Background: Hypotension following spinal anesthesia of Cesarean section is mainly caused by peripheral vasodilation and venous pooling due to sympathetic blockade. The degree of sympathetic blockade is known to affect the occurrence of hypotension after spinal anesthesia. The perfusion index (PI) and plethysmographic variability index (PVI) are non-invasive tools for measuring the vasomotor tone and volume status, respectively. The purpose of this study is to compare the trends of PI and PVI values between hypotension and normotension groups during Cesarean section following spinal anesthesia. Methods: Fifty-one parturients were divided into two groups whether they developed hypotension or maintained normotension after spinal anesthesia. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine (10 mg) and fentanyl (15 μg) at the L3-4 intervertebral space. The data of blood pressure, heart rate, PI and PVI were recorded every minute until delivery of baby. Results: Hypotension occurred in 61% of parturients during Cesarean section. The overall PI and PVI value after spinal anesthesia have gradually increased and decreased, respectively. The degree of increase and decrease in PI (p = 0.31) and PVI value (p = 0.35) was not significant between hypotension and normotension groups. Conclusions The trend of PI value has gradually increased while the PVI value has decreased, regardless of whether the parturient has experienced hypotension or not.

Background: Hypotension following spinal anesthesia of Cesarean section is mainly caused by peripheral vasodilation and venous pooling due to sympathetic blockade. The degree of sympathetic blockade is known to affect the occurrence of hypotension after spinal anesthesia. The perfusion index (PI) and plethysmographic variability index (PVI) are non-invasive tools for measuring the vasomotor tone and volume status, respectively. The purpose of this study is to compare the trends of PI and PVI values between hypotension and normotension groups during Cesarean section following spinal anesthesia. Methods: Fifty-one parturients were divided into two groups whether they developed hypotension or maintained normotension after spinal anesthesia. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine (10 mg) and fentanyl (15 μg) at the L3-4 intervertebral space. The data of blood pressure, heart rate, PI and PVI were recorded every minute until delivery of baby. Results: Hypotension occurred in 61% of parturients during Cesarean section. The overall PI and PVI value after spinal anesthesia have gradually increased and decreased, respectively. The degree of increase and decrease in PI (p = 0.31) and PVI value (p = 0.35) was not significant between hypotension and normotension groups. Conclusions The trend of PI value has gradually increased while the PVI value has decreased, regardless of whether the parturient has experienced hypotension or not.

Purpose: : This retrospective study aims to provide basic data for intervention to improve clinical outcomes and identify the characteristics of the rebound hyperthermia (RHG) and non-rebound hyperthermia (NRHG) groups by checking body temperature in patients with post-cardiac arrest syndrome.Method : The study involved 118 patients who completed target temperature management (TTM) in an acute-care unit. Data were analyzed for frequency, percentages, mean, standard deviation, median, and quartiles, and compared using the chi-squared test and Mann–Whitney U-test. Results: : Rebound hyperthermia (RH) was observed in 74 (62.7%) patients, predominantly male (69.5%), with an average age of 64.54 ± 15.98, and a body mass index of 23.22 ± 4.75kg/m2 (overweight). Hypertension (50%) was the most common co-morbidity, followed by diabetes and heart disease (33.1%). Neuron-specific enolase levels were higher in the NRHG 24, 48, and 72 hours after recovery of spontaneous circulation (p = .037, p＜ .001, p= .008). The APHCHE Ⅳ was also higher in the NRHG (p＜ .001). RH occurred 25.49 (7.28–52.96) hours after TTM completion, lasting for 2 (1–3) hours. Temperature reduction strategies included notifying doctors, administering antipyretics, and nursing intervention, with the latter being the most common at 94.6%. Half of the subjects in the RHG and 77.3% in the NRHG fell into cerebral performance categories 3, 4, and 5 (p= .003). Conclusion : RH is more likely a body mechanism related to CPR and TTM than a result of pathogenic infection. Therefore, we require an active intervention for hyperthermia, and a patient-specific nursing intervention protocol.

