Fluid resuscitation is a basic treatment in hemorrhagic shock. We compared the circulatory responses to fluid resuscitation of 10% pentastarch with those of fresh whole blood and plasmanate in hemorrhagic shock. Eighteen mongrel dogs were bled 24 ml/kg and replaced by equivalent amounts of fresh whole blood(n=6, group B), pentastarch(n=6, group P) and plasmanate(n=6, group PL). Hemodynamic measurements and calculations were performed before and after bleeding and after volume therapy. The decrease of hematocrit and platelet count after volume replacement indicate that hemodilutional effect was maximum 30 min after volume therapy and significantly greater in group P than PL(p<0.05). Central venous pressure(CVP), pulmonary capillary wedge pressure(PCWP) and cardiac index(CI) were increased to 146-189%, 146-172% and 146-175% in group P, respectively during 60 min. These changes were significantly greater than group B and PL(p<0.05). There was delayed recovery of mean arterial pressure in group PL(92% 30 min after volume therapy) compared with group B and P(92% and 93% 5 min). Also group P and PL showed significant prolongation in prothrombin time and partial thromboplastin time during experiment(120 min) and these were significantly more prolonged in group P than PL(P<0.05). And group P showed similar O transport and O extraction ratio to those of group B. The increases in plasma catecholamine were observed after hemorrhage, but no significant changes 5 and 30 min after volume therapy. This suggests that the neurohumoral response to hemodilution was not marked. Mixed venous O2 saturation(SvO2) was directly proportional to CI during experiment(r=0.69, p<0.01), indicating that SvO2 can represent CI during shock and volume therapy. In conclusion, l0% pentastarch is useful as a substitute for fresh whole blood or plasmanate.
Animals ; Arterial Pressure ; Blood Transfusion, Autologous* ; Capillaries ; Dogs* ; Hematocrit ; Hemodilution ; Hemodynamics ; Hemorrhage ; Hydroxyethyl Starch Derivatives ; Partial Thromboplastin Time ; Plasma ; Platelet Count ; Prothrombin Time ; Resuscitation* ; Shock ; Shock, Hemorrhagic*

To compare the effects of atracurium, 0.75 mg/kg, on the mean arterial pressures, heart rates and plasma histamine levels under 2%-enflurane inhalation with mask, 24 patients were allocated randomly into two groups; one(Group I, n=12) which atracurium was administered with rapid bolus injection for 5 seconds and the other(Group II, n=12) with the slow injection for 75 seconds. In both groups, there are the most significant decreases and the recovery in mean arterial pressure 1~2 min and 5 min after atracurium, respectively, Group I showed a significant decrease of mean arterial pressure about 10% more than Group II. In heart rate, there are the significant decreases gradually to 87~88% of control 5 min after atracurium in both graups except the only significant increase(104%) 1 min after atracurium in Group I. And Group I showed a significant increase(200%) in plasma histamine concentration (p< 0.05) 2 min after injection than before, but Group II did no significant change. In conclusion, the slow injection of atracurium over 75s during induction of anesthesia can attenuate the histamine-induced cardiovascular response.
Anesthesia* ; Arterial Pressure ; Atracurium* ; Heart Rate ; Histamine Release* ; Histamine* ; Humans ; Inhalation ; Masks ; Plasma

OBJECTIVES: The purpose of this study was to compare the safety and efficacy of midazolam sedated Endoscopic retrograde cholangiopancreatography (ERCP) with unsedated ERCP in patients 70 years of ages and older. METHODS: Seventy elderly patients 70 years of age or older who underwent ERCP were divided into two groups: midazolam sedated group (n=43) and unsedated group (n=27). Procedure time, success rate, complications related with ERCP procedure, satisfaction score were analyzed between two groups. RESULTS: Mean procedure time was 20.6 minutes for sedated group and 21.0 minutes for unsedated group (P=0.88). Success rate was 87.5% for sedated group and 100% for unsedated group (P=0.07). Incidence of complications from ERCP procedure showed no significant differences between the sedated and unsedated groups (P=0.10). There was no mortality in both groups related to the sedation or post-ERCP complication. Compared to the unsedated procedure, the sedated ERCP procedure was associated with higher patient satisfaction (P<0.001) and better repeat compliance (P=0.004). CONCLUSION: There was no significant difference in success rate and complications at sedated and unsedated ERCP in patients 70 years of age and older. Unsedated ERCP showed 66.6% satisfaction score compared to sedated ERCP.
Aged ; Cholangiopancreatography, Endoscopic Retrograde* ; Compliance ; Humans ; Incidence ; Midazolam ; Mortality ; Patient Satisfaction

