Case of Mycobacterium Massiliense Infection Presenting as Recurrent Pneumonia in Sjogren's Syndrome / 대한내과학회지

Mycobacterium massiliense is an emerging pathogen that is increasingly reported as a causative agent occurring during medical procedures, at surgical sites, and intramuscularly [1]. Although previously classified as part of M. abscessus, M. massiliense has recently been identified as a new species of rapidly growing nontuberculous mycobacteria [1,3] via a comparative sequence analysis of rpoB and hsp65 [3,5]. However, the clinical manifestations of M. massiliense have not been well characterized. We report here in a case of recurrent pneumonia for 3 years that improved with antibiotic treatment for M. massiliense in a 37-year-old woman with Sjogren's syndrome. The patient showed a substantial response to treatment with a combination of antimicrobial therapies comprising clarithromycin and amikacin without cefoxitin for 6 months. This is the first report of pulmonary infection of M. massiliense with Sjogren's syndrome in Korea.

Influence of Fentanyl, Fentanyl-Midazolam, and Fentanyl-Ketorolac as Analgesic Supplementations on the Induction of Propofol Anesthesia with Dipifusor TCI / 대한마취과학회지

BACKGROUND: The pharmacologic interactions between propofol and adjuvant agents have increasingly been recognized as clinically important and the improved knowledge of these is being used to optimise the quality of total intravenous anesthesia. The aim of the present study was to investigate the effects of fentanyl, fentanyl-midazolam, and fentanyl-ketorolac as analgesic supplementations on the induction of propofol anesthesia with Diprifusor TCI. METHODS: Sixty ASA 1 patients undergoing elective diagnostic laparoscopy were randomly allocated to three groups equally according to injected adjuvant agents : group F, fentanyl 1 microgram/kg; group FM, fentanyl 1 microgram/kg-midazolam 0.05 mg/kg; group FK, fentanyl 1 microgram/kg-ketorolac 0.5 mg/kg IV before induction. Propofol target concentration of 4 microgram/ml was preset and unconsciousness with 3 min was considered as successful. Induction dose, time, success rate of induction, calculated and effective concentration, context sensitive decrement time when awakening concentration was 1.2 microgram/ml, vital signs and side effects were checked. RESULTS: Successful induction rate was 55% in the group F, 100% in the group FM, and 85% in the group FK (P< 0.05). Induction time and dose were significantly decreased in the group FM compared with the group F and FK. Calculated concentration, effective concentration, and context sensitive decrement time were significantly lower in the group FM than other groups. Injection pain score and postoperative pain score showed no differences between groups, but incidence of apnea was significantly increased in the group FM. CONCLUSIONS: Fentanyl-midazolam as a analgesic supplementation offered better quality of propofol induction using TCI, but showed increased incidence of apnea compared with fentanyl or fentanyl- ketorolac.

Induction Dose of Midazolam for General Anesthesia / 대한마취과학회지

Midazolam, a new water-soluble benzodiazepine, has a few important advantages over diazepam which are lack of vascular irritation and rapid onset and short duration of action. So it has been used for an induction agent for anesthesia. But there were many different reports about the effective dose of midazolam as an induction agent for anesthesia, and which showed intersubject variability. Therefore, this study was aimed to verify the effective induction dose of midazolam comparing with thiopental 5 mg/kg for general anesthesia. The patients were divided into 6 groups. The patients of group 1, 2, 3, 4, and 5 were injected midazolam 0.15, 0.20, 0.25, 0.30, and 0.35 mg/kg, respectively, and, of group 6, thiopental 5 mg/kg for induction of anesthesia. Induction of anesthesia was defined as complete with loss of eyealsh reflex and failure to verbal commands. Unless induction was attained within 3 minutes, it was considered as failure of induction, and further steps of study were discontinued. After anesthesia was induced, stimulus to trapezius muscle relevant to endotracheal intubation was applied. The blood pressure, heart rate and arterial oxygen saturation were recorded before induction, at induction, and 1, 2, and 3 minutes after a stimulus to trapezius muscle. The incidences of pain on injection, venous irritations and antegrade amnesia were evaluated. The results were as follows; 1) Induction fractions of group 1, 2, 3, 4, 5, and 6 were 21.5, 57.2, 81.9, 100, and 100%, respectively. Induction times of group 1 to 5(midazolam groups) were 74.7-87.9 sec.(raanges, 40 -150 sec.) and, of group 6, 39.5 sec.(ranges, 33-55 sec.). But there was no relationship between midazolam doses and induction times. 2) At induction, systolic blood pressures of patients in group 3, 4, 5, and 6 decreased 6.1%, 5.8%, 10.5%, and 8.8%, respectively, and remained so after stimulus to trapezius muscle, but in group 6, which returned to preinduction value. Changes in sytoiic blood pressure were statistically insignificant among groups. 3) At induction, diastolic blood pressures of patients in group 5 and 6 decreased 11.0% and 11.3%, respectively, and, after stimulus to trapezius muscle, diastolic blood pressures did not change in group 3, 4, and 5, but, in group 6, returned to preinductuin value. Changes in diastolic blood pressure were statistically insignificant among groups. 4) At induction, heart rates of patients in group 3, 4, 5, and 6 increased 10.0%, 13.8%, 7.5%, and 25.8%, respectively. Changes in heart rate were significantly different between group 6 and other groups. 5) Arterial oxygen saturations decreased 0.25%, 0.3%, and 0.35% in group 3, 4, and 5 at induction, respectively, but, in group 6, decreased 3.4% after stimulus to trapezius muscle. Changes in arterial oxygen saturation were statistically insignificant among groups. 6) There were no differences in incidences of pain on injection, venous irritations, and antegrade amnesia among groups. In summary, midazolam can be used to induce general anesthesia safely with dose of 0.25 mg/ kg to 0.35 mg/kg, although there remains intersubject variability.

Clinical study of weaning process from ventilator support in acute respiratory failure / 대한구급학회지

No abstract available.

Two cases of ovarian pregnancy / 대한산부인과학회잡지

No abstract available.