(never smokers 23, ex smokers 11). The average CO concentration in exhaled air in smokers was 17.247.30 ppm, in nonsmokers 6.031.06 ppm(in ex smokers 6.361.29 ppm, in never smokers 5.870.92 ppm). A significant difference was evident between smokers and non smokers(P<0.0001). The CO concentration values compared among the groups divided in terms of daily smoking rate were as the following 11.885.57 ppm in subjects smoking less than 10 cigarettes/day, 17.356.48 ppm in those smoking 11 20 cigarettes/day, 20.006.35 ppm in the 21 30 cigarettes/day group, and 24.889.70 ppm in the 31 cigarettes/day group (p<0.0001). In addition, the CO concentration was influenced by the change of the degree of inhalation and the elapsed time since last smoking. CONCLUSION: The measurement of CO concentration in exhaled air among the Koreans proved to be an accurate and reliable method reflecting the present smoking status.
Carbon Monoxide* ; Carbon* ; Exhalation ; Humans ; Inhalation ; Korea ; Male ; Smoke* ; Smoking* ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: It is known that a part of laryngeal premalignant lesions progresses to an invasive carcinoma. Despite many previous reports, conventional histology is not sufficient to predict such tumor progression. Herein, the authors investigated the role of CD44v3 as a biomarker in predicting the progression of laryngeal premalignant lesion to an inavasive cancer. SUBJECTS AND METHOD: Paraffin-embedded tissue specimens from 40 patients were diagnosed accordingly as laryngeal invasive squamous cell carcinoma (n=10), Carcinoma in situ (n=10), dysplasia (n=10), and hyperkeratosis (n=10) between 1993 and 2002. They were immunohistochemically stained for CD44v3 protein. RESULTS: In invasive squamous cell carcinoma, the expression of CD44v3 was diffused and gave a strong positive stain, and in carcinoma in situ, it was diffused and gave 3+-2+ stain. However, in dysplasia and hyperkeratosis, the proportion of CD44v3 expression was decreased by 2+-1+, and 1+-0, respectively. CONCLUSION: These results suggest that the expression of CD44v3 in laryngeal premalignant and malignant lesions can be associated with tumorigenesis and invasion. Those strong positive expressions of CD44v3 may represent more aggressive pathology of the larynx.
Carcinogenesis ; Carcinoma in Situ ; Carcinoma, Squamous Cell ; Humans ; Larynx* ; Pathology

OBJECTIVE: To identify the center of extensor indicis (EI) muscle through cadaver dissection and compare the accuracy of different techniques for needle electromyography (EMG) electrode insertion. METHODS: Eighteen upper limbs of 10 adult cadavers were dissected. The center of trigonal EI muscle was defined as the point where the three medians of the triangle intersect. Three different needle electrode insertion techniques were introduced: M1, 2.5 cm above the lower border of ulnar styloid process (USP), lateral aspect of the ulna; M2, 2 finger breadths (FB) proximal to USP, lateral aspect of the ulna; and M3, distal fourth of the forearm, lateral aspect of the ulna. The distance from USP to the center (X) parallel to the line between radial head to USP, and from medial border of ulna to the center (Y) were measured. The distances between 3 different points (M1– M3) and the center were measured (marked as D1, D2, and D3, respectively). RESULTS: The median value of X was 48.3 mm and that of Y was 7.2 mm. The median values of D1, D2 and D3 were 23.3 mm, 13.3 mm and 9.0 mm, respectively. CONCLUSION: The center of EI muscle is located approximately 4.8 cm proximal to USP level and 7.2 mm lateral to the medial border of the ulna. Among the three methods, the technique placing the needle electrode at distal fourth of the forearm and lateral to the radial side of the ulna bone (M3) is the most accurate and closest to the center of the EI muscle.
Adult ; Cadaver* ; Electrodes ; Electrodiagnosis ; Electromyography* ; Fingers ; Forearm ; Head ; Humans ; Needles* ; Ulna ; Upper Extremity

Hereditary hemolytic anemia comprises a group of disorders in which red blood cells are destroyed faster than they are produced in the bone marrow; various hereditary factors can cause this condition, including production of defective Hb and erythrocyte membrane. Recently, we identified Hb Koriyama, a rare Hb variant that was undetectable in Hb electrophoresis and stability tests, in a patient with severe hemolytic anemia. This is the first study to show the nucleotide-level sequence variations in Hb Koriyama. On the basis of our results, we conclude that unstable Hb may not be detectable by conventional Hb electrophoresis or stability tests. Thus, we suggest further genetic workup in cases of unexplained hereditary hemolytic anemia.
Amino Acid Sequence ; Anemia, Hemolytic/blood/*diagnosis ; Child ; Female ; Gene Duplication ; Hemoglobins, Abnormal/*genetics ; Heterozygote ; Humans ; Molecular Sequence Data ; Mutation ; Sequence Analysis, DNA

