BACKGREOUND: Cerebral damage caused by hemorrhagic shock presents an important challenge for critical care medicine. The type of fluid to resuscitate hemorrhagic shock is important for the outcome of such patients. Pentastarch is low-molecular-weight hydroxyethyl starch, which increases cerebral blood flow (CBF) by plasma volume expansion and compensatory vasodilation, and improves the microcirculation in the ischemic brain area by reducing the blood viscosity. METHODS: The authors continuously determined CBF and CMRO2 in 10 mongrel dogs weighing 20.1 +/- 0.8 kg with posterior sagittal sinus outflow method. Dogs were subjected to the 20 minute-period of hemorrhagic shock to a mean arterial pressure of 40 mmHg. The shock phase was followed by resuscitation with the same volume of 10% pentastarch as blood loss. The authors assessed the changes of CBF, CMRO2, and CBF/CMRO2 ratio immediately and 30, 60, 90, 120 minutes after pentastarch infusion. Brain water content was assessed by the wet-dry weight method. RESULTS: CBF was increased above the control level, immediately and 30 minutes after 10% pentastarch infusion (p<0.05), and approximated to the control level for the remaining time. CMRO2 was increased, immediately and 30, 60, 90 minutes after 10% pentastarch infusion (p<0.05), and approximated to the control level at 120 minutes. CBF/CMRO2 ratio was recovered to the control level after 10% pentastarch infusion. Brain water content was not significantly different from the normal value of dogs. CONCLUSION: 10% pentastarch may be used with safety to resuscitate hemorrhagic shock because it recovers the balance between the cerebral oxygen supply and demand, and does not cause cerebral edema.
Animals ; Arterial Pressure ; Blood Viscosity ; Brain ; Brain Edema ; Critical Care ; Dogs ; Humans ; Hydroxyethyl Starch Derivatives* ; Microcirculation ; Oxygen* ; Plasma Volume ; Reference Values ; Resuscitation ; Shock ; Shock, Hemorrhagic* ; Starch ; Vasodilation

BACKGROUND: Direct laryngoscope may be less useful under conditions of limited visualization. Light wand is a lighted stylet to transilluminate neck tissues allowing intubation without visualization. Thus, difficult intubation due to anatomy can be overcome. For comparison of light wand and direct laryngoscope, we checked time to intubation (TTI), success rate, relation of TTI and thyromental distance (TMD), and change of blood pressure and heart rate after intubation. METHODS: We selected and randomly allocated sixty adults to direct layngoscope group (D) and light wand group (L). Without premedication, propofol and vecuronium were injected for intubation. Time to intubation was measured from the time of grasping direct laryngoscope or light wand until the time of inserting endotracheal tube into trachea. We checked the change of blood pressure and heart rate after intubation, and studied the correlation of TTI and TMD. RESULTS: TTI was 16.5 sec (6.53~115.3 sec) for group D and 11.8 sec (4.31~36.0 sec) for group L. There was no significant difference between the groups. The rise of blood pressure and heart rate was less with light wand. There was a correlation of [TTI]=1248- 388[TMD]-30[TMD]2 in group L patients whose TMD is less than 7 cm. CONCLUSION: Compared with direct laryngoscope, light wand is as easy to use and can be more effective especially for patients whose anatomy may make intubation difficult or whose cardiovascular system is unstable.
Adult ; Blood Pressure* ; Cardiovascular System ; Hand Strength ; Heart Rate* ; Heart* ; Humans ; Intubation* ; Laryngoscopes* ; Neck ; Premedication ; Propofol ; Trachea ; Vecuronium Bromide

BACKGROUND: Direct laryngoscope may be less useful under conditions of limited visualization. Light wand is a lighted stylet to transilluminate neck tissues allowing intubation without visualization. Thus, difficult intubation due to anatomy can be overcome. For comparison of light wand and direct laryngoscope, we checked time to intubation (TTI), success rate, relation of TTI and thyromental distance (TMD), and change of blood pressure and heart rate after intubation. METHODS: We selected and randomly allocated sixty adults to direct layngoscope group (D) and light wand group (L). Without premedication, propofol and vecuronium were injected for intubation. Time to intubation was measured from the time of grasping direct laryngoscope or light wand until the time of inserting endotracheal tube into trachea. We checked the change of blood pressure and heart rate after intubation, and studied the correlation of TTI and TMD. RESULTS: TTI was 16.5 sec (6.53~115.3 sec) for group D and 11.8 sec (4.31~36.0 sec) for group L. There was no significant difference between the groups. The rise of blood pressure and heart rate was less with light wand. There was a correlation of [TTI]=1248- 388[TMD]-30[TMD]2 in group L patients whose TMD is less than 7 cm. CONCLUSION: Compared with direct laryngoscope, light wand is as easy to use and can be more effective especially for patients whose anatomy may make intubation difficult or whose cardiovascular system is unstable.
Adult ; Blood Pressure* ; Cardiovascular System ; Hand Strength ; Heart Rate* ; Heart* ; Humans ; Intubation* ; Laryngoscopes* ; Neck ; Premedication ; Propofol ; Trachea ; Vecuronium Bromide

We investigated the effects of isoflurane-induced hypotension on global cerebral blood flow (CBF), cerebral metabolic rate for oxygen (CMRO,), and the balance between cerebral oxygen supply and demand in 8 mongrel dogs. After endotracheal intubation, anesthesia was maintained with nitrous oxide (50%)-oxygen (50%)-fentanyl (2u/kg/hour). Ventilation was controlled to normocapnia. Mean arterial pressure (MAP) was lowered to 60 mmHg with inhalation of isoflurane. CBF was measured directly using sagittal sinus outflow method before (prehypotension), during (hypotension), and after (posthypotension) isoflurane-induced hypotension. Concomitantly, arterio-sagittal sinus venous oxygen content differen- ce was measured to calculate CMRO2. During hypotension, CBF and CMRO, were measured at 20 minutes after MAP was lowered to 60 mmHg and maintained stably. The time to induce hypotension was 8.6+/-6.1 (mean+/-SD) min. Mean inspired isoflurane concentra tion to induce desired hypotension was 3.1+/-0.9 vol%. The time to recover from hypotension was 28.6+/-7.7 min. MAP and heart rate were reduced significantly during hypotension (p<0.05, respectively) and returned to prehypotensive values during posthypotension. CBF was not changed between three peroiods. CMRO2 was reduced significantly during hypotension (6.5+/-1.2 vs 4.3+/-0.8ml/100/g/min, mean+/-SD, p<0.05) and returned to prehypotensive values during posthypotension. The percentage of CMRO2 reduction from prehypotension to hypotension (% CMRO2 reduction) was 32.5+/-12.9%. CBF/CMRO2 ratio was increased significantly during hypotension (12.8+/-3.3 vs 18.2+/-6.1, mean+/-SD, p<0.05) and lowered to prehypotensive values during posthypotension. Isoflurane-induced hypotension maintained CBF and reduced CMRO2 and therefore favorably influenced the balance between the global cerebral oxygen supply and demand. In conclusion, isoflurane induced-hypotension may be a safe and effective technique in view of the balance of the global cerebral oxygen supply and demand.
Anesthesia ; Animals ; Arterial Pressure ; Dogs* ; Heart Rate ; Hypotension* ; Inhalation ; Intubation, Intratracheal ; Isoflurane* ; Nitrous Oxide ; Oxygen* ; Ventilation

The effect of epidural morphine on the mean inspired concentration of isoflurane was inves- tigated in 34 patients undergoing hepatoma surgery, The patients were randomly assigned to the control(CTRL), epidural morphine(MORP) or epidural bupivacaine(BUPI) groups. Before induction of anesthesia, epidural catheter was inserted beween T6-10 intervertebral space in the right lateral decubitus position. MORP group(n=13) received morphine sulfate 4 mg in 4 ml normal saline and BUPI group(n=10) received 0.5% bupivacame 10 md through epidural eatheter. CTRL group(n=11) wss treated in an identical fashion except that, after placement of epidural catheter, nothing was injected. After endotracheal intubation, general anesthesia was maintained during surgery with oxygen-nitrous oxide(1:1 ratio) and isoflurane. Inspired concentration of isoflurane was adjusted to maintain blood pressure in the range of blood pressure at the ward during surgery. Mean inspired concentration of isoflurane was monitored from incision to last skin suture. Mean inspired concentration of isoflurane(+/-SD) of CTRL, MORP and BUPI group was 1.41+/-0.36, 1.52+/-0.39 and 0.37+/-0.16 vol%, respectively. There was no difference in mean inspired concentration of isoflurane between CTRL and MORP group. Under the condition of this study, epidural morphine did not reduce inspired concentration of isoflurane during surgery even though epidural morphine is effective for post operative pain control.
Analgesics ; Anesthesia, Epidural ; Anesthesia, General* ; Blood Pressure ; Carcinoma, Hepatocellular ; Catheters ; Humans* ; Intubation, Intratracheal ; Isoflurane* ; Morphine* ; Skin ; Sutures

High frequency ventilation considerably reduces the risk of barotrauma due to low peak airway pressure compared to conventional mechanical ventilation. This risk, however, is also preaent with high frequency jet ventilation (HFJV) if excessive driving preasure are used and, above all if expiration is impeded. We investigated the effects of outflow resistance, which was varied by connecting different size of tube (ID 8.0, 7.5, 7.0, 6.5, 5.5, 5.0, 4.5, 4.0 mm), which was cut in 10 cm length, to the proximal site of endotracheal tube (ID 8.0 mm), which was inserted into the trachea of anesthetized dogs with a attached airway pressure monitoring catheter externally, in different driving pressure (2 kg/cm2, 1 kg/cm2) and frequency (100beats/min, 200beats/min) on the intra-airway preesure during HFJV. HFJV was performed with a catheter (diameter 2.5 mm) which was inaerted through endotracheal tube and located 1 cm proximal to the tip of endotracheal tube. Intra-airway pressure was acutely increased with the tube size of smaller than 5.5 mm in driving pressure 2 kg/cm2 and 5.0 mm in driving pressure 1 kg/cm2 compared to previous size of tube. 2 kg/cm2 of driving pressure showed significant higher airway pressure compared to 1 kg/cm in any size of tube. There was no difference in airway pressure by varing of frequency with same driving preasure. In summary, pulmonary barotrauma due to higher airway pressure may be occur if HFJV catheter occupied more than 25% of outflow tract area especially in higher driving pressure.
Airway Resistance ; Animals ; Barotrauma ; Catheters ; Dogs ; High-Frequency Jet Ventilation* ; High-Frequency Ventilation ; Respiration, Artificial ; Trachea ; Ventilation

PURPOSE: The aim of the study was to evaluate the effect of abutment shade, ceramic thickness, and coping type on the final shade of zirconia all-ceramic restorations. MATERIALS AND METHODS: Three different types of disk-shaped zirconia coping specimens (Lava, Cercon, Zirkonzahn: o10 mm x 0.4 mm) were fabricated and veneered with IPS e.max Press Ceram (shade A2), for total thicknesses of 1 and 1.5 mm. A total of sixty zirconia restoration specimens were divided into six groups based on their coping types and thicknesses. The abutment specimens (o10 mm x 7 mm) were prepared with gold alloy, base metal (nickel-chromium) alloy, and four different shades (A1, A2, A3, A4) of composite resins. The average L*, a*, b* values of the zirconia specimens on the six abutment specimens were measured with a dental colorimeter, and the statistical significance in the effects of three variables was analyzed by using repeated measures analysis of variance (alpha=.05).The average shade difference (DeltaE) values of the zirconia specimens between the A2 composite resin abutment and other abutments were also evaluated. RESULTS: The effects of zirconia specimen thickness (P<.001), abutment shade (P<.001), and type of zirconia copings (P<.003) on the final shade of the zirconia restorations were significant. The average DeltaE value of Lava specimens (1 mm) between the A2 composite resin and gold alloy abutments was higher (close to the acceptability threshold of 5.5 DeltaE) than th ose between the A2 composite resin and other abutments. CONCLUSION: This in-vitro study demonstrated that abutment shade, ceramic thickness, and coping type affected the resulting shade of zirconia restorations.
Alloys ; Ceramics* ; Composite Resins ; Masks*

In Korea, studies of splenectomies are mainly performed in adult groups, but a review of splenectomies in children is significant because the indications of a splenectomy and the importance of the spleen in children are different from those in adults. The authors reviewed 51 cases of splenectomies performed between January 1986 and April 1996 on children under 15 years of age. The indications of the splenectomy were divided based on hematologic diseases (37) and non-hematologic diseases (14). For the hematologic diseases, hereditary spherocytosis (24) was the most common indication of a splenectomy and idiopathic thrombocytopenic purpura (11) was the next most common. For the non-hematologic diseases, trauma (10) was the most common indication of a splenectomy. After the splenectomy, abnormal hematologic findings were improved in all hereditary spherocytosis patients and in nine of the idiopathic thrombocytopenic purpura patients (82%). To prevent postsplenectomy sepsis, 27 patients received antibiotic medication, but no one received a pneumococcal vaccination. One case of postsplenectomy sepsis occurred in a patient who had not received antibiotic medication. This study suggests that a splenectomy provides efficacious treatment for a number of pediatric disorders, but it is associated with a risk of postsplenectomy sepsis.
Adult ; Child* ; Hematologic Diseases ; Humans ; Korea ; Purpura, Thrombocytopenic, Idiopathic ; Sepsis ; Spleen ; Splenectomy* ; Vaccination

OBJECTIVE: Chronic subdural hematoma (CSDH) is known to have a significant recurrence rate. There are different criteria defining the recurrence of CSDH. We evaluated the postoperative course of CSDH and tried to propose the reasonable criteria of recurrence. METHODS: We retrospectively examined the medical records and pre- and postoperative CT scans of 149 consecutive patients who underwent surgery from January 2005 to December 2009. Diagnosis was confirmed by CT scanning or MRI. The postoperative courses were either resolved or recurrent. The resolved CSDH was one of the three types; early resolution, delayed resolution, or late resolution. The recurrent CSDH was one of the four types; recurrence without resolution, early recurrence after resolution, late recurrence after resolution, or recurrent-and-resolved type. RESULTS: The CSDH was resolved within 30 days after surgery in 58 (39%) patients, between 1 to 3 months in 62 (42%), and after 3 months in 11 (7%) patients. The CSDH was recurred in 18 (12%) patients. Late resolution or recurrence was more common in the aged. The recurrent hematoma was seen on the same side in 11 patients, on the different side in 7 patients. Recurrence was significantly more common in the thick hematomas. CONCLUSION: For a working criteria of the recurrence of CSDH, we propose the early recurrence as return of symptoms or reaccumulation of the hematoma after a surgery within 3 months regardless of the location, amount or repeated operations. The late recurrence can be defined as reappearance or enlargement of a liquefied hematoma within the cranial cavity surrounded by the membranes or persistent CSDH beyond 3 months after surgery.
Aged ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Medical Records ; Membranes ; Recurrence ; Retrospective Studies ; Risk Factors

OBJECTIVE: Antidepressants Modulate Neuronal Plasticity. Tianeptine, An Atypical Antidepressant, Might Be Involved In The Restoration Of Neuronal Plasticity; It Primarily Enhances The Synaptic Reuptake Of Serotonin. Ncam140 Is Involved In Neuronal Development Processes, Synaptogenesis And Synaptic Plasticity. We Investigated The Effect Of Tianeptine On The Expression Of Ncam140 And Its Downstream Signaling Molecule In The Human Neuroblastoma Cell Line Sh-sy5y. METHODS: NCAM protein expression was measured in human neuroblastoma SH-SY5Y cells that were cultivated in serum-free media and treated with 0, 10, or 20 microM tianeptine for 6, 24, or 72 hours. NCAM140 expression in the tianeptine treatment group was confirmed by Western blot, and quantified through measurement of band intensity by absorbance. CREB and pCREB expression was identified after treatment with 20 microM tianeptine for 6, 24, and 72 hours by Western blot. RESULTS: Compared to cells treated for 6 hours, cells treated with 0 or 10 microM tianeptine for 72 hours showed a significant increase in NCAM140 expression and cells treated with 20 microM tianeptine showed a significant increase after 24 and 72 hours. The pCREB level in cells treated with 20 microM tianeptine increased in time-dependent manner. CONCLUSION: Our findings indicated that the tianeptine antidepressant effect may occur by induction of NCAM140 expression and CREB phosphorylation.
Antidepressive Agents ; Blotting, Western ; Cell Line ; Culture Media, Serum-Free ; Humans ; Neural Cell Adhesion Molecules ; Neuroblastoma ; Neuronal Plasticity ; Neurons ; Phosphorylation ; Plastics ; Serotonin