Backgronud : Postoperative pain control became anesthesiologist's familiar yield, so many anesthesiologists are very interested in opioid and local anesthetic's characterestics and there cardiovascular effects. It's important which anesthetic has the best pain killing and the least cardiovascular effect. We used epidural opioid and local anesthetics and intravenous opioid to investigate their pain killing and cardiovascular effects. METHODS: We studied 50 patients undergoing gastrectomy. An epidural catheter was placed via the T8-9 or L1-2 interspace. Epidural fentanyl group (Ep-F) received fentanyl 2 microgram/kg in 10ml saline, epidural bupivacaine group (Ep-B), 10 ml 0.25% bupivacaine, and epidural lidocaine group (Ep-L), 10 ml 1.5% lidocaine, epidurally; intravenous fentanyl group (IV-F) received fentanyl, 2 microgram/kg. 50% of the original dose was repeated every hour until the operation ended. Control group was given nothing before general anesthesia. Cardiovascular data was compared between those before and those at 1hour after skin incision. The time interval between end of the operation and the time of first analgesic requirement and the total number of intramuscular analgesic requirements during the first 48hours postoperatively were compared. RESULTS: Urinary output during surgery was significantly larger in group Ep-F. Group Ep-L developed more frequent episodes of hypotension. Group Ep-F, group IV-F and control group required higher enflurane concentrations. CONCLUSIONS: Group Ep-F was accompanied less hypotension and postoperative analgesic requirements were reduced.
Anesthesia, General* ; Anesthetics, Local ; Bupivacaine* ; Catheters ; Enflurane ; Fentanyl* ; Gastrectomy* ; Homicide ; Humans ; Hypotension ; Lidocaine* ; Pain, Postoperative ; Skin

No abstract available.
Hyperbaric Oxygenation* ; Skin* ; Transplants*

BACKGROUND: Serotonin is found in the blood of the umbilical cord at birth in concentrations sufficiently high to affect vascular tone. Serotonin has been suggested to be involved in the pathogenesis of preeclampsia. Magnesium sulfate (MgSO4) is used to treat convulsions and hypertension in patients with preeclamptic toxemia. Bupivacaine is used in the epidural anesthesia for a cesarean section. The effects of magnesium and bupivacaine on serotonin-induced vasocontraction in a human umbilical artery was investigated. METHODS: Experiments were performed on 52 human umbilical arteries. The rings were suspended in an organ bath to record isometric mechanical activity. The concentration-contraction responses to bupivacaine, magnesium and serotonin were measured respectively. Vessels were pretreated with bupivacaine (10(-5) M) or magnesium (2 mM or 6 mM), and then serotonin (10(-9) M - 10(-6) M) was added cumulatively. Data analysis was assessed by an unpaired t test, one-way ANOVA and a Kruskal-Wallis test. RESULTS: Bupivacaine induced a contraction of umbilical arterial rings, and showed a maximal contraction (51.8 +/- 6.1%) at a concentration of 43nM. Magnesium induced relaxation of the umbilical artery in a concentration dependent manner. Pretreatment with bupivacaine (10(-5) M) potentiated significantly the concentration response to serotonin (P < 0.05). Pretreatment with MgSO4 (2 mM or 6 mM) significantly suppressed the contractile response to serotonin (P < 0.05). CONCLUSIONS: Bupivacaine, magnesium and serotonin are vasoactive on human umbilical arteries. Magnesium exerts a strong relaxant effect on serotonin induced vasocontraction in the human umbilical artery. Potentiation of serotonin induced vasoconstriction by bupivacaine may play a significant role in the reduction of umbilicoplacental blood flow.
Anesthesia, Epidural ; Baths ; Bupivacaine* ; Cesarean Section ; Female ; Humans* ; Hypertension ; Magnesium Sulfate ; Magnesium* ; Parturition ; Pre-Eclampsia ; Pregnancy ; Relaxation ; Seizures ; Serotonin ; Statistics as Topic ; Toxemia ; Umbilical Arteries* ; Umbilical Cord ; Vasoconstriction