Drug-induced neutropenia (DIN), particularly that in which antibiotic-dependent antineutrophil antibodies have been detected, is a rare disorder. We report the case of a child with pneumococcal pneumonia, who experienced severe neutropenia during various antibiotic treatments. We detected 4 kinds (cefotaxim, augmentin, vancomycin, and tobramycin) of antibiotic-dependent antineutrophil antibodies by using the mixed passive hemagglutination assay (MPHA) technique with this child.
Anti-Bacterial Agents/*therapeutic use ; Antibodies, Antineutrophil Cytoplasmic/*blood/immunology ; Autoantibodies/blood/immunology ; Drug Therapy, Combination ; Humans ; Infant ; Male ; Neutropenia/chemically induced/*diagnosis ; Pneumonia, Pneumococcal/complications/*drug therapy ; Tomography, X-Ray Computed

Oral sodium phosphate is known to be safe and it is widely used as a colon cleansing agent for colonoscopy. Yet several complicated cases with the development of electrolyte imbalance have been reported. We report here on 2 interesting cases: after administration of oral sodium phosphate, one patient presented with hyponatremia (Na, 122 mEq/L) with seizure and the other patient presented with hyponatremia (Na, 120 mEq/L) with a confused mentality. Brain imaging and electroencephalography showed no evidence of other causes for the seizure and mental change. We report here on two cases of hyponatremia with neurologic side effects, and this was all caused by oral sodium phosphate. We also include a review of the relevant literature.
Colon ; Colonoscopy ; Detergents ; Electroencephalography ; Humans ; Hyponatremia ; Neuroimaging ; Phosphates ; Seizures ; Sodium

BACKROUND/AIMS: Bismuth-based quadruple therapy for second-line eradication treatment achieves the eradication rate ranging from 70% to 81% due to antimicrobial resistance and poor compliance. The aim of this study was to compare the eradication rate of levofloxacin-based triple therapy with that of bismuth-based quadruple therapy in second-line Helicobacter pylori (H. pylori) eradication therapy. METHODS: Seventy-six outpatients with persistent H. pylori infection after first-line triple therapy were enrolled in this prospective randomized trial. The subjects were randomized to receive levofloxacin 300 mg, amoxicillin 1 g, and pantoprazole 20 mg, given twice daily for 7 days (LAP group), or metronidazole 500 mg twice, tetracycline 500 mg four times, and pantoprazole 20 mg twice, bismuth subcitrate 600 mg twice daily for 7 days (MTPB group). Eradication was confirmed with 13C-urea breath test or rapid urease test 4 weeks after the cessation of therapy. RESULTS: Among Seventy-six patients initially included, eleven were lost during follow-up. The eradication rates, expressed as intention to treat (ITT) and per protocol (PP) analyses, were 51.6% and 53.3% in the LAP group, and 48.9% and 62.9% in the MTPB group, respectively. There was no significant difference in H. pylori eradication rates between the two groups (p=0.815 by ITT, p=0.437 by PP). LAP regimen was better tolerated than MTPB regimen with lower incidence of side effects (10.0% versus 31.4%, p=0.03). CONCLUSIONS: H. pylori eradication rates of levofloxacin-based triple therapy and bismuth-based quadruple therapy were not significantly different in second-line H. pylori eradication therapy, and low incidence of side effects was observed in levofloxacin-based triple therapy.
2-Pyridinylmethylsulfinylbenzimidazoles/administration & dosage ; Adult ; Antacids/administration & dosage ; Anti-Bacterial Agents/*administration & dosage ; Anti-Ulcer Agents/administration & dosage ; Data Interpretation, Statistical ; Drug Therapy, Combination ; Female ; Helicobacter Infections/*drug therapy/microbiology ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Ofloxacin/*administration & dosage ; Organometallic Compounds/administration & dosage ; Time Factors ; Treatment Outcome

Paecilomyces lilacinus is an ubiquitous saprophytic fungus and very rarely pathogenic to the human. Although it has been reported to cause endophthalmitis, orbital cellulitis, prosthetic valve endocarditis, and pulmonary infection, cutaneous infection caused by Paecilomyces lilacinus has been rarely reported. A 46-year-old Korean man had asymptomatic slowly growing multiple cutaneous nodules on the left arm and wrist for 8 months. He received a renal transplantation in 1991 because of end-stage renal disease. Postoperatively, he has taken cyclosporin and deflazacort for immunosuppression. Physical examination revealed that the lesions were discrete or confluent, firm, elevated, well-defined fluctuating nodules. Histologic section showed multiple well-encapsulated intradermal abscesses with some foci of chronic granulomatous changes composed of lymphocytes, histiocytes and giant cells. PAS positive fungal hyphae and spores were also found. On the Sabouraud's dextrose agar media, the organism grew rapidly to form velvety lilac-colored colonies with shallow radiating furrows. Slide culture showed brush-like conidiophores ending in flask-shaped phialides carrying chain of conidia. Because of the poor response to the oral antifungal drug for 2 months, all the lesions were completely excised.
Abscess* ; Agar ; Arm ; Cyclosporine ; Endocarditis ; Endophthalmitis ; Fungi ; Giant Cells ; Glucose ; Histiocytes ; Humans ; Hyphae ; Immunosuppression ; Kidney Failure, Chronic ; Kidney Transplantation ; Lymphocytes ; Middle Aged ; Orbital Cellulitis ; Paecilomyces* ; Physical Examination ; Spores ; Spores, Fungal ; Wrist

In order to find out the distribution of fibronectin and fibrinogen in placenta among pregnancy induced hypertensive (PIH) patients, 6 normotensive pregnancies and 17 PIH patients were chosen. The placentas were obtained right after delivery and soaked in the 10% formalin solution. The score was measured in terms of the positiveness of the stain in immunohistochemical stain by using I antibody with the rabbit antihuman fibronectin and the rabbit anti-human fibrinogen. Comparison between two groups are as following: 1.The placenta of PIH patients showed significantly reduced positiveness of fibronectin in their fetal villous vessels and villous stroma. 2. In the PIH patients, the positiveness was reduced in the group giving the birth to intrauterine fetal growth retardation compared to giving birth to normal baby. 3. In both normotensive and PIH patients, the villous basement membrane did not show the staining response to fibronectin, while showing heavy staining response to fibrinogen. 4. The positiveness of fibrinogen in fetal vessels, villous basement membrane, intervillous space and stroma were almost same in both normotensive and PIH patients. From above results, we can conclude that there is abnormality in the distribution of fibronectin especially in the fetal vessels and the villous stroma of placenta among PIH patients. The cause of this result needs further study.
Basement Membrane ; Fetal Growth Retardation ; Fibrinogen* ; Fibronectins* ; Formaldehyde ; Humans ; Parturition ; Placenta* ; Pre-Eclampsia ; Pregnancy*

The incidence of ectpic pregnancy has increased rapidly over the past decade. Currently, the complications of this disorder make it one of the leading causes of maternal mortality and morbidity. In the late 1980s, reports of successful use of methotrexate (MTX) as a non surgical treatment for ectopic pregnancy (EP) also began to appear in the literature. With MTX emerging as a possible alternative management of selected women with an EP, an analysis of its comparative costs is now needed. We examined retrospectively the costs associated with management of EP in our hospital. We selected 30 women with EPand divided them into two groups of MTX treated group (n= l0) and surgically treated group (n=20). There were no statistically significant differences in the doctors fee, room, charge and cost of laboratory and radiologic examination between two groups. But We found significant reduction in cost with regard to pharmacy, injection, procedure and operation of MTX treated group compared to surgically treated group (p<0.05). Consequently the use of MTX for EP should still be considered investigational; we recognize and agree that the evolution of this remedial option should be based primarily on its ability to decrease morbidity and mortality rather than on its ability to reduce costs. If medical treatment proves to be effective, the potential cost savings demonstrated in this report will become an important influential factor on selecting alternative remedy.
Cost Savings ; Fees and Charges ; Female ; Humans ; Incidence ; Maternal Mortality ; Methotrexate ; Mortality ; Pharmacy ; Pregnancy ; Pregnancy, Ectopic* ; Retrospective Studies

Obstructive jaundice caused by tuberculous lymphadenitis is a rare manifestation of tuberculosis (TB), with 15 cases having been reported in Korea. We experienced a case of obstructive jaundice caused by pericholedochal tuberculous lymphadenitis in a 30-year-old man. The patient's initial serum total bilirubin level was 21.1 mg/dL. Abdominal computed tomography revealed narrowing of the bile duct by a conglomerated soft-tissue mass involving the main portal vein. Abrupt obstruction of the common bile duct was observed on cholangiography. Pathologic analysis of a ultrasonography-guided biopsy sample revealed chronic granulomatous inflammation, and an endoscopic examination revealed esophageal varices and active duodenal ulceration, the pathology of which was chronic noncaseating granulomatous inflammation. Hepaticojejunostomy was performed and pathologic analysis of the conglomerated soft-tissue mass revealed chronic granulomatous inflammation with caseation of the lymph nodes. Tuberculous lymphadenitis should be considered in patients presenting with obstructive jaundice in an endemic area.
Adolescent ; Adult ; Bilirubin/blood ; Duodenal Ulcer/pathology ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/pathology ; Female ; Humans ; Jaundice, Obstructive/*diagnosis ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node/*diagnosis ; Young Adult