Present study aimed to investigate the immunological activities of cell wall associated protein antigen solubilized with Triton X-100 (TSP) from Mycobacterium tuberculosis H37Rv and conducted on 43 patients with pulmonary tuberculosis (newly diagnosed, medicated within 12 months and chronic refractory patients) and 17 normal healthy controls. These immunological responses were compared with those induced by the PPD or 30 kDa antigen from M, tuberculosis H37Rv culture filtrates, identified as biologically important secreted proteins. Proliferative responses to mycobacterial antigens were compared in peripheral blood mononuclear cells (PBMC) of healthy subjects and pulmonary tuberculosis patients. Signiticant blastogenic responses to the TSP were observed in healthy tuberculin reactors, newly diagnosed and some of antituberculosis drug-medicated patients by H-thymidine incorporation assay. IL-12 p40 and IFN-r mRNA expressions to the TSP were markedly increased, whereas IL-10 and TNF-a mRNA expressions were decreased at a 5 day-stimulation by PBMC in healthy tuberculin reactors, newly diagnosed and medicated patients. However, patients with chronic refractory tuberculosis exhibited more depressed IL-12 p40 and IFN-r mRNA expressions to all of the antigens than another groups. Interestingly, very low IL-10 and TNF-a mRNA expressions cultured with the TSP were also shown. These data suggest that the TSP may be involved in the macrophage activation by induction of Th1 stimulatory signals, such as IL-12, and suppression of Th1 inhibitory cytokine, IL-10.
Tumor Necrosis Factor-alpha

PURPOSE: To investigate the localization and functional lateralization of the supplementary motor area (SMA) in motor activation tests in comparison to that of the primary motor area. MATERIALS AND METHODS: Seven healthy volunteers obtained echoplanar imaging blood oxygen level dependent technique. This study was carried on 1.5T Siemens Magneton Vision system with the standard head coil. Parameters of EPI were followed as ; TR/TE; 1.0/66.0 msec. flip angle : 90degree, field of view : 22cmx22cm, matrix : 128x128, slice number/slice thickness/gap : 10/4mm/0.8mm with fat suppression technique. Motor task as finger opposition in each hand consisted of 3 sets of alternative rest and activation periods. Postprocessing were done on Stimulate 5.0 by using cross-correlation statistics. To compare the functional lateralization of the SMA in the right and left hand tests, each examination was evaluation for the percent change of signal intensity and the number of activated voxels both in the SMA and in the primary motor area. Hemispheric asymmetry was defined as difference of summation of the activated yokels between each hemisphere. RESULTS: Percent change of signal intensity in the SMA (2.49-3.06%) is lower than that of primary motor area(4.4-7.23%). Percent change of signal intensity including activated voxels were observed almost equally in the right and left SMA. As for summation of activated voxels primary motor area had significant difference between each hemisphere but not did the SMA. CONCLUSION: Preferred contralateral dominant hemisphere and hemispheric asymmetry were detected in the primary motor area but not in the SMA.
Echo-Planar Imaging ; Fingers ; Hand* ; Head ; Healthy Volunteers ; Magnetic Resonance Imaging* ; Oxygen

BACKGROUND: It has been a standard practice in many institutions to combine light general anesthesia with epidural block for abdominal and pelvic surgery. We attempted to prove the effectiveness of prehydration and to find an suitable epidural local anesthetic dose in terms of hemodynamic stability for upper abdominal surgery. METHODS: For preliminary studies, 11 patients scheduled for elective upper abdominal surgery had received general anesthesia immediately after epidural anesthesia. After epidural injection of 10~16 mL of 2% plain lidocaine into the T9~10 intervertebral space, the changes in blood pressure were observed. Thirty-two patients scheduled for elective upper abdominal surgery were divided into two groups. In group A (study group), after prehydration with Hartmann solution (10 mL/kg), 5~7 mL of 2% plain lidocaine was injected into T8~9 or T9~10 intervertebral space and general anesthesia was then induced. Group B (control group) received general anesthesia only. RESULTS: There were no significant differences in hemodynamics between the epidural with general anesthesia and the control group except SVR (systemic vascular resistance). SVR in group A increased in contrast to the group B in which it remained unchanged. CONCLUSIONS: The combined epidural and general anesthesia, using prehydration and 0.5~1 mL/segment of 2% plain lidocaine at the T8~9 or T9~10 intervertebral space was safe without significant hemodynamic changes.
Anesthesia, Epidural ; Anesthesia, General* ; Blood Pressure ; Hemodynamics* ; Humans ; Injections, Epidural ; Lidocaine

No abstract available.
Myocardial Infarction*

Since there is no report of daily walking activity of Korean, authors studied on normal adult daliy walking activity in korean of various kinds of occupation, personal life and patients. Total 134 cases were studied and in which there were 10 patients, 7 retired elderlies, 4 house wives, 48 employees of compaines, 30 nurses, 4 laboratory technicians, 2 pharmacists, 7 house staff doctors, 12 chief doctors, 4 cases of hicking and 6 cases of 18 holes golf players. The daily walking steps were measured with pedometer in 167 times in total and following results were, obtained. 1. Bed rest patients ; less than 1000 steps/day 2. Retired elderly ; 2,724(2,150-3,500) steps/day 3. House wife ; 5,437(3,030-7,920) steps/day 4. High ranking, old clerk and chief doctor ; 5,000-6,000 steps/day 5. Ordinary non-active clerk and non-clerk employee ; 6,000-9,000 steps/day 6. common young active clerk and nurse ; 10,000-15,000 steps/day 7. Very active clerk and non-clerk employee ; 15,000(13,000-20,000) steps/day 8. Heavy worker ; more than 20,000 steps/day
Adult ; Aged ; Bed Rest ; Golf ; Humans ; Internship and Residency ; Laboratory Personnel ; Occupations ; Pharmacists ; Spouses ; Walking*

PURPOSE: The pharmacologic effect of atropine on HPS can be considered to control pyloric muscle spasm. Therefore, we studied the effects of intravenous atropine sulfate on the clinical course of HPS, and periodically observed the ultrasonographic appearance of the pyloric muscles after atropine treatment. METHODS:From April 1998 to May 1999, 14 infants who were diagnosed with HPS were treated with intravenous atropine sulfate. Intravenous atropine sulfate was administered at an initial dose of 0.04mg/kg/day, which was divided into 8 equal doses. The daily dose was increased by 0.01 mg/kg/day until vomiting was controlled for an entire day while infants received unrestricted oral feeding. Ultrasonographic examinations were performed during hospitalization and repeated at least every 2 months until normalization of pyloric muscles was confirmed. RESULTS: Intravenous atropine was effective in 12 of 14 infants with HPS and the conditions of 9 of them improved. Two infants who were not free from vomiting despite a week of intravenous atropine sulfate treatment underwent pyloromyotomy. A series of ultrasonographic examinations were done after vomiting had improved with intravenous atropine sulfate. The ultrasonographic findings showed good passage of gastric contents through pyloric canals despite thickening of the pyloric muscles. CONCLUSION: Intravenous administration of atropine sulfate is an effective therapy for HPS and can be an alternative to pyloromyotomy. (J Korean Pediatr Soc 2000;43:763-768)
Administration, Intravenous ; Atropine* ; Hospitalization ; Humans ; Infant ; Muscles ; Pyloric Stenosis, Hypertrophic* ; Spasm ; Vomiting

The authors analyse the ultrasonographic findings of 10 cases of appendiceal mucocele retrospectively. In atotal of 10 cases, 6 cases showed only cystic masses with posterior reinforcement. The remaining 4 cases showedinternal echoes in the cystic masses. Differential diagnosis of mucocele from periappendiceal abscess is notpossible in ultrasound. The possibility of mucocele shold be considered if cystic mass in right lower quadrantabdomen is observed in ultrasound.
Abscess ; Diagnosis, Differential ; Mucocele ; Retrospective Studies ; Ultrasonography

Hemodialysis requires anticoagulants to prevent fibrin deposition and thrombus formation in the extracorporeal circuit. Unfractionated heparin (UFH) has been used as a conventional anticoagulant for a long time. But recently, many side effects of heparin have been documented: hemorrhage, thrombocytopenia with or without thrombosis, osteoporosis, skin necrosis, alopecia, and hypersensitivity reactions. In the past decade, low molecular weight heparins (LMWH) have been developed. Compared with UFH, these compounds have a longer plasma half life, less variability in the anticoagulant response to fixed doses, and a more favorable antithrombotic to hemorrhagic ratio. Thus, rationales for using LMWH as an alternative to UFH would be a reduced risk of bleeding complications and simplified routines for heparinization due to a longer half-life of the anticoagulant activity. To evaluate the dfficacy and safety of LMWH as an anticoagulant in hemodialysis treatment, we conducted a prospective crossover study with paired comparison of two different heparins in 18 end-stage renal disease patients undergoing hemodialysis. During the first two months of observation, patients received a single bolus of LMWH (Fragmin(R)) 2,552+/-221 aXa IU/one dialysis session. Then patients were switched to UFH dose regimen comprised of a saline prime, no initial bolus and a continuous infusion of 3,174+/-420 IU/one dialysis session for further two months. All hemodialysis sessions were completed uneventfully. The coagulation values of an anti-factor Xa-specific clotting method (Heptest(R)) from citrated whole blood samples taken 15 minutes after starting hemodialysis were 0.47+/-0.21 U/ml with LMWH and 0.12+/-0.03 U/ml with UFH (p<0.05). The values taken 4hours after starting hemodialysis were 0.24+/-0.10 U/ml with LMWH and 0.22+/-0.04 U/ml with UFH (p>). The prolongation of the Heptest clotting times with LMWH and UFH was 2.86 for LMWH and 2.55 for UFH using the shole blood assay. The mean frequency of clot deposition in dialyzer was similar (1.1 vs 0.87) as well as mean venous compression time at the end of dialysis (5.96 vs 6.23 minutes). The hematologic and biochemical parameters such as hemoglobin, platelet count, triglyceride level, total cholesterol and HDL-cholesterol level did not show any differences between the two heparins. We conclude that a single dose of LMWH is effective and safe in repeated use for hemodialysis and prevents clot formation to a similar degree as UFH.
Alopecia ; Anticoagulants ; Cholesterol ; Cross-Over Studies ; Dialysis ; Fibrin ; Half-Life ; Hemorrhage ; Heparin* ; Heparin, Low-Molecular-Weight* ; Humans ; Hypersensitivity ; Kidney Failure, Chronic ; Matched-Pair Analysis ; Necrosis ; Osteoporosis ; Plasma ; Platelet Count ; Prospective Studies ; Renal Dialysis* ; Skin ; Thrombocytopenia ; Thrombosis ; Triglycerides

BACKGROUND: Epidural opioids are commonly used for postoperative analgesia. However, the side effects of epidural opioids include respiratory depression, sedation, pruritus, nausea, vomiting and urinary retention. Meperidine, due to its intermediate lipid solubility and local anesthetic properties, permits postoperative analgesia. The aim of this study was to compare meperidine alone to meperidine coupled with bupivacaine, and to determine the effects of epidural meperidine without bupivacaine, when used for epidural analgesia following hepatectomy abdominal surgery. METHODS: Patients received thoracic epidural analgesia with meperidine alone (3.5 mg/ml in saline) or with additional bupivacaine (0.15%) for 2 days after surgery. Postoperative pain was assessed using a visual analog scale (VAS) pain score 2 days after the operation, with the incidence and dose supplementation also evaluated. Postoperative side effects were assessed using a 3 grade system. RESULTS: No significant difference was found between the two groups in terms of age and weight, or in the pain scores, side effects, incidence and dose supplementation. CONCLUSIONS: 3.5 mg/ml epidural meperidine at a dose of 2 ml/hr provides effective postoperative analgesia.
Analgesia ; Analgesia, Epidural ; Analgesics, Opioid ; Bupivacaine ; Hepatectomy ; Humans ; Incidence ; Meperidine* ; Nausea ; Pain, Postoperative* ; Pruritus ; Respiratory Insufficiency ; Solubility ; Urinary Retention ; Visual Analog Scale ; Vomiting

Small cell carcinoma is most frequently found in the lung. Extrapulmonary sites of this neoplasm account for only 4% of all small cell carcinomas. Small cell carcinomas arising in the salivary glands are extremely rare, accounting for less than 1% of all parotid gland carcinomas. A 72-years- old women visited our clinic to evaluate hard protruding masses in the left preauricular region and the left orbit. Superficial parotidectomy and incisional biopsy for orbital mass revealed small cell neuroendocrine carcinoma. As the extrapulmonary small cell neuroendocrine carcinoma, arising in both left parotid and lacrimal glands is reported rarely in the world and not reported in Korea yet, we report its clinical progress.
Biopsy ; Carcinoma, Neuroendocrine* ; Carcinoma, Small Cell ; Female ; Humans ; Korea ; Lacrimal Apparatus* ; Lung ; Orbit ; Parotid Gland ; Salivary Glands