BACKGROUND: Nitric Oxide (NO) has been discovered to be an important endothelium-derived relaxing factor. The exogenous inhaled NO may diffuse from the alveoli to pulmonary vascular smooth muscle and produce pulmonary vasodilation, but any NO that diffuses into blood will be inactivated before it can produce systemic effects. To examine the effects of NO on pulmonary and systemic hemodynamics, NO was inhaled by experimental dogs in an attempt to reduce the increase in pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) induced by hypoxia in dogs. METHODS: Eight mongrel dogs were studied while inhaling 1)50% O2 (baseline), 2)12% O2 in N2 (hypoxia), 3)followed by the same hypoxic gas mixture of O2 and N2 containing 20, 40 and 80 ppm of NO, respectively. RESULTS: Breathing at FIO2 0.12 nearly doubled the pulmonary vascular resistance from 173 56dyn sec cm-5 to 407 139dyn sec cm-5 and significantly increased the mean pulmonary artery pressure from 16 3mmHg to 22 4mmHg. After adding 20~80 ppm NO to the inspired gas while maintaining the FIO2 at 0.12, the mean pulmonary artery pressure decreased (p<0.05) to the level when breathing oxygen at FIO2 0.5 while the PaO2 and PaCO2 were unchanged. The pulmonary vascular resistance decreased significantly and the right ventricular stroke work index returned to a level similar to breathing at FIO2 0.5 by addition of NO into the breathing circuit. Pulmonary hypertension resumed within 3~5 minutes of ceasing NO inhalation. In none of our studies did inhaling NO produce systemic hypotension and elevate methemoglobin levels. CONCLUSIONS: Inhalation of 20~80 ppm NO selectively induced pulmonary vasodilation and reversed hypoxic pulmonary vasoconstriction without causing systemic vasodilation and bronchodilation. Methemoglobin and NO2 were within normal limit during the study.
Animals ; Anoxia ; Dogs ; Endothelium-Dependent Relaxing Factors ; Hemodynamics* ; Hypertension, Pulmonary ; Hypotension ; Inhalation* ; Methemoglobin ; Muscle, Smooth, Vascular ; Nitric Oxide* ; Oxygen ; Pulmonary Artery ; Respiration ; Stroke ; Vascular Resistance ; Vasoconstriction* ; Vasodilation

Authors reviewed clinical records of 92 patients with tetanus from January 1974 to December 1983 at Severance Hospital and the following results wre obtained. 1) There were about 2.2 times more cases of neonatal tetanus than that of nonneonatal. The admitted cases of tetanus decreased in 1980's compared to those of 1970's. 2) The male versus female ratio was 3 : 1 not only in nonneonatal but also in neonatal teanus. 3) There was a tendency of higher mortality when the site of injury was on the central part of the body than on the distal. 4) Most cases of tetanus developed after the injury with bactrial contamination as expected, but a few cases are due to only trivial injury such as acupuncture or injection without overt contamination. 5) There was a close relationship between the incubation period and mortality in neonatal tetaus but no such definite relationship in nonneonatal tetaus. 6) The duraton of admission was about 3 weeks and the majority of deaths occureed in less than one week of admission. 7) There was no statistically significant difference in mortality between the group who used tetanus antitoxin from animal and that who used human tetanus immuneglobulin.
Acupuncture ; Animals ; Female ; Humans ; Male ; Mortality ; Tetanus Antitoxin ; Tetanus*

