Analgetic effect of small amount of morphine on spinal and epidural anesthesia was investigated. Patients who received morphine showed marked analgetic effect compared to control group. It was found that the amount of morphine needed was larger for epidural anesthesia than for spinal anesthesia, the former being more than 2mg, and the latter less than 0.5mg. Spinal and epidural morhphine caused complications on several occasions: pruritis, respiratory depression with pinpoint pupil and urinary retention in spinal anesthesia, and nauses and pruritis in epidural anesthesia.
Anesthesia, Epidural ; Anesthesia, Spinal ; Humans ; Injections, Epidural* ; Morphine* ; Pruritus ; Pupil ; Respiratory Insufficiency ; Urinary Retention

The author have had experience with seven cases of acute pulmonary edema. There are many predisposing factors for acute pulmonary edema, namely, left ventricular failure due to cardiac disease or overloading, hypoalbuminemia, pulmonary capillary endothelial damage from bacterial infections, toxins or irritant gases, rarely central nervous system injuries and pulmonary hypersensitivity reactions. For these presented cases, we believe that overloading, hypoalbuminemia, bile pneumonitis were the causative factors. There are many preventive measures and treatment for acute pulmonary edema. We conclude that prompt recognition and attention by the anesthesiologist are the most important preventive measures.
Anesthesia, General* ; Bacterial Infections ; Bile ; Capillaries ; Causality ; Central Nervous System ; Gases ; Heart Diseases ; Hypersensitivity ; Hypoalbuminemia ; Pneumonia ; Pulmonary Edema

No abstract available.
Arteriovenous Fistula* ; Biopsy*

BACKGROUND AND PURPOSE: Little is known about the relationships between provoking risk factors, prognosis, and optimal duration of anticoagulation in patients with cerebral venous thrombosis (CVT), especially in Asians. We aimed to investigate whether the prognosis and required duration of anticoagulation in CVT patients differ according to the provoking risk factors. METHODS: Prospectively recorded data from a tertiary medical center in South Korea were retrospectively reviewed. CVTs were categorized into three groups: unprovoked, those with possibly resolved provoking factors (PR), and those with persistent provoking factors (PP). The baseline characteristics, treatment, and prognosis of patients in these three groups were analyzed. RESULTS: From 2000 to 2015, 61 patients presented with CVT: 19 (31.1%) unprovoked, 11 (18.0%) with PR, and 31 (50.9%) with PP. The patients in our cohort had a slight female predominance and lower frequency of oral contraceptive use compared to Western cohorts. Median follow-up and duration of anticoagulation were 35 and 8 months, respectively. Despite the similarities in baseline characteristics, deaths (n=3; P=0.256) and recurrences (n=7; P=0.020) were observed only in the PP group. The median intervals to death and recurrence were 9 and 13 months, respectively. Death was associated with underlying disease activity, not with CVT progression. Recurrences in the PP group were associated with lack of anticoagulation (P=0.012). CONCLUSIONS: Although the prognosis of CVT is generally benign in Koreans, recurrence and death were observed in patients with persistent risk factors, suggesting their need for long-term treatment with anticoagulants.
Anticoagulants ; Asian Continental Ancestry Group ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Korea ; Prognosis* ; Prospective Studies ; Recurrence ; Retrospective Studies ; Risk Factors* ; Venous Thrombosis*

OBJECTIVES: An efficient clinical process guideline (CPG) modeling service was designed that uses an enhanced intelligent search protocol. The need for a search system arises from the requirement for CPG models to be able to adapt to dynamic patient contexts, allowing them to be updated based on new evidence that arises from medical guidelines and papers. METHODS: A sentence category classifier combined with the AdaBoost.M1 algorithm was used to evaluate the contribution of the CPG to the quality of the search mechanism. Three annotators each tagged 340 sentences hand-chosen from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) clinical guideline. The three annotators then carried out cross-validations of the tagged corpus. A transformation function is also used that extracts a predefined set of structural feature vectors determined by analyzing the sentential instance in terms of the underlying syntactic structures and phrase-level co-occurrences that lie beneath the surface of the lexical generation event. RESULTS: The additional sub-filtering using a combination of multi-classifiers was found to be more effective than a single conventional Term Frequency-Inverse Document Frequency (TF-IDF)-based search system in pinpointing the page containing or adjacent to the guideline information. CONCLUSIONS: We found that transformation has the advantage of exploiting the structural and underlying features which go unseen by the bag-of-words (BOW) model. We also realized that integrating a sentential classifier with a TF-IDF-based search engine enhances the search process by maximizing the probability of the automatically presented relevant information required in the context generated by the guideline authoring environment.
Data Mining ; Humans ; Hypertension ; Imidazoles ; Joints ; Knowledge Bases ; Natural Language Processing ; Nitro Compounds ; Search Engine

