In order to assess the efficiency of Percoll gradient centrifugation(PGC) as a method of sperm selection, we have examined morphological characteristics of spermatozoa from 40 teratozoospermic patients attending the Infertility Clinic of Inchon Gil Gerneral Hospital. Patients were divided into three groups according to percentage normal morphology in the fresh sample : group A(n=5), < 5% normal morphology : group B(n=21), 5~14% normal morphology : and group C(n=14), > 14% normal morphology. Morphology slides were perpared using Diff-Quik staining techniques and evaulated by Kruger strict criteria, under oil immersion at a magnification of X 1000, specific defects, head, neck and tail were assesed individualy. The results were as follows. 1. Following PGC, sperm samples with enhanced morphology were recovered for all groups. 2. For group A, PGC did not select a sample with significantly improved morphological characteristics. 3. Usually, sperm defects affected by PGC was head and neck. No significant difference was found for tail abnormality. In conclusion, Percoll gradient centrifugation is an efficient sperm preparation technique when the semen sample exhibits teratozoospermia, especially head or neck abnormality. However, in sample with < 5% normal form or tail abnormality, There is not significant improvement following PGC.
Centrifugation* ; Equidae ; Head ; Humans* ; Immersion ; Incheon ; Infertility ; Neck ; Semen ; Spermatozoa*

Between january 1, 1981 and December 31, 1986, 1,310 Cesarean sections (26.7%) were performed among 4,898 paturient women at St. Mary's pospital, Catholic Medical College. The perioperative condition of the newborns along with morbidity and mortality after Cesarean section wha analyzed. The incidencea of Cesarean sections between 1981 and 1986 were 25.0% 27 .6%, 23.4%, 29.5%, 31.2% and 27.1%, respectively. The anesthetic methods employed were inhalation anesthesia with thiopental sodium for induction and nitrous oxide-oxygen-halothane for maintenance of anesthesia. This study did net include the 76 cases of lumbar epidural or spinal technique performed during this Period. Based on one minute Apgar scores, 82 infants (6.26%) were assessed as moderately (score 4-6) depressed, and 44 infants (3.36%) were rated as severely (score 0~3) depressed. Twenty (45.5%) of the severely depressed newborns were promptly resuscitated and given ade- quate treatement, but 11 infants (25.0%) did not survive. The incidence of idiopathic respiratory distress syndrome (IRDS) in this study was 9 cases (0.79%) Ammong 7he total 1,310 cases; this induded 7 cases of premature birth or low birth weight and 2 cases of aspiration pneumonia. The mortality of the IRDS group was 4 of 9 cases (44.4%). Among the severely depressed group, the time from induction to delivery was five minutes in 8 case? (18.2%) , six to ten minutes in 22 cases (57.777) and more than 11 minutes in 14 cases (31.8%) . The pro7n7stic status of newborn babies was evaluated with respect to the anesthetic procedure and the outcome of deliveries by Cesarean sections performed between 1981 and 1986 at St. Mar's Hospital, Catholic Medical College, Seoul, Korea.
Anesthesia ; Anesthesia, Inhalation ; Cesarean Section* ; Female ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn* ; Korea ; Mortality ; Pneumonia, Aspiration ; Pregnancy ; Premature Birth ; Seoul ; Thiopental

BACKGROUND: International consensus guidelines have recently been developed to improve the assessment and management of asthma. One of the major recommendations of these guidelines is that asthma severity should be assessed through the recognition of key symptoms, such as nocturnal waking, medication requirements, and objective measurements of lung function. Differential classification of asthma severity would lead to major differences in both long term pharmacological management and the treatment of severe exacerbation. METHODS: This study examined the relationship between the symptom score and measurements of FEV1 and PEF when expressed as a percentage of predicted values in asthmatics(n=107). RESULTS: The correlation of FEV1% with PEFR% was highly significant(r=0.83, p<0.01). However, there was agreement in terms of the classification of asthma severity in 76.6% of the paired measurements of FEV1% and PEFR%. Agreement in the classification of asthma severity was also found in 57.1% of the paired analysis of FEV1% and symptom score. 39% of the patients classified as having moderate asthma on the basis of FEV1% recording would be considered to have severe asthma if symptom score alone were used. Low baseline FEV1 and high bronchial responsiveness were associated with a low degree of perception of airway obstruction. CONCLUSION: The relationships between the symptom score, PEFR and FEV1 were generally poor. When assessing asthma severity, age, duration, PC20, and baseline FEV should be considered.
Airway Obstruction ; Asthma* ; Classification ; Consensus ; Humans ; Lung ; Peak Expiratory Flow Rate