BACKGROUND: This study was designed to evaluate the effect of propofol and oral clonidine on bleeding and their efficacy in blunting the hemodynamic effects of epinephrine during endoscopic sinus surgery. METHODS: Informed consent was obtained from eighty patients scheduled for endoscopic sinus surgery under general anesthesia. All patients received atropine 0.5 mg IM for premedication. Group I (n = 20) received thiopental sodium 5 mg/kg and vecuronium 0.1 mg/kg followed by an isoflurane 1 - 1.5 vol% in O2/N2O 50/50. Group P (n = 20) received propofol 2 mg/kg and vecuronium 0.1 mg/kg followed by an infusion of 6 - 10 mg/kg/hour in O2/N2O 40/60. Group P + 75 (n = 20) received oral clonidine 75ng and Group P + 150 (n = 20) received oral clonidine 150ng 60 min before induction of anesthesia. In anesthetic induction and maintenance, Group P + 75 and Group P + 150 were identical to Group P. Blood pressure, heart rate, EKG and SpO2 were continuously monitored. Blood losses were collected and measured at the end of each procedure. Pre- and postoperative hematocrit were checked. The duration of heart rate to peaked level and side effects were observed in all patients after the intranasal injection of epinephrine. RESULTS: The average estimated blood losses in Group P, P + 75 and P + 150 were significantly less than that of Group I (P < 0.05). In Group P + 150, the duration of heart rate increase was significantly shorter than that of Group I (P < 0.05). In Group P + 150, mean arterial pressure and the difference between preoperative and postoperative hematocrit were significantly less than that of Group I (P < 0.05). CONCLUSIONS: General anesthesia based on propofol infusion may have the advantage of decreased bleeding compared with conventional inhalation agents during endoscopic sinus surgery. Tachycardia inresponse to intranasal epinephrine injection was attenuated by oral clonidine.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Atropine ; Blood Pressure ; Clonidine* ; Electrocardiography ; Epinephrine ; Heart Rate ; Hematocrit ; Hemodynamics* ; Hemorrhage ; Humans ; Informed Consent ; Inhalation ; Isoflurane ; Premedication ; Propofol* ; Tachycardia ; Thiopental ; Vecuronium Bromide

No abstract available.
Arthritis, Juvenile*

Objectives: The aim of this study was to investigate the effect of daily living dual-task training focused on improving attention and executive function of the upper extremities, cognitive function, and quality of life in stroke patients. Methods: We included 30 stroke patients who were hospitalized between July 2020 and October 2020. They were divided into experimental and control groups through randomization. The experimental group performed 20 minutes of dual-task training and received 10 minutes of conventional occupational therapy, while the control group performed 20 minutes of single-task training and received 10 minutes of conventional occupational therapy. Both groups underwent their respective rehabilitation for 30 minutes per session, 5 times per week for 5 weeks. Results: Both groups showed significant improvements in upper extremity function, cognitive function, and quality of life; the experimental group showed higher results for all items. A significant between-group difference was observed in the magnitude of the changes. Conclusion In stroke patients, dual-task training that combined attention and executive function with daily living activities was found to be meaningful, as it encouraged active participation and motivation. This study is expected to be used as a foundation for future interventions for stroke patients.

Classification* ; Critical Care*

Hydorxyapatite ocular implants, which are used to replace the volume of the orbit following enucleation and evisceration, allow the artificial eye to move. For this advantage, drilling is required to integrate peg into implant for transfer of motion. The earlier drilling, the earlier good results in cosmesis, but it should be done in the conditon of complete vascularization to reduce infection and exposure. To evaluate the proper timing for drilling and the difference of vascularization rate between standard eevisceration(group A) and modified evisceration(group B), we attempted to evaluate implant vascularization by using 99mTc-MDP bone scan prospectively at various intervals from 10 to 23 weeks(6 patients at 10-12 weeks, 29 patients at 13-16 weeks, 31 patients at 1720 weeks, and 7 patients as 21-23 weeks) after implantation. In 7 out of 73 patients postcontrast MRI was performed on the same day of 99mTc-MDP bone scan, we compared the degree of enhancement with that of uptake in each patients. In group A the ratio of complete graft vascularization was seen in 0% at 1012 weeks, 33% at 13-16 weeks, 50% at 17-20 weeks, and 67% at 21-23 weeks. On the other hadnd in group B it was seen in 50% at 10-12 weeks, 55% at 13-16 weeks, 55% at 17-20 weeks, and 75% at 21-23 weeks. It was increased with time. The time of complete vascularization was not different between group A and B. In 7 patients studied with both 99mTc-MDP bone scan and MRI, the degrees of vascularization were very similar on the two examinations in each patients. We would like to suggest that it is proper to perform 99mTc-MDP bone scan at 21 weeks after implantation regardless of surgical methods. 99mTc-MDP bone scan is more economic than postcontrast MRI for evaluation of complete vascularization in hydroxyaptite implant.
Durapatite* ; Eye, Artificial ; Humans ; Magnetic Resonance Imaging ; Orbit ; Prospective Studies ; Technetium Tc 99m Medronate* ; Transplants

