The posaconazole tablet formulation was developed to have improved bioavailability compared to the oral suspension. Here, we compared posaconazole plasma concentration (PPC) with the posaconazole oral suspension versus the tablet in Korean patients undergoing remission induction chemotherapy for hematologic malignancies. PPC was measured at 3, 8, and 15 days of treatment with the oral suspension (174 patients) or the tablet (40 patients). At all time-points, mean PPC was significantly higher with the tablet compared to the oral suspension. Our findings suggest that posaconazole tablets generate an optimal PPC earlier and in more patients than the oral suspension among Korean patients.
Antifungal Agents ; Biological Availability ; Dosage Forms ; Drug Therapy ; Hematologic Neoplasms* ; Humans ; Plasma* ; Remission Induction ; Tablets

The incidence of acute leukemia during pregnancy is extremely rare, and often it is not easy to differentiate it from other diseases associated with pregnancy such as sepsis or hemorrhage. Pregnancy itself is not known to affect the natural course of leukemia; however, complications of leukemia like anemia, infections, and coagulopathy can adversely influence both the fetus and the mother. In this case, a pregnant patient misdiagnosed with septic shock and severe leukocytosis was correctly diagnosed with acute myeloid leukemia after surgical delivery.
Anemia ; Cesarean Section* ; Female ; Fetus ; Hemorrhage ; Humans ; Incidence ; Intensive Care Units ; Leukemia ; Leukemia, Myeloid, Acute* ; Leukocytosis ; Mothers ; Pregnancy ; Sepsis* ; Shock, Septic

Vancomycin induced agranulocytosis is a rare but life-threatening complication. We here report a case of vancomycin induced agranulocytosis in a patient with chronic renal failure. A 36-year-old woman receiving hemodialysis via jugular cannulation developed staphylococcus sepsis. The catheter was removed and she was started on vancomycin therapy (1.0 g/week). New catheter was inserted for next hemodialysis. Second sepsis of same organism developed 12 days after initial sepsis inspite of vancomycin therapy. We removed this catheter and continued vancomycin therapy. After 19 days of vancomycin treatment, the patient developed a severe agranulocytosis with white blood cell count of 1, 600/ mm3 and the complete absence of neutrophil. Vancomycin was discontinued and teicoplanin was substituted for vancomycin therapy and G-CSF (granulocyte colony stimulating factor) therapy was begun. White blood cell count including neutropil was completely recovered after 13 days of discontinuation of vancomycin.
Adult ; Agranulocytosis* ; Catheterization ; Catheters ; Female ; Granulocyte Colony-Stimulating Factor* ; Humans ; Kidney Failure, Chronic ; Leukocyte Count ; Lupus Nephritis ; Neutrophils ; Renal Dialysis* ; Sepsis ; Staphylococcus ; Teicoplanin ; Vancomycin

BACKGROUND: Not much of the fund is invested in the intensive care unit (ICU) in Korean hospitals since the cost of ICU care is set too low compared to the other medical fields as well as to the other part of the world. This study is designed to support the base of an ICU standard guideline in Korea. METHODS: The questionnaire were sent to 73 ICUs and 24 neonatal ICUs (NICU) of 30 hospitals. Twenty-two of them were teaching hospitals and 8 of them were general hospitals. RESULTS: The ratios of ICU bed number to total bed number were 5.0% and 6.0% in teaching hospital and general hospital respectively. The ratios of NICU bed to total bed were 3.4% and 2.0% in teaching hospital and general hospital respectively. Intensivists were kept in 24.6% of ICU and 36.4% of NICU. Residents were kept in 43.1% of ICU and 45.5% of NICU. The utilization of ICU service was 90% for teaching hospital and 86% for general hospital. The utilization of NICU was 89% for teaching hospital and 3% of general hospital. Nurse to patient ratios varied widely. Most ICUs in teaching hospital showed the nurse to patients ratio of 1 : 4 which was about 32% of total ICU. Most NICUs in teaching hospital showed the nurse to patients ratio of 1 : 5 which was around 20% of total NICU. Most of the ICUs were equipped with central piping system for oxygen and compressed air supply, vacuum system and all the necessary medical gadgets such as mechanical ventilators, ECG monitors, defibrillators, pulse oximeters and infusion pumps. CONCLUSIONS: The distribution of medical personnel as well as medical equipments were varied widely. The variation existed between teaching hospital and general hospital as well as within the teaching hospitals. We need to establish a standard, which grades the level of ICU according to the number of keeping physician, nurse-patients ratio, and the types of medical equipments they have.
Compressed Air ; Defibrillators ; Electrocardiography ; Financial Management ; Hospitals, General ; Hospitals, Teaching ; Humans ; Infusion Pumps ; Intensive Care Units* ; Critical Care* ; Korea* ; Oxygen ; Surveys and Questionnaires ; Vacuum ; Ventilators, Mechanical

BACKGROUND: Midazolam relaxes airway smooth muscle. The aim of this study is to evaluate the influence of flumazenil or verapamil on the relaxation effects of midazolam in tracheal smooth muscle of guinea pig. METHODS: After isolating guinea-pig tracheal preparations, the maximal tracheal tones were induced by 2 10(-7) M carbachol. When tracheal tones stabilized, midazolam was added cumulatively (10(-6), 3 10(-6), 10(-5), 3 10(-5), 10(-4) M, n=14) with or without flumazenil (10(-6) M, n=15) and verapamil (10(-5) M, n=13) to obtain the concentration-relaxation curves, and then the ED50 and ED95 calculated. RESULTS: Midazolam decreased maximal tracheal smooth muscle tones in concentration-dependent manners. Pretreatment with flumazenil had no effect on the midazolam-induced relaxation. Verapamil enhanced the relaxation effect of midazolam. CONCLUSIONS: Midazolam relaxes airway smooth muscle and has synergistic effect with calcium channel blocker, verapamil.
Animals ; Calcium Channels ; Carbachol ; Flumazenil* ; Guinea Pigs ; Midazolam* ; Muscle, Smooth* ; Relaxation* ; Verapamil*

BACKGOUND: The number of ICU beds related to the number of general acute care beds provides a broad measure of intensive care, but it has obvious limitations and underestimates extreme regional differences. As a first step, we evaluated the number of ICU beds or the ratio of ICU beds to hospital beds in university and non-university hospitals in Korea. METHODS: The number of ICU beds and hospital beds, the ratio of the number of ICU beds to hospital beds, and the types of ICU in each range of ICU beds and hospital beds in the university and non-university hospital were analyzed as well. RESULTS: Thirty university hospitals had 1,824 ICU beds out of 25,966 hospital beds, an average of 7.0%. The number of ICU beds ranged from 17 to 159 beds and hospital beds ranged from 400 to 2,000 beds in university hospitals. Fourteen non-university hospitals had 377 ICU beds out of 6,121 hospital beds, an average of 6.2%. In non-university hospitals, the number of ICU beds ranged from 6 to 67 beds with 50 to 700 hospital beds. If there was only one ICU, e.g. multidisciplinary, or more than one, the director of a multidisciplinary and surgical ICU was usually filled by an anesthesiologist, while the directors of other ICUs were usually specialists according to each specific ICU. CONCLUSIONS: There was a large disparity in the number of ICU beds and in the ratio of ICU beds to hospital beds between university and non-university hosptials, and even between university hospitals.
Hospitals, University ; Intensive Care Units* ; Critical Care* ; Korea* ; Specialization

Paraquat(Gramoxone) is the most commonly used herbicide in Korea. But serious paraquat poisoning in human beings has occurred following ingestion or exposure to the skin. Exposure to paraquat through the skin has resulted in local irritation or inflammation of varyiig degree, sometimes severe. We report three cases of primary irritant dermatitis due to paraquat. Two patients developed generalized vesicobullae and necrotirulcer in the scrotum, respectively. The other patient developed painful whitish patch and erosion in ttie tongue after accidental exposure.
Dermatitis, Irritant* ; Eating ; Humans ; Inflammation ; Korea ; Paraquat ; Poisoning ; Scrotum ; Skin ; Tongue

Ewing's sarcoma is a highly malignant, small, round cell tumor that usually affects long bones. The acral part of the extremities is a very rare primary site for this neo plasm. A fifteen-year-old girl was seen for a lobulated, dome-shaped, 2.7cm diameter, denuded mass on the distal phalanx of the right middle finger which had increased in size over a 14-month period. The radiological featuies of the hand showed a cortical brick of distal phalanx and surrounding soft tissue mass. Histologically, the biopsy specimen showed sheets of small round to oval cells with scanty cytoplasm, that were closely packed and separated into lobules by trands of fibrous tissue. A periodic acid-Schiff stain demonsirated glycogen in the cytoplasm of the tumor cells. Electron microscopy showed large aggregates of glycogen in the cytoplasm of the neoaplastic cells. Immunohistochemical stains revealed positive staining for vimentin, glial fibrillary acid potein, and neuron specific enolase, stains for S-100, Factor VIII, and cytokeratin were negative.
Biopsy ; Coloring Agents ; Cytoplasm ; Extremities ; Factor VIII ; Female ; Fingers ; Glycogen ; Hand ; Humans ; Keratins ; Microscopy, Electron ; Phosphopyruvate Hydratase ; Sarcoma* ; Sarcoma, Ewing ; Vimentin

Ewing's sarcoma is a highly malignant, small, round cell tumor that usually affects long bones. The acral part of the extremities is a very rare primary site for this neo plasm. A fifteen-year-old girl was seen for a lobulated, dome-shaped, 2.7cm diameter, denuded mass on the distal phalanx of the right middle finger which had increased in size over a 14-month period. The radiological featuies of the hand showed a cortical brick of distal phalanx and surrounding soft tissue mass. Histologically, the biopsy specimen showed sheets of small round to oval cells with scanty cytoplasm, that were closely packed and separated into lobules by trands of fibrous tissue. A periodic acid-Schiff stain demonsirated glycogen in the cytoplasm of the tumor cells. Electron microscopy showed large aggregates of glycogen in the cytoplasm of the neoaplastic cells. Immunohistochemical stains revealed positive staining for vimentin, glial fibrillary acid potein, and neuron specific enolase, stains for S-100, Factor VIII, and cytokeratin were negative.
Biopsy ; Coloring Agents ; Cytoplasm ; Extremities ; Factor VIII ; Female ; Fingers ; Glycogen ; Hand ; Humans ; Keratins ; Microscopy, Electron ; Phosphopyruvate Hydratase ; Sarcoma* ; Sarcoma, Ewing ; Vimentin

Vibrio vulnificus is a halophilic gram-negative, marine bacterium which causes fulminating and potentially fatal human disease. A new sensitive and specific serogrouping procedure was developed for identifying V. vulnificus. Reference antis:ra(01-014) to V. vulnificus were prepared by vaccinated rabbits with heat-killed bacteria, and the antisera were examined whether erogrouping test will be available for rapid and sensitive identification method of V. vulnifiius or not. All of thirty-seven clinical strains tested were agglutinated with 5 kinds of aritisera such as 04A, 01, 013, 03, and 014. Of these serovar 04A was predominant(75.7%). The author investigated the correlation among certain serovars, consumed seafoods, and nortality rate to verify whether the serovar is of pognostic value. There was no significant orrelation among them. These results suggest theart serogrouping procedure could be of value in rapidly identifying V. vulnificus.
Bacteria ; Humans ; Immune Sera ; Rabbits ; Seafood ; Vibrio vulnificus* ; Vibrio*