Adenosquamous carcinomas of the intestine are rare tumors, especially when they occur in the small bowel. We report a case of primary adenosquamous carcinoma of the proximal jejunum in a 66 year old woman with no underlying pathologic condition. The tumor mainly consisted of well differentiated squamous cell carcinoma showing keratin pearl and conspicuous intercellular bridges, and minor portion revealed well differentiated adenocarcinoma. The tumor seemed to have originated from the mucosal epithelium, invading the entire wall and metastasizing to the regional lymph nodes. Previous reports of adenosquamous carcinoma of the small intestine have been associated with metastatic disease from distant sites or intestinal duplication. In the colon, squamous cell differentiation have been seen in about 0.05% of adenocarcinomas and in 0.4% of adenomata. The pathogenesis of squamous cell carcinoma of the intestine is unknown, but some possible mechanisms are proposed. :1)malignant transformation of squamous cell epithelium in the submucosa, 2)aberrant differentiation of stem cells to squamous cell with subsequent malignant change, 3)squamous metaplasia of glandular cells with subsequent malignant change, 4)transformation of an adenosquamous into an epidermoid carcinoma.
Adenocarcinoma ; Aged ; Carcinoma, Adenosquamous* ; Carcinoma, Squamous Cell ; Cell Differentiation ; Colon ; Epithelium ; Female ; Humans ; Intestine, Small ; Intestines ; Jejunum* ; Lymph Nodes ; Metaplasia ; Stem Cells

PURPOSE: This study evaluated the difference between the modified subvastus approach in total knee arthroplasty (TKA) and the medial parapatellar approach in terms of the postoperative function of the knees. MATERIALS AND METHODS: From March to December 2002, 40 primary TKAs from 26 patients were divided into two groups by a prospective, randomized, blinded trial. The patients were followed up for more than 1 year. The modified subvastus approach was used in 21 knees, and the medial parapatellar approach was used in the remaining 19 knees. The time of postoperatively active straight-leg raise (SLR), and the range of flexion of the operated knee were assessed at postoperative 10 days, 6 weeks, 3, 6, and 12 months. The degree of the patellar tilt and subluxation was investigated at postoperative 12 months. The data collected was analyzed using a t-test. RESULTS: The patients with the modified subvastus approach performed active straight-leg raise sooner mean, 0.5 day) than the patients operated on using medial parapatellar approach (mean 2.2 days). Knee flexion was better at post-operative 10 days in the modified subvastus approach group than the medial parapatellar approach group. However, there was no statistical difference after 6 weeks, 3 months, 6 months, and 12 months after surgery. The level of patellar tilt and subluxation was similar in the two groups. CONCLUSION: The modified subvastus approach provided the advantage of early postoperative rehabilitation in terms of an earlier active SLR and greater knee flexion at 10 days compared with the medial parapatellar approach. The use of the modified subvastus approach in primary TKA is recommended.
Arthroplasty* ; Humans ; Knee* ; Prospective Studies ; Rehabilitation

Accelerated idioventricular rhythm is defined as a ventricular rhythm of 60-100 beats per minute or a ventricular tachycardia that does nor exceed 120 beats per minutes. Although, it rarely converts to a fatal arrhythmia like ventricular fibrillation, it needs to be differentiated from AIVR, which is from another origin. AIVR may occur due to ischemic heart disease (ST elevated myocardial infarction), cardiomyopathy, rheumatic fever and digitalis intoxication. We report here on a case of AIVR that was related to desflurane administration.
Accelerated Idioventricular Rhythm ; Anesthesia ; Arrhythmias, Cardiac ; Cardiomyopathies ; Digitalis ; Isoflurane ; Methyl Ethers ; Myocardial Ischemia ; Rheumatic Fever ; Tachycardia, Ventricular ; Ventricular Fibrillation

Streptococcal toxic shock like syndrome is a rapidly progressive and a fatal disease like staphylococcal toxic shock syndrome. In spite of the wide expansion and development of potent antibiotics, streptococcal infection still threatens human being. Recently we experienced a patient with toxic shock like syndrome who was suffered from fever and neck pain with rapid progression to hypotension and multiorgan failure. Streptococcus pyogenes was proven in his throat culture which was done on admission. Pleural effusion and suspicious carditis with aortic and mitral valve regurgitation were examined on the third hospital day. He was treated successfully with antibiotics but we wanted to emphasize potentially fatal streptococcal toxic shock like syndrome in pediatric patients.
Anti-Bacterial Agents ; Fever ; Humans ; Hypotension ; Mitral Valve Insufficiency ; Myocarditis ; Neck Pain ; Pharynx ; Pleural Effusion* ; Shock, Septic* ; Streptococcal Infections ; Streptococcus pyogenes