Occult papillary adenocarcinoma of the thyroid is known to be indolent, slow metastatic, and has a good prognosis. Occult thyroid carcinoma presenting as a blood-borne metastasis without obvious cervical lymph node involvement is extremely rare. A 65-year-old male patient was visited for hoarseness, dysphagia, and shortness of breath. Bronchoscopy with biopsy revealed a papillary carcinoma of thyroid by immunohistochemical staining. Head & neck CT revealed that involving both the upper esophagus and the posterior tracheal wall, extending into the mediastinum along the upper thoracic spine at T1-T2. We have experienced a rare case of occult papillary carcinoma which invaded the trachea, esophagus and fascia of thoracic spine. Treatment was initiated with radioactive iodine and external bean therapy.
Adenocarcinoma, Papillary ; Aged ; Biopsy ; Bronchoscopy ; Carcinoma, Papillary* ; Deglutition Disorders ; Dyspnea ; Esophagus* ; Fascia ; Head ; Hoarseness ; Humans ; Iodine ; Lymph Nodes ; Male ; Mediastinum ; Neck ; Neoplasm Metastasis ; Prognosis ; Spine ; Thyroid Gland* ; Thyroid Neoplasms ; Trachea*

A 47-year-old male patient in whom atrial septal defect (ASD) had been diagnosed 15 years previously was admitted for cardiac catheterization. He had definite cyanotic lips and nail beds and severe pulmonary arterial hypertension (PAH). He had received medical treatment only for the last few years after being diagnosed with Eisenmenger syndrome. After cardiac catheterization, he received iloprost inhalation therapy pre and postoperation and was discharged after successful surgical closure of the ASD.
Cardiac Catheterization ; Cardiac Catheters ; Eisenmenger Complex ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Humans ; Hypertension ; Hypertension, Pulmonary ; Iloprost ; Lip ; Male ; Middle Aged ; Nails ; Respiratory Therapy

OBJECTIVE: To investigate neural correlates associated with recovery of motor function over 6 months in patients with basal ganglia (BG) stroke using acetazolamide (ACZ) stress brain-perfusion single-photon emission computed tomography (SPECT). METHODS: Medical records of 22 patients presenting first-ever BG stroke were retrospectively reviewed. Regional cerebral blood flow (CBF) and cerebrovascular reserve (CVR) were measured for 9 regions in each cerebral hemisphere (primary motor cortex, supplementary motor area, premotor cortex, prefrontal cortex, temporal lobe, parietal lobe, occipital lobe, BG, and thalamus). The Fugl-Meyer Assessment (FMA) motor score was used to assess motor function. RESULTS: After ACZ injection, CBF of all regions of interest (ROIs) increased compared with baseline. Baseline CBF of all ROIs was not significantly correlated with changes in FMA upper or lower motor score. However, multivariate analysis revealed CVR was significantly associated with change in FMA upper score in the ipsilateral primary motor cortex (R2=0.216, p=0.017), the ipsilateral parietal lobe (R2=0.135, p=0.029), and the contralateral primary motor cortex (R2=0.210, p=0.041). CONCLUSION: CVR in the bilateral primary motor cortex and ipsilateral parietal lobe was associated with restoration of upper motor function 6 months after BG stroke. SPECT is a readily available imaging modality useful in studying brain residual function in patients with BG stroke.
Acetazolamide ; Basal Ganglia* ; Brain ; Cerebrovascular Circulation ; Cerebrum ; Humans ; Medical Records ; Motor Cortex ; Multivariate Analysis ; Occipital Lobe ; Parietal Lobe ; Prefrontal Cortex ; Recovery of Function ; Retrospective Studies ; Stroke* ; Temporal Lobe ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon*