BACKGROUNDS: Carbon Dioxide (CO2) insufflation during thoracoscopy may result in adverse hemodynamic consequences such as increase in central venous pressure, decrease in cardiac output and increase in arterial carbon dioxide pressure. But the cerebral effects of CO2 insufflation during thoracoscopy are not known yet. To evaluate the cerebral effect of CO2 insufflation during thoracoscopy, jugular bulb venous blood oxygen saturation and pressure were measured. METHODS: Nine patients were underwent thoracic surgery by thoracoscopy and one lung ventilation. After operation, CO2 was insufflated and hemodynamic parameters, arterial blood pressure, heart rate, central venous pressure, jugular bulb pressure, arterial blood gases and jugular bulb venous blood gases were measured at intrathoracic pressure 5 mmHg, 10 mmHg and 15 mmHg respectively. RESULTS: Central venous pressure was increased with insufflation of CO2 of 10 mmHg and 15 mmHg. Jugular bulb pressure was increased with insufflationof of CO2 of 5mmHg, 10 mmHg and 15 mmHg. Arterial PCO2, jugular bulb venous PO2 and jugular bulb venous blood oxygen saturation were increased with insufflation of CO2 of 5 mmHg, 10 mmHg and 15 mmHg. CONCLUSION: CO2 insufflation pressure of 5 mmHg or greater resulted in significant increase in jugular bulb venous blood oxygen saturation and pressure.
Arterial Pressure ; Carbon Dioxide ; Cardiac Output ; Central Venous Pressure ; Gases ; Heart Rate ; Hemodynamics ; Humans ; Insufflation* ; Jugular Veins ; One-Lung Ventilation ; Oxygen* ; Thoracic Surgery ; Thoracoscopy*

BACKGROUND: We analysed simple chest PA and high-resolution CT findings in patients with spontaneous pneumothorax in order to help selecting the kind of treatment, provide a guidline during surgical treatment, and to recognize the bulla which may not be detected by simple radiographs or may be a potential cause of recurrence. MATERIAL AND METHOD: We retrospectively analysed the presence and number of bulla in each side, combined pulmonary disease on simple chest films and high-resolution CT, and methods and frequency of the treatment in 70 patients with spontaneous pneumothorax excluing traumatic origin. RESULT: 45 patients were revealed primary spontaneous pneumothorax, and the remaining 25 patients were revealed secondary spontaneous pneumothorax. All secondary spontaneous pneumothorax were from the longstanding sequelle of pulmonary tuberculosis. The patients with primary spontaneous pneumothorax group was younger(mean:26.0 years old) than secondary group (mean: 44.1 years old). On simple radiography, bulla was detected in 16 patients(30.2%). On HRCT, the bulla was detected in 53 patients(75.7%) of the total 70 patients. In 48 patients(68.6%), the bulla or bleb was noted in ipsilateral side to the pneumothorax, and 34 patients(48.6%) of them showed bulla or bleb bilaterally. 39 patients(55.7%) showed bulla or bleb in contralateral side. The number of bulla or bleb was variable. In secondary spontaneous pneumothorax group, the incidence of multiple(more than 10) bulla or bleb was higher than primary type. Most of the patients were treated by thoracostomy(36 patients) or bullectomy( 7 patients). CONCLUSION: HRCT was superior to detect bulla and analyse the combined pulmonary disease than simple radiography. Therefore, HRCT can help to determine the mothod of treatment, provide a guidline during surgical treatment, and notify the bulla as a possible cause of recurrent pneumothorax.
Blister ; Humans ; Incidence ; Lung Diseases ; Pneumothorax* ; Radiography ; Recurrence ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary

The management of malignant pleural effusion is a difficult problem. Tetracycline was probably the most commonly used sclerosing agent, but parenteral tetracycline is no longer available. This prospective study was designed to determine the efficacy of insufflated talc in producing plerodesisin patients with malignant pleural effusions. Fifteen patients managed between March 1995 and March 1997 underwent thoracoscopy and had 4 gm sterile asbestos-free talc insufflation throughout the pleural space. The mean interval between the procedure and last follow-up was 101 days (range: 25-233 days). The results of treatment were clinically and radiologically compared with pre-operative status. The results were as follows: 1. The patients were 6 men and 9 women with a mean age of 55.1 years (range: 31-74 years). The primary tumors were lung cancer in 10 patients, breast cancer in two, hepatoma in one, stomach cancer in one, and adenocarcinoma of unkown origin in one. 2. Cancer cell positive ratio was 36% in sputum cytology study and 100% in thoracoscopic biopsy. 3. Symptoms improved in 94% of patients treated by talc pleurodesis. 4. After 30 days of the procedure, there was radiologically no recurrence of plural fluid in 94% patients. 5. There were wound infection in one, respiratory failure in one. In conclusion, the insufflation of 4 gm sterile asbestos-free talc in the pleural space is an effective method to control malignant pleural effusions and patients selection is important factor for reexpansion the lung.
Adenocarcinoma ; Biopsy ; Breast Neoplasms ; Carcinoma, Hepatocellular ; Female ; Follow-Up Studies ; Humans ; Insufflation ; Lung ; Lung Neoplasms ; Male ; Pleural Effusion ; Pleural Effusion, Malignant* ; Pleurodesis* ; Prospective Studies ; Recurrence ; Respiratory Insufficiency ; Sputum ; Stomach Neoplasms ; Talc* ; Tetracycline ; Thoracoscopy ; Wound Infection

