BACKGROUND: Silver has been used for disinfection and sterilization. We aimed to confirm the in-vitro antibacterial effects of nanocrystalline silver-coated gauze. METHODS: Fourteen clinical isolates each of Escherichia coli and Acinetobacter baumannii were used. Bacterial suspensions made in tryptic soy broth were exposed to Ordinary and silver-coated gauze. Bacteria were then harvested from the gauze immediately and after 24 h incubation, cultured on blood agar plates and eunmerated for viable counts. The number of colonies was converted into common logarithms for comparison. RESULTS: The number of colonies recovered from silver-coated gauze was significantly lower than those recovered from ordinary gauze when harvested immediately after exposure (E. coli, 3.06 vs 1.73; A. baumannii, 3.13 vs 1.98; P<0.001). After 24 h incubation of exposed gauze, silver-coated gauze produced less than 1 CFU/mL, whereas ordinary gauze produced a number of colonies significantly higher than it did immediately after exposure (E. coli, 4.13; A. baumannii, 4.46; P<0.001). Conclusion: Compared with ordinary gauze, silver-coated gauze was shown to have 99.99% antibacterial effect.
Acinetobacter baumannii ; Agar ; Bacteria ; Disinfection ; Escherichia coli ; Silver ; Sterilization ; Suspensions

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest* ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced* ; Hysterectomy* ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Resuscitation

INTRODUCTION: Several methods, including loss of eye lash (eyelash) reflex and loss of verbal contact, have heen used as criteria for estimating the optimal hypnosis for anesthesia induction. However, these methods are too objective. We examined the hypnotic dose response of etomidate, using a bispectral index as a more subjective criterion for anesthesia induction. METHODS: Fourty-Five ASA I or II adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to induction dose of etomidate. They were Group 1: 0.1 mg/kg ; Group 2: 0.15 mg/kg; Group 3: 0.2 mg/kg (n = 15 for each group), respectively. Etomidate diluted as 10 ml in a syringe injected through an 18G forearm intravenous catheter, using a syringe pump at the rate of 20 ml/min. Observer's Assessment of Alertness/sedation (OAA/S) scale of 1 was considered optimal for hypnosis. Bispectral index, OAA/S scale, and vital signs were checked every minute until spontaneous eye opening after end of drug infusion. Also, the correlation coefficient between BIS and OAA/S scale was checked for evaluating the bispectral index; this was a useful tool for estimating the degree of hypnosis. RESULTS: BIS and OAA/S showed their lowest scores around 60 sec. after the etomidate injection, which was very different from time to peak effect known to be the 2 min. The correlation coefficient (r) between BIS and OAA/S was 0.84 on average, suggesting the BIS as an good subjective indicator of optimal hypnosis for anesthesia induction. Vital signs were stable in all groups. Hypnotic ED50 and ED95 were 0.12 and 0.19 mg/kg, respectively. CONCLUSIONS: Bispectral index can be a useful tool for estimating the optimal hypnosis for anesthesia induction. Hypnotic ED50 of etomidate was 0.12 mg/kg.
Adult ; Anesthesia* ; Catheters ; Etomidate* ; Forearm ; Humans ; Hypnosis ; Orthopedics ; Reflex ; Syringes ; Vital Signs

