The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy.
Administration, Intravenous ; Amnesia ; Anesthesia ; Blood Pressure ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Premedication*

Gastric glomus tumor is an uncommon benign, submucosal neoplasm and does not require radical surgical procedure. Because there are no specific clinical or radiologic features associated with the glomus tumor, it can be recognized only by its histologic characteristics. We report a 30-year-old woman who had 10 years history of epigastric hunger pain. Radiologically, a gastric submucosal tumor was discovered, which was suggestive of leiomyoma. Gastric antrectomy was performed. The tumor cells showed immunohistochemical and ultrastructural evidence of smooth muscle differentiation.
Female ; Humans

BACKGROUND: Intermediate myasthenia syndrome(IMS) is thought to have clinical importance because it may cause sudden respiratory failure during the recovery phase of a cholinergic crisis of organophosphate poisoning. We designed this study to identify the prevalence, the inducing agent, clinical predictor, and the proposed treatment of IMS. METHODS: Patients who had admitted with the diagnosis of acute organophosphate poisoning from 1992 to 1998 at two teaching hospitals were enrolled in this study. We selected the cases of IMS based on a review of medical records using modified He's criteria. RESULTS: Twelve(12) out of 110 patients with acute organophosphate poisoning were diagnosed for a prevalence at 10.9%. The drug inducing IMS were identified as dichlorvos, fenthion, EPN, methidathion, and phosphamidon. The occurrence of IMS was not related to either the initial treatment with atropine and pralidoxime, or the level of serum cholinesterase. Complications were pneumonia, sepsis, pancreatitis, and pseudomembranous colitis, etc. Eleven(11) patients were discharged without sequelae, and one patient was discharged as a hopeless care. CONCLUSION: This study suggests that IMS is not rare, so close observation is required to detect IMS in organophosphate-poisoning patients. Also, more studies are required to find predictors and treatments.
Atropine ; Cholinesterases ; Diagnosis ; Dichlorvos ; Enterocolitis, Pseudomembranous ; Fenthion ; Hospitals, Teaching ; Humans ; Medical Records ; Organophosphate Poisoning ; Pancreatitis ; Phosphamidon ; Pneumonia ; Prevalence ; Respiratory Insufficiency ; Sepsis

PURPOSE: To evaluate the prevalence of the opacification of paranasal sinuses and to correlate the prevalence and severity of the sinus opacification with presence of upper respiratory infection (URI) in infants and children using CT. MATERIALS & METHODS: We analyzed CT scans of 162 children aged under 16 who have no signs and symptoms of paranasal sinusitis. Both sides of maxillary and ethmoidal sinuses were evaluated. We scored from 0 to 3 according to the degree of soft tissue opacification of each sinus and then summed up the scores of each sinus. We divided the children into 5 groups according to their age. We paid particular attention to the following respects: 1) the prevalence of the opacification of the paranasal sinuses in each group; 2) the difference in the prevalence between the children with and without URI ;3) the correlation between the severity of the sinus opacification and the presence of URI. RESULTS: Of 162 children, one or more paranasal sinus opacification was noted in 76(47 %):31(65%) less than 1 year old;11(52%) between 1 and 2 years old;16(53%) between 2 and 6 years old ;15(28%) between 6 and 12 years old;and 3(33%) above 12 years old. In children less than 1 year old, no significant difference in the prevalence of the sinus opacification was found between URI-positive(71%) and URI-negative(58%) subgroups. In chilren between 1 and 12 years old, although the prevalence of the sinus opacification in URI-positive subgroups was much greater than that in URI-negative subgroup, statistically significant difference was noted only in children between 2 and 6 years old. As to the correlation between the severity of the sinus opacification and the presence of URI, these was a statistically significant difference in children between 2 and 6 years old and between 6 and 12 years old. CONCLUSION: Although the exact pathophysiology is not fully understood, the opacification of the paranasal sinuses is not an uncommon finding at CT in children without the signs and symptoms of sinusitis. We think that the clinical correlation is essential in determining the diagnosis and treatment plan in cases that the sinus radiographs or CT scans show the abnormal findings.
Child* ; Diagnosis ; Humans ; Infant* ; Paranasal Sinuses ; Prevalence* ; Sinusitis* ; Tomography, X-Ray Computed

BACKGROUND: Hyperkalemia is a common and potentially life-threatening metabolic disorder. The electrocardiogram(ECG) is known to be a relatively sensitive diagnostic tool hyperkalemia. However many exceptions, in which patients showed normal ECG findings even though hyperkalemic, have been reported. The purpose of this study was to determine the extent of correlation between the ECG findings and hyperkalemia and to determine when the ECG has value for diagnosing hyperkalemia. METHODS: Patients who had been diagnosed as having hyperkalemia at two university hospitals during three years were enrolled in this study. We reviewed the medical records of the patients and evaluated the following 6 ECG abnormalities: tall T waves, narrow T waves, QRS widening, atrioventricular block, loss of P waves, and sine waves. We defined tall T waves and narrow T waves as 20 percentiles of heights and widths of the T waves from the 100 patients with normokalemia. RESULTS: During the study period, there were 100 hyperkalemic patients, and we analyzed 69 available electrocardiograms. Abnormal ECG findings were revealed in 67% of 69 patients. The higher the serum potassium level, the more abnormal ECG findings. The common ECG abnormalities were tall T waves and loss of P waves. The patients with normal ECGs even though hyperkalemic had relatively low potassium levels. And whether chronic renal disease was not correlated to the ECG abnormality. CONCLUSION: The electrocardiogram is a good diagnostic tool for hyperkalemia if it is used with accurate diagnostic criteria. Thus, hyperkalemia should be considered when the ECG shows tall T waves or loss of P waves.
Atrioventricular Block ; Electrocardiography* ; Hospitals, University ; Humans ; Hyperkalemia* ; Medical Records ; Potassium ; Renal Insufficiency, Chronic

No abstract available.
DNA* ; Laryngeal Neoplasms*

BACKGROUND: Hypothermia is a condition that can lead to serious complications and even to death in newborn. Although the temperature control is essential in neonatal care, it is often neglected during urgent transfer from local private hospitals. The purpose of this study is to evaluate the incidence and clinical outcomes of transfer induced neonatal hypothermia. SUBJECTS AND METHOD: In this retrospective study, subject is limited to transferred outborn babies with age less than 24 hours from June 1996 to May 1999. A total of 3,086 patients were admitted in NICU during the study period and inborn and outborn babies were 1,743(56%) and 1,343(44%) respectively. Among the 1,343 outborn babies, 212 babies were transferred from the private hospital within 24 hours of birth and were eligible for the study. Rectal temperature on arrival, transfer time, birth weight, gestational age, initial arterial gas study, and clinical outcome were compared. Statistical analysis has been done with chi-sqaure test and multiple logistic regression analysis. RESULTS: There were 84 cases(39.6%) hypothermia(<36degrees C> among the 212 babies and the rate of hypothermia in transfered babies have not decreased over the study period. There were significantly more hypothermia in lower gestational age (less than 28 weeks) and lower birth weight (less than 2,000gm) caused hypothermia significantly more than normal gestational age or normal range of birth weight. And time interval (less than 12 hour) from birth to arrival at emergency department was also significant factor in hypothermia. The mortality rate was three fold higher in hypothermia than normothermic or hyperthermic babies. CONCLUSION: This study shows that hypothermia during neonate transportation is a major cause of neonatal mortality and morbidity in prehopital care. Body temperature control during transport of neonates under 24 hours of age should be emphasized for the better outcome of treatment.
Birth Weight ; Body Temperature ; Emergency Service, Hospital ; Gestational Age ; Hospitals, Private ; Humans ; Hypothermia* ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn* ; Logistic Models ; Mortality ; Parturition ; Reference Values ; Retrospective Studies ; Transportation*

BACKGROUND: The end-tidal carbon dioxide (ETCO2) is defined as a partial pressure of carbon dioxide at the end of an exhaled breath. And it has been found to correlate with cardiac output during cardiopulmonary resuscitation (CPR) in animal model. The purpose of this study is to determine that the assessment of ETCO2 could provide a highly sensitive predictor of return of spontaneous circulation (ROSC) during CPR. METHODS: Prospective, observational study was performed from Oct 1996 to Mar 1997 at the Severance hospital. All patients were endotracheally intubated and connected immediately to mainstream capnography sensor. We measured ETCO2 with Escort II model 20100 monitor(Medical Data Electronics, Inc, USA). It works on the principle of nondispersed infrared absorption with radiometric single beam optics. RESULTS: This study included 70 patients (52 were men) with a mean age of 54+/-15 years. ROSC was obtained in 43 patients. The initial ETCO2 averaged 15.5 +/-8.2 mmHg in survivors and 6.5+/-5.3 mmHg in nonsurvivors (p<0.01), and during the first 20 minutes of CPR, the maximal ETCO2 averaged 29.7+/-10.3 mmHg in survivors and 10.2+/-8.9 mmHg in nonsurvivors (p<0.01). ETCO2 was not significantly different in relation to initial rhythm, survival time after ROSC and possible cause of arrest. There is no cutoff value of ETCO2 satisfying greater than 90% of both sensitivity and specificity in predict ROSC. When maximal ETCO2 was less than 12 mmHg, we observed sensivity of 100% in predicting ROSC. CONCLUSION: Our results demonstrate that ETCO2 measurement represents a valuable, noninvasive, and clinical tool for monitoring patients during CPR.
Absorption ; Capnography ; Carbon Dioxide* ; Carbon* ; Cardiac Output ; Cardiopulmonary Resuscitation* ; Humans ; Models, Animal ; Observational Study ; Partial Pressure ; Prospective Studies ; Sensitivity and Specificity ; Survivors

No abstract available.
Nasal Cavity* ; Solitary Fibrous Tumors*

We studied the ultrastructural alteration of glomerular anionic sites in 6 patients with minimal change nephrotic syndrome, 5 patients with membranous glomerulonephritis, 4 patients with focal segmental glomerulosclerosis, and 4 patients with IgA nephropathy by staining with polyethyleneimine (PEI) as a cationic probe. The control study was examined by using a nephrectomy specimen of non-glomerular disease which had no proteinuria. This method seems to selectively stain heparan sulphate in the basement membranes and has been widely used to evaluate changes in basement membrane charge in various human diseases as well as in experimental studies. The anionic sites in the lamina rara interna and lamina densa of normal glomerular basement membrane were always less numerous and less regularly distributed than those in the lamina rara externa. Characteristic common findings in these glomeruli showed a marked decrease of glomerular anionic sites in the regions with immune-complex deposits and normal distribution in the regions with focally those being absorbed and newly forming glomerular basement membrane. They were not detected in the gap of the basement membrane and on the area of the detached overlying epithelium using the PEI method. But the foot process fusion of epithelial cells seems not to influence the loss of anionic sites on the glomerular basement membrane.
Basement Membrane ; Epithelial Cells ; Epithelium ; Foot ; Glomerular Basement Membrane* ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Humans ; Nephrectomy ; Nephrosis, Lipoid ; Polyethyleneimine ; Proteinuria