Diffuse lung disease is amenable to diagnosis by means of clinical evaluation, bronchoalveolar lavage, transbronchial biopsy, and lung biopsy. The recently introduced technique of thoracoscopic wedge biopsy provides the potential advantages of greater selection of biopsy sites and reduced postoperative pain compared with those associated with standard open lung biopsy. Video assisted thoracoscopic lung biopsy was performed in 22 patients for the diagnosis of diffuse lung disease during the period from August 1994 to December 1996, and the following results were obtained: 1. The patients were 14 men and 8 women. The average age was 54.6 years. 2. 13 lung biopsy specimens were obtained from the right lower lobe, 4 from the right upper lobe, 3 from the right middle lobe, 3 from the left upper lobe, and 3 from the left lower lobe. 3. A comparison of pulmonary function tests between preoperative and postoperative values showed no significant differences in FVC, FEV1, and FEV1/FVC(p>0.05). 4. All patients were pathologically diagnosed and the most common disease was usual interstitial pneumonia(8/22). In conclusion, thoracoscopic lung biopsy was a safe and effective diagnostic method of diffuse lung disease.
Biopsy* ; Bronchoalveolar Lavage ; Diagnosis ; Female ; Humans ; Lung Diseases ; Lung Diseases, Interstitial* ; Lung* ; Male ; Pain, Postoperative ; Respiratory Function Tests ; Thoracoscopy

BACKGROUND: The macrophages activated by lipopolisaccharide produce numerous molecules and proteins, such as tumor necrotic factor-alpha (TNF-alpha), interleukin-6 (IL-6), IL-1beta, inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and free radicals, associated with inflammation. The response was occurred by intracellular cascaded, NF-kappaB pathway. So, the regulation of this pathway is very important in control of inflammation. OBJECTIVE: In this study, the anti-inflammatory and anti-oxidant effects of Sophora flavescens that is used empirically in oriental medicine and folk remedy were evaluated and the mechanism of the effects was studied. METHODS: By using the root extracts of Sophora flavescens, we performed experiment in LPS and interferon-gamma (IFN-gamma)-activated Raw 264.7 cells. We measured the production of NO, PGE2 and expression of iNOS and COX-2 in activated Raw 264.7 cells with Sophora flavescens root extract. Also, we tested anti-oxidant effect of Sophora flavescens root extracts by ELISA kit in activated Raw 264.7 cells, and the free radical scavenging effect of material itself by DPPH assay. RESULTS: The Sophora flavescens root extracts decreased the production of NO (p<0.001) and PGE2 (p<0.01) in Raw 264.7 cells activated by LPS and IFN-gamma. The expression of proteins, iNOS and COX-2, suppressed along with the elevated concentration of Sophora flavescens root extracts. The result of DPPH assay was that the test material itself had scavenging effect for free radical (p<0.001). And the antioxidant activity in activated Raw 264.7 cells was increased with the level of the Sophora flavescens root extracts (p<0.05). CONCLUSION: The Sophora flavescens root extracts suppressed the production of NO and PGE2 through the decreased expression of iNOS and COX-2. And the Sophora flavescens root extracts had the scavenging effect about free radicals itself and increased the antioxidant activity in activated macrophages.
Antioxidants ; Cyclooxygenase 2 ; Dinoprostone ; Enzyme-Linked Immunosorbent Assay ; Free Radicals ; Inflammation ; Interferon-gamma ; Interleukin-6 ; Macrophages ; Medicine, East Asian Traditional ; Medicine, Traditional ; NF-kappa B ; Nitric Oxide Synthase Type II ; Proteins ; Sophora

