Fungi have been recognized as a significant cause of external otitis and it may be the primary pathogen or be part of a mixed infection. In the immunocompromised host, fungus is capable of producing infection in inner ear or middle ear. Otomycoses are most frequently caused by Aspergillus spp. and Candida sap. There are few reports that Aspergillus species other than A. fumigatus, A. niger and f. flavus have caused chronic otitis media. We report two cases of chronic otitis media caused by Aspergillus ferrous in Korea. One case is a 7-year-old girl who had recurrent serous otorrhea and otalgia for 4 years, was reattended otolaryngology clinics with otorrhea of 3 days durations and another is a 6-year-old girl who had serous otorrhea for 2 months and 3 day fever, was attended otolaryngology clinics with them. Microscopic appearance and colony morphology from ear discharge cultures revealed A. ferrous. The infection responded well to topical ketoconazole therapy. This report should help to raise medical personnel's awareness of such human opportunistic fungal ear infections.
Aspergillus* ; Candida ; Child ; Coinfection ; Ear ; Ear, Inner ; Ear, Middle ; Earache ; Female ; Fever ; Fungi ; Humans ; Immunocompromised Host ; Ketoconazole ; Korea ; Niger ; Otitis Externa ; Otitis Media* ; Otitis* ; Otolaryngology ; Otomycosis

The impurities of diethyl ether are mainly acetic aldehyde and ether peroxide. Other impurities are sulfuric acid, sulphur dioxide, mercaptane and ethyl ester. It was believed that these impurities are produced during production and storage. When we use ether containing impurities, inhalation of excessive peroxide can cause salivation, profuse bronchial secretion, lung edema and pneumonia. Excessive aldehyde also irritates the mucous membrane and can cause lacrimation, photophobia, conjunctivitis, an oppressive feeling of the chest, severe cough, headache, unconsciousness, bronchitis and pneumonia. It is well known that the deterioration of ether is favoured by contact with air, heat and sunlight. There are two opposite opinions on reuse of ether. Baskerville(1910) claimed that it should not be used for anesthesia twenty-four hours after the container is opened. However Harry and David Gold(1934) showed that, in ordinary anesthetic ether cans which were opened many times and stoppered with cork, the contents remaining pure by very delicate chemical tests for the usual impurities, aldehyde and peroxide, during a period of months. In order to measure the impurities of ether, four brands of ether for anesthesia were randomly selected for analysis. Type of containers and date of production in each group are as follows: Group I: Kong Shin Pharmaceutical Co. LTD., so called Korean made ether, 140 ml in brown, bottle one month old. Group II: May & Baker LTD., made in England, 100g(140 ml)can. Group III: Mallinckrodt Chemical Works, made in U.S.A., (1/4)lb(113.4 gm) can. Group IV: Showa Co., so called Japan made ether, 160 ml in brown bottle, fourteen months old in three samples and four years and six months old in another three samples, They were analysed by chemical tests for peroxide, aldehyde and acetic acid just after the containers were opened(zero day) and one, two, four, six and eight days later. Ethyl alcohol was analysed by gas chromatography. The results were as follows; Ether peroxide: Threshold limit value for U.S.P. is 7. 1 microgram/10 ml ether (0.025 mg of hydrogen peroxide/25 gm ether), In group I and III, they were within this value from zero to eight days but in group II and IV, they exceed this value already on zero day. Aldehyde: Threshold limit value in U.S.P. is 0.007mg/20ml ether(formaldehyde 0.0005%). In group I, there was nothing on zero day but after twenty-four hours it exceed threshold limit value and increased day by day up to eight days. In groups II, III and IV, they exceeded this value already on zero day, and increased day by day up to eight days but were below maximum allowable concentration for U.S.P. Acidity: The incidence was slightly increased day by day up to eight days but all were within normal range. By gas chromatography, analysis showed 4% ethyl alcohol in group III and IV. On the other hand, to ascertain the interrelationship between the production of impurities and the existence of alcohol or H2O2 in ether, 3% alcohol(group A), 6% alcohol(group B), H2O2 (600 microgramg%)(group C), and H2O2 with 3% alcohol together(group D) were added to ether respectively. In four groups, immediately after one, two, four, six and eight days after the containers were opened, they were analysed for peroxide, aldehyde and acidity. Peroxide: This was increased in all groups just after adding, and increased furthur day by day up to eight days when the increase was marked. Especially in group D, it increased sharply. Aldehycte: It was increased in all groups just after acding, and there after increased or decreased irregularly day by day up to eight days by which time it had increased markedly. Acidity: It was increased in all groups up to one and/or two days, there after decreased day by day up to eight days. However none of the groups exceeded the threshold limit value of 0.4 ml of N/50 NaOH. It was concluded that: 1. Impurities in ether for anesthesia are influenced by type of container for storage, date of its production, and duration after container is opened. 2. Ether for anesthesia should not be used for this purpose, if the original container has been opened longer than twenty four hours. 3. The production of impurities in ether was influenced by the presence of alcohol in ether. 4. It would be better to analyse the ether for impurities by chemical tests prior to clinical use.
Acetic Acid ; Anesthesia ; Bronchitis ; Chromatography, Gas ; Conjunctivitis ; Cough ; Edema ; England ; Ethanol ; Ether* ; Hand ; Headache ; Hot Temperature ; Hydrogen ; Incidence ; Inhalation ; Japan ; Lung ; Maximum Allowable Concentration ; Mucous Membrane ; Photophobia ; Pneumonia ; Reference Values ; Salivation ; Sulfur ; Sunlight ; Thorax ; Unconsciousness

PURPOSE: The ideal goal of the surgery for mild or moderate unilateral ptosis is to obtain symmetric palpebral fissure. The purpose of this paper is to evaluate the surgical outcome of mild or moderate unilateral ptosis patients after the procedure of external levator resection. METHODS: External levator resection with aponeurotic approach was performed on 25 mild to moderate unilateral ptosis patients with less than 2 mm MRD difference from June 1997 through May 2000. Outcome was defined as good, fair, and poor. RESULTS: Of the patients, 21 patients had congenital ptosis and 4 patients revealed acquired ptosis. Ten patients were male and 15 were female. Age ranged from 3 to 58 years(mean 19.8 years). Amount levator resection was 8~15 mm (mean 11.2 mm) with mild overcorrection. After the follow-up period 6~30 months (mean 10.8 months), 18 patients (72%) showed good results. Three patients (12%) revealed fair, and poor results were noted in 4 patients (16%). Patients with good and fair results were satisfied aesthetic aspect. CONCLUSIONS: Based on this study, mild overcorrection of levator resection was one of the ideal procedures for mild to moderate unilateral ptosis patients.
Female ; Follow-Up Studies ; Humans ; Male

The influences of osmolarity on the cardiac muscle contraction were investigated in cat papillary muscles. The muscle was immersed in the modified Krebs-Ringer-bicarbonate solutions containing various Ca ion concentrations and osmolarities and the resultant changes in maximum developed tension, rate of development of tension and time to maximum tension were analyzed. Following are the results. 1) Mean length of papillary muscle used was 9.3+/-0.60mm, end mean cross-sectional area was l. 73+/-0.07 mm2. Normal contraction amplitude at 5 mM Ca ion-K-R-B solution was 2. 46+/-0. 1 gram/mm. 2) Within the range of 2.5-10.0 mM Ca ion concentration, the contraction amplitude increased along with the increment of Ca concentration. 3) Osmolarity exerted dual effects on contraction; within the range of 300-400 mosm/I solution, the hypertonic solution exported a positive inotropic effect while 500 mOsm/1 solution exerted a negative inotropic effect upon papillary muscle. 4) Maximum rate of tension development increased in 350 mOsm/1 solution, but decreased in 400 mOsm/1 or more hypertonic solution. The time to maximum tension did not change within the range of 300 400 mOsm/1 osmolarity and in 500 mOsm/1 solution. 5) The difference in maxium developed tension between single and paired stimulation was 1. 99 gram/mm' at 300 mOsm/1 solution and was negligible in 450 mOsm/1 or more hypertonic solutions.
Animals ; Cats ; Hypertonic Solutions ; Myocardium ; Osmolar Concentration ; Papillary Muscles

