BACKGROUND: This study was designed to examine the interactions between mivacurium and vecuronium when administered during a standardized technique. METHODS: Eighty patients (ASA physical status I or II) were randomly assigned to one of four groups (n=20). Their neuromuscular function was measured in response to ulnar nerve supramaximal square-wave TOF stimulation at 10-sec intervals. After the attainment of a stable baseline neuromuscular response, the patients were randomly assigned to receive a rapid iv bolus of either: (1) 3M group (n=20): mivacurium 0.21 mg/kg. Alone, or (2) 2M1V group (n=20): mivacurium 0.14 mg/kg plus vecuronium 0.05 mg/kg, or (3) 1M2V group (n=20): mivacurium 0.07 mg/kg plus vecuronium 0.10 mg/kg, or (4) 3V group (n=20): vecuronium 0.15 mg/kg alone. The onset time of the neuromuscular block, time of recovery of T1 to 25% and reblock time (the time from the reinjection of vecuronium at the time of recovery of T1 to 25% to the time of recovery of T1 to 25%: T25-25) were measured. The intubating condition was evaluated clinically with a scoring system. RESULTS: The onset of block in the 3M group was 33% slower than in the 3V group. The time durations until 25% recovery in the 2M1V, 1M2V and 3V groups were longer than in the 3M group, and the durations in the 1M2V and 3V groups were longer than in the 2M1V group. The T25-25 reblock times of the 2M1V, 1M2V and 3V groups were prolonged in comparison to that of the 3M group. There was no difference in intubating conditions between any of the groups. CONCLUSIONS: A combination of mivacurium with vecuronium provides rates of onset and duration of block which are more effective than an equivalent dose of mivacuriun alone as an additive reaction.
Anesthesia, General* ; Humans ; Neuromuscular Blockade* ; Ulnar Nerve ; Vecuronium Bromide*

The epidural abscess, while rare, should be taken seriously, as it can result in permanent neurological complications. Fever, back pain, leukocytosis and elevation of Erythrocyte Sedimentation Rate (ESR) are major signs and symptoms of epidural abscesses. But clinical recognition of such abscesses may be very difficult because of nonspecific symptoms or signs as well as previous or underlying painful disorders. Few cases has been reported of epidural abscess and epidural fibrosis associated with back surgery or temporary epidural blocks. In these cases, however, fever, low back pain, sciatica and elevation of ESR were the major findings. Magnetic Resonance Imaging findings after Gadolinium- diethylenetriaminopenta-acetic acid (Gd-DTPA) enhancement show central low signal intensity and surrounding high signal intensity at the anterior epidural space between the 5th lumbar and 1st sacral vertebrae. We suspected an epidural abscess caused by epidural block, and so operated. But our operative finding was epidural fibrosis without abscess. Our final pathological diagnosis was epidural fibrosis.
Abscess ; Back Pain ; Blood Sedimentation ; Diagnosis* ; Epidural Abscess* ; Epidural Space ; Fever ; Fibrosis* ; Leukocytosis ; Low Back Pain ; Magnetic Resonance Imaging ; Sciatica ; Spine

Extramammary Pagets disease(EMPD) of the vulva is an uncommon neoplasm which accounting for 2.5% of all vulvar malignancies and 0.02% of all female cancer. Several hundred cases have been reported worldwide since the first description by sir James Paget in 1874, It generally affects postrnenopausal age poup and presents high rate of recurrence but the precise incidence remines unclear, Although Paget's disease of the breast and the vulva are histologically similar, their histogenesis and biological behavior are considered to be significantly different and EMPD has gcnerally perceived rnore benign compared to that of the breast. Four histologic forms of vulvar EMPD have been recognized and treated vulvar EMPD in according to the 4 histologic classification. The high rate of recurtence disease remains a challenge for optimal management. Recently we experienced a case of Paget's disease of the vulva, diagnosed as an intraepithelial Pagets disease preoperatively and underwent radical vulvectomy and superiomedial thigh(SMT) flap, and present with a brief review of literature.
Breast ; Classification ; Female ; Humans ; Incidence ; Paget's Disease, Mammary ; Recurrence ; Vulva*

OBJECTIVES: This study examined the association between socioeconomic factors and asthma symptoms. METHODS: A total of 6,919 elementary school children in Seoul were enrolled in the study. Data were obtained from a web-based questionnaire survey. The questionnaire was based on the International Study of Asthma and Allergies in Childhood core module. The prevalence of wheeze in the past 12 months and severe asthma symptoms were obtained. The potential risk factors for asthma symptoms included household income and the number of siblings. A multiple logistic regression analysis was used to calculate the odds ratios (OR) and 95% confidence interval (CI) for the risk factors of asthma symptoms. RESULTS: The prevalence of current wheeze (wheeze in the past 12 months) was 5.2%. Household income and asthma symptoms were inversely associated after adjusting for other potential risk factors (p for trend=0.03). This association was modified by the number of siblings. With two or more siblings, the effect of household income on asthma symptoms was not significant. However, low household income was still a significant variable for patients with fewer than two siblings (OR 1.41; 95% CI, 1.09-1.81). CONCLUSIONS: It appears that childhood asthma disparity is dependent on household income. Therefore, policies to improve childhood health inequities should be emphasized.
Asthma ; Child ; Family Characteristics ; Humans ; Hypersensitivity ; Logistic Models ; Odds Ratio ; Prevalence ; Risk Factors ; Siblings ; Socioeconomic Factors ; Surveys and Questionnaires

Section of the corpus callosum(SCC) is a useful surgical therapy in selected types of epilepsy, i.e., tonic, atonic, and intractable generalized convulsive seizures. The object of this study was to determine effect of SCC on behaviors, electroencephalography(EEG) and Fos expression in the lithium-pilocarpine model of status epilepticus in the rat. A total of 40 Sprague-Dawley rats were used. They were divided into two groups: control and lesioned group, 20 rats for each. The control group had no callosal section and was injected with lithium-pilocarpine. The lesioned group had callosal section before lithium-pilocarpine injection. In each group, ten rats were used for behavior and EEG monitoring and other 10 were used for Fos expression. The results were as follows: 1) In the SCC group, four(40%) rats never developed status epilepticus, among them two(20%) never exhibited any seizure, while all of the control group developed seizure and status epilepticus. None of the SCC animals died until 24 hours after lithium-pilocarpine injection but 70% of the control animals died within 24 hours of status epilepticus. This difference was statistically significant(p<0.05). 2) The mean latency to the first seizure, status epilepticus and periodic epileptiform discharges after lithium-pilocarpine injection were 34.7+/-2.6min, 32.3+/-1.8min and 180.4+/-9.8min, respectively, in the SCC group, while was 21.0+/-2.0min, 58.2+/-6.9min and 215.6+/-7.2min, respectively, in the control group. These latencies were significantly longer than in the control group(p<0.05). 3) There was a massive Fos expression on the cerebral cortex in the control group at 4 hours after lithiumpi-locarpine injection , while it was less in the SCC group. This difference was statistically significant(p<0.05). In conclusion, complete corpus callosotomy had contributed to the protective effect on the development of status epilepticus in the lithium-pilocarpine model which was similar to that observed in humans. And result of Fos expression suggest that Fos immunohistochemisty may be useful in the study of seizure pathways as a metabolic marker in the lithium-pilocarpine model.
Animals ; Cerebral Cortex ; Electroencephalography ; Epilepsy ; Humans ; Rats* ; Rats, Sprague-Dawley ; Seizures ; Status Epilepticus

BACKGROUND: Suicide is one of the ten largest causes of death in the world. The rate of suicide is recently significantly increasing in Korea and the rate is relatively high, particularly in adolescence. The purpose of this study was to support the establishment of appropriate measures for prevention of suicide through a better recognition of suicide and to investigate the factors that lead to suicide in adolescence with high school students who have large risk factors of suicide due to entrance examination, future courses, etc. METHODS: A questionnaire regarding the factors influencing the impulse of suicide was conducted to 770 high school students in eight high schools in Seoul and local areas between June 1 and July 31, 2005. Suicidal impulses was checked by SSI (scale for suicidal ideation). Depressive mood and internet addiction degrees was evaluated by BDI (Beck's depression inventory) and IAS (internet addiction scale), respectively. RESULTS: The final subjects of the study were 719 (93.3%) high school students among 770 students in eight high schools in Seoul and local areas, excluding 51 (6.6%) students with insufficient response. There were, 362 (50.3%) male students and 357 (49.7%) female students. Among the total 443 (61.6%) of the subjects had a high risk of suicide. The risk was high in subjects whose parents were divorced, who solved their difficulties by themselves, either expressed suicidal ideation to friends or not expressed suicidal ideation, knew an suicidal internet site and had freguent visits to the internet site. And alcohol experience, drug abuse, BDI and IAS were also connected with a high risk of suicide (P<0.05). Marital status of parents, resolution of problems, expression of suicidal ideation, BDI and IAS were independent factors affecting SSI (OR= 3.7, 0.7, 0.8, 2.4, and 1.6, P<0.05) in logistic regression analysis. CONCLUSION: High suicidal risk is associated with complex factors. We have discovered several causes which augment the impulse of suicide in adolescence. They are parent's divorce or separation, an expression of suicidal ideation, depressive mood, and the extent of internet addiction, etc. Therefore in order, to prevent adolescent suicide, a unified personal, family, and social efforts are required.
Adolescent* ; Cause of Death ; Depression ; Divorce ; Female ; Friends ; Humans ; Internet ; Korea ; Logistic Models ; Male ; Marital Status ; Parents ; Risk Factors ; Seoul ; Substance-Related Disorders ; Suicidal Ideation ; Suicide* ; Surveys and Questionnaires