BACKGROUND: In the studies of the distribution of time to death in trauma patients, the early deaths within several hours after injury were a large component of total trauma deaths. Due to the development of trauma system, overall mortality of trauma was decreased, but trauma is still the major cause of deaths. MATERIAL AND METHOD: From January 1994 to December 2003, trauma patients who had been admitted and had expired at tertiary hospital were enrolled. There was a total of 400 cases, a retrospective study was done to determine the distribution of trauma mortality according to the part of the body that were severely injured part and compared the difference between early deaths within 6 hours and late deaths after 6 hours. We also analysed the risk factors of early deaths due to trauma. RESULT: In severe injury to the head and abdomen, the distribution of mortality was bimodal. But, in severe chest injuries, the distribution was log-shape and most early deaths were almost of trauma related. The average of GCS were 5.86+/-4.15 for the early deaths and 8.24+/-5.02 for the late deaths (p <0.05). The AIS of thorax were 2.66+/-1.87 for the early deaths and 1.55+/-1.76 for late deaths. The risk factors for early mortality were non-EMS transportation (odds ratio 3.474), high AIS (odds ratio 1.491) and GCS (odds ratio 0.859). CONCLUSION: In trauma patients, the causes of early mortality were severe brain injury and massive hemorrhage. Also severe chest injuries were the major cause of the early deaths in truama. Early diagnosis of chest injury can frequently be missed in the acute trauma setting. Therefore, high index of suspicion, a careful examination, and aggressive surgical treatment are important in multiple trauma patients.
Abdomen ; Brain Injuries ; Cause of Death ; Early Diagnosis ; Head ; Hemorrhage ; Humans ; Mortality ; Multiple Trauma ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Thoracic Injuries* ; Thorax* ; Transportation

BACKGROUND: We compared the analgesic effects of an intravenous infusion of remifentanil with local lidocaine injection during endovenous laser treatments (EVLT) for varicose veins. MATERIAL AND METHOD: In order to compare the efficacy of analgesia between the lidocaine group (n=15) and the remifentanil group (n=15), we measure the pain intensity of the patients, with using the visual analogue scale, during EVLT and at the first week, the second week, the third week and the fourth week after EVLT. RESULT: The remifentanil group showed significantly less pain intensity during EVLT (p<0.01), but there were no differences of pain intensity between the two groups from the first week to the fourth week after EVLT (p>0.3). CONCLUSION: The result showed that the intravenous infusion of remifentanil during EVLT can be a good option to reduce pain during EVLT for treating varicose veins.
Analgesia ; Anesthesia, Local ; Humans ; Infusions, Intravenous ; Laser Therapy ; Lidocaine ; Piperidines ; Varicose Veins ; Veins

BACKGROUND: More than 70% of morbidity and mortality of diabetes mellitus is due to macrovascular complications. These complications may be associated with defect of endothelium-dependent vascular relaxation. There have been suggestions that this defect might be due to direct toxicities of oxygen-free radical. So in this study ascorbic acid was used as a dietary supplement in streptozotocin induced diabetic rats to correct this defect. MATERIAL AND METHOD: Sixty male Sprague-Dawley rats were used in this study. They were divided into control and experimental groups. Streptozotocin was injected to the 33 rats of experimental group and then divided into two the other receiving subgroups; one receiving ascorbic acid supplement(1 g/l in drinking water); and nosupplements. At 6, 9 and 12 weeks, abdominal aortic rings were obtained to make tissue preparations for evaluation of vascular smooth muscle contractility. RESULT: While control group showed good response to acetylcholine induced relaxation, diabetic group showed decreased relaxation regardless of ascorbic acid supplement at the experiments 6 weeks after streptozotocin treatment. This abnormal endothelium-dependent vascular relaxation was markedly reversed at 9 and 12 weeks into the diabetic group with ascorbic acid supplement. There were no differences in sodium nitroprusside induced relaxation responses between control and experimental groups; also, norepinephrine induced contractile responses did not show any remarkable effects. CONCLUSION: These results strongly suggest that the endothelial cells have defects in diabetic rats. Dietary supplement of ascorbic acid can reverse the defects of diabetic endothelial cells through its antioxidant effects and it may further protect against vascular disease in diabetic patients.
Acetylcholine ; Animals ; Antioxidants ; Ascorbic Acid* ; Diabetes Mellitus ; Dietary Supplements ; Drinking ; Endothelial Cells ; Humans ; Male ; Mortality ; Muscle, Smooth, Vascular ; Nitroprusside ; Norepinephrine ; Rats* ; Rats, Sprague-Dawley ; Relaxation ; Streptozocin ; Vascular Diseases