BACKGROUND: Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is known to have analgesic properties in subanesthetic doses and has been used as an analgesic in the postoperative period by variable routes. The effect of adding ketamine to analgesia using intravenous PCA morphine was evaluated in 90 women after cesarean section. METHODS: Ninety parturients were randomly allocated to three groups and each group had 30 women. The parturients in group 1 were given analgesics of morphine only, group 2 were given analgesics of the 2 : 1 mixture of morphine and ketamine, and group 3 were given analgesics of the 1 : 1 mixture of morphine and ketamine. We evaluated the analgesic requirement, numerical rating pain score, side effects and patient's satisfaction. RESULTS: The morphine requirement in group 3 was significantly lower than that in groups 1 and 2 at 3, 6, 12, 24 and 48 hours postoperatively. The pain score in group 2 was lower than that in group 1 at 3 and 6 hours and the pain score in group 3 was lowest of all groups at 3 and 6 hours. The incidence of dizziness was higher in group 3 than in groups 1 or 2. CONCLUSIONS: We concluded that adding ketamine with morphine in using an intravenous PCA can decrease analgesic requirements and improve analgesic property.
Analgesia ; Analgesics ; Cesarean Section* ; Dizziness ; Female ; Humans ; Incidence ; Ketamine* ; Morphine* ; N-Methylaspartate ; Passive Cutaneous Anaphylaxis* ; Postoperative Period ; Pregnancy

BACKGROUND: Impulse Oscillometry is a noninvasive and effort-independent test used to characterize the mechanical impedance of the respiratory system. The clinical potential of the 105 is rapid and demands only passive cooperation which makes it especially appealing for children, for epidemiologic surveys and for conditions in which quiet breathig instead of forced expiratory maneuvers are preferred. However, several studies have shown conflicting results that the role of 108 about detection of smoking induced small airway diseases or early airway obstruction METHODS: Study was to evaluate the clinical ability of the 108 to detect about smoking induced early airway obstruction in persons with normal spirometry test. Respiratory asymptomatic study groups were formed that one is non-smoking group, another is smoking group. RESULTS: The parameters of spirometry were not significantly differences between non-smoking group and smoking group. Among the parameters of 108, total resistance(non-smoking group: smoking group= 2.22 +/-1.20 : 2.58 +/-1.71), peripheral resistance( 1.25 +/-0.62 : 1.47 +/-0.10), bronchial compliance(0.44 +/-0.12: 0.47 +/-0.16) were not statistically significant different (p<0.05), but central resistance and lung compliance were not statistically significant different (unit ; resistance= hPa/l/s, compliance= 1/hPa). Resistance(Rrs) was not statistically significant different with changes of frequences(5, 10, 15, 20, 25, 30, 35Hz), but Reactance(Xrs) was statistically significant differenct with low frequences that X5(non-smoking group : smoking group= -0.62 +/-0.28 : - 0.76 +/-0.48, p<0.001) and X10(-0.06 +/-0.19 : -0.15 +/-0.33, p<0.013) (unit; hPa/l/s, hPa=cmH2O) CONCLUSION: Impulse oscillometer(IOS) is clinically available method to detect about smoking induced early airway obstruction. And clinically potential parameters of IOS were considers that total resistance, peripheral resistance, bronchial resistance, and reactance of low frequency at 5Hz, 10Hz.
Airway Obstruction* ; Child ; Electric Impedance ; Humans ; Lung Compliance ; Oscillometry ; Respiratory System ; Smoke* ; Smoking* ; Spirometry ; Vascular Resistance

PURPOSE: An oral cholera vaccine (OCV), Euvichol, with thimerosal (TM) as preservative, was prequalified by the World Health Organization (WHO) in 2015. In recent years, public health services and regulatory bodies recommended to eliminate TM in vaccines due to theoretical safety concerns. In this study, we examined whether TM-free Euvichol induces comparable immunogenicity to its TM-containing formulation in animal model. MATERIALS AND METHODS: To evaluate and compare the immunogenicity of the two variations of OCV, mice were immunized with TM-free or TM-containing Euvichol twice at 2-week interval by intranasal or oral route. One week after the last immunization, mice were challenged with Vibrio cholerae O1 and daily monitored to examine the protective immunity against cholera infection. In addition, serum samples were obtained from mice to measure vibriocidal activity and vaccine-specific IgG, IgM, and IgA antibodies using vibriocidal assay and enzyme-linked immunosorbent assay, respectively. RESULTS: No significant difference in immunogenicity, including vibriocidal activity and vaccine-specific IgG, IgM, and IgA in serum, was observed between mice groups administered with TM-free and -containing Euvichol, regardless of immunization route. However, intranasally immunized mice elicited higher levels of serum antibodies than those immunized via oral route. Moreover, intranasal immunization completely protected mice against V. cholerae challenge but not oral immunization. There was no significant difference in protection between two Euvichol variations. CONCLUSION: These results suggested that TM-free Euvichol could provide comparable immunogenicity to the WHO prequalified Euvichol containing TM as it was later confirmed in a clinical study. The pulmonary mouse cholera model can be considered useful to examine in vivo the potency of OCVs.
Animals* ; Antibodies ; Cholera Vaccines ; Cholera* ; Clinical Study ; Enzyme-Linked Immunosorbent Assay ; Immunization ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Mice ; Models, Animal* ; Public Health ; Thimerosal ; Vaccines ; Vibrio cholerae O1 ; World Health Organization