OBJECTIVE: Many previous studies have shown that electrocardiographic (ECG) changes occur patients with subarachnoid hemorrhage (SAH). This study was designed to identify the frequency, influencing factors, and outcome of clinically significant cardiac arrhythmias after SAH. METHODS: We retrospectively analyzed clinical data of 122 patients including ECG finding, age, sex, the Hunt-Hess grade, the Fisher's grade, the history of hypertension, peak blood pressure and heart rate, location of aneurysm, Glasgow Outcome Scale (GOS) score, the days of admission to the intensive care unit, the presence of symptomatic vasospasm. RESULTS: Of 122 SAH patients, 50% (n = 61) had a verified clinically significant arrhythmia. There were no statistically significant independent factors associated with clinically significant arrhythmia in multivariate analysis. Although adjustments for the effects of age, Hunt-Hess grade, and the presence of symptomatic vasospasm on death were made, clinically significant arrhythmias were still independently predictive of death (no arrhythmia versus arrhythmia, 11.5% versus 27.9%, adjusted odds ratio [OR] 3.524, 95% confidence interval [CI] 1.229-10.100, p = 0.019) and poor outcome (GOS < or = 2, 13.1% versus 29.5%, adjusted OR 3.202, 95% CI 1.174-8.732, p= 0.023). CONCLUSION: Clinically significant arrhythmias after SAH are associated with a high mortality rate, and serious cardiac and neurological comorbidity. Patients with an abnormal ECG on admission should undergo close cardiac monitoring, and the presence of rhythm disturbances should prompt aggressive measures to treat myocardial infarction (MI), maintain a normal cardiac rhythm, and minimize the presence of autonomic stress.
Aneurysm ; Arrhythmias, Cardiac ; Blood Pressure ; Comorbidity ; Electrocardiography ; Glasgow Outcome Scale ; Heart Rate ; Humans ; Hypertension ; Intensive Care Units ; Multivariate Analysis ; Myocardial Infarction ; Odds Ratio ; Retrospective Studies ; Subarachnoid Hemorrhage

Background: Reversal of neuromuscular blockade (NMB) at the end of surgery is important for reducing postoperative residual NMB; this is associated with an increased risk of postoperative pulmonary complications (PPCs). Moreover, PPCs are associated with poor prognosis after video-assisted thoracoscopic surgery (VATS) for lobectomy. We compared the effects of two reversal agents, sugammadex and neostigmine, on the incidence of PPCs and duration of hospital stay in patients undergoing VATS lobectomy. Methods: After VATS lobectomy was completed under neuromuscular monitoring, the sugammadex group (n = 46) received sugammadex 2 mg/kg, while the neostigmine group (n = 47) received neostigmine 0.05 mg/kg with atropine 0.02 mg/kg after at least the third twitch in response to the train of four stimulation. The primary outcome was incidence of PPCs. The secondary outcomes were duration of hospital stay and intensive care unit (ICU) admission. Results: There was no significant difference in the incidence of PPCs for both the sugammadex and neostigmine groups (32.6% and 40.4%, respectively; risk difference = 0.08; 95% confidence interval = [−0.12, 0.27]; P = 0.434). The lengths of hospital (P = 0.431) and ICU (P = 0.964) stays were not significantly different between the two groups. Conclusions The clinical use of sugammadex and neostigmine in NMB reversal for patients undergoing VATS lobectomy was not significantly different in the incidence of PPCs and duration of hospital and ICU stay.

No abstract available.
Genitalia* ; Poroma*

In evaluating the esophago-gastric junction, many difficulties are well known in a single contrast study, andit may often be resolved with double contrast technique. By double contrast technique, the special en face viewfor the esophago-gastric junction was obtained in 298 cases at Inje Medical College Paik Hospital from Jan. 1981 to June 1981. Five basic patterns were recognized and classifed from type I to V. Their incidences were obtained.-type I ; 18%, type II; 50%, type III; 23% type IV ; 7%, type V; 2%. The most common position of patients is left lateral, and zero degree is the most common at elevation of fluoroscopic table. Type III is the most common typeof the esophage-gastric junction in inspiration, and type I expiration. Any significant deviations from thesenormal geometry of the esophago-gastric junction as displayed by double contrast study, indicate an abnormality.More special attentions are required to evaluate a minute pathologic condition of the esophago-gastric junction.
Attention ; Humans ; Incidence

