The Effect of Anesthetic Technique on White Blood Cell Response to Surgery in Patients Who Underwent Laparoscopic Cholecystectomy and Cesarian Section / 대한마취과학회지

BACKGROUND: Surgical stress causes changes in the composition of white blood cells in peripheral blood. In addition, anesthesia itself has been suggested to have an immunosuppressive effect. Therefore, the aim of the present study was to investigate the effect of anesthetic technique on the changes of postoperative peripheral white blood cell (WBC) subsets in laparoscopic cholecystectomy patients and cesarian section patients. METHODS: We reviewed 100 patients who had laparoscopic cholecystectomy under conventional general anesthesia or propofol infusion. Each group contained 50 patients equally. We also reviewed 100 patients who had cesarian section under spinal and epidural anesthesia, 50 patients in each group, respectively. The changes of total WBC, lymphocytes, neutrophils and monocytes at 24 h and 48 h postoperatively were compared to baseline values within the groups and these values were compared between the groups. RESULTS: There were significant increases in total WBC and neutrophils, decreases in lymphocytes, no changes in monocytes at 24 h after surgery compared to baseline values for the groups receiving laparoscopic cholecystectomy. No differences were found between the two laparoscopic cholecystectomy groups. Cesarian section patients showed significant differences in total WBC, neutrophils, lymphocytes and monocytes at 48 h after surgery compared to baseline values for the groups. There were no significant differences between the groups. CONCLUSIONS: Neither laparoscopic cholecystectomy nor cesarian section showed significant differences in WBC subsets after surgery according to anesthetic technique.

Therapeutic Predictor of Disodium Eromoglycate(DSCG) on Bronchial Asthma / 대한내과학회지

OBJECTIVES: Although DSCG protects against the stimuli of various bronchoconstictor, such as exercise, it is not effective to all patients. There seems to be no therapeutic predictor that determines effectiveness of DSCG on bronchial asthma. Although it is commonly assumed that children with predominantly allergic asthma have a better response to DSCG therapy than adult patient, this has not been convincingly demonstrated, and even adult with late onset nonallergic asthma may benefit. In this study, we evaluated the factors that potentially influenced the ability of DSCG to reduce bronchial hyperresponsibility. METHODS: The treatment groups were sub-divide into effective group(n=14) and ineffective group(n=6) on the basis of significant improvement of followedup PC20 after long term therapy of DSCG. We compared clinical and laboratory data and pulmonary function test between two groups. RESULTS: 1) Disease durtion and pre-treatment pulmonary function (FEV1% predicted, FVC% predicted value) may play a role in determining effectiveness of DSCG on bronchial asthma(p0.05). CONCLUSION: These results show that DSCG is effective in adult chronic asthma and early administration of DSCG, good pulmonary function test and allergic rhinitis history may lead to more favorable outcome.

The effect of 8 French catheter and chest tube on the treatment of spontaneous pneumothorax / 결핵

BACKGROUND: Spontaneous pneumothorax have been managed with a variety of methods. The technique most frequently used is chest tube drainage. Small caliber catheters were first used in the management of pneumothorax complicating the percutaneous needle aspiration lung biopsy, and the try to treat spontaneous pneumothorax also has been reported. However, the value of small caliber catheters in spontaneous pneumothorax has not been fully evaluated. So, we tried to elucidate the efficacy of 8 French catheter in the management of spontaneous pneumothorax. METHOD: From January, 1990, to April, 1994, 44 patients with spontaneous pneumothorax treated at Chung-Ang university hospital were reviewed. The patients were sub-divide into 8 French catheter insertion group (n=21) and chest tube insertion group (n=23). We compared the presence of underlying lung disease, the extent of the collapse, the duration of indwelling catheter and complication between two groups. RESULTS: 1) The duration of indwelling showed no significant difference between 8 French catheter group and chest tube. But, complication after insertion as subcutaneous emphysema was developed in only chest tube group. (p<0.05) 2) In the primary spontaneous pneumothorax, all case of the pneumothorax of which size was less than 50% showed complete healing with 8 French catheter insertion. Whereas the success rate in patients with large pneumothorax (more than 50%) was tended to be dependent on the age. 3) In the patients with secondary spontaneous pneumothorax who were managed with 8 French catheter, the success rate was trended to be high if the underlying disease of pneumothorax was not COPD and if the patient was young. CONCLUSION: These results show that 8 French catheter insertion probably was effective in the pneumothorax less than 50%, the primary spontaneous pneumothorax, young age or secondary pneumothorax not associated with COPD.

Airway Responses to Bronchoprovocation Using High-Resolution Computed Tomography in Patients with Bronchial Asthma / 결핵

BACKGROUND: Bronchial hyperresponsiveness and abnormal response such as a loss of distensi- bility are pathophysiologic characteristics if bronchial asthma. The only means of direct in vivo measurement of airway size had been a tantalium bronchography, until high-resolution computed tomography(HRCT) enabled to measure noninvasively two dimensional airway area more accurately and reliably. METHOD: To investigate airway area responses to bronchial provocation with methacholine and evaluate the major sites of bronchial constriction in patients with bronchial asthma. We examined HRCT scans in five patients with bronchial asthma who had significant bronchoconstriction(20% or more decrease in FEV1) using CT scanner(5,000T CT, Shimadzu Co, Japan) before and in 3~5 min. after methacholine inhalation. Airways which were matched by parenchymal anatomic landmarks in each patient before and after methacholine inhalation were measured using film scanner(TZ-3X scanner; Truvel Co. Chatsworth CA, USA) and a semiautomated region growing method. RESULTS: 1) We identified 9 to 12 airways in each patient which were matched by parenchymal anatomic landmarks before and after methacholine inhalation. 2) Airway responses to methacholine are quite different even in a patient. 3) The constriction of small airways(average diameter 2 mm; area >3.14 mm2), 53.8% (4.4;SEM, n=10), but not significantly different(p>0.05). 4) There was no significant difference in the degree of constriction between upper(44.3% +5.8; mean + SEM, n=30) and lower lung regions(56.7% +4.5, n=23). CONCLUSIONS: Thus airway responses to methacholine bronchoprovocation is quite variable in a patient with bronchial asthma and has no typical pattern in patients with bronchial asthma.