Diagnostic Decision Points of Specific IgE Concentrations in Korean Children With Egg and Cow's Milk Allergies

PURPOSE: The purpose of this study was to evaluate the utility of specific IgE (sIgE) concentrations for the diagnosis of immediate-type egg and cow's milk (CM) allergies in Korean children and to determine the optimal cutoff levels. METHODS: In this prospective study, children > or =12 months of age with suspected egg or CM allergy were enrolled. Food allergy was diagnosed by an open oral food challenge (OFC) or through the presence of a convincing history after ingestion of egg or CM. The cutoff levels of sIgE for egg white (EW) and CM were determined by analyzing the receiver operating characteristic curves. RESULTS: Out of 273 children, 52 (19.0%) were confirmed to have egg allergy. CM allergy was found in 52 (23.1%) of 225 children. The EW-sIgE concentration indicating a positive predictive value (PPV) of >90% was 28.1 kU/L in children or =24 months of age. For CM-sIgE, the concentration of 31.4 kU/L in children or =24 months of age indicated a >90% PPV. EW-sIgE levels of 3.45 kU/L presented a negative predictive value (NPV) of 93.6% in children or =24 months of age presented a NPV of 99.2%. The CM-sIgE levels of 0.59 kU/L in children or =24 months of age showed NPVs of 100% and 96.9%. CONCLUSIONS: Our results indicate that different diagnostic decision points (DDPs) of sIgE levels should be used for the diagnosis of egg or CM allergy in Korean children. The data also suggest that DDPs with high PPV and high NPV are useful for determining whether OFC is required in children with suspected egg or CM allergy.

Superior Cervical Sympathetic Ganglion Block may not Influence Early Brain Damage Induced by Permanent Focal Cerebral Ischemia in Rats / 대한통증학회지

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglion (SCG). The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats subjected to permanent focal cerebral ischemia. METHODS: Thirty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of three groups (control, lidocaine and ropivacaine). A brain injury was induced in all rats by middle cerebral artery occlusion with a nylon thread. The animals of the local anesthetic group received 30 microl of 2% lidocaine or 0.75% ropivacaine in the SCG. Neurologic scores were assessed 24 hours after brain injury. Brain samples were then collected. The infarct and edema ratios were measured by 2.3.5-triphenyltetrazolium chloride staining. RESULTS: There were no differences in the death rates, neurologic scores, or infarction and edema ratios between the three groups. CONCLUSIONS: These findings suggest that superior cervical sympathetic ganglion block may not influence the brain damage induced by permanent focal cerebral ischemia in rats.

Clinical effect of smoking on the healing response following scaling and root planing / 대한치주과학회지

No abstract available.

Does Autonomic Dysfunction in Diabetic Patients Affect Intraoperative Hemodynamic Instability during Coronary Artery Bypass Surgery? / 대한마취과학회지

BACKGROUND: In this study, we examined diabetic patients scheduled for elective coronary artery bypass surgery to determine whether there is an association between autonomic dysfunction and intraoperative hemodynamic instability, and if perioperative autonomic function tests are effective predictors for diabetic patients at greatest risk for hemodynamic events during the intraoperative period. METHODS: We examined 52 patients, 25 without diabetes (nonDM group) and 27 with diabetes (DM group). Preoperative autonomic function tests included are the valslava maneuver (valsalva ratio, valsalva index, strain response), change in heart rate with deep breathing (I/E ratio), change in heart rate (30:15 ratio, stress response) and diastolic blood pressure (L-S(d)) while standing. Anesthesia was established with midazolam, fentanyl, isoflurane and vecuronium. Several hemodynamic variables such as heart rate (HR), mean arerial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), cardiac output (CO), and cardiac index (CI) were obtained at the following times: before induction; after induction; after intubation; after skin incision and after sternotomy. RESULTS: The DM group had a significantly diminished response compared with the nonDM group in the valsalva ratio, valsalva index, 30:15 ratio, and L-S(d). The remaining tests (I/E ratio, strain response, stress response) showed similar but nonsignificant diminished trend response in the DM group. Most patients had one or more abnormal test results in this group (76%), whereas in the control group most patients did not show any abnormal test results (74.1%). The comparison of hemodynamic response between the DM group and non-DM group reveal a significant difference between times within each group but not between groups. CONCLUSIONS: This study indicates that increased hemodynamic instability during the intraoperative period is not an obligatory association with diabetes and autonomic dysfunction and is not detected bypreoperative autonomic function tests in patients with coronary artery disease and diabetes mellitus when anesthesia is induced and maintained with a large dose of opioid and anesthetic agent which has minimal hemodynamic effects.