No abstract available.
Chlamydia trachomatis* ; Chlamydia* ; Female ; Humans ; Infant, Newborn* ; Nasal Cavity* ; Polymers* ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnancy*

BACKGROUND: A retrospective study was performed to evaluate postoperative mortality within 30 days following surgery. METHODS: The records of 31,806 patients who received operation under general anesthesia were reviewed. RESULTS: 1) Postoperative deaths were 184 cases, the ratio of which was comprising 0.57% of all surgical operative cases. 2) The highest ratio of the mortality in age group was 51~60 years group which was 24.5%, and in physical status it was ASA class III which was 36.4%. The highest ratio to the mortality rate in postoperative days was 8~30 days which was 45.1%. 3) The most common causes of death was low cardiac output due to heart failure on operating theater, and hypovolemic shock within postoperative 2 days, and intracranial problem within postoperative 7 days, and pulmonary complication within postoperative 30 days. CONCLUSION: We conclude that fatality rate could be decreased by intensive and multidisciplinary care for postoperaive complications as respiratory and renal failure.
Anesthesia, General ; Cardiac Output, Low ; Cause of Death ; Heart Failure ; Humans ; Mortality ; Renal Insufficiency ; Retrospective Studies ; Shock

BACKGROUND: Elevated serum cholesterol level is a major risk factor for cardiovascular morbidity and mortality. Simvastatin is effective for treating hypercholesterolemia. The aim of the study was to evaluate efficacy and safety of 6-month therapy with simvastatin with relatively low dose, 10 mg and 20 mg/day over 60-year-old patients. METHODS: Seventy-senven patients with hyperlipidemia(triglycerides <400 g/dL and low-density lipoprotein(LDL) cholesterol >130 mg/dL) were randomized to receive either simvastatin 10 mg/day(n=32) or 20 mg/day(n=45). Efficacy was determined by measuring changes from baseline in lipid parameters including LDL cholesterol, total cholesterol, triglycerides and high-density lipoprotein(HDL) cholesterol. RESULTS: Of the senventy-seven patients randomized to treatment, eighteen patients were men and fiftynine patients were women. sixty-five percent of patients had hypertension, eighteen percent coronary artery disease and fourteen percent type 2 diabetes mellitus. Mean baseline lipid concentrations were 254 (total cholesterol), 291(triglycerides), 50(HDL) and 166 mg/dL(LDL). Both 10 mg and 20 mg of simvastatin produced statistically significant improvements in all measured serum lipid parameters(p<0.001). Compared with 10 mg of simvastatin, 20 mg of simvastatin produced significantly greater(p<0.001) reductions from baseline LDL cholesterol(32.9 mg/dL vs 24.2 mg/d). There was no significant difference in both doses at improving total cholesterol and HDL cholesterol level and TG cholesterol level. Percentage of patients at goal LDL as recommended by NCEP guideline(ATP III) were 100% and 89% for patients in low risk but 25% and 38.5% for patients in coronary heart disease and its risk equivalents, taking 10 mg and 20 mg/day respectively. Both doses were well tolerated. Only 3 patients(6.6%) in the 20 mg group and one patient(3. 1%) in the 10 mg group experienced mild adverse events. Most patients contacted by telephone wanted to take 10 mg of simvastatin. CONCLUSION: In patients with hypercholesterolemia over 60 year old in Korea, both doses(10 mg, 20 mg) of simvastatin were effective in improving serum lipid parameters and well-tolerated. We recommend, considering patients preference, that 10 mg of simvastatin be intial dosage and in patients with coronary heart disease, higher doses than 20 mg should be prescribed to allow most patients to reach their NCEP target levels.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Coronary Artery Disease ; Coronary Disease ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Hypercholesterolemia* ; Hypertension ; Korea ; Male ; Middle Aged* ; Mortality ; Risk Factors ; Simvastatin* ; Telephone ; Triglycerides

