BACKGROUND: Left ventricular ejection fraction (LVEF) is considered to be an index of LV function. However, LVEF in chronic mitral regurgitation (MR) is overestimated due to a "systolic unloading effect" into the left atrium and leads to underestimation of the degree of LV dysfunction preoperatively. The purpose of this study was to evaluate the exact degree of preoperative LV dysfunction by LVEF, according to the MR grade. METHODS: Transesophageal echocardiography (on transgastric short axis view) was performed to compare LVEF at the Pre- and Post-MVR periods, in 39 patients with chronic MR: group I, MR grade III (n = 16) and group II, MR grade IV (n = 23). RESULTS: LVEF at Pre- and Post-MVR were 63.8 +/- 6.1% and 54.8 +/- 6.0%, respectively, and the LVEF difference between Pre- and Post-MVR was 9.0 +/- 3.5 by number (14.1 +/- 5.3% by ratio) in group I. LVEF at Pre- and Post-MVR were 68.1 +/- 7.2% and 51.7 +/- 6.0%, respectively, and the LVEF difference between Pre- and Post-MVR was 16.4 +/- 4.2 by number (24.0 +/- 5.2% by ratio) in group II. CONCLUSIONS: For the exact evaluation of preoperative LV function in patients with chronic MR, we have to subtract 9.0 by number (14.1% by ratio) from the preoperative LVEF in MR grade III and 16.4 by number (24.0% by ratio) from the preoperative LVEF in MR grade IV.
Axis, Cervical Vertebra ; Echocardiography, Transesophageal ; Heart Atria ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Stroke Volume*

We concentrated ourselves to evaluate the prognostic significance of the p53 gene mutations, its protein expression and MIB-1 index as a proliferative marker in canine mammary tumors. In the present study, a total of 20 cases were examined, among which there were 5 malignant mixed tumors, 4 mammary gland adenocarcinomas, 1 papillary adenocarcinoma, 8 benign mixed tumors and 2 mammary gland adenomas. Positive immunostaining for p53 with PAb240 antibody was found in 2 benign (20%) and 3 malignant (30%) tumors. However, PAb421 antibody did not give positive result at all. In Western blot analysis, the p53 expression in benign and malignant tumors was detected in 4 and 3 cases, respectively. p53 mutations were found in 6 cases out of the cases with detected p53 protein expression. The MIB-1 index in benign and malignant tumors were 17.6+/-20.8% and 29.0+/-27.2%, respectively and there was no significant difference between tumor types. There was a significant correlation between p53 mutations and p53 overexpression (correlation coefficient = 0.5, p < 0.05). In Kaplan-Meier survival analysis, the p53 index was associated with significantly shortened survival time (p < 0.01). In multivariate analysis, p53 overexpression was only an independent factor for indicator of worse prognosis in canine mammary tumors (p = 0.01). These results demonstrated that p53 gene mutations and protein overexpression using the PAb240 anti-p53 antibody were useful predictors of increased malignant potential and poor prognosis in canine mammary tumors.
Animals ; Antibodies, Antinuclear/metabolism ; Antibodies, Monoclonal/metabolism ; Blotting, Western/veterinary ; Dog Diseases/genetics/*metabolism ; Dogs ; Female ; Genes, p53/*genetics ; Immunohistochemistry/veterinary ; Ki-67 Antigen/metabolism ; Mammary Neoplasms, Animal/genetics/*metabolism ; *Mutation ; Predictive Value of Tests ; Proportional Hazards Models ; Tumor Suppressor Protein p53/*biosynthesis/genetics