PURPOSE: To evaluate the results of postoperative radiotherapy in patients with extra-hepatic bile duct cancer (EHBDC) and identify the prognostic factors for local control and survival. MATERIALS AND METHODS: Between January 2001 and December 2010, we retrospectively reviewed the cases of 70 patients with EHBDC who had undergone curative resection and received postoperative radiotherapy. The median radiation dose was 50.4 Gy (range, 41.4 to 54 Gy). The resection margin status was R0 in 30 patients (42.9%), R1 in 25 patients (35.7%), and R2 in 15 patients (21.4%). RESULTS: The 5-year rates of overall survival (OS), event-free survival (EFS), and locoregional control (LRC) for all patients were 42.9%, 38.3%, and 61.2%, respectively. The major pattern of failure was distant relapses (33 patients, 47.1%). A multivariate analysis showed that the postradiotherapy CA19-9 level, radiation dose (> or =50 Gy), R2 resection margins, perineural invasion, and T stage were the significant prognostic factors for OS, EFS, and LRC. OS was not significantly different between the patients receiving R0 and R1 resections, but was significantly lower among those receiving R2 resection (54.6%, 56.1%, and 7.1% for R0, R1, and R2 resections, respectively). CONCLUSION: In patients with EHBDC who had undergone curative resection, a postoperative radiotherapy dose less than 50 Gy was suboptimal for OS and LRC. Higher radiation doses may be needed to obtain better LRC. Further investigation of novel therapy or palliative treatment should be considered for patients receiving R2 resection.
Bile Duct Neoplasms* ; Bile Ducts* ; Bile* ; Disease-Free Survival ; Humans ; Multivariate Analysis ; Palliative Care ; Radiotherapy Dosage ; Radiotherapy* ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies

Objectives: ZZKetamine has been reported to have antidepressant effects or psychotomimetic effects. The aim of this study was to investigatethe behavioral effects of ketamine treatment at various sub-anesthetic doses in adolescent and adult naïve mice. Methods: ZZIn each experiment for adolescent and adult mice, a total of 60 male Institute of Cancer Research mice were randomly dividedinto 6 groups, which were intraperitoneally treated with physiological saline, 10, 20, 30, 40, and 50 mg/kg ketamine for consecutive3 days. At 1 day after last injection, the locomotor and depressive-like behaviors were evaluated in mice, using open field test (OFT)and forced swim test (FST), respectively. Results: ZZIn case of adolescent mice, ketamine dose was negatively correlated with total distance traveled in the OFT (Spearman’srho = -0.27, p = 0.039). In case of adult mice, we found significant positive correlation between ketamine dose and duration of immobilityin the FST (Spearman’s rho = 0.45, p < 0.001). Immobility time in the 50 mg/kg ketamine-treated mice was significantly higher comparedto the saline-treated mice (Dunnett’s post-hoc test, p = 0.012). Conclusions ZZWe found that the repeated treatment with ketamine could decrease the locomotor or prolong the duration of immobilityin mice as the dose of ketamine increased. Our findings suggest that sub-anesthetic doses of ketamine might induce schizophrenia-like negative symptoms but not antidepressant effects in naïve laboratory animals.

Objectives: ZZKetamine has been reported to have antidepressant effects or psychotomimetic effects. The aim of this study was to investigatethe behavioral effects of ketamine treatment at various sub-anesthetic doses in adolescent and adult naïve mice. Methods: ZZIn each experiment for adolescent and adult mice, a total of 60 male Institute of Cancer Research mice were randomly dividedinto 6 groups, which were intraperitoneally treated with physiological saline, 10, 20, 30, 40, and 50 mg/kg ketamine for consecutive3 days. At 1 day after last injection, the locomotor and depressive-like behaviors were evaluated in mice, using open field test (OFT)and forced swim test (FST), respectively. Results: ZZIn case of adolescent mice, ketamine dose was negatively correlated with total distance traveled in the OFT (Spearman’srho = -0.27, p = 0.039). In case of adult mice, we found significant positive correlation between ketamine dose and duration of immobilityin the FST (Spearman’s rho = 0.45, p < 0.001). Immobility time in the 50 mg/kg ketamine-treated mice was significantly higher comparedto the saline-treated mice (Dunnett’s post-hoc test, p = 0.012). Conclusions ZZWe found that the repeated treatment with ketamine could decrease the locomotor or prolong the duration of immobilityin mice as the dose of ketamine increased. Our findings suggest that sub-anesthetic doses of ketamine might induce schizophrenia-like negative symptoms but not antidepressant effects in naïve laboratory animals.

Purpose: Duchenne muscular dystrophy (DMD) is the most common lethal muscular dystrophy and is caused by the genetic variants of DMD gene. Because DMD is X-linked recessive and shows familial aggregates, prenatal diagnosis is an important role in the management of DMD family. We present our experience of prenatal molecular diagnosis and carrier detection based on multiplex polymerase chain reaction (PCR), multiplex ligation-dependent probe amplification (MLPA), and linkage analysis. Materials and Methods: During study period, 34 cases of prenatal diagnosis and 21 cases of carrier detection were performed at the Seoul National University Hospital. Multiplex PCR and MLPA was used to detect the exon deletions or duplications. When the DMD pathogenic variant in the affected males is unknown and no DMD pathogenic variant is detected in atrisk females, linkage analysis was used. Results: The prenatal molecular diagnosis was offered to 34 fetuses. Twenty-five fetuses were male and 6 fetuses (24.0%) were affected. Remaining cases had no pathogenic mutation. We had 24 (80.0%) cases of known proband results; exon deletion mutation in 19 (79.2%) cases and duplication in 5 (20.8%) cases. Linkage analysis was performed in 4 cases in which 2 cases (50.0%) were found to be affected. In the carrier testing, among 21 cases including 15 cases of mother and 6 cases of female relative, 9 (42.9%) cases showed positive results and 12 (57.1%) cases showed negative results. Conclusion Prenatal molecular diagnosis and carrier detection of DMD are effective and feasible. They are useful in genetic counseling for DMD families.