BACKGROUND: It is well known that neuronal degeneration can occur after a brief deprivation of energy source. To investigate whether glial astrocyte can induce a phenomenon of delayed cell death after transient energy loss and to see how different are the effects of nifedipine, lidocaine, carnosine and hypothermia on delayed toxicity in astrocyte. METHODS: Human astrocytoma cells (U1242MG) were used in this study. To assess the astrocyte survival during post-ischemic period after transient histotoxic hypoxia, 3-[4,5-dimethylthiazol-2yl]-2,5, diphenyl tetrazolium bromide (MTT) test was used. Compared to MTT test, tryphan blue test was also used to demonstrate membrane damage of affected cells. Studies on intracellular calcium dynamics during ischemic and post-ischemic period were carried out with fluo-3 and flow cytometry system. RESULTS: The percentage survival of astrocyte during post-ischemic period was decreasing with time. Calcium channel blocker nifedipine, sodium and calcium channel blocker lidocaine and free radical scavenger carnosine could not prevent post-ischemic cell damage. But, hypothermia was only an effective method in ameliorating post-ischemic cell death. Intracellular calcium increase during ischemia and post-ischemia was dependent on extracellular calcium influx. CONCLUSIONS: Only hypothermia was effective in reducing astrocyte death during post-ischemia after transient energy depletion. Intracellular calcium alterations during post-ischemia was from extracellular space.
Anoxia* ; Astrocytes* ; Astrocytoma ; Calcium ; Calcium Channels ; Carnosine ; Cell Death ; Extracellular Space ; Flow Cytometry ; Humans ; Hypothermia* ; Ischemia ; Lidocaine ; Membranes ; Neurons ; Nifedipine ; Sodium

No abstract available.
Calcium* ; Lidocaine* ; Neuroglia* ; Reperfusion*

BACKGROUND: The fast EMS helicopter was introduced to Korea in 1996 and from Dec. 1. 1997, it was used far transporting emergent patients. Authors, here upon, report the transporting experiences. METHODS: From Dec. 1, 1996 to Dec. 31,1997, Samsung Medical Centers EMS helicopter was used for air evacuation of critically ill patients. The patients data prospectively analyzed. RESULT: A total of 65 patients were transported. Male to female ratio was 1.95 : 1. The mean transport time was 64.1min(10-160 min). Majority of the evacuated patients was surgical patients (General Surgery'16, Orthopedic surgery : 10, Neurosurgery : 6, Infernal medicine 13, Pediatrics : 3, and others : 3). Twenty-one of the 65 patients transported were admitted to ICU and 31 did not require ICU care. During the air evacuation, one physician and one nurse trained for air evacuation amended The patients. No medical problems or deaths developed during the air evacuation period. CONCLUSION: The first EMS helicopter was introduced to Korea in 1996. From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data reported.
Aircraft* ; Critical Illness ; Emergencies* ; Female ; Humans ; Korea ; Male ; Neurosurgery ; Orthopedics ; Pediatrics ; Prospective Studies

Laparoscopic Burch operation is one of laparoscopic surgery for stress urinary incontinence. Subcutaneous emphysema and hypercarbia are potential complications of laparoscopic surgery, but are more likely to occur in extraperitoneal surgery than in intraperitoneal surgery, since insufflated CO2 can diffuse easily into the surrounding tissues. We report a patient in whom pneumomediastinum and extensive subcutaneous emphysema developed during laparoscopic Burch operation. Transient hypoxemia was also accompanied with hypercarbia. Possible mechanisms are presented, along with discussion of prompt diagnosis and treatment. For the management of laparoscopic extraperitoneal surgery, it is necessary to be careful with monitoring of CO2 insufflation pressure, routine examination and palpation of chest wall, use of N2O with caution, increase of ventilation to eliminate CO2, and excluding other causes of subcutaneous emphysema and hypercarbia.
Anoxia ; Carbon Dioxide ; Diagnosis ; Humans ; Insufflation ; Laparoscopy ; Mediastinal Emphysema* ; Palpation ; Subcutaneous Emphysema* ; Thoracic Wall ; Urinary Incontinence ; Ventilation