BACKGROUND: In laparoscopic surgery with pneumoperitoneum, end-tidal CO2 (PeTCO2) monitoring may inaccurately estimate PaCO2 due to ventilation/perfusion mismatch. This study assessed the clinical usefulness and accuracy of transcutaneous CO2 (PtCCO2) monitoring during laparoscopic surgery. METHODS: Thirty-two patients with ASA physical status 1 requiring laparoscopic surgery were recruited. We measured PaCO2, PeTCO2, and PtCCO2 before and 20 min after pneumoperitoneum. To compare differences in PeTCO2/PaCO2 and PtCCO2/PaCO2, we determined bias values (mean difference between values) and precision (standard deviation of bias) with a Bland-Altman plot and compared them with a Student's t-test. RESULTS: Bias and precision values of PeTCO2/PaCO2 and PtCCO2/PaCO2 were 6.6 +/- 2.0 mmHg, 1.2 +/- 2.8 mmHg before pneumoperitoneum and 8.5 +/- 2.8 mmHg, 2.1 +/- 4.5 mmHg 20 min after pneumoperitoneum. PtCCO2/PaCO2 differences were significantly smaller than PeTCO2/PaCO2 differences (P< 0.05). CONCLUSIONS: In laparoscopic surgery, PtCCO2 monitoring is more accurate than PeTCO2 monitoring for assessing PaCO2 levels.
Bias (Epidemiology) ; Carbon Dioxide ; Humans ; Laparoscopy ; Pneumoperitoneum

BACKGROUND: In thoracic anesthesia with one lung ventilation (OLV), end-tidal CO2 (PeTCO2) monitoring may not be accurate to estimate PaCO2 mainly due to ventilation/perfusion mismatching.This study aimed to asses the clinical usefulness and accuracy of a transcutaneous CO2 (PtCCO2) monitoring in thoracic anesthesia, compared with PeTCO2. METHODS: 18 patients of ASA physical status 1 or 2, required a long period of OLV were researched.The lungs were mechanically ventilated in the lateral decubitus position.We measured PaCO2, PeTCO2, PtCCO2 during two lung ventilation (TLV) and 15 min, 30 min, 60 min after OLV.For comparing the differences of PtCCO2/PaCO2 and PtCCO2/PaCO2, we figured out bias (mean difference between values) and precision (standard deviation of bias) by using Bland-Altman plot.We compared the differences of each value, PeTCO2/PaCO2, PtCCO2/PaCO2, using the student's t-test. RESULTS: The bias +/- precision of PeTCO2/PaCO2 and PtCCO2/PaCO2 was each 7.82 mmHg +/- 3.98 mmHg, 1.95 mmHg +/- 2.66 mmHg during TLV and that of mean value of PeTCO2/PaCO2 and PtCCO2/PaCO2 was each 6.93 mmHg +/- 2.6 mmHg, 2.35 mmHg +/- 1.66 mmHg during OLV.PtCCO2/PaCO2 differences were significantly less than PeTCO2/PaCO2 differences (P < 0.05). CONCLUSIONS: During one lung ventilation, PtCCO2 monitoring is more useful and accurate than PeTCO2 monitoring for assessing PaCO2 levels.
Anesthesia ; Bias (Epidemiology) ; Blood Gas Monitoring, Transcutaneous ; Capnography ; Equidae ; Humans ; Lung ; One-Lung Ventilation ; Thoracic Surgery ; Ventilation

BACKGROUND: Spinal pain is most common symptom in pain clinic. In most cases, before the treatment of spinal pain, physician explains the patient's disease and treatment. We investigated patient's satisfaction and physician's explanation related to treatments in spinal pain patients by questionnaires. METHODS: Anonymous questionnaires about physician's explanation and patient's satisfaction in each treatment and post-treatment management were asked to individuals suffering from spinal pain. Patients who have spinal pain were participated in our survey of nationwide university hospitals in Korea. The relationships between patient's satisfaction and other factors were analyzed. RESULTS: Between June 2016 and August 2016, 1007 patients in 37 university hospitals completed the questionnaire. In the statistical analysis, patient's satisfaction of treatment increased when pain severity was low or received sufficient preceding explanation about nerve block and medication (P < 0.01). Sufficient explanation increased patient's necessity of a post-treatment management and patients' performance rate of post-treatment management (P < 0.01). CONCLUSIONS: These results show that sufficient explanation increased patients' satisfaction after nerve block and medication. Sufficient explanation also increased the practice of patients' post-treatment management.
Anonyms and Pseudonyms ; Hospitals, University ; Humans ; Korea ; Nerve Block ; Pain Clinics ; Patient Satisfaction*