Cartilage is commonly used autogenous material for aesthetic and reconstructive surgery and major donor sites of cartilage are ear, nasal septum, and rib. As the cartilage correlates with ossification and can be used for joint reconstruction. Many growth factors influencing growth and differentiation of chondrocytes have been reported, and matrix composition produced by chondrocytes may vary in types and quantity according to culture duration. Initially the chondrocytes in culture aggregate, then secrete type I collagen. Type II collagen is produced during differentiation process, and synthesis of type X collagen is the last step. In this study, chondrocytes were isolated from ear cartilage of the New Zealand white rabbit weighing 400 gm. We performed high density culture using penicylinder and pellet method. The cells were polygonal in morphology and viable under the inverted microscope. This experiment was designed to evaluate the effect of IGF-I, TGF- p, and b- FGF on the synthesis of collagen in chondrocyte culture. Optimal concentration of growth factors was determined using H-thymidine incorporation into DNA. After the addition of optimal concentration of each growth factors in experimental groups, the uptake of H-proline was measured. Only IGF-I showed a statistically significant increase of collagen synthesis. We observed how subtypes of collagen were influenced by growth factors in two culture methods and by differing the addition timing of growth factors. SDS-PAGE was adopted for subtyping of collagen. All subtypes of collagen were found in both culture methods and all growth factors facilitated the production of type II and type X collagen and may be devoted to the differentiation of chondrocytes. Immunohistochemical staining for type I, and type II collagen was examined to confirm the above result. In pellet culture, type II collagen was stained densely in response to the addition of three kinds of growth factors. The results of penicylinder culture showed similar outcome to those from pellet cultured group. From the above results, we concluded as follows; First, IGF-I generally influence the synthesis of type I and II collagen. Second, TGF beta increased the synthesis of collagen. Third, b-FGF increased the synthesis of type II and type X collagen. We concluded that IFG-I is the only growth factor which is effective regardless of culture duration and method. TGF- beta and b-FGF, which are potent mitogen, facilitate the secretion of collagen.
Cartilage ; Chondrocytes* ; Collagen Type I ; Collagen Type II ; Collagen Type X ; Collagen* ; DNA ; Ear ; Ear Cartilage ; Electrophoresis, Polyacrylamide Gel ; Humans ; Insulin-Like Growth Factor I ; Intercellular Signaling Peptides and Proteins* ; Joints ; Nasal Septum ; New Zealand ; Ribs ; Tissue Donors

PURPOSE: To evaluate the clinical significance of the multiple increased uptake lesions other than in femoral heads as seen on whole body bone scan in patients with avascular necrosis of femoral heads. MATERIALS AND METHODS: One hundred and seventy three patients with clinical diagnosis of avascular necrosis of fthe emoral head underwent a bone scan using Tc-99m MDP. Increased uptake lesions other than in femoral heads were evaluated, including frequency and common sites of involvement, and correlated with clinical information and plain radiographic findings. Two hundred patients without AVN, who had undergone a bone scan, were included as a control group. RESULTS: Increased uptake lesions in extrafemoral head locations were found in 36 of 173 patients(20.8% ; the location of 79 lesions was other than the femoral head, This result is statistically different from patients without avascular necrosis of femoral head(p<0.0001). The most common site of involvement was the knee joint area(62.5%). Other lesions were located in the mid-shafts of the long bones of the lower extremities, calcaneus, proximal humerus, etc., in order of decreasing frequency. Plain radiographs of 17 lesions were nonspecific, except for three lesions showing definite changes associated with avascular necrosis. The risk factors included alcoholism, the prolonged use of steroids, renal transplantation, herbal medication and working as a working as deep-sea diver. Most patients did not complain of pain, except for two with irreversible osteonecrotic changes as seen on plain radiograph. CONCLUSION: in patients with avascular necrosis of the femur, increased uptake lesions other than in the femoral head as seen on bone scan, may represent the early stage of osteonecrosis, which shows a characteristic appearance on bone scan. In order to avoid possible misdiagnoses of multiple extrafemoral lesions as bony metastasis or traumatic lesions, in patients with avascular necrosis of the femur these should be carefully evaluated.
Alcoholism ; Calcaneus ; Diagnosis ; Diagnostic Errors ; Femur ; Head* ; Humans ; Humerus ; Kidney Transplantation ; Knee Joint ; Lower Extremity ; Necrosis* ; Neoplasm Metastasis ; Osteonecrosis ; Risk Factors ; Steroids ; Technetium Tc 99m Medronate*