INTRODUCTION: Several methods, including loss of eye lash (eyelash) reflex and loss of verbal contact, have heen used as criteria for estimating the optimal hypnosis for anesthesia induction. However, these methods are too objective. We examined the hypnotic dose response of etomidate, using a bispectral index as a more subjective criterion for anesthesia induction. METHODS: Fourty-Five ASA I or II adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to induction dose of etomidate. They were Group 1: 0.1 mg/kg ; Group 2: 0.15 mg/kg; Group 3: 0.2 mg/kg (n = 15 for each group), respectively. Etomidate diluted as 10 ml in a syringe injected through an 18G forearm intravenous catheter, using a syringe pump at the rate of 20 ml/min. Observer's Assessment of Alertness/sedation (OAA/S) scale of 1 was considered optimal for hypnosis. Bispectral index, OAA/S scale, and vital signs were checked every minute until spontaneous eye opening after end of drug infusion. Also, the correlation coefficient between BIS and OAA/S scale was checked for evaluating the bispectral index; this was a useful tool for estimating the degree of hypnosis. RESULTS: BIS and OAA/S showed their lowest scores around 60 sec. after the etomidate injection, which was very different from time to peak effect known to be the 2 min. The correlation coefficient (r) between BIS and OAA/S was 0.84 on average, suggesting the BIS as an good subjective indicator of optimal hypnosis for anesthesia induction. Vital signs were stable in all groups. Hypnotic ED50 and ED95 were 0.12 and 0.19 mg/kg, respectively. CONCLUSIONS: Bispectral index can be a useful tool for estimating the optimal hypnosis for anesthesia induction. Hypnotic ED50 of etomidate was 0.12 mg/kg.
Adult ; Anesthesia* ; Catheters ; Etomidate* ; Forearm ; Humans ; Hypnosis ; Orthopedics ; Reflex ; Syringes ; Vital Signs

BACKGROUND: Anesthesia induction time is related to speed of injection, injected volume, and Keo. In the case of target controlled infusion, induction time can be controlled by adjusting the induction time mode. The aim of this study was to estimate the effect of induction time mode on variable parameters and vital signs during anesthesia induction with propofol using a target controlled infusion (TCI). METHODS: Sixty unpremedicated adult patients (ASA class I or II, 18 55 yrs) scheduled for elective surgery were randomly allocated to four groups according to induction mode. Group 1 was assigned a flash induction mode, and groups 2, 3 and 4 were assigned 2, 3 and 4min respectively. The end point of anesthesia induction was loss of eyelash reflex. Various parameters including induction time, infused volume, current/effect concentration at induction, and vital signs were compared. RESULTS: As the induction time mode was prolonged, induction time was delayed, but there was no difference in infused volume. Also, the current concentration decreased gradually, but the effect concentration did not show any difference. The vital signs were more stable in groups 3 and 4 compared with groups 1 and 2. CONCLUSIONS: For anesthesia induction, a rapid induction mode showed more rapid induction and low current concentration, but vital signs were relatively unstable and the effect concentration at induction showed no difference. For critically ill patients or patients with unstable hemodynamics, a more gradual induction mode for anesthesia induction in propofol TCI is recommended.
Adult ; Anesthesia* ; Critical Illness ; Hemodynamics ; Humans ; Propofol* ; Reflex ; Vital Signs*

BACKGROUND: The aging of the patient population is one of rhe most important factirs influencing health care delivery. Currently 5% of the Korean population is elderly, defined as older than 65years of age, with this group projected to increase to 13.1% by the year 2021. Cardiovascular disease is the leading cause of death and of disability in the elderly age group. mong them, coronary heart disease is the most importane. METHOD: Study population composed of 216 patients who were admittied to the hospital with first acute myocardial infarction and they were divided into two groups according to the age(older than 65 years of age vs younger). Clonical features, risk factors of coronary heart disease, in-hospital outcome and complication were compared in elderly patients and others group. Results : 1) The risk factors of coronary heart disease is similar to younger patients but pattern of chest pain is less typical than younger patients. 2) Clinical presentation of elderly patients is similar to younger patients except Killip class on admission.(1.66vs 1.91,P=0.04) 3) In-hospital mortality of elderly patients in higher than younger patients. In addition to an increased incidence of death, recurrent ischemia, stroke, AV block, ventricular arrythmia, pulmonary edema occured more frequently with advanced age. 4) Especially in the thrombolytic therapy group, in-hospital death, reinfarction and recurrent ischemia is higher than primary PTCA group in elderly patients. CONCLUSIONS: Diagnosis of acute chest pain is difficult in elderly patients and in-hospital mortality and morbidity is higher than in younger patients. Thus more accurate diagnosis and discriminative therapeutic modality is needed.
Aged ; Aging ; Arrhythmias, Cardiac ; Atrioventricular Block ; Cardiovascular Diseases ; Cause of Death ; Chest Pain ; Coronary Disease ; Delivery of Health Care ; Diagnosis ; Hospital Mortality ; Humans ; Incidence ; Ischemia ; Myocardial Infarction* ; Pulmonary Edema ; Risk Factors ; Stroke ; Thrombolytic Therapy

