Association between Recent Acetaminophen Use and Asthma: Modification by Polymorphism at TLR4

The risk of asthma has been increasing in parallel with use of acetaminophen, which is a potential source of oxidative stress. Toll-like receptor 4 (TLR4) plays a critical role not only in innate immunity, but also in mediating reactive oxygen species induced inflammation. Therefore, we investigated associations between acetaminophen usage and TLR4 polymorphism on asthma and bronchial hyperresponsiveness (BHR). The number of 2,428 elementary school children in Seoul and Jeongeup cities was recruited. Subjects who used acetaminophen with a family history of asthma had an increased risk of both asthma diagnosis ever and current asthma. Individuals with CT+TT genotypes at the TLR4 polymorphism, in combination with acetaminophen usage, also demonstrated an increased risk of asthma diagnosis ever (aOR, 2.08; 95% confidence interval [CI], 1.10-3.92). Family history of asthma and acetaminophen usage were risk factors for BHR. Although TLR4 was not an independent risk factor for BHR, individuals with CT+TT genotypes at the TLR4 polymorphism had an increased risk of BHR when combined with acetaminophen usage (aOR, 1.74; 95% CI, 1.03-2.94). In conclusion, acetaminophen usage may be associated with asthma and BHR in genetically susceptible subjects. This effect may be modified by polymorphism at TLR4.

Factors Associated with Relapse to Smoking Behavior Using Health Belief Model / 農村醫學 地域保健

OBJECTIVES: This study aimed to identify factors associated with smoking relapse. METHODS: The study sample was recruited among subjects who were enrolled in the smoking cessation clinic of a public health center and had succeeded in quitting smoking for at least six months. A total of 159 male subjects were followed via mail survey one year later. The independent variables in the analyses were socio-demographic characteristics, smoking history and behavior, receipt of smoking cessation aids, health behaviors and components of the health belief model (HBM). The dependent variable was smoking relapse assessed one year after quitting. Ordered logit regressions were used to identify factors associated with smoking relapse. RESULTS: The relapse rate of the ex-smokers in our sample was 25.8%, and the occasional smoking rate was 17.0%. Univariate analyses revealed that only factors related to the HBM, such as perceived susceptibility to diseases (p<0.01), perceived severity of diseases (p<0.01), perceived health benefits of not smoking (p<0.01), perceived barriers to quitting smoking due to increasing stress and difficulty in social life (p<0.01), and self-efficacy (p<0.01) were associated with the likelihood of relapse for ex-smokers. Ordered logit analyses yielded two significant factors affecting the likelihood of relapse, the perceived barriers to quitting smoking and self-efficacy. CONCLUSIONS: Our results indicate that higher levels of barriers to quitting smoking and lower levels of self-efficacy were significantly related to risk of smoking relapse. These findings may be useful for identifying those at highest risk for relapse and choosing the optimal strategies for prevention of relapse for ex-smokers.

Compliance with the Protocol Considered Emetogenic Potential for Prophylaxis of Chemotherapy Induced Nausea and Vomiting / 종양간호학회지

PURPOSE: The purpose of this study was to identify the compliance with the protocol, which was developed considering the emetogenic potential for prophylaxis of chemotherapy. METHODS: Data was collected from 144 patients who received chemotherapy from June 15 to August 31, 2010 in C University Hospital in Jeollanamdo, Korea. The level of chemotherapy-induced nausea and vomiting (CINV) and the compliance with the protocol for prophylaxis of CINV were measured. RESULTS: There was statistically significant difference of CINV in morning sickness and anticipatory nausea of general and clinical characteristics. Also, the compliance with the protocol developed according to emetogenic potential of chemotherapy was statistically significant. There was no difference in CINV in regard to the compliance with the protocol. CONCLUSION: There was a good compliance with the protocol for prophylaxis according to emetogenic potential. But it should be recommended to use antiemetics for prophylaxis aggressively to relieve CINV for the patients who already experienced morning sickness and anticipatory nausea. In addition, the oncology nurses should respond sensitively to the complaints of nausea and vomiting no matter what the emetogenic potentials of chemotherapy regimen are.

Effects of Epidural Naloxone on Pruritus Induced by Hydromorphone Epidural Patient-Controlled Analgesia / 대한통증학회지

BACKGROUND: Opioid delivered by epidural patient-controlled analgesia (PCA) is effective in relieving pain after surgery, but it is associated with side effects, such as nausea, vomiting, pruritus, respiratory depression, and urinary retention. The purpose of this study was to compare hydromorphone related side effects and the quality of analgesia when naloxone was added to epidural PCA regimen. METHODS: Fifty-two thoracotomy patients with PCA were allocated blindly into two groups. Patients in group H (n = 26) received continuous epidural hydromorphone (16microgram/ml) in 0.1% bupivacaine; patients in group N (n = 26) received an epidural infusion containing naloxone (2 microgram/ml) and hydromorphone (16microgram/ml) in 0.1% bupivacaine. The basal rate of PCA was 4 ml/hr and the demand dose was 1.5 ml with a lockout time of 15 min. Pain intensity, sedation, pruritus, nausea and vomiting, respiratory depression were checked at 6, 12, 24 hours postoperatively. RESULTS: The Visual Analog Scale (VAS) scores were significantly lower in group H than in group N. There were no significant differences in the overall incidence of pruritus, nausea and sedation between the two groups. CONCLUSIONS: Continuous epidural infusion of naloxone combined with hydromorpho-ne is not effective in reducing the incidence and severity of pruritus induced by epidural hydromorphone.

Effect of Ropivacaine on Endothelium and Nitric Oxide in Rat Thoracic Aortic Rings / 대한마취과학회지

BACKGROUND: Ropivacaine is a new amino ethylamide which was developed as a less cardiotoxic and long lasting local anesthetic. The local anesthetics relax bronchial and intestinal smooth muscles. In addition, most local anesthetics cause arterial dilation. METHODS: The ability of ropivacaine to elicit a relaxant effect and it's relationships with vascular endothelium and nitric oxide have been studied using isolated rat thoracic aortic rings contracted with phenylephrine (PE). Each ring of thoracic aorta was suspended on wire supports in a 20 ml tissue bath under 2 g of resting tension. All tissues were bathed in Tris Tyrode solution at 37oC and 100% oxygen was supplied. RESULTS: Ropivacaine 10-5 M inhibited PE induced contractions of aortic rings significantly (P <0.05). Relaxation effect of ropivacaine 10-5 M was recovered in denuded tracheal rings significantly (P <0.05). Relaxation effect of ropivacaine 10-5 M was recovered with L-NAME pretreatment. Ropivacaine 10-5 M inhibited both the influx of extracellular Ca2+ and intracellular Ca2+ release. CONCLUSIONS: From the results obtained with this experiments, it is concluded that the relaxation effects of ropivacaine are related with endothelium dependent and NO related. Ropivacaine inhibited both intracellular calcium release and extracelluar calcium influx.

Anesthetic Management of Pulmonary Arterial Pressure Change during the Ethanol Sclerotherapy of Peripheral Arteriovenous Malformations / 대한마취과학회지

BACKGROUND: We frequently experience the elevation of pulmonary arterial pressure (PAP) during ethanol sclerotherapy of arteriovenous malformations. But, the study on the degree of PAP elevation during ethanol sclerotherapy has not yet been made. Therefore, we evaluated the PAP elevation during ethanol sclerotherapy. METHODS: We retrospectively reviewed PAP changes in 124 procedures conducted on 41 arteriovenous malformation patients during ethanol sclerotherapy. We investigated the degree of elevation of PAP and the incidences of pulmonary arterial hypertension during ethanol sclerotherapy. RESULTS: High incidences of pulmonary arterial hypertension were observed during ethanol sclerotherapy (53/124 procedures, 42.7%). The mean highest PAP values were 33.8 +/- 10.9 mmHg (systolic), 25.2 +/- 7.9 mmHg (mean), and 18.3 +/- 7.4 mmHg (diastolic). Incidence of nitroglycerine administration was 47.5% (59/124 procedures). Mean PAP values at the end of procedure was 29.1 +/- 9.1 mmHg (systolic), 22.0 +/- 7.0 mmHg (mean), and 16.1 +/- 6.4 mmHg (diastolic). Conclusion: The incidences of pulmonary hypertension during ethanol sclerotherapy were high. Therefore, cautious management and close cooperation between anesthesiologist and interventional radiologist are essential to prevent dreadful outcome.

A Case of carbamazepine induced bronchiolitis obliterans organizing pneumonia / 결핵

BOOP(Bronchiolitis Obliterans Organizing Pneumonia) is an inflammatory reaction that follows damage to the bronchiolar epithelium of the small conducting airways. BOOP is characterized by the pathologic finding of excessive proliferation of granulation tissue within the respiratory bronchioles, alveolar duct and spaces, accompanied by organizing pneumonia. BOOP may result from diverse causes such as toxic fumes, connective tissue disorders, infections, organ transplantation and drugs or appear idiopathically. Drug induced BOOP has been described in association with acebutolol, amiodarone, cephalosporin, bleomycine, tryptophan, gold salts, barbiturates, sulfasalazine, and carbamazepine. Carbamazepine is an iminostilbene derivative that is used as both and anticonvulasnt and pain reliever for pains associated with trigeminal neuralgia. It is structually related to the tricyclic antidepressants. To our knowledge, there have been no previously reported case that has described development of BOOP during carbamazepine treatment in Korea, and only two cases have been reported in the world. We report a case of carbamazepine-induce BOOP with a brief review of literature.

