No abstract available.
Humans

No abstract available.
Humans ; Infant, Newborn* ; Respiration, Artificial*

No abstract available.
Gestational Age* ; Mortality

In an attempt to define quantitatively the relation between left atrial size and atrial fibrillation, echocardiography was used to study 58 patients with mitral stenosis and sinus rhythm, 22 patients with mitral stenosis and newly appeared atrial fibrillation, 62 patients with mitral stenosis and atrial fibrillation, 14 patients with sinus rhythm who undergone mitral valve replacement, 18 patients with atrial fibrillation who undergone mitral valve replacement,17 patients with idiopathic atrial fibrillation and 22 control persons. In all groups of mitral stenosis, atrial fibrillation was rare when left atrial dimension was below 40mm but common when this dimension exceeded 40 mm. When left atrial dimension exceeded 50 mm, sinus rhythm was rare even in patients who undergone mitral replacement operation. These data suggest that left atrial size is an important factor in the development of atrial fibrillation. To reduce the risk of systemic embolism complicating atrial fibrillation and to reduce the need of long term anticoagulant therapy postoperatively, the left atrial dimension should be followed closely for the patients with mitral stenosis.
Atrial Fibrillation* ; Echocardiography* ; Embolism ; Heart Atria* ; Humans ; Mitral Valve ; Mitral Valve Stenosis

BACKGROUND: Recently, using propofol as intravenous anesthetic agent is increasing. And it is known that propofol has little effects on liver function even after long operation such as plastic surgery. But its effect on liver functon after hepatobilliary operation which may damage liver was not studied. Thus, authors carried out this study to evaluate the effect of propofol on liver function by comparing with enflurane in the patients who had laparoscopic cholecystectomy. METHODS: Patients's anesthesia records and hospital charts from January 1994 to June 1996 were anlaysed retrospectively. Three hundred and thirty three patients who had normal liver function preoperatively and had no complications during and after operation were selected. They were divided into two groups ; propofol group (n=191) and enflurane group (n=142). The preoperative values of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were compared with those of 1 and 3 days after operation. RESULTS: One day after operation, both propofol and enflurane group showed significant increase in AST and ALT (p<0.05) and decrease in ALP (p<0.05). But there was no difference between two groups. CONCLUSION: Concerned to liver function, propofol is as useful as enflurane to the patients who scheduled for laparoscopic cholecystectomy.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia* ; Aspartate Aminotransferases ; Cholecystectomy, Laparoscopic* ; Enflurane* ; Humans ; Liver* ; Propofol* ; Retrospective Studies ; Surgery, Plastic

No abstract available.
Chest Pain* ; Emergencies* ; Emergency Service, Hospital* ; Thorax*

BACKGROUND: Although impaired endothelial function is well known in patients with diabetes mellitus, the precise mechanism and the factors that contribute to this dysfunction remain to be clarified. We examined the effect of acute hyperglycemia on patients with impaired glucose metabolism in vivo by plethysmography. METHODS: Seven patients with diabetes mellitus or impaired glucose metabolism were studied. In each patient, endothelial function was examined in the fasting state and at two levels of hyperglycemia, which were achieved by the infusion of glucose, insulin, and somatostatin. Forearm blood flow was measured while acetylcholine was infused in increasing concentrations(7.5, 15, and 30 microgram/min) through the brachial artery. RESULTS: Glucose concentrations increased accordingly at each stage, from 135.3+/-18.4 mg/dl at stage 1(the fasting state), to 239.0+/-15.2 mg/dl at stage 2(the first level of hyperglycemia), and to 378.3+/-25.3 at stage 3 (the second level of hyperglycemia) [p<0.01]. Maximal acetylcholine-dependent vasodilation achieved by infusion of acetylcholine at 30 microgram/min was significantly aftenuated during stages 2 and 3 compared with stage 1(p<0.05 by AVOVA; forearm blood flow ratio was 2.87+/-0.18 and 2.56+/-0.14 versus 3.58+/-0.21, respectively). This was also evident during the infusion of 15 microgram/min and 7.5 microgram/min of acetylcholine. CONCLUSIONS: Endothelium-dependent vasodilation is significantly aftenuated by acute hyperglycemia in patients with diabetes mellitus or impaired glucose metabolism. Our findings suggest that elevated glucose may contribute to the endothelial dysfunction observed in patients with diabetes mellitus or impaired glucose metabolism.
Acetylcholine ; Brachial Artery ; Diabetes Mellitus* ; Endothelium ; Fasting ; Forearm ; Glucose* ; Humans ; Hyperglycemia* ; Insulin ; Metabolism* ; Plethysmography ; Somatostatin ; Vasodilation*

PURPOSE: To assess the changes of corneal aberration in the front and rear surface measured by Pentacam(R) following cataract surgery. METHODS: Thirty-two eyes of 30 consecutive patients that underwent phacoemulsification and IOL insertion via 3 mm superotemporal corneoscleral incision were examined. The corneal aberration was measured with Pentacam(R) (Oculus, Wetzlar, Germany) at 1 week and 1 month after the surgery, and these postoperative values were compared with values taken before the operation. The data were analyzed from 6 mm pupil size, using Zernike's polynomial expansion. RESULTS: In anterior corneal aberration, Z (4, -2); secondary astigmatism at 1 week postoperatively and Z (3, -3); the trefoil at 1 month postoperatively changed significantly (p<0.05). By contrast, in posterior corneal aberration, Z (2, -2), Z (2, 0), Z (2, 2), Z (3, 1), Z (4, -4), and Z (4, -2) changed significantly (p<0.05). However, there were no significant changes at 1 month postoperatively (Paired t-test). CONCLUSIONS: There were significant changes in posterior corneal aberration compared to anterior corneal aberration at 1 week postoperatively. However, the corneal aberration recovered to the preoperative level at one month after the operation. Presumably, these results might be due to the corneal edema of the incision site, caused by measuring the corneal thickness in the early phase of surgery.
Astigmatism ; Cataract ; Corneal Edema ; Eye ; Humans ; Lotus ; Phacoemulsification ; Pupil

BACKGROUND: This study was planned to evaluate the influence of propranolol and esmolol on cerebral circulation and to estimate clinical implications and usefulness. METHODS: This study was designed to measure vital signs, cerebrospinal fluid pressure, cerebral perfusion pressure and blood flow velocity of common carotid artery. This was measured by Doppler Flowmeter after intravenous administration of propranolol 12.5, 25, 50 microgram/kg (P-12.5, P-25, P-50, respectively), and esmolol 0.5, 1.0, 2.0 mg/kg (E-0.5, E-1.0, E-2.0 group, respectively) at 1 or 2 minute intervals for 14 minutes. RESULTS: In the propranolol group (P-12.5, P-25 and P-50), the systolic blood pressure (SBP) significantly decreased since postinjection 1 minute and this decreased pressure continued throughout the entire experiment. But in esmolol group (E-0.5, E-1.0 and E-2.0), the SBP decreased significantly and rapidly recovered within 4 minutes. Heart rate significantly decreased in the propranolol group and continued throughout the experiment, but in the esmolol group the heart rate decreased and rapidly recovered within 10 minutes. The duration of the decreased heart rate in the esmolol group was shortened by decreasing the dosage. The blood flow velocity of the common carotid artery significantly decreased at 1 to 14 minutes after the injection of propranolol, but in group E-1.0, it was significantly decreased at 1 to 2 minutes, and in group E-2.0 at 1 to 3 minutes. CONCLUSIONS: The esmolol group showed less changes of SBP, heart rate and common carotid artery flow, and shorter duration of effect than the propranolol group. Mean blood pressure, cerebrospinal fluid pressure and cerebral perfusion pressure had no significant differences between propranolol and esmolol groups.
Administration, Intravenous ; Blood Flow Velocity ; Blood Pressure ; Carotid Artery, Common* ; Cerebrospinal Fluid Pressure ; Flowmeters ; Heart Rate ; Perfusion ; Propranolol* ; Rabbits* ; Vital Signs*

In order to determine the electrophysiologic properties of aberrant ventricular conduction we analyzed the electrophysiologic studies done for various reasons in SNUH(1983.3 -1987.8). All patients did not have underlying heart disease and were in sinus rhythm with normal PR intervals & no intraventricular conduction delay at the time of study. The patients of preexcitation syndrome were excluded. Only aberrant ventricular conduction induced by premature atrial stimulation at the high right atrium or(HRA) during sinus rhythm or HRA pacing was analyzed. 1) Aberrant ventricular conuction was induced by premature atrial extrastimulation in 34 subjects of 156 cases reviewed(21.8%). The patients were 16 to 70 years old(sixteen males and eighteen females). 2) The longest atrial coupling(A1S2) interval resulting in aberrant ventricular conduction approximated 45%(600-280) of the basic cycle length(450-1550 msec). 3) As a prerequisite for aberrant ventricular conduction, the functional refractory period(FRP) of the AV node should be less than the relative refractory period(RRP) of the His Purkinje System and the most important determinant of aberrant ventricular conduction by atrial extreastimulation was resultant H1H2 interval, which should be between RRP and effective refractory period(ERP) of HPS. 4) There was good linear correlation between the basic cycle length(BCL) and RRP of the HPS(RRP=0.247xBCL+247.048, r=0.885, p-value<0.001). 5) 155 different configurations of aberrant ventricular conduction were recorded during atrial extrastimulation till atrial ERP. The pattern frequencies were as follows : left anterior hemiblock, 6(3.9%) ; right bundle brach block, 92(59.4%) ; left bundle branch block, 28(18.0%) ; left anterior hemiblock combined with right bundle branch block, 14(9.0%) ; left posterior hemiblock combined with right bundle branch block, 9(5.8%) ; unclassified intraventricular conduction disturbances, 6(3.9%). 6) As the atrial coupling intervals were further shortened, aberrant conduction persisted up to the point of atrial ERP at 19/41 BCL's(46.3%). Other patterns of atrioventricular conduction were as follows : atrio-His block, 7(17.1%) ; His-ventricular block, 6(14.6%) ; normal conduction due to prolonged A2H2, 9(22.0%). But there was no statistical significance between the pattern of A-V conduction and the longest S2H2 & H2V2 intervals during VAB (p-value=0.235>0.050). In conclusion, atrial extrastimulation which is routinely done during clinical EPS is an effective method to induce aberrant ventricular conduction and to study the electrophysiologic characteristics of atrioventricular conduction. Further study with recording of bundle branch electrogram, after infusion of cardioactive drugs and pacing of HRA at fixed rate should be done to determine the electrophysiologic properties of VAB more completely.
Atrioventricular Node ; Bundle-Branch Block ; Heart Atria ; Heart Diseases ; Humans ; Male ; Pre-Excitation Syndromes