BACKGROUND: Sustained-release theophylline, which is generally prescribed as a twice-daily equal-dose regimen, is one of the more common asthma treatments. the development of a sustained-release drug delivery technology that enables improved control of the theophylline blood levels represents a significant advancement in both the efficacy and safety of dosing. METHOD: A crossover study was conducted with 25 adult chronic asthmatic patients requiring daily bronchodilator therapy. The study group included thirteen males and twelve females with ages ranging from 19 to 71 years. The overall approach was to place the patients first on the twice-daily preparation(Etheophyl®) for 28 days at 8 AM and 8 PM, and measure the pulmonary function and theophylline level on the 28th day. the patients were subsequently switched to the once-daily preparation(Uniphyl®) in the same daily dose at 8 PM on the 29th day and the same parameters were measured on the 56th day. RESULTS: the mean serum levels of theophylline were 8.18±1.66µg/ml in the Etheophyl®-treated period and 8.00±1.75µg/ml in the Uniphyl®-treated period. In addition, the FEV1 showed 71.40±7.48 percent in the Etheophyl®-treated and 69.18±9.00 percent in the Uniphyl®-treated period. Thus there were no significant differences between the once-daily and twice-daily preparation. CONCLUSION: The results indicated little clinical differences between the two medication. The two drugs are equally effective in controlling asthma over the four weeks of treatment.
Adult ; Asthma* ; Cross-Over Studies ; Female ; Humans ; Male ; Theophylline

No abstract available.
Aneurysm* ; Renal Artery*

BACKGROUND: Exercise is a very common precipitant of asthma. Broncho-constriction associated with exercise can occur in 75~90% of individuals with asthma. The estimated prevalence ( 30~85% ) of gastroesophageal reflux ( GER ) in patients with asthma is significantly higher than in general population. We performed pH monitoring during the exercise in order to evalute whetherexercise induced asthma EIA ( 6 men, 12 women ) were studied. Monitoring of intraesophageal pH, ECG and spirometry was done for 1 hour before treadmill exercise. After baseline monitoring, subjects underwent symptom-limited treadmill exercise with Bruce protocol and continuous monitoring for 60 min after exercise. Spirometry was done at baseline prior to exercise, and repeated every 10 min after full exercise for 60 min. RESULTS: Exercise-induced bronchoconstriction was noted in 15 patients, who performed MBPT and 12 patients confirmed for bronchial asthma and 3 patients were diagnosed exercise-induced astham. Five 15 EIA patients demonstrated a pathologic degree of GER. CONCLUSION: We suggest that GER may be one of pathophysiologic factors of ELA and evoke further concentration on the GER in the EIA patients.
Asthma ; Asthma, Exercise-Induced* ; Bronchoconstriction ; Electrocardiography ; Female ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Male ; Prevalence ; Spirometry

We report an autopsy case of the brain stem glioma that extended extensively in the brain stem itself and cephalad. This 18-year-old boy first presented with dizziness, vomiting and left side weakness with left facial palsy. Brain MRI revealed a diffusely infiltrative tumor involving whole medulla, pons and lower midbrain. A total of 4000 R was given with some alleviation of respiratory difficulty. He died one year after the onset. Autopsy revealed the tumor involving pons, a portion of medulla oblongata, and cerebellum. The tumor showed diffusely infiltrative pattern and extended along the periventricular area to the thalamus and corpus callosum. The cut surface was grayish white and solid. It also showed areas of myxoid degeneration and necrosis probably related to radiation therapy. Microscopically the tumor was a cellular and pleomorphic glioma that showed some astrocytic differentiation. It was diffuse without geographic necrosis.

BACKGROUNDS: When measuring lung function and response to bronchodilator, MDI(metered-dose inhaler) is commonly used but unfamiliarity of its use and cold sensation by the puffed gas decrease reliability of the result. Spacer can reduce the cold freon effect and undesired oropharyngeal deposition caused by the rapid evaporation of the propellant and there are many studies which showed more effectiveness of spacer on the treatment of children with asthma but no study whether it is effective on the bronchodilator response test in the first medical examination of old age. Therefore, we tested whether the use of spacer can reduce the cold freon effect and improve the bronchodilator response in the first medical examination of old age. METHODS: Two hundred of elderly patients( 65years) who had never used MDI were measured the bronchodilator response. Subjects were randomised to either spacer-user or spacer-nonuser. Twenty minutes after 400 g fenoterol was administered, FEV1 (forced expiratory volume in one second) was measured. Bronchoconstriction was defined as a decrease in FEV1 by 10% or greater after bronchodilator inhalation. We further devided each group into normal or obstructive group, obstructive group was defined as FEV1<80% of predicted and FEV1/FVC<70%. RESULTS: In normal group, spacer-user(n=83) showed greater bronchodilator response than spacer-nonuser(n=66), 6.43% vs 3.81% respectively(p<0.05) and two case of bronchoconstriction occured only in spacer-nonuser. In obstructive group, there is no significant difference in bronchodilator response between spacer-user(n=18) and spacer-nonuser(n=33), 12.32% vs 11.16% respectively(p>0.05) but brochoconstriction(n=1) occured only in spacer-nonuser. CONCLUSION: Spacer improved bronchodilator response and prevented bronchoconstriction, in the first medical examination of old age.
Aged ; Asthma ; Bronchoconstriction ; Child ; Chlorofluorocarbons ; Fenoterol ; Humans ; Inhalation ; Lung ; Sensation

BACKGROUND: A number of studies indicate that aerosol spray lidocaine and non-steroidal anti- inflammatory drugs (NSAIDs) provide good postoperative analgesia for both minor and major surgeries. The aim of this study was to compare the analgesic and side effects of topical lidocaine spray with that of ketorolac after a tonsillectomy. METHODS: In a double blind, randomized manner, sixty ASA class 1 or 2 patients were selected for a tonsillectomy under general anesthesia. All patients received propofol 2 mg/kg and vecuronium 0.1 mg/kg followed by a propofol infusion of 6 - 10 mg/kg/h in O2/N2O 40%/60%. At the end of surgery, the patients were divided into three groups and given no drug (group 1, n = 20), given 2 mg/kg 10% lidocaine sprayed to posttonsillectomy sites (group 2, n = 20) or given intravenous ketorolac 0.5 mg/kg (group 3, n = 20). Postoperative pain was assessed using the visual analogue scale (VAS) score at 30 minutes, 1, 2 and 4 hours after full recovery and the side effects of the three groups were evaluated. RESULTS: The VAS of group 2 was significantly lower than that of other groups at 30 min after recovery (P = 0.00). At 1 h, the VAS of group 2 and 3 were significantly lower than that of group 1 (P = 0.00), and the VAS of group 2 was significantly lower than that of group 3 (P = 0.02). At 2 and 4 hrs, the VAS of groups 2 and 3 were significantly lower than that of group 1 (P = 0.00), but the difference was not significant between groups 2 and 3. Side effects such as hoarseness, oral paresthesia, swallowing difficulty and oral bleeding were observed. However, the intensity of side effects was mild. CONCLUSIONS: 10% lidocaine spray and intravenous ketorolac injection produce a significant analgesic effect without specific complications after a tonsillectomy. In control of immediate postoperative pain, 10% lidocaine spray has a better effect than that of intravenous ketorolac injection.
Analgesia ; Anesthesia, General ; Deglutition ; Hemorrhage ; Hoarseness ; Humans ; Ketorolac* ; Lidocaine* ; Pain, Postoperative ; Paresthesia ; Propofol ; Tonsillectomy* ; Vecuronium Bromide

Almost always patients with multiple neurofibromatosis show cafe-au-lait macules on their skin. At times the skin macules are seen even before the appearance of the neurofibromata in childhood. The author experienced one case of neurofibromatosis in a 12-year-old boy who has no cafe-au-lait macules. Besides the clinical peculiarity of having no skin pigmentation, the histopathology of the case showed well-formed double-palisading structure, which is not common among the micro-scopical findings of neurofibromata.
Child ; Humans ; Male ; Neurofibromatoses* ; Skin ; Skin Pigmentation

BACKGROUND: There are many risk factors for osteoporosis in patients with chronic obstructive pulmonary disease(COPD). These include smoking, a low body mass index, insufficient exercise, and the use of glucocortcoids. However, there is lack of data on the incidence of osteoporosis according to the different glucocorticoid administration methods in patients with COPD. This study compared the incidence of osteoporosis according to the different administration methods of glucocorticoid. METHODS: A matched case-controlled study (gender, age, cumulative steroid dose and pack-years of smoking) was conducted. Forty-five patients with documented COPD for at least a 3 year duration and a cumulative glucocorticoid dose above 1,000 mg were enrolled in study. The patients were classified into the following three groups. First, fifteen patients received continuous inhaled glucocorticoid with intermittent oral steroids but had no admission history due to an acute exacerbation(Group I). Secondly, fifteen patients received a multiple course of oral steroids with additional inhaled glucocorticoid but had no admission history due to their acute exacerbation(Group II). Lastly, fifteen patients received intermittent oral or inhaled glucocorticoids and had an admission history due to the acute exacerbation with intravenous steroid treatment for at least 2 weeks per year(Group III). The enrolled patients had apulmonary function test and bone densitometry performed at the lumbar spine and femoral neck. RESULTS: The patients from Group III had significantly high incidence of osteoporosis in the lumbar and femoral neck compared to Group I and Group II (p<0.01). CONCLUSION: The incidence of osteoporosis in patients with COPD appears to be strongly affected by the method of steroid administration. This result suggests that intravenous steroid administration is strongly associated with the risk of osteoporosis.
Body Mass Index ; Case-Control Studies ; Densitometry ; Femur Neck ; Glucocorticoids ; Humans ; Incidence* ; Osteoporosis* ; Pulmonary Disease, Chronic Obstructive* ; Risk Factors ; Smoke ; Smoking ; Spine ; Steroids

The effects of oral premedication with diazepam and atropine were evaluated. We made three kinds of syrup which were composed of diazepam 0.3mg/0.5cc, diazepam 0.3 mg mixed with atropine 0.001 mg in 0.5cc and diazepam 0.3mg mixed with atropine 0.03mg in 0.5cc, respectively. The 1st was administered to Group l (n=21), the second to group ll (n=21) and the last to group lll (n= 24) one and half to two hours before induction of anesthesia. Each child received 0.5 cc/kg. On arrival at pediatric operating room, anxiety levels, vital signs, antisalivatory effect and side effects were checked. The attitude of children was evaluated just before induction of anesthesia. In group land lll, slight elevation of diastolic blood pressure was noticed. The satisfaotory levels, checked by anxiety level O, were 86% in group l, 90% in group ll and 79% in group lll. The altitudes in the operating rooms just before induction of anesthesia were satisfactory and cooperative in 77 %, 81%, and 87% of patients in group l, ll and lll, respectively. Antisalivatory effect was not good in group l, but satisfactory in 82% and 75% of cases in group ll and lll. But side effect was present in 25% of cases in group ll and lll, in spite of 10% in group l. So we can conclude that preoperative oral diazepam in a dose of 0.3mg/0.5cc/kg is very good for the reduction of anxiety and the additiopn of atropine may increase the incidence of side effects. Threefore we recommend parentreral belladonna alkaloids just before induction instead of preoperative oral medication.
Altitude ; Anesthesia ; Anxiety ; Atropine ; Belladonna Alkaloids ; Blood Pressure ; Child* ; Diazepam ; Humans ; Incidence ; Operating Rooms ; Premedication* ; Vital Signs

The prevention of and the controlling of symptoms, reductions in the frequency of exacerbations, and disease severity are central to the pharmacologic therapy of chronic obstructive pulmonary disease (COPD). COPD patients are inclined to be older, have more comorbidities, and use polypharmacy as a result. Long-acting inhaled muscarinic antagonists (LAMAs) is a preferred treatment modality. However, the cardiovascular (CV) safety of anti-cholinergics, including LAMA, has been an issue. In contrast, the results of the UPLIFT trial and a pooled analysis of data from 30 trials of tiotropium illustrates the association of tiotropium with reductions in the risk of all cause mortality, CV mortality and CV events. And, the UPLIFT trial provides clues regarding the additive advantages of tiotropium in COPD patients who already are using long-acting inhaled beta2 agonists and inhaled corticosteroids. Following the contribution of tiotropium as a first LAMA, new LAMAs such as aclidinium and glycopyrrolate (NVA-237) seem to be emerging.
Adrenal Cortex Hormones ; Cholinergic Antagonists ; Comorbidity ; Glycopyrrolate ; Humans ; Muscarinic Antagonists ; Polypharmacy ; Pulmonary Disease, Chronic Obstructive ; Scopolamine Derivatives ; Tiotropium Bromide