BACKGROUNDMedically unexplained dyspnea refers to a condition characterized by a sensation of dyspnea and is typically applied to patients presenting with anxiety and hyperventilation without underlying cardiopulmonary pathology. We were interested to know how anxiety triggers hyperventilation and elicits subjective symptoms in those patients. Using an imagery paradigm, we investigated the role of fearful imagery in provoking hyperventilation and in eliciting symptoms, specifically dyspnea.

METHODSForty patients with medically unexplained dyspnea and 40 normal subjects matched for age and gender were exposed to scripts and asked to imagine both fearful and restful scenarios, while end-tidal PCO(2) (PetCO(2)) and breathing frequency were recorded and subjective symptoms evaluated. The subject who had PetCO(2) falling more than 5 mmHg from baseline and persisting at this low level for more than 15 seconds in the imagination was regarded as a hyperventilation responder.

RESULTSIn patients with medically unexplained dyspnea, imagination of fearful scenarios, being blocked in an elevator in particular, induced anxious feelings, and provoked a significant fall in PetCO(2) (P < 0.05). Breathing frequency tended to increase. Eighteen out of 40 patients were identified as hyperventilation responders compared to 5 out of 40 normal subjects (P < 0.01). The patients reported symptoms of dyspnea, palpitation or fast heart beat in the same fearful script imagery. Additionally, PetCO(2) fall was significantly correlated with the intensity of dyspnea and palpitation experienced during the mental imagery on one hand, and with anxiety symptoms on the other.

CONCLUSIONSFearful imagery provokes hyperventilation and induces subjective symptoms of dyspnea and palpitation in patients with medically unexplained dyspnea.

Adult ; Anxiety ; complications ; Carbon Dioxide ; analysis ; Dyspnea ; etiology ; Fear ; Female ; Humans ; Hyperventilation ; etiology ; Imagination ; Male

No abstract available.
Adult ; Brain Ischemia/diagnosis/*etiology ; Cerebral Angiography ; Fatal Outcome ; Female ; Humans ; Hyperventilation/complications ; Moyamoya Disease/*complications/diagnosis/therapy ; Risk Factors ; Stroke/diagnosis/*etiology ; Thyroid Crisis/*complications/diagnosis/therapy

Since laparoscopic cholecystectomy(LC) was first introduced in early 1990 in Korea, LC is now widely used with an acknowledgement of the benefits of LC.The author retrospectively analyzed 120 patients who were treated by LC and 40 patients who were treated by open cholecystectomy(OC), at the Department of Surgery, Kwang Hye Hospital from Jan. 1992 to July 1995. For the statistical analysis of the variables, student's t-test and ANOVA F-test were used to assess the differences between two groups(p value = 0.05). The obtained results were as follows. 1. The mean age and sex ratio(M:F) between LC and OC group were 48.3-years-old and 1:1.45, 57.6-years-old and 1:3.4, respectively. 2. Associated diseases were observed in 62 patients (51.7%) of the LC group and 23 patients (57.5%) of the OC group. Peptic ulcer and DM were most frequent, respectively. 3. 20 patients (16.7%) had a previous abdominal operation, with appendectomy, the most frequent among them. 4. The operation times(p=0.05), hospitalization stay(p=0.0001), and postoperative hospitalization stay(p=0.0001) were significantly shorter in the LC group than in the OC group. 5. In the preoperative, intraoperative, and postoperative ABGA of the LC group, especially, intraoperative PCO2 was increased due to CO2 retension and metabolic acidosis was developed, intraoperatively. PaO2 was excessively increased due to hyperventilation to correct the metabolic acidosis, intraoperatively. Satistically, intraoperative pH (p=0.0001), PaO2 (p=0.0001), PCO2 (p=0.0001) except bicarbonate (p=0.1987) were significantly changed, compared with preoperative pH or postoperative pH. 6. Operative cholangiography(OPC) was proceeded in 17 patients(14.2%) and concurrent laparoscopic appendectomy was done in 7 patients (5.8%) of the LC group. 7. Postoperative complications were occurred in 19 patients (15.8%) of the LC group. 3 patients (2.5%) were explorated, the remainders were recovered by conservative treatment. 8. On pathologic findings, cholelithiasis and chronic cholecystitis with 105 patients (87.5%) were most frequent in the LC group. In the OC group, cholelithiasis and chronic cholelithiasis with 25 patients (62.5%) were also most frequent, GB empyema with 8 patients (20%), acute cholecystitis with 7 patients (17.5%). Conclusively, laparoscopic cholecystectomy can be safely applied with lower morbidity, shorter operation times, and shorter hospital stay in selected patients.
Acidosis ; Appendectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute ; Cholelithiasis ; Empyema ; Hospitalization ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation ; Korea ; Length of Stay ; Peptic Ulcer ; Postoperative Complications ; Retrospective Studies