The orbicularis oculi muscle transpositions with horizontal shortening procedures were performed for involutional entropion of the fourteen lower eyelids in twelve patients. The age ranged from 51 to 84 years (average 66.9 years). One patient was man and eleven patients were women. All patients were satisfactory with good cosmesis and improvement of tearing, discharge and ocular pain etc. after the follow-up period of 6 to 26 months. But mild subcutaneous hematoma of the eyelid was noticed in 3 cases with good absorption.
Absorption ; Entropion* ; Eyelids ; Female ; Follow-Up Studies ; Hematoma ; Humans

The severely burned patient, when first seen by the anesthesiologist, is usually in the "high-risk" category, envincing malnutrition and protein defficiency, combined with toxicity, dehydration and oliguria. Since homeostatic controls are markedly impaired, the cardiovascular system may be unable to respond to the changes in body position frequently necessary during surgical procedures. Especially when the burn involves the head, neck, and upper chest, the mucous membrane of the respiratory tract may be edematous and pulmonary atelectasis may be present. Inhalation agents such as ether, halothane, methoxyflurane, cyclopropane and nitrous oxide have serious disadvantages in anesthesia for burned patients, because: 1) the use of endotracheal tube to ensure an unobstructed airway is mandatory, but use of succinyl-choline for intubation may be dangerous, 2) there is a danger of introducing pathogenic organisms into upper respiratory tract with repeated intubation. 3) inhalation agents may impair the function of liver, kidney, and hemopoietic system. In the course of our clinical experience of ketamine in 45 burned patients, it became apparent that ketamine may be the anesthetic of choice for burn surgery, particularly for children, since the drug offers several distinct advantages over conventionally employed anesthetic agents. Protective reflexes are peserved, thereby rendering unnecessary an endotracheal tube. Also cardiovascular homeostasis, ease and simplicity of administration, rapid onset of anesthetic action, short duration, relatively quick recovery, virtual absence of postanesthetic nausea and vomiting and of toxicity for vital organs, and the absence of clinically detectable respiratory depression seemed to provide optimal conditions for surgery in burns.
Anesthesia ; Anesthetics ; Burns* ; Cardiovascular System ; Child ; Dehydration ; Ether ; Halothane ; Head ; Homeostasis ; Humans ; Inhalation ; Intubation ; Ketamine* ; Kidney ; Liver ; Malnutrition ; Methoxyflurane ; Mucous Membrane ; Nausea ; Neck ; Nitrous Oxide ; Oliguria ; Pulmonary Atelectasis ; Reflex ; Respiratory Insufficiency ; Respiratory System ; Thorax ; Vomiting

Open reduction and internal fixation of the displaced fractures of the acetabulum represents one of the greatest challenge in fracture surgery. The purpose of our study is to report the results of operative treatment and establish the guideline for the operative treatment of the displaced acetabular fractures with the analysis of the clinical and radiological results. This retrospective study reports the results of 21 fractures in 21 patients(19 male and 3 female) treated by open reduction and internal fixation from January 1990 to July 1994. The patients were followed up more than 1 year and mean length of follow-up was 2.3 years. According to Letournel's classification, we had 9 elementary fractures(42.8%) and 12 associated fractures(57.2%). Among the elementary fractures, the posterior wall fracture was the most common type(7 cases, 33.3%) and the transverse-posterior wall fracture was the most common type among associated fractures(4 cases, 19.0%). Surgical approaches were 14 Kocher-Langenbeck, 6 Ilioinguinal and 1 extended iliofemoral. Indirect reduction and specially designed reduction method using C-arm and radiolucent operating table were also helpful to achieve satisfactory reduction. Overall quality of clinical results was graded according to the D'Aubigne and Postel rating score. Satisfactory reduction was gained in 16 cases(76.1%). Unsatisfactory reduction was gained in 5 cases(23.8%). Among the cases within category of satisfactory reduction, there were 7 excellent and 8 good clinical results. But among unsatisfactorily reduced 5 cases, there were 2 good clinical results. It seems that the satisfactory operative reduction of the fracture is the factor that correlates with a satisfactory clinical result. There were complications such as 3 secondary osteoarthritis(14.2%), 3 wound infection(14.2%, 2 superficial and 1 deep), 2 iatrogenic nerve palsy(9.5%, 1 sciatic and 1 obturator nerve) and 1 intrapelvic protrusion acetabuli(4.7%) and no postoperative ectopic ossification.
Acetabulum ; Classification ; Follow-Up Studies ; Humans ; Male ; Methods ; Operating Tables ; Ossification, Heterotopic ; Retrospective Studies ; Wounds and Injuries

