Voice changes developing after endotracheal intubation during right hemicolectomy with endotracheal intubation have been found to be due to a right recurrent laryngeal nerve palsy in 43-years-old male patient. It was likely that the inflated cuffed tube rode up to the level of the cricoid cartilage during the course of surgery as traction was placed on the endotracheal tube because the condenser humidifier and breathing circuit weighed heavy. Cuff overexpansion, in addition to muscle relaxation and decreased tracheal elasticity were considered as contributing factors of vocal cord palsy. We believe that tube traction and cuff overexpansion were the mechanism of vocal cord palsy in our patient. So we recommend the routine use of tube stand so that weigh of the breathing circuit does not transmit traction to the endotracheal tube. Concurrently, filling the cuff with a sample of the inspired mixture of gases, saline and 4% lidocaine in special cases or regular deflation of the cuff must be considered.
Cricoid Cartilage ; Elasticity ; Gases ; Humans ; Intubation, Intratracheal* ; Lidocaine ; Male ; Muscle Relaxation ; Respiration ; Traction ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice

BACKGROUND: Aspirin, one of the antiplatelet agents, improves the survival rate after myocardial infarction. This beneficial effect is known to be obtained in part by the antiarrhythmic action of aspirin. It is not known whether other antiplatelet agents have such effects. This study was performed to compare the effects of aspirin, ticlopidine, and abciximab (platelet glycoprotein IIb/IIIa receptor antagonist) on the ischemia-induced arrhythmias with a rat model of cardiac regional ischemia. METHODS: Experiments were performed in 4 groups of rats. The 4 groups were as follows : control, n=10:aspirin-pretreated, 300 mg/kg po for 1 week:ticlopidine-pretreated, 200 mg/kg po for 1 wk:abciximab-pretreated, 2 mg/kg iv 10-20 minutes before experiment. The electrocardiogram and blood pressure were recorded during 20 minutes. The time to the onset of ST-segment elevation and ventricular tachyarrhythmias, frequency and incidence of ventricular tachyarrhythmias, and death rate were assessed during acute myocardial ischemia induced by ligation of proximal left anterior descending coronary artery in anesthetized rats. RESULTS: Platelet aggregations to ADP were significantly lower in aspirin (42.8%), ticlopidine (43.8%), and abciximab group (34.0%) than in control group (66.4%). The frequencies of sustained ventricular tachycardia (VT) were 6.8+/-3.6 in control, 3.6+/-3.8 aspirin, 4.7+/-3.7 ticlopidine, and 1.4+/-2.5 abciximab group. The frequency of sustained VT in the abciximab group was significantly lower than in control group. The incidences of ventricular arrhythmias for 20 min were 10/10 for VT and 8/10 for ventricular fibrillation (VF) in control group, 7/10 for VT and 3/10 for VF in aspirin group, 10/10 for VT and 3/10 for VF in ticlopidine group, and 5/10 for VT and 4/10 for VF in abciximab group. The incidences of cardiac death during 20 min were 8/10 in control group, 4/10 in aspirin group, 2/10 in ticlopidine group and 5/10 in abciximab group. The incidence of VT in the abciximab group was significantly lower than in control group, incidences of VF in the aspirin and ticlopidine groups were significantly lower than in control group, and death rate in ticlopidine group was significantly lower than in control group. CONCLUSION: The present study suggested that aspirin, ticlopidine, and abciximab could prevent ventricular tachycardia or ventricular fibrillation in a rat model of cardiac regional ischemia and their antiarrhythmic effects improve the survival rate.
Adenosine Diphosphate ; Animals ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Blood Pressure ; Coronary Vessels ; Death ; Electrocardiography ; Glycoproteins ; Incidence ; Ischemia ; Ligation ; Models, Animal ; Mortality ; Myocardial Infarction ; Myocardial Ischemia* ; Platelet Aggregation Inhibitors* ; Rats* ; Survival Rate ; Tachycardia* ; Tachycardia, Ventricular ; Ticlopidine ; Ventricular Fibrillation

