BACKGROUND: Respiratory depression with high dose of propofol during induction is one of the major complications. We studied the effects of midazolam as premedicant on frequency and duration of apnea and frequency of loss of consciousness in relation to single dose of propofol. METHODS: We selected 194 adult patients who had clear consciousness and no depression of respiration. We allocated patients randomly to control group and midazolam group. In midazolam group, we injected 0.06mg/kg of midazolam intravenously 10min before induction, and in control group, we did nothing. Under mask oxygenation with 100% oxygen, we administered a bolus of propofol (1, 1.5, 2 mg/kg to subgroup 1, 2, 3 respectively) intravenously. The change of respiration and loss of consciousness were observed. RESULTS: The frequency and duration of apnea increased with the dose of propofol in both control and midazolam group. But there were no difference between groups except frequency of apnea with 1.5 mg/kg of propofol. In control group, frequency of loss of consciousness increased with the increasing dose of propofol. But in midazolam group, nearly all the patients was slept without difference by the dose. CONCLUSIONS: Premedication with midazolam reduce the sleeping dose of propofol to induce anesthesia, so the frequency and duration of apnea which is caused by high dose of propofol can be decreased.
Adult ; Anesthesia ; Apnea* ; Consciousness ; Depression ; Humans ; Masks ; Midazolam* ; Oxygen ; Premedication ; Propofol* ; Respiration ; Respiratory Insufficiency ; Unconsciousness*

The tongue is located inside the oral cavity at rest, and the structural interrelations between the tongue and the oral cavity is essentially important for normal tongue function. Macroglossia is clinically diagnosed whenever the tongue does not fit the oral cavity, thus patients complain of noisy breathing, drooling, speech and swallowing dysfunction, malocclusion, and social ridicule. Partial glossectomy for macroglossia volume has been assumed to be difficult. In this study, we attempted to measure the tongue volume with the plaster tongue model in a 7-year-old macroglossia patient. This method is reliable and simple for measuring the tongue volume in macroglossia.
Child ; Deglutition ; Glossectomy* ; Humans ; Macroglossia* ; Malocclusion ; Mouth ; Respiration ; Sialorrhea ; Tongue*

No abstract available.
Fingers* ; Toes*

BACKGROUND: Allergic diseases are characterized by immediate - and late - phase reactions to various allergens by the selective activation of a subset of CD4 + T cells. In response to allergen, T cells isolated from atopic donors are biased to low levels of IFN - y and high levels of IL - 4, and vice versa by T cells from non - atopic donor. Objective : The aim of this study was to evaluate the patterns of IL - 4 and IFN - y production after Der p I stimulation and the effect on the cytokine production from T cells by budesonide, disodium cromoglycate and cyclosporin A in atopic and non - atopic individuals. MATERIAL AND METHOD: Seven Der p I specific atopic and 7 non - atopic individuals were selected. We decided the 50% inhibiting concentration of each immunomodulator by lymphocyte proliferation assay, and measured their effects on the cytokine production in vitro by intracellular IL - 4, IFN - y staining and flow cytometry. Results and CONCLUSION: There was significant difference on stimulation index ( SI ) of production of IFN - y as well as IL-4 after Der p I stimulation between atopic and non-atopic individuals ( IL - 4 ; 1.57 +/- 0.7 : 0.98 +/- 0.2, p = 0.026, IFN - r : 1.45 +/- 0.5 : 0.95 +/- 0.2, p = 0.048 ). The synthesis of IL - 4, and IFN - r were significantly inhibited after the stimulation of every immunomodulators in atopic individuals, DSCG couldnt inhibit IL - 4 and IFN - r in nonatopic individuals. There was no significant difference in the inhibiting effect of these immunomodulators in both of them.
Allergens ; Bias (Epidemiology) ; Budesonide ; Cromolyn Sodium ; Cyclosporine ; Dust* ; Flow Cytometry ; Humans ; Immunologic Factors ; Interferons* ; Interleukin-4 ; Lymphocytes ; Pyroglyphidae* ; T-Lymphocytes* ; Tissue Donors