Statistical Study of Extremely Low Birth Weight (ELBW) Infants / 대한주산의학회잡지

PURPOSE: The purpose of our study was to review the perinatal clinical characteristics of extremely low birth weight(ELBW) infants and determine their risk factors of their deaths. METHODS: The medical records of 96 infants weighing less than 1,000g, who were born at Seoul National University Hospital and admitted to our neonatal intensive care unit(NICU) were analyzed retrospectively on the basis of clinical characteristics, obstetrical problems, postnatal complications and outcome. RESULTS: The annual birth rate of ELBW infants was 0.11% to 0.90% of total live births and the mean annual birth rate was 0.56% at Seoul National University Hospital. Preeclampsia was the most common obstetrical problem(34.4%), followed by incompetent internal os of cervix(IIOC) (13.5%), multiple pregnancy(13.5%) and in vitro fertilization(IVF)(13.5%). Respiratory distress syndrome(RDS) was the most common postnatal complication(78.1%), followed by sepsis(60.4%) and apnea(39.6%). Comparing the ELBW infants weighing less than 750g with those weighing more than 751g, sepsis was more frequent in the latter group(p<0.05), whereas high grade intraventricular hemorrhage(grade Ill) was more frequent in the former group(p<0.05). Otherwise there was no statistically significant difference concerning the frequency of perinatal complications between two groups. Comparing the ELBW infants born before the year 1991, when surfactant treatment started to be used routinely at our NICU, with those born after the year 1991, apnea and sepsis could be observed more frequent in the latter group(p<0.05). Otherwise there was no statistically significant difference in the frequency of perinatal complications between two groups, The survival rate of ELBW infants was 0.0% in 1986, 50.0% in 1991 and 40.0% in 1995. The risk factors of neonatal deaths of ELBW infants included birth weight, gestational period, mode of delivery, IIOC, RDS, apnea, pneumonia, pneumothorax, acute renal failure(ARF) and infections(except pneumonia), but analyzing these risk factors by multivariate logistic regression analysis, the resultant significant independent risk factors consisted only of birth weight, RDS and pneumonia(p<0.05). There was no statistically significant difference in survival rate between ELBW infants born before and after the year 1991, but there was a tendency toward increasing survival rates in the latter group. CONCLUSION: Recently, the survival rate of ELBW infants is improving steadily, but is still lower than that of western countries and postnatal morbidity remains high. Therefore, there is an urgent need to give more efforts to the neonatal intensive care of ELBW inFants in order to increase survival rates and reduce postnatal morbidity. But it is more important to reduce preterm birth by the treatment of preventable obstetrical risk factors.

A Case of A-V Malformation Associated with Porencephaly

Authors report a rare case of arteriovenous malformation associated with porencephaly in left frontal lobe of a 35 years old man. Local brain atrophy is generally ascribed to local pressure effect by the vascular malformation or to localized circulatory disturbances, so as in this case.

Surgically Treated Lesions Detected by CT in 3 Cases of Early Seizure

CT findings justified surgical intervention in three young patients who had suffered from epilepsy and attack like unconsciousness. Other neurodiagnostic procedures with these patients had failed to show focal cerebral lesions amenable to surgical treatment. Two patients of them achieved significant relief from seizures after operation, but one has been suffering from occasional epileptic attacks yet.

A Case of Metastatic Papillary Adenocarcinoma in the Posterior Fossa Originating from the Maxillary Sinus

We had experienced a case of metastatic papillary adenocarcinoma in the posterior fossa originating from the maxillary sinus, though there is general agreement that the commonest orgin of the metastatic intracranial tumors is bronchogenic carcinoma with carcinoma of the breast a close second;stomach and kidney come next and the carcinomas metastasize to the supratentorial cavity mostly. The patient was 41-year-old male who had complained of severe frontal headache, vomiting and loss of weight for about 40 days prior to admission. The tumor was located between the cerebellum and the meninges, and well demarcated, yellowhish and soft. We could remove it easily. Microscopic findings of the tumor showed papillomatous overgrowth of moderately differentiated signet ring cells with areas of necrosis and frequent mitosis. PAS staining revealed the presence of PAS positive materials in those cells.