No abstract available.
Facial Bones*

BACKGROUND: The measurement of nonspecific bronchial hyperreactivity is valuable for diagnosis and management of bronchial asthma. Methacholine or histamine is used for the pharmacologic provocation test. Usually a methacholine bronchial provocation test is performed by a dosing technique with counted number of breaths. A dosimeter is indispensable in the dosing technique. Recently a timed tidal breathing technique which dose not need an expensive dosimeter was introduced. We measured the degree of nonspecific bronchial hyperreactivity to histamine using a simple timed tidal breathing technique. METHOD: Forty two healthy volunteers, 12 patients with bronchial asthma(BA), 10 patients with rhinitis(RH) and 10 patients with upper respiratory infection(URI) participated in the study. The subject's nose was clipped and inhalation continued during tidal breathing for 2 minutes via a face mask. FEV1 was measured at 30 seconds, 90 seconds after inhalation and inhalation of next solution was continued until there was a fall in FEV1 of 20%. Histamine PC20 was defined as the concentration at 20% fall of FEV1 and it was obtained from the log dose-response curve by linear interpolation. RESULTS: Inhalation of serial dilution of histamine could be performed in all patients without significant side of effects. The geometric mean±standard deviation of histamine PC20 in healthy volunteers is 8.27±2.22mg/ml, BA group 0.33±3.02mg/ml, RH group 0.85 ±3.24mg/ml, and URI group 1.47±1.98mg/ml. CONCLUSION: Histamine bronchial provocation test using timed tidal breath method is a simple and suitable tool for management of patients with bronchial hyperreactivity.
Asthma ; Bronchial Hyperreactivity ; Bronchial Provocation Tests* ; Diagnosis ; Healthy Volunteers ; Histamine* ; Humans ; Inhalation ; Masks ; Methacholine Chloride ; Nose ; Respiration*

No abstract available.
Adult* ; Humans

BACKGROUND: The decision to institute mechanical ventilation for patients with COPD is very difficult. The accurate informaiton regarding weaning success and long-term survival will improve communication with patients and family and enhance informed consent. The aims of this study are to describe outcomes and identify variables associated with survival for patients experiencing mechanical ventilation with an acute respiratory failure of COPD. METHODS: The 53 cases of mechanical ventilation in the intensive care unit in the National Medical Center from 1989 to 1998 were included. Data were collected retrospectively from medical records. Weaning success rate and 3 month and 1 year survival rates were estimated. Factors associated with weaning success and survival were determined. RESULTS: Weaning success was 55%. For success group with 29 cases, 3 months survival rate was 61% and 1 year survival rate 37%. APACHE II scores in weaning success group were significantly lower than those in the failure group. Factors such as age, sex, comorbid-illnes, previous steroid use, causes of respiratory failure, RVH or arrhythmia on EKG, serum albumin level, arterial blood pH, PaO2, PaCO2, FEV1, duration of mechanical ventilation and steroid use during mechanical ventilation were not associated with weaning success. Only age and serum albumin level were associated with 3 month and 1 year survival. No COPD patients of age more than 75 years and serum albumin level less than 3g/dl had survived at 1 year after weaning success. CONCLUSION: While seaning success from mechanical ventilation can be predicted by APACHE IIscore in COPD patients, long-term outcomes of survivors may be influenced by nutritional status and age.
APACHE ; Arrhythmias, Cardiac ; Electrocardiography ; Humans ; Hydrogen-Ion Concentration ; Informed Consent ; Intensive Care Units ; Medical Records ; Nutritional Status ; Pulmonary Disease, Chronic Obstructive* ; Respiration, Artificial* ; Respiratory Insufficiency ; Retrospective Studies ; Serum Albumin ; Survival Rate ; Survivors ; Weaning

BACKGROUND: Joint symptoms frequently occur in the course of antituberculous chemotherapy and tend to be ignored and overlooked, but in some cases, they are often very troublesome in obstructing ordinary life. Joint symptoms that develop during antituberculous chemotherapy need to be understood, but there are few materials describing them systematically. METHOD: This study enrolled 33 patients with tuberculosis treated with first line antituberculous agents for more than 6months. In the course of treatment, joint symptoms not associated with specific cause, such as pre-existing joint disease or trauma, were investigated and compared with those of the asymptomatic group, We confirmed the incidence of joint symptoms and factors associated with them. RESULTS: Nineteen of 33 patients (58%) had joint symptoms. Joint symptoms developed 1.9±1.4 months after the beginning of chemotherapy and lasted for 3.6±2.5 months. IN 18 of 19 symptomatic patients, multiple joints were involved : shoulder(10 patients, 53%), knee(10,53%), finger(6,32%). Joint symptoms were expressed as pain(19 patients, 100%), stiffness(7,37%) and/or swelling (3,16%). Fourteen patients (74%) took analgesics to relieve their symptoms and in 2 patients, antituberculous agents were discontinued because of the severity of their symptoms. The symptoms seem to be caused by agents other than pyrazinamide, but it was very difficult to identify the definite causative agent. In age, sex, underlying disease and serum uric acid level, no significant differences were noted between the two groups. CONCLUSIONS: Although joint symptoms are common during antituberculous chemotherapy, their development is difficult to predict. Because some joint symptoms can become very bothersome, the physician should pay close attention to these symptoms.
Analgesics ; Arthralgia ; Drug Therapy* ; Humans ; Incidence ; Joint Diseases ; Joints* ; Pyrazinamide ; Tuberculosis ; Uric Acid

PURPOSE: The purposes of this study were to analyze the MR findings of medulloblastoma, and to evaluate the subarachnoid dissemination and the significance of contrast enhanced MR of brain and spine for tumor.. MATERIALS AND METHODS: The preoperative brain MR studies of 18 patients (9 males, 9 females;mean age, 9.4 years) with surgically proved medulloblastomas were retrospectively reviewed to characterize these neoplasms with regard to their location, size, MR signal intensity, appearance after contrast enhancement, presence of cyst and necrosis, subarachnoid dissemination, and other associated findings. In 14 patients postoperative spine MR studies were evaluated for staging and therapeutic planning. RESULTS: The most frequent location of medulloblastoma was the inferior vermis and the mean tumor size was 4.1 x 3.6 x 3.9 cm. On Tl-weighted image, medulloblastomas generally had low to intermediate signal, predominantly hypointense relative to white matter. On T2-weighted image, medulloblastomas showed modetately high signal, hyperintense relative to white matter. Inhomogeneous contrast enhancement was demonstrated in 13 patients(72.2%) after injection of gadopentetate dimeglumine(Gadolinium). Cyst and necrosis within the tumor were visualized in 15 patients(83.3%). Subarachnoid disseminations of medulloblastomas were noted in 11 patients(61.1%), of which 6 demonstrated intracranial and 2 intraspinal dissemination. Three had both intracranial and intraspinal dissemination. In nine cases with intracranial lesions, there were intraparenchymal mass formation(7), subarachnoid nodules(5), infundibular lesions(2) and diffuse gyral enhancement(I). In five cases with intraspinal lesions, there were extramedullary intradural small nodules(3), central canal nodules(2), intradural masses(I)and fine nodular and sheet-like leptomeningeal enhancement(1). Other associated findings included intratumoral hemorrhage(11.1%), per/tumoral edema(44.4%), tonsillar herniation(44.4%), hydrocephalus(88.9%) and calcification(44.4%). CONCLUSION: Medulloblastomas revealed low to intermediate signal intensity on Tl-weighted image and intermediate to moderately high signal intensity on T2-weighted image, relative to cerebellar white matter. Medulloblastomas were solid tumors with cystic necrosis, which showed inhomogeneous enhancement and subarachnoid disseminations to the intracranial and intraspinal spaces after Gd-DTPA enhancement. Gd-enhanced MR of brain and spine was an useful diagnostic modality in preoperative diagnosis and in staging of postoperative cases of medulloblastomas, which was superior to postcontrast CT or precontrast MR.
Brain* ; Diagnosis ; Gadolinium DTPA ; Humans ; Male ; Medulloblastoma ; Necrosis ; Retrospective Studies ; Spine*

A functional upper airway obstruction due to a vocal cord dysfunction(VCD) is characterized by a paradoxical adduction of the vocal cords throughout the respiratory cycle with no obvious organic cause for the obstruction. It commonly occurs paroxysmally and imitates acute asthmatic attacks, often in patients with coexisting asthma. They present with episodes of dyspnea associated with inspiratory wheezing that persists despite conventional asthma treatment and a flattening of the inspiratory limb of the flow-volume curve; an adduction of the vocal cord during inspiration. Failure to recognize concurrent vocal cord dysfunction and asthma has led not only to the excessive use of bronchodilators and corticosteroids, but also to intubation and tracheostomy. Here, we report a case of coexistent obstructive pulmonary disease and functional upper airway obstruction due to a vocal cord dysfunction where a bronchoscopy showed a paradoxical vocal cord motion and typical features of a variable extrathoracic obstruction and a lower airway obstruction on the Flow-volume loop during a symptomatic period.
Adrenal Cortex Hormones ; Airway Obstruction* ; Asthma ; Bronchodilator Agents ; Bronchoscopy ; Dyspnea ; Extremities ; Humans ; Intubation ; Lung Diseases, Obstructive* ; Respiratory Sounds ; Tracheostomy ; Vocal Cord Dysfunction* ; Vocal Cords*

BACKGROUND: Weaning is the process of switching a patient from mechanical ventilator to spontaneous breathing. A number of different weaning techniques can be employed. At recent study, conventional spontaneous breathing trial was superior to other techniques, such as intermittent mandatory ventilation(IMV) or pressure support ventiation(PSV). But adequate observation time of the spontaneous breathing trial was not determined. We reported the effectiveness of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotrachial tube. In this study, we tried to shorten the spontaneous breathing time from 60 minutes to 30 minutes. If weaning success was predicted after 30 minutes spontaneous breathing, extubation was done without reconnection with ventilator. METHODES: Subjects consisted of 42 mechanically ventilated patients from August 1994 to July 1995. The weaning trial was done when the patients recovered sufficiently from respiratory failure that originally required ventilatory assistance, the patients became alert and showed stable vital sign, and arterial O2 tension was adequated(PaO2>55 mmHg) with less than 40% of inspired oxygen fraction. We conducted a careful physical examination when the patients was breathing spontaneously through the endobronchial tube for 30 minutes. We terminated the trial if a patients was any of following signs of distress; cyanosis, diaphoresis, tachypnea(above 30 breaths per minute), and extreme tachycardia. Patients who had none of this features during spontaneous breathing for 30 minutes were extubated promptly. RESULT: 17 weaning trials of 15 patients were done in 42 mechanically ventilated patients. Successful weaning and extubation was possible in 14 trials of total 17 trials. In this 14 patients, 8 patients were extubated after 30 minutes spontaneous breathing, 3 patients were extubated after 60 minutes spontaneous breathing, and 3 patients needed over 3 hours for extubation from weaning. We found similar overall success rate compared with weaning following a 60 minutes spontaneous breathing trial. CONCLUISON: From the result of present study, we believe that weaning and extubation from mechanical ventilation following a 30 minutes spontaneous breathing with 02 supply through the endotracheal tube is a simple and effective method
Cyanosis ; Humans ; Oxygen ; Physical Examination ; Respiration* ; Respiration, Artificial ; Respiratory Insufficiency ; Tachycardia ; Ventilators, Mechanical ; Vital Signs ; Weaning*

No abstract available.
Cartilage* ; Ear*

PURPOSE: To evaluate CT features of metastatic ureteral tumors. MATERIALS AND METHODS: CT findings in 16 patients with ureteral metastases were evaluated retrospectively ;there were eight cases of bilateral ureteral involvement. Primary tumors metastatic to the ureter were advanced gastric cancer (n=13), breast cancer (n=l), colon cancer (n=l), or adenocarcinoma of unknown primary (n=l). We analysed CT findings with regard to the site of ureteral obstruction, configuration of obstructed sites of ureter, presence or absence of periureteral soft tissue density, and status in other organs. RESULTS: Among 24 ureters involved, ureteral wail thickening was noted in 15, periureteral soft tissue density in 13. Small nodular enhancing lesions less than lcm, within the retroperitoneal space around the involved ureters were noted in seven patients, and four of them were multiple lesions. CONCLUSION: Among various primary tumors, gastric cancer was the most common cause of ureteral metastasis. The common CT findings of ureteral metastases were thickening of ureteral wall, periureteral soft tissue density, and small periureteral enhancing nodular lesions. The constellation of these CT findings may be helpful in making the diagnosis of ureteral metastases.
Adenocarcinoma ; Breast Neoplasms ; Colonic Neoplasms ; Diagnosis ; Humans ; Neoplasm Metastasis* ; Retroperitoneal Space ; Retrospective Studies ; Stomach Neoplasms ; Ureter* ; Ureteral Obstruction