A 44-year-old man was cutting an outer plate of a ship, at a depth of 25 m below sea level. Following a sudden explosion, he was discovered unconscious and was carried to the surface by other divers. There was no evidence of vital signs upon arrival at the hospital. Postmortem computed tomography, which was performed prior to autopsy, revealed massive pneumocephalus in the brain, pneumohemothorax, diffuse lung contusions with multiple traumatic lung cysts, air-fluid level in the cardiac chamber of the chest, and pneumoperitoneum in the abdomen. Postmortem external examination showed a circular abrasion on the jaw, diffuse subcutaneous emphysema, and contusion in the right upper arm. An internal examination revealed intravascular air bubbles in all four chambers of the heart, and diffuse pulmonary trauma including contusion, laceration, and multiple traumatic cysts. Blast injury to the chest, and air embolism due to the underwater explosion were established as the underlying cause of death.
Abdomen ; Adult ; Arm ; Autopsy ; Blast Injuries ; Brain ; Cause of Death ; Contusions ; Diving ; Embolism, Air ; Explosions* ; Heart ; Humans ; Jaw ; Lacerations ; Lung ; Pneumocephalus ; Pneumoperitoneum ; Ships ; Subcutaneous Emphysema ; Thorax ; Vital Signs

PURPOSE: Cystoscopy is very common and is one of the major office based procedures used in urologic clinics. However, a majority of patients complain of fear, pain, and discomfort when performing the procedure in an alert state. Routine administration of sedative and analgesic drugs is widely provided for gastorintestinal endoscopy to prevent patient discomfort and increase tolerance. Based on this, we investigated the safety and efficacy of midazolam induced sedative cystoscopy. MATERIALS AND METHODS: One hundred and twenty patients were enrolled in this study. They were divided into two groups; group I (n=80) consisted of patients who were sedated by midazolam 2.5mg IV before cystoscopy, and group II (n=40) consisted of patients who were not sedated and diclopenac 90mg was injected in them intramuscularly before cystoscopy to prevent pain. All patients in group I were reversed from the sedative state by flumazenil 0.5mg IV right after the completion of the cystoscopic procedure. The two groups were not significantly different in their age, sex, and weight distribution (p>0.05). Blood pressure, pulse, and respiratory rates were monitored pre-, intra-, and post procedure. The status of consciousness was monitored every three minutes by the OAA/S (Observer's Assessment of Alertness/Sedation) scale. Pain scale, anxiety scale, satisfaction score from patients and operators were measured using a specified questionnaire. RESULTS: In group I, the pain scale and anxiety scale were significantly reduced compared to group II (p<0.001). There were temporary changes in blood pressure and pulse rate in group I, but they were not clinically significant and no specific management was required. Group I patients were significantly more satisfied with their procedures compared to the patients of group II (p<0.001). CONCLUSIONS: Midazolam induced sedative cystoscopy can be applied safely and effectively as an outpatient base procedure. Further, we expect to apply this sedative procedure to other urologic procedures.
Analgesics ; Anxiety ; Blood Pressure ; Conscious Sedation ; Consciousness ; Cystoscopy* ; Endoscopy ; Flumazenil ; Heart Rate ; Humans ; Midazolam* ; Outpatients ; Surveys and Questionnaires ; Respiratory Rate

This study was performed to evaluate the effect of hydrogen peroxide-producing Lactobacillus acidophilus V-2Oonthe replication of periodontal pathogens, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. When A. actinomycetemcomitam and P. gingivalis were incubated alone and in the combination with L. acidophilus V-20, the viable cell numbers of A. actinomycetemcomitans and P. gingivalis were compared between those cultures. The effect of S. mutans, E. durans, and L. lactis on the replication of A. actinomycetemcomitans and P. gingivalis was also evaluated. The change of periodontal indexes(probine depth, gingival index, GCF volume) and the viable cell numbers of A. actinomycetemcomitans and black pigmented bdcteroides in subgingival plaque sample were evaluated following gargling of fermented milk made from L. acidophilus V-20 for 1 month on patients with periodontal disease in maintenance phase. In the mixed culture of L. acidophilus V-20 and A. actinomycetemcomitans or P. gingivalis, the replication of A. adinomycetemcomitam or P. gingivalis was completely inhibited. But in the mixed culture of P. gingivalis and hydrogen peroxide-nonproducing Lactobacillus casei, the viable cell numbers of P. gingivalis was not decreased when compared with the numbers in the mixed culture of P. gingivalis and L. acidophilus V-20. In the mixed culture of A. actinomycetemcomitam and S. mutans, E. durans, or L. lactis, the viable cell number of A. adinomycetemcomitans was not almost changed when compared with the numbers in the culture of A. actinomycetemcomitans alone. And in the mixed culture of P. gingivalis and E. durans or L. lactis, the viable cell numbers of P. gingivalis was not almost changed compared with the counts in the culture of P. gingivalis alone. But the replication of P. gingivalis was completely inhibited in the mixed culture of P. gingivalis and S. mutans. When the change of periodontal indexes following gargling of fermented milk was compared with baseline, probing depth and gingival index were not changed, but GCF volume was significantly dcreased(p (0.05). And when the viable cell numbers of microorganisms in subgingival plaque sample were compared with baseline, total viable cell number was almost unchanged and the viable cell numbers of A. actinomycetemcomitans and black pigmented bdcteroides were significantly decreased(p<0.05). These results suggest that L. acidophilus V-20 inhibit the replication of A. actinomycetemcomitans and black pigmented bacteroides by the formation of hydrogen peroxide.
Aggregatibacter actinomycetemcomitans ; Bacteria* ; Bacteroides ; Cell Count ; Gingival Crevicular Fluid ; Humans ; Hydrogen ; Hydrogen Peroxide ; Lactic Acid* ; Lactobacillus acidophilus ; Lactobacillus casei ; Milk ; Periodontal Diseases ; Periodontal Index ; Porphyromonas gingivalis