No abstract available.
Carcinoma, Renal Cell* ; Melena*

BACKGROUND: Aspirin, one of the antiplatelet agents, improves the survival rate after myocardial infarction. This beneficial effect is known to be obtained in part by the antiarrhythmic action of aspirin. It is not known whether other antiplatelet agents have such effects. This study was performed to compare the effects of aspirin, ticlopidine, and abciximab (platelet glycoprotein IIb/IIIa receptor antagonist) on the ischemia-induced arrhythmias with a rat model of cardiac regional ischemia. METHODS: Experiments were performed in 4 groups of rats. The 4 groups were as follows : control, n=10:aspirin-pretreated, 300 mg/kg po for 1 week:ticlopidine-pretreated, 200 mg/kg po for 1 wk:abciximab-pretreated, 2 mg/kg iv 10-20 minutes before experiment. The electrocardiogram and blood pressure were recorded during 20 minutes. The time to the onset of ST-segment elevation and ventricular tachyarrhythmias, frequency and incidence of ventricular tachyarrhythmias, and death rate were assessed during acute myocardial ischemia induced by ligation of proximal left anterior descending coronary artery in anesthetized rats. RESULTS: Platelet aggregations to ADP were significantly lower in aspirin (42.8%), ticlopidine (43.8%), and abciximab group (34.0%) than in control group (66.4%). The frequencies of sustained ventricular tachycardia (VT) were 6.8+/-3.6 in control, 3.6+/-3.8 aspirin, 4.7+/-3.7 ticlopidine, and 1.4+/-2.5 abciximab group. The frequency of sustained VT in the abciximab group was significantly lower than in control group. The incidences of ventricular arrhythmias for 20 min were 10/10 for VT and 8/10 for ventricular fibrillation (VF) in control group, 7/10 for VT and 3/10 for VF in aspirin group, 10/10 for VT and 3/10 for VF in ticlopidine group, and 5/10 for VT and 4/10 for VF in abciximab group. The incidences of cardiac death during 20 min were 8/10 in control group, 4/10 in aspirin group, 2/10 in ticlopidine group and 5/10 in abciximab group. The incidence of VT in the abciximab group was significantly lower than in control group, incidences of VF in the aspirin and ticlopidine groups were significantly lower than in control group, and death rate in ticlopidine group was significantly lower than in control group. CONCLUSION: The present study suggested that aspirin, ticlopidine, and abciximab could prevent ventricular tachycardia or ventricular fibrillation in a rat model of cardiac regional ischemia and their antiarrhythmic effects improve the survival rate.
Adenosine Diphosphate ; Animals ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Blood Pressure ; Coronary Vessels ; Death ; Electrocardiography ; Glycoproteins ; Incidence ; Ischemia ; Ligation ; Models, Animal ; Mortality ; Myocardial Infarction ; Myocardial Ischemia* ; Platelet Aggregation Inhibitors* ; Rats* ; Survival Rate ; Tachycardia* ; Tachycardia, Ventricular ; Ticlopidine ; Ventricular Fibrillation

BACKGROUND: Losartan potassium, one of an orally active, selective type 1 angiotensin II receptor blocker, has been introduced recently as an antihypertensive agent. METHOD: Losartan, angiotensin II receptor blocker, was administrated as an initial antihypertensive agent over 12 weeks in 30 patients (11 male, 19 female, 60.1+/-7.2 years) with stage 1 to 3 hypertension in order to observe the clinical effects. Changes in quality of life, side effects, electrocardiogram and left ventricular function were also evaluated before and after losartan therapy. RESULTS: 1) After 12 weeks treatment with 50 to 100 mg of losartan, blood pressure was lowered markedly in 18 (60%), moderately in 9 (30%) and mildly in 1 (3%) out of 30 patients studied. The average of blood pressures of the 30 subjects were systolic 159.0+/-13.2 mmHg and diastolic 100.7+/-9.4 mmHg before treatment, which were lowered to 130.7+/-15.6 and 85.9+/-9.1 mmHg respectively after 12 weeks (p<0.005). 2) Heart rates were not changed with losartan. 3) Quality of life including general well-being, physical symptom, sleep and sexual dysfunction improved markedly in 2 (7%) and slightly in 17 (57%) out of 30 subjects. 4) Laboratory findings revealed no significant changes. 5) In electrocardiographic and echocardiographic follow-up 1 patient with ST-T abnormality and 2 patients with mild LV systolic dysfunction improved to normal. 6) Undesirable side effects were observed in 2 cases with dizziness, 1 dry cough, 1 skin rash, 1 leg edema and 1 epigastric discomfort, among whom one with dizziness stopped losartan. 7) In the final clinical assessment according to the scores of hypotensive effect, quality of life, LV function and side effect, losartan was very useful in 3 (10%), useful in 18 (60%) and slightly useful in 3 (10%) out of 30 hypertensive patients. CONCLUSION: Losartan can be used as an effective initial agent for the treatment of hypertension of various severities with the improvement of quality of life and low side effects.
Blood Pressure ; Cough ; Dizziness ; Echocardiography ; Edema ; Electrocardiography ; Exanthema ; Female ; Follow-Up Studies ; Heart Rate ; Humans ; Hypertension ; Leg ; Losartan* ; Male ; Quality of Life ; Receptors, Angiotensin ; Ventricular Function, Left

In all patients with oral and maxillofacial surgery under the general anesthesia from January 1986 to December 1988, a clinical analysis had been made on preperative physical status, preoperative complicating medical disease ar abnormal laboratory finding, intubation and anesthetic agent used including the age and sex distribation of patients and the surgical lesion. The following results were obtained: 1) The male patients were 1.3 times more than the female in sex distribution 2) The patients between 20 and 29 years old were the most in age distribution 3) The benign tumors were the most common surgieal lesion(20.2%) 4) Of the 1393 patients with oral and maxillofacial surgery, the l34 patients were observed to have the underlying medical diseases or abnormal laboratory findings preoperatively(9.6%). In these patients the abnormal findings on E. K. G were most common. 5) Of the l393 patients, the 1170 patients were classified physical status l. and there were 206 patients of physical status 2 and 17 patients of physical status 3. 6) Of 1393 patients, the intubation were performed through tracheostomy in 6 patients and the fiberoptic endoscope were used to secure the endotracheal intubation in 20 patients. In 3 patients the blind nasotracheal intubation were made to secure the endotracheal intubation. 7) The conventional laryngoscopic instrumentations for the oral or nasotracheal intubation were performed in 1355 patients(97.3%). 8) The use of O2, N2O and halothane for the general anesthesia was the most common method for the general anesthesia.
Adult ; Age Distribution ; Anesthesia, General ; Endoscopes ; Female ; Halothane ; Humans ; Intubation ; Intubation, Intratracheal ; Male ; Sex Distribution ; Surgery, Oral* ; Tracheostomy

OBJECTIVE: Brief epidodes of ischemia have been shown to make the heart more resistant to subsequent ischemia in animal studies(known as ischemic preconditioning, IP). This phenomenon was tested in patients undergoing percutaneous transluminal coronary angioplasty(PTCA). METHODS: Thirteen patients who had significant epicardial coronary stenosis without myocardial infarction, ventricular hypertrophy or conduction defect, received two to four 2-min balloon inflations separated by 5 min of reperfusion. Surface electrocardiogram(S-ECG) and intracoronary electrocardiogram (IC-ECG) from an angioplasty guide wire were recorded before and after balloon inflation. RESULTS: The changes of ST segment were observed in 13 out of 15 lesions on IC-ECG and 7 on S-ECG. The maximal ST changes on IC-ECG and S-ECG were 20.2+/-13.7mm and 1.21.5mm respectively(p<0.01). The time to beginning of ST segment change after balloon inflation were 10.1+/-12.6 seconds and 63.3+/-14.2 seconds on IC-ECG and S-ECG, respectively(p<0.01). The maximal changes of ST segment on IC-ECG during the second inflation were significantly lower than that during the first(20.2+/-13.7 vs 16.312.3mm, p<0.05). However, changes of R wave, T wave and QT interval were not significantly different between two inflations. The recovery time to baseling ECG after initiation of reperfusion were 50.2+/-41.7 seconds and 38.5+/-29.6 seconds for the first inflation and the second, respectively(P<0.05). CONCLUSION: These results suggest that IC-ECG is more sensitive and reliable than S-ECG in detection of myocardial ischemia and that IP may occur during PTCA since ST segment shift is decreased and is normalized earlier at the second balloon inflation compared with the first.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Animals ; Coronary Stenosis ; Electrocardiography* ; Heart ; Humans ; Hypertrophy ; Inflation, Economic ; Ischemia ; Ischemic Preconditioning ; Myocardial Infarction ; Myocardial Ischemia ; Reperfusion