This study evaluated the optimal vegetative growth conditions and molecular phylogenetic relationships of eleven strains of Agrocybe cylindracea collected from different ecological regions of Korea, China and Taiwan. The optimal temperature and pH for mycelial growth were observed at 25degrees C and 6. Potato dextrose agar and Hennerberg were the favorable media for vegetative growth, whereas glucose tryptone was unfavorable. Dextrin, maltose, and fructose were the most effective carbon sources. The most suitable nitrogen sources were arginine and glycine, whereas methionine, alanine, histidine, and urea were least effective for the mycelial propagation of A. cylindracea. The internal transcribed spacer (ITS) regions of rDNA were amplified using PCR. The sequence of ITS2 was more variable than that of ITS1, while the 5.8S sequences were identical. The reciprocal homologies of the ITS sequences ranged from 98 to 100%. The strains were also analyzed by random amplification of polymorphic DNA (RAPD) using 20 arbitrary primers. Fifteen primers efficiently amplified the genomic DNA. The average number of polymorphic bands observed per primer was 3.8. The numbers of amplified bands varied based on the primers and strains, with polymorphic fragments ranging from 0.1 to 2.9 kb. The results of RAPD analysis were similar to the ITS region sequences. The results revealed that RAPD and ITS techniques were well suited for detecting the genetic diversity of all A. cylindracea strains tested.
Agar ; Agrocybe ; Alanine ; Arginine ; Carbon ; China ; DNA ; DNA, Ribosomal ; Fructose ; Genetic Variation ; Glucose ; Glycine ; Histidine ; Hydrogen-Ion Concentration ; Korea ; Maltose ; Methionine ; Nitrogen ; Polymerase Chain Reaction ; Solanum tuberosum ; Taiwan ; Urea

BACKGROUND: The overexpression of transforming growth factor-beta 1 receptor II (TGF-beta1RII) and transforming growth factor-beta 1 (TGF-beta1) ligand may be involved in the formation of a bulla. In this study, we tested if serum TGF-beta1 ligand levels correlated with the expression level of TGF-beta1RII and TGF-beta1 in bullous tissues from patients with spontaneous pneumothorax. MATERIAL AND METHOD: Bullous lung tissues and blood samples were obtained from 19 patients with spontaneous pneumothorax, 18 males and 1 female, aged 17 to 35 years old. The bullous tissues were obtained by video-assisted thoracic surgery (VATS), fixed in formalin, embedded in paraffin, and cut into 5~6micrometer thick slices. Sections were immunohistochemically stained with primary antibodies against TGF-beta1 or TGF-beta1RII, and serum levels of TGF-beta1 in patients and normal controls was measured by enzyme-linked immunosorbent assay (ELISA). RESULT: Of the 19 patients, 16 were TGF-beta1 positive and 10 were TGF-beta1RII positive. Among the 16 TGF-beta1 positives, 9 were also TGF-beta1RII positive. As seen previously, strong immunohistochemical staining of TGF-beta1RII and TGF-beta was detected in the boundary region between the bullous and normal lung tissues. Average TGF-beta1 blood levels of both TGF-beta1 and TGF-beta1RII positive patients was 38.36+/-16.2 ng/mL, and that of five controls was 54.06+/-15 ng/mL. CONCLUSION: These results suggest that overexpression of TGF-beta1 and TGF-beta1RII expression may be involved in the formation of bullae. TGF-beta1 blood levels in patients with primary spontaneous pneumothorax is lower than normal people, suggesting that the high level of local TGF-beta1 expression in the bullous tissue region, but not in the whole blood, may contribute more in the formation of bullae.
Aged ; Antibodies ; Blister ; Enzyme-Linked Immunosorbent Assay ; Female ; Formaldehyde ; Humans ; Lung ; Male ; Paraffin ; Pneumothorax ; Thoracic Surgery, Video-Assisted ; Transforming Growth Factor beta ; Transforming Growth Factor beta1

Tumor necrosis factor-related apoptosis-induced ligand (TRAIL) induces apoptosis selectively in cancer cells while sparing normal cells. However, many cancer cells are resistant to TRAIL-induced cell death. Here, we report that paxilline, an indole alkaloid from Penicillium paxilli, can sensitize various glioma cells to TRAIL-mediated apoptosis. While treatment with TRAIL alone caused partial processing of caspase-3 to its p20 intermediate in TRAIL-resistant glioma cell lines, co-treatment with TRAIL and subtoxic doses of paxilline caused complete processing of caspase-3 into its active subunits. Paxilline treatment markedly upregulated DR5, a receptor of TRAIL, through a CHOP/GADD153-mediated process. In addition, paxilline treatment markedly downregulated the protein levels of the short form of the cellular FLICE-inhibitory protein (c-FLIPS) and the caspase inhibitor, survivin, through proteasome-mediated degradation. Taken together, these results show that paxilline effectively sensitizes glioma cells to TRAIL-mediated apoptosis by modulating multiple components of the death receptor-mediated apoptotic pathway. Interestingly, paxilline/TRAIL co-treatment did not induce apoptosis in normal astrocytes, nor did it affect the protein levels of CHOP, DR5 or survivin in these cells. Thus, combined treatment regimens involving paxilline and TRAIL may offer an attractive strategy for safely treating resistant gliomas.
Antineoplastic Agents/*pharmacology ; Apoptosis/*drug effects ; Astrocytes/metabolism ; CASP8 and FADD-Like Apoptosis Regulating Protein/genetics/*metabolism ; Caspase 3/metabolism ; Cell Line, Tumor ; Drug Discovery ; Flow Cytometry ; Glioma/*metabolism/pathology ; Humans ; Indoles/*pharmacology ; Inhibitor of Apoptosis Proteins/metabolism ; RNA, Small Interfering ; Receptors, TNF-Related Apoptosis-Inducing Ligand/genetics/metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; TNF-Related Apoptosis-Inducing Ligand/metabolism/*pharmacology ; Transcription Factor CHOP/analysis

OBJECTIVE: The aim of this study was to determine whether 1 cycle of dexamethasone administration to women at risk of preterm delivery causes adrenal suppression METHODS: Nonpregnant ten control subjects were checked baseline cortisol and stimulated cortisol level after low-dose (1 microgram) ACTH stimulation test. Ten women at risk of preterm delivery had two weekly low-dose (1 microgram) ACTH stimulation tests with the first one at admission. Immediately after the first ACTH stimulation test, we gave each women a 5 mg dexamethasone dose intramuscularly and repeated it 12 hours later for two days. Serum cortisol levels were measured before (baseline) and 30 minutes after ACTH administration. RESULTS: All ten subjects had normal baseline and stimulated cortisol levels for the first ACTH stimulation test. The adrenal suppressed Group was composed of 5 patients. But the remainders was not suppressed. Mean baseline serum cortisol levels decreased from 38.52 microgram/dL (before dexamethasone) to 33.26 microgram/dL (1 week after 1 cycle of dexamethasone) in adrenal suppressed Group. The mean stimulated cortisol levels also decreased from 46.40 microgram/dL (before dexamethasone) to 45.02 microgram/dL (1 week after 1 cycle of dexamethasone) in adrenal suppressed Group. CONCLUSIONS: Antenatal administration of 1 cycle dexamethasone produced slightly adrenal suppression, but no adrenal insufficiency, in some women at risk of preterm delivery and may be harmless to maternal and fetal adrenal function.
Adrenal Insufficiency ; Adrenocorticotropic Hormone ; Dexamethasone* ; Female ; Humans ; Hydrocortisone ; Obstetric Labor, Premature* ; Pregnancy

BACKGROUND: C677T single nucleotide polymorphism (SNP) of Methylentetrahydrofolate reductase (MTHFR) has been known to be associated with plasma homocysteine (Hcy) levels, which is an independent risk factor for stroke. However, recent large clinical trials did not show any benefits of Hcy lowering therapy with vitamins on the prevention of stroke. We hypothesized that the Hcy lowering effect by vitamins would be different according to the MTHFR C677T SNP types (CC, CT or TT), which may influence the benefits of vitamins by Hcy lowering on stroke prevention. METHODS: The authors retrospectively studied acute stroke patients with information of the genotype of MTHFR and serial levels of Hcy during a recent 4 year period (July 2002 - Dec 2005). Vitamins (folic acid 1 mg, and/or cobalamin 750 microgram and pyridoxine 75 mg) were prescribed to the patients whose basal plasma Hcy levels were above 12 umol/L. RESULTS: Among 172 patients, 68 patients took vitamins. The mean basal Hcy level was significantly higher in the TT type than the others, and was decreased by vitamin therapy. Distribution of homocysteine grading (normal, intermediate or high) in follow up was not significantly different according to these SNP types. CONCLUSIONS: The Hcy lowering effect by vitamins was not different by MTHFR genetic polymorphism. Considering the higher prevalence of certain gene types in stroke and our study results, genetic factors such as MTHFR polymorphism may play an important role on the development of stroke rather than the plasma Hcy levels.
Follow-Up Studies ; Genotype ; Homocysteine* ; Humans ; Oxidoreductases ; Plasma* ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide* ; Prevalence ; Pyridoxine ; Retrospective Studies ; Risk Factors ; Stroke* ; Vitamin B 12 ; Vitamins*