Recently, halothane has been commonly used as an inhalation anesthetic agent, but it is generally accepted that it can cause postoperative hepatic dysfunction. Therefore, other anesthetic agents which have relatively less hepatotoxic effects have been recommended. This study was undertaken to evaluate the postoperative hepatic changes in patients with abnormal liver function or hepatobiliary diseases. Patients were divided into three subgroups hepatobiliary, other hepatobiliary and jaundice, or HBsAG(+) for the two anesthetic agents, enflurane and Thalamonal. Liver function tests were performed before surgery, and on the 3rd, 5th and 9th postoperative days. The results were as follows: 1) SGOT and SGPT showed a more statistically significant decrease in Thalamonal anesthesia than in enflurane anesthesia in hepatobiliary and jaundice or HBsAg(+) groups. However, in the other hepatobiliary groups, there were no significant differences between the anesthetics. 2) Total protein, albumin, total bilirubin, direct bilirubin and alkaline phosphatase levels were not shown to be significantly different between the use of the two anesthetics in all groups. It is suggested that postoperative hepatic changes may have improved more significantly in Thalamonal anesthesia than in enflurane anesthesia in hepatobiliary patients with abnormal liver function and jaundice or HBsAg(+) patients.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Aspartate Aminotransferases ; Bilirubin ; Enflurane ; Halothane ; Humans ; Inhalation ; Jaundice ; Liver Function Tests ; Liver*

A clinical study was carried out on 575 cases with tuberculous meningitis who were admitted to the department of pediatrics, Yonsei University College of Medicine during the 18 years from January 1959 to December 1976. The following results were obtained. 1.The age incidence was highest in the age of 2 to 5 and 89.1% were under the age of 8 years. Male to female ratio was 1.5:1 2.The seasonal incidence in order of frequency were spring (30.9%), summer (25.9%), autumn(20.8%) and winter (22.4%). 3. 25% out of the 575 cases had the source of infection infamily members. 4. The tuberculous skin test showed positive reaction in 53.5% 5. The common chief complaints in order of frequency were fever, vomiting, convulsion, unconsciousness and headache. 6. At the time of admission, 80% of 575 cases were diagnosed as meningitis. 7. The major neurologic findings were unconsciousness (34.7%) neck stiffness (86.2%) and positive Kernings sign(62.7%) 8. Chest X-Ray showed normal in 11.6% an miliary tuberculous in 13.7% 9. According to the findings of C.S.F., increased pressure, high protein and low sugar level were associated with poor prognosis. But there were no significant differences on mortality in relation with cell count and chloride level. 10.Mortality rate was 17.5%. Highest mortality was noted in young infants.
Cell Count ; Female ; Fever ; Headache ; Humans ; Incidence ; Infant ; Male ; Meningitis ; Mortality ; Neck ; Neurologic Manifestations ; Pediatrics ; Prognosis ; Seasons ; Seizures ; Skin Tests ; Thorax ; Tuberculosis, Meningeal* ; Unconsciousness ; Vomiting

BACKGROUND: Association of arterial stiffness and osteoporosis has been previously reported in women. However, this association is still controversial for men. Therefore, we investigated correlation of arterial stiffness and osteoporosis by measuring brachial-ankle (ba) pulse wave velocity (PWV) and bone mineral density (BMD). METHODS: We reviewed medical charts of 239 people (women: 128, men: 111) who visited the Health Promotion Center, retrospectively. ba-PWV was measured by automatic wave analyzer. Lumbar spine (L1-L4) BMD and femur BMD were measured by dual energy X-ray absorptiometry. Metabolic syndrome was based on the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATPIII) definition. Body mass index (BMI)>25 kg/m2 was used instead of waist circumference. RESULTS: In Pearson's correlation analysis, PWV and femur BMD (Neck, total) had a significant inverse relationship in men (r=-0.254, P=0.007; r=-0.202, P=0.034). In women, PWV and the L-spine, femur (Neck, total) had a significant inverse relationship. (r=-0.321, P<0.001; r=-0.189, P=0.032; r=-0.177, P=0.046) Age and PWV showed the greatest association in both men and women (r=0.46 P<0.001; r=0.525, P<0.001) In multiple regression analysis, the L-spine BMD and PWV had an independent relationship in women after adjusting for age, metabolic syndrome, BMI, smoking, drinking and exercise. (r=-0.229, P=0.015). No independent association was found between PWV and BMD in men. CONCLUSIONS: The association between arterial stiffness and BMD was confirmed in women. However, this association was not statistically significant for men.
Absorptiometry, Photon ; Body Mass Index ; Bone Density ; Cholesterol ; Drinking ; Education ; Female ; Femur ; Health Promotion ; Humans ; Male ; Mass Screening* ; Osteoporosis* ; Pulse Wave Analysis ; Retrospective Studies ; Smoke ; Smoking ; Spine ; Vascular Stiffness* ; Waist Circumference

Congenital hypoplasia of the right ventricular myocardium, also known as parchment heart or Uhl's anomaly, is a rare congenital heart defect. It was first described in Oslers principles and Practice of Medicine in 1905 and reviewed by Segall We found 29 reported cases, but there was no reported case in Korea. Recently, we experienced a case of Uhls anomaly associated with patent ductus arteriosus, atrial septal defect, pulmonary atresia and tricuspid abnormality in a 3 month-old infant, which was confirmed by autopsy. We present a case with a brief review of litteratures.
Autopsy ; Ductus Arteriosus, Patent ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Humans ; Infant ; Korea ; Myocardium ; Pulmonary Atresia

We measured the degree of immunity of 326 Korean children to rubella virus by enzyme-linked immunosorbent assy (ELISA). They were admitted to Pediatrics Unit of Yonsei Medical Center between April and July, 1980 with various illnesses excluding rubella disease. Among the 326 tested, 172 cases gave a positive titer of antibodies (mainly, IgG and IgM antibodies) and 127 had IgG antibody against rubella virus antigen. These represented 52.8% and 39.0%, respectively, of the total number of children tested. There was no significant difference in the rate of positivity between sex, but the positive rate increased as the age increased. The antobody titers of positive individuals to rubella virus were higher among the older children. Results and a brief outline of the ELISA method for serodiagnosis of rubella in clinical use will be discussed.
Adolescent ; Age Factors ; Antibodies, Viral/analysis* ; Child ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay* ; Female ; Human ; Immunoenzyme Techniques* ; Infant ; Infant, Newborn ; Korea ; Male ; Rubella/immunology ; Rubella virus/immunology*

Drawing on our observation that many medical professionals have considerable difficulty in using what they know about ethics, we have developed a course for teaching the fifth year medical students a systematic approach to ethical reasoning and problem-solving, rather than teaching bioethical theories or prominent current ethical issues in developed countries. This course consisted of a series of guided group discussions and debates in classroom using over 50 cases classified under seven major headings. Responses and reactions from students and participating clinicians are encouraging. Several ideas for improving medical ethics curricula are discussed, including emphases on the thorough understanding of various aspects of human relations in medical practice, enhancing the ability of articulate the students own values, provoking the student to get involved in the ethical situation when studying the cases, and the need to introduce social science concepts in analyzing the ethical issues in the health care system.
Curriculum ; Delivery of Health Care ; Developed Countries ; Ethics ; Ethics, Medical* ; Head ; Humans ; Social Sciences ; Students, Medical