This study was to determine the effects of allogenicumbilical cord blood (UCB)-derived mesenchymal stemcells (MSCs) and recombinant methionyl humangranulocyte colony-stimulating factor (rmhGCSF) on acanine spinal cord injury model after balloon compressionat the first lumbar vertebra. Twenty-five adult mongreldogs were assigned to five groups according to treatmentafter a spinal cord injury: no treatment (CN); salinetreatment (CP); rmhGCSF treatment (G); UCB-MSCstreatment (UCB-MSC); co-treatment (UCBG). The UCB-MSCs isolated from cord blood of canine fetuses wereprepared as 10(6) cells/150microl saline. The UCB-MSCs weredirectly injected into the injured site of the spinal cord andrmhGCSF was administered subcutaneously 1 week afterthe induction of spinal cord injury. The Olby score,magnetic resonance imaging, somatosensory evokedpotentials and histopathological examinations were used toevaluate the functional recovery after transplantation. TheOlby scores of all groups were zero at the 0-week evaluation.At 2 week after the transplantation, the Olby scores in thegroups with the UCB-MSC and UCBG were significantlyhigher than in the CN and CP groups. However, there wereno significant differences between the UCB-MSC andUCBG groups, and between the CN and CP groups. Thesecomparisons remained stable at 4 and 8 week aftertransplantation. There was significant improvement in thenerve conduction velocity based on the somatosensory evokedpotentials. In addition, a distinct structural consistency ofthe nerve cell bodies was noted in the lesion of the spinalcord of the UCB-MSC and UCBG groups. These resultssuggest that transplantation of the UCB-MSCs resulted inrecovery of nerve function in dogs with a spinal cord injuryand may be considered as a therapeutic modality for spinalcord injury.
Animals ; Behavior, Animal/physiology ; Cord Blood Stem Cell Transplantation/methods/*veterinary ; Dog Diseases/pathology/*therapy ; Dogs ; Evoked Potentials, Somatosensory/physiology ; Histocytochemistry/veterinary ; Magnetic Resonance Imaging/veterinary ; Random Allocation ; Spinal Cord Injuries/pathology/therapy/*veterinary ; Videotape Recording

BACKGROUND: Continuous epidural block after surgery has been able to get better postoperative analgesic effect than intermittent intravenous (IV) opioids and to decrease the duration of mechanical ventilatory support, endotracheal intubation and ICU stay. The purpose of this study is to observe these effects of continuous epidural block after cardiac surgery. METHODS: 30 patients, undergoing cardiac surgery, were divided into 2 groups. Postoperative analgesia were performed by intermittent IV meperidine 25 mg in group 1 and by continuous epidural block with 1% mepivacaine 100 ml and morphine 4 mg in group 2. Both groups were supplemented, at the patient's request, by IV meperidine 25 mg as needed. Quality of pain relief, total number of IV meperidine and duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay were compared between 2 groups. RESULTS: Quality of pain relief and total number of IV meperidine were significantly lower in group 2 than group 1, each time interval. Duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay and time interval between consciousness return & mechanical ventilatory support were significantly shorter in group 2 than group 1. CONCLUSIONS: Continuous epidural block, with 1% mepivacaine 100 ml and morphine 4 mg, for postoperative analgesia decreases the duration of intensive care compaered with intermittent IV meperidine 25 mg, after cardiac surgery.
Analgesia ; Analgesics, Opioid ; Consciousness ; Humans ; Critical Care* ; Intubation, Intratracheal ; Meperidine ; Mepivacaine ; Morphine ; Thoracic Surgery*

Background: Use of opioids for chronic intractable pain is increasing globally, and their proper use can improve patients’ quality of life. In contrast, opioid use disorders, such as abuse or addiction, caused by prescribing opioids, are a worldwide issue. This study aimed to understand current opioid prescribing patterns and pain physicians’ experiences with opioid use in South Korea. Methods: Pain physicians in 42 university hospitals in South Korea were asked to complete anonymous questionnaires regarding opioid prescriptions. Results: A total of 69 surveys were completed. Most pain physicians started prescribing opioids at a pain score of 7/10 and aimed to reduce pain by 50%. Most physicians (73.1%) actively explained the prescribed medications and possible side effects, and 61.2% of physicians preferred the prescription interval of 4 weeks.Immediate-release opioids were the most popular treatment for breakthrough pain (92.6%). The most common side effect encountered by physicians was constipation (43.3%), followed by nausea/vomiting (34.3%). Of the physicians, 56.5% replied that addiction and misuse prevalences were less than 5%. However, the most concerning side effect was addiction (33.0%). Conclusions The survey results showed that the prescribing patterns of pain physicians generally followed Korean guidelines. Physicians were most interested in the safety and effectiveness of opioid prescriptions. They were most concerned about respiratory depression and abuse or addiction. A significant number of physicians agreed that the NHIS regulations needed improvement for patient convenience and safe and effective treatment, though there were pros and cons of the NHIS restrictions on prescription conditions.

Background: Complex regional pain syndrome (CRPS) is an intractable pain disease with various symptoms. Here, we investigated the disease status, work life, sleep problems, medical insurance, economic status, psychological problems, and quality of life (QOL) of CRPS patients. Methods: CRPS patients from 37 university hospitals in South Korea were surveyed.The survey questionnaire consisted of 24 questions on the following aspects of CRPS patients: sex, age, occupation, cause of injury, activities of daily living (ADL), pain severity, sleep disturbance, level of education, economic status, therapeutic effect, and suicidal ideation. Additionally, the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions, was used to identify the status of QOL. Results: A total of 251 patients completed the questionnaire. According to the survey, 54.2% patients could not perform ADL on their own. Over the previous week, the mean pain score was 7.15 ± 1.78 (out of a total of 10 points); 92.1% of patients had sleep disorders and 80.5% had suicidal ideation, with most patients suffering from psychological problems. The average for each domain of WHOQOL-BREF was as follows: 21.74 ± 14.77 for physical, 25.22 ± 17.66 for psychological, 32.02 ± 22.36 for social relationship, and 30.69 ± 15.83 for environmental (out of a total of 100 points each). Occupation, ADL, sleep time, therapeutic effect, and suicidal ideation were statistically correlated with multiple domains. Conclusions Most patients had moderate to severe pain, economic problems, limitations of their ADL, sleep problems, psychological problems, and a low QOL score.

Background: Complex regional pain syndrome (CRPS) is an intractable pain disease with various symptoms. Here, we investigated the disease status, work life, sleep problems, medical insurance, economic status, psychological problems, and quality of life (QOL) of CRPS patients. Methods: CRPS patients from 37 university hospitals in South Korea were surveyed.The survey questionnaire consisted of 24 questions on the following aspects of CRPS patients: sex, age, occupation, cause of injury, activities of daily living (ADL), pain severity, sleep disturbance, level of education, economic status, therapeutic effect, and suicidal ideation. Additionally, the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions, was used to identify the status of QOL. Results: A total of 251 patients completed the questionnaire. According to the survey, 54.2% patients could not perform ADL on their own. Over the previous week, the mean pain score was 7.15 ± 1.78 (out of a total of 10 points); 92.1% of patients had sleep disorders and 80.5% had suicidal ideation, with most patients suffering from psychological problems. The average for each domain of WHOQOL-BREF was as follows: 21.74 ± 14.77 for physical, 25.22 ± 17.66 for psychological, 32.02 ± 22.36 for social relationship, and 30.69 ± 15.83 for environmental (out of a total of 100 points each). Occupation, ADL, sleep time, therapeutic effect, and suicidal ideation were statistically correlated with multiple domains. Conclusions Most patients had moderate to severe pain, economic problems, limitations of their ADL, sleep problems, psychological problems, and a low QOL score.