No abstract available.

Mitral ring motion and indices of left ventricular diastolic filling were measured by M-mode and Doppler echocardiography in apical 4 chamber view in 11 dilated cardiomyopathy patients and 9 normal subjects without clinical evidence of heart disease. The mean age of patients was 52 years and average heart rate was 76 beats/min. The parameters of mitral annulus motion include earley relaxation amplitude(ER), late atrial contraction amplitude(AC) and A2-peak excursion(A2-PE). Transmitral flow velocity parameters include peak flow velocity of early diastolic flow velocity(PFVE), peak flow velocity of late atrial contraction(PFVA), the ratio between early and late peak flow velocity(PFVE/PFVA), Acceleration rate of early diastolic peak flow(AR), deceleration rate of early diastolic peak flow(DR), time velocity integral of early diastolic flow velocity(TVIE), time velocity integral of late atrial contraction flow velocity(TVIA) and ratio between early diastolic and late atrial flow velocity integral(TVIE/TVIA). In patients with dilated cardiomyopathy, ER(4.5+/-2.3mm) and AC(2.3+/-1.6mm) were significantly decreased than normal(10.7+/-2.6mm, 6.6+/-1.6mm, p<0.01, p<0.01, respectively), whereas ER/AC(1.7+/-0.7) was not significantly different than normal subjects(1.6+/-0.5). A2-PE(100+/-80 msec) was significantly delayed in dilated cardiomyopathy patients than normal subjects(35+/-25 msec, p<0.01). In analysis of transmitral flow velocities, PFVE, PFVA and PFVE/PFVA, etc were not significantly different compared to normal subjects in patients with dilated cardiomyopathy. Mitral ring motion amplitude was decreased and A2-peak excursion time interval(A2-PE) was delayed in patients with dilated cardiomyopathy, but transmitral flow velocities were not significantly different from normal subjects in patients with dilated cardiomyopathy. These results reflect the facts that early diastolic relaxation amplitude is decreased by the change of compliance of LV and late atrial contractin amplitude is decreased by decrease of atrial contractility and increased stiffness of LA and LV. Despite of decreased mitral ring motion, transmitral flow velocity is not significantly different compared to normal subjects in patients with dilated cardiomyopathy. From these evidences, not only transmitral flow velocity affected by multiple factors but also mitral ring motion affected by LA and LV function are considered in assessment of LV diastolic dysfuction.
Acceleration ; Blood Flow Velocity* ; Cardiomyopathy, Dilated* ; Compliance ; Deceleration ; Echocardiography, Doppler ; Heart Diseases ; Heart Rate ; Humans ; Relaxation

Pseudocholinesterase is an essential enzyme for hydrolysis of succinylcholine and some people has low activity. The pseudocholinesterase from a normal individual has a greater apparent affinity for the cholinester substrate than the enzyme from succinylcholine-sensitive individuals, who has genetic variants. The ideal situation would be one in which a single, simple test would detect and identify all the variant forms of enzyme, but no such test currently exsits. The inhibitors frequently used to identify variants are dibucaine, fluoride, chloride, urea or succinylcholine as inhibition numbers. The authors found that dibucaine, fluoride and chloride numbers in Korean adults (mean+/-SD, %) are 85.8+/-1.83, 46.5+/-2,05 and 3.53+/-1.64, respectively (substrate is butyrylthiocholine).
Adult* ; Dibucaine ; Fluorides ; Humans ; Hydrolysis ; Pseudocholinesterase* ; Succinylcholine ; Urea

We performed laparoscopic pelvic lymphadenectomy in 7 patients with squamous cell carcinoma in the uterine cervix. Among them, 5 cases were subsently laparotomy with radical hysterectomy. The others, one case was performed Laparoscpic pelvic lymphadenectomy as Staging Procedure and the other was laparoscopically assisted radical vaginal hysterectomy with pelvic lymphadenectomy without complication. The following results were obtained 1. Total number of pelvic nodes obtained at laparoscopy in 7 cases were 104 2. Averege number of pelvic nodes obtained at laparoscopy were 14.2+/-6.38(7-23) 3. Average number of additional pelvic nodes obtained at laparotomy were 10.4+/-279(7-13) 4. % yield by laparoscopy/laparoscopy+laparotomy was 71/123(58%) 5. No positive metastatic lymph nodes were missed by laparartomy 6. Average time, blood loss at laparoscopic lymphadenectomy was 172.1min and 304.3ml, seperately 7. surgical staging procedure was performed at Case 3 8. Laparoscopic Pelvic lym phadenectomy with radieal vaginal hysterectomy (type II radical) was done in Case 5. without Laparotomy or complication.
Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Laparoscopy ; Laparotomy ; Lymph Node Excision* ; Lymph Nodes ; Uterine Cervical Neoplasms*

