Adequate relaxation of the laryngeal adductor muscle is required to obtain good tracheal intubating condition. But we couldnt check rountinely laryngeal adductor muscle response, so we quantify the effects of succinylcholine and vecuronium at the laryngeal adductor muscles and the adductor pollicis. Twenty adult patients of ASA physical status 1-2 were studied during propofol-fentanyl anesthesia. The trachea was intubated without the use of muscle relaxants and the tube cuff placed between the vocal cords. Succinylcholine 1.5 mg/kg or vecuronium 0.1 mg/kg was given as a single bolus by random allocation. Muscular activity was evoked with supramaximal stimuli in a train-of-four sequence every 12 sec to the ulnar nerve and the anterior branch of the recurrent laryngeal nerve at the notch of the thyroid cartilage and forehead. Neuromuscular transmission was monitored at wrist by mechano-myography and laryngeal response was measured as pressure changes in the cuff of the tracheal tube positioned between the vocal cords. Pressure inside the cuff was measured with an air-filled transducer. TOF responses of both sites were continuously recorded on strip chart. Lag time and onset time were no statistically significant differences at the laryngeal adductor and adductor pollicis after succinylcholine or vecuronium bolus injection. Clinical durations were significantly shorter at the laryngeal adductor than at the adductor pollicis after succinylcholine and vecuronium injection. In one patient, onset of neuromuscular blocking effect with vecuronium was 125 sec slower at the laryngeal adductor than at the adductor pollicis. We recommand that if vecuronium is selected for gentle and smooth tracheal intubation, intubation will be delayed sufficient time after adductor pollicis relaxation.
Adult ; Anesthesia ; Forehead ; Humans ; Intubation ; Muscles* ; Neuromuscular Blockade* ; Random Allocation ; Recurrent Laryngeal Nerve ; Relaxation ; Succinylcholine* ; Thyroid Cartilage ; Trachea ; Transducers ; Ulnar Nerve ; Vecuronium Bromide* ; Vocal Cords ; Wrist

OBJECTIVES: The purpose of this study was to evaluate the polymerization shrinkage stress among conventional methacrylate-based composite resins and a silorane-based composite resin. MATERIALS AND METHODS: The strain gauge method was used for the determination of polymerization shrinkage strain. Specimens were divided by 3 groups according to various composite materials. Filtek Z-250 (3M ESPE) and Filtek P-60 (3M ESPE) were used as a conventional methacrylate-based composites and Filtek P-90 (3M ESPE) was used as a silorane-based composites. Measurements were recorded at each 1 second for the total of 800 seconds including the periods of light application. The results of polymerization shrinkage stress were statistically analyzed using One way ANOVA and Tukey test (p = 0.05). RESULTS: The polymerization shrinkage stress of a silorane-based composite resin was lower than those of conventional methacrylate-based composite resins (p < 0.05). The shrinkage stress between methacrylate-based composite resin groups did not show significant difference (p > 0.05). CONCLUSIONS: Within the limitation of this study, silorane-based composites showed lower polymerization shrinkage stress than methacrylate-based composites. We need to investigate more into polymerization shrinkage stress with regard to elastic modulus of silorane-based composites for the precise result.
Composite Resins ; Elastic Modulus ; Light ; Polymerization ; Polymers ; Sprains and Strains

Background: The OptiscopeTM and the backward, upward, rightward pressure (BURP) maneuver are widely used in clinical practice because the BURP maneuver facilitates intubation by improving visualization of the larynx. However, the effect of the BURP maneuver is unclear when using the OptiscopeTM. Therefore, we retrospectively investigated the effect of the BURP maneuver on intubation using the OptiscopeTM. Methods: Sixty-eight patients intubated with the OptiscopeTM were enrolled. We used the BURP maneuver in Group A (n = 33) and the conventional maneuver (which does not use the BURP maneuver) in Group B (n = 35). BURP application status was a binary variable representing whether the BURP maneuver was used during the intubation. A multiple linear regression analysis was performed to assess the effects of the BURP application status on intubation time controlling for body mass index, preoperative dental injury status, obstructive sleep apnea history, thyromental distance, sternomental distance (SMD), interincisor distance, history of neck rotation restriction, and Mallampati classification. Results: There was no difference in the intubation time between the two groups. According to the regression model (R2 = 0.308, P = 0.007), the BURP maneuver (Group A) decreased the intubation time by 6.089 seconds (95% confidence interval 1.303–10.875, P = 0.014) compared to Group B. Conclusion The BURP maneuver reduced intubation time when using the OptiscopeTM.

Galeazzi fractures in child is rare and seldom necessary of operative treatment because the result of conservative treatment is good. We present the patient who was a 11-year-old male and fell onto his both hands during a hundred-meter dash. His diagnosis was bilateral Galeazzi fractures and limited open reduction and internal fixation with Kirschner pins was initial treatment at local hospital. After 4 weeks postoperatively, Kirschner pins were removed and rehabilitating exercise was started. After 4 months postoperatively, he was transferred to our hospital due to malunion with severe angular deformities and distal radioulnar joint (DRUJ) dislocation. He was treated with corrective osteotomy. Thus, as in this case, we suggest more careful treatment and observation if conservative method of Galeazzi fracture in child is chosen and consider operative method as treatment according to age and pattern of fracture.
Child ; Congenital Abnormalities ; Dislocations ; Hand ; Humans ; Joints ; Male ; Osteotomy

BACKGROUND: Food restriction has been reported to ameliorate diabetes and obesity. In this study, we examined the effects of the food restriction on phenotypes of TALLYHO/JngJ (TH) mouse, a recently developed diabetic model animal. METHODS: 3 week-old TH mice were divided into 2 groups (n = 20 each for food-restricted (THR) and free-fed (THF)) and THR mice were fed the same amount of food as normal control mice (C57BL/6, n = 20). Body weight was weekly monitored till 14 weeks of age. The half of animals were sacrificed at 8 weeks of age, and liver, kidney, and fat weight were measured. The histopathology of liver and brown fat tissues and mRNA expression of leptin in adipose tissue were analyzed. The oral glucose tolerance test and insulin resistance test was done at 14 weeks of age. The plasma concentrations of glucose, free fatty acid, triglyceride, cholesterol and leptin were analyzed. RESULTS: The THR mice had lower body weights than the THF mice, similar to C57BL/6 mice, with reduced fat deposition in liver and brown fat tissue. The plasma levels of glucose, triglyceride and free fatty acid were decreased in the THR group. The THR mice, however, carried more fat than normal mice, with increased plasma leptin concentration and leptin mRNA expression in fats and no alteration in plasma cholesterol levels. Furthermore, the THR mice revealed glucose intolerance with impaired after-meal insulin secretion and slight insulin resistance CONCLUSION: The food restriction apparently ameliorated the obesity and diabetic phenotypes of TH mice. However, plasma concentration of cholesterol were not improved in THR mice with increased adiposity index and glucose intolerance, suggesting the genetically prone tendency of obesity and diabetes development in TH mice possibly with an impairment in cholesterol metabolism.
Adipose Tissue ; Adipose Tissue, Brown ; Adiposity ; Animals ; Body Weight ; Cholesterol ; Diabetes Mellitus ; Fats ; Glucose ; Glucose Intolerance ; Glucose Tolerance Test ; Insulin ; Insulin Resistance ; Kidney ; Leptin ; Liver ; Mice ; Obesity ; Phenotype ; Plasma ; RNA, Messenger

It is known that physicochemical conditions (e.g., pH, temperature, and ionic strength) affect the size of trichomonads. In this study, the sizes of 4 isolates of Trichomonas vaginalis cultured for more than a year (called "old T") and 3 isolates freshly isolated from vaginitis cases (called "fresh T") were compared by scanning electron microscopy. Although the fresh T had shorter body length, body width, and flagellar length than old T, total length (about 26 microm), including body length, flagella length, and axostyle length was almost the same in the 2 groups. A striking difference was observed between the axostyles of the 2 groups; the axostyle length of the fresh T (8.2 microm) was more than twice as long as that of the old T (4.0 microm). However, in several parasitology textbooks, the length of T. vaginalis is said to vary widely from 7 to 32 microm, and its undulating membrane is said to extend about half way (53.5%) to the posterior end of the body. On the other hand, in our study, the undulating membrane was observed to extend more than 3/4 of the body length (72.1%) in old T, whereas in fresh T it could not be measured. Taken together, we suggest that T. vaginalis averages 26 (21-32) microm in total length, with 9.5 (7.4-11.4) microm of body length and 6.8 (5.3-7.7) microm of width, and its undulating membrane extending 3/4 of its body length. Therefore, these findings may provide useful information for morphological characteristics of T. vaginalis.
*Biometry ; Female ; Humans ; *Microscopy, Electron, Scanning ; Organelles/ultrastructure ; Trichomonas Infections/parasitology ; Trichomonas vaginalis/*cytology/isolation & purification/*ultrastructure

It has been known that clozapine treatment combining with cytotoxic antitumor therapy for schizophrenia is not recommended because both durgs have agranulocytosis as their side effect. Since the introduction of granulocyte colony-stimulating factor(G-CSF), it has been used to treat agranulocytosis or granulocytopenia associated with antitumor chemotherapy or clozapine. We report a case with schizophrenia on clozapine treatment who developed agranulocytosis following combined cytotoxic chemotherapy for a sex-cord stromal tumor which was successfully treated with G-CSF. The hematological status before combining with antitumor chemotherapy had been within normal range, and agranulocytosis following the antitumor chemotherapy returned to normal after treatment with G-CSF. This suggests that clozapine could be administered in combination with cytotoxic antitumor agents if the following indications are met : normal hematological status before starting antitumor chemotherapy, carefully monitoring hematological status by oncologist and psychiatrist, and prepared G-CSF administration when agranulocytosis is anticipated.
Agranulocytosis ; Antineoplastic Agents ; Clozapine* ; Drug Therapy* ; Granulocyte Colony-Stimulating Factor ; Granulocytes ; Psychiatry ; Reference Values ; Schizophrenia

For evaluating the reproductive performances of GTD patients, we found 115 cases of GTD patients, 77 HM and 38 GTT, who became pregnant after the completion of treatments and follow-up period. The results of this study suggest subsequent pregnancies after the completion of treatments may promise normal reproductive outcomes regardless of the chemotherapy.
Drug Therapy ; Follow-Up Studies ; Gestational Trophoblastic Disease* ; Humans ; Pregnancy

BACKGROUND: Alpha-1-antitrypsin (A1AT) deficiency is the only established genetic resk factor for emphysema. This study was undertaken to investigate the prevalence of the genotypes of A1AT genotypes in healthy Koreans. METHOD: The study population consisted of 380 healthy Koreans enrolled at the Health Promotion Center in Kyungpook National University Hospital. The polymerase chain reaction (PCR) and restriction fragment length polymorphim (RFLP) for detecting the A1AT variants M1(Ala), M1(Val), M2, S and Z were used. RESULTS: The genotypes of subjects were as follows : M1(Val)/M1(Val), 254(66.8%) ; M1(Val)/M2, 105(27.6%) ; M2/M2, 19 (5.0%) ; and M1(Val)/M1(Ala), 2 (0.5%). There was no case with 'deficiency' alleles such as S and Z found in this study. CONCLUSION: These results suggest that A1AT deficient alleles are either extremely rare or not present in Koreans.
Alleles ; Emphysema ; Genotype* ; Gyeongsangbuk-do ; Health Promotion ; Polymerase Chain Reaction ; Prevalence*

PURPOSE: To evaluate the side effects, pattern of failure, and survival rate according to the sequence of postoperative adjuvant radiotherapy and chemotherapy, patients with stages II and lll rectal cancer who had undergone curative resection were randomized to early radiotherapy group (arm I) or 'late radiotherapy group (arm II)', then we intend to determine the most effective sequence of the radiotherapy and chemotherapy. MATERIALS AND METHODS: From January 1996 to March 1999, 3 13 patients with curatively resected stages II and III rectal cancer have been randomized to early' or late radiation therapy group and recei ved combined chemotherapy (5-FU 375 mg/m/day, leucovorin 20 mg/m, IV bolus daily D1-5, 8 cycles) and radiation therapy (whole pelvis with 45 Gy/25 fractions/5 weeks). Arm I received radiation therapy from day 1 with first cycle of chemotherapy and arm II received radiation therapy from day 57 with third cycle of chemotherapy after completion of first two cycles. Preliminary analysis was performed with 228 patients registered up to Jun 1998. Two out of the 228 patients were excluded because of double primary cancer. Median follow-up period was 23 months. RESULTS: Local recurrence occurred in 11 patients (9.7%) for arm I and 9 patients (8%) for arm II. There was no significant difference between both groups (p=0.64). However, distant metastasis was found in 22 patients (19.5%) for arm I and 35 patients (31.0%) for arm II and which showed statistically significant difference between the two groups (p=0.046). And neither 3-year disease-free survival (70.2% vs 59.2%, p=0.2) nor overall survival (89.4% vs 88.0%, p=0.47) showed significant differences. The incidence of leukopenia during radiation therapy and chemotherapy was 78.3% and 79.9% respectively but leukopenia more than RTOG grade 3 was only 2.1% and 6.0% respectively. The incidence of diarrhea more than 10 times per day was significantly higher in the patients for arm I than for arm II (71.2% vs 4 1.6%, p=0.02) but this complication was controlled with supportive cares. CONCLUSION: Regardless of the sequence of postoperative adjuvant radiation therapy and chemotherapy a fter curative resection for rectal cancer, local recurrence rate was low with combined chemoradiotherapy. But distant metastasis rate was lower in early radiation therapy group than in late radiation therapy group and the reason is unclear. Most patients completed these treatments without severe complication, so these were thought to be safe treatments but the treatment compliance should be improved.
Arm ; Chemoradiotherapy ; Chemotherapy, Adjuvant* ; Compliance ; Diarrhea ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Leucovorin ; Leukopenia ; Neoplasm Metastasis ; Pelvis ; Prospective Studies* ; Radiotherapy* ; Radiotherapy, Adjuvant ; Rectal Neoplasms* ; Recurrence ; Survival Rate