This study included 38 children patients of less than 4 years old and 18 kg body weight. After 8 hours of starvation, the children were divided into 2 groups: Group I received Hartmann's solution and Group II received Hartmann's dextrose solution. In both groups, the rates of infusion were 10 ml/kg/hr before and during operation and blood samples were collected just before and 1 hr after induction of anesthesia, respectively. The results were as follows; 1) In the Group I, blood glucose concentration just before induction was decreased than control values that was checked at ward, and 1 hr value after induction was significantly increased then control values. 2) In the Group II, blood glucose concentration was increased just before and 1hr after induction than control values significantly respectively. 3) In the blood glucose concentration 1 hr after induction, difference between Group I and Group II was not significant. 4) In children, duration of starvation about 8 hrs did not significant influence on blood glucose concentration although dextrose was not administered.
Anesthesia* ; Blood Glucose* ; Body Weight ; Child* ; Fluid Therapy* ; Glucose ; Humans ; Starvation*

BACKGROUND: The incidence of Bacillus cereus bacteremia is increasing, but the identification of Bacillus species remains difficult. Brilliance Bacillus cereus agar (BBC agar; Oxoid, UK) is a new CHROMagar medium that allows selective isolation and identification of B. cereus; however, its clinical usefulness is seldom studied. We evaluated the usefulness of BBC agar to identify B. cereus isolates recovered from blood cultures. METHODS: We analyzed a total of 53 blood isolates that showed a Bacillus-like morphology on Gram staining. All isolates were identified by using both the API Coryne (bioMerieux, France) and API 50CH/B (bioMerieux) systems. They were subsequently subcultured on BBC agar, incubated for 24 hr, and then examined for characteristic blue-green colonies. The clinical characteristics of patients whose isolates were identified as B. cereus were assessed. RESULTS: Of the 53 isolates, 18 were identified as B. cereus by API 50CH/B. With the API 50CH/B system used as gold standard, the sensitivity and specificity for the identification of B. cereus were 100% (18/18) and 100% (35/35), respectively, using BBC agar, and 67% (12/18) and 100% (35/35), respectively, using the API Coryne system. Of the 18 patients with B. cereus bacteremia, 15 showed infectious signs, and 3 had more than 2 blood cultures positive for B. cereus on separate days. CONCLUSIONS: Our study shows, for the first time, that BBC agar, with its good agreement and ease of use, is a valuable alternative to the API 50CH/B system for the presumptive identification of B. cereus isolates from blood cultures.
Adolescent ; Adult ; Agar/chemistry ; Aged ; Bacillus cereus/*isolation & purification ; Bacteremia/*diagnosis/microbiology ; Child ; Child, Preschool ; Chromogenic Compounds/*chemistry ; Culture Media ; Female ; Gram-Positive Bacterial Infections/*diagnosis/microbiology ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Reagent Kits, Diagnostic ; Sensitivity and Specificity

We report a rare case of fungemia due to Exophiala (Wangiella) dermatitidis in a 4-month-old female infant who was admitted to an intensive care unit with sudden infant death syndrome (SIDS). E. dermatitidiswas repeatedly isolated from blood cultures (on the 28th and 32nd day of hospitalization) of the patient, who died on the 44th day of hospitalization. The fungus was identified by its morphological characteristics and DNA sequencing of both the D1/D2 domain and the ITS region of rDNA. To our knowledge, this is the first reported case of E. dermatitidis fungemia in Korea.
DNA, Ribosomal ; Exophiala ; Female ; Fungemia ; Fungi ; Hospitalization ; Humans ; Infant ; Intensive Care Units ; Korea ; Sequence Analysis, DNA ; Sudden Infant Death

Surgical tissue damage induces dual phenomenon of peripheral and central sensitization. Postoperative pain could be partially explained by neuronal hyperexcitability. As a postoperative pain model, formalin test, subcutaneous injection of formalin in the rat hind paw, results in initial vigorous flinching(phase 1), depends on acute chemical stimulation, followed by cessation of activity, and then resumption of flinching(phase 2), which depends on central sensitization. Pre-emptive analgesia, given before the onset of a painful stimuli, reduces or ptevents postoperative pain by preventing this central sensitization. This study was performed to evaluate the effect of local infiltration of lidocaine as a pre-emptive analgesia in the formalin test. Forty experimental rats were divided four groups; CONTROL group(without any treatment), POST group(0.04 mL of 1% lidocaine injection 5 min after formalin injection), PRE group(0.04mL of 1% lidocaine 5 min before formalin injection), and SHAM group(injection of normal saline 5 min before formalin injection). All animals received inhalation anesthesia for 15 min before and 5 min after formalin injection. Under halothane inhalation anesthesia, all were injected subcutaneously 0.04 mL of 5% formalin in the distal plantar area of right hind paw. After recovery of anesthesia, the formalin-induced flinching behavior was observed during only the phase 2 period(10-60 min) after formalin injection. The time to first flinching, the mean number of flinches per min, and the mean number of total flinches during phase 2 expressed as a percent of the values of the CONTROL group were compared between the groups with an t-test or an ANOVA. The first flinching was appeared before recovery of anesthesia in CONTROL and SHAM groups. The time to first flinching after formalin injection was 21.2+/-3.4, 16.6+/-3.1 min respectively in PRE and POST groups. It was significantly longer in PRE group than in POST group(P<0.05), despite of 10 min earlier injeetion of lidocaine in PRE group. The mean number of flinches per min was significantly lower in PRE and POST groups(P<0.05) until 25 min after formalin injection, and after that time the difference between PRE group and POST group was significant(P<0.05). The means of the total number of flinches during phase 2, expressed as a percent of the values of the CONTROL poup, were 100+/-17.2%, 31.8+/-13.1%, 76.9+/-14.5% respectively in SHAM, PRE and POST groups. Those in PRE and POST groups were significantly lower than that of CONTROL group(P<0.001), and the difference between PRE group and POST group was significant(P<0.05). In summary, pre-emptive infiltration of lidocaine on formalin test prolongs the duration of analgesia and reduces the severity of formalin pain in rat. Therefore, the infiltration of lidocaine before formalin test is really provided pre-emptive analgesia.
Analgesia ; Anesthesia ; Anesthesia, Inhalation ; Animals ; Central Nervous System Sensitization ; Formaldehyde* ; Halothane ; Injections, Subcutaneous ; Lidocaine* ; Neurons ; Pain Measurement ; Pain, Postoperative ; Rats* ; Stimulation, Chemical

We describe here a case of central venous catheter (CVC)-related bacteremia caused by Microbacterium species in a 14-year-old patient, who had received chemotherapy for acute lymphoblastic leukemia. All nine blood cultures obtained from admission day 2 to day 62 yielded the same yellow-pigmented coryneform rod. Both Vitek 2 (bioMerieux, USA) and MicroScan (Dade Behring, USA) identified the isolate as Micrococcus species, and the API Coryne (bioMerieux, France) identified the isolate as Rhodococcus or Brevibacterium species. However, the 16S rRNA gene sequence showed a 99% identity with Microbacterium species. The bacteremia was recurrent or persistent over 60 days despite alternate systemic antibiotic therapy, but blood culture became negative after an addition of teicoplanin lock therapy for eradicating CVC-related bacteremia. This represents the first report of CVC-related Microbacterium bacteremia cured by antibiotic lock therapy in Korea.
Adolescent ; Bacteremia ; Brevibacterium ; Central Venous Catheters ; Genes, rRNA ; Humans ; Micrococcus ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Rhodococcus ; RNA, Ribosomal, 16S ; Teicoplanin

BACKGROUND: Human papillomavirus (HPV) is a small double-stranded DNA virus. Of HPV, type 16 and 18 are associated with high risk in the development of cervical cancer. In order to evaluate HPV infections, several HPV typing and detection methods have been developed. The aim of this study was to compare the detection rates of HPV 16 and 18 by polymerase chain reaction (PCR), in situ hybridization(ISH), and PCR in situ in uterine cervical cancers. METHODS: PCR, ISH and PCR in situ were performed for the detection of HPV DNA in fifty-one formalin fixed, paraffin embedded blocks of uterine cervical cancer tissues. Twenty uterine cervical specimens from patients with uterine myomas were used as controls. RESULTS: The detection rates of HPV 16 and HPV 18 in cervical cancers were 56.9% (29/51) and 45.1% (23/51) by PCR, 9.8% (5/51) and 5.9% (3/51) by ISH, 17.6% (9/51) and 11.8% (6/51) by PCR in situ, respectively. In control group, the detection rate of HPV 16 and 18 by PCR were 10% (2/20) and 5% (1/20), but HPV was not detected by both ISH and PCR in situ. CONCLUSION: PCR was the most sensitive method for the detection of HPV. However, PCR in situ was more informative fort the specific detection and cell localization of HPV DNA.
DNA ; Formaldehyde ; Human papillomavirus 16 ; Human papillomavirus 18 ; Humans* ; In Situ Hybridization* ; Leiomyoma ; Paraffin ; Polymerase Chain Reaction* ; Uterine Cervical Neoplasms*

PURPOSE: Radiation-induced chromosomal damage and apoptosis were compared in human lymphocytes. MATERIALS AND METHODS: Peripheral lymphocytes from 10 normal volunteers (6 males, 4 females, age range 23~41 years) were irradiated by gamma rays from a cell irradiator. Doses of irradiation were 0 (control), 0.18, 2, 5, 10, 20 and 25 Gy. Irradiated lymphocytes were examined by metaphase analysis for chromosomal aberrations and by flow cytometry for apoptosis. RESULTS of both studies were compared according to dose. RESULTS: Number of dicentric and ring chromosomes (D+R) was 0.5+/-0.53 at baseline, which was significantly increased after radiation according to the dose. The fraction of cells showing annexin V-fluore-scein isothiocyanate uptake was 0.55+/-0.39%, which increased to 3.58+/-1.85% by 2 Gy irradiation, and then decreased. The fraction of cells showing propidium iodide (PI) uptake was 0.52+/-0.12%, which significantly increased according to dose (upto 15.64+/-5.99% by 20 Gy irradiation). D+R and PI uptake were well correlated (r=0.84, p<0.001). CONCLUSION: Radiation-induced chromosomal aberration was correlated to nuclear uptake of PI, a marker of late apoptosis.
Apoptosis* ; Chromosome Aberrations* ; Female ; Flow Cytometry ; Gamma Rays ; Healthy Volunteers ; Humans* ; Lymphocytes* ; Male ; Metaphase* ; Propidium ; Radiation Injuries ; Ring Chromosomes

It is true that intracranial pressure(ICP) and mean arterial pressure(MAP) are increased by induction of conventional inhalation general anesthesia, and it may be very dangerous in neurosurgical patients who had increased ICP. Therefore, this study was performed to know the ranges of ICP and MAP increase during induction of the general anesthesia with laryngoscopy and endotracheal intubation following thiopental sodium(4mg/kg) and succinyeholine chioride(1 mg/kg) injections in 16 neurosurgical patients with normal pulmonary and cardiac functions. All the patients were monitored ICP and intraarterial pressure preoperatively, and intracranial compliance, ICP, MAP and pulse rate were measured in all patients during induction of general anesthesia. The results were as follows: 1) Intracranial compliance; ICP during endotracheal intubation increased by 2 mmHg in those patients with pre-operatively normal range of compliance, but in those patients with compliance range of 2-3 ml/CmH2O, mean ICP increase was 5. 6+/-2. 45 mmHg, and in those patients with compliance range of 4-6 ml/CmH2O, it was 13. 010. 23 mmHg. 2) Mean ICP increased from 13.5+/-6.16 mmHg at pre-induction to-20.4+/-10.02 mmHg during endotracheal intubation, but it was not statistically significant(p>0.05) because the rate of ICP increase was not remarkable by endotracheal intubation in the patients without ICP increase in pre-induction. 3) Mean arterial pressure increased significantly from 116.71+/-6.65 mmHg at pre-induction to 160. 3+/-34. 24 mmHg during endotracheal intubation(P<0.05). 4) Pulsse rate increased significantly from 94.8+/-20.28 beat/min to 120.5+/-15.93 beat/min(p<0.001). 5) Cerebral perfusion pressure increased from 103.3+/-14.49mmHg 137.3+/- 35.91mmHg(p<0.025). It is stressed that certain procedures are necessary to prevent from further increase of ICP due to induction of general anesthesia in patient with increased ICP.
Anesthesia, General* ; Arterial Pressure ; Compliance ; Heart Rate ; Humans ; Inhalation ; Intracranial Pressure* ; Intubation, Intratracheal ; Laryngoscopy ; Perfusion ; Reference Values ; Thiopental ; Vital Signs*

BACKGROUND: Statins reduce mortality of patients with coronary artery disease. However, many trials have excluded patients with ischemic heart failure. Statins may have other beneficial effects besides cholesterol lowering, such as anti-inflammatory properties and improvement of endothelial function. The aim of this study was to determine the effects of statin therapy in acute myocardial infarction (AMI) patients with left ventricular (LV) dysfunction. METHODS: We studied 202 patients with AMI with LV dysfunction [ejection fraction (EF) below 40%] between January 2001 and June 2002. The patients were divided into two groups: Group I (n=106, 60.8 +/- 10.3 years, male 71.7%) who were treated with simvastatin and Group II (n=96, 60.9 +/- 10.4 years, male 78.1%) who were not treated with simvastatin. RESULTS: At six-month after percutaneous coronary intervention (PCI), LVEF was more improved in Group I than in Group II (30.8 +/- 10.0% to 42.4 +/- 10.7% vs 31.9% to 38.9%, p=0.042). The levels of total cholesterol, triglyceride and low density lipoprotein-cholesterol were more decreased and the level of high density lipoprotein-cholesterol was more increased in Group I than in Group II. The levels of C-reactive protein, fibrinogen, white blood cell and monocyte count were more decreased in Group I than in Group II. During one-year clinical follow-up, statin therapy was associated with a significant reduction in mortality (1.9% vs 7.5%, p=0.048), restenosis rate (25.7% vs 43.1%, p=0.033) and repeat PCI rate (25.7% vs 43.1%, p=0.033). The event-free survival rate was higher in Group I than in Group II (79.8% vs 57.0%, p=0.001). CONCLUSION: Statin therapy improves LV systolic function and decreases mortality, restenosis and repeat PCI in the AMI with LV dysfunction.
C-Reactive Protein ; Cholesterol ; Coronary Artery Disease ; Disease-Free Survival ; Fibrinogen ; Follow-Up Studies ; Heart Failure ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Inflammation ; Leukocytes ; Male ; Monocytes ; Mortality ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Simvastatin ; Triglycerides ; Ventricular Dysfunction, Left*

BACKGROUND AND OBJECTIVES: The level of cardiac specific troponin (cTn) may be important in patients with acute coronary syndrome (ACS), but with normal electrocardiography (ECG). SUBJECTS AND METHODS: Three hundred and nineteen patients (61+/-11 years, M:F=212:107), with ACS and normal ECG, who underwent a diagnostic coronary angiogram (CAG), between July 2000 and June 2001, were analyzed according to their cTn level. The clinical characteristics, initial CAG findings and major adverse cardiac events (MACE), during a one-year clinical follow-up, were compared between positive and negative cTn groups. RESULTS: Of the enrolled patients, 191 had a negative cTn (group A, 61+/-10 years, M:F=131:60), and 128 a positive cTn (group B, 60+/-11 years, M:F=81:47), and 176 (55.2%) were shown to have significant coronary artery stenosis on CAG. There were no significant differences in risk factors between the two groups. The mean left ventricular ejection fraction was 64+/-9%, and was lower in group B than in group A (59+/-10% vs. 67+/-7%, p<0.05). cTn positivity was associated with the percentage of significant coronary artery stenosis present (88% vs. 32%, p<0.05), a smaller minimal luminal diameter (1.09+/-0.44 mm vs. 2.68+/-0.33 mm, p<0.05) and a larger diameter of stenosis (68+/-6% vs. 44+/-6%, p<0.05). A multi-vessel lesion was more common in group B than in group A (58.3% vs. 30.3%, p<0.05). During the one-year follow-up period, 36 patients developed MACE, resulting in 3 deaths, 7 acute myocardial infarctions and 34 patients with restenosis. MACE was observed in 9 patients of group A and in 27 of group B (4.7% vs. 21.1%, p<0.05). CONCLUSION: The troponin levels are valuable for the early diagnosis, and prediction of the long-term prognosis, in patients with ACS and a normal ECG.
Acute Coronary Syndrome* ; Angina, Unstable ; Constriction, Pathologic ; Coronary Disease ; Coronary Stenosis ; Early Diagnosis ; Electrocardiography* ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Phenobarbital ; Prognosis ; Risk Factors ; Stroke Volume ; Troponin*