Generally, many Asian women tend to dislike the square jaw, as they believe it makes the face look wider, giving a stubborn and strong impression. Contouring of the mandible is therefore a relatively common aesthetic procedure among Asians. These days, the use of botulinum toxin for contouring of the lower face offer simple alternative to surgery. Motor point, which is the site over a muscle where its contraction may be elicited by a minimal intensity short duration electrical stimulus, is the optimal injection point of botulinum toxin. Study was undertaken to identify the location of motor point of the masseter muscle and the skin surface landmark. First, the thickest point of the masseter muscle was inspected through palpation and inspection by 3 different individual plastic surgeons and then compound muscle action potentials(CMAPs) of masseter muscle in 15 health volunteers were recorded using EMG. For the localization of the measured points, line between lateral canthus to the mandibular angle was used. Location of motor points were mapped to skin surface from lateral canthus in a percentage of the distance along the landmark line and in distance in millimeters. The clinical injection point was located at 71.69 percentile and 7.3mm of the landmark line. The motor point test was located at 72.54 percentile and 7.1mm of the landmark line. The depth of motor point was 16mm. There was no statistically significant difference between the clinical injection point and the motor point. We conclude that surface mapping of motor point of the masseter muscle would increase accessibility and accuracy in botulinum toxin injection for contouring of the lower face.
Asian Continental Ancestry Group ; Botulinum Toxins* ; Female ; Humans ; Jaw ; Mandible ; Masseter Muscle ; Palpation ; Skin ; Volunteers

BACKGROUND: Recent studies reported that untreated patients with obstructive sleep apnea syndrome had high long-term mortality rates, and cardiovascular complications of these patients had a major effect on mortality. Several data indicates that obstructive sleep apnea syndrome contributes to the development of diurnal systemic hypertension. But the pathophysiological mechanism of the development of systemic hypertension in these patients is still uncertain. This study was performed to evaluate the possible role of sympathetic nervous system activity for the development of systemic hypertension in patients with obstructive sleep apnea syndrome. METHOD: 35 patients with obstructive sleep apnea syndrome(OSAS) and 13 control subjects (Control) were included in this study. 21 patients of OSAS were normotensives(OSAS-NBP), and 14 patients of OSAS were hypertensives(OSAS-HBP). Full night polysomnography was undertaken to all subjects. We measured plasma norepinephrine(NE) and epinephrine(EP) concentrations during waking and sleep, using high performance liquid chromatography, in all patients and control subjects. RESULTS: In OSAS, OSAS-NBP and Control, plasma NE and EP concentrations during sleep were lower than during waking(p<0.01). But, in OSAS-HBP, there was no difference between during waking and sleep. Plasma NE concentrations during sleep of OSAS, OSAS-NBP and OSAS-HBP were higher than Control(p<0.05). In OSAS-HBP, daytime systolic blood pressure correlated with plasma NE concentration during sleep(r=0.7415, p<0.01), and correlated inversely with mean arterial oxygen saturation(r=-0.6465, p<0.05) or arterial oxygen saturation nadir(r=-0.6114, p<0.05) during sleep. CONCLUSION: The sympathetic activity during sleep of obstructive sleep apnea syndrome patients was higher than control subjects. In obstructive sleep apnea syndrome patients with systemic hypertension, there was no diurnal variation of sympathetic activity, and there was correlation between daytime systolic blood pressure and sympathetic activity during sleep. These data suggests that chronic hyperactivity of sympathetic nervous system may contribute to the development of diurnal systemic hypertension in patients with obstructive sleep apnea syndrome.
Blood Pressure ; Catecholamines* ; Chromatography, Liquid ; Humans ; Hypertension* ; Mortality ; Oxygen ; Plasma* ; Polysomnography ; Sleep Apnea, Obstructive* ; Sympathetic Nervous System

BACKGROUND: The optimal time to remove the laryngeal mask airway (LMA) at the end of surgery is still a matter of controversy. The purpose of this study was to compare the incidence of complications associated with the removal of the LMA from the deeply anesthetized and from the awake patient. METHODS: The LMA was used in 120 adults undergoing general elective lower abdominal or extremity surgery. The patients were randomly assigned to two groups. In 60 patients the LMA was removed by the anesthetist with the patient deeply anesthetized in the operating room. In the other 60 patients it was removed by the anesthetist when the patient responded to verbal commands in the operating room. Any airway complications occurring within 15 minutes of LMA removal were recorded. These complications included coughing, biting, retching, vomiting, excessive salivation, airway obstruction and laryngospasm. RESULTS: Groups were similar in age, weight, and duration of surgery. Airway complications associated with LMA removal were noted in fourteen patients. Airway complications occurred in six patients who had their LMA removed during deep anesthesia, and in eight patients who under went removal of their LMA on awakening. In the anesthetized group, there were four kinds of airway complications in six patients (retching, excessive salivation, airway obstruction and laryngospasm). In the awake group, eight patients experienced six kinds of airway complications (coughing, biting, vomiting, excessive salivation, airway obstruction and laryngospasm). There was no significant difference between the two groups in the incidence of complications after removal of the LMA. CONCLUSIONS: Removal of the LMA under deep anesthesia had no advantage compared to removal from awakening patients in terms of complications in adult.
Adult ; Airway Obstruction ; Anesthesia* ; Anesthesia, General ; Cough ; Extremities ; Humans ; Incidence ; Laryngeal Masks* ; Laryngismus ; Operating Rooms ; Salivation ; Vomiting

