The incidence of myocardial ischemia and silent myocardial infarction are higer in diabetic than in nondiabetic patients. We had a case of a disbetic, myocardial ischemic female patient, 54years old, who had cardiac arrest during an emergency surgery. The patient was admitted via emergency room with the diagnosis of rupture of basilar artery aneurysm. During the dissection for the exposure of the artery. The aneurysm ruptured. causing massive hemorrhage. At this time, cardiac arrest was revealed at the monitoring EKG, cardiopulmonary resuscitation with DC shock were performed to reverse venticular fibriliation but the EKG monitor showed T wave inversion and sinus tachycardia in several leads. And the blood pressure was hardly audible with systolic of about 50mmHg. So nitroglycerin 0.05mg, intravenous bolus injection was given twice and the systolic went up to 110mmHg with a diastolic of 80mmHg. So the operation proceeded and finished. The patient was sent to the ICU. On the third postoperative day, the patient again had cardiac arrest but this time could not be resuscitated. We experienced the dramatic effect of nitroglycerin on this ischemic patient during cardio pulmonary resuscitation and we would like to share this experience with our colleagues.
Aneurysm ; Arteries ; Blood Pressure ; Cardiopulmonary Resuscitation* ; Diagnosis ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Heart Arrest ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin* ; Rupture ; Shock ; Tachycardia, Sinus

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

Objective: The purpose of the present study was to screen the prevalence of aneurysms in migraineurs; to differentiate presenting features in migraineurs with and without aneurysm; and also to correlate the locations of aneurysm to the clinical features of migraine. Methods: A total of 4,416 subjects were interviewed and completed self-reported questionnaires on headache. Of these, 1,773 subjects diagnosed to have migraines based on the International Classification of Headache Disorders II (ICHD-II) criteria were screened for aneurysm by magnetic resonance angiography (MRA). When aneurysm was suspected, further investigation with trans femoral cerebral angiography (TFCA) or three dimensional computerized tomography (CT) angiography was performed. Based upon MRA findings, subjects were grouped into unruptured aneurysm migraine patients (UAMP) and no aneurysm migraine patients (NAMP). Results: The prevalence of aneurysm was 3.6% (63 of 1,773) with the mean age of 56.0 years, which were not different from those of general population. There was no difference in migraine subtypes between UAMP and NAMP. Aggravation of headache by estrogen replacement therapy during menopause (p=.039), history of migraine in young age (p= .021), diplopia (p=.026), and retroauricular pain (p=.025) were significantly associated with presence of aneurysm. Although aneurysms were detected more in anterior circulation, there was no correlation between aneurysm site and headache location. The average size of aneurysm was 3.5 ± 2.1 mm and none were ruptured. Interventional therapy of aneurysm did not alter the feature of migraine. Conclusions: The incidence of aneurysm was not different in migraine patients as compared to the general population. Some features which significantly differentiate whether migrainuers have aneurysm or not warrant further study to have a predictive and localizing value.

The salt-sensitivity has been generally accepted as a mechnism of high blood pressure in elderly hypertensive patients, and so it may result in a difference of renal handling of sodium and potassium between normal healthy control and elderly hypertensive patient. So to evaluate an lbove difference, the amount of 24 hours' urinary excretion of Na+ & K+ were measured in healthy normotensive control (10 case) and elderly hypertensive group(10 case) according to normal diet (12-15gm of NaCl) for first 3 days and low salt diet (3~5)gm of NaCi) for next 3 days, also blood rewwure was mintored. The results were followed : 1) 24 hours' urinary excretion of NA+ was increased in hypertensive group more than control group at first day of normal diet and low salt diet significantly. 2) After a replacement of normal diet to low salt diet, a maximal decrement of 24 hours' urinary excretion of Na+ was 25% at first day in control but 40% at second day in hypertensive group only. 3) There was a similar pattern of urinary excretion of K+ as Na+ in hypertensive group, but it was not stastically significant. 4) There was no significant changes of blood pressure, serum electrolyte and BUN/creatinine according to salt intake in both group. From above findings. We can conclude that a urinary excretion of sodium is delayed in elderly hypertensive group, and it is suggested that a delayed excretion of sodium. is associated with retention of sodium in body. So a persistent restriction of sodium is recommended in elderly hypertensive patient.
Aged ; Blood Pressure ; Diet ; Humans ; Hypertension ; Potassium* ; Sodium*

No abstract available.

No abstract available.
Esophagus*

No abstract available.
Arteriovenous Fistula* ; Renal Dialysis*

BACKGROUND AND PURPOSE: Discrepancies between objectively measured sleep and subjective sleep perception in patients with insomnia have been reported. However, few studies have investigated sleep-state misperception in patients with obstructive sleep apnea (OSA). We designed this study to 1) delineate the factors that could affect this discrepancy and 2) infer an underlying mechanism in patients with OSA. METHODS: We recruited patients who visited our sleep clinic for the evaluation of their snoring and/or observed OSA. Participants completed a structured questionnaire and underwent overnight polysomnography. On the following day, five sessions of the multiple sleep latency test (MSLT) were applied. We divided the patients into two groups: normal sleep perception and abnormal perception. The abnormal-perception group included patients whose perceived total sleep time was less than 80% of that measured in polysomnography. RESULTS: Fifty OSA patients were enrolled from a university hospital sleep clinic. Excessive daytime sleepiness, periodic limb movement index (PLMI), and the presence of dreaming were positively associated with poor sleep perception. REM sleep near the sleep termination exerted important effects. Respiratory disturbance parameters were not related to sleep perception. There was a prolongation in the sleep latency in the first session of the MSLT and we suspected that a delayed sleep phase occurred in poor-sleep perceivers. CONCLUSIONS: As an objectively good sleep does not match the subjective good-sleep perception in OSA, physicians should keep in mind that OSA patients who perceive that they have slept well does not mean that their OSA is less severe.
Dreams ; Extremities ; Humans ; Polysomnography* ; Sleep Apnea, Obstructive* ; Sleep Initiation and Maintenance Disorders ; Sleep, REM ; Snoring

BACKGROUND: There are reports suggesting the effect of red blood cells (RBCs) on blood coagulation. The effects of red blood cells (RBCs) on coagulation were investigated in vitro while maintaining other coagulation elements constant. METHODS: Twenty-five healthy male volunteers were enrolled. Citrated fresh whole blood was drawn from each subjects and processed into washed RBCs and platelet-rich plasma (PRP). To make six different hematocrit groups with each blood, PRP was mixed with the same volume of serially diluted washed RBCs. Reaction time, coagulation time, clot formation rate, and maximum amplitude were measured using recalcified TEG. RESULTS: The mean +/- SD of six different hematocrit was 38.0 +/- 2.3% (group 1), 28.9 +/- 2.2% (group 2), 21.3 +/- 1.9% (group 3), 13.8% +/- 1.6% (group 4), 7.1 +/- 1.0% (group 5), and 0 +/- 0% (group 6). The platelet count ranged from 141,000 to 292,000/mm3. Maximum amplitude (r = -0.4213, P< 0.001) and alpha angle (r = -0.216, P< 0.05) showed statistically significant negative linear relationship with hematocrit. CONCLUSIONS: A gradual reduction in hematocrit was associated with a shortened coagulation time, no changes in reaction time. This study results suggest that a gradual reduction in the RBC mass in vitro accelerates coagulation and forms stronger fibrin strands.
Blood Coagulation ; Erythrocytes ; Fibrin ; Hematocrit ; Humans ; Male ; Platelet Count ; Platelet-Rich Plasma ; Reaction Time ; Thrombelastography

BACKGROUND: Neurological injury after cerebral air embolism may be due to thromboinflammatory responses at sites of air-injured endothelium. Because heparin inhibits multiple thromboinflammatory processes. we hypothesized that heparin would decrease neurological impairment after cerebral air embolism. METHODS: Anesthetized rabbits received either heparin (n=14) or saline (n=13), 5 minutes before air injection (150 microliter/kg). Heparin was given as a 200 IU/kg bolus and followed by a constant infusion of 75 IU/kg/h for 2 hours. Equal volumes of salines were given to saline group. Two hours later, anesthesia was discontinued. Rabbits were neurologically evaluated 24 hours after air embolism. RESULTS: Heparin group had significantly less neurological impairment at 24 hours (34 14) than saline controls (52 8) (p=0.0013). CONCLUSIONS: When given prophylactically, heparin decreases neurological impairment caused by severe cerebral arterial air embolism.
Anesthesia ; Embolism, Air ; Endothelium ; Heparin* ; Rabbits*