We investigated the prevalence of bronchial hyperreactivity and atopic state in patients with chronic cough to see the cause and clinical significance of those factors in chronic cough.

We studied 92 individuals who had presented with paroysmal cough over 3 weeks without dyspnea or wheezing. Methacholine bronchial provocation test and allergic skin test with paranasal sinus X ray, symptoms, serum lgE levels and peripheral eosinophils were measured and analyzed.

1) Forty eight percent of patients showed positive hyperreactivity to methacholine provocation, 11 percent had postnasal drip syndrome and 9 percent had both of them, Three precent of patients were thought to have gastroesophageal reflux. However 29% has do specific causes for their cough.

2) Forty four percent of patients were atopic patients and others were non-atopics. There were no significant differences of symptom score, serum lgE levels and peripheral eosinophil count between the two groups.

3) Sixty two percent of atopic patients and 40 percent of non-atopic patient were cough variant asthma with positive reaction to methacholine provocation test. However there was no significant difference of mean PC20 of methacholine between the two group.

These results indicated that airway responsiveness and atopic started are important factors for chronic cough. However they were not predictable on the basis of clinical and ordinary laboratory findings.

Serologic test the diagnosis of Helicobacter(H.) pylori infection si one of noninvasive test that do not require endoscopy. This study was performed to evaluate the diagnostic value of serum anti-H. pylori lgG test, especially compared with other invasive tests.

From December 1995 to December 1996, one hundred and fifty one patients had UGI endoscopy and serum anti-H. pylori lgG test. They were 48 duodenal ulcer patients(36 active stage and 12 scar stage), 5 duodenitis patients, 19 gastric ulcer patients 2 duodenal ulcer with gastric ulcer patients, 48 gastritis patients, 13 gastric cancer patients, 4 postgastrectomy patients and 12 endoscopically normal patients. Serum anti-H. pylori lgG was measured by enzyme immunoassy(Enzygnost^R anti-H. pylori lgG kit). To determine the sensitivity and specificity of the serologic test, CLO test, culture and histopathology were used as reference tests for the diagnosis of anti-H. pylori infection.

The anti-H. pylori lgG antibody was positive(cutoff value ; 10U/mL) in 91 among 151 patients(60.3%). The positive rate of anti-H. pylori lgG showed slightly increasing tendency by age until the 6th decade of age(0% in 2nd decade, 52.4% in 3rd, 59.5% in 4th, 62.1% 5th, 67.8% in 6th 60.9% in 7th and 66.7% in 8th decade). According to the endoscopic diagnosis the positive rate of anti-H. pylori lgG was 61.1% in active duodenal ulcer, 63.2% in gastric ulcer, 64.6% in gastritis and 61.5% in gastric cancer, but it was only 25% in ednoscopically normal patients, which was significantly lower than active duodenal ulcer(p<0.05), gastric ulcer(p<0.05) and gastritis(p<0.05) patients. The concordance rate between anti-H. pylori lgG and COO test was 59.6%. Using the cutoff value of anti-H. pylori lgG titer as 10U/mL, the sensitivity and specificity of serum anti-H. pylori lgG test were 61% and 30%, when 20U/mL, 35% and 60%, and when 50U/mL, 20% and 90% respectively.

The sensitivity and specificity of serum anti-H. pylori lgG test were low in this study. Even though it is an noninvasive test, we cannot rely on it without other invasive tests for the diagnosis of H. pylori infection.

Apoptosis is a specific mode of cell death recognized by a characteristic pattern of morphological, biochemical, and molecular changes, There are several methods of detection of apoptosis. Morphological changes involve a characteristic pattern of chromation and cytoplasm. The landmark of apoptosis is endonucleolysis, with nuclear DNA initially degraded at the linker sections to fragments equivalent to single and multiple nucleosomes. Detection of DNA fragments is situ using the terminal deoxyribonucleotidyl transferase(TDT)-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay is increasingly applied to investigate apoptosis. We studied the detection method of apoptosis morphologically and by using TUNEL assay and examined the correlation of p53 expression and apoptosis.

Forty-five cases of colorectal cancer were selected. The number of apoptotic bodies was expressed as a number per 100 cancer cells. The TUNEL assay was performed with in situ Apoptag kit®.

The mean number of the apoptotic bodies was 2.28 in the patients who survived over 5 years after curative resection and 3.55 in the patients who died within 5 years(p=0.001). There was a relationship between the number of apoptotic bodies which were measured by morphologic study and the results which were measured by TUNEL assay. There was no relationship between p53 expression and apoptosis.

These results suggest that the frequency of apoptotic bodies may be a prognostic factor for colorectal cancer and apoptosis could be measured by morphological study without special study.

The intervertebral disc has an important role in the spinal biomechanics. The influence of lumbar discectomy on the disc space height is still uncleared. This study was performed to evaluate the long term influence of lumbar discectomy on intervertebral disc space height.

The author analysed the disc space height in 25 patients who had performed open discectomy for the disc herniation at least two years age. The height was compared with that of unoperated disc and evaluated the role of discectomy in the change of disc space height.

The decrease of disc space height was 3.3mm in average. The loss of anterior height was 4.1mm and that of posterior height was 2.5mm. This discrepancy was statistically significant(p<0.05). Although the difference of disc height loss in each disc space was not significant. the loss in L4-5 disc space was greater than that of other disc space.

These data suggest that lumbar discectomy accelerate the loss of disc height and influence the process of vertebral degeneration by change of spinal biomechanics in long term period.

The multifactorial character of cervical spondylotic myelopathy indicates a probable onset and progression of this disease as well as a diversity of clinical manifestations.

Patients admitted with the clinical symptomatology of a progressive myelopathy associated with radiologic findings compatible with spondylotic degeneration of the cervical spine and who manifest appropriate neurophysiological abnormalities should be considered as candidates for surgical treatment. For several decades, both anterior and posterior spinal decompressive procedures have been performed who are generally being informed before the operation that the aim of surgery is to stabilize their neurologic condition and that actual improvement often cannot be expected.

A retrospective analysis of 42 patients admitted to the Dongdaemoon hospital utilizing MRI, CT in small amount to make diagnosis and surgical indication of degenerative cervical spine lesions was undertaken. Almost all patents were taken T1 Weighted Image(T1W1),T2 Weighted Image(T2W1) and gradient echo image on 1.5 Tesla unit. All patients could be evaluated the extent and degrees of disc hemiation, osteophytes and cord compression.

A focal area of High-Signal-Intensity(HSI) was observed on T2W1 in 15 patients with myelopathy predominantly. HSI was diminished postoperatively in the patients who improved clinically , remained and unchanged who didn't improve.

In this study, MRI with high resolution images I the initial procedure of choice of degenerative cervical spine lesion was important on the decision making of the patients, Furthermore hight signal of the spinal cord by the compressive lesions appear to be an important indicator for predicting prognosis of patients with myelopathy.

Arterovenous malformations(AVVMs) represent the most commonly encountered symptomatic vascular malformations in the field of vascular neurosurgery. Surgically accessible AVMs that present with hemorrhage should be removed to reduce the risk of subsequent hemorrhage. The advance of surgery is based on the size, location and pattern of venous drainage and these anatomic features influence the treatment risk. The author studied the above features for predictor of the surgical resection of AVMs.

Nineteen patients(8 male and 11 female patients) with intracranial AVMs were treated at the Ewha Womans Medical Center between March 1989 and Dec. 1996. The mean age, and sexual ratio, of the pts as will as symptoms, location, feeding arteries, pattern of venous drainage and size of the nidus were studied. AVMs were graded according to the Spetzler and martin grade system. Overall outcome and postoperative results in eighteen patients were evaluated according to Glasgow Outcome SCale(GOS).

The average age at the time of treatment was 30.8 years old(range 4-55 years old). The hemorrhage was the most common symptom, occurring in 15(80%) patients, and 2(10%) patients presented with headache, 195%) patient with seizure, 1(5%) patient with neurological deficit. The feeding arteries were as the followings ; middle cerebral artery 8(42%), anterior cerebral artery 2(10%), posterior cerebral artery 1(5%), The pattern of draining veins were described into superficial and deep ; superficial 9(47%), deep 10(53%), The size of the nidus were as the followings ; small(<3cm) 9(47.5%), medium(3-6cm) 9(47.5%), large(>6cm) 1(5%), The Spetzler-Martin's grade and the outcome according to the grade were as follows ; grade I;3(17%) resulted GOS-5 3 patients, grade II ;5(26%) did GOS-5 6 patients, grade III; 5(26%) did GOS-5 4 patients and GOS-4 1 patient, grade IV;4(21%) did GOS-5 3 patients and GOS-4 1 patient, grade V;1(5%0 did GOS-1 1 patient. Overall, there were no death in surgical treatment, patients, the morbidity value was 2(10%) patients, the remainder were completely cured.

The Spetzler-Martin grade I-IV AVMs were associated with low rates of surgical morbidity and mortality, Therefore, surgery is the best treatment in the these grades.

The use of cis-platinum as therapeutic drug in malignant neoplasm has associated side effects such as nephrotoxicity and ototoxicity. The nephrotoxic effects of this drug is decreased by use of hydration method. The ototoxic effect, however, cause a irreversible sensorineural hearing loss and incidence of ototoxicity is not changed, so prevention of ototoxic effect is important.

The efficacies of fosfomycin, agent in ameliorating cisplatin induced ototoxicity, are investigated in guinea pig cochleas and the effects of pentoxifylline, agent in therapeutic drug of idiopathic sensorineural hearing loss, are evaluated anatomically by cochlear histology with scanning eletromicroscopy.

Protection against the distortion and injury of outer hair cell according to position of the cochlea caused by cicplatin was statistically significant in groups injected with fosfomycin. Also the injury of hair cells seen in groups injected with both pentoxifyllin and cisplatin was significantly higher than that of cisplatin only group.

Fosfomycin protects against cisplatin induced ototoxicity but pentoxifylline does not protect cesplatin induced ototoxicity.

This study attempts to explore the adapting behaviors of medical professions in information society, focusing on nurses' responses to the changes driven by the implementation of information system in four general hospitals. In addition to the general status of the information in the hospitals, we analyze four dimensions of the adapting behaviors of nursed in the implementation process of the hospital work. These are 1) changes in the jobs and functions of the nurses ; 2) changes in their autonomy and status; 3)changes in human relations ; and 4) the quality of medical services.

Both quantitative and qualitative data were collected from two university-affiliated hospitals and two private general hospitals in Seoul. The quantitative data contain the responses of 92 nurses from four hospitals and we performed an in-depth-interview with 12 nurse to complement the quantitative data.

1) The implementation of information system in the sample hospitals are limited to the computerization of the administrative part of the medical care.

2) This limited computerization of the hospital works does not seem to increase the efficiency of nursing itself, but rather put mote burden on nurses doing double jobs of handwriting and computerization.

3) The autonomy of nurses and their relate status has not been noticeably changed in the process. Nurses, however, reported to have conflicts with other professions over the job distributions.

4) The computerization of the hospital works tend to reduce an unnecessary face-to-face interaction, which is expected to facilitate communications in the hospital. But there are still conflicts among medical professions over the boundary of their duties and responsibilities.

5) Nurse pointed out that the positive effects of the computerization on the quality of service are limited to shorten the time of care.

The results of this study confirms our hypothesis that the information system would change jobs and functions, autonomy and status, human relations, and quality of sevices in nursing. Some of the changes are positive although the implementation of information system is expected to put more burden on nursing for a while. Most nurses, however, expected the computerization will provide better services to the patients in the long run.

Neuoleptic induced akathisia is an unsual state of subjective feeling of tension to move and objective motor restlessness, so frequently results in non-compliance. Several studies have suggested that akathisia is associated with low serum iron but there is no general agreement nowadays. Author investigated whether akathisic patients had lower indices of serum iron status than matched non-akathisic controls by 2 weeks-prospective study.

The subjects were 30 inpatients who were receiving antimycotic medication. Akathisia severity was measured by Chouinard rating scale, then 15 akathisic patients were matched with 15 non-akathisic controls for age, sex, length of illness, duration of treatment, the highest dosage of natipsychotic medication, and use of antiparkinsonian agents. The frequency of acute dystonia and AIMS for other extrapyramidal side effects were examed, also. Venous blood samples of all subjects were analysed for serum Fe, ferritin, TIBC on the 1st, 7th, and 14th medication day.

Sociodemographic factors, such as, sex, mean age, and clinical characteristics such as, length of illness, duration of treatment, the kinds and mean dosage of neuroleptics, were not different between the akathisia and the control group(p>0.05). The akathisic patients had significantly lower level of serum Fe than the control on 14th day(p<0.05), but no significant decrease during the 2 weeks follow-up(p>0.05). The frequency of acute dystonia, and anticholinergic medication were not different between the two groups(p>0.05), but AIMS score was significantly higher in the akathisia group(p<0.05).

Neuroleptic induced akathisia may be related to the low serum Fe. So, this study supports that low serum iron, via dopamine(D2) receptor hypofunction, increases the susceptibility to akathisia on antipsychotic medication.

Pneumocephalus is a pathologic collection of gas within the cranial cavity. Patients undergoing neurosurgical procedures may be at increased risk for the development of tension paneumocephalus if nitrous oxide(N₂O) is used during a subsequent anesthetic.

Thirty-seven patients undergoing cerebral aneurysm surgery had a computed tomographic scan of the head performed on or after the day of their surgery. 64 scans were examined for the presence of intracranial air. The magnitude of pneumocephalus was recorded as A-P(mm), width(m),& numbers of section.

Air was seen in all scans obtained in the first three postoperative days, During the second postoperative weeks, the incidence and the size of pneumocephalus decreased. A significant number of patients have an intracranial air collection in the first two weeks after the procedure.

These data indicate that all patients have pneumocephalus immediately after a cerebral aneurysm surgery. This information should be considered in the evaluation of the patient and the selection of anesthetic agents during a second anesthetic in the first 2 weeks after the first procedure.

Ultrasound has been found to be accurate, reliable and noninvasive method in the measurement of spleen. The study was undertaken to obtain standard values of size in three dimensions and normal range of splenic volume by the use of splenic volumetric index(SVI) in normal korean adults.

We experienced 100 cases of abdominal ultrasonography of normal korean adults from May 1995 to August 1995.

1) The average size of spleen in adult male was 6.85±1.31cm in breadth, 4.93±1.27cm in thickness, 6.33±1.46cm in height ; in adult females, 6.61±1.23cm, 5.17±1.26cm, 6.33. 42cm, respectively ; total average, 6.73±1,27cm, 5.05±1.27cm, 6.33±1.39cm,respectively.

2) The average splenic volumetric index in adult male was 8.20±3.95; in adult females, 8.41±4.08 ; total average,8.31±4.00. There were no statistical differences of SVI and size between sex and age.

Although ultrasonography is less accurate than computed tomography, it is rapid and simple method for splenic measurement.