BACKGROUND: Nitrous oxide (N2O) and remifentanil both have anesthetic-reducing and antinociceptive effects. We aimed to determine the anesthetic requirements and stress hormone responses in spinal cord-injured (SCI) patients undergoing surgery under sevoflurane anesthesia with or without pharmacodynamically equivalent doses of N2O or remifentanil. METHODS: Forty-five chronic, complete SCI patients undergoing surgery below the level of injury were randomly allocated to receive sevoflurane alone (control, n = 15), or in combination with 67% N2O (n = 15) or target-controlled infusion of 1.37 ng/ml remifentanil (n = 15). Sevoflurane concentrations were titrated to maintain a Bispectral Index (BIS) value between 40 and 50. Measurements included end-tidal sevoflurane concentrations, mean arterial blood pressure (MAP), heart rate (HR), and plasma catecholamine and cortisol concentrations. RESULTS: During surgery, MAP, HR, and BIS did not differ among the groups. Sevoflurane concentrations were lower in the N2O group (0.94 +/- 0.30%) and the remifentanil group (1.06 +/- 0.29%) than in the control group (1.55 +/- 0.34%) (P < 0.001, both). Plasma concentrations of norepinephrine remained unchanged compared to baseline values in each group, with no significant differences among groups throughout the study. Cortisol levels decreased during surgery as compared to baseline values, and returned to levels higher than baseline at 1 h after surgery (P < 0.05) without inter-group differences. CONCLUSIONS: Remifentanil (1.37 ng/ml) and N2O (67%) reduced the sevoflurane requirements similarly by 31-39%, with no significant differences in hemodynamic and neuroendocrine responses. Either remifentanil or N2O can be used as an anesthetic adjuvant during sevoflurane anesthesia in SCI patients undergoing surgery below the level of injury.
Anesthesia ; Arterial Pressure ; Catecholamines ; Heart Rate ; Hemodynamics ; Humans ; Hydrocortisone ; Nitrous Oxide* ; Norepinephrine ; Plasma ; Spinal Cord Injuries

BACKGROUND: A low fraction of inspired oxygen (FiO2) increases venous deoxygenated hemoglobin concentrations, making the color of the blood darker. The present study was aimed to determine the effects of FiO2 on the ability to discriminate venous from arterial blood. METHODS: One-hundred and sixty surgical patients undergoing percutaneous central venous access of the internal jugular vein were randomly assigned to receive an FiO2 of 0.2, 0.4, 0.6, or 1.0 (n = 40 each) for at least 20 min prior to central line placement under general anesthesia. Vascular access was achieved with a 22-gauge needle; 2 ml of blood was withdrawn and shown to three physicians including the operator. Each of them was asked to identify the blood as 'arterial', 'venous' or 'not sure'. Simultaneous blood gas analysis of the samples was performed on blood taken from the puncture site and the artery after visual comparison to confirm blood's origin and hemodynamic measurements. RESULTS: Lowering FiO2 progressively increased venous deoxygenated hemoglobin concentrations (2.24 +/- 1.12, 3.30 +/- 1.08, 3.66 +/- 1.15, and 3.71 +/- 1.33 g/dl) in groups having an FiO2 of 1.0, 0.6, 0.4 and 0.2, respectively (P < 0.001), thereby facilitating the 'venous' blood identification (P < 0.001). Neither heart rate nor mean arterial pressure differed among the groups. None developed hypoxemia (percutaneous hemoglobin oxygen saturation < 90%) in any group during the study period. CONCLUSIONS: A low FiO2 increases venous deoxygenated hemoglobin levels, thereby facilitating the recognition by clinicians of its venous origin in percutaneous central venous catheterization under general anesthesia.
Anesthesia, General ; Anoxia ; Arterial Pressure ; Arteries ; Blood Gas Analysis ; Catheterization, Central Venous ; Central Venous Catheters ; Heart Rate ; Hemodynamics ; Hemoglobins ; Humans ; Jugular Veins ; Oxygen ; Punctures

BACKGROUND: N2O has a unique analgesic effect and reduces the amount of hypnotics for preventing surgical stimuli during maintenance of anesthesia. Also, it was reported that high concentrations of N2O affect level of consciousness. The aim of this study was to evaluate the effect of inhaled concentrations of N2O during emergence on awakening time after propofol-N2O-O2 anesthesia. METHODS: Sixty ASA class I or II patients scheduled for lower extremity surgery were randomly allocated to one of three groups according to inhaled concentration of N2O during emergence. Group 1: 0% N2O (n = 20), group 2: 33% N2O (n = 20) and group 3: 50% N2O (n = 20). Anesthesia was induced and maintained with propofol (Ct: 3.5 6 microgram/ml)-67% N2O-33% O2 and the target concentration of propofol was kept at 4 microgram/ml at least 30 min before the end of infusion of propofol using TCI. At the time of skin closure, we discontinued the propofol, maintained the allocated concentration of N2O and continuously checked vital signs, current/effect concentration of propofol, bispectral index (BIS), and elapsed time until eye opening to verbal contact (awakening time). RESULTS: Awakening time and bispectral index significantly increased as the inhaled concentration of N2O was higher. At awakening time, The predicted current/effect site concentrations of propofol significantly decreased as the inhaled concentrations of N2O were increased. CONCLUSIONS: Continuous inhalation of N2O after discontinuation of propofol infusion significantly delayed the awakening time after propofol-N2O-O2 anesthesia using TCI.
Anesthesia* ; Consciousness ; Humans ; Hypnotics and Sedatives ; Inhalation ; Lower Extremity ; Propofol ; Skin ; Vital Signs

