Malignant hyperthermia is an inherited disorder of skeletal muscle, characterized by temperature elevation, muscle destruction, muscle rigidity and high oxygen consumption, etc. It is triggered by anesthetic agents, usually potent inhalation anesthetics and succinylcholine. It is fatal in the majority of cases unless early diagnosis andtreatment are performed. We experienced a case of malignant hyperthermia after general anesthesia with succinylcholine and halothane. The case is presented of an 11 year old male weighing 35.5kg. He had developed the strabismus one year prior, but he was relatively healthy and had no considerable past or family history. He underwent surgery for correction of the strabismus under N2O-O2-halothane anesthesia with induction by thiopental and succinycholine. Approximtely 25 minutes after induction tachycardia developed, followed by severe arrhythmia with unstable BP, temperature elevation and cyanosis. About 30 minutes after induction, anesthesia was stopped and aggressive emergency management was performed. Unfortunately, the patient died 4 hours and 30 minutes after induction. We discuss this case and review the history, incidence, etiology, pathophysiology, symptoms, diagnosis, pervention and treatment.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Anesthetics, Inhalation ; Arrhythmias, Cardiac ; Child ; Cyanosis ; Diagnosis ; Early Diagnosis ; Emergencies ; Halothane ; Humans ; Incidence ; Male ; Malignant Hyperthermia ; Muscle Rigidity ; Muscle, Skeletal ; Myasthenia Gravis* ; Oxygen Consumption ; Strabismus ; Succinylcholine ; Tachycardia ; Thiopental ; Thymectomy*

PURPOSE: Liver biopsy plays an important role in the histopathological evaluation of the transplanted liver, but till now pretransplant graft biopsy has limited role in predicting primary non function of the graft. Desferrioxamine (DFO), the iron chelating agent, has been known to be effective in reducing rat liver ischemia-reperfusion injury. We tried desferrioxamine in canine partial liver transplantation, and pathologic scores were compared. METHODS: ~70% partial liver was harvested and reimplanted in same mongrel dog weighing about 25 kg. Desferrioxamine (20 mg/kg) was infused via splenic vein just from the beginning of reperfusion of the partial liver graft (n=5). Serum aspartate aminotransferase (AST) Alkaline phosphatase (ALP), Lactate dehydrogenase (LDH) were checked and compared with the control group (n=5). Morphological liver injury score were compared to the control group. Statistical analysis was done with independent T-test. RESULTS: Total ischemic time was 4 hours and 42 minutes in average. AST level was significantly lower in Desferrioxamine group at 1 hour and 48 hours after reperfusion, (P=0.4) ALP level was significantly lower in desferrioxamine group at 48 hours after reperfusion (P=0.4). LDH level in desferrioxamine group was lower than that of control group but without statistical significance. The pathologic score at 1 hour after reperfusion showed a reduced degree of sinusoidal injury among the DFO group but the difference was not statistically significant. The pathologic score just before harvest of the graft showed no correlation with serum AST, ALP, LDH levels at that time or at 1 hour or 48 hours after reperfusion. Only the pathologic score at 1 hour after reperfusion had significant correlation with the serum LDH levels at 48 hours after reperfusion. CONCLUSION: In canine live donor partial liver transplantation, desferrioxamine infusion just before reperfusion might be an effective way of reducing ischemia-reperfusion injury. And the pathologic grading on samples obtained at 1 hour after reperfusion showed a significant correlation with subsequent liver function
Alkaline Phosphatase ; Animals ; Aspartate Aminotransferases ; Biopsy ; Deferoxamine* ; Dogs ; Humans ; Iron ; L-Lactate Dehydrogenase ; Liver Transplantation* ; Liver* ; Rats ; Reperfusion ; Reperfusion Injury ; Splenic Vein ; Tissue Donors ; Transplants

BACKGROUND: LB20304(gemifloxacin) is a new fluoroquinolone antibacterial agent with excellent activity against both Gram-negative and Gram-positive organisms. In vitro studies using clinical isolates have shown gemifloxacin to be highly active against penicillin-resistant strains of S. pneumoniae and in contrast to other reference quinolones, gemifloxacin retained good activity against clinical isolates of S. pneumoniae that were resistant to other members of the quinolone class. Therefore, gemifloxacin is thought to be effective in treating acute bacterial exacerbation of chronic bronchitis(AECB). The objective of this study was to evaluate the efficacy and safety of oral gemifloxacin at doses of 160mg or 320mg once daily for 7 days for the treatment of AECB in Korean adult population. METHODS: This was a randomized, multicenter, double-blind, parallel group Phase II study to assess the clinical and antibacterial efficacy and safety of oral gemifloxacin for the treatment of AECB. Treatment Group A (67 patients) took oral gemifloxacin 160mg once daily for seven days and treatment Group B (70 patients) took oral gemifloxacin 320mg once daily for seven days. RESULTS: The demographic profiles of the two treatment groups were similar. The clinical response at follow-up was 84.2% in the gemifloxacin 160-mg group, and 88.7% in the gemifloxacin-320 mg group, showing no statistically significant difference between two treatment groups(p=0.49). The clinical response at the end of therapy was 96.5% in the 160-mg group, and 96.4% in the 320-mg group. The bacteriological response at the end of therapy and follow-up were 81.8% and 78.9%, respectively, in the 160-mg group, and 86.4% and 84.2%, respectively, in the 320-mg group, showing no statistically significant difference between two treatment groups(p=0.68 and 0.68, respectively). S. pneumoniae(12 isolates) and H. influenzae(10 isolates) were the most prevalent pathogens. The MICs were lower for gemifloxacin than other quinolones against these key pathogens, and for S. pneumoniae, the MICs for gemifloxacin were considerably lower(< or = 0.03 ug/mL) than those for other quinolones, beta-lactams and acrolides. In the period on-therapy plus 30 days post-therapy, a total of 18 patients(26.9%) in the gemifloxacin 160mg group and 22 patients(31.4%) in the 320mg group reported at least one adverse event(AE). The most frequently reported AE was abdominal pain(3/67 patients, 4.5%) in the gemifloxacin 160mg group and increased level of hepatic enzyme(5/70 patients, 7.1%) in the 320mg group. The overall AE profiles for the two treatment groups were similar. Two out of 67 patients(3.0%) in the gemifloxacin 160mg group and 1/70 patients(1.4%) in the 320mg group reported at least one serious AE, however, none of which was considered by the investigator to be of suspected or probable relationship to study medication. CONCLUSION: The results of this study showed that gemifloxacin at doses of 160mg or 320mg once daily for 7 days in the treatment of acute exacerbations of chronic bronchitis(AECB) in adult Koreans was a very effective and safe treatment both clinically and bacteriologically.
Adult* ; beta-Lactams ; Bronchitis, Chronic* ; Double-Blind Method* ; Follow-Up Studies ; Humans ; Mesylates* ; Pneumonia ; Quinolones ; Research Personnel

BACKGROUND: The incidence of penicillin-resistant streptococcus pneumoniae(PRSP) accounts for almost 70% of all pneumococcal pneumonia cases in Korea. It is still unclear as to whether the efficacy of penicillin or equally active beta-lactam agents is compromised in PRSP pneumonia. This study investigated the prevalence of PRSP in community-acquired pneumonia and its clinical course. METHODS: A total of 42 patients with community-acquired pneumococcal pneumonia were evaluated from July 1999 to May 2001. The cultured strains of Streptococcus pneumoniae were divided into susceptible, intermediately resistant, and resistant strains by an E-test, and the effect of the clinical course was investigated. RESULTS: From a total of 42 patients, 22 (52.4%) patients had an intermediate resistance (MIC 0.1-1 microgram/ml) and six (14.3%) showed a high resistance (MIC> or =2.0 microgram/ml) with current penicillin susceptibility categories. However, according to the classification of the DRSPTWG (Drug Resistant Streptococcus pneumoniae Therapeutic Working Group), there were 11 cases (26.2%) of intermediate resistance and no case of high resistance. Under empirical antimicrobial treatment, there was no difference in the clinical outcome between the penicillin susceptible and resistant group. CONCLUSION: The clinical outcome of PRSP pneumonia with empirical therapy was acceptable. These results suggest that the current MIC breakpoint for penicillin resistance in Streptococcus pneumoniae has been set at a very low level and penicillin resistance according to the NCCLS classification does not significantly influence the outcome of the empirical treatment for pneumococcal pneumonia.
Classification ; Humans ; Incidence ; Korea ; Penicillin Resistance ; Penicillins ; Pneumonia ; Pneumonia, Pneumococcal* ; Prevalence* ; Prognosis ; Streptococcus ; Streptococcus pneumoniae