Changes in arterial blood gases and arterial pressure during laparoscopic cholecystectomy under the general anesthesia (enflurane in N2O/O2 50%) were investigated in 30 patients, who were divided into two groups according to control of minute ventilation. During surgery, minute ventilation was set 100 ml/kg in group I and 150 ml/kg in group II, and intraabdominal pressure was maintained at 15mmHg by CO2 insufflation, in both groups. Variables were measured before CO2 gas insufflation, 15 and 30 minutes after insufflation, just after exsufflation, 15 and 30 minutes after exsufflation and in recovery room. 1. PaCO2 was increased significantly during CO2 gas insufflation and just after exsufflation in both group, and degree of increase (PaCO2) was significantly greater in group I compared to group II. 2. Changes of PaO2 were not statistically significant in comparison to control value and between two groups during CO2 gas insufflation and exsufflation. 3. Blood pH in both groups were lowered significantly compared to control value during CO2 gas insufflation and exsufflation, and group II (increased minute ventilation group), represents lower risk of acidosis compared to group I. 4. Mean arterial pressure and airway pressure were significantly increased compared to control value during CO2 gas insufflation, but there was no significant difference between two groups. These results suggest that minute ventilation during laparoscopic cholecystectomy should be increased up to maintaining normal PaCO2 for prevention of hemodynamic and blood gas changes due to CO2 retention.
Acidosis ; Anesthesia, General* ; Arterial Pressure ; Cholecystectomy, Laparoscopic* ; Gases* ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Insufflation ; Recovery Room ; Ventilation

OBJECTIVE: The etiology and pathogenesis of moyamoya disease remain unclear. Furthermore, the definitive diagnostic protein-biomarkers for moyamoya disease are still unknown. The present study analyzed serum proteomes from normal controls and moyamoya patients to identify novel serological biomarkers for diagnosing moyamoya disease. METHODS: We compared the two-dimensional electrophoresis patterns of sera from moyamoya disease patients and normal controls and identified the differentially-expressed spots by matrix-assisted laser desorption/ionization-time-of flight mass spectrometry and electrospray ionization quadruple time-of-flight mass spectrometry. RESULTS: We found and analyzed 22 differently-expressed proteomes. Two proteins were up-regulated. Twenty proteins were down-regulated. Complement C1 inhibitor protein and apolipoprotein C-III showed predominantly changed expressions (complement C1 inhibitor protein averaged a 7.23-fold expression in moyamoya patients as compared to controls, while apolipoprotein C-III averaged a 0.066-fold expression). CONCLUSION: Although our study had a small sample size, our proteomic data provide serologic clue proteins for understanding moyamoya disease.
Apolipoprotein C-III ; Biomarkers ; Complement C1 Inhibitor Protein ; Electrophoresis ; Humans ; Mass Spectrometry ; Moyamoya Disease ; Proteins ; Proteome ; Sample Size

