BACKGROUND: It is well known that administration of nutrients, especially protein and amino acids mixtures, stimulates energy expenditure in the unanesthetized patients. Also, there were reports that the mechanisms for nutrient-induced thermogenesis are not impaired during general anaesthesia. The enhanced amino acid-induced thermogenesis would counteract the anaesthesia-induced reduction in metabolism and prevent the development of hypothermia. The present study was designed to see if completing the amino acid infusion before induction of anaesthesia would induce heat production, which would promote energy expenditure and thereby counteract the development of anaesthesia-induced hypothermia. METHODS: Body temperatures and arterial blood gases were measured in 48 patients during perioperative period. 24 patients had an amino acid mixture of 227 cal infused over 2 hours before anesthesia and 24 control patients received Hartman's solution. RESULTS: Amino acid infusion attenuated the development of hypothermia during the period from 60 min to 105 min after induction of anaesthesia compared to control group, however, did not prevent overall hypothermia throughout the study period. CONCLUSION: This result may indicate amino acid infusion before anesthesia can be an adjuvant to prevent intraoperative hypothermia.
Amino Acids ; Anesthesia ; Body Temperature ; Energy Metabolism ; Gases ; Humans ; Hypothermia ; Metabolism ; Perioperative Period ; Thermogenesis

No abstract available.
Endocarditis* ; Hypertension ; Mitral Valve

BACKGROUND AND OBJECTIVES: Increased carotid intima-media thickness (IMT) is known to be associated with adverse cardiovascular events in the patients with risk factors or established atherosclerosis. However, the prognostic importance of carotid IMT is uncertain in the patients who underwent percutaneous coronary intervention (PCI). We sought to evaluate the association of carotid IMT with major adverse cardiovascular events (MACE) and restenosis in the patients who underwent PCI. SUBJECTS AND METHODS: The study population consisted of 308 consecutive patients who underwent PCI, and they were followed up for mean of 30.6+/-13.3 months. Base on the median values of carotid IMT, which was measured in the right common carotid artery at the time of PCI with using high-resolution ultrasound and a semiautomatic method, the subjects were divided into the thick (n=156, 1.003+/-0.14 mm) and thin IMT (n=152, 0.748+/-0.07 mm) groups, and they were followed up for at least 1 year. RESULTS: Patients with thick carotid IMT were older (61+/-9 years vs. 57+/-10 years, respectively, p=0.001), had a higher body mass index (25.0+/-3.0 vs. 23.9+/-4.0, respectively, p=0.017), a history of previous myocardial infarction (20% vs. 9%, respectively, p=0.008), more multivessel disease and more restenosis (34.6% vs. 23.0%, respectively, p=0.025) than those patients with a thin carotid IMT. However other MACEs such as death, myocardial infarction, stroke, heart failure and target lesion revascularization did not show any significant differences between the two groups. Multivariate Cox regression analysis showed that carotid IMT was an independent predictor of restenosis (odds ratio: 1.754, 95% confidence interval: 1.1296 to 2.726, p=0.012). CONCLUSION: An increased carotid IMT is associated with restenosis, but it does not have clinical prognostic importance for the patients who underwent PCI during a mean follow up period of 31 months.
Angioplasty, Balloon, Coronary ; Atherosclerosis ; Body Mass Index ; Carotid Artery, Common ; Carotid Intima-Media Thickness* ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Prognosis ; Risk Factors ; Stroke ; Ultrasonography

Electrical injury may lead to a conduction disorder of the heart. We report here on a 36-year-old man, who was treated with a permanent pacemaker, after an electrical injury induced high-degree atrioventricular block and clinical manifestations (dizziness and dyspnea).
Adult ; Atrioventricular Block* ; Electric Injuries ; Heart ; Heart Conduction System ; Humans

BACKGROUND AND OBJECTIVES: While the clinical significance of descending thoracic aorta intima-media thickness (DTA-IMT) remains unclear, common carotid IMT (CIMT) is known to be associated with major adverse cardiovascular events (MACE) in patients with atherosclerotic disease. SUBJECTS AND METHODS: A total of 104 patients (mean age, 59 yrs; 69 male) with angiographically proven coronary atherosclerosis underwent transesophageal echocardiography (TEE) for DTA-IMT measurement and carotid scanning for CIMT measurement. The patients were divided into two groups based on the median IMT value, and they were followed up for cardiovascular events and all-cause mortality for a period of 50+/-21 months. RESULTS: Patients having a higher DTA-IMT value (n=44, >2.1 mm) had a higher chance of stroke (6.7% vs. 2.8%, p=0.04), peripheral vascular disease (6.7% vs. 1.9%, p=0.02), and death (2.9% vs. 0%, p=0.04) than those who had lower DTA-IMT values (n=60, < or =2.1 mm). The patients who had higher CIMT values (n=49, >0.089 mm) had a higher chance of peripheral vascular disease (16% vs 2%, p=0.009) than those having lower IMT values (n=55, < or =0.089 mm). However, there was no significant difference between the groups in terms of recurrent chest pain, heart failure, syncope, myocardial infarction or chronic kidney disease during the