BACKGROUND AND OBJECTIVES: Heart rate variability (HRV) illustrates the autonomic integration of the heart. Depressed HRV has been proven to be associated with an increased risk of cardiac death, whereas heart rate turbulence (HRT) is believed to reflect baroreflex sensitivity and it was recently introduced as another noninvasive tool for risk stratification. The aim of this study was to determine the relationship between the HRT and HRV parameters in Korean adults with a structurally normal heart. SUBJECTS AND METHODS: We studied 61 adults (males: 31) who showed ventricular premature complexes on 24 hour Holter recording and who were found to have normal hearts on full noninvasive investigation. We calculated the mean heart rate (RR interval), the number of VPBs, the time- and frequency-domain HRV parameters and two HRT parameters: turbulence onset (To) and turbulence slope (Ts). RESULTS: Ts showed a strong correlation with the HRV parameters (LF/HF ratio: r=0.35, p=0.006; VLF: r=0.32, p=0.013; LF: r=0.27, p=0.035; SDNN: r=0.28, p=0.029; SDANN: r=0.32, p=0.012), but To showed no significant correlation with the HRV parameters. CONCLUSION: The HRT parameters, and especially Ts, correlate strongly with the HRV parameters; therefore, Ts should be considered as a parameter that reflects the overall cardiac autonomic tone.
Adult* ; Baroreflex ; Death ; Heart Rate* ; Heart* ; Humans ; Ventricular Premature Complexes

Objective: We analyzed the number of deaths due to poisoning by pesticides over 38 years through vital statistics published annually by the Ministry of Health, Labour and Welfare of the Japanese government, from 1968 through 2005. Materials and Methods: Data not published as vital statistics were obtained from the Ministry of Health, Labour and Welfare Statistics and Information Department. The vital statistics provide the numbers of deaths with individual causes of death classified by sex and 5-year age group. We also calculated age-adjusted death rates by this classification, using a direct method based on the 1985 Japanese model population. Results: Deaths from pesticide poisoning increased rapidly beginning in 1982, reached a peak in 1986 (death rate per 100,000 population: 2.6 in males and 1.7 in females) and declined gradually thereafter. In the most recent several years, these figures have declined to levels previously unseen (death rate per 100,000 population: 0.4 in males and 0.3 in females). A difference in death rates between the sexes was observed at every age level, with death rates of males approximately 1.1-1.5-fold those of females. In the 1985-1987 data, these figures were highest in the three prefectures of northern Kanto (Tochigi, Gunma, and Ibaraki Prefectures; crude death rates per 100,000 population: 6.8, 6.8, 6.2, respectively), followed by that in Kagoshima Prefecture (5.0). In the 2003-2005 data, the figure was highest in southern Kyushu (Miyazaki Prefecture; crude death rate per 100,000 population: 1.9), followed by Tochigi (1.6), Ibaraki (1.4), and Kagoshima (1.4). Conclusions: Deaths from pesticide poisoning were extremely well correlated to the history of paraquat. Through the 1985 Advisory Resolution on Paraquat Regulations by the Japanese Association of Rural Medicine and other public health-oriented efforts, the concentration of highly fatal paraquat formulations was reduced, leading to discontinuation of its production, customer identification was strictly enforced when purchasing pesticides, and people's safety consciousness regarding pesticides improved. We regard and these developments as having had the greatest contribution to the reduction in deaths from pesticide poisoning.
Pesticides ; Death Rate ; seconds ; Vital Statistics ; Poisoning aspects

No abstract available.
Cause of Death* ; Humans ; Kidney Failure, Chronic* ; Renal Dialysis* ; Survival Rate*

OBJECTIVES: We studied the circadian rhythm of nonlinear heart rate dynamics in healthy subjects. BACKGROUND: The frequency of sudden cardiac death increases in the morning. The relationship between decreased complexity of heart rate dynamics and sudden cardiac death has been documented. An understanding of the circadian variation in the complexity of cardiac dynamics may be important and to predict and prevent this sudden cardiac death. METHODS: Dynamic 24-hour electrocardiographic recordings were obtained from 30 healthy ambulant subjects aged 41 to 50 years and the digitized data was partitioned into sections of 30 minutes' duration. For each section, four indexes obtained from separate algorithms of nonlinear dynamics of RR interval - correlation dimension, Lyapunov exponent, approximate entropy, and fractal dimension - were calculated. Normalized low- (0.04-0.1 hertz) and high-frequency (>0.15 hertz) components were also calculated. RESULTS: All the four indexes of nonlinear dynamics showed a remarkably similar circadian rhythm: a prominent morning dip preceded by a steep decline during the late night, a recovery during the evening and a peak around midnight. In the morning, the low frequency component rose rapidly with concomitant withdrawal of the high frequency component. CONCLUSION: The complexity of cardiac dynamics decreases significantly in the morning, and this may contribute to the ominously increased rate of cardiac death in the morning hours.
Circadian Rhythm* ; Death ; Death, Sudden, Cardiac ; Electrocardiography ; Entropy ; Fractals ; Heart Rate ; Nonlinear Dynamics

Anesthesiologists are faced with a growing number of patients in need of cardiac pacing with symptoms of increasing complexity. Because intraoperative pacemaker malfunction can lead to sudden death, it is important for the anesthesiologists to possessthe information necessary to evaluate and treat such patients. On the other hand, torsade de pointes, a particular form of life-threatening polymorphic ventricular tachycardia, is known to be elicited in patients with cardiac pacemakers in the setting of abnormally long QT intervals, decreased heart rate and severe electrolyte disturbances, notably hypokalemia. We herein report a case of intraoperative torsade de pointes that was triggered by pacemaker malfunction-induced bradycardia in a patient with a VVI-type cardiac pacemaker, whose serum potassium and magnesium level were low preoperatively. (Korean J Anesthesiol 1999; 37: 164~167)
Bradycardia ; Death, Sudden ; Hand ; Heart Rate ; Humans ; Hypokalemia ; Magnesium ; Potassium ; Tachycardia, Ventricular ; Torsades de Pointes*

Pediatric surgery could establish a definitive position in the medical field on the basis of a stable patient population. Neonatal surgery, the core of pediatric surgery, requires highly skilled surgeons. However, recent advancement of prenatal diagnosis followed by intervention and decreased birth rate has resulted in a significant decrease in the neonatal surgical population and the number of surgical operations. The purpose of this study is to examine the outcome of neonatal surgeries and to propose a guide for the future surgeries. A total of 359 neonatal surgical patients operated upon at the Department of Surgery, Ewha Medical Center, during past 21 years were studied. The study period hasbeen divided into two time periods : from 1983 to 1993 and from 1994 to 2004. Analysis was based on the Clinical Classification System and mortality pattern, frequency of disorders, occurrence and cause of death, and other changes. Neonatal surgery was 6.4 % of all pediatric surgery during the total 21 year period, 9.9 % in the first period and 4.8 % in the second. Male to female ratio increased from 2.7 : 1 to 2.1 : 1. The overall mortality was 6.7 %, and there was significant decrease from 7.4 % in the first period to 6.0 % in the second. The clinical classification system (CCS) for death cases included class II 2, III 4, and IV 7 during the first period and class III 3, and IV 8 during the second, respectively. According to the mortality pattern by Hazebroek, there were 6 preventable death cases during the first period, and only one in the second, and 2 non-preventable death cases during the first period and 8 in second, respectively. Although the patients in the second period had more serious diseases, surgical mortality has been decreased in the second period, which may be the result of improved surgery methods for newborns and advanced patient care.
Birth Rate ; Cause of Death ; Classification ; Female ; Humans ; Infant, Newborn* ; Male ; Mortality* ; Patient Care ; Prenatal Diagnosis

OBJECTIVETo establish a stable and modified mouse model of brain death (BD) and to share our experiences in BD induction and maintenance.

METHODSTotally 35 C57BL/6 male mice were randomized into BD group (n=25) or sham control group (n=10). BD was induced by inserting a 2F Fogarty catheter connected to a syringe pump after trepanation of the left frontoparietal area and injecting volume at the speed of 6 μl/min until spontaneous respiration ceased. BD was diagnosed by electroencephalogram, apnea testing,as well as testing of brain stem reflexes. Mechanical ventilation was performed by orotracheal intubation. Right carotid artery was intubated by a PE-10 cannula for the continuous monitoring of mean blood pressure (MAP) and heart rate (HR). The right external jugular vein was catheterized for volume resuscitation.The sham control group underwent the same procedure with catheter insertion but without balloon inflation.Livers were removed and fixed in paraffin to evaluate the histological alterations with the light microscopy.

RESULTSMouse models of BD were successfully established about 20 minutes after balloon inflation, and the mean balloon volume at the time of BD was (105.77 ± 21.57)μl. The MAP and HR rapidly increased on occurrence of BD and the peak value was (128.28 ± 17.16) mmHg and (434.16 ± 55.75) beat/min, respectively, which were significant higher than those in the sham control group at the same time point (P=0.000). During the 4-hour follow-up time, MAP and HR in 72% (18/25) of BD animals remained haemodynamically stable. No animal died due to anesthesia and surgical operation.Hepatic tissues in BD mice showed mild focal ischemic damages (cellular edema, congestion, and inflammatory infiltration), which were slighter and fewer in sham control group.

CONCLUSIONThe mouse model of BD was successfully established with lower surgical difficulty and can be performed in a standardized, reproducible and successful way.

STUDY DESIGN: This is a retrospective study analyzing survivorship of pedicle screw fixation in various spinal lesions. OBJECTIVES: To determine the survivorship of pedicle screw fixation and to assess the risk factors for the death of system. SUMMARY OF LITERATURE REVIEW: The previous reports of ten years survival rate of pedicle screw instruments was about eighty percent and the factors which influenced were bone quality, strength of instruments, design of instruments and compliance of patients. MATERIALS AND METHODS: Three hundred and thirty-eight patients(178 males and 160 females), treated by pedicle screw fixation from May 1988 to Dec. 1997, were analysed. Follow-up averaged 26.8months(3 to 116 months). The survival rates according to spinal lesions which caused spinal fixation, types of instruments, level of fusion and methods of fusion were predicted by life table method. The criteria of death were 1)breakage of screw or rod 2)gross bending of screw >5 degree 3)screw pullout and 4)dissociation of rod-screw coupling mechanism. RESULTS: Death of instrumentation was identified in twenty-six patients(7.7%). Of the 1,827 screws used, forty-three screws(2.4%) in twenty patients had broken(28) or bent(15). Thirty-nine Cotrel-Dubousset screws(3.5%) and four Diapason screws(1.6%) had involved. Four patients showed pullout of screws and two had dissociation of rod and screw. There was no rod broken. Life table calculations predicted the survivorship of instrumentation would be 88.7% at 10 years of follow-up. Single segment fixation showed higher survival rate than more than three segments fixation(93.3% vs 83.4%). Fracture had the lowest survival rate(78.3%). Screw failure was not influenced by the method of fusion. Suspected causes of death were collapse of disc space(12 patients), increased kyphosis(6), forceful reduction of fracture(3), infection(2), nonunion(2) and trauma(1). CONCLUSIONS: Ten year survival rate of pedicle screw fixaion was 88.7%. The survival rate was influenced by 1)number of fixed segments 2)cause of fixation .
Cause of Death ; Compliance ; Follow-Up Studies ; Humans ; Life Tables ; Male ; Retrospective Studies ; Risk Factors ; Survival Rate*

OBJECTIVE: To evaluate the value of intrauterine shunting and to investigate the complication and outcome of these procedures for different fetal indications. METHODS: 7 fetuses who underwent 13 intrauterine catheter shunting from 1992 to 1997 were reviwed. The indications were uni-or bilateral hydrothorax in 4 cases, ascites in one case, and obstructive uropathy in 2 cases. RESULTS: Catheter migration occurred 6 times out of the 13 shunts (46%). Procedure related death rate was 23% (3/13); within 48 hours of pleuroamniotic shunting, amniorrhexis and coincidental abruptio placenta resulting in one fetal death and each one of amniorrhexis and premature labor resulting in 2 neonatal deaths. Pregnancy was terminated after shunting in one case of urethral atresia. Postnatal survival rate was 50% (3/6). CONCLUSION: A high complication rate requires the selection of cases for shunting. A large prospective controlled trial is needed to determine its value.
Ascites* ; Catheters ; Female ; Fetal Death ; Fetus ; Hydrothorax* ; Mortality ; Obstetric Labor, Premature ; Placenta ; Pregnancy ; Survival Rate

BACKGROUND AND OBJECTIVES: Sirolimus-eluting stents (SES) have been shown to significantly inhibit neointimal hyperplasia, resulting in reduced restenosis compared with bare metal stents (BMS). However, the efficacy and safety of SES implantation for patients with acute ST-segment elevation myocardial infarction (STEMI) remain unclear. SUBJECTS AND METHODS: Primary stenting was performed using SES in 74 patients (mean age: 58.0+/-12.7 years, 59 males) and BMS in 88 patients (mean age: 59.3+/-10.7 years, 63 males) between April 2003 and July 2004. We retrospectively compared the incidence of 6-month angiographic restenosis and the major adverse cardiac events (MACE) defined as cardiac death, non-fatal myocardial infarction and target lesion revascularization (TLR), between the SES group and the BMS group. RESULTS: The SES group had smaller vessels (3.04+/-0.47 mm vs. 3.24+/-0.56 mm, respectively, p=0.02) and a longer stent length (33.7+/-14.3 mm vs. 25.0+/-9.6 mm, p=0.00). The procedural success rate (87.8% vs. 92.0%, respectively, p=0.37) and the peak creatine kinase-MB (239+/-196 ng/mL vs. 274+/-188 ng/mL, p=0.26) were similar. The 6-month angiographic restenosis rate (0.0% vs. 30.4%, respectively, p=0.00) and late loss (-0.03+/-0.55 mm vs. 1.28+/-0.58 mm, p=0.00) were significantly lower in the SES group compared with the BMS group. Stent thrombosis developed in only 1 case of the SES group (1.4% vs. 0.0%, respectively, p=0.45). At 6 months, SES implantation significantly reduced the incidence of MACE (6.9% vs. 19.5%, respectively, p=0.04), because of a reduction in the incidence of TLR (1.4% vs. 11.5%, p=0.01). Likewise, the MACE-free survival rate was significantly higher in the SES group (93.06% vs. 80.46%, respectively, p=0.03). CONCLUSION: Compared with the BMS, the SES was effective in reducing the incidence of 6-month angiographic restenosis and MACE without any increased risk of stent thrombosis in the patients with STEMI who received primary stenting.
Creatine ; Death ; Humans ; Hyperplasia ; Incidence ; Myocardial Infarction* ; Retrospective Studies ; Sirolimus ; Stents* ; Survival Rate ; Thrombosis