A randomised trial was conducted in 13 patients to assess the circulatory response to endotracheal intubation. None of the patient suffered from heart or lung disease, all were premedicated with lorazepam 0.4 mg/kg, glycopyrrolate 0. 004 mg/kg intramuscularly 30-60 min. beforehand. Patients received vecuronium 0.01mg/kg intravenously for precrurarization and 2 min. later 6 patients received lidocaine 2 mg/kg intravenously and 7 patients received saline 1 ml/20 kg intravenously. Blood pressure and pulse rate were measured repeatedly by an automatic recording device (Datascope 2100A) and cardiac output was measured by noninvasive cardiac output monitor with suprasternal doppler ultrasound. After laryngoscopy and intubation, systolic arterial pressure increased 19.7% mean arterial pressure 18.8% from baseline values in lidocaine group (p<0.05), and systolic arterial pressure increased 21.4% mean artereal pressure 19.8% from baseline values in saline group (p<0. 05). Pulse rate increased 30.9% from baseline values in lidocaine group (p<0.05) and 32.5% from baseline in saline group (p<0.05). But there was no intergroup difference in systolic arterial pressure, mean arterial pressure and pulse rate. Diastolic pressure of both group did not increase significantly and did not show intergroup difference. Cardiac output increased 35.3% from baseline values in lidocaine group (p<0.05). We concluded that lidocaine 2 mg/kg infusion intravenously 2 min prior to laryngoscopy and intubation does not prevent hemodynamic reaction evoked by endotracheal intubation.
Arterial Pressure ; Blood Pressure ; Cardiac Output ; Glycopyrrolate ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy ; Lidocaine* ; Lorazepam ; Lung Diseases ; Ultrasonography ; Vecuronium Bromide

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

PURPOSE: Entering a new century in the year 2001, Chungbuk National University Medical School (CNUMS) decided to adopt a fully integrative curriculum. This plan has been executed from 2002 to 2005. we are now at a point to assess this new curriculum and further improve it for the future. METHODS: We studied 'Curricula for Undergraduate' from Chungbuk National University and 'The Present Educational Status of Medical College' the Dean's Council of Korean Medical College published from 1987 to 2005. RESULTS: All lectures consisted of integrated lectures between the basic and clinical medical sciences. First and second year lectures focused on the horizontal integration of basic and clinical medical sciences, respectively. Also lectures between the first and second years formed longitudinal integration and purposeful repetition. Practical Classes were comprised of essential major clinical medicines and elective clinical medicines. Generally, lectures were reduced to introduce active learning subjects including problem-based learning (PBL), communicational skills, objective structured clinical examination (OSCE) /clinical performance examination (CPX), basic clinical skills, community medicine, and health and society. CONCLUSION: The curriculum of CNUMS was changed from the traditional department-centered lectures to integrated organ-centered integrated lectures and practical classes. However, further innovation is required on the inside of curriculum.
Chungcheongbuk-do* ; Clinical Competence ; Community Medicine ; Curriculum* ; Educational Status ; Lectures ; Problem-Based Learning ; Schools, Medical*

Management of unstable angina has evolved progressively. Although coronary angioplasty has recently shown to be relatively safe and effective treatment strategy for unstable angina, aute occlusion due to intracoronary thrombus accumulation during or immediately after coronary angioplasty remains to be one of the most common serious complication of this procedure. Intracoronary urokinase has been used to treat flow-limiting intracoronary thrombus accumulation that complicated initial successful percutaneous transluminal coronary angioplasty(PTCA) in unstable angina patient, which made the patient stablilzed. Thus in patient with flow-limiting intracoronary thrombus accumulation complicating PTCA, intracoronary urokinase proved to be highly effective in restoring vessel patency and preventing acute myocardial infarction. We report a case of successful revascularization with intracoronary infusion of urokinase in patient with intracoronary thrombus accumulation that complicated PTCA.
Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary* ; Humans ; Myocardial Infarction ; Thrombosis ; Urokinase-Type Plasminogen Activator

Pathophysiological conditions such as sepsis and hepatitis are frequently associated with cholestasis. Cholestasis in patients with sepsis has been attributed to the effects of endotoxin(lipopholysaccharides, LPS) and LPS-induced cytokines(TNF-a, IL-6, IL-1, etc.). LPS and cytokines reduced bile acid uptake in cultured hepatocyte. Perfusion of LPS decrease the bile flow in the isolated liver. Bile flow is increased by intravenous infusion of secretin, but it's effect remains unclear in sepsis. The aim, of this study is to elucidate the effect of LPS on the bile flow and bile composition and to test the effect of secretin on the bile flow. The animals used in this study were Korean wild cats. Under the general anesthesia, the incision was made on the midline. Common bile duct was cannulated with polyethylene tube after cholecystectomy. Bile was collected every five minutes and its volume was measured. E. coli LPS(1 mg/kg), secretin(0.1mg/kg) and H3-taurocholic acid(0.2uCi/kg) were infused via mesenteric vein. Bile was collected every 5 minutes, and the volume and its composition were analyzed. Radio-activity of the bile was quantified by Packard 1600 TR liquid scintillation analyzer. LPS of E.coli (1mg/kg) had a little effect on the blood pressure. LPS decreased the bile flow by 37% compared with the control group. Maximal impairment of the bile secretion appeared 15 minites after LPS infusion, and then secreted stablely thereafter. Secretin increased the bile flow in the normal control group. It, however, did not make any change in the bile flow after LPS infusion. LPS also reduced H3-taurocholate secretion(maximum 56%), and peak level was delayed about 10 minites compared with control group. In the composition of the bile, LPS decreased the secretion of bile acids significantly compared with the control group. Conclusively, LPS decreased the bile flow and the bile acid secretion. Secretin did not stimulate the bile flow in the LPS group. It also reduced the bile acids secretion compared with the control group. These findings will contribute to the understanding and treatment of the cholestasis and impairment of the liver function of sepsis. The findings, of reduced bile acids secretion in the LPS group may explain the pathogenesis of intrahepatic gallstone partly.
Anesthesia, General ; Animals ; Bile Acids and Salts ; Bile* ; Blood Pressure ; Cats* ; Cholecystectomy ; Cholestasis ; Common Bile Duct ; Cytokines ; Escherichia coli* ; Escherichia* ; Gallstones ; Hepatitis ; Hepatocytes ; Humans ; Infusions, Intravenous ; Interleukin-1 ; Interleukin-6 ; Liver ; Mesenteric Veins ; Perfusion ; Polyethylene ; Secretin ; Sepsis

PURPOSE: Long-term treatment with inhaled steroids (ICS), especially fluticasone that developed lately, may suppress the hypothalamic-pituitary-adrenal (HPA) axis. This study investigated the relationship between ICS use and HPA axis suppression in asthmatics under ICS treatment for average 4.5 years. METHODS: The medical records of 129 adult asthmatics who received ICS treatment for 6 months or more and underwent a corticotropin stimulation test from January 2005 to August 2013 were retrospectively reviewed. RESULTS: The patients received ICS only (n=87) were found to have an abnormal response to the corticotropin test in as high as 32.2%, and those received ICS in combination with oral steroids (n=42) had a significantly higher prevalence of the response (71.4%, P<0.001). Abnormal responses to corticotropin occurred depending on ICS daily doses (low, n=8, 12.5%; medium, n=19, 36.8%; high, n=102, 49.0%; chi2=4.384, P=0.036). Among the subjects received ICS only, nasal steroid doses (P=0.016) but not ICS doses (P=0.159) were significantly higher in those with abnormal responses than the others. Among all the subjects, oral steroid use (odds ratio [OR], 4.27; 95% confidence interval [CI], 2.35-11.80; P<0.001) and nasal steroid dose (OR, 1.02; 95% CI, 1.00-1.04; P=0.015) were significant risk factors for HPA axis suppression. CONCLUSION: One-third of asthmatics under long-term treatment with ICS showed a suppression of the HPA axis in a dose-dependent manner. Oral or nasal steroid use may be a risk factor for the suppression. However, since our results may have been overestimated due to subject selection bias, further prospective case-control studies are warranted.
Adrenal Glands ; Adrenocorticotropic Hormone ; Adult ; Asthma* ; Axis, Cervical Vertebra* ; Case-Control Studies ; Humans ; Medical Records ; Prevalence ; Retrospective Studies ; Risk Factors ; Selection Bias ; Steroids* ; Fluticasone

On page 289 of this paper, the x-axis title in Fig. 3A has been incorrectly spelled.

No abstract available.

Some parts of Tables 1 and 2 in this paper was described incorrectly.

Prediction of individual outcome after cardiopulmonary resuscitation is of major medical, ethical, and socioeconomic interest but uncertain. We experienced the case thats the patient got complete neurologic recovery after the 123th day firm cardiac arrest, who had been suspected to go with poor prognosis because she got the findings of Glasgow Coma Scale 4, severe diffuse encephalopathy on encephalogram and generalized tonic-clonic seizure at the 4th day. Recently, a 29 year-old women who sustained from respiratory arrest induced presumably by sedative and anticonvulsant therapy for control of seizure that happened during local lidocaine anesthesia far mamoplasty was transfered to our emergency medical center from local private plastic office. Arrest time was about 20 minutes. On hospital arrival, she had a pulseless bradyasystole and no respiration, but spontaneous circulation was restored at 10 minutes artier CPR started. We started cerebral oriented resuscitation including mild hypothermia(34degrees C), hemodilution, calcium channel blocker infusion. On hospital day 4, patient's glasgow coma scale(GCS) was 4. On hospital clay 7, Brain Magnetic Resonance Imaging(MRI) showed high signal intensity on T2WI, involving the bilateral basal ganglia. After contrast administraton, marked enhancement can be seen at the lesion site. Patient's glasgow coma scale(GCS) increased step by step to 5 on 8th day, 7 on 14th day, 10 on 15th day, 13 on 17th day, 15 on 20th day. 40 days later the patient was discharged with minor neurologic abnormality including hand tremor, dysphonia, amenorrhea and Mini Mental State Examination(MMSE) score(26). Long-term Follow up revealed that all neurologic functional abnormality inducting hand tremor, dysphonia, amenorrhea and MMSE score(26) is completely recovered on 123th day after episode of cardiopulmonary arrest.
Adult ; Amenorrhea ; Anesthesia ; Basal Ganglia ; Brain ; Calcium Channels ; Cardiopulmonary Resuscitation ; Coma ; Dysphonia ; Emergencies ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Hand ; Heart Arrest* ; Hemodilution ; Humans ; Hypoxia-Ischemia, Brain* ; Lidocaine ; Plastics ; Prognosis ; Respiration ; Resuscitation ; Seizures ; Tremor