Recently epidemiologic studies have indicated that the patients with periodontitis may have increased risk of ischemic cardiovascular events, and have suggested the important roles of blood cytokines and acute reactant proteins in the systemic infection and inflammatory response. Periodontitis and coronary heart disease (CHD) may share the common risk factors and the genetic mechanism associated with interleukin(IL)-1A, B and RA genotype may be involved in the production of IL-1. This study was aimed to investigate the relationship between angiographically defined CHD and periodontitis as chronic Gram-negative bacterial infection and to determine whether the IL-1 gene polymorphism is associated in both diseases. Patients under the age of 60 who had undergone diagnostic coronary angiography were enrolled in this study. Subjects were classified as positive CHD (+CHD, n=37) with coronary artery stenosis more than 50% in at least one of major epicardial arteries, and negative CHD (-CHD, n=30) without significant stenosis. After recording the number of missing teeth, periodontal disease severity was measured by means of plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and radiographic bone loss around all remaining teeth. Gingival crevicular fluid (GCF) was collected from the 4 deepest periodontal pockets and assessed for cytokine (IL-1beta, IL-6, IL-1ra, tumor necrosis factor-alpha, and prostaglandin E2). Additionally, blood CHD markers, lipid profile, and blood cytokines were analyzed. IL-1 gene cluster genotyping was performed by polymerase chain reaction and enzyme restriction using genomic DNA from buccal swab, and allele 2 frequencies of IL-1A(+4845), IL-1B(+3954), IL-B(-511), and IL-1RA(intron 2) were compared between groups. Even though there was no significant difference in the periodontal parameters between 2 groups, GCF level of PGE2 was significantly higher in the +CHD group(p<0.05). Correlation analysis showed the positive relationship among PD, CAL and coronary artery stenosis(%) and blood PGE2. There was also significant positive relationship between the periodontal parameters (PI, PD, CAL) and the blood CHD markers (leukocyte count, C-reactive protein, and lactic dehyrogenase). IL-1 gene genotyping showed that IL-1A(+3954) allele 2 frequency was significantly higher in the +CHD group compared with the -CHD group (15 % vs. 3.3 %, OR 5.118, p=0.043). These results suggested that periodontal inflammation is related to systemic blood cytokine and CHD markers, and contributes to cardiovascular disease via systemic inflammatory reaction. IL-1 gene polymorphism might have an influence on periodontal and coronary heart diseases in Korean patients.
Alleles ; Arteries ; C-Reactive Protein ; Cardiovascular Diseases ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease* ; Coronary Stenosis ; Coronary Vessels ; Cytokines ; Dinoprostone ; DNA ; Epidemiologic Studies ; Genotype ; Gingival Crevicular Fluid ; Gram-Negative Bacterial Infections ; Hemorrhage ; Humans ; Inflammation ; Interleukin 1 Receptor Antagonist Protein ; Interleukin-1* ; Interleukin-6 ; Korea* ; Multigene Family ; Periodontal Diseases ; Periodontal Index ; Periodontal Pocket ; Periodontitis* ; Polymerase Chain Reaction ; Risk Factors ; Tooth ; Tumor Necrosis Factor-alpha

Candidemia is increasing cause of mortality, especially in intensive care unit patients. And Candida endophthalmitis, developed with or without symptoms, has poor outcome. Prompt use of antifungal agents and early diagnosis of Candida endophthalmitis are clinically important to treat candidemia. In this study, we compared clinical, microbiological, ophthalmological characteristics and treatment outcomes whether infectious disease (ID) specialists mediate candidemia or not in a tertiary hospital by retrospective chart review. Group A includes patients who had candidemia at least one time from January 2012 to July 2013, without ID specialists mediation. Group B includes patients who had candidemia at least one time from August 2013 to December 2014, with ID specialists surveillances and mediations. We compared clinical manifestations of candidemia, uses of antifungal agent, ophthalmologic evaluations and treatment outcomes between two groups. In group A, rate of ophthalmologic evaluations was 4.4% and mean duration was 64.60 hours from blood culture to use of antifungal agents. In group B, the rate of ophthalmologic evaluations was 43.2% and mean duration was 50.15 hours. There was no statistically significant difference in clinical characteristics and 30-day mortality between two groups. Increasing rate of ophthalmologic evaluations and decreasing mean duration from blood culture to use of antifungal agents was shown in surveillance and mediation group.
Antifungal Agents* ; Candida ; Candidemia* ; Communicable Diseases ; Early Diagnosis ; Endophthalmitis ; Humans ; Intensive Care Units ; Mortality ; Negotiating ; Retrospective Studies ; Specialization ; Tertiary Care Centers