Induction of general anesthesia with direct laryngoscopy and tracheal intubation is routine procedure but causes varying degree of sympathetic stimulation such as increasing in blood pressure and heart rate. Many approaches have been tried to attenuate these hemodynamic responses. To evaluate the effects of nicardipine, a new calcium channel blocker, for prevent sympathetic stimulation induced by direct laryngoscopy and tracheal intubation, we administered nicardipine (40 mg P.O.) 60 minutes before laryngoscopy and endotracheal intubation. 60 patients, ASA physical status 1,2, scheduled operation, were selected randomly. We divided these patients into two groups. Group 1: control, valium 0.1-0.2 mg/kg P.O. (N=30), Group 2: valium 0.1-0.2 mg/kg with nicardipine 40 mg P.O. (N=30). We measured systolic blood pressure, diastolic blood pressure and heart rate before premedicstion, before induction and 1,3,5,10 minutes after intubation in both groups and compared with control group. The results were follows ; 1) Systolic blood pressure and diastolic pressure in nieardipine group were significantly decreased before induction after premedication. 2) After induction systolic blood pressure increased in both group (p<0.005) but increasing rate was significantly less than in nicardipine group (p<0.005). 3) After intubation diastolic pressure decreased significantly in nicardipine group (p<0.005). 4) The changes of heart rate were no difference in both groups.
Anesthesia, General ; Blood Pressure ; Calcium Channels ; Diazepam ; Heart Rate ; Hemodynamics ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy ; Nicardipine* ; Premedication

Induction of general anesthesia with direct laryngoscopy and tracheal intubation is routine procedure but causes varying degree of sympathetic stimulation such as increasing in blood pressure and heart rate. Many approaches have been tried to attenuate these hemodynamic responses. To evaluate the effects of nicardipine, a new calcium channel blocker, for prevent sympathetic stimulation induced by direct laryngoscopy and tracheal intubation, we administered nicardipine (40 mg P.O.) 60 minutes before laryngoscopy and endotracheal intubation. 60 patients, ASA physical status 1,2, scheduled operation, were selected randomly. We divided these patients into two groups. Group 1: control, valium 0.1-0.2 mg/kg P.O. (N=30), Group 2: valium 0.1-0.2 mg/kg with nicardipine 40 mg P.O. (N=30). We measured systolic blood pressure, diastolic blood pressure and heart rate before premedicstion, before induction and 1,3,5,10 minutes after intubation in both groups and compared with control group. The results were follows ; 1) Systolic blood pressure and diastolic pressure in nieardipine group were significantly decreased before induction after premedication. 2) After induction systolic blood pressure increased in both group (p<0.005) but increasing rate was significantly less than in nicardipine group (p<0.005). 3) After intubation diastolic pressure decreased significantly in nicardipine group (p<0.005). 4) The changes of heart rate were no difference in both groups.
Anesthesia, General ; Blood Pressure ; Calcium Channels ; Diazepam ; Heart Rate ; Hemodynamics ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy ; Nicardipine* ; Premedication

Adenomyosis is a common disease of middle-aged women and adenomyoma is a variety of adenomyosis that formed localized tumor. Cystic degeneration of an adenomyoma is a rare clinical manifestation. A 30-year-old parous woman suffered from severe dysmenorrhea and menorrhagia for about 5 months, was operated under the impression of endometriosis of the pelvis. Following the operation, cystic degeneration of an adenomyoma was found incidentally. The authors experienced a case of adenomyosis that formed cystic tumor of uterus and presented with a pertinent literatures.
Adenomyoma ; Adenomyosis* ; Adult ; Dysmenorrhea ; Endometriosis ; Female ; Humans ; Menorrhagia ; Pelvis ; Uterus

Monogenic diabetes, including maturity-onset diabetes of the young, neonatal diabetes, and other rare forms of diabetes, results from a single gene mutation. It has been estimated to represent around 1% to 6% of all diabetes. With the advances in genome sequencing technology, it is possible to diagnose more monogenic diabetes cases than ever before. In Korea, 11 studies have identified several monogenic diabetes cases, using Sanger sequencing and whole exome sequencing since 2001. The recent largest study, using targeted exome panel sequencing, found a molecular diagnosis rate of 21.1% for monogenic diabetes in clinically suspected patients. Mutations in glucokinase (GCK), hepatocyte nuclear factor 1α (HNF1A), and HNF4A were most commonly found. Genetic diagnosis of monogenic diabetes is important as it determines the therapeutic approach required for patients and helps to identify affected family members. However, there are still many challenges, which include a lack of simple clinical criterion for selecting patients for genetic testing, difficulties in interpreting the genetic test results, and high costs for genetic testing. In this review, we will discuss the latest updates on monogenic diabetes in Korea, and suggest an algorithm to screen patients for genetic testing. The genetic tests and non-genetic markers for accurate diagnosis of monogenic diabetes will be also reviewed.

The AO internal fixation system(the Fixateur Interne) is effective in reducing and stablizing a variety of unstable thoracolumbar fracture patterns. It is relatively effective in decompressing the canal of retropulsed bony fragments associated with burst fracture. Sixty-Two patients with unstable thoracolumbar spine fractures were treated with the AO internal fixator. They were followed for an average of 21 months(range 15-29 months). A compartive radiographic analysis of kyphosis and vertebral height was made using pre-operative, post-operative and follow-up radiogram. Changes in neural canal compromise were measured in 18 cases of burst fractures. Failure of instrumentation occured in 9 cases which were carefully analyzed. Recently, we've constructed the system of which the Schanz screws would be directed divergently in sagittal plane in the hope that the load to the screws might be reduced, thus the failure rate.
Follow-Up Studies ; Hope ; Humans ; Internal Fixators ; Kyphosis ; Neural Tube ; Spine

A 33-year old male was admitted due to continuous high spiking fever for 2 months via local clinic. He had been diagnosed pulmonary tuberculosis at local clinic. However, spiking fever had not been controlled by anti-tuberculous medications. Chest PA showed confluent consolidation on right upper & mid-lung field. 5 anti-tuberculous regimens (Streptomycin, Isoniazid, Rifampin, Ethambutol, Pyrazinamaide) were administered initially and steroid therapy was followed for relieving toxic symptoms Very slowly resolved chest X-ray lesion and continuous fever suggested the possibility of misdiagnosis. After 60th hospital day, the chest X-ray lesion was resolved gradually and fever subsided almost completely. He was discharged on 76th hospital day with anti-tuberculous drugs and steroid(prednisolon), without any other problems except sustained mild fever.
Diagnostic Errors ; Ethambutol ; Fever* ; Humans ; Isoniazid ; Male ; Pneumonia* ; Rifampin ; Thorax ; Tuberculosis, Pulmonary

PURPOSE: To evaluate the lung changes in healthy smokers, as seen on inspiratory and expiratoryhigh-resolution computed tomography (HRCT). MATERIAL AND METHODS: Twenty-seven healthy smokers (light smokers,below 20 pack-years, n=16; heavy smokers, above 20 pack-years, n=11) and 25 nonsmokers underwent inspiratory andexpiratory HRCT. All healthy smokers had normal pulmonary function and chest radiography. Parenchymal andsubpleural micronodules, ground-glass attenuation, centrilobular and paraseptal emphysema, bronchial wallthickening, bronchiectasis and septal line were evalvated on inspiratory scan and by air-trapping on expiratoryscan. RESULTS: On inspiratory scan, parenchymal micronodules were observed in one of 25 nonsmokers(4%), two of 16light smokers(13%) and five of 11 heavy smokers(45%); subpleural micronodules in two(8%), four(25%), two(18%);ground-glass attenuation in 0(0%), one(6%), three(27%); centrilobular emphysema in 0(0%), one(6%), three(27%);paraseptal emphysema in three(12%), 0(0%), five(45%); bronchial wall thickening in 0(0%), two(13%), one(9%),bronchiectasis in 0(0%), one(6%) two(18%) and septal line in one(4%), four(25%), two(18%). On expiratory scan,air-trapping was detected in 0 of 15 nonsmokers(0%), two of 17 light smokers(12%), and five of 11 heavysmokers(45%). Statistically significant differences between these three groups were found in parenchymalmicronodules(P=0.006), ground-glass attenuation(P=0.008), centrilobular emphysema(P=0.018), paraseptal emphysema(P=0.005) and air-trapping(P=0.013) between these three groups. CONCLUSION: According to the findings of HRCT,heavy smokers had higher frequency of parenchymal micronodules, ground-glass attenuation, centrilobular andparaseptal emphysema, and air-trapping than nonsmokers and light smokers.
Bronchiectasis ; Bronchiolitis ; Emphysema ; Lung* ; Pulmonary Emphysema ; Radiography ; Thorax

PURPOSE: To clarify the short-term effect and long-term results of bronchial arterial embolization forhemoptysis in three groups with tuberculosis, idiopathic bronchiectasis and lung cancer. MATERIALS AND METHODS:This study invo l ved 54 patients who underwent arterial embolization for the control of hemoptysis. Among 54, thecauses of hemorrhage were; pulmonary tuberculosis(n=32), idiopathic bronchiectasis (n=15), and lung cancer(n=7).In all patients, em-bolization was performed using Gelfoam particles and three underwent additional coilemboliza-tion. After the procedure, patients were followed up for between 1 and 95 (mean, 36.7) months. Short-termresults were assessed on the basis of careful observation of patients for 1 month after ar-terial embolization andwere classified as either; successful, indicating complete cessation of he-moptysis for 1 month, or failed,indicating continuing hemoptysis or recurrence within 1 month. Long-term results were evaluated in patients inwhom the procedure was successful in the short term and who could be followed up for at least 6 months. Patientsshowed either complete remis-sion(CR), indicating complete cessation of bleeding during the observation period;partial remis-sion(PR), indicating complete cessation of hemoptysis with recurrent bloody sputum during theobservation period; or recurrence, indicating recurrent hemoptysis, and were grouped accordingly. RESULTS: Noserious procedure related complications occurred except for mild chest pain or fever, of which showed spontaneousrelief within a few day s. The overall short-term success rate was 7 9 .6 %(43/54); individual rates were 84.4%for pulmonary tuberculosis (27/32), 80% for idiopathic bronchiectasis (10/15), and 57.1 % for lung cancer (4/7).Long-term follow-up showed that complete remission was achieved in 24 of 43 cases (55.8 %).The respectivelong-term remission and recur-rence rates were 75 % and 25 % for bronchiectasis, 70.4 % and 29.6 % for pulmonarytuberculosis. While four lung cancer patients whose initial outcome was successful showed no recurrence ofhe-moptysis, three died within 3 months of embolization. CONCLUSION: Embolization of bronchial arteries using aGelfoam sponge is effective as initial treat-ment for moderate or severe hemoptysis caused by benign disease.During long-term follow up, high remission rates were achieved in pulmonary tuberculosis and idiopathicbronchiectasis pa-tients, while the shortest bleeding control was in cases involving lung malignancy.
Bronchial Arteries ; Bronchiectasis ; Chest Pain ; Fever ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Hemoptysis* ; Hemorrhage ; Humans ; Lung ; Lung Neoplasms ; Porifera ; Recurrence ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Suicide is one of important health problems in Korea. Previous studies showed factors associated with suicide in individual levels. However, suicide was influenced by society that individuals belong to, so it was required to analyze suicide in local levels. The purpose of this study was to analyze the regional disparities of suicide mortality by gender and the association between local characteristics and suicide mortality. METHODS: This study included 229 city.county.district administrative districts in Korea. Age- and sex-standardized suicide mortality and age-standardized suicide mortality (male/female) were used as dependent variables. City.county.district types, socio-demographics (number of divorces per 1,000 population, number of marriages per 1,000 population, and single households), financial variable (financial independence), welfare variable (welfare budget), and health behavior/status (perceived health status scores and EuroQol-5 dimension [EQ-5D]) were used to represent the local characteristics. We used hot-spot analysis to identify the spatial patterns of suicide mortality and negative binomial regression analysis to examine factors affecting suicide mortality. RESULTS: There were differences in distribution of suicide mortality and hot-spot regions of suicide mortality by gender. Negative binomial regression analysis provided that city.county.district types (city), number of divorces per 1,000 population, financial independence, and EQ-5D had significant influences on the age- and sex-standardized suicide mortality per 100,000. Factor influencing suicide mortality was the number of divorces per 1,000 population in both male and female. CONCLUSION: Study results provided evidences that suicide mortality among regions was differed by gender. Health policy makers will need to consider gender and local characteristics when making policies for suicides.
Divorce ; Female ; Health Policy ; Humans ; Korea ; Male ; Marriage ; Mortality* ; Spatial Analysis ; Suicide*

BACKGROUND: Cisatracurium, one of 10 isomers of atracurium, undergoes pH and temperature-dependent Hofmann elimination in plasma and tissues. Physiologic changes may affect the pharmacodynamics of neuromuscular bldegrees Cking agent during pregnancy. So, we compared the difference in the infusion rate and its spontaneous recovery of cisatracurium between full-term pregnant and nonpregnant women. METHODS: Muscle relaxation of full-term pregnant(group I, n=10) and nonpregnant(group II, n=10) women was maintained by continuous infusion of cisatracurium to keep 1st twitch response of train-of-four(TOF) at 5~10% of control. After discontinuation of infusion, recovery index was measured without reversals using the accelerograph. RESULTS: The infusion rate of cisatracurium in group I(1.25+/-0.16 mcg/kg/min) was not significantly different from that in group II(1.31+/-0.22) and recovery indices were not different between two groups(10.7+/-2.0 vs. 11.6+/-1.9 min). CONCLUSION: The infusion rate of cisatracurium in parturients to maintain surgical relaxation is not different from that in non-parturients. For Cesarean section, the usual infusion rate of cisatracurium is recommeneded to achieve the adequate surgical relaxation.
Anesthesia* ; Atracurium ; Cesarean Section* ; Enflurane* ; Female ; Humans ; Hydrogen-Ion Concentration ; Muscle Relaxation ; Plasma ; Pregnancy ; Relaxation