The aim of present study was to establish the baseline data for pregnancy induced hypertension (PIH). From November 2000 through October 2001, a total of 212 women diagnosed as PIH and delivered at Samsung Cheil Hospital were included in this study. We reviewed the obstetric and neonatal records, then analyzed the incidence, maternal complications, and neonatal outcomes according to the severity of PIH. The incidence of PIH was 2.6% (mild and severe form was 59% and 41%, respectively). In maternal age, parity, number of fetus (singletone or multiple pregnancy), and gestational diabetus, there was no significant different incidence between mild and severe form of PIH. But, the women with severe PIH delivered more frequently at 21~28 and 33~36 gestational weeks than in mild form (p<0.05). Among fetuses with intrauterine growth restriction (IUGR), a group with birth weight below the population 5 percentile was more frequent in severe than in mild form of PIH (p0.05). As to maternal, fetal and neonatal complications of PIH, maternal anemia, preterm labor, and IUGR were more frequently founded in severe form of PIH than in mild. We could not found significant different frequency in other complication (disseminated intravascular coagulation, abruptio placenta, pulmonary edema, low apgar score, meconium stained, respiratory distress syndrome, and intracranial hemorrhage) between mild and severe form of PIH.
Pregnancy ; Female ; Infant, Newborn ; Humans ; Incidence

BACKGROUND: Bacterial infections in diabetic patients are an important cause of increased morbidity and mortality. It has been reported that bacterial infections in diabetics showed more impaired PMN functions such as reduced PMN respiratory burst and decreased microbicidal activity in inflammed tissues. Also, apoptosis(programmed cell death) is postulated to be a key mechanism for neutrophil elimination. It is very important that PMN apoptosis keeps the balance from an area of inflammation. Actuallly, as little was known about PMN apoptosis and respiratory burst in diabetes, we investigated PMN apoptosis and hydrogen peroxide production after endotoxin exposure. METHODS: Peripheral venous blood samples were collected by routine venipuncture from healthy volunteers and diabetics to harvest neutrophils. We respectively measured the PMN apoptosis, the production of hydrogen peroxide, and the cell viability. RESULTS: Normal neutrophils showed a tendency to decreased apoptosis after endotoxin treatment. In patients with diabetes, PMN apoptosis was significantly decreased compared with healthy controls. In addition, the LPS-induced neutrophils in diabetics demonstrated more decreased apoptosis. However, the production of hydrogen peroxide was not different between groups. CONCLUSION: These observations suggest that the decreased PMN apoptosis in diabetics with endotoxin exposure may also affect the increased susceptibility and severity of infections.
Apoptosis* ; Bacterial Infections ; Cell Survival ; Healthy Volunteers ; Humans ; Hydrogen Peroxide ; Inflammation ; Mortality ; Neutrophils* ; Phlebotomy ; Respiratory Burst

BACKGROUND/AIMS: Lactobacillus rhamnosus GG (LGG) has been used in acute colitis treatment. However, it is unclear whether the LGG prevents chronic colitis. The aim of this study was to examine the prophylactic effect of LGG on animal colitis, cytokine secretion, and mucin gene expression. METHODS: BALB/c mice (n=64) were exposed to 5% dextran sulfate sodium (DSS) for 7 days followed by 10 days recovery period and repeatedly exposed for 4 days. Then, the mice were devided into three group; group of oral LGG adminstration throughout the recovery and repeated colitis period; PBS group of PBS administration; control group. Colon length, histologic score, tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10) levels, mucin gene expressions were determined at each period. RESULTS: In acute colitis period, the LGG group showed higher levels of disease activity index (DAI), histologic score, TNF-alpha, IL-10, but shorter colon length, lower levels of mucin gene expressions than the control group. However, in repeated colitis period, the LGG group showed markedly lower levels of DAI and IL-10 but significantly longer colon length than PBS group (p<0.05). There was no difference in the mucin gene expression. CONCLUSIONS: These results suggest that LGG prevents chronic murine colitis. It may be associated with cytokine modulation and competitive inhibition of pathogenic bacteria. However, it may not be related with gene expression.
Animals ; Colitis/*prevention & control ; Cytokines/*metabolism ; English Abstract ; Gene Expression/*drug effects ; *Lactobacillus ; Mice ; Mice, Inbred BALB C ; Mucins/*genetics/metabolism ; Probiotics/*therapeutic use

A 32-year-old woman presented with cough and hemoptysis. The radiologic findings showed increased interstitial markings in the right lung, a slightly decreased ling volume in the RLL and a hypoplastic right pulmonary arte ry with collaterals in the mediastinum and subpleural area. The pulmonary angiography showed an abrupt occlusion of the right lower pulmonary artery. The echocardiographic findings indicated pulmonary hypertension. A doppler leg ultrasonograph disclosed that the left politeal vein was occluded with collateral veins, not filling the defect in the venous lumen. The D-dimer increased 1.0 micro gram/ml. This condition was initially misdiagnosed as a congenital pulmonary artery agenesis. Finally, a chronic pulmonary thromboembolism with a deep vein thrombosis was confirmed.
Adult* ; Angiography ; Cough ; Echocardiography ; Female* ; Hemoptysis* ; Humans ; Hypertension, Pulmonary ; Leg ; Lung* ; Mediastinum ; Pulmonary Artery ; Pulmonary Embolism ; Veins ; Venous Thrombosis

BACKGROUND: Many clinicians are reluctant to prescribe systemic corticosteroids to manage and asthmatic attack because of many complications such as osteoporosis, cushing's syndrome, diabetes, hypertension and blee ding tendency. The use of nebulized budesonide may be of value in some infants, old men, and in particular adult asthmatic patients who complain of severe dyspnea. A clinical validation and steroid-sparing effect of nebulized budesonide in asthmatic adults and COPD were evaluated, and the short-term effects of budesonide use on the HPA axis were assessed. METHODS: Study A was propectively done with 41 patients diagnosed with pure asthma and 30 patients diagnosed wit COPD (including asthmatic component) in Soonchunhyang Hospital, Chunan from June. 2000 to Sep. 2001. They were treated with nebulized budesonide including sytemic steroids (Group 1), a budesonide tubuhaler including a sytemic steroid (Group 2), or only the systemic steroid (Group3). The peak flow rate, arterial blood gas in room air, pulmonary function test, symptom scoring, steroid amount and hospital stay were analyzed. Study B was conducted with 19 patients to evaluate the short-term effects on the HPA axis of treatment with nebulized budesonide 1mg twice daily and a budesonide turbuhaler 5 puffs twice daily. The adrenal function was assessed prior to budesonide inhalation and after 7 days of budesonide inhalation. RESULTS: In the pure asthmatic patients, the mean value of the symptoms (dyspnea, wheezing, cough, night asthma) or the arterial BGAs, total amounts of steroid or hospital stay and the difference in the results of the pulmonary function tests or peak expiratory flow rate were similar in the three groups. In COPD with an asthmatic component, there were no significant differences among the three groups. Although nebulized budesonide suppressed HPA function, (p=0.006) the HPA responses from the nebulized budesonide and turbuhaler budesonide were similar (p=0.288). CONCLUSION: This result suggests that systemic steroid should only be made available for acute asthmatic patients irrespective of the inhaled budesonides. Nebulized budesonide at the therapeutic dose has similar effects on the HPA axis compared to that of turbuhaler budesonide.
Adrenal Cortex Hormones ; Adult* ; Asthma ; Axis, Cervical Vertebra* ; Budesonide* ; Chungcheongnam-do ; Cough ; Cushing Syndrome ; Dyspnea ; Humans ; Hypertension ; Infant ; Inhalation ; Length of Stay ; Male ; Osteoporosis ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Respiratory Sounds ; Steroids

No abstract available.
Adenocarcinoma*

BACKGROUND: The immediate host response to LPS is the production of proinflammatory cytokines that act as intercellular mediators in inflammatory reactions, including acute lung injury. These "early response" cytokines transmit signals from recognition cells to target or effector cells. This host response is futher amplified by the expression of leukocyte chemoattractants, growth factors, and adhesion molecules, resulting in an array of proinflammatory events. This experiment was performed to define the lung origin of proinflammatory cytokines, such as TNF-alpha IL 6 in early periods of endotoxin induced acute lung injury (ALl). METHOD: The healthy male Sprague-Dawley, weighted 150-250g, were divided into saline control (NC) and endotoxemia-induced ALl (ETX-), and leukopenic endotoxemia-induced ALl (CPA-ETX-Group) which was induced by cyclophosphamide, 70 mg/kg i.p. injection. Acute lung injury was evoked by LPS, 5 mg/kg, intravenously administered. Bronchoalveolar lavage was performed at 0, 3, 6 h after LPS-treated to estimate the influx of phagocytes and concentration of total protein, and cytokines as TNF-alpha and IL 6 by a bioassy using MTT method. We also examined the localization of TNF-alpha and IL 6 protein in endotoxemia-challenged lung tissue by immunohistochemical stain (IH). RESULTS: The total cell, macrophage and PMN count in BALF were elavated in ETX group compared to NC (p<0.05). In CPA-ETX group, total cell and macrophage count in BALF were not changed compared to NC, but PMN count was markedly reduced and it took part. in less than 0.1% of total BAL cells (p<0.01). The protein concentration in BALF were significantly increased in ETX and CPA-ETX group compared to NC (p<0.05), but there was signifcant difference between ETX- and CPA-ETX group only at 6 h (p<0.05). This observation suggested that even if PMNs are involved in the pathogenesis of acute lung injury, their role cannot be viewed as essential. The concentration of TNF-alpha and IL 6 in BALF was significantly increased in the ETX- and CPA-ETX group compared to NC. There was no difference between ETX- and CPA-ETX group. In IH, anti-TNF-alpha- and anti-IL 6 antibody was strongly localized at interstitial monocytes and alveolar macro-phages in endotoxemia-challenged lung tissue. From above point of view, activated alveolar macrophage/monocyte considered as a prominent source of proinflammatory cytokines in endotoxemia-challenged lung injury. CONCLUSION: The prominent source of proinflammatory cytokines in early periods of endotoxemia-induced lung injury will be the activated resident macrophages like an alveolar macrophage and interstitial monocytes. The pulmonary macrophage/monocyte will impact the initiation and continuance of lung injury without PMNs s certain inflammatory role, particularly in endotoxemia-induced acute lung injury.
Acute Lung Injury ; Bronchoalveolar Lavage ; Chemotactic Factors ; Cyclophosphamide ; Cytokines* ; Endotoxemia* ; Humans ; Intercellular Signaling Peptides and Proteins ; Interleukin-6* ; Interleukins* ; Leukocytes ; Lung Injury ; Lung* ; Macrophages ; Macrophages, Alveolar ; Male ; Monocytes ; Phagocytes ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha*

BACKGROUND: Patients with established ARDS have a mortality rate that exceeds 50 percent despite of intensive care including artificial ventilation modality. Mortality has been associated with sepsis and organ failure preceding or following ARDS ; APACHE ll score ; old age and predisposing factors. Revised ventilator strategy over last 10 years especially at ARDS appeared to improve the mortality of it. We retrospectively investigated 40 ARDS patients of respiratory-care unit to examine how these factors influence outcome. METHODS: A retrospective investigation of 40 ARDS patients in respiratory-care unit with ventilator management over 46 months was performed. We investigated the clinical characteristics such as a risk factor, cause of death and mortality, and also parameters such as APACHE ll score, number of organ dysfunction and hypoxia score (HS, PaO2/FIO2) at day 1, 3, 7 of severe acute lung injury, and simultaneously the PEEP level and tidal volume. RESULTS: Clinical conditions associated with ARDS were sepsis 50%, pneumonia 30%, aspiration pneumonia 20%, and mortality rate based on the etiology of ARDS was sepsis 50%, pneumonia 67% (p<0.01 vs sepsis), aspiration pneumonia 38%. Overall mortality rate was 60%. In 28 day-nonsurvivors, leading cause of death was severe sepsis (42.9%) followed by MOF (28.6%), respiratory failure (19.1%), and others (9.5%). There were no differences in variables of age, sex, APACHE ll score, HS, and numbers of organ dysfunction at day 1 of ARDS between 28-days survivor and nonsurvivors. In view of categorized variables of age( > 70), APACHE ll score( > 26), HS(< 150) at day 1 of ARDS, there were significant differences between 28-days survivor and nonsurvivors(p<0.05). After day 1 of ARDS, the survivors have improved their APACHE ll score, HS, numbers of organ dysfunction over the first 3d to 7d, but nonsurvivors did not improve over a seven-day course. There were significant differences in APACHE II score and numbers of organ dysfunction of day 3, 7 of ARDS, and HS of day 7 of ARDS between survivors and nonsurvivors(p<0.05). Fatality rate of ARDS has been declined from 68% to less than 40% between 1995 and 1998. There were no differences in APACHE ll score, HS, numbers of organ dysfunction, old age at presentation of ARDS. In last years, mean PEEP level was significantly higher and mean tidal volume was significantly lower than previous years during seven days of ARDS(p<0.01). CONCLUSIONS: Improvement of HS, APACHE ll score, organ dysfunction over the first 3d to 7d is associated with increased survival. Decline in ARDS fatality rates between 1995 and 1998 seems that this trend must be attributed to improved supportive therapy including at least high PEEP instead of conventional-least PEEP approach in ventilator management of acute respiratory distress syndrome.
Acute Lung Injury ; Anoxia ; APACHE ; Causality ; Cause of Death ; Humans ; Intensive Care Units* ; Critical Care* ; Mortality ; Organ Dysfunction Scores ; Pneumonia ; Pneumonia, Aspiration ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors ; Sepsis ; Survivors ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

BACKGROUND: It is known that airway inflammation is present in most patients with asthma, but the relationship between symptoms and the severity and nature of airway inflammation has not been established. Cough variant asthma is defined as an asthma in which the dominant symptom is cough and the condition can be successfully treated with inhaled steroids. This study was performed to evaluate the time coulee of bronchial responsiveness according to an inhaled anti-inflammatory therapy and the factors which affect the resolution of bronchial responsiveness, and an efficacy of nedocromil to cough asthma. METHOD: A prospective study for the investigation of bronchial responsiveness according to an inhaled anti-inflammatory treatment in sixty-one cough asthmatics was performed. Twenty-three entered budesonide (400microgram 2/day), twenty-two entered nedocromil (4mg2/day) and sixteen patients entered combined group. The bronchial hyperresponsiveness (BHR) was estimated by methacholine challenge test using counted breath method. The symptom was estimated by 'symptom score'. Reevaluation of BHR and symptom was performed at 2 month after treatment, and if BHR was not resoluted at this time, regarded as a non-responder, and then follow-up of BHR and symptom was performed at 4-and/or 6 month after treatment. RESULTS: The improvement of BHR and symptom was significant in 2 month (p < 0.05), but there was no change of them during follow-up period of 4-and/or 6 month in non-responders. In comparison of allergic markers such as serum total IgE, peripheral eosinophil count and skin test reactivity between responders and non-responders, there was no difference in each other. However, in comparison of other factors such as cumulative pack-years, symptom duration age, gender, and the initial degree of PC20, there was a significant difference in each other(p < 0.05). The percent of patients with the resolution of BHR in 2 month was not different in each group (p=0.95). There was no significant difference in the degree of improvement of BHR and symptom in each group. CONCLUSION: Bronchial responsiveness and symptom was not significantly improved in non-responders during follow-up period of 4-and/or 6 month. The effect of inhaled nedocromil was equivalent to that of inhaled steroid in cough asthmatics, and the response to combined treatment is not superior to that achieved by either of these agents used alone.
Asthma* ; Budesonide ; Cough* ; Eosinophils ; Follow-Up Studies ; Humans ; Immunoglobulin E ; Inflammation ; Methacholine Chloride ; Nedocromil ; Prospective Studies ; Skin Tests ; Steroids

BACKGROUND:Chronic cough is commomly defined as a persistent or recurrent cough exceeding 3 week's duration. The prevalence of chroinc cough is reported to range from 14% to 23% for nonsmoking adults. The post nasal drip syndrome has been determined to be the most common cause of chronic cough, followed by asthma, chronic bronchitis, gastroesophageal reflux and bronchiectasis. Cough can be the only manifestation of asthma.. Bronchial provocation tests are useful in diagnosing cough variant asthma. We investigated the clinical or laboratory findings and the incidence of airway hyperresponsiveness and evaluated the etiology in patients with chronic cough. METHOD: We evaluated 46 patients with chronic cough. Methacholine challenge test were done. RESULTS: The results were as follows : 1) Thirty - five percent(16/46) of the chronic cough patients and 44% of the post nasal drip syndrom(7/16) showed the positive responses to methacholine challenge test. 2) The underlying causes of chronic cough were post nasal drip syndrome in 35%, bronchitis in 21.7%, cough-variant asthma in 17.4%, and unknown condition in 25.9%. 3) Airway hyperresponsiveness in chronic cough was not related to respiratory symptom, nasal symptom, post nasal drip, smoking, derangement of ventilatory function, atopy, or sinusitis. CONCLUSION: Airway hyperresponsivenss in patients with chronic cough increased in frequency when compaired with normal control, allergic rhinitis. Cough-variant asthma account for 17.4% of patients with chronic cough.
Adult ; Asthma ; Bronchial Provocation Tests ; Bronchiectasis ; Bronchitis ; Bronchitis, Chronic ; Cough* ; Gastroesophageal Reflux ; Humans ; Incidence ; Methacholine Chloride ; Prevalence ; Rhinitis ; Sinusitis ; Smoke ; Smoking