PURPOSE: To evaluate the clinical significance of the multiple increased uptake lesions other than in femoral heads as seen on whole body bone scan in patients with avascular necrosis of femoral heads. MATERIALS AND METHODS: One hundred and seventy three patients with clinical diagnosis of avascular necrosis of fthe emoral head underwent a bone scan using Tc-99m MDP. Increased uptake lesions other than in femoral heads were evaluated, including frequency and common sites of involvement, and correlated with clinical information and plain radiographic findings. Two hundred patients without AVN, who had undergone a bone scan, were included as a control group. RESULTS: Increased uptake lesions in extrafemoral head locations were found in 36 of 173 patients(20.8% ; the location of 79 lesions was other than the femoral head, This result is statistically different from patients without avascular necrosis of femoral head(p<0.0001). The most common site of involvement was the knee joint area(62.5%). Other lesions were located in the mid-shafts of the long bones of the lower extremities, calcaneus, proximal humerus, etc., in order of decreasing frequency. Plain radiographs of 17 lesions were nonspecific, except for three lesions showing definite changes associated with avascular necrosis. The risk factors included alcoholism, the prolonged use of steroids, renal transplantation, herbal medication and working as a working as deep-sea diver. Most patients did not complain of pain, except for two with irreversible osteonecrotic changes as seen on plain radiograph. CONCLUSION: in patients with avascular necrosis of the femur, increased uptake lesions other than in the femoral head as seen on bone scan, may represent the early stage of osteonecrosis, which shows a characteristic appearance on bone scan. In order to avoid possible misdiagnoses of multiple extrafemoral lesions as bony metastasis or traumatic lesions, in patients with avascular necrosis of the femur these should be carefully evaluated.
Alcoholism ; Calcaneus ; Diagnosis ; Diagnostic Errors ; Femur ; Head* ; Humans ; Humerus ; Kidney Transplantation ; Knee Joint ; Lower Extremity ; Necrosis* ; Neoplasm Metastasis ; Osteonecrosis ; Risk Factors ; Steroids ; Technetium Tc 99m Medronate*

BACKGROUND AND OBJECTIVES: The Osborn wave is the name designated to the wave formation produced when there is a large, prominent deviation of the J point from the baseline. The wave has been reported in many countries, but only 2 cases have been reported in Korea. Thus, the purpose of our study was to evaluate the clinical characteristics and therapy of hypothermia employing the Osborn wave with Koreans. SUBJECTS AND METHODS: Between February 2001 and April 2001, five patients visiting our department with hypothermia were enrolled in this study. We analyzed these patients for their distribution, symptoms and signs, associated disorders, risk factors, electrocardiogram and laboratory findings. RESULTS: All 5 patients were male with an average age was 44.8+/-12.7 years. Three patients had a semi-comatose mentality and 2 cases had a comatose mentality. Their associated disorders were diabetes (2 cases), psychotic problems (1 case) and nutritional deficiency (1 case). Risk factors were alcohol abuse (3 cases) and drug in toxication (1 case). Laboratory abnormalities were acidosis (4 cases), increased serum glucose levels (all 5 cases) and increased serum potassium levels (3 cases). After active core rewarming by a line heat exchanger, 3 of the 5 patients completely recovered from hypothermia, 1 case immediately expired following admission and 1 case survived for 10 days, but later expired due to acute respiratory distress syndrome. The Osborn wave was persistent in 1 case and disappeared in 3 cases. CONCLUSION: We experienced 5 cases of hypothermia with an Osborn wave. The mortality of patients displaying an Osborn wave is expected to decrease if this anomaly is immediately found and treated by an appropriate method.
Acidosis ; Alcoholism ; Blood Glucose ; Coma ; Electrocardiography* ; Hot Temperature ; Humans ; Hypothermia* ; Korea ; Male ; Malnutrition ; Mortality ; Potassium ; Respiratory Distress Syndrome, Adult ; Rewarming ; Risk Factors