PURPOSE: The insulin like growth factors (IGFs) circulate complexed to IGF-binding proteins(IGFBPs). IGFBP-3 is the major circulating IGFBP and is found primarily as a 150 kDa complex which contains an acid labile subunit(ALS), IGFBP-3, and IGF-I or IGF-II and is considered to be growth hormone(GH) dependent. In this study, we measured serum IGF-I, IGFBP-3 and 150 kDa levels in sera of growth hormone deficient children(GHD) before and after GH treatment respectively to clarify the utility of these factors as a diagnostic marker for GHD and to observe the alterations of these factors according to GH treatment. METHODS: Measurement of serum IGF-I, IGFBP-3 and 150 kDa complex were performed in 10 children with complete growth hormonr deficiency(cGHD), in 6 children with partial growth hormone deficiency(pGHD) and in 10 normal healthy subjects. Serum IGF-I was measured by radioimmunoassay (RIA). IGF-I was seperated from IGFBPs by Sephadex G-50 acid chromatography. Serum IGFBP-3 was assessed by Western ligand blot(WLB) analysis as described by Hossenlopp with minor modifications. To evaluate alterations of different molecular size classes of IGF-BP complexes according to GH treatment, WLB was done after neutral size-exclusion chromatography using Sephacryl S-200. RESULTS: 1) The serum IGF-I level in children with GHD was significantly lower than that of control subjects(96.2+/-40.1 ng/ml vs 147.5+/-37.9 ng/ml)(p<0.01). 2) The serum IGF-I level in children with cGHD was significantly lower than that of normal subjects (p<0.01). But four of the 10 children with cGHD the IGF-I levels were distributed within the range of -2 S.D.. The serum IGF-I level in children with pGHD was also lower than that of normal subjects but there was no statistical significance between two groups(P>0.05). 3) The serum IGFBP-3 level is markedly decreased in 9 of 10 children with cGHD, but only in 2 of 6 children with pGHD which was measured by WLB method. 4) The serum IGF-I level after GH treatment was increased significantly in children with GHD(138.7+/-49.2 ng/ml vs 78.7+/-23.4 ng/ml)(p<0.01). The serum IGFBP-3 level was also increased after GH treatment as similar pattern. 5) The marked decrement of serum IGFBP-3 level in children with cGHD was explained as the result of decline in the 150 kDa IGFBP complex, and after GH treatment 150 kDa complex was increased; in the 150 kDa IGFBP complex, free IGF-I binding sites were increased. CONCLUSIONS: The serum levels of IGF-I, IGFBP-3 and 150 kDa complex in children with cGHD were decreased significantly, but in children with pGHD these changes were not observed as prominant as cGHD. These findings suggest that the measurments of serum IGF-I, IGFBP-3 level may be useful not only in the diagnosis of GHD but also differentiate cGHD from pGHD and the serum IGFBP-3 level may be more sensitive for diagnosing GHD even though each test by itself has a limited diagnostic accuracy as a single test.
Binding Sites ; Child* ; Chromatography ; Diagnosis ; Growth Hormone* ; Humans ; Insulin* ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor Binding Proteins ; Insulin-Like Growth Factor I ; Insulin-Like Growth Factor II ; Radioimmunoassay ; Somatomedins

PURPOSE: To determine whether there are significant differences between the retinal thicknesses of the macular area in eyes of healthy Koreans compared with normative data using OCT3 (version 4.0). METHODS: The study was performed in 111 eyes of 71 adults between the ages of 20 and 69 with corrected vision of 0.8 or greater and no systemic or ocular disease. The subject group was designed to have a similar age distribution to that of normative data. An OCT3 fast macular map was used to measure macular thickness. The results were further analyzed and compared with the normative data. RESULTS: The overall results from the subject group were similar to the normative data. However, the nasal parts of the outer ring were thicker than the normative data and the temporal parts of the outer ring were thinner (p<.0001). When each age group was compared, the thickness of the superior part of the inner ring and the nasal part of the inner and outer rings were thicker than the normative data in the age groups of twenties and thirties (p<.05). For the nasal parts of outer ring, the macula were thicker by OCT examination than the normative data in 25.2% of subjects, although they were clinically normal. CONCLUSIONS: Macular thickness in healthy Koreans was generally similar to the normative data of OCT3. However, a slight difference may exist and must be considered when measuring and interpreting macular thickness measurements.
Adult ; Age Distribution ; Eye ; Humans ; Retinaldehyde ; Tomography, Optical Coherence ; Vision, Ocular