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most common complaints following laparoscopic surgery, and being female is a risk factor for PONV. Therefore, we conducted this study to determine if the incidence of PONV is associated with variations in the blood concentration of female hormones that occur during different stages of the menstrual cycle. METHODS: We recruited 103 women who were undergoing gynecological laparoscopic surgery under general anesthesia and met all of the inclusion criteria for this study. A menstrual history was taken from each patient during the preoperative anesthetic visit and blood samples were collected from all patients to determine the concentration of female hormones (estradiol, progesterone). We then assessed the nausea rating scale (NRS) and the occurrence of retching and vomiting at 0-2 hours, 2-6 hours, and 6-24 hours postoperatively. RESULTS: The overall incidence of PONV was 60.2% within the first 24 hours following surgery. However, no significant differences in the incidence of PONV were observed in women in different menstrual phases (follicular phase, 63.5% vs. luteal phase, 56.9%). In addition, there was no significant difference observed in the female hormonal concentration of the blood of patients who experienced PONV and those that did not, and there was no correlation between the NRS and the blood concentration of female hormones. CONCLUSIONS: The results of this study suggest that female hormones (estradiol, progesterone) are not associated with the occurrence of PONV following gynecological laparoscopic surgery.
Anesthesia, General ; Estradiol ; Female ; Humans ; Incidence ; Laparoscopy ; Luteal Phase ; Menstrual Cycle ; Nausea ; Postoperative Nausea and Vomiting ; Progesterone ; Risk Factors ; Vomiting

Cyclosporin A-induced gingival hyperplasia is frequently found in the patients who have been received an immunosuppressant for the organ transplantation. However, its exact mechanism is still unknown. The expression of FGF-5 and FGF-7 were studied in cyclosporine A-induced gingival hyperplasia (CGH) and inflammatory gingival hyperplasia (IGH). Immunohistochemistry and in situ hybridization were used for localization of protein and mRNA. The expression of FGF-5 and FGF-7 was different from CGH and IGH. FGF-5 and FGF-7 was strongly expressed in fibroblast in CGH (P<0.005 and P<0.05, respectively). FGF-5 mRNA was localized in the middle portion of connective tissue. FGF-7 mRNA was also identified in fibroblasts and mast cells. In conclusion, FGF-5 and FGF-7 were produced excessively by fibroblasts in CGH. Considering their known functions, their expression in CGH is important for production of collagen and proliferation of fibroblasts.
Collagen ; Connective Tissue ; Cyclosporine* ; Fibroblasts ; Gingival Hyperplasia* ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Mast Cells ; Organ Transplantation ; RNA, Messenger ; Transplants

PURPOSE: To correlate SOhographic and pathologic findings of gallbladder adenoma, and to evaluate the clinical significance of sonographic findings. MATERIALS AND METHODS: Ultrasound findings of twenty gallbladder adenomas were retrospectively reviewed to evaluate the size, shape and echogenicity of the adenoma, and was correlated with the pathological finding. RESULTS: Among 14 patients, 11 patients had single lesion and 3 patients had multiple lesions. Three patients showed 2, 3 and 4 adenomas, respectively. Nine of 20 lesions showed focal dysplasia pathologically. Among the nine adenomas with dysplasia, two adenomas showed focal cancerous change. The nine adenomas showing focal dysplasia measured 25.6mm (14-35mm) in mean diameter, while the mean diameter of adenomas without dysplasia was 8.7 mm (3-13mm). The echogenicity of adenoma with focal dysplasia were hyperechoic in 8, isoechoic in 1. The echogenicity of adenomas without dysplasia were hyperechoic in 7, isoechoic in 4. Sessile(7/9) and papillary shape(6/9) were predominant in adenoma with dysplasia, but smooth shape(8/11) and stalked type(9/11) were predominant in adenoma without dysplasia. Two adenomas with focal cancerous change showed histological transition from cancer to dysplasia and to adenomatous tissue. In adenoma with dysplasia, the diameter more than 14 mm on sonography was statistically significant (p<0. 005). Also age of patient was significantly different between the two groups (p<0.01), while echogenicity and associated stone were not statistically significant. CONCLUSION: As gallbladder adenoma more than 14ram in diameter on US is suggestive of dysplasia on pathology, so, close follow up US or surgery is recommended.
Adenoma* ; Follow-Up Studies ; Gallbladder* ; Humans ; Pathology ; Retrospective Studies ; Ultrasonography