Sine 1961, Dr. Safar postulated the new form of patient, so called "progressive patient care", the hospital service in all countries are fashioned with intensive therapy unit. Particulary the- World Federation Society of Anesthesiologists who have discusincerly at several International congress. we were interested from the literature and visited England, Denmark, United States. and Japan. Of course in Korea, the intensive therapy unit developed from the recovery room and is thus intimately oonnected with anesthesiologists. Here we reviewed with literature and introduced the activities af the intensive therapy unit of Hanyang University Hospital from May 1972 to October 1973, from the point view of the definition, building design, location, capacity, equipment, staff organization and charge of patient, several problems and regulations. Furthermore we recommended with the following new ideas for establishment in hospital of an intensive therapy. unit. a. The design should be arranged on the same floor (OR-RR-Anes.-1TU) and in central part of building. b. Several isolation rooms should be made in 1-T-U. c. One central monitoring system will serve each units. d. The 1-T-U equipment should be used with wall trolly system. e. The regulations of 1-T-U should be noted and advocated by all hospital members. f. The beds in 1-T-U should be arranged with open system.
Denmark ; England ; Humans ; Japan ; Korea ; Recovery Room ; Social Control, Formal ; United States

Benzodiazepine derivatives, chlordiazepoxide(Librium), diazepam(Valium), nitrazepam(Mogadon) and oxazepam(Serenid-D) are mainly used as hypnotics at present. Diazepam has been used mainly for premedication in anesthesia and as an intravenous anesthetic agent. The pharmacological actions of these drugs are tranquilizing effects for central nervous system, slight depression on the cardiovascular and respiratory system, anticonvulsant, anxiolytic and antidepressant effects. A new benzodiazepine derivative, Flunitrazepam(Ro 5-4200) has strong hypnotic action, is anticonvulsant and antidepressant in spite of slight depression of the cardiovascular and respiratory systems. Furthermore the onset and duration of this drug are shorter than the others. In our clinical study, flunitrazepam in the dosage of 0.005mg/kg was administered intravenously, as an intravenous anesthetic induction agent, for 22 surgical adult patients. In each patient, the blood pressure, pulse rate, respiratory rate, minutes volume and arterial gas study were done, before and after administration of the Ro 5-4200. The results are as follows; 1. Dosage of this flunitrazepam is not constant as other benzodiazepines. 2. The effects of flunitrazepam on the cardiovascular system showed slight depression but no effect by one hour post-operation. 3. In respiratory system, the minute volume was depressed slightly and the respiratory rate was increased but negligibly. 4. Undesirable side effects attributed to this drug were not found, except the developing of cough (one case).
Adult ; Anesthesia ; Benzodiazepines ; Blood Pressure ; Cardiovascular System ; Central Nervous System ; Clinical Study* ; Cough ; Depression ; Diazepam ; Flunitrazepam ; Heart Rate ; Humans ; Hypnotics and Sedatives ; Premedication ; Respiratory Rate ; Respiratory System ; Tranquilizing Agents

In the present study, we investigated the effect of staurosporine on the formation of cellular processes in human gingival fibroblasts and rat astrocytes. Staurosporine caused a rapid induction of process formation in human gingival fibroblasts and rat astrocytes in a concentration dependent manner. The process formation of human gingival fibroblasts and rat astrocytes was prevented by the pretreatment with N-acetylcysteine, suggesting that staurosporine-induced ROS production was responsible for the process formation. Colchicine, a microtubule depolymerizing agent, inhibited the staurosporine-induced process formation, whereas cytochalasin D, an actin filament breakdown agent, failed to suppress the formation of cellular processes. This result indicated that polymerization of microtubule, and not actin filament, was responsible for the formation of cellular processes induced by staurosporine. In support of this hypothesis, Western blot analysis was conducted using anti-tubulin antibody, and the results showed that the amount of polymerized microtubule was increased by the treatment with staurosporine while that of depolymerized beta-tubulin in soluble fraction was decreased. These results indicate that staurosporine induces ROS-mediated, microtubule-dependent formation of cellular processes in human gingival fibroblasts and rat astrocytes.
Acetylcysteine ; Actin Cytoskeleton ; Animals ; Astrocytes* ; Blotting, Western ; Colchicine ; Cytochalasin D ; Fibroblasts* ; Humans ; Microtubules ; Polymerization ; Polymers ; Rats* ; Staurosporine* ; Tubulin

BACKGROUND: Systemic hypertension produces varying degree of LVH which is associated with increased cardiovascular morbidiity. Previous studies have documented regression of LVH with various antihypertensives including calcium channel blockers, except diuretics and vasodilators. Recently echocadiographic assessment of the change of left ventricular mass(LVM) after antihyertensive therapy have been reported to offer prognostic cardiovascular information. The aim of this echocardiographic study is determining the influence of nicardipine, a calcium channel blocker, on the change of LVM in patients with essential hypertenison. METHODS: Left ventricular mass(LVM) and left ventricular mass index(LVMI) were measured by M-mode echocardiography in 15 patients with essential hypertension. Nicardipine, a calcium channel blocker, was administered for 6 months and two echocardiographies were done before and after administering, respectively. RESULTS: In the 15 patients treated for 6 months, systolic and diastolic pressure remained very significantly decreased compared with pressure before before therapy(135+/-15mmHg vs 168+/-26mmHg, and 86+/-7mmHg vs 105+/-16mmHg, both p<0.01). Concomitantly both LVM and LVMI decreased significantly(209+/-49g vs 235+/-71g, and 116+/-6g/m2 vs 131+/-38g/m2,both p<0.05). And no change was noted in left ventricular cavity size, demonstration that LVM reduction was due to regression of hypertrophy. CONCLUSION: This study showed that nicardipine produced a significant decrease in blood pressure, LVM, and LVMI over the 6 months period. And large and longterm controlled studies are needed for the clarification of the association between nicardipine and regression of LVH in hypertensive patients.
Antihypertensive Agents ; Blood Pressure ; Calcium Channel Blockers ; Calcium Channels ; Diuretics ; Echocardiography ; Humans ; Hypertension ; Hypertrophy ; Nicardipine* ; Vasodilator Agents

Two cases of incomplete transverse vaginal septum with a small opening in the upper third of vagina were presented. One case was a patient presenting at 31 years of age for evaluation of primary infertility and oligomenorrhea. Diagnosis was made by hysterosalpingography, tranvaginal ultrasonography, MRI, and diagnostic pelviscopy for evaluation of abnormality of endopelvic organs. The patient was treated with surgical resection of septum (simple septectomy). Examination 3 months later demonstrated narrowing of the vaginal lumen. Another case was a patient presenting intrauterine pregnancy at 8 weeks and 2 days accompanying transverse vaginal septum with small opening. She had previous septotomy history and presented postoperative scarring. She had septectomy and anastomosis of the mucosa, and presented postoperative narrowing again about a month postoperatively. In this report we describe the two cases of transverse vaginal septum. We also reviewed the literature including diagnostic and treatment guidelines. Prevention of postoperative scarring is the most important factor in management of transverse vaginal septum. For that, first of all, initial septectomy should be done with approximation of the mucosa and postoperative dilatation is necessary. Importance of the initial accurate septectomy is too important to be over-emphasized.
Cicatrix ; Constriction, Pathologic* ; Diagnosis ; Dilatation ; Female ; Humans ; Hysterosalpingography ; Infertility ; Magnetic Resonance Imaging ; Mucous Membrane ; Oligomenorrhea ; Pregnancy ; Ultrasonography ; Vagina

OBJECTIVETo identify the risk factors associated with congenital microtia.

METHODSA case-control, retrospective study was performed. A total of 207 cases of congenital microtia and 209 age-frequently-matched controls were interviewed individually according to the uniform questionnaire. The questionnaire included: (1) Essential information about patients and their parents. (2) First trimester diseases and medication of mother. (3) Past gestation history of mother. (4) Family history and life style of the parent. The available data were analyzed by chi-square test and multivariate Logistic regression model.

RESULTSThe factors, such as gender (OR = 5.893), first trimester disease of mother (OR = 34.49) and medication (OR = 4.299), excessive drinking and smoking of father (OR = 4. 347, OR = 4.304), non-primiparous parity (OR = 9.524), abortion (spontaneous and induced, OR = 1.723), low-education of mother (OR = 2.275) were risk factors contributing to microtia in multivariate study. The factors, such as tea (OR = 0.179) were protective factors in multivariate study.

CONCLUSIONSMulti-risks factors are contributing to microtia. Preventive measures according to risk factors should be put forward.

Case-Control Studies ; Child ; Congenital Abnormalities ; etiology ; Ear Auricle ; abnormalities ; Female ; Humans ; Male ; Maternal Exposure ; Paternal Exposure ; Pregnancy ; Retrospective Studies ; Risk Factors ; Surveys and Questionnaires

OBJECTIVESTo explore the clinical characteristics of cardiac syncope (CS) in children, and understand their significance in predicting the cardiac syncope.

METHODSTwenty-three patients were referred to our department for evaluation of syncope. The diagnosis of the above cases was cardiac syncope. Each patient was interviewed using a standard questionnaire. The clinical histories and standard baseline electrocardiogram were analyzed to identify the variables contributing to the diagnosis of CS in children.

RESULTSA cardiac cause was identified in 23 syncopal patients presenting to the Department of Pediatrics, Peking University First Hospital: sick sinus syndrome in 7, congenital long QT syndrome in 4, third degree atrioventricular block in 2, supraventricular tachycardia in 2, ventricular tachycardia in 1, atrial fibrillation in 1, pacemaker dysfunction in 1, idiopathic pulmonary hypertension in 3, hypertrophic cardiomyopathy in 1, and dilated cardiomyopathy in 1. The average age of CS patients was 9 years. In totally 23 patients, exertion related syncope spells were found in 14 cases (60.9%), syncope spells at various position 7/23 (30.4%), absence of prodromes in 12/23 (52.2%), syncope spells with incontinence in 4/23 (17.4%), history of heart disease in 4/23 (17.4%). Abnormal standard baseline electrocardiogram was found in 21 cases (91.7%).

CONCLUSIONSThe children with cardiac syncope have overt clinical features, especially abnormal findings in electrocardiogram and exertion related syncope spells are the most common clinical features.

Adolescent ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Heart Diseases ; complications ; Humans ; Male ; Retrospective Studies ; Syncope ; diagnosis ; etiology ; Tachycardia, Ventricular ; complications

OBJECTIVE Vascular dementia (VD) refers to a progressive decline in memory and cognitive function caused by chronic cerebral ischemia. 2-Vessels occlusion (2-VO) has been widely used as a model of VD. Xiao-Xu-Ming decoction, a well-known traditional Chinese medicine prescrip-tion,has been widely used to treat stroke and sequelae of stroke.The present study was to investigate the mechanism of Xiao-Xu-Ming decoction(XXM) against chronic cerebral ischemia injury in rats. METHODS After XXM treatment, rats were performed a memory testing with Morris water maze and motor ability testing using prehensile test and inclined screen test.Neuronal plasticity was observed by immunofluorescent staining with MAP2 antibody. Differentially expressed proteins of rat hippocampus were analyzed by Label-free quantitative proteomics. RESULTS XXM significantly alleviated 2-VO-induced learning and memory deficits, motor ability dysfunction, and neuronal plasticity injury in rats. The mechanism might be involved in up-regulation of 39 proteins and down-regulation of 13 proteins in the hippocampus of rats after XXM treatment vs 2-VO group rats.Gene ontology and pathway analysis showed that the regulated proteins are mainly involved in oxidation reduction process, intracellular signaling cascade process, and protein catabolic process, etc. The signal pathways are mainly involved in ubiquitin mediated proteolysis and phosphatidylinositol signaling system. CONCLUSION Current findings provide new insights into the molecular mechanisms of XXM on chronic cerebral ischemia.

Background: Periprosthetic infection after total knee arthroplasty is a challenging problem, and physicians should identify risk factors to decrease recurrence. However, risk factors for reinfection with two-stage reimplantation have not yet been well established. The purpose of this study was to assess treatment outcomes of subsequent twostage knee reimplantation and identify risk factors for uncontrolled periprosthetic knee joint infections. Methods: We retrospectively reviewed 70 knees diagnosed with a periprosthetic knee joint infection treated with two-stage reimplantation between September 2011 and October 2016 at our institution. Patients in the controlled infection group (group C) required no further medication or surgical treatment within 2 years after reimplantation.Patients in the uncontrolled infection group (group U) displayed symptoms of active infection after resection arthroplasty or were reinfected after two-stage reimplantation. We compared group C and group U, and analyzed potential risk factors for uncontrolled prosthetic joint infection (PJI). Results: Of 70 knees included in this analysis, 53 (75.7%) were clinically deemed free from infection at the latest follow-up. The remaining 17 knees (24.3%) required additional surgical procedures after two-stage reimplantation.Demographics were not statistically significantly different between the two groups. Wound complications were statistically more frequent in group U (p = 0.030). Pre-reimplantation C-reactive protein (CRP) was statistically different between groups C and U (0.44 and 1.70, respectively, (p = 0.025). Among the cultured microorganisms, fungus species were statistically more frequently detected in group U compared with group C ((p = 0.031). Conclusions The reinfection rate of our two-stage reimplantation protocol was 24.3% in the included cases.Wound complications, higher pre-reimplantation CRP levels, and fungus species were statistically more common in group U compared with group C. Our findings will help in counseling patients and physicians to understand that additional caution may be required when treating PJI if the aforementioned risk factors are present.Level of evidence: IV, case series.

Distal clavicle fractures are less common than mid-shaft fractures in adults and there is no consensus on the best classification system or the ideal treatment approach considering that high nonunion rates have been reported. Although there are numerous treatment options for distal clavicle fractures, a gold standard treatment has not yet been established. Each surgical technique has its pros and cons. In this review article, we provide an overview of classification systems and treatment methods for distal clavicle fractures.