BACKGROUND: This study was designed to examine the interactions between mivacurium and vecuronium when administered during a standardized technique. METHODS: Eighty patients (ASA physical status I or II) were randomly assigned to one of four groups (n=20). Their neuromuscular function was measured in response to ulnar nerve supramaximal square-wave TOF stimulation at 10-sec intervals. After the attainment of a stable baseline neuromuscular response, the patients were randomly assigned to receive a rapid iv bolus of either: (1) 3M group (n=20): mivacurium 0.21 mg/kg. Alone, or (2) 2M1V group (n=20): mivacurium 0.14 mg/kg plus vecuronium 0.05 mg/kg, or (3) 1M2V group (n=20): mivacurium 0.07 mg/kg plus vecuronium 0.10 mg/kg, or (4) 3V group (n=20): vecuronium 0.15 mg/kg alone. The onset time of the neuromuscular block, time of recovery of T1 to 25% and reblock time (the time from the reinjection of vecuronium at the time of recovery of T1 to 25% to the time of recovery of T1 to 25%: T25-25) were measured. The intubating condition was evaluated clinically with a scoring system. RESULTS: The onset of block in the 3M group was 33% slower than in the 3V group. The time durations until 25% recovery in the 2M1V, 1M2V and 3V groups were longer than in the 3M group, and the durations in the 1M2V and 3V groups were longer than in the 2M1V group. The T25-25 reblock times of the 2M1V, 1M2V and 3V groups were prolonged in comparison to that of the 3M group. There was no difference in intubating conditions between any of the groups. CONCLUSIONS: A combination of mivacurium with vecuronium provides rates of onset and duration of block which are more effective than an equivalent dose of mivacuriun alone as an additive reaction.
Anesthesia, General* ; Humans ; Neuromuscular Blockade* ; Ulnar Nerve ; Vecuronium Bromide*

Arterial blood gas analysis is essential laboratory test in monitoring of acid-base balance and respiratory care, but it has been known that there was many variabilities according to method of sampling and care before analysis. We compared the effects of liquid Na heparin and dry Li-heparin on blood gas analysis, hemoglobin and electrolytes, and studied in 25 patients who were taken elective operation with radial arterial eannulation. The samples were obtained from radial artery; sample 1, drawn to a total volume of 1 cc with 2cc plastic syringe utilizing liquid Na-heparin; sample 2, drawn to a total volume of 2 cc with 2 cc plastic syringe utilizing liquid Na-heparin ; sample 3, drawn to a total volume of 1 cc with Bard parker Preset 1 cc kit that pre-filled dry Li-heparin; control value, sampled arterial blood without heparin for measurement of hemoglobin and electrolytes. These samples were analyzed with minimum error, as possible. We obtained the following results. 1) There was no atatistical difference in pH, PCO2, PO2 and hemoglobin in each sample. 2) The value of Na+ and K+ were no statistical differences in sample 1,2 and 3, but sig- nificantly lower level than control value (P<0.01). 3) The Ca2+ level was significantly lower in sample 1 and 2(P<0.01) and not significantly different in sample 3 when compared with the control value. The Ca level was significantly higher in sample 2 and 3 when compared with sample 1 (P<0.01). So we conclude that arterial blood gas analysis and hemoglobin level showed no statistical difference between the liquid Na heparin and the dry Li-heparin. Heparin is not suitable for Na+ and K+ measurement. Low dose liquid Na heparin and dry Li heparin is reliable for obtaining Ca2+ level.
Acid-Base Equilibrium ; Blood Gas Analysis* ; Electrolytes ; Heparin ; Humans ; Hydrogen-Ion Concentration ; Plastics ; Radial Artery ; Syringes

Hemoglobin (Hb) Yamagata is a rare Hb variant, which has been reported only twice-one case each in Japan and Korea. This variant arises from a Lys --> Asn substitution due to a mutation of AAA to AAC or AAT at codon 133 of the beta-globin gene. This study reports the third case of a patient detected with Hb Yamagata [HBB: c.399A>T; p.Lys133Asn] and discusses the effect of this variant on HbA1c measurement. This variant was detected in a 70-yr-old Korean man with diabetes mellitus during a routine follow-up. The HbA1c concentration determined using Variant ll Turbo (Bio-Rad, USA) was abnormally high at 47.9%. It was impossible to measure the HbA1c level accurately using Variant ll Thalassemia Mode (Bio-Rad, USA). However, the HbA1c levels analyzed by HLC-723 G7 (Tosoh, Japan), Cobas Integra (Roche, Switzerland) and NycoCard (Axis-Shield, Norway) were 5.0%, 8.0%, and 7.9%, respectively. This study shows that Hb Yamagata interferes with the accurate measurement of HbA1c levels in a diabetic patient. Taking these findings into consideration, we think that an immunoassay or affinity chromatography can be used as an alternate method for measuring the HbA1c level in a patient with this variant. In conclusion, a patient can be inferred to have an Hb variant if the HbA1c concentration is abnormally high or low or if there is a discrepancy between the results obtained using different methods, and if the clinical status of the patient suggests the presence of abnormal Hb. Subsequently, the HbA1c values can be determined by methods based on different principles.
Aged ; Amino Acid Substitution ; Diabetes Mellitus/diagnosis ; Electrophoresis, Capillary ; Hemoglobin A, Glycosylated/*analysis ; Hemoglobins, Abnormal/*analysis ; Humans ; Male ; Reagent Kits, Diagnostic ; Sequence Analysis, DNA ; beta-Globins/genetics

