Interferon-alpha in the Treatment of Behcet's Disease

PURPOSE: To determine the therapeutic efficacy of interferon-alpha on patients with Behcet's disease who have been resistant to conventional therapies. METHODS: We treated 22 eyes of 13 patients with interferon-alpha for a mean of 20.5 months. They were given 3 million units interferon-alpha subcutaneously three times a week. Using slit lamp microscopy, fluorescent angiography, the authors compared visual acuity, frequency of relapse of uveitis and complications of interferon-alpha. RESULTS: The average ocular attack rate fell from 0.41 times a month to 0.19 times after interferon therapy. In addition, the degree of intraocular inflammation and especially retinal vasculitis decreased. There were no side effects significant enough to stop using interferon. CONCLUSIONS: Therapy with interferon-alpha seems to be an effective and safe regimen in Behcet's disease for refractory ocular attack and for the protection of vision.

Reliability and Validity of the Measurement for Assessing Resourcefulness / 간호학회지

The purpose of this study was to verify the reliability and validity of the Rosenbaum self-control schedule(SCS) for assessing resourcefulness in Korea and to explore the simplified scale. The study subjects consisted of 787 adults in a community. The data was collected during the period from Oct. to Dec., 1995 and analyzed as Cronbach alpha item correlation with total, Perarson correlation and factor analysis with varimax rotation using SAS. Results were as follows : The mean SCS score for this sample was 17.2 and there were statistical differences for gender(men, 13.1 ; women, 20.0) on the SCS scores. The cronbach alpha of SCS with 36 items was .74 and when simplified with 30 items, it's coefficient alpha was .78. The translated content of the SCS was validated by two nursing faculty members and one professor of psychology. Factor analysis revealed the most parsimonious structure was obtained when six factors were extracted and subsequently rotated via the varimax criterion. There was 40.2% of total communality variance in the SCS with 36 items. The total communality variance was slightly increased to 43.4% with 30 items of the SCS. In order to reduce from 36 items to 30 items, the process excepted 6 items having low item correlation with total and low MSA(means of sampling adequacy) of factor analysis. According to factor analysis, there are six factors such as emotion control, impulse control, self-efficacy, coping with problems, pain control and satisfaction control. The SCS was found to have low, but statistically significant, correlations with social desirability and helplessness. From the above results, it can be concluded that the reliability of the SCS(inherent and simplified) was a acceptable level and its validity was reasonable when comparing it with other validity studies. To determine the usefulness the simplified scale, further study is necessary to simultaneously compare and analyze both scales for stability.

Comparison of the Degree of Bronchial Mucosal Damage according to the Bronchial Cuff Pressure of Double Lumen Tubes / 대한마취과학회지

BACKGROUND: Pressure damage to respiratory mucosa from overinflation of bronchial cuffs has been implicated as a cause of bronchial rupture, a rare but devastating complication of double-lumen endobronchial tubes. We evaluated the severity of bronchial mucosal damage by bronchial cuff pressure in Robertshaw double-lumen endobronchial tubes. METHODS: Eighteen patients were divided into two groups: in group 1(n=9), bronchial cuff pressure was maintained by 25 mmHg; in group 2(n=9), bronchial cuff pressure was maintained by 35 mmHg during one-lung ventilation. We evaluated the bronchial mucosa by using fiberoptic bronchoscopy before bronchial intubation and following extubation. According to the number of petechia and mucosal hemorrage or tearing, damage scoring was performed. RESULTS: Damage scores of Group 1 are represented by 0(normal mucosa) in number of 3 patients, 1 (small number of petechia) in 2 patients, 2 (large number of petechia) in 3 patients, 3 (mucosal hemorrhage) in 1 patient and above score 4 (mucosal tearing) was not existed. Scores of Group 2 are represented by 0 in number of 1 patient, 1 in 3 patients, 2 in 4 patients, 3 in 1 patient and above score 4 was not existed. CONCLUSION: Degree of bronchial mucosal damage was not related with the bronchial cuff pressure of double lumen tubes.

The Effect of Different Dosage of Propofol on Cardiovascular Responses to Tracheal Intubation in Hypertensive Patients / 대한마취과학회지

BACKGROUND: Laryngoscopy and endotracheal intubation are potent stimuli that increase heart rate and blood pressure. Especially, hypertensive patients are more prone to have significant increase in heart rate and blood pressure and cardiac complications such as arrythmia, myocardial ischemia and infarction can lead to fatal situation. This study was designed to evaluate the effectiveness of different dosage of propofol on cardiovascular responses to tracheal intubation in hypertensive patients. METHODS: Sixty hypertensive patients, ASA PS 1 or 2, scheduled for elective surgery were selected randomly. They were divided into three groups(Group 1: propofol 2.0 mg/kg, Group 2: propofol 2.5 mg/kg, Group 3: propofol 3.0 mg/kg, n=20 in each group). Induction of Anesthesia was started with propofol 2.0 mg/kg(Group 1), 2.5 mg/kg(Group 2), 3.0 mg/kg(Group 3) and succinylcholine(1 mg/kg). After tracheal intubation, pancuronium bromide 0.08 mg/kg was injected, 50 % nitrous oxide in oxygen and 2 % enflurane were inhaled. Using noninvasive automatic blood pressure monitor(CRITIKON DINAMAP TM 1846SX, USA), blood pressure(systolic, diastolic, and mean arterial pressure) and heart rate were measured at 4 points; 1) as the control value, on arrival to operating room, 2) 1 minute after tracheal intubation, 3) 3 minutes after intubation, 4) 5 minutes after intubation. RESULTS:In group 3, systolic, diastolic pressure and mean arterial pressure at 1 minutes, 3 minutes, 5 minutes after intubation were less increased than group 1, 2 and blood pressure response was more effectively blunted than heart rate response CONCLUSIONS: we suggested that 3.0 mg/kg of propofol for the induction of anesthesia could blunt hemodynamic changes caused by laryngoscopy and endotracheal intubation in hypertensive patients, but we had to give attention to the side effect until postoperative period.

Comparison of Culture Results after Preoperative Chemical Preparation of The Eye in Cataract Surgery

Postoperative endophthalmitis is one of the devastating complications following cataract surgery. Ocular flora has been presumed to be a major source of infectious organisms in postoperative endophthalmitis. We compared the efficacies of various chemical preparation methods that decrease or eradicate ocular flora effectively before surgery. 355 eyes undergoing cataract surgery were randomly divided into 4 groups according to chemical preparation methods. 0.3% gentamicin eyedrop was used in group 1, 0.3% ciprofloxacin eyedrop in group 2, 0.3% gentamicin eyedrop and 5.0% povidone-iodine solution in group 3, and 0.3% ciprofloxacin eyedrop and 5.0% povidone-iodine solution were used in group 4 to prepare eye before surgery. Cultures of eyelid-conjunctival swab and aqueous humor were performed just before operation and at the time of wound closure, respectively, and then compared among 4 groups. The culturepositive rate was the lowest in group 4 and increased in group 3, group 2, and group 1 in a order. The culture-positive rate from the eyelid-conjunctiva in group 2 was significantly lower than that in group 1(p<0.05). The culture positive rates in the groups(group 3, 4) using the combination of antibiotics eyedrop and povidone-iodine solution for chemical preparation were significantly lower than those in the groups(group 1, 2) using antibiotics eyedrop only(p<0.05). The culture results of aqueous humor showed similar pattern as those from the eyelid-conjunctival swab. This study suggests that combined use of 0.3% ciprofloxacin eyedrop and 5.0% povidone-iodine solution is an effective and recommendable preoperative chemical preparation.

Carbon Monoxide Production by Electrocautery during Laparoscopic Cholecystectomy and Carboxyhemoglobin Concentrations in Patients and Operators / 대한마취과학회지

Pyrolysis of tissue in a hypoxic environment can produce carbon monoxide. Peritoneal cavity is hypoxic during laparoscopic cholecystectomy by insufflation with 100% carbon dioxide, then, carbon monoxide is produced by electrocautery of tissue. To determine whether carbon monoxide was being absorbed in dangerous amounts to patients and operating room workers, blood was analyzed for carboxyhemoglobin in patients and their operators. Twenty-one patients undergoing this procedure, sampling the insufflation gas before, after use of electrocautery analyzed for carbon monoxide. Carbon monoxide was present in the peritoneal cavity, 5 min after use of electrocautery at a median concentration of 430 ppm(range 20~1000 ppm), and at the end of surgery at a median concentration of 174 ppm(range 10~720 ppm). This is well in excess of the 35 ppm upper limit for a 1-hr exposure set by the Environmental Protection Agency in U.S.A.. The patients carboxyhemoglobin concentrations(mean +/- SD) at the beginning, at the end and 3 hrs after surgery were 0.51+/-0.30%, 0.41%+/-0.28%, and 0.45%+/-0.74%, respectively. The operator's carboxyhemoglobin concentrations before and at the end of surgery were 1.12%+/-1.09% and 1.03%+/-1.03%, respectively. Although there was no evidence of significant absorption of carbon monoxide in these patients and operators, care should be taken to scavenge the gases produced by electrocautery of tissues to avoid operating room contamination during laparoscopic cholecystectomy.