Plain 0.5% bupivacaine and hyperbaric 0.5% tetracaine were compared for spinal anesthesia in 40 patients undergoing operation of lower extremities. Lumbar puncture was performed with a 22 gauge spinal needle with the patient in the lateral recumbent position. The third lumbar interspace was chosen for the puncture, when a free flow of clear CSF was obtained, the local anesthetic solution (2.5 ml of 0.5% bupivacaine or 2.0 ml of hyperbaric 0.5% tetracaine) was injected at a rate of 0.1ml/sec without barbotage. After injection of anesthetics, clinical features were observed and compared between the two groups. The results were as follows: 1. The two groups were well matched for age, sex, height and weight. 2. In both groups, sensory block to T₁₂ dermatome was obtained within 4 minutes, mean maximal level of analgesia was T₆₋₇, and the mean time for maximal level was around 20 minutes. 3. The onset times of motor block were similar in both groups and complete motor block was obtained in all cases within 20 minutes. 4. The duration of analgesia above the T₁₂ dermatome was 3 hours, postoperative analgesia was 7 hours. These value were significantly prolonged than those of the tetracaine group (p<0.05). 5. The changes in systolic pressure in the bupivacaine group were significantly less than those of the tetracaine group (p<0.05). 6. The complications after spinal anesthesia were headache, numbness, urinary retention and backpain, and were no significant difference in both groups. From the obtained results, we concluded that plain 0.5% bupivacaine was a relatively satisfactory agent for spinal anesthesia for operation of lower extremities. The time of onset, height of block and the complications of postoperative period were similar in both groups. The advantages of plain 0.5% bupivacaine were less hypotension and long duration of analgesia.
Analgesia ; Anesthesia, Spinal* ; Anesthetics ; Blood Pressure ; Bupivacaine* ; Headache ; Humans ; Hypesthesia ; Hypotension ; Lower Extremity* ; Needles ; Postoperative Period ; Punctures ; Spinal Puncture ; Tetracaine* ; Urinary Retention

No abstract available.
Dislocations* ; Elbow*

The CD8(+)CD28(+) T cells have known to mediate major histocompatibility complex class I-restricted cytolysis and to secret an HIV-1 inhibitory factor. As HIV infection lead to dramatic changes within the cellular immune system, the cellular cytotoxicities decrease in the duration of the HIV infection. To determine the importance of the cellular cytotoxicities in long-term nonprogression, we tried to compare CD28 expression on total T, CD4(+) T, and CD8(+) T cells as one of methods for cellular cytotoxicity measurements between long-term nonprogressor and normal person or between long-term nonprogressor and rapid progressor. The median percentages and counts of CD4(+) T cells of the norrnal, the long-term nonprogressor, and the rapid progressor groups were 39.9 and 0.96 * 10(9) cells/L, 24.6 and 0.58 * 10(9) cells/L, 9.9 and 0.15 * 10 cells/L, respectively. As a result of comparison of the cells having CD28 surface molecules on CD8(+) T cells in the long-term nonprogressor and the rapid progressor group, they showed over 5 times lower than that in the normal group. Especially, the long-term nonprogressor regarded to the healthy HIV-infected patient showed much lower CD28 expression on total T, CD4(+) T, and CD8(+) T cells than those of the normal person. The proportions of CD4'CD28 T and CD3CD28 T cell subsets showed the significant difference between the LTNP and the RP group. In conclusion, although HIV-infected patients were LTNPs having the steady CD4(+) T cell counts and no clinical symptoms, we suggested that HIV led to abnormality within the lymphocyte subsets such as the altered expression of CD28 molecules on various T cell subsets and this result would cause deficiency of host immune function and failure of control of HIV replication by anergy in T cell subsets.
Cell Count ; HIV ; HIV Infections ; HIV-1 ; Humans ; Immune System ; Lymphocyte Subsets ; Major Histocompatibility Complex ; T-Lymphocyte Subsets* ; T-Lymphocytes

Two hundred sixty two patients of the essential blepharospasm and hemifacial spasm were treated with Botulinum toxin A (Oculinum(R)). A total of 620 treatments was given injections over a 3-year period. A reduction in spasm intensity was noted in most patients, and the mean response time of the essential blepharospasm and hemifacial spasm were 144.2 days and 172.3 days, respectively, There was no clear relationship between age, sex, toxin dose or preinjected spasm intensity, the amount of spasm reduction, and the mean response time. The mean respone time had no difference from the first through the fourth treatments; but in hemifacial spasm, the mean response time of the second treatment was longer than that of first, third and fourth treatments. The lagophthalmos and superficial punctate keratitis were the most frequent complications. As a result of the injection to avoid the center of the upper and lower eyelids, the frequency of complications could be minimized. There was no clear difference in the beneficial effect and the mcidence of complication (lagophthalmos) between toxin stored in the vaccum and in the non-vaccum state. Patients who were treated with lidocaine mixed toxin had a less effective result than those with saline-mixed toxin.
Blepharospasm* ; Botulinum Toxins* ; Eyelids ; Hemifacial Spasm* ; Humans ; Keratitis ; Lidocaine ; Reaction Time ; Spasm