BACKGROUND AND OBJECTIVES: One of the major limitations in coronary intervention is restenosis. This study was aimed to identify clinical, angiographic and procedural factors, which may be related to the second restenosis (SR). MATERIALS AND METHOD: We studied 101 patients who underwent more than two follow-up coronary angiograms after two coronary interventions between Jan 1996 and Dec 1998 in Chonnam University Hospital (out of 4092 total coronary interventions in 3030 patients during the same period). The patients were divided into two groups according to the evidence of second restenosis (SR). Fifty two patients (Group A: 56.6+/-9.9 year, M: F=44:8) who had SR, and the other 49 patients (Group B: 53.8+/-8.5 year, M: F=44: 5) were analyzed. Clinical features, angiographic characteristics, coronary interventional procedures, and other risk factors were compared between two groups by univariate analysis and multivariate stepwise logistic regression analysis for the predictive factors of second restenosis. RESULTS: 1) The clinical variables of age, sex, clinical diagnosis, and risk factors were not different between two groups. 2) The lesion types severer than B2 by AHA/ACC classification were associated with SR (p<0.05). 3) Recurrent angina as an indication for follow up angiography was associated with SR (p<0.01). CONCLUSION: The predictive factors associated with SR were patient's subjective symptom and lesion severer than type B2 according to AHA/ACC classification.
Angiography ; Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Jeollanam-do ; Logistic Models ; Risk Factors*

Gastric wall abscess is a one form of phlegmonous gastritis and there are scare reports on this. Gastric wall abscess is a purulent inflammatory disease and it is commonly caused by a focal injury to the gastric mucosa such as a penetrating trauma from an ingested foreign body or an endoscopic biopsy where by bacterial infection occurs throughout all the layers of the gastric wall. With symptoms such as abdominal pain and fever, making the diagnosis after an operation was possible in the past, but it has recently become possible to make the diagnosis before the operation via esophagogastroduodenoscopy, endoscopic ultrasonography and/or abdominal computed tomography. We recently experienced a case of gastric wall abscess that was associated with a foreign body (presumably a fish bone) in a healthy middle aged woman. By performing generalized esophagogastroduodenoscopy and abdominal computed tomography at a primary medical institution, we made an early diagnosis and treated the patient. Herein, we report on this case and we review the relevant literature.
Abdominal Pain ; Abscess ; Bacterial Infections ; Biopsy ; Cellulitis ; Early Diagnosis ; Eating ; Endoscopy, Digestive System ; Endosonography ; Female ; Fever ; Foreign Bodies ; Gastric Mucosa ; Gastritis ; Humans ; Middle Aged

BACKGROUND: We observed the changes of clinical characteristics after oral Molsidomine, a nitric oxide donor, in patients who have documented coronary artery spasm by ergonovine coronary angiogram and refractory to conventional anti-anginal therapy. METHOD: Molsidomine, oral nitric oxide donor, was administrated over 12 weeks in 20 patients (6 male, 14 female, 54+/-11.5 years) in order to observe the clinical effects in patients with coronary artery spasm unresponsive to nitrate and calcium channel blockers. Changes in the frequency of pain and sublingual nitroglycerin use, blood pressure, heart rate, side effects, electrocardiogram, and laboratory findings were evaluated before and after Molsidomine therapy. RESULTS: The frequencies of pain and sublingual nitroglycerin use were 3.9+/-0.9/week before treatment and decreased to 2.9+/-0.9/week at 4th week after the additional Molsidomine treatment (pre-treatment vs. 4th week; p<0.001), to 1.0+/-0.8/week at 8th week (4th week vs. 8th week; p<0.001), and to 0.7+/-0.8/week at 12th week. Systolic blood pressure decreased after treatment, but there were no significant changes in diastolic blood pressure, heart rate, resting electrocardiogram and laboratory findings. Molsidomine was discontinued in one patient because of headache. CONCLUSIONS: Molsidomine is an effective and well tolerated anti-ischemic agent in patients with variant angina refractory to conventional anti-anginal therapy.
Blood Pressure ; Calcium Channel Blockers ; Coronary Vessels ; Electrocardiography ; Ergonovine ; Female ; Headache ; Heart Rate ; Humans ; Male ; Molsidomine ; Nitric Oxide* ; Nitroglycerin ; Spasm ; Tissue Donors*