BACKGROUND: The optimal time to remove the laryngeal mask airway (LMA) at the end of surgery is still a matter of controversy. The purpose of this study was to compare the incidence of complications associated with the removal of the LMA from the deeply anesthetized and from the awake patient. METHODS: The LMA was used in 120 adults undergoing general elective lower abdominal or extremity surgery. The patients were randomly assigned to two groups. In 60 patients the LMA was removed by the anesthetist with the patient deeply anesthetized in the operating room. In the other 60 patients it was removed by the anesthetist when the patient responded to verbal commands in the operating room. Any airway complications occurring within 15 minutes of LMA removal were recorded. These complications included coughing, biting, retching, vomiting, excessive salivation, airway obstruction and laryngospasm. RESULTS: Groups were similar in age, weight, and duration of surgery. Airway complications associated with LMA removal were noted in fourteen patients. Airway complications occurred in six patients who had their LMA removed during deep anesthesia, and in eight patients who under went removal of their LMA on awakening. In the anesthetized group, there were four kinds of airway complications in six patients (retching, excessive salivation, airway obstruction and laryngospasm). In the awake group, eight patients experienced six kinds of airway complications (coughing, biting, vomiting, excessive salivation, airway obstruction and laryngospasm). There was no significant difference between the two groups in the incidence of complications after removal of the LMA. CONCLUSIONS: Removal of the LMA under deep anesthesia had no advantage compared to removal from awakening patients in terms of complications in adult.
Adult ; Airway Obstruction ; Anesthesia* ; Anesthesia, General ; Cough ; Extremities ; Humans ; Incidence ; Laryngeal Masks* ; Laryngismus ; Operating Rooms ; Salivation ; Vomiting

PURPOSE: To analyze the clinical and angiographic features with outcome of transcatheter arterial embolization in patients with secondary postpartum hemorrhage. MATERIALS AND METHODS: Clinical details and angiographic features with assessment of arterial embolization were reviewed in total 38 patients underwent arterial embolization at single tertiary referral center. RESULTS: Twenty patients (53%) had Cesarean section. The major causes of bleeding were iatrogenic vascular injury, and retained placenta (55%). The patterns of vaginal bleeding were recorded as intermittent (50%), or as persistent (50%). Seven patients (18%) were hemodynamically unstable at presentation. Positive angiographic findings appeared in eighteen patients (47.3%). The frequency of pseudoaneurysm was statistically high in the Cesarean section (p < 0.001). The used embolic agents except gelfoam were N-butyl cyanoacrylate (n = 7), and microcoil (n = 7). Unilateral selective embolization (26.3%) was shown effective in superselective embolization of bleeding focus. Technical and clinical success rate were 100% and 97.4%, respectively with no complication. Sixteen resumed regular menstruation, and one pregnancy were observed in patients with available follow-up of over 6 months. CONCLUSION Considerable rate of hemodynamically unstable patients was observed with high rate of positive angiography findings. Given high successful rate and few complications, early angiographic assessment with embolization should be considered.

BACKGROUND/AIMS: Inflammatory bowel disease is commonly accompanied by colonic dysmotility and causes changes in intestinal smooth muscle contractility. In this study, colonic smooth muscle contractility in a chronic inflammatory condition was investigated using smooth muscle tissues prepared from interleukin-10 knockout (IL-10(-/-)) mice. METHODS: Prepared smooth muscle sections were placed in an organ bath system. Cholinergic and nitrergic neuronal responses were observed using carbachol and electrical field stimulation with L-NG-nitroarginine methyl ester (L-NAME). The expression of interstitial cells of Cajal (ICC) networks, muscarinic receptors, neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) was observed via immunofluorescent staining. RESULTS: The spontaneous contractility and expression of ICC networks in the proximal and distal colon was significantly decreased in IL-10(-/-) mice compared to IL-10(+/+) mice. The contractility in response to carbachol was significantly decreased in the proximal colon of IL-10(-/-) mice compared to IL-10(+/+) mice, but no significant difference was found in the distal colon. In addition, the expression of muscarinic receptor type 2 was reduced in the proximal colon of IL-10(-/-) mice. The nictric oxide-mediated relaxation after electrical field stimulation was significantly decreased in the proximal and distal colon of IL-10(-/-) mice. In inflamed colon, the expression of nNOS decreased, whereas the expression of iNOS increased. CONCLUSIONS: These results suggest that damage to the ICC network and NOS system in the proximal and distal colon, as well as damage to the smooth muscle cholinergic receptor in the proximal colon may play an important role in the dysmotility of the inflamed colon.
Animals ; Baths ; Carbachol ; Colon* ; Inflammatory Bowel Diseases* ; Interleukin-10* ; Interstitial Cells of Cajal ; Mice ; Mice, Knockout* ; Muscle, Smooth ; Nitrergic Neurons ; Nitric Oxide Synthase Type I ; Nitric Oxide Synthase Type II ; Receptors, Muscarinic ; Relaxation