BACKGROUND: Intravenous patient controlled analgesia (IV-PCA) is a very popular and relatively safe technique due to its innate negative feedback mechanism. Morphine, the most commonly used analgesic, however, has its own drawbacks due to troublesome side effects. Narcotic agonist-antagonists are known to have ceiling effects not only to their analgesic potency, but also to their side effects. The authors studied the efficacy and incidence of side effects of Butorphanol IV-PCA for postoperative analgesia and compared these to morphine. METHODS: 38 ASA class I or II patients, undergoing gynecological surgery were randomly assigned into two groups, respectively Butorphanol and Morphine and examined hemodynamic changes, overall pain relief, patients satisfaction and the frequency of side effects. After general anesthesia, each patient randomly received loading dose of butorphanol or morphine in the recovery room and discharged to the floor with the PCA module. Upon arrival, individual patient was evaluated at predetermined time interval for 24 hours. RESULTS: The percentage of patient satisfaction was very high in both groups. The incidence of nausea was less in butorphanol group. The incidence of other side effects was statistically insignificant. CONCLUSIONS: Butorphanol has less incidence of side effects and comparable level of analgesia when compared to morphine. We conclude that butorphanol may be considered as a part of routine IV-PCA regimen, in postoperative pain management.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia, General ; Butorphanol* ; Female ; Gynecologic Surgical Procedures* ; Hemodynamics ; Humans ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Recovery Room

BACKGROUND: Mechanisms of secondary injury(post-ischemic injury) in the central nervous system have recently reported in a vast of amount of experiments. Among many factors which give rise to post-ischemic neuronal damage, glial deterioration probably mediated by calcium paradox, could be another of the aggravating deleterious factors to the already ischemic neurophil. METHODS: here we have designed experiment to investigate calcium paradox in astroglial cell line, human astrocytoma U1242MG. Intracellular calcium alterations in experimental cells were monitored by using calcium indicating dye fura-2 and epifluorescent photometry system. RESULTS: Intracellular free calcium changes during reperfusion phase after exposure to low calcium led to a prompt increase in intracelluar calcium level after 10 and 30 minutes. The way of calcium entry during the reperfusion phase was mediated by the reverse mode of NA+/Ca2+ exchanger. Cells that had a reduction of reperfusate calcium to 10uM increased cell viability. Also we observed an inverse relationship between major enzymatic activity in the astrocytoma cells(i.e., gultamine synthetase activity) and the duration of reperfusion in the the same protocols. CONCLUSIONS: A relatively small amount of intracellular clcium increase by the reverse mode of Na+/Ca2+ exchanger during the reperfusion period is related to a limitation of enzyme activity and viability 24hours later.
Astrocytoma ; Brain ; Calcium ; Cell Line ; Cell Survival ; Central Nervous System ; Fura-2 ; Humans ; Ions ; Ligases ; Neuroglia* ; Neurons ; Photometry ; Reperfusion Injury* ; Reperfusion*

Background: Conventional laryngoscopy with Macintosh blade requires a movement of the head, neck and cervical spine. The Bullard laryngoscope is an anatomically shaped, potentially eliminating the need for cervical spine extension. Bullard and Macintosh laryngoscopes were compared by measuring the degree of cervical spine extension by radiological measurement. Methods: Eighteen patients requiring endotracheal intubation were studied. Anesthesia was induced in neutral head position followed by laryngoscopy. Each patients was intubated two times by Macintosh and Bullard laryngoscope in random order. Radiographic evaluation was performed to determine the degree of cervical spine extension on four occasions; before induction, during facial mask ventilation, and during Bullard and Macintosh laryngoscopy. Results: The extension of cervical spine was significantly less following Bullard laryngoscopy than Macintosh laryngoscopy for best view (p<0.05). Conclusions: The Bullard laryngoscope can be used with less cervical spine extension than Macintosh laryngoscope. It may be useful in patients in whom cervical spine movement is limited or undesirable.
Anesthesia ; Head ; Humans ; Intubation, Intratracheal ; Laryngoscopes ; Laryngoscopy* ; Masks ; Neck ; Spine* ; Ventilation

"Background: In using the Double-lumen tube (DLT), knowing the minimum bronchial cuff volume (MCV) for an effective air-tight seal will be useful; to provide a collapse of the lung; and to avoid pressure damage. The aims of the present study are thus three-fold: to measure the MCV; to measure the diameter of left main bronchus (LMBD); and to prove any relationships between two parameters. METHODS: One hundred men and forty women who needed intubation of left-sided DLT were enrolled in this study. 37 Fr DLTs were used in male patients, and 35 Fr DLTs were used in female patients. We evaluated the MCV by air bubble method and measured the LMBD in chest PA. We also evaluated the pressure/volume characteristics of the bronchial cuffs by control inflator. RESULTS: 29 patients of 100 patients (29%) exhibited persistent air leakage in 2.5 ml cuff volume in male patients (group of MCV >2.5). On the contrary, 18 patients of 40 patients (45%) did not require any cuff volume in female patients (group of MCV 0). The mean LMBD were 13.23 1.45 mm in male and 11.09 0.96 mm in female. There were significant positive correlations between MCV and LMBD in both sex and their respective correlation coefficients were 0.264 (P=0.008) in male and 0.484 (P=0.002) in female. The equations of linear regression were: LMBD = 12.394 0.429xMCV in male, LMBD = 10.725 0.438xMCV in female. CONCLUSIONS: The MCV of the brochial cuffs in left-sided DLTs has significant relationships with the LMBD measured in chest PA.
Bronchi ; Female ; Humans ; Intubation ; Linear Models ; Lung ; Male ; Thorax

BACKGROUND: Hemodilution reduces the concentration of clotting factors in blood and this may induce some degree of impairment of coagulation. But there are some evidence that hemodilution may induce a hypercoagulable state. The goal of this study is to investigate the changes of coagulation status during progressive hemodilution. METHODS: Whole Blood was diluted by 10% increment to 80% with 0.9% normal saline. At each 10% dilution blood coagulation status was analysed using thrombelastography (TEG) and was compared with that of an undiluted control specimen obtained concurrently from the same patients. RESULTS: Hemodilutions up to 40% decrease r and K times and increase values of MA and angle. Hemodilutions more than 70% increase r and K times and decrease values of MA and angle. CONCLUSIONS: Hemodilutions up to 40% increase coagulability and hemodilutions more than 70% decrease coagulability of whole blood in vitro.
Blood Coagulation ; Hemodilution* ; Humans ; Thrombelastography

OBJECTIVE: A national survey was conducted to assess orthodontic residents' current concepts and knowledge of cleft lip and palate (CLP) management in Korea. METHODS: A questionnaire consisting of 7 categories and 36 question items was distributed to 16 senior chief residents of orthodontic department at 11 dental university hospitals and 5 medical university hospitals in Korea. All respondents completed the questionnaires and returned them. RESULTS: All of the respondents reported that they belonged to an interdisciplinary team. Nineteen percent indicated that they use presurgical infant orthopedic (PSIO) appliances. The percentage of respondents who reported they were 'unsure' about the methods about for cleft repair operation method was relatively high. Eighty-six percent reported that the orthodontic treatment was started at the deciduous or mixed dentition. Various answers were given regarding the amount of maxillary expansion for alveolar bone graft and the estimates of spontaneous or forced eruption of the upper canine. Sixty-seven percent reported use of a rapid maxillary expansion appliance as an anchorage device for maxillary protraction with a facemask. There was consensus among respondents regarding daily wearing time, duration of treatment, and amount of orthopedic force. Various estimates were given for the relapse percentage after maxillary advancement distraction osteogenesis (MADO). Most respondents did not have sufficient experience with MADO. CONCLUSIONS: These findings suggest that education about the concepts and methods of PSIO and surgical repair, consensus regarding orthodontic management protocols, and additional MADO experience are needed in order to improve the quality of CLP management in Korean orthodontic residents.
Cleft Lip ; Consensus ; Surveys and Questionnaires ; Dentition, Mixed ; Hospitals, University ; Humans ; Infant ; Korea ; Orthodontic Extrusion ; Orthopedics ; Osteogenesis, Distraction ; Palatal Expansion Technique ; Palate ; Surveys and Questionnaires ; Recurrence ; Transplants