Fractures of the neck of the femur have always presented great challenges to orthopedic surgeons and still remain as one of the unsolved fracture as far as treatment and results are concerned. With life expectancy increasing with each decade, becoming more and more patients suffering from femoral neck fractures and their sequelae. The objoct of this study is to observe the relationship between the clinical results and the degree of displacement of fracture, degree of osteoporosis and duration between injury and operation in femoral neck fractures treated with multiple pin fixation. The author clinically analyzed 56 patients of the femoral neck fractures treated with closed reduction and multiple Knowles pinning followed by more than 1 year at Korea University Hospital from January 1986 to December 1991. There were 20 male and 36 female. The age of patients were ranged from 32 to 88 years(average:65.1 years) and most commonly occurred in 7th decade (23cases,41%). The most common cause was slip down(44 cases;79%). The most common type of fracture was stage III (48%) following to Gardens classification. The obtained results were as follows; 1. Union occurred in 49 cases(88%). 2. Among fifty-six cases, five cases(9%) of avascular necrosis, two cases(4%) Of non-union, two cases(4%) of malunion and one case of posttraumatic arthritis were occurred. 3. The functional results by Lunceford criteria were excellent in 30 cases(53% ), good in 13 cases(23%), fair in 5 cases(10%) and poor in 8 cases(14%). 4. Unsatisfactory results were noted in Garden stage II or IV, osteoporosis below Singh index 3 and delayed treatment over 1 week. Above results suggest that multiple Knowles pinning in femoral neck fractures offers high union rate and low complication rate, and so is also one of salvaging method of femoral head.
Agriculture ; Arthritis ; Classification ; Clinical Study ; Female ; Femoral Neck Fractures ; Femur ; Femur Neck ; Head ; Humans ; Korea ; Life Expectancy ; Male ; Methods ; Neck ; Necrosis ; Orthopedics ; Osteoporosis ; Surgeons

OBJECTIVES: As a part of plan to develop evidence-based treatment guidelines for depression that is more suitable for Korean situation, we investigate the present status and client's requirements for non-pharmacological treatment of depression in Korean clinical situation. METHODS: Subjects were patients with depression in 12 university hospitals which are located in metropolises in Korea. We analyzed the records from questionnaires about current clinical status and requirements for the non-pharmacological treatment of depression in Korea. RESULT: 50.8% of the subjects have experienced non-pharmacological treatments for their depression. The preference of non-pharmacological treatment method of depression is exercise/interesting activity, counseling by psychiatrists and psychotherapy, and the best effective treatment method is psychotherapy (Es=4.36). Actually, the mean consultation time by psychiatrist is 11.31+/-7.16 min, and the appropriate consultation time for client's situation is 18.39+/-8.95 min. During consultation, patients' satisfaction measurement for psychiatrist's explanation about pharmacological treatment is 64.17+/-27.11, and satisfaction measurement for psychiatrist's counseling for their depression about personal problems, resent stress, interpersonal relationship is 61.66+/-26.63. CONCLUSION: In Korea, many psychiatrists offered biologically oriented treatment to their patients with depression, and patients' satisfaction measurement about consultation by psychiatrists is low. Many patients wanted to combined pharmacological and non-pharmacological treatment for their depression, and aspired to information about complementary and self-help treatment methods. It is necessary to develop non-pharmacological treatment guideline for depression which reflect the clinical situation in Korea and meet Korean patients' need.
Counseling ; Depression* ; Hospitals, University ; Humans ; Korea* ; Psychiatry ; Psychotherapy

The purpose of this randomized, prospective study was to compare the intubation time, hemodynamic effect and complication rates of orotracheal intubation performed by direct laryngoscopic or lighted stylet (lightwand) methods in the controlled settings of the operating room. After approval of clinical investigation committee and informed consent from patients, healthy ASA class 1 and 2 elective surgical patients were studied. On arrival to operating room, EKG, radial arterial cannulation to monitor blood pressure continously and neuromuscular monitoring device were applied to patients. Anesthesia was induced with fentanyl 3 ug/kg, thiopental 4 mg/kg and vecuronium 0.15 mg/kg to facilliate relaxation. Ventilation was controlled for 5 min by facemask with oxygen-isoflurane (1.2 vol%) or enflurane(1.7 vol%) before intubation. The patients were intubated randomly using either direct curved laryngoscope (DL, 37 patients) or lightwand (LW, 36 patients). The time to intubation (TTI) was recorded. The mean arterial pressure(MAP) and heart rate(HR) were recoreded every 30 sec after intubation for 5 min. The changes of MAP and HR after intubation were compared with pre-intubation value. After extubation, complications such as mucosal trauma and postoperative sore throat were recorded. The data were analyzed using either unpaired t-test or Chi-square analysis, where appropriate. There were no failed intuhation in either groups. There was no significant differences between the groups with respect to sex, age, weight, height, existence of nasogastric tube. The TTI was similar between groups(14.5+/-8.1 sec for LW, 16.8+/-9.5 sec for DL). There was no differences in incidence of trauma(19.4% for LW, 16.2% for DL) between groups. There were no statistically significant difference in the maximal increase in MAP(44% for LW, 55% for DL at 30 sec) and HR(25.6% for LW, 24.1% for DL at 30 sec) and during 5 min following intubation. In canclusion, even though the hemadynamic effect after intubation was not influenced by using LW, the results of this study indicate that the use of the LW is as useful, effective and safe method as using DL for oro-endotracheal intubation. Further study may prove that using the LW to be an effective alternative technique of intubation in patients with difficult airway.
Anesthesia ; Blood Pressure ; Catheterization ; Electrocardiography ; Fentanyl ; Heart ; Hemodynamics* ; Humans ; Incidence ; Informed Consent ; Intubation* ; Laryngoscopes ; Neuromuscular Monitoring ; Operating Rooms ; Pharyngitis ; Prospective Studies ; Relaxation ; Thiopental ; Vecuronium Bromide ; Ventilation

Sporotrichosis is a chronic infection that follows accidental implantation of the fungus Sporothrix schenckii into the skin. The infection begins with skin trauma under conditions when conidia may be present. A 48-year-old woman presented with a 5-year history of an 8X 12 cm sized, centrally depressed, erythematous plaque on the left wrist. She had been treated with antifungal agents at an other hospital for about 6 months but there was no improvement. The histopathological findings showed an infiltration of mononuclear cells and tuberculoid structures on the whole dermis and subcutis. According to the histopathological findings and clinical manifestations, she was diagnosed as having lupus vulgaris. There was much improvement of the lesion after antituberculous therapy. However, 2 months later she developed asymptomatic multiple erythematous papules around the lesion of lupus vulgaris and along the lymphatic drainage of the left arm. The histopathological findings of the newly developed lesion showed a granulomatous reaction and an infiltrate of acute and chronic inflammatory cells. Moist and creamy colonies were changed into brown-to-black ones with a leathery appearance with age. This appearance and clinical manifestations confirmed the diagnosis of lymphocutaneous sporotrichosis. This clinical appearance reflects that the sporotrichosis developed on the ulcerative lesion or biopsy site of lupus vulgaris.
Antifungal Agents ; Arm ; Biopsy ; Dermis ; Diagnosis ; Drainage ; Female ; Fungi ; Humans ; Lupus Vulgaris* ; Middle Aged ; Skin ; Spores, Fungal ; Sporothrix ; Sporotrichosis* ; Ulcer ; Wrist

No abstract available.
Obstetrics*

BACKGROUND: Ischemia-reperfusion injury and ventilation/perfusion mismatch are the major complication of lung transplantation. Application of positive end-expiratory pressure(PEEP) on reperfused lung can prevent hypoxemia, because it increases functional residual capacity and improves oxygenation without contralateral dynamic hyperexpansion. To identify which differential lung ventilation with PEEP reduces ischemia-reperfusion lung injury, PaO2, intrapulmonary shunt, pulmonary compliance and water content of lung tissue were measured and compared with those of conventional two lung ventilation. METHODS: Nineteen Korean mongrel dogs were included for study. Double lumen endotracheal tube was inserted via tracheostomy site. Femoral arterial catheter and Swan-Ganz catheter were inserted for hemodynamic data and thoracotomy was done. The right pulmonary artery, vein, and main bronchus were clamped for 90 minutes and released to produce unilateral warm ischemia-reperfusion lung injury. In control group(C), conventional two lung ventilation was applied, and in experimental group(P), the right lung was ventilated with 10 cmH2O PEEP independent of the left lung. PaO2, intrapulmonary shunt, pulmonary compliance and water content of lung tissue were measured. RESULT: At 60 min after reperfusion, PaO2 in group P was higher than in group C(512.4+/-58.8 mmHg vs 263.6+/-165.8 mmHg), and intrapulmonary shunt was smaller(9.8+/-3.4 vs 25.9+/-11.3%). Dynamic and static pulmonary compliance in group P were higher than in group C(42.3+/-9.4, 95.2+/-14.7 vs 29.2+/-1.4, 60.2+/-17.1 dyne, sec/cm5). Water content of the right lung in group P was lower than in group C(81.1+/-1.6 vs 85.1+/-3.9%). CONCLUSION: In conclusion, these data suggest that application of positive end-expiratory pressure on reperfused lung is more effective to improve ventilation/perfusion mismatch and oxygenation, so it is thought to be a good treatment for ischemia-reperfusion lung injury.
Animals ; Anoxia ; Bronchi ; Catheters ; Compliance ; Dogs* ; Functional Residual Capacity ; Hemodynamics ; Lung Injury* ; Lung Transplantation ; Lung* ; Oxygen ; Positive-Pressure Respiration* ; Pulmonary Artery ; Reperfusion ; Reperfusion Injury ; Thoracotomy ; Tracheostomy ; Veins ; Ventilation*