PURPOSE: The purpose of this study was to evaluate the degree of liver injury after injection of ethanol, hot normal saline and hot hypertonic saline into normal rat liver. MATERIALS AND METHODS: Sixty white rats weighing 200-300g were used. There were three groups (ethanol, hot normal saline, and hot hypertonic saline), and these were divided into subgroups (5 rats in each) according to amount of injected material and duration. Under either anesthesia, each drug (ethanol -0.05ml, 0.1ml, 0.2ml ; hot normal saline -0.1ml, 0.2ml, 0.4ml ; hot hypertonic saline -0.1ml, 0.2ml, 0.4ml ) was introduced directly into the liver. Pathologic specimens were obtained 7 and 14 days after injection. RESULTS: With regard to histologic change after 7 days, the ethanol group showed less tissue damage such as coagulation necrosis and inflammatory infiltration-than the hot saline group. There was however, no significant difference among the three groups in tissue damage 14 days. Nor was there any significant histologic difference between the different saline concentration groups. CONCLUSION: Histologically, there was no significant difference among the three groups in tissue damage at 14 days, and it is suggested that this is due to irreversible change in damaged tissue. Tissue damage was caused mainly by the high temperature of saline rather than by high osmolarity.
Anesthesia ; Animals ; Ethanol* ; Liver* ; Necrosis ; Osmolar Concentration ; Rats*

Renal transplantation has been adopted as the treatment of choices for most patients with a end stage renal disease. This is the presentation of our experience of renal transplantation at Hallym University Hospital. From March 1984 to July 1998, 207 cases of renal transplantations were performed, 15 cases out of which were lost during follow-up period and excluded from the study. The mean age of recipients was 37.1 years. The male to female ratio was 1.5:1. Eighty nine renal allografts (46.4%) were from living unrelated donors, 59 (30.7%) from living donors and 44 (22.9%) from cadaveric donors. As an immunosuppression theray, a triple regimen was used in 104 cases (54.2), a double regimen in 86 (44.8%) and a single regimen in one (0.5%). The overall rejection developed in 87 cases (45.3%). The rejection rate was 59.3% in renal allografts from living related donors, 37.1% from living unrelated donors and 43.2% from cadavaric donors. The OKT3 and the antilymphocyte globulin (ALG) were used for steroid resistent rejection in 8 and 2 cases, respectively. Post-transplant diabetes mellitus were noticed in 22 cases (11.5). The most common complication was infection (28.1%), and 11 recipeints (5.7%) died during follw-up period. Infection was the leading cause of mortality. The overall graft survival was 92.2% at 1 year span and 83.1% at 3 year span. The overall patient survival was 95.6% at 1 year span and 92.5% at 3 year span.
Allografts ; Antilymphocyte Serum ; Cadaver ; Diabetes Mellitus ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppression ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Living Donors ; Male ; Mortality ; Muromonab-CD3 ; Tissue Donors ; Unrelated Donors

BACKGROUND: Accurate measurement of blood glucose concentrations is essential for defining diabetes, and the minimization of ex vivo glycolysis has been recommended. Recent guidelines advocate two kinds of methods for sample collection and processing: either the sodium fluoride (NaF) method or immediate refrigeration using a serum separation tube (SST). We investigated the difference between the two methods in measuring subsequent glucose concentrations using blood specimens from participants recruited for the fourth Korean National Health and Nutrition Examination Survey. METHODS: Paired venous blood samples were collected in an SST and a NaF tube from 1,103 men and women. SST serum was separated within 30 min, including standing for 15 min, and then refrigerated. The NaF samples were refrigerated, but not separated until immediately before analysis. We compared the blood glucose concentrations between the SST (SST glucose) and NaF (NaF glucose) methods. RESULTS: The mean SST glucose was significantly higher than NaF glucose (99.0 mg/dL vs 96.5 mg/dL, P<0.05). NaF glucose showed a negative mean bias of 2.6 mg/dL vs SST glucose but showed high correlation (R=0.9899). There was no significant correlation between the bias of blood glucose concentrations by two methods and the storage time of NaF glucose. CONCLUSIONS: The negative bias associated with the use of NaF tubes may significantly affect the prevalence of diabetes. Serum separation and refrigeration within 30 min after venous sampling is recommended over NaF method, not only to minimize the preanalytical impact on detecting diabetes but also to reduce sample volume and number of tubes.
Blood Glucose/*analysis ; Blood Specimen Collection/*methods ; Diabetes Mellitus/diagnosis ; Female ; Glycolysis/*drug effects ; Humans ; Male ; Nutrition Surveys ; Republic of Korea ; Sodium Fluoride/*pharmacology ; Specimen Handling

BACKGROUND:Even though it is well known that pulmonary rehabilitation (PR) improves exercise capacity, and the quality of life, in patients with chronic lung disease, not many patients can attend hospital based intensive PR in Korea. The purpose of this study was to develop a method for a home-based PR program, and study its effectiveness. METHODS:Twenty patients with chronic lung diseases were randomly divided into two groups : a home PR group comprising of 10 male patients, with a mean age of 70 years, and a control group comprisiong of 10 male patients, with a mean age of 65 years. We developed exercise programs, depending on the exercise capacity of each patient, which were easy to do at home. The PR program consisted of a 12 week period of enforced aerobic (mostly walking) and muscle strengthening exercises, as prescribed by the exercise specialist, in accordance with the functional capacity of the patient. In addition to the education, nutritional and psychiatric consultation was undertaken, and respiratory muscle training arranged. Patients visited hospital every 2 weeks for evaluation and exercise prescription. RESULTS: All patients finished the 12 week course of therapy. Following the home PR, the endurance times and work capacity of the upper and lower extremities were significantly increased in the treatment group in comparison to the controls. The six minute working (Eds note : should) 'working' read 'walking'?) distance was increased from 465+/-60m to 508+/-37m and the maximal inspiratory pressure from 72.8+/-27.2cmH2O to 91.4+/-30.9 cmH2O. The quality of life, as assessed by St Georges Respiratory Questionnaire (SGRQ), was also improved following PR. (Eds note : do you have figures for before and after, and a reference for the SGRQ? i.e. for the main paper.) CONCLUSION: The home PR program we developed seemed to be applicable, and effective, to most of the patients with chronic lung diseases in the study.
Breathing Exercises ; Education ; Exercise ; Humans ; Korea ; Lower Extremity ; Lung Diseases* ; Lung* ; Male ; Prescriptions ; Quality of Life ; Surveys and Questionnaires ; Rehabilitation* ; Specialization

BACKGROUND:Even though it is well known that pulmonary rehabilitation (PR) improves exercise capacity, and the quality of life, in patients with chronic lung disease, not many patients can attend hospital based intensive PR in Korea. The purpose of this study was to develop a method for a home-based PR program, and study its effectiveness. METHODS:Twenty patients with chronic lung diseases were randomly divided into two groups : a home PR group comprising of 10 male patients, with a mean age of 70 years, and a control group comprisiong of 10 male patients, with a mean age of 65 years. We developed exercise programs, depending on the exercise capacity of each patient, which were easy to do at home. The PR program consisted of a 12 week period of enforced aerobic (mostly walking) and muscle strengthening exercises, as prescribed by the exercise specialist, in accordance with the functional capacity of the patient. In addition to the education, nutritional and psychiatric consultation was undertaken, and respiratory muscle training arranged. Patients visited hospital every 2 weeks for evaluation and exercise prescription. RESULTS: All patients finished the 12 week course of therapy. Following the home PR, the endurance times and work capacity of the upper and lower extremities were significantly increased in the treatment group in comparison to the controls. The six minute working (Eds note : should) 'working' read 'walking'?) distance was increased from 465+/-60m to 508+/-37m and the maximal inspiratory pressure from 72.8+/-27.2cmH2O to 91.4+/-30.9 cmH2O. The quality of life, as assessed by St Georges Respiratory Questionnaire (SGRQ), was also improved following PR. (Eds note : do you have figures for before and after, and a reference for the SGRQ? i.e. for the main paper.) CONCLUSION: The home PR program we developed seemed to be applicable, and effective, to most of the patients with chronic lung diseases in the study.
Breathing Exercises ; Education ; Exercise ; Humans ; Korea ; Lower Extremity ; Lung Diseases* ; Lung* ; Male ; Prescriptions ; Quality of Life ; Surveys and Questionnaires ; Rehabilitation* ; Specialization