A Lithiasis within the nasal cavity (rhinolith) can be formed by either endogenous or exogenous material. It occurs as a result of the solidification of mucus and nasal debris by mineral salts, calcium, magnesium phosphate and carbonate. Rhinolithiasis leads to unilateral obstruction of the nasal airway followed by inflammation of the nasal mucus membrane and the paranasal cavities. It can be seen by the endoscopic examination as a hard intranasal mass, but diagnosis of rhinolithiasis can be difficult due to the varying clinical presentations. Surgery is obligatory for the removal of rhinoliths and in most cases it can be done by nasal endoscopic removal. Giant rhinolith, which is penetrated into the surrounding anatomical structures, needs more extended surgical approaches such as Caldwell-Luc operation or lateral rhinotomy. Here, we report one case of rhinolithiasis, which was removed surgically for the purpose of diagnosis and treatment, and present a literature review of this condition.
Calcium ; Carbon ; Diagnosis ; Endoscopy ; Inflammation ; Lithiasis ; Magnesium ; Membranes ; Mucus ; Nasal Cavity ; Salts

Lipoprotein lipase (LPL) is known to be attached to the luminal surface of vascular endothelial cells in a complex with membrane-bound heparan sulfate, and released into blood stream by heparin. LPL that catalyzes hydrolysis of triglyceride (TGL) on chylomicron and VLDL into two fatty acids and monoacylglycerol, is also implicated to participate in an enhancement of cholesterol uptake by arterial endothelial cells in vitro. But little is known about the LPL-mediated cholesterol uptake in physiological state. In this study, changes in blood lipid composition and levels of lipoproteins were determined after the injection of heparin in human. The level of LPL in plasma was increased from 0 to 11 mU/ml within 30-40 min post-heparin administration and decreased to the basal level within 2 h. The level of TGL in plasma decreased from 70 mg/dl to 20 mg/dl within 1 h and gradually increased to 80 mg/dl within 4 h. However the level of total cholesterol in plasma remained at 140 mg/dl during an experimental period of 4 h. Analysis of Lipoproteins in plasma by NaBr density gradient ultracentrifugation showed that the level of VLDL decreased from 50 mg/dl to 10 mg/dl within 1-2 h and returned to normal plasm level at 4 h. However there were no significant changes in the level of LDL and HDL. These results suggest that, at least, in normo-lipidemic subjects, increased free plasm LPL acts primarily on VLDL and failed to show any significant uptake of cholesterol-rich lipoproteins in human.
Adult ; Cholesterol/blood ; Heparin/pharmacology* ; Heparin/administration & dosage ; Human ; Immunoblotting ; Lipoprotein Lipase/blood* ; Lipoproteins/blood* ; Lipoproteins, HDL/blood ; Lipoproteins, LDL/blood ; Lipoproteins, VLDL/blood ; Triglycerides/blood

Cytomegalovirus (CMV) is potentially the most important pathogen affecting organ transplant recipients. The overall incidence of documented CMV infection after liver transplantation ranges from 23% to 85%. Approximately 15~40% of infected patients develop CMV disease such as pneumonia, hepatitis, gastrointestinal involvement, central nervous system involvement, retinitis, or nephritis. The gastrointestinal tract is one of the least common sites of CMV disease and usually presents as fever, diarrhea, and abdominal pain. We report a case of a 45-year-old man with end-stage liver disease who developed CMV colitis 6 weeks after deceased donor whole liver transplantation with a review of the relevant literature.
Abdominal Pain ; Central Nervous System ; Colitis* ; Cytomegalovirus* ; Diarrhea ; Fever ; Gastrointestinal Tract ; Hepatitis ; Humans ; Incidence ; Liver Diseases ; Liver Transplantation* ; Liver* ; Middle Aged ; Nephritis ; Pneumonia ; Retinitis ; Tissue Donors ; Transplants

