BACKGROUND: Circadian variations in the absorption, distribution, protein binding, elimination and metabolism of drugs account for many of the administration-time-dependent differences in their pharmacokinetics. The aim of this study is to determine whether the time of intrathecal injection influences spinal anesthesia. METHODS: Ninety patients scheduled for orthopedic surgery were randomly assigned to three groups. Each group received spinal anesthesia with 0.5% bupivacaine 10 mg at different times; group AM (8 am to 12:00), group Noon (12:00 to 4:00 pm) and group PM (4:00 pm to 8:00 pm). Sensory and motor blockade were assessed by pinprick and a four-point modified Bromage scale. Time to first postoperative analgesic requirement and side effects such as hypotension, bradycardia, nausea, and shivering were recorded. RESULTS: No significant differences were found among the three groups in peak sensory blockade, duration of motor block to Bromage 1 or side effects, but time to first postoperative analgesic requirement (P = 0.008), and recovery time of S1 sensation to pinprick were significantly prolonged in group Noon compared with the other groups (P = 0.03). CONCLUSIONS: The tine of administration of spinal local anesthetics influences the duration of local anesthesia.
Absorption ; Anesthesia, Local ; Anesthesia, Spinal ; Anesthetics, Local ; Bradycardia ; Bupivacaine ; Humans ; Hypotension ; Injections, Spinal ; Nausea ; Orthopedics ; Protein Binding ; Sensation ; Shivering

The nonstinging house ant, Monomorium pharaonis (pharaoh ant), was recently identified as a cause of respiratory allergy. This study was performed to evaluate the extent of sensitization to pharaoh ant, and its clinical significance in asthmatic patients. We carried out skin prick tests in 318 patients with asthma. Specific IgE (sIgE) to pharaoh ant was measured by ELISA, and cross-reactivity was evaluated by ELISA inhibition tests. Bronchial provocation testing was performed using pharaoh ant extracts. Fifty-eight (18.2%) of 318 patients showed positive skin responses to pharaoh ant, and 25 (7.9%) had an isolated response to pharaoh ant. Positive skin responses to pharaoh ant were significantly higher among patients with non-atopic asthma than among those with atopic asthma (26.0% vs. 14.9%, p<0.05). There was significant correlation between sIgE level and skin responses to pharaoh ant (rho=0.552, p<0.001). The ELISA inhibition tests indicated that pharaoh ant allergens had various pattern of cross-reactivity to house dust mites and cockroaches. Bronchial provocation tests to pharaoh ant were conducted for 9 patients, and eight showed typical asthmatic reactions. In conclusion, pharaoh ant is an important source of aeroallergens, and it should be included in the skin test battery for screening the causative allergens in patients with asthma.
Administration, Inhalation ; Adolescent ; Adult ; Allergens/immunology ; Animals ; Ants/*immunology ; Asthma/blood/*immunology ; Bronchial Hyperreactivity/immunology ; Bronchial Provocation Tests ; Female ; Humans ; Immunoglobulin E/blood ; Male ; Middle Aged ; Research Support, Non-U.S. Gov't ; Skin Tests

PURPOSE: A number of clinical decision tools for osteoporosis risk assessment have been developed to select postmenopausal women for the measurement of bone mineral density. We developed and validated machine learning models with the aim of more accurately identifying the risk of osteoporosis in postmenopausal women compared to the ability of conventional clinical decision tools. MATERIALS AND METHODS: We collected medical records from Korean postmenopausal women based on the Korea National Health and Nutrition Examination Surveys. The training data set was used to construct models based on popular machine learning algorithms such as support vector machines (SVM), random forests, artificial neural networks (ANN), and logistic regression (LR) based on simple surveys. The machine learning models were compared to four conventional clinical decision tools: osteoporosis self-assessment tool (OST), osteoporosis risk assessment instrument (ORAI), simple calculated osteoporosis risk estimation (SCORE), and osteoporosis index of risk (OSIRIS). RESULTS: SVM had significantly better area under the curve (AUC) of the receiver operating characteristic than ANN, LR, OST, ORAI, SCORE, and OSIRIS for the training set. SVM predicted osteoporosis risk with an AUC of 0.827, accuracy of 76.7%, sensitivity of 77.8%, and specificity of 76.0% at total hip, femoral neck, or lumbar spine for the testing set. The significant factors selected by SVM were age, height, weight, body mass index, duration of menopause, duration of breast feeding, estrogen therapy, hyperlipidemia, hypertension, osteoarthritis, and diabetes mellitus. CONCLUSION: Considering various predictors associated with low bone density, the machine learning methods may be effective tools for identifying postmenopausal women at high risk for osteoporosis.
Aged ; *Artificial Intelligence ; Bone Density/*physiology ; Female ; Humans ; Middle Aged ; Osteoporosis, Postmenopausal