The Comparison of Cryoanalgesia and Epidural Analgesia in Thoracotomy / 대한마취과학회지

BACKGROUND: Cryoanalgesia provides postoperative analgesia following thoracotomy without serious complications compared with epidural analgesia, but little data indicates which one is better in terms of postoperative analgesia, side effects or associated complications. METHODS: Forty patients undergoing lateral thoracotomy, were randomized to receive a mixture of fentanyl and 0.15% bupivacaine at 0.5 microgram/kg/h of fentanyl via thoracic epidural catheter (Group E) or cryotherapy on the 4th, 5th, 6th, or 7th intercostal nerves using Frigitronics (Group C). Postoperative pain was assessed everyday for 7 days after the thoracotomy by a visual analog scale (VAS). The side effects and patient satisfaction of analgesia were assessed by a system of 4 grades. RESULTS: The VAS scores at rest in group C were significantly higher than those in group E. There was no side effect except numbness in group C, which continued for 3 months on the average. The incidences of side effects (nausea, vomiting, pruritus, sedation, urinary retention) were 15-35% in group E. The 35% of patients in group C were satisfied with postoperative analgesia compared with 95% in group E (P < 0.05). CONCLUSIONS: Epidural fentanyl provided a better analgesic effect than cryoanalgesia for thoracotomy, but there is a clinical advantage in cryoanalgesia over epidural fentanyl with respect to incidences of serious side effects not including. (Korean J Anesthesiol 2000; 39: 83-90)

Comparative Clinical Study of Pofol(Dong-guk Pharm Co.) with Diprivan(ICI Pharm Co.): Evaluation of Efficacy and Safety of Intravenous anesthetics "Pofol" / 대한마취과학회지

Propofol is a new, rapidly effective, short-acting intravenous sedative-hypnotic agent that can be used for induction and maintenance of general anesthesia. This study was performed to evaluate the efficacy and safety of domestic product Pofol in comparison with Diprivan for the management of total intravenous general anesthesia by double blind method. This study was approved by the Clinical Research Committee of SNUH. Test drugs were administered in a double-blinded fashion for the anesthesia. Seventy-four patients(aged 18-60 yr, operation time below two hours) were induced anesthesia with bolus injection of 2 mg/kg of test drug for 20 seconds and then anesthesia was maintained with continuous infusion method by syringe pump. Infusion dose of test drug during maintenance of anesthesia was controlled to maintain the systolic blood pressure measured at ward +/-20%. To evaluate the efficacy of drug, induction dose, mean maintenance dose, time to loss of conciousness after injection of induction dose and awakening time were measured or calculated. To evaluate the safety of drug, pain after injection of drug, recovery condition of patients and adverse events or side effects were recorded. Changes of blood pressure and heart rate were measured and arterial blood gas was also analyzed during perianesthetic period. There were no statistically significant differences in sex, age, weight, duration of anesthesia and ASA physical status distribution between Pofol group(P) and Diprivan group(D). There were no differences in induction dose and mean maintenance dose between P and D (mean+SD, 121+/-25 mg and 0.213+/-0.064 mg/kg/min vs 125+/-27 mg and 0.233+/-0.058 mg/kg/min, respectively). Time to loss of conciousness, time to response and time to orientation after cessation of drug were 14+/-19 sec, 10 min 2 sec+/-5 min 39 sec, 17 min 16 sec+/-9 min 43 sec for P and 14+/-26 sec, 12 min 52 sec+/-8 min 42 sec, 22 min 47 sec+/-14 min 17 sec for D. But there were no statistically differences between P and D, respectively. The incidence of pain after injection was 65.7% for P and 52.7% for D. Recovery from anesthesia was assessed as smooth in 82.9% for P and 91.7% for D. Adverse events during induction were recorded in four patients (apnea(1), opisthotonus(2) and hypotension(1)) for P and in two patients (apnea(1), bradycardia(l)) for D. The number of patients showed adverse events during maintenance of anesthesia and postanesthesia recovery period were same to P and D as 8 patients. Even though the characters of adverse events to P and D were different, the incidence rate was not different between two drugs. These adverse events were resolved without any specific treatment. In conclusion, there were no differences in efficacy and safety between Pofol and Diprivan.