Paragonimiasis is widely distributed in Far East and Southeast Asia, particularly in Korea. The centralnervous system is the most frequent location for paragonimiasis outside the lungs. We analized the computedtomographic findings of 17 cases which were diagnosed pathologically and clinically as cerebral paragonimiasis.The results were as follows; 1. The ratio of male to female was 10:7 and about 88% of cases were under the age of40 years. 2. The common location so cerebral paragonimiasis were the occipital (12 cases ) and temporal (11 cases) lobes. 3. Precontrast CT findings of cerebral paragonimiasis were low density with calcifications in 6 cases,low and isodensities in 4 cases, mixed densities in 3 cases, only low density in 2 cases and only calcification sin 2 cases. Hydrocephalus (7 cases), mass effect (6 cases), atrophic change(6 cases) and cyst formation (3 cases)were associated. 4. The shape of calcifications in CT scan were soap-bubble or ring in 6 cases, nodular or oval in6 cases, stippled in 4 cases and amorphous conglomerated in 2 cases. 5. The contrast-enhanced 8 cases were 5 ringor rim like, 2 nodular and 1 irregular enhancements, while 9 cases were not enhanced.
Asia, Southeastern ; Far East ; Female ; Humans ; Hydrocephalus ; Korea ; Lung ; Male ; Paragonimiasis ; Tomography, X-Ray Computed

The dangers of explosion hazards and operation theater contamination by inhalation anesthetics have led to a renewed interest in intravenous anesthesia. without intubation. We have reported clinical studies of Thalamonal-ketamine anesthesia under room air breathing in non-abdominal surgery in a previous paper that discussed advantages, disadvantages and usefulness. Now, we report Thalamonal-N2O-Ketamine anesthesia with a microdrip technique and intubation in 63 patients undergoing various operations. These patients were divided into three groups by operation site: Group 1-upper abdominal, Group 2-lower abdominal and Group 3-non-aMominal surgery. These groups were subdivided, by muscle relaxants used, into pancuronium, d-tubocurarine and no relaxant groups. To minimize potential cardiovascular stimulation and postoperative sequelae, ThalamonaI was used at the beginning of anesthesia. The results were as follows: 1) The average duration of anesthesia was 153.9 minutes. The duration of anesthesia was 217.9 minutes in Group I, 121.9 minutes in Group 2 and 152.1 minutes in Group 3. 2) The average dose of ketamine-during induction was 1mg/kg/19 minutes. The average maintenance dose of ketamine was 1.8mg/kg/hr, 2.3mg/kg/hr in Group 1, 1.6mg/kg/hr in Group 2 and 1.8mg/kg/hr in Group 3. 3) The order of frequency of administration and total dose of pancuronium and d-tubocurarine was Group 1, Group 2 and Group 3. 4) The changes in vital signs after intubation and during anesthesia were insignificant clinically. 5) The average duration required from the end of operation to extubation was 10 minutes. 6) Arterial blood gas study performed preoperatively, during operation and in the recovery room in 11 patients revealed no significant changes. 7) The postanesthetic complications were pleasant dreams 18% (11), unpleasant dreams 6% (4), emergence delirium 3% (2), vomiting 6% (4) and shivering 3% (2).
Anesthesia ; Anesthesia, Intravenous ; Anesthetics, Inhalation ; Delirium ; Dreams ; Explosions ; Humans ; Intubation ; Ketamine* ; Pancuronium ; Recovery Room ; Respiration ; Shivering ; Tubocurarine ; Vital Signs ; Vomiting

Gingivitis and periodontitis are infectious diseases in that microorganisms are the primary extrinsic cause of the diseases. the occurrence of gingivitis has been associated clearly with the presence of microorganisms at the disease site, and the histologic nature of the tissue involved is indicative of an inflammatory response induced by microorganisms. additional evidence for the microbial etiology of periodontal disease is that numerous antimicrobial agents are effective in reducing plaque accumulation and periodontal diseases. the purpose of this article is to analyze the antimicrobial effects of Pulsatilla koreana. Well-dried Pulsatilla koreana purchased from herbs distributor was ground and extracted into methanol(MeOH), ethylacetate(EtoAc), chlorform(CHCl3) and Butyl alcohol(BuOH). we have then applied each solution to the bacteria samples(Bacteroides forsythus, Streptococcus mutans, Streptococcus sanguis, Porphylomonas gingivalis, Actinobacillus actinomycetemcomitans, Eikenella corrodens, Prevotella intermedia, Actinomyces viscosus, Prevotella nigrescens, Rothia dentocariosa, Fusobacterium nucleatum, Pseudomonas aeruginosa, Staphylococcus aureus) collected from several organizations. To conduct susceptibility test(Kirby-Bauer method), plate contained each periodontopathic bacteria is spread extracted into methanol(MeOH), ethylacetate(EtoAc), chlorform(CHCl3) and Butyl alcohol(BuOH) and to measure the minimum inhibition concentration(MIC) of the bacteria against the solutions to ultimately determine antimicrobial effects of the solutions, insert bacteria sample into 20microliter/ml, 10microliter/ml, 5microliter/ml, 2.5microliter/ml of each solution and control group(not contained solution) 1. Solution extracted into methanol did not show clear zone against all bacteria samples. Only P. nigrescens, S. mutans and S. sanguis in soluton extracted into ethylacetate, S. mutans and S. anguis in solutions extracted into chlorform and Butyl alcohol showed clear zone against all bacteria samples. Solution extracted into Butyl alcohol showed clear zone against 13 types of bacteria, excluding P. gingivalis. 2. In Solution extracted into methanol, the bacteria samples grew in the highest concentrated plate, showing minimal variation from control group. 3. In Solution extracted into Butyl alcohol, S. aureus, P. intermedia, E. corrodens, A. actinomycetemcomitans, B. forsythus, P. gingivalis et al. showed decreased growth in the highest concentrated plate. P. auruginosa, R. dentocariosa, A. viscosus, P. nigrescens, S. mutans et al. showed decreased growth at MIC 20microliter/ml and S. sanguis showed decreased growth at MIC 10microliter/ml. 4. By analyzing the MIC level through considering the results from Kirby-Bauer method, Solution extracted into methanol did not reveal any antimicrobial effects and Solution extracted into Butyl alcohol showed the highest antimicrobial effects In conclusion, it can be used the extracts of Pulsatilla koreana as wide spectrum antimicrobial agent.
1-Butanol ; Actinomyces viscosus ; Aggregatibacter actinomycetemcomitans ; Anti-Infective Agents ; Bacteria ; Communicable Diseases ; Eikenella corrodens ; Fusobacterium nucleatum ; Gingivitis ; Methanol ; Periodontal Diseases ; Periodontitis ; Prevotella intermedia ; Prevotella nigrescens ; Pseudomonas aeruginosa ; Pulsatilla* ; Staphylococcus ; Streptococcus mutans ; Streptococcus sanguis