BACKGROUND: Cardiovascular drugs are frequently used to assist myocardial function after discontinuation of cardiopulmonary bypass (CPB) in the open heart surgery (OHS) because of unstable hemodynamics. At this time we should always consider that the radial arterial pressure (RAP) may be lower than the aortic pressure (AP). In this study we evaluated the difference between AP and RAP in propofol-alfentanil anesthesia. METHODS: 28 patients undergoing elective OHS were randomly allocated into a midazolam-fentanyl (MA) group (n = 14) or a propofol-alfentanil (PA) group (n = 14). Anesthesia in the MF group consisted of midazolam and fentanyl with intermittent bolus injection, and anesthesia in the PA group consisted of propofol and alfentanil with continuous in fusion. RAP and AP in the two groups were recorded for 5 minutes after CPB discontinuation. RESULTS: No significant difference was founded between the two groups in age, weight, height, CPB time, aortic cross clamping (ACC) time, or temperature. There was a relatively high correlation between the difference of systolic AP-RAP and CPB time (r = 0.01), and ACC time (0.001). The systolic and mean blood pressure difference between the aorta and the radial artery in the MF group was significantly greater than in the PA group. CONCLUSIONS: This findings suggest that propofol-alfentanil anesthesia in OHS may be more helpful for hemodynamic management after CPB discontinuation than midazolam-fentanyl anesthesia.
Alfentanil ; Anesthesia ; Aorta ; Arterial Pressure* ; Blood Pressure ; Cardiopulmonary Bypass* ; Cardiovascular Agents ; Constriction ; Fentanyl ; Heart* ; Hemodynamics ; Humans ; Midazolam ; Propofol ; Radial Artery ; Thoracic Surgery* ; Weaning*

ansen's disease, death certificates of the inpatients of Sorokdo National Hospital between 2001 and 2008 and died during the same time period were used to analyze the causes of their death, and the morbidity patterns of those patients who are hospitalized in the same hospital as of 2008 were analyzed. The results are as follows: The average number of diseases per inpatient was 3.4 with the maximum being 10. The distribution of morbidity was 67.2% for circulatory diseases, 58.4% for musculoskeletal diseases, and 36.3% for infectious diseases and skin diseases respectively. The morbidity rank of all patients was 50.1% for primary hypertension, 34.4% for chronic viral hepatitis, 27.4% for arthritis, 27.2% for skin diseases, and 23.7% for cataracts. The age-standardized death rate of males per 100,000 was 557.6 for heart diseases, 500.2 for liver diseases, 460.5 for respiratory diseases, and 459.8 for cancers. The age-standardized death rate of females was 266.3 for sepsis, 232.6 for liver diseases, 212.0 for cancers, 208.8 for pneumonia and 206.9 for respiratory diseases. The standardized death rate for all patients was 456.6 for heart diseases, 414.7 for liver diseases, 393.8 for respiratory diseases, and 383.0 for malignant neoplasms. In conclusion, the patterns of morbidity and mortality of patients with Hansen's disease was different than those of the general population. Additional public health approaches will be needed to improve the health status and quality of life of these patients, and additional studies on related factors will also be in order.
Arthritis ; Cataract ; Communicable Diseases ; Death Certificates ; Female ; Heart Diseases ; Hepatitis ; Humans ; Hypertension ; Inpatients ; Leprosy ; Liver Diseases ; Male ; Musculoskeletal Diseases ; Pneumonia ; Public Health ; Quality of Life ; Sepsis ; Skin Diseases

PURPOSE: Ketamine may decrease core-to-peripheral redistribution of heat through direct central sympathetic stimulation and inhibition of norepinephrine uptake into postganglionic sympathetic nerve endings. The purpose of this study was to evaluate the efficacy of epidural ketamine in preventing shivering during transurethral resection of the prostate (TURP) under epidural anesthesia. MATERIALS AND METHODS: Ninety-three male patients scheduled for TURP under epidural anesthesia were enrolled in this study. Patients were randomized into one of three groups. Group 1 consisted of 31 patients who received epidural 0.75% ropivacaine, group 2 consisted of 32 patients who received epidural ketamine (0.2 mg/kg) in addition to 0.75% ropivacaine, and group 3 consisted of 30 patients who received epidural ketamine (0.4 mg/kg) in addition to 0.75% ropivacaine. Shivering and side effects such as hypotension, bradycardia, nausea, and hallucination were recorded during the anesthesia and for 2 hours while in the postanesthetic recovery room. RESULTS: Shivering was statistically more frequent in group 1 than in the other groups. The incidence of sedation was significantly higher in group 3 than in the other groups. The incidences of side effects such as hypotension, bradycardia, and nausea were significantly higher in group 1 than in the other groups. CONCLUSIONS: In this study, epidural ketamine 0.2 mg/kg and 0.4 mg/kg was shown to have a lower incidence of shivering and other side effects except sedation. In patients who undergo TURP under epidural anesthesia, the prophylactic use of low-dose epidural ketamine would be helpful in preventing any adverse effects, including shivering.
Amides ; Anesthesia ; Anesthesia, Epidural ; Bradycardia ; Hallucinations ; Hot Temperature ; Humans ; Hypotension ; Incidence ; Ketamine ; Male ; Nausea ; Nerve Endings ; Norepinephrine ; Prostate ; Recovery Room ; Shivering ; Transurethral Resection of Prostate

We recently encountered an interesting case of acute inferior ST segment elevation myocardial infarction (STEMI). This patient had a rare anatomic variation, single coronary artery. The right coronary artery originate from the left circumflex proper artery, not from aorta, was totally obstructed with thrombi. Though it took more time to figure out the patient's coronary anatomy and the culprit lesion, we successfully performed primary percutaneous coronary intervention within the guideline-recommended time period. We performed left coronary angiography at the beginning. This strategy could be helpful in determining the culprit lesion and preventing unnecessary procedural delay in acute inferior STEMI.
Anatomic Variation ; Aorta ; Arteries ; Coronary Angiography ; Coronary Vessel Anomalies ; Coronary Vessels* ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention

Benign tumors of the esophagus occur rarely as compared with the incidence of carcinomas. Among the benign tumors of the esophagus such as leiomyoma, lipoma, hemangioma, papilioma. polyp, cystetc. leiomyoma is the most common, although less than 10 percents of leiomyomas of the gastrointestinal tract are found in the esophagus. Most of leiomyomas of the esophagus present as solitary lesions but multiple tumors occur in about 4 percents of cases. Leiomyomas of the esophagus are diagnosed by thorough clinical evaluation, esophagogram and upper gastrofiberscopic examination but histological confirmation requires surgical or necropsy specimens. Occasionally gastrofiberscopic polypectomized specimens are used. We report one case of multiple leiomyomas of the esophagus located in between 25 cm and 40 cm distance from the incisor in a 38-year-old man who complained of vague substernal discomfort for about 10 years. Gastrofiberscopic polypectomized specimen was used for preoperative histological confirmation. The pathologic examination of the specimen showed leiomyoma of the esophagus.
Adult ; Esophagus* ; Gastrointestinal Tract ; Hemangioma ; Humans ; Incidence ; Incisor ; Leiomyoma* ; Lipoma ; Polyps

BACKGROUND: Recent increases in use of sevoflurane have made active researches on its effects in the cerebral metabolism. However, no specific data on brain glucose metabolism has been reported from human study. We compared the brain glucose metabolism during sevoflurane anesthesia with that of propofol anesthesia using positron emission tomography (PET) in the same human volunteers. METHODS: PET scan was performed two times at intervals of one week in each eight volunteers. One scan was performed in sevoflurane anesthesia, and the other was performed in propofol anesthesia. Each was titrated to the point of unconsciousness. The scan was obtained by the 18fluorodeoxyglucose technique. Relative cerebral glucose metabolic rate (rCMRg) was assessed with statistical parametric mapping. RESULTS: The regions of decreased rCMRg during sevoflurane aneshesia were the visual cortex, posterior parietal association area, primary somatosensory area, and premotor area. During propofol anesthesia the decreased regions were the visual inferotemporal area and prefrontal association area in addition to those area of sevoflurane anesthesia. The increased regions were the partial prefrontal association area, basal ganglia, cingulate, olfactory-limbic cortex, midbrain, and pons during sevoflurane anesthesia, and the primary motor area, insula, thalamus, medulla along with those area of sevoflurane during propofol anesthesia. CONCLUSION: Propofol suppressed the rCMRg of neocortex area more than sevoflurane, and sevoflurane suppressed the rCMRg of paleocortex, telencephalon more than propofol when the unconsciousness level was achieved by anesthesia. Sevoflurane produces different effects on relative brain glucose metabolism with propofol.
Anesthesia* ; Basal Ganglia ; Brain ; Electrons* ; Glucose* ; Healthy Volunteers ; Humans* ; Mesencephalon ; Metabolism* ; Neocortex ; Pons ; Positron-Emission Tomography* ; Propofol* ; Rabeprazole ; Telencephalon ; Thalamus ; Unconsciousness ; Visual Cortex ; Volunteers

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome associated with anticonvulsant drugs is a rare but potentially life-threatening disease that occurs in response to arene oxide producing anticonvulsant such as phenytoin and carbamazepine. There have been many reports of cross reactivity among the anticonvulsants upon first exposure to the offending drugs. However, there has been few data describing the development of DRESS syndrome after switching medication from previously well-tolerated phenytoin to carbamazepine, and the induction of hypersensitivity to phenytoin by DRESS to carbamazepine. We experienced a case of a 40-yr-old man who had uncontrolled seizure that led to the change of medication from the long-term used phenytoin to carbamazepine. He developed DRESS syndrome after changing the drugs. We stopped carbamazepine and restored phenytoin for seizure control, but his clinical manifestations progressively worsened and he recovered only when both drugs were discontinued. Patch tests with several anticonvulsants showed positive reactions to both carbamazepine and phenytoin. Our case suggests that hypersensitivity to a previously tolerated anticonvulsant can be induced by DRESS to another anticonvulsant, and that the patch test may be a useful method for detecting cross-reactive drugs in anticonvulsant-associated DRESS syndrome.
Syndrome ; Skin/drug effects/immunology/pathology ; Phenytoin/immunology ; Male ; Humans ; Drug Hypersensitivity/*immunology ; Drug Eruptions/etiology/*immunology ; Carbamazepine/*adverse effects ; Anticonvulsants/adverse effects ; Adult