BACKGROUND: In the Republic of Korea, there had been no reports about indigenous malaria cases since 1984 until a vivax malaria case was detected in 1993. Thereafter vivax malaria has been a reemerging disease in Korea, the number of cases of malaria increasing recently and the prevalent area being more wider. We suggested that we should take malaria into consideration as the differential diagnosis whenever we meet the febrile patients. We analyzed the cases of malaria who were treated in Myoungji hospital located in Goyang-Si during 4years. METHODS: We retrospectively analyzed data of 79 confirmed cases of malaria treated in the Myoungji hospital from January 1, 1998 to December 31, 2001. All of the patients had no histories of traveling abroad, drug abuse or blood transfusion. The clinical manifestation, hematologic abnormalities and prognosis of patients were reviewed. RESULTS: Seventy-nine cases of malaria were diagnosed as vivax malaria by blood smears. Vivax malaria was developed in Goyang-Si from May through November. Common symptoms were fever (100%), chilling (84.8%), headache (64.6%) and myalgia (55.7%). Splenomegaly was detected in 77.2% of cases by sonography. In 1998, Tertian fever pattern was most frequent. Since 1999, irregular and atypical fever patterns, such as almost-daily high fever or the every fourth or fifth-day fever, were increased in numbers. Laboratory findings included thrombocytopenia (92.4%), anemia (29.1%), leukopenia (25.3%) and leukocytosys (5.1%). CONCLUSION: ICases of indigenous malaria have been progressively increasing in the Republic of Korea. Therefore early diagnosis, treatment and prevention of malaria are very important. Fortunately, patients were well responsed to treatment.
Anemia ; Blood Transfusion ; Diagnosis, Differential ; Early Diagnosis ; Fever ; Headache ; Humans ; Korea ; Leukopenia ; Malaria* ; Malaria, Vivax ; Myalgia ; Plasmodium vivax ; Prognosis ; Republic of Korea ; Retrospective Studies ; Splenomegaly ; Substance-Related Disorders ; Thrombocytopenia

We have determined the infusion rates of rocuronium in the elderly and young adult patients during sevoflurane and nitrous oxide anesthesia. The correlation of some anthropometric predictors with infusion rate of rocuronium was also investigated for both elderly and young adult. Participating patients were assigned to one of two groups: 1) young adult patients aged 20 to 50 years (n = 30) ; 2) elderly patients aged over 65 years (n = 30). The anthropometric variables such as height, weight, ratio of weight to body surface area, subscapularis and suprailiac skin folds, body surface area, body mass index and % ideal body weight were evaluated as predictors for infusion rate. The infusion rate in elderly patients was significantly less compared with that in young adult patients (p < 0.05). In elderly patients, no anthropometric predictor was related to the infusion rate of rocuronium. This suggests that the infusion rate of rocuronium for an elderly patient needs to be individualized by monitoring neuromuscular transmission to avoid excessive dose.
Skinfold Thickness ; Neuromuscular Nondepolarizing Agents/*administration & dosage ; Middle Aged ; Male ; Infusions, Intravenous ; Humans ; Female ; Body Weight ; Body Surface Area ; Body Mass Index ; Body Height ; *Anthropometry ; Androstanols/*administration & dosage ; Aged ; Adult

BACKGROUND: Although the pro-convulsant or anticonvulsant properties of propofol remain a matter of controversy, it is evident that propofol can produce involuntary movement. Such movement is a relatively common side effect, especially in children, and may be dose-related or injection rate-related. The goal of this study was to evaluate the effect of injection rate upon involuntary movement during propofol induction in children. METHODS: Children (age 3-14 yr) undergoing elective Eye and ENT surgery were randomly allocated to one of 4 groups based on the propofol injection rate (A, manual/15 s; B, 360 ml/hr; C, 200 ml/hr, D, 100 ml/hr) using a manual injection method and syringe pumps. No premedication was used. The induction dosage of propofol was 3 mg/kg in all groups. Fentanyl 1mcg/kg and 1% lidocaine 1-2ml were given I.V. before propofol. Involuntary movement was graded 0-2 on severity. The infused dose of propofol at movement was measured. Movement due to pain or mask fitting was not regarded as an involuntary movement. All results were analyzed using the Chi-Square Test and ANOVA. RESULTS: 595 children were studied. Age, gender, and weight were similar in the 4 groups. Involuntary movements were apparent in 179 (30.1%) of the 595 subjects. Movements were significantly less in group A (12.4%) and B (16.4%) compared to group C (46.6%) and D (45.3%). The grades of movement were not different among the 4 groups. The durations of movement in group A and B were significantly short compared to group C and D. The infused dose of propofol (mg/kg) at movement was higher in group C (2.65+/-0.62) than in A (1.99+/-0.62) and B (2.43+/-0.78). There were no significant hemodynamic and SPO2 changes during and after the propofol injection. CONCLUSIONS: We concluded that slow injection may increase the incidence of involuntary movement during propofol induction in children. Since the bolus injection rates are usually slow in most syringe pumps, manual injection for 10 15 s may be a better choice for smoother induction, as it requires fewer interventions to prevent venous catheter displacement in children.
Catheters ; Child* ; Dyskinesias* ; Fentanyl ; Hemodynamics ; Humans ; Incidence ; Lidocaine ; Masks ; Premedication ; Propofol* ; Syringes