BACKGROUND: The aims of this study are to determine the predicting factors related with cardiovascular injuries in sternal fractures and to suggest the indication of emergency echocardiography. MATERIAL AND METHOD: A retrospective review of the Ewha Womans University Mok-Dong Hospital trauma registry revealed 40 patients, that visited the hospital with a sternal fracture a over 5-year period. We analyzed 4 factors as predicting factors; 1) presence of restraint, 2) presence of associated injuries, 3) presence of a past medical history involving cardiovascular system, and 4) Revised Trauma Score(RTS). We, also, assessed the utility of conventional study methods involving cardiovascular injuries, such as ECG, chest X-ray, and enzyme level. Based on the methods, we inferred an indication for emergency echocardiography in sternal fractures. RESULT: Statistically significant predicting factors were the presence of a past medical history involving cardiovascular system and abnormal RTS on admission. Usage of emergency echocardiography depended upon the predicting factors and the results from conventional evaluations. We can now suggest the indications of emergency echocardiography in sternal fractures as 1) if more than two studies reveal abnormality without any significant predicting factors, and 2) if more than one study reveals abnormality with any significant predicting factors. CONCLUSION: The past medical history involving cardiovascular system and initial vital signs imply the presence of cardiovascular injuries in sternal fractures. And if needed, emergency echocardiography should be performed.
Cardiovascular System ; Echocardiography ; Electrocardiography ; Emergencies ; Female ; Humans ; Retrospective Studies ; Sternum ; Thoracic Injuries ; Thorax ; Vital Signs

BACKGROUND: It has been documented that brief repetitive periods of ischemia and reperfusion (ischemic preconditioning, IP) enhances the recovery of post-ischemic contractile function and reduces infarct size after a longer period of ischemia. Many mechanisms have been proposed to explain this process. Recent studies have suggested that transient increase in the intracellular calcium may have triggered the activation of protein kinase C(PKC); however, there are still many controversies. Accordingly, the author performed the present study to test the hypothesis that preconditioning with high concentration of calcium before sustained subsequent ischemia(calcium preconditioning) mimics IP by PKC activation. MATERIAL AND METHOD: The isolated hearts from the New Zealand White rabbits(1.5~2.0 kg body weight) METHOD: The isolated hearts from the New Zealand White rabbits(1.5~2.0 kg body weight) were perfused with Tyrode solution by Langendorff technique. After stabilization of baseline hemodynamics, the hearts were subjected to 45-minute global ischemia followed by a 120-minute reperfusion with IP(IP group, n=13) or without IP(ischemic control, n=10). IP was induced by single episode of 5-minute global ischemia and 10-minute reperfusion. In the Ca2+ preconditioned group, perfusate containing 10(n=10) or 20 mM(n=11) CaCl2 was perfused for 10 minutes after 5-minute ischemia followed by a 45-minute global ischemia and a 120-minute reperfusion. Baseline PKC was measured after 50-minute perfusion without any treatment(n=5). Left ventricular function including developed pressure(LVDP), dP/dt, heart rate, left ventricular end-diastolic pressure(LVEDP) and coronary flow(CF) was measured. Myo car ial cytosolic and membrane PKC activities were measured by 32P-gamma-ATP incorporation into PKC-specific pepetide. The infarct size was determined using the TTC (tetrazolium salt) staining and planimetry. Data were analyzed using one-way analysis of variance(ANOVA) variance(ANOVA) and Tukey's post-hoc test. RESULT: IP increased the functional recovery including LVDP, dP/dt and CF(p<0.05) and lowered the ascending range of LVEDP(p<0.05); it also reduced the infarct size from 38% to 20%(p<0.05). In both of the Ca2+ preconditioned group, functional recovery was not significantly different in comparison with the ischemic control, however, the infarct size was reduced to 19~23%(p<0.05). In comparison with the baseline(7.31 0.31 nmol/g tissue), the activities of the cytosolic PKC tended to decrease in both the IP and Ca2+ preconditioned groups, particularly in the 10 mM Ca2+ preconditioned group(4.19 0.39 nmol/g tissue, p<0.01); the activity of membrane PKC was significantly increased in both IP and 10 mM Ca2+ preconditioned group (p<0.05; 1.84 0.21, 4.00 0.14, and 4.02 0.70 nmol/g tissue in the baseline, IP, and 10 mM Ca2+ preconditioned group, respectively). However, the activity of both PKC fractions were not significantly different between the baseline and the ischemic control. CONCLUSION: These results indicate that in isolated Langendorff-perfused rabbit heart model, calcium preconditioning with high concentration of calcium does not improve post-ischemic functional recovery. However, it does have an effect of limiting(reducing) the infart size by ischemic preconditioning, and this cardioprotective effect, at least in part, may have resulted from the activation of PKC by calcium which acts as a messenger(or trigger) to activate membrane PKC.
Calcium* ; Cytosol ; Heart Rate ; Heart* ; Hemodynamics ; Ischemia ; Ischemic Preconditioning ; Membranes ; New Zealand ; Perfusion ; Protein Kinase C* ; Protein Kinases* ; Reperfusion ; Ventricular Function, Left