Development of transfusion-related acute lung injury (TRALI), a non-cardiogenic pulmonary edema, after blood transfusion, is a rare but potentially leading cause of mortality from blood transfusion. We report on a case of TRALI in a 51-year male with acute calculous cholecystitis and liver cirrhosis. As preoperative treatment, he was given ten units of fresh frozen plasma (FFP) for 3 days before the operation. During the transfusion of the 10th unit of FFP, he experienced a sudden onset of hemoptysis, tachypnea, tachycardia, and cyanosis. Bilateral pulmonary infiltration not observed on the chest X-ray at the visit was newly developed. There was no evidence of volume overload but severe hypoxemia. Blood transfusion was stopped and he recovered fully after 8 days of oxygen therapy through a nasal cannula. Although HLA and HNA antibodies were not detected in the donor's blood, HLA antibodies (A2, B57, B58) were detected in the patient's blood. We reported this meaningful case of TRALI that occurred after transfusion of only fresh frozen plasma which did not contain human leukocyte antibody in a patient with HLA antibody.
Acute Lung Injury* ; Anoxia ; Antibodies ; Blood Transfusion ; Catheters ; Cholecystitis ; Cyanosis ; Hemoptysis ; Humans ; Leukocytes ; Liver Cirrhosis ; Male ; Mortality ; Oxygen ; Plasma* ; Pulmonary Edema ; Tachycardia ; Tachypnea ; Thorax

No abstract available.
Kidney Transplantation*

We investigated a topographical distribution of managanese, and immunohistochemical density of tyrosine hydroxylase (TH), and histopathologic findings in globus pallidus and substantia nigra according to manganese dose and time course in the brain of rats which received MnCl2 intravenously. Topographical distribution of manganese was also investigated after injection of FeCl2. The manganese concentrations of brain in control and experimental group were highest in pituitary gland and thalamus, and lowest in the cerebral cortex. The manganese concentration of blood was increased proportionally to the dose administered, and the biological half-life of blood manganese was between 21 and 42 days. The manganese concentrations of brain were increased proportionally to the dose, and increase rate was highest in olfactory bulb, and the biological half-lives of brain manganese ranged from 42 days to 90 or more days; the longest were observed in pituitary gland, medulla oblongata and cerebral cortex. In case of administration of FeCl2, the manganese concentrations of brain were higher than that of control group in dose of 2.5 mg/kg, and decreased proportionally to the administered dose, resulting in lower level compared with control group in high dose of FeCl2 administered. Significantly decreased number of nerve cell and increased gliosis in globus pallidus were observed in experimental group, which were closely correlated with the duration after manganese injection, but no significant change of number of nerve cell expressing TH and gliosis were observed in substantia nigra. Density of immunohistochemical reaction for TH in globus pallidus made little difference between control and experimental group. These results suggest that pathology of manganese intoxication is caused by the loss of nerve cells in globus pallidus, and closely correlated with the duration after manganese exposure.
Animals ; Brain* ; Cerebral Cortex ; Gliosis ; Globus Pallidus ; Half-Life ; Manganese* ; Medulla Oblongata ; Neurons ; Olfactory Bulb ; Pathology ; Pituitary Gland ; Rats* ; Substantia Nigra ; Thalamus ; Tyrosine 3-Monooxygenase

BACKGROUND: Posterior cortical atrophy (PCA) is characterized by slowly progressive early onset dementia with cortical visual dysfunction and disproportionate atrophy of the posterior cortex. CASE REPORT: A 55-year-old right-handed woman developed visuo-spatial impairments that progressed rapidly into cortical blindness over the following 3 months. Neuro-psychological evaluation revealed Gerstmann syndrome and severe constructional impairments with all components of Balint syndrome. However, her memory, insight, and judgment were preserved. Her brain MRI was normal. However, 18F fluorodeoxyglucose positron emission tomography revealed a marked hypometabolism in the bilateral parieto-occipital region. CONCLUSIONS: Although rapid progression of visuo-spatial dysfunction without memory impairment occurred, we considered PCA as well.
Atrophy* ; Blindness, Cortical ; Brain ; Dementia ; Female ; Fluorodeoxyglucose F18 ; Gerstmann Syndrome ; Humans ; Judgment ; Magnetic Resonance Imaging ; Memory ; Middle Aged ; Passive Cutaneous Anaphylaxis ; Positron-Emission Tomography