OBJECTIVES: Muramyl peptide derived from bacterial cell wall has been identified as one of several endogenous sleep-promoting factors. Several studies have shown that the administration of antibiotics decreased sleep amount as well as bacterial colony numbers in rats. Electroconvulsive shock (ECS)has been widely used in the treatment of many psychiatric disorders, including depression, bipolar disorder, and some cases of schizophrenia. However exact mechanism of ECS on the normal or psychiatric condition is not well understood so far. Previous studies indicated that ECS has diverse effects on sleep parameters both in the human and animal subjects. However, there was no report to examine the relationship between effects of ECS and sleep in the antibiotic imposed animal subjects. Therefore the author studied the effects of ECS on chloramphenicol-induced insomnia in rats. METHODS: Twelve Sprague-Dawley strain rats were divided into control (N=6)and experimental group (N=6) The sleep-wake activity was recorded continuously for consecutive three days(baseline, day 1 and day 2) On day 1, both groups were intraperitoneally injected with chloramphenicol 150mg/kg. On day 2, the control group was intraperitoneally injected with chloramphenicol 150mg/kg only, whereas experimental group received ECS an hour after they were injected with chloramphenicol 150mg/kg. RESULTS: 1)Chloramphenicol administration decreased light period slow wave sleep (SWS) (t=4.944, p=0.000) and paradoxical sleep (PS) (t=3.887, p=0.003) as well as total SWS(t=2.98, p=0.012)and total PS (t=4.391, p=0.001) 2)ECS increased dark period SWS(t=-3.863, p=0.003)and dark period PS (t=-2.458, p=0.034)as well as total dark period sleep (t=-4.302, p=0.002) CONCLUSION: These results suggest that ECS may be effective to reverse chloramphenicolinduced insomnia in rats. Furthermore, chloramphenicol-induced insomnia in rats could be a useful animal model for the future sleep research.
Animals ; Anti-Bacterial Agents ; Bipolar Disorder ; Cell Wall ; Chloramphenicol ; Electroshock* ; Humans ; Models, Animal ; Rats* ; Rats, Sprague-Dawley ; Schizophrenia ; Sleep Initiation and Maintenance Disorders* ; Sleep, REM

Balloon dilatation has been applied in treatint of various pathologic narrowing of the hollow viscus. It is now accepted as very effective modality especially in treating esophageal stenosis obviating surgical procedure. We performed 128 balloon dilatations in 29 patients with the number of dilatations in each patient ranging from once to 12 times. The age distribution of the patients was from 3 weeks to 6 years, with the median age of 3 months. Twenty nine patients consisted of 25 postoperative esophageal strictures (21 esophageal atresia with tracheoesophageal fistula, 1 congenital esophageal stenosis, 2 tracheobronchial remnant, and 1 congenital esophageal stenosis with esophageal atresia), 2 achalasia, 1 congenital esophageal stenosis, and 1 corrosive esophagitis. We had successful dilation in 22 patients, who showed subsequent relief of symptoms and improvement in the diameter of stenotic segment. In 4 patients, esophageal perforation occurred during the procedure, one requiring emergency thoracotomy and the other threeconservative management. Seven patients had no improvement in stenotic sites after several balloon dilatations. Failed cases were congenital stenosis, achalasia, corrosive esophagitis and four postoperative strictures. We believe that balloon dilatation is the procedure of choice in the treatment of postoperative esophageal stricture in infants and children and is a safe method as the perforation which can complicate the procedure could be managed conservatively.
Age Distribution ; Child* ; Constriction, Pathologic* ; Dilatation* ; Emergencies ; Esophageal Achalasia ; Esophageal Atresia ; Esophageal Perforation ; Esophageal Stenosis ; Esophagitis ; Humans ; Infant* ; Methods ; Thoracotomy ; Tracheoesophageal Fistula

OBJECTIVE: To critically compare the benefits and risks of labor induction versus spontaneous labor in uncomplicated nulliparous women at 39 or more weeks of gestation. METHODS: We conducted a retrospective, observational study of 237 nulliparous women who were at 39 or more weeks of a singleton pregnancy with vertex presentation and intact membranes. We compared maternal outcomes including the Cesarean section rate and neonatal outcomes in the induced labor and spontaneous labor groups. RESULTS: Among the 237 women, 199 delivered vaginally (84.0%). The spontaneous labor group and induced labor group had a similar incidence of Cesarean delivery (17.7% vs. 12.3%, P=0.300). The length of stay and blood loss during delivery were also similar between the groups (4.3±1.5 vs. 3.9±1.5 days and 1.9±1.3 vs. 1.8±1.0 mg/sL, respectively; all P > 0.05). Regarding neonatal outcomes, the rate of meconium-stained amniotic fluid, Apgar score < 7 at 5 minutes, and intubation rate were similar between the groups (18.9% vs. 24.7%, 7.9% vs. 4.1%, and 6.1% vs. 4.4%, respectively, all P > 0.05). Only the neonatal intensive care unit admission rate was significantly lower in the induction group than in the spontaneous labor group (28.0% vs. 13.2%, P=0.001). CONCLUSION: Maternal adverse outcomes of labor induction at 39 weeks of gestation were similar to those in a spontaneous labor group in uncomplicated nulliparous women. Neonatal adverse events were also similar between the groups. It may be acceptable to schedule labor induction as long as 7 days before the estimated date, even when the indication is only relative.
Amniotic Fluid ; Apgar Score ; Appointments and Schedules ; Cesarean Section ; Delivery, Obstetric ; Female ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Intubation ; Labor, Induced ; Length of Stay ; Membranes ; Observational Study* ; Postpartum Period ; Pregnancy ; Retrospective Studies* ; Risk Assessment*

BACKGROUND: Trimethoprim/sufamethoxazole (TMP/SMX) is the recommended treatment for Pneumocystis jirovecii pneumonia (PCP). However, the efficacy and the safety of alternative salvage treatments are less guarauteed especially when patient experiences treatment failure and/or an adverse drug reactions (ADR). The purpose of this study is to recognize potential risk factors imitating successful treatment with TMP/SMX among PCP patients. MATERIALS AND METHODS: Ninety one adult patients diagnosed with PCP were included after searching electronical medical records from January 2013 through July 2015 at Asan Medical Center Seoul, Korea. We compared clinical characteristics and laboratory findings including bronchoalveolar lavage (BAL) fluid analysis in patients who experienced TMP/SMX treatment failure or ADR (the case group) versus those who did not (the control group). RESULTS: Among the enrolled PCP patients, 39 (42.9%) required salvage treatment owing to either treatment failure (28, 28.6%) and/or ADR (17, 18.7%). The BAL lymphocyte percentage (25% [IQR, 8–40%] vs. 47% [IQR, 15–62%]; P = 0.005) was lower in the case group. Diabetes mellitus (adjusted odds ratio [aOR] 4.98, 95% confidence interval [95% CI] 1.20–18.58), glomerular filtration rate ≤50 mL/min (aOR 4.48, 95% CI 1.08–18.66), and BAL lymphocyte percentage ≤45% (aOR 9.25, 95% CI 2.47–34.58) were independently associated with the case group in multivariate analysis. CONCLUSION: This study suggests that BAL lymphocyte count may play some role during PCP treatment. Further studies should be followed to reveal what the role of BAL lymphocyte is in the PCP treatment.
Adult ; Bronchoalveolar Lavage Fluid* ; Bronchoalveolar Lavage* ; Chungcheongnam-do ; Diabetes Mellitus ; Drug-Related Side Effects and Adverse Reactions ; Glomerular Filtration Rate ; Humans ; Korea ; Lymphocyte Count ; Lymphocytes* ; Medical Records ; Multivariate Analysis ; Odds Ratio ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia* ; Risk Factors* ; Salvage Therapy ; Seoul ; Treatment Failure

BACKGROUND: Trimethoprim/sufamethoxazole (TMP/SMX) is the recommended treatment for Pneumocystis jirovecii pneumonia (PCP). However, the efficacy and the safety of alternative salvage treatments are less guarauteed especially when patient experiences treatment failure and/or an adverse drug reactions (ADR). The purpose of this study is to recognize potential risk factors imitating successful treatment with TMP/SMX among PCP patients. MATERIALS AND METHODS: Ninety one adult patients diagnosed with PCP were included after searching electronical medical records from January 2013 through July 2015 at Asan Medical Center Seoul, Korea. We compared clinical characteristics and laboratory findings including bronchoalveolar lavage (BAL) fluid analysis in patients who experienced TMP/SMX treatment failure or ADR (the case group) versus those who did not (the control group). RESULTS: Among the enrolled PCP patients, 39 (42.9%) required salvage treatment owing to either treatment failure (28, 28.6%) and/or ADR (17, 18.7%). The BAL lymphocyte percentage (25% [IQR, 8–40%] vs. 47% [IQR, 15–62%]; P = 0.005) was lower in the case group. Diabetes mellitus (adjusted odds ratio [aOR] 4.98, 95% confidence interval [95% CI] 1.20–18.58), glomerular filtration rate ≤50 mL/min (aOR 4.48, 95% CI 1.08–18.66), and BAL lymphocyte percentage ≤45% (aOR 9.25, 95% CI 2.47–34.58) were independently associated with the case group in multivariate analysis. CONCLUSION: This study suggests that BAL lymphocyte count may play some role during PCP treatment. Further studies should be followed to reveal what the role of BAL lymphocyte is in the PCP treatment.
Adult ; Bronchoalveolar Lavage Fluid* ; Bronchoalveolar Lavage* ; Chungcheongnam-do ; Diabetes Mellitus ; Drug-Related Side Effects and Adverse Reactions ; Glomerular Filtration Rate ; Humans ; Korea ; Lymphocyte Count ; Lymphocytes* ; Medical Records ; Multivariate Analysis ; Odds Ratio ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia* ; Risk Factors* ; Salvage Therapy ; Seoul ; Treatment Failure

From Jan. 1991 to Apr. 1996, 99 cases of microsurgical tubal reversal were performed in the Department of Obstetrics and Gynecology, Chunchon Sacred Heart Hospital of Hallym University. 80 cases among them were followed up over 1 year postoperatively. The results were as follows : 1. The mean age of total 99 women was 32.5 years(24~42 years), and the average interval between tubal sterilization and tubal reversal was 7.2 years(1~17 years). 2. The methods of sterilization were laparoscopic fallope ring in 59 cases(59.6 %), laparoscopic electrocautery in 30 cases(30.3 %), tubal ligation during cesarean section in 9 cases(9.1 %) and minilap in 1 case. 3. The most common reason for tubal reversal was remarriage(61 case, 61.6 %) and the next was desire for son(16 cases, 16.2 %). 4. 80 cases(81 %) among the total 99 women were followed up over 1 year postoperatively. Intrauterine pregnancy was documented in 59 cases(73.7 %), 53 viable fetuses and 6 spontaneous abortions. Ectopic pregnancy was noted in 3 cases(3.8 %). 5. Pregnancy rates according to maternal age were as follows ; 88.9 % in less than 30 years, 70.3 % in 30~34 years, 71.4 % in 35~39 years. Two normal pregnancies were resulted from 4 women over 39 years. 6. Pregnancy rates according to the method of sterilization were as follows ; 78 % in fallope ring, 89 % in tubal ligation during cesarean section, 55 % in electrocautery. The statistical differences between each groups were not significant(p = 0.053). 7. Pregnancy rates according to the site of anastomosis were as follows ; 81.4 % in isthmicisthmic, 67.1 % in isthmic-ampulla. There was significant statistical difference between them(p = 0.011). 8. Pregnancy rates according to the postoperative tubal length were as follows ; 60 % in less than 4cm, 66 % in 4~6 cm, 95.4 % in more than 6cm(p = 0.024). 9. Among the 59 pregnant women, 38 pregnancies(65.4 %) were resulted within six months after surgery, 48(82.3 %) within one year, and 55(94.2 %) within 2 years. 10. Pregnancy rates according to the interval from tubal sterilization to tubal reversal were as follows ; 89.6 % in less than 5years of interval, 74.5 % in 5~10 years, 44.4 % in 11~15 years(p = 0.230).
Abortion, Spontaneous ; Cesarean Section ; Electrocoagulation ; Female ; Fetus ; Gangwon-do ; Gynecology ; Heart ; Humans ; Maternal Age ; Obstetrics ; Pregnancy Rate* ; Pregnancy* ; Pregnancy, Ectopic ; Pregnant Women ; Sterilization ; Sterilization, Tubal

BACKGROUND: The standard approach in treating cardiac myxoma is the median full sternotomy. With the evolution of surgical techniques, the right minithoracotomy approach has emerged as an alternative method. Since few studies have been published assessing the right minithoracotomy approach, we performed a retrospective study to compare the clinical outcomes of the right minithoracotomy approach with those of the sternotomy approach. METHODS: From January 2005 to December 2014, 203 patients underwent resection of a cardiac myxoma. Patients with preexisting cardiac problems were excluded from this study. 146 patients were enrolled in this study; 83 patients were treated using a median sternotomy and 63 patients were treated using a right minithoracotomy. RESULTS: No early mortalities were recorded in either group. Although the cardiopulmonary bypass time and aorta cross-clamp time were significantly shorter in the sternotomy group (p<0.001 and p=0.005), postoperative blood transfusions and arrhythmia events were significantly less common in the thoracotomy group (p=0.004 and p=0.025, respectively). No significant differences were found in the duration of the hospital stay, postoperative intubation time, the duration of the intensive care unit stay, and recurrence. CONCLUSION: The minimally invasive right minithoracotomy approach is a good alternative method for treating cardiac myxoma because it was found to be associated with a lower incidence of postoperative complications and a shorter postoperative recovery period.
Aorta ; Arrhythmias, Cardiac ; Blood Transfusion ; Cardiopulmonary Bypass ; Humans ; Incidence ; Intensive Care Units ; Intubation ; Length of Stay ; Methods ; Minimally Invasive Surgical Procedures ; Mortality ; Myxoma* ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Sternotomy* ; Thoracotomy

BACKGROUND: The interest in robotic cardiac surgery has recently grown but there has not been much clinical research reported on this. The aim of this study is to examine our initial experience, since August 2007, with robotic cardiac surgery using the da Vince(TM) surgical system and to evaluate the feasibility and safety of it. MATERIAL AND METHOD: Between August and December 2007, a total of 20 patients underwent robotic cardiac surgery using the da Vinci surgical system. For mitral valve repair (n=11), tricuspid valve repair (n=1), and ASD repair (n=1), cannulation, antegrade cardioplegia and transthoracic aortic cross-clamping were conducted for the right femoral vessels and the right internal jugular vein. For minimally invasive direct CABG (MIDCAB) (n=7), the internal thoracic artery (ITA) was harvested with the da Vinci surgical system. RESULT: The mean age of the patients was 50.1 (range: 26~78) years. Three concomitant Maze procedures and one tricuspid annuloplasty were combined with mitral valve repair. The mean cardiopulmonary bypass time was 208.0+/-61.3 minutes and the aortic cross clamp time was 158.8+/-40.6 minutes. No patients showed more than mild mitral regurgitation after repair and the median hospital stay was 4 days. The robotic-harvested ITA was used for either left ITA (n=6) or bilateral ITA (n=1). The mean harvest time was 43.2+/-12.0 minutes. The harvested ITA showed good flow and it was anastomosed under direct vision after left anterolateral thoracotomy. The patency of all the grafts was 100% (18/18) in MIDCAB. CONCLUSION: Robotic cardiac surgery using the da Vinci surgical system was variously adapted to areas such as mitral and tricuspid valve repair, ASD repair and ITA harvest for MIDCAB. The early results of the robotic cardiac surgery showed its safety and feasibility. With this primary report, we anticipate that clinical applications and further studies on robotic cardiac surgery using the da Vinci surgical system will be actively conducted in Korea.
Cardiopulmonary Bypass ; Catheterization ; Heart Arrest, Induced ; Humans ; Jugular Veins ; Korea ; Length of Stay ; Mammary Arteries ; Mitral Valve ; Mitral Valve Insufficiency ; Research Report ; Robotics ; Thoracic Surgery ; Thoracotomy ; Transplants ; Tricuspid Valve ; Vision, Ocular

Objective: This study aimed to evaluate the endometrial transcriptomic patterns in the early secretory phase (ESP) and mid-secretory phase (MSP) of the natural menstrual cycle before in vitro fertilization and embryo transfer (IVF-ET). Methods: Thirty patients whose endometrial tissues were obtained from the ESP or MSP of a natural menstrual cycle immediately before IVF-ET were included. Endometrial dating was histologically confirmed as ESP (cycle days 16-18) or MSP (cycle days 19-21), according to the noyes criteria. The patients were divided into two groups depending on the IVF-ET outcome: pregnant (n=14; 7 in ESP and 7 in MSP) or non-pregnant (n=16; 8 in ESP and 8 in MSP). Differentially expressed genes (DEGs) in the MSP, compared to the ESP, were identified using NanoString nCounter (NanoString Technologies, Seattle, WA, USA) data for both the pregnant and non-pregnant groups. Results: Thirteen DEGs in the pregnant group and 11 DEGs in the non-pregnant group were identified in the MSP compared to those in the ESP. In both groups, adrenoceptor alpha 2A, interleukin 1 receptor-associated kinase 2, a disintegrin and metalloproteinase with thrombospondin repeats 15 (ADAMTS15), serpin family E member 1, integrin subunit beta 3, transmembrane protein 252 (TMEM252), huntingtin associated protein 1, C2 calcium-dependent domain containing 4A, and integrin subunit alpha 2 were upregulated in the MSP, compared to the ESP. TMEM37, galactosidase beta 1 like 2, Rho family GTPase 3, and cytochrome P450 family 24 subfamily A member 1 were upregulated in the MSP only in the pregnant group. ADAMTS8 was downregulated and monoamine oxidase A was upregulated in the MSP only in the non-pregnant group. Conclusion Transcriptomic patterns in the endometrium immediately before IVF-ET appear to differ according to the IVF-ET outcome. These novel DEGs, which have not been previously studied, may have functional significance during the window of implantation and serve as potential biomarkers of endometrial receptivity.

BACKGROUND: Comprehensive geriatric assessment is identified as a dynamic process responsive to the changes on health status that occurs over time in the context of extremely increasing trend in the numbers of the elderly people, their office visit, and the medical cost universally. We completed the comprehensive geriatric assessment and applied it to the Korean elderly through the multi-center trials. METHODS: We performed studies variables using questionnaires, with interviewing, physical examination to the number of total 312 elderly people who visited the department of family medicine or physical medicine and rehabilitation of the 11 university hospital or general hospital in Korea from July 1, 1999 through October 31, 1999. We, the geriatrician, met and discussed 3 times to complete the comprehensive geriatric assessment through the consensus panel. RESULTS: We found the sex ratio of 312 subjects was 1 to 2 (104 males and 208 females) and the average age was 73.2 years old. The orders of more frequency of self-reported health status of the respondents were hypertension, arthritis, cataract, gastrointestinal disturbance, diabetes mellitus, urinary/fecal incontinence, depression, cerebrovascular accident, anemia, and heart disease. Nearly 15% of those showed depression, 41.6% of those were in the status of socially isolation. We found 43.1% of those showed hypertension, 3.7% isolated systolic hypertension, and 20.2% orthostatic hypotension. Of those, cognitive impairment were measured in 37.1%, gait disturbance 13.0%, and the risk of malnutrition 39.6%. Geriatrician spent 21.1 minutes per person during the process of comprehensive geriatric assessment. CONCLUSION: We realized we could diagnose and intervene effectively certain hidden conditions/diseases, particularly urinary incontinence, falls, visual impairment, hearing impairment, pain, depression, social isolation, cognitive impairment, and orthostatic hypotension, with using the comprehensive geriatric assessment. These results reflected the fact that the comprehensive geriatric assessment might be necessary for the care of the elderly.
Aged* ; Anemia ; Arthritis ; Cataract ; Consensus ; Surveys and Questionnaires ; Depression ; Diabetes Mellitus ; Gait ; Geriatric Assessment* ; Hearing Loss ; Heart Diseases ; Hospitals, General ; Humans ; Hypertension ; Hypotension, Orthostatic ; Korea ; Male ; Malnutrition ; Office Visits ; Physical and Rehabilitation Medicine ; Physical Examination ; Sex Ratio ; Social Isolation ; Stroke ; Urinary Incontinence ; Vision Disorders