PURPOSE: To analyze retinal tears and to compare the clinical outcomes between retinal tear and rhegmatogenous retinal detachment (RRD) as the cause of dense non-diabetic vitreous hemorrhage in patients who underwent vitreoretinal surgery. METHODS: In a retrospective case series, the medical records of patients who presented dense non-diabetic vitreous hemorrhage and who underwent vitreoretinal surgery between January 2005 and June 2009 were reviewed. Among the 134 patients, 27 patients had dense vitreous hemorrhage caused by retinal tears. The first group had retinal tears only and the second group had accompanying RRD. A comparison of clinical features and postoperative prognoses between the two groups was performed. RESULTS: Among the 27 eyes with non-traumatic retinal tear and RRD, 18 were categorized into the retinal tear group and 9 to the RRD group. The demographic findings between the two studied groups exhibited no significant differences except for time between onset of symptoms and diagnosis. However, the time to diagnosis was significantly delayed in the group with RRD (22.67 +/- 37.47 days) compared to the retinal tear group (5.00 +/- 3.41 days) (p = 0.035). The amount of visual improvement was also greater in the retinal tear group than the RRD group (p = 0.002). CONCLUSIONS: Retinal tears are a major cause of non-diabetic vitreous hemorrhage. Vitreous hemorrhage caused by retinal detachment may result in delayed diagnosis and poor visual recovery. Therefore, early examinations in suspicion of RRD and appropriate treatments are needed in non-diabetic vitreous hemorrhage.
Delayed Diagnosis ; Eye ; Humans ; Medical Records ; Prognosis ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Retrospective Studies ; Vitreoretinal Surgery ; Vitreous Hemorrhage

BACKGROUND: Several recent studies have suggested the context-sensitive half-time (CSHT) as a clinically more relevant measure of decreasing drug concentrations after a constant infusion of a given duration. The purpose of this study was to simulate the CSHT using a PK-SIM computer simulation program and compare this with duration of propofol infusion and real awakening time from anesthesia for the evaluation of CSHT as a useful tool of prediction of recovery from anesthesia. METHODS: Ninety-five ASA class I or II adult patients (18-55 yrs) scheduled for orthopedic elective surgery were randomly allocated into 5 groups according to duration of propofol infusion. Five groups were Group 1: less than 60 min, Group 2: 61-120 min, Group 3: 121-180 min, Group 4: 181-240 min, and Group 5: 241-300 min. Anesthesia was induced and maintained with propofol-nitrous oxide (67%)-oxygen (33%) according to Prys-Roberts' method. Propofol was discontinued immediately after skin closure and duration of infusion was checked. Duration of infusion, CSHT, and awakening time from anesthesia were compared and evaluated correlationship among them using a correlation coefficient. RESULTS: Plasma and effect site concentration after 5 hrs infusion of propofol derived from computer simulation was 3.3 microgram/ml. Awakening time for each group was 8.5-11.8 min and plasma CSHT for that was 6.4-9.5 min. The correlation coefficient (r) between duration of propofol infusion and awakening time was 0.98 (p<0.01) and that between CSHT and awakening time was 0.95 (p<0.01). CONCLUSIONS: There were strong relationship among duration of infusion of propofol, awakening time and CSHT. It seems that CSHT could be a good predictor of awakening from propofol-N20-02 general anesthesia.
Adult ; Anesthesia* ; Anesthesia, General ; Computer Simulation* ; Humans ; Orthopedics ; Plasma ; Propofol* ; Skin