No abstract available.
Smoking* ; Tobacco Products*

BACKGROUND: Since endotracheal tube is the most important factor involved in the imposed work of breathing during mechanical ventilation, extubation of endotracheal tube is supposed to reduce respiratory work of patient. However, some patients show labored breathing after extubation despite acceptable blood gases. We investigated the changes of work of breathing before and after extubation and the factors involved in the change of WOB after extubation. METHODS: The subjects were 34 patients(M : F = 20 : 14, mean age = 61 l7yre) who recovered from respiratory failure after ventilatory support and were considered to be ready for extubation. The patients with clinical or radiologic evidences of upper airway obstruction before endotracheal intubation for mechanical ventilation were excluded. Vital sign, physical examination, chest X-ray, work of breathing and other respiratory mechanic indices were measured prior to, immediately, 6, 24 and 48 hours after extubation serially. Definition of weaning failure after extubation was resumption of ventilatory support or reintubation of endotracheal tube within 48 hour after extubation because of respiratory failure. The patients were classified into group I (decreased work of breathing), group 2(unchanged work of breathing) and group 3(increased work of breathing) depending on the statistical difference in the change of work of breathing before and after extubation. RESULTS: Work of breathing decreased in 33%(11/34, group 1), unchanged in 41%(14/34, group 2) and increased in 26% (9/34, group 3) of patients after extubation compared with before extubation. Weaning failure occurred 9%(1/11) of group, 1, 28.67(4/14) of group 2 and 44.4%(4/9) of group 3 after extubation(p = 0.07). The change of work of breathing after extubation was positively correlated with change of mean airway resistance(mRaw). (r = 0.794, p> 0.01) In three cases of group 3 whose respiratory indices could be measured until 48 hr ater extubation, the change in work of breathing paralleled with the sequential change of mRaw. The work of breathing was peaked at 6 hr after extubation, which showed a tendency to decrease thereafter. CONCLUSIONS: Reversible increase of work of breathing after extubation may occur in the patients who underwent extubation, and the increase in mRaw could be responsible for the increase in work of breathing. In addition, the risk of weaning failure after extubatuion may increase in the patients who have increased WOB immediately after extubation.
Airway Obstruction ; Gases ; Humans ; Intubation, Intratracheal ; Physical Examination ; Respiration ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Mechanics ; Thorax ; Vital Signs ; Weaning ; Work of Breathing*

OBJECTIVE: Microcystic meningioma is a rare histological subtype of meningioma, which constitutes about 1.6% of intracranial meningiomas. The authors present the feasibility of preoperative histological diagnosis by characteristic finding of neuroradiologic studies especially magnetic resonance(MR) image. METHODS: Eleven cases were collected retrospectively in the archives of brain tumor registry in the Department of Neurosurgery during recent eight years. There were five men and six women, ranging in age from 37 to 67 years(average, 56.7). All 11 cases had underwent the craniotomy and histological diagnosis of microcystic meningioma had been made. RESULTS: The MR image showed high signal intensity in T2-weighted images and low signal intensity in T1-weighted images. In all cases, peritumoral edema was moderate to severe and location of the masses was in the surface of the brain with dural attachment. MR image after administration of Gd-DTPA showed 2 patterns: pattern I demonstrated homogeneous strong enhancement similar to ordinary meningioma in seven cases and pattern II showed peripheral rim enhancement with low signal intensity inside of tumor masses in four cases. Dural tail sign was seen in all cases. In cerebral angiography, patten I revealed strong vascular tumor staining, however, there was no staining or faint staining in pattern II. CONCLUSION: Preoperative histological diagnosis of microcystic meningioma should be considered by the characteristic findings of MR image. It may help neurosurgeons to avoid of preoperative radiologic misdiagnosis especially concerning the malignancy.
Angiography ; Brain ; Brain Neoplasms ; Cerebral Angiography ; Craniotomy ; Diagnosis ; Diagnostic Errors ; Edema ; Female ; Gadolinium DTPA ; Humans ; Male ; Meningioma* ; Neurosurgery ; Retrospective Studies

BACKGROUND: Cytomegalovirus(CMV) disease is an important opportunistic infection and contributes to significant morbidity and mortality in immunocompromised hosts. To determine predisposing conditions to CMV disease and its prognosis, the authors reviewed the clinical courses of patients with CMV disease. METHODS: We reviewed medical records of 23 patients with CMV disease diagnosed at Seoul National University Hospital from 1987 to 1997. RESULTS: CMV pneumonia was diagnosed in 8 patients. Underlying conditions of the patients were allogeneic bone marrow transplant(BMT) in 4 patients, lupus nephritis in 1, dermatomyositis in 1, and renal transplantation recipient in 1. The cumulative dose of corticosteroid given to the BMT recipients before the development of CMV pneumonia ranged between 1,000 and 4,700 mg, whereas that to the non-BMT patients ranged between 2,100 and 6,000 mg. Of the 8 patients with CMV pneumonia, five patients(75%) died. Of the 15 CMV gastroenteritis, two had CMV gastric ulcers. The gastric ulcers showed clinical and endoscopic improvement with systemic ganciclovir therapy. Among 13 patients with CMV enterocolitis, nine had preceding GI diseases, and nine had received systemic corticosteroids. Five patients died. The mortality was lower in patients with underlying bowel diseases than in those without ones(22% vs. 75%, respectively). CONCLUSION: The mortality of CMV disease was 62.5%, 0%, and 38% in patients with CMV pneumonia, gastric ulcer, and enterocolitis, respectively. GVHD, systemic corticosteroid and/or immunosuppressive therapy were major risk factors of CMV diseases.
Adrenal Cortex Hormones ; Bone Marrow ; Cytomegalovirus* ; Dermatomyositis ; Enterocolitis ; Ganciclovir ; Gastroenteritis ; Humans ; Immunocompromised Host ; Kidney Transplantation ; Lupus Nephritis ; Medical Records ; Mortality ; Opportunistic Infections ; Pneumonia ; Prognosis ; Risk Factors ; Seoul ; Stomach Ulcer

Biopsy ; Encephalitis ; HIV ; Korea

OBJECTIVES: The purpose of this experimental study was to investigate the toxic effects of toluene on the placental functions and reproductionin the rat. In this study, the expression of placental prolactin-growth hormone (PRL-GH) and Pit-1 genes, the frequency of placental trophoblast cells, and the reproductive data were analyzed. METHODS: The pregnancy of the Sprague-Dawley rats (250+/-25 g) was determined by verifying the presence of the copulatory plug or sperm in the vaginal smear and the day on which this was observed was defined as pregnancy day 0. The pregnant rats were divided into three groups. The control group was intraperitoneally (ip) injected with sesame oil, and the other two groups were given either 150 or 750 mg/kg BW/day of toluene resuspended in sesame oil during pregnancy days 7-11 and 16-20. The rats from the three experimental groups were sacrificed on pregnancy days 11 and 20, respectively. The mRNA levels of the PRL-GH, Pit-1a and b isotype genes were analyzed by Northern blot hybridization and Reverse transcription-polymerase chain reaction (RT-PCR), respectively. The hormonal concentration was analyzed by Radioimmunoassay. The frequency of the placental trophoblast cells was determined by means of a histochemical study. Reproductive data, such as the placenta and infnat weight, pregnancy period and litter size were surveyed at pregnancy day 20 and after birth. Statistical analysis was carried out by means of the SAS program (version 8.1). RESULTS: The mRNA levels of the PRL-GH family genes were reduced in a linear fashion by exposure to toluene. The mRNA levels of the Pit-1a and b isotype genes, which induce the expression of the PRL-GH family genes, were also reduced by exposure to toluene. The placental lactogen Iv and II concentrations in the rat placenta, fetus and maternal blood were also decreased by exposure to toluene. During the last stage of gestation, exposure to a high dose of toluene reduced the frequency of the spongiotrophoblast cells that secrete the PRL-GH hormones. Reproductive data such as the placenta and infant weight, and litter size were reduced, and the pregnancy period was extended in the toluene exposed group as compared with the control group. CONCLUSIONS: Toluene disrupts the PRL-GH hormone metabolism in the rat placenta and this leads to reproductive disorder.
Animals ; Blotting, Northern ; Fetus ; Humans ; Infant ; Litter Size ; Metabolism ; Parturition ; Placenta ; Placental Lactogen ; Pregnancy ; Radioimmunoassay ; Rats* ; Rats, Sprague-Dawley ; Reproduction* ; RNA, Messenger ; Sesame Oil ; Spermatozoa ; Toluene* ; Trophoblasts ; Vaginal Smears

Thoracic epidural analgesia is a common method of pain relief for thoracic and upper abdominal surgery. Misplacement of the epidural catheter is one of the complications associated with epidural analgesia. A 60-year-old man was scheduled for a right pneumonectomy under general anesthesia. Before inducing general anesthesia, the patient was placed in the left lateral decubitus position. A 18-gauge Tuohy needle was inserted into the T6-T7 level using the left paramedian approach 1.5 cm lateral to the midline with a loss of resistance at 7 cm, and uneventful catheter advancement was performed. Approximately 30 minutes after commencing surgery, the surgeon found the epidural catheter in the right pleural cavity. We report a case of the accidental intrapleural positioning of a thoracic epidural catheter.
Analgesia, Epidural ; Anesthesia, General ; Catheters ; Humans ; Middle Aged ; Needles ; Pleural Cavity ; Pneumonectomy

BACKGROUND: Reoxygenation of an ischemic heart causes a decrease in the cardiac function, which is known as reperfusion injury that is associated with an increase in the concentration of reactive oxygen species (ROS). This study examined the effect of the propofol concentration on the generation of ROS during reoxygenation in rat embryonic heart H9c2 cells. METHODS: Cultured H9c2 cells were examined in the following sequences: Prehypoxic, Hypoxic and Reoxygenation period. Each period required 60 minutes. The cells were exposed to propofol at the beginning of the prehypoxic period. Thirty minutes later, DCFH-DA (dichlorofluorescin diacetate) 10 micrometer was added to detect the ROS. The propofol concentrations used were 0, 5, 25, 50, 250 micrometer in the first experiment and 0, 1, 2, 3, 4, 5 micrometer in the second experiment. The ROS level was estimated using a fluorometer at 5-minute intervals from 5 to 60 minutes after reoxygenation. RESULTS: When the propofol concentrations was > 5 micrometer, the ROS levels were significantly lower than those of the untreated group (P0) (P < 0.05). At propofol concentrations < 5 micrometer, the ROS levels 35 to 60 minutes after reoxygenation were significantly lower that in the untreated group (P < 0.05). Between 5 and 30 minutes after reoxygenation, the cells exposed to 1, 4 and 5 micrometer propofol also showed lower ROS levels than the untreated group P0. However, 2 and 3 micrometer propofol did not show any significant difference in ROS values to those observed in the untreated group except for 2 micrometer at 25 minutes after reoxygenation. CONCLUSIONS: During the reoxygenation period in H9c2 cells, propofol concentrations > 5 micrometer inhibited ROS production over the whole period, and even 1micrometer showed some inhibition of ROS.
Animals ; Heart* ; Propofol* ; Rats* ; Reactive Oxygen Species* ; Reperfusion ; Reperfusion Injury

Cytomegalovirus (CMV) disease is an important cause of morbidity and mortality in immunocompromised patients. Transplant recipients, patients with malignancies and those receiving immunosuppressive therapies are susceptible to CMV diseases. While the gastrointestinal infection of CMV is relatively common in AIDS, it is uncommon in other immunocompromised patients. We report a case of CMV gastric ulcer mimicking Borrmann typeIII gastric cancer on gastroscopy in a patient with immunosuppressive therapy.
Cytomegalovirus* ; Gastroscopy ; Humans ; Immunocompromised Host ; Immunosuppression ; Kidney Transplantation ; Mortality ; Stomach Neoplasms* ; Stomach Ulcer* ; Transplantation

Background: It is known that pulmonary rehabilitation improves dyspnea and exercise tolerance in patient with chronic lung disease, although it does not improve pulmonary function. But there is a controversy whether this improvement after pulmonary rehabilitation is due to increased aerobic exercise capacity. We performed this study to evaluate the effect of pulmonary rehabilitation for 6 weeks on the pulmonary function, gas exchange, exercise tolerance and aerobic exercise capacity in patients with chronic lung disease. Methods: Pulmonary rehabilitations including education, muscle strengthening exercise and symptom-limited aerobic exercise for six weeks, were performed in fourteen patients with chronic lung disease (COPD 11, bronchiectasis 1, IPF 1, sarcoidosis 1 ; mean age 57 +/-4 years ; male 12, female 2). Pre- and post-rehabilitation pulmonary function and exercise capacity were compared. Results: 1) Before the rehabilitation, FVC, FEV1 and FEF25-75% of the patients were 71.5+/-6.4%, 40.6+/- 3.4% and 19.3+/-3.8% of predicted value respectively. TLC, FRC and RV were 130.3+/-9.3%, 157.3 +/-13.2% and 211.1 +/-23.9% predicted respectively. Diffusing capacity and MW were 59.1 +/-1.1% and 48.6 +/-6.2%. These pulmonary functions did not change after pulmonary rehabilitation. 2) In the incremental exercise test using bicycle ergometer, maximum work rate (57.7 +/-4.9 watts vs. 64.8 +/-6.0 watts, P=0.036), maximum oxygen consumption (0.81 +/-0.07 L/min vs. 0.96 +/-0.08 L/min, P=0.004) and anaerobic threshold (0.60 +/-0.06 L/min vs. 0.76 +/-0.06 L/min, P=0.009) were significantly increased after pulmonary rehabilitation. There was no improvement in gas exchange after rehabilitation. 3) Exercise endurances of upper (4.5 +/-0.7 joule vs. 14.8+/-2.4 joule, P< 0.001) and lower extremity (25.4+/-5.7 joule vs. 42.6+/-7.7 joule, P<0.001), and 6 minute walking distance (392+/-35 meter vs. 459+/-33 meter, P<0.001) were significantly increased after rehabilitation. Maximum inspiratory pressure was also increased after rehabilitation (68.5 +/-5.4 cmH2O vs. 80.4 +/-6.4 cmH20, P<0.001). Conclusion: The pulmonary rehabilitation for 6 weeks can improve exercise performance in patients with chronic lung disease.
Anaerobic Threshold ; Bronchiectasis ; Dyspnea ; Education ; Exercise ; Exercise Test ; Exercise Tolerance ; Female ; Humans ; Lower Extremity ; Lung Diseases* ; Lung* ; Male ; Oxygen Consumption ; Rehabilitation* ; Sarcoidosis ; Walking