A Rapid Assessing Method of Drug Susceptibility Using Flow Cytometry for Mycobacterium tuberculosis Isolates Resistant to Isoniazid, Rifampin, and Ethambutol / 결핵및호흡기질환

Background@#The current conventional drug susceptibility test (DST) for Mycobacterium tuberculosis (Mtb) takes several weeks of incubation to obtain results. As a rapid method, molecular DST requires only a few days to get the results but does not fully cover the phenotypic resistance. A new rapid method based on the ability of viable Mtb bacilli to hydrolyze fluorescein diacetate to free fluorescein with detection of fluorescent mycobacteria by flow cytometric analysis, was recently developed. @*Methods@#To evaluate this cytometric method, we tested 39 clinical isolates which were susceptible or resistant to isoniazid (INH) or rifampin (RIF), or ethambutol (EMB) by phenotypic or molecular DST methods and compared the results. @*Results@#The susceptibility was determined by measuring the viability rate of Mtb and all the isolates which were tested with INH, RIF, and EMB showed susceptibility results concordant with those by the phenotypic solid and liquid media methods. The isolates having no mutations in the molecular DST but resistance in the conventional phenotypic DST were also resistant in this cytometric method. These results suggest that the flow cytometric DST method is faster than conventional agar phenotypic DST and may complement the results of molecular DST. @*Conclusion@#In conclusion, the cytometric method could provide quick and more accurate information that would help clinicians to choose more effective drugs.

Ultrasonography-guided Fine-needle Aspiration for Solid Thyroid Nodules Less than 5 mm in the Largest Diameter: Comparison in Diagnostic Adequacy and Accuracy According to Nodule Size

PURPOSE: This study assessed the adequacy and accuracy of ultrasonography (US)-guided fine-needle aspiration (US-FNA) of solid thyroid nodules, less than 5 mm in maximum diameter. MATERIALS AND METHODS: From January to December 2009, US-FNA was performed for small solid thyroid nodules in 201 patients. Each thyroid nodule was classified into group A and B according to the largest diameter (1 mm or = 3 mm in the largest diameter, were higher than those of US-FNA for very small nodules, < 3 mm in the largest diameter.

Oncologic Outcomes and Risk Factors for Recurrence after Tumor-specific Mesorectal Excision of Rectal Cancer: 782 Cases

PURPOSE: The aim of this study was to analyze the oncologic outcomes and the risk factors for recurrence after a tumor-specific mesorectal excision (TSME) of resectable rectal cancer in a single institution. METHODS: A total of 782 patients who underwent a TSME for resectable rectal cancer between February 1995 and December 2005 were enrolled retrospectively. Oncologic outcomes included 5-year cancer-specific survival and its affecting factors, as well as risk factors for local and systemic recurrence. RESULTS: The 5-year cancer-specific survival rate was 77.53% with a mean follow-up period of 61 +/- 31 months. The overall local and systemic recurrence rates were 9.2% and 21.1%, respectively. The risk factors for local recurrence were pN stage (P = 0.015), positive distal resection margin, and positive circumferential resection margin (P < 0.001). The risk factors for systemic recurrence were pN stage (P < 0.001) and preoperative carcinoembryonic antigen level (P = 0.005). The prognostic factors for cancer-specific survival were pT stage (P < 0.001), pN stage (P < 0.001), positive distal resection margin (P = 0.005), and positive circumferential resection margin (P = 0.016). CONCLUSION: The oncologic outcomes in our institution after a TSME for patients with resectable rectal cancer were similar to those reported in other recent studies, and we established the risk factors that could be crucial for the planning of treatment and follow-up.

Combined Reconstruction of Posterior Cruciate Ligament and Posterolateral Rotatory Instability with Fresh-frozen Achilles Tendon Allograft

PURPOSE: We analyzed the clinical and radiologic results after arthroscopic reconstruction of the posterior cruciate ligament and posterolateral rotatory instability using fresh frozen Achilles tendon allograft. MATERIALS AND METHODS: Nine patients (10 cases) were evaluated. Male was 8 and female 1. Mean age was 38.4 years (23~59) and interval after trauma was 12.4 months (3~25 mo). Mean follow-up period was 14 months (12~21 mo). Posterior cruciate ligament was reconstructed with arthroscopic transtibial, single bundle technique and posterolateral rotatory instability with figure of "8" method using fibular tunnel. Clinical evaluation was done using posterior drawer test, posterolateral drawer test, varus stress test, prone external rotation (dial) test and range of motion. Functional evaluation was done by Lysholm knee score and Tegner activity scale. RESULTS: 90% of cases showed improvement to grade I by posterior drawer and to normal by posterolateral drawer, varus stress and dial test. One case showed flexion limitation more than 10degrees compared to opposite knee. Lysholm knee score and Tegner activity scale have been improved from mean 48.5 and 2.1 preoperatively to mean 80.2 and 4.5 postoperatively (p<0.05). Posterior drawer stress radiographs showed the improvement from mean 17 mm to 4.2 mm(p<0.05). CONCLUSION: Successful results were obtained by combined reconstruction of the posterior cruciate ligament and posterolateral rotatory instability with fresh frozen Achilles allograft.

The Changes of BIS and Hemodynamic Variables during Pediatric Open Heart Surgery with Sevoflurane or Midazolam / 대한마취과학회지

BACKGROUND: The bispectral index (BIS) has been shown to be useful for monitoring the degree of hypnosis in anesthetized adults. Although several studies have been performed to evaluate BIS in pediatric patients, it is unclear whether a BIS monitor can be applied in infants. This study was designed to evaluate changes of BIS, mean arterial pressure and heart rate during anesthesia with sevoflurane or midazolam in pediatric open heart surgery patients. METHODS: Eighteen patients under 3 years of age scheduled for an elective cardiac surgery were studied. Group S (n = 9) received sevoflurane-fentanyl, group M (n = 9) received midazolam-fentanyl. BIS, mean arterial pressure, heart rate, temperature, and end-tidal sevoflurane concentrations were obtained during anesthesia and surgery including cardiopulmonary bypass. The amount of fentanyl injected on an as needed base, total mechanical ventilation duration and intensive care unit stay were compared. RESULTS: A significant overall association between BIS and temperature was observed (Group S; R2 = 0.309, Group M; R2 = 0.225). There were no correlation between BIS and mean arterial pressure, heart rate, end-tidal sevoflurane concentration, and were no difference in the BIS scores of the groups. The mean arterial pressure of the M group from incision to CPB and post CPB 30 minutes were greater than those of the S group. The dose of fantanyl injected as needed during operation was greater in the M group than in the S group. No significant differences in the perisod of ventilation care and ICU stay. CONCLUSIONS: BIS decreased in both groups of patients as temperature decreased. Midazolam and fentanyl anesthesia in congenital heart disease may cause insufficient anesthesia regardless of BIS scores.

The Effects of Milnacipran on Rat Pain Model / 대한마취과학회지

BACKGROUND: Serotonin and norepinephrine are known as agents of the nonopiate endogenous descending pain control system. Recently, selective serotonin norepinephrine receptor inhibitors (SNRIs) have been developed as antidepressants. We studied the effects of milnacipran, a SNRI in a spinal nerve ligation (SNL) model and formalin test. METHODS: Male Sprague-Dawley rats weighing 200-250 gm were used for this study. In the SNL model, under an anesthetic state, the 5th lumbar spinal nerve was ligated and a PE-10 catheter was inserted into the subarachnoid space. Milnacipran was injected intraperitoneally or intrathecally and the threshold of tactile allodynia was measured. In the formalin test, milnacipran was administered intraperitoneally or intrathecally. 30 minutes after intraperitoneal injection or 60 minutes after intrathecal injection the formalin test was performed and flinching was counted for 60 minutes. RESULTS: In the spinal nerve ligation model, pain response decreased significantly (P <0.05). But, after intraperitoneal milnacipran administration in the spinal nerve ligation model, no difference in mechanical allodynia was observed between among groups. In formalin test, intraperitoneal and intrathecal milnacipran administration decreased phase I response, but there was no change in phase II response. CONCLUSIONS: Milnacipran reduced neuropathic pain after intrathecal administration. But there was no difference after intraperitoneal administration. Intraperitoneal and intrathecal milnacipran administration in formalin test reduced only the acute phase, but no difference in chronic chemical induced centralization pain was observed.

Application of ThermalCAMTM P40-Infrared Thermographic Imaging in the Monitoring of Survival of Lower Abdominal Random Flap in the Rabbit

The monitoring of viability of the flap is important in improvement of the flap survival. The flap survival depends on the vascularity of the flap, and the skin temperature is up to the vascularity. The authors applied ThermalCAMTM P40 infrared thermographic imaging system for the monitoring of the vascular supply of the flap. The various sized flaps are designed on the lower abdomen of rabbit, having expected risk rate of flap necrosis respectively. The surface temperatures on designed flap were checked with ThermalCAMTM P40 before flap elevation and after respectively. The flaps with high risk of necrosis, 1:4(width/length) designed flaps and some 1:3 flaps, showed remarkable color change in distal portion according to difference of surface temperatures. After 1 week, the flaps of lower abdomen showed different viability of flap, and the flap with remarkable color change showed partial necrosis distally. The Necrotic areas were identical with the color change area checked with ThermalCAMTM P40. This study shows that ThermalCAMTM P40 infrared thermographic imaging system has the utility in prediction on flap survival through detection of the vascularity with ease, quickness and safety for patient and flap.

A case of Sheehan's syndrome presented by recurrent ventricular tachycardia / 대한내과학회지

Electrocardiographic abnormalities commonly associated with hypopituitarism are low QRS voltage, ST-segment depression, inverted T waves and a prolonged QT interval. Although the mechanism remains unclear, glucocorticoid therapy, an intracelluar-extracellular electrolyte imbalance of myocytes, and histopathological changes in the myocardium are thought to play a role in this disorder. We discribe a 64 year old woman with recurrent ventricular tachycardia associated with QT prolongation in Sheehan's syndrome. Ventricualr tachycardia was treated by lidocain and direct current cardioversion. Sheehan's syndrome was confirmed by past history, anterior pituirary stimulation test and brain MRI showed empty sella. After hormone replacement treatment, inverted T waves and prolonged QT interval was normalized and ventricular tachycardia did not recur.

Comparison analysis of an indirect measurement of friedwal formula method and direct measurment of immunoseparation method on low-density lipoprotein cholesterol measurement / 대한내과학회지

BACKGROUND: In 2001, the third report the National Cholesterol Education Program (NCEP) has concluded that LDL cholesterol levels should be a major goal for preventing coronary artery disease and atherosclerotic events. Those in the higher risk groups should then have lipoprotein analysis to determine LDL cholesterol levels. LDL cholesterol has traditionally been estimated by the Friedwald forrmula : LDL-C=total cholesterol-[high density lipoprotein cholesterol (HDL-C)+trigryceride/5]. However, when trigryceride level is >400 mg/dL, this formula is inaccurate. Therefore, We have compared the direct LDL cholesterol immunoseparation method with Friedwald formula from both normotriglyceridemic (triglyceride400 mg/dL). METHODS: The direct LDL cholesterol immunoseparation method was performed on 53 sera with triglyceride levels 61 to 1,684 mg/dL (classified as400 mg/dL : 31). Total cholesterol was measured enzymatic colorimetry. HDL cholesterol was measured in the supernatant after precipitating LDL by HDL cholesterol precipitating reagent containing dextran sulfate and magnesium chloride for serum. Direct LDL cholesterol was measured by immunoseparation method (Sigma Diagnostics, St Louis, Mo) that is based on selective absorption of HDL cholesterol and VLDL cholesterol by polystylene beads coated with goat polyclonal antibodies to human apolipoproteins. The cholesterol was measured by an enzamatic method on Hitachi 747. The linear regression and paird t-test were performed to evaluate the differences of data from Immunoseparation method and Friedwald formula. RESULTS: In triglyceride400 mg/dL, the LDL cholesterol value obtained by the direct LDL-C assay on the 31 frozen sera studied was significantly different from that of Friedwald formula (103+/-38.4; 50.4+/-56.2 mg/dL). Therefore, Friedwald formula is unreliable in triglyceride>400 mg/dL. CONCLUSION: Guidelines for treatment decisions, including diet and drug initiation, and therapeutic goals for high risk groups are based entirely on the LDL cholesterol level. At triglyceride levels >400 mg/dL, Friedwald fomula is inaccurate. Immunoseparation method is more rapid, higher specific, precise and helps monitor LDL lowering drugs and diets in triglyceride level>400 mg/dL.

Clinical Studies of Customized Silastic Nasal Stent Application after Correction of Deviated Nose

No abstract available.

Epidemic MRSA Infection after Intranasal Surgery / 대한이비인후과학회지

In recent years, drug-resistant bacterial and nosocomial infections have been increased. The epidemic Methicillin Resistant Staphylococcus aureus (MRSA) infection after intranasal surgery was broken out at Wallace Memorial Baptist Hospital recently. MRSA was identified in 22 patients among 118 patients who underwent intranasal operation from January 23rd, 1996 to February 8th, 1996. Most patients represented symptoms the 7th day after the operation. Among 22 patients, 17 patients were treated with hydration, daily nasal dressing and intravenous antibiotics; Vancomycin or Ciprofloxacin was administrated in 11 patients, and primary antibiotics in five patients. Other five patients were treated with daily nasal dressing and oral antibiotics (Trimethoprim-Sulfamethoxazole or Ciprofloxacin). One of Vancomycin-treated patients developed sepsis. No further MRSA infection occurred after emphasizing thorough hand-washing, sterilization and disinfection of equipment, and control of health care providers, showing that the prevention of MRSA infection is very important.

Vecuronium Administration for Endotracheal Intubation: The Priming Method vs. Intravenous Infusion Method / 대한마취과학회지

BACKGROUND: Priming significantly shortened the onset of neuromuscular blockade(NMB), but also results in a high incidence of side effects. This study was designed to determine the effect of infusion priming method on the side effects, intubation condition, and onset of NMB compared with divided priming method. METHOD: The effects of different priming method of vecuronium on onset time and endotracheal intubation condition were investigated. 40 patients were studied in two parts. In control part, 20 patients were allocated into two groups(n=10 in each group) receving 10, 20 g/kg vecuronium as a priming dose, followed by a intubating dose(0.1 mg/kg-priming dose) 3 min later; the other part, 20 patients were allocated into two groups(n=10 in each group) receving 0.2 mg/kg/hr vecuronium continuous intravenous infusion, followed by a intubating dose(0.1 mg/kg-total infusion dose) 3, 5 min later. Onset time is calculated by single twitch stimulation test from injection of the intubating dose to maximum depression of the single twitch. Intubatin condition was appreciated based on vocal cord reflex, coughing, and jaw relaxation and scored. RESULTS: The times to fade out on the single twitch of the intravenous infusion priming group were shorter than control priming group. There was no difference between control priming group and infusion priming group to evaluate the intubation conditions. Side effects in the continuous infusion group were lesser than control priming group. CONCLUSION: This results suggest that the use of continuous infusion method is one of the promising methods to shorten the neuromuscular blockade and to provide more comfort to the patients.

Profound Hypothermia and Circulatory Arrest for Adult PDA Surgery: Case report / 대한구급학회지

Correction of a calcified patent ductus arteriosus (PDA) is a difficult surgical procedure. Simple ligation or division of PDA is not possible if diffuse circumferential calcification is present. Several techniques using cardiopulmonary bypass and closure of PDA from within the aorta or pulmonary artery have been introduced. And the surgical procedure is performed under profound hypothermia and circulatory arrest. Total ischemia time should be less than 30 minutes, which is free from the organ damage by the circulatory arrest. Barbiturates, calcium channel blockers and steroids are used for brain protection. We experienced successful use of these techniques for adult female patch closure of PDA and reviewed the anesthetic considerations of the profound hypothermia and circulatory arrest for cardiac surgery.