Endotracheal tube obstruction causes serious complications, including cardiovascular instability, pneumothorax, pulmonary edema and brain death. A 64 year old man was scheduled for a laminectomy and instrument fixation due to spinal stenosis. The patient was intubated with a 8.5 mm reinforced endotracheal tube and turned to the prone position. An hour later, signs of partial endotracheal obstruction were observed including high airway pressure and low tidal volume. Airway obstruction signs were aggravated as the operation proceeded. Two hour later, passage of a suction catheter was difficult and PaCO2 increased significantly, so we temporarily stopped the operation and turned the patient to supine. After that, we exchanged the tube with another tube and found the distal tip of the reinforced tube impacted with mucous secretions.
Airway Obstruction ; Brain Death ; Catheters ; Humans ; Intubation ; Laminectomy ; Middle Aged ; Pneumothorax ; Prone Position ; Pulmonary Edema ; Spinal Stenosis ; Suction ; Tidal Volume

Endoscopic sphincterotomy (E.S.T.) has relatively low complications and is the theraphy of choice in patients with common bile duct stones. It is also an useful technique for decompression of biliary tract obstruction. Thirty two cases of patients were selected according to opedrative risks: old age, severe jaundice and recurrent or retained bile duct stones after cholecystecomy from 1986 to 1988. The results were as follows, 1) In thirty two cases nf E.S.T., male to female ratio was 1:1.46. Most frequent age was older than 40 years. (male, 84.6%, female, 84.2%). 2) Out of thirty two cases, 20 cases (62.5% were under post clholecystectomy state, 12 eases (37.5%) were obstructive jaundice. 3) Spontaneous stone passage after E.S.T. was 81.3% (26 cases), and total stone remoral rate was 87.5% (28 cases), 4) Complications of E.S.T. were noted in three cases. In the two cases of bleeding, it was spontaneously improved and a case of acute pancreatitis was treated by medical care.
Bile Ducts ; Biliary Tract ; Common Bile Duct* ; Decompression ; Female ; Hemorrhage ; Humans ; Jaundice ; Jaundice, Obstructive ; Male ; Pancreatitis ; Sphincterotomy, Endoscopic*

13 cases of intracranial Aneurysm were obliterated intracranially with Heifetz clip under Halothane /O2 Deliberate Hypotensive anesthesia. Deliberate hypotension in the surgery of intracranial aneurysm is used to diminish bleeding and render an aneurysmal sac slack to make clipping easy. Herein is presented a review of clinical experience of deliberate hypotension in conjunction with postural drainage. Clinical investigation has shown that this method offers a wider margin of safety. All factors stressed again the needs for careful, adequate and ideal clippage of the neck of aneurysm preferably with the use of Heifetz clip. Deliberate hypotension and adequate clippage of the neck of aneurysm subsequently allowed a favorable clinical result with an operative mortality by 7.7%.
Anesthesia* ; Aneurysm ; Drainage, Postural ; Halothane ; Hemorrhage ; Hypotension ; Intracranial Aneurysm* ; Mortality ; Neck

As prediction of rapidly aging society, bone health is considered increasingly important and received more attention than ever. Bone health is regulated by balancing between bone resorptive osteoclasts and bone formative osteoblasts. Disruption of balance between bone-resorbing osteoclasts and bone-forming osteoblasts results in bone disease. Natural products have recently received much attention as an alternative tool for the development of novel therapeutic strategy. Baicalein is reported it has anti-cancer, anti-inflammatory and antioxidant effects. Baicalein also has been known that it has both promotive effect on MC3T3-E1 cell line and inhibitory effect on RAW 264.7 cell line. However, the inhibitory mechanism of baicalein using bone marrow derived macrophages (BMMs) on osteoclast differentiation remains not clear. In this study, the suppressive mechanism by baicalein on osteoblast differentiation was evaluated. Bicalein inhibited receptor activator of nuclear factor-kappaB ligand (RANKL)-induced osteoclast differentiation in BMMs in a dose dependent manner without any toxicity. Baicalein suppressed phosphorylation of protein kinaseB (Akt), c-Jun N-terminal kinases (JNK) and phosphoinositide-specific phospholipaseCgamma2 (PLCgamma2). Furthermore, Baicalein suppressed the induction of RANKL-induced c-Fos and Nuclear factor of activated T cell c1 (NFATc1), essential genes on osteoclastogenesis. In BMMs, Bicalein inhibited the mRNA expression of tartrate-resistant acid phosphatase (TRAP), osteoclast-associated receptor (OSCAR), cathepsinK, dendritic cell-specific transmembrane protein (DC-STAMP). Moreover, baicalein promoted differentiation of osteoblast on bone marrow stromal cells (BMSCs). Taken together, these results suggest that baicalein has a potential for treating bone lytic diseases, such as osteoporosis, periodontitis, and rheumatoid arthritis.
Acid Phosphatase ; Aging ; Antioxidants ; Arthritis, Rheumatoid ; Biological Products ; Bone Diseases ; Bone Marrow* ; Cell Line ; Genes, Essential ; Macrophages* ; Mesenchymal Stromal Cells ; Osteoblasts ; Osteoclasts* ; Osteoporosis ; Periodontitis ; Phospholipase C gamma ; Phosphorylation ; Phosphotransferases ; RANK Ligand ; RNA, Messenger

BACKGROUND: A portable glucometer is commonly used to immediately check the blood glucose level. In the anesthetic field, some blood gas analyzers can also give a rapid indication of the blood sugar level but the accuracy is unknown. Therefore, this study assessed the accuracy of the blood glucose values measured by either a blood gas analyzer or portable glucometer. METHODS: Venous blood from diabetic patients was used to measure the glucose level with either a blood gas analyzer or a portable glucometer. The difference and 5% deviation from reference values was analyzed. These values were also assessed using a Bland-Altman plot and clinical significance was examined using a Clarke error grid. RESULTS: The differences from the reference values were smaller using the blood gas analyzer (1.3 +/- 7.8 mg/dl) than using the portable glucometer (-5.1 +/- 16.7 mg/dl)(P < 0.01). 73.4% of the values measured by the blood gas analyzer and 40.0% of those measured by the portable glucometer were within 5% of the reference value. The 95% limits of agreement in the difference ranged from -14.3 to 16.9 in the blood gas analyzer and -38.5 to 28.2 in the portable glucometer. Error grid analysis showed that 100% of the values measured by the blood gas analyzer were located in zone A. When locating the values measured using the portable glucometer, 95.6% were located in zone A, and the remaining 4.4% are located in zone B. CONCLUSIONS: The blood gas analyzer measures the blood glucose more accurately than the portable glucometer. However, the blood glucose values measured by the portable glucometer are clinically acceptable.
Blood Glucose* ; Glucose ; Humans ; Reference Values

BACKGROUND: Bronchial hyperresponsiveness and abnormal response such as a loss of distensi- bility are pathophysiologic characteristics if bronchial asthma. The only means of direct in vivo measurement of airway size had been a tantalium bronchography, until high-resolution computed tomography(HRCT) enabled to measure noninvasively two dimensional airway area more accurately and reliably. METHOD: To investigate airway area responses to bronchial provocation with methacholine and evaluate the major sites of bronchial constriction in patients with bronchial asthma. We examined HRCT scans in five patients with bronchial asthma who had significant bronchoconstriction(20% or more decrease in FEV1) using CT scanner(5,000T CT, Shimadzu Co, Japan) before and in 3~5 min. after methacholine inhalation. Airways which were matched by parenchymal anatomic landmarks in each patient before and after methacholine inhalation were measured using film scanner(TZ-3X scanner; Truvel Co. Chatsworth CA, USA) and a semiautomated region growing method. RESULTS: 1) We identified 9 to 12 airways in each patient which were matched by parenchymal anatomic landmarks before and after methacholine inhalation. 2) Airway responses to methacholine are quite different even in a patient. 3) The constriction of small airways(average diameter <2 mm; area <3.14mm2) was 48.7% (8.3; SEM, n=43), being more prominant than that of large airways(average diameter >2 mm; area >3.14 mm2), 53.8% (4.4;SEM, n=10), but not significantly different(p>0.05). 4) There was no significant difference in the degree of constriction between upper(44.3% +5.8; mean + SEM, n=30) and lower lung regions(56.7% +4.5, n=23). CONCLUSIONS: Thus airway responses to methacholine bronchoprovocation is quite variable in a patient with bronchial asthma and has no typical pattern in patients with bronchial asthma.
Anatomic Landmarks ; Asthma* ; Bronchoconstriction ; Bronchography ; Constriction ; Humans ; Inhalation ; Lung ; Methacholine Chloride

OBJECTIVES: Although DSCG protects against the stimuli of various bronchoconstictor, such as exercise, it is not effective to all patients. There seems to be no therapeutic predictor that determines effectiveness of DSCG on bronchial asthma. Although it is commonly assumed that children with predominantly allergic asthma have a better response to DSCG therapy than adult patient, this has not been convincingly demonstrated, and even adult with late onset nonallergic asthma may benefit. In this study, we evaluated the factors that potentially influenced the ability of DSCG to reduce bronchial hyperresponsibility. METHODS: The treatment groups were sub-divide into effective group(n=14) and ineffective group(n=6) on the basis of significant improvement of followedup PC20 after long term therapy of DSCG. We compared clinical and laboratory data and pulmonary function test between two groups. RESULTS: 1) Disease durtion and pre-treatment pulmonary function (FEV1% predicted, FVC% predicted value) may play a role in determining effectiveness of DSCG on bronchial asthma(p<0.05). 2) Allergic rhinitis history seems to have been associated with effectiveness of DSCG(p<0,05). But this findings was not clearly demonstrated the association of atopic status because skin test, eosinophil count, serum IgE level were not significant difference between two groups(p>0.05). CONCLUSION: These results show that DSCG is effective in adult chronic asthma and early administration of DSCG, good pulmonary function test and allergic rhinitis history may lead to more favorable outcome.
Adult ; Asthma* ; Child ; Cromolyn Sodium ; Eosinophils ; Humans ; Immunoglobulin E ; Respiratory Function Tests ; Rhinitis ; Skin Tests

BACKGROUND: Spontaneous pneumothorax have been managed with a variety of methods. The technique most frequently used is chest tube drainage. Small caliber catheters were first used in the management of pneumothorax complicating the percutaneous needle aspiration lung biopsy, and the try to treat spontaneous pneumothorax also has been reported. However, the value of small caliber catheters in spontaneous pneumothorax has not been fully evaluated. So, we tried to elucidate the efficacy of 8 French catheter in the management of spontaneous pneumothorax. METHOD: From January, 1990, to April, 1994, 44 patients with spontaneous pneumothorax treated at Chung-Ang university hospital were reviewed. The patients were sub-divide into 8 French catheter insertion group (n=21) and chest tube insertion group (n=23). We compared the presence of underlying lung disease, the extent of the collapse, the duration of indwelling catheter and complication between two groups. RESULTS: 1) The duration of indwelling showed no significant difference between 8 French catheter group and chest tube. But, complication after insertion as subcutaneous emphysema was developed in only chest tube group. (p<0.05) 2) In the primary spontaneous pneumothorax, all case of the pneumothorax of which size was less than 50% showed complete healing with 8 French catheter insertion. Whereas the success rate in patients with large pneumothorax (more than 50%) was tended to be dependent on the age. 3) In the patients with secondary spontaneous pneumothorax who were managed with 8 French catheter, the success rate was trended to be high if the underlying disease of pneumothorax was not COPD and if the patient was young. CONCLUSION: These results show that 8 French catheter insertion probably was effective in the pneumothorax less than 50%, the primary spontaneous pneumothorax, young age or secondary pneumothorax not associated with COPD.
Biopsy ; Catheters* ; Catheters, Indwelling ; Chest Tubes* ; Drainage ; Humans ; Lung ; Lung Diseases ; Needles ; Pneumothorax* ; Pulmonary Disease, Chronic Obstructive ; Subcutaneous Emphysema ; Thorax*

Free Cy5.5 dye and Cy5.5-labeled thermally cross-linked superparamagnetic iron oxide nanoparticles (TCL-SPION) have been routinely used for in vivo optical imaging. However, there is little information about the distribution and accumulation of free Cy5.5 dye and Cy5.5-labeled TCL-SPION in the tissues of mice. Free Cy5.5 dye (0.1 mg/kg body weight) and Cy5.5-labeled TCL-SPION (15 mg/kg body weight) were intravenously injected into the tail vein of ICR mice. The biodistribution and accumulation of the TCL-SPION and Cy5.5 were observed by ex vivo optical imaging and fluorescence signal generation at various time points over 28 days. Cy5.5 dye fluorescence in various organs was rapidly eliminated from 0.5 to 24 h post-injection. Fluorescence intensity of Cy5.5 dye in the liver, lung, kidney, and stomach was fairly strong at the early time points within 1 day post-injection. Cy5.5-labeled TCL-SPION had the highest fluorescence density in the lung at 0.5 h post-injection and decreased rapidly over time. Fluorescence density in liver and spleen was maintained over 28 days. These results suggest that TCL-SPION can be useful as a carrier of therapeutic reagents to treat diseases by persisting for long periods of time in the body.
Animals ; Carbocyanines/*pharmacology ; Ferric Compounds/*pharmacology ; Fluorescent Dyes/*pharmacology ; Kinetics ; Male ; Mice ; Mice, Inbred ICR ; Nanoparticles/*metabolism ; Time Factors ; Tissue Distribution

BACKGROUND: The drug-resistant tuberculosis has recently decreased in Korea, but it is still one of the major obstacles in the treatment of pulmonary tuberculosis. Unfortunately there are no reliable ways to figure out the drug sensitivity pattern of the M. tuberculosis in the starting point of treatment. At least several months which is critical for the success of treatment have to be passed away before getting the report of drug-sensitivity test. The aim of this study was to find out the clinical and radiological parameters that make it possible to predict the drug-resistant pulmonary tuberculosis and to make a correct decision on the antituberculosis drug regimens. METHOD: We studied 253 pulmonary TB patients with sputum and/or bronchial washing fluid culture-positive diagnosed at the Chung-Ang University Young-San Hospital in the period of 1989-1994. The differences in the clinical and raiological variables between the drug-sensitive and the drug-resistant tuberculosis patients were evaluated. RESULTS: In 66 out of 253 patients(26.1%), drug resistant tuberculosis to at least one antituberculosis drug were found. Patients with retreatment showed higher resistance rate than those with initial treatment (30/69,43.5% vs 36/184, 19.5%, p<0.01). Patients with cavitary TB showed higher resistance rate than those with non-cavitary TB( (24/54, 44.4% vs 42/199, 21.1%, p<0.05). Among patients with initial treatment, those with far-advanced TB showed a higher drug resistance rate than those with minimal lesion(9/23, 36.9% vs 10/82, 12.5%, p<0.05). Patients with culture positive only in the bronchial washing fluid showed lower resistance rate than those with sputum culture positive(7/63, 11.1% vs 59/190, 31.1%, p<0.05) CONCLUSION: Prior treatment history for pulmonary tuberculosis, the presence of cavity & far advanced tuberculosis in the radiologic exam, sputum rather than solely bronchial washing culture positivity would be the related factors to the drug resistance. So in the patients with such characteristics, it is needed to try to find out the drug sensitivity pattern of the infecting tuberculosis organism as soon as possible.
Drug Resistance ; Humans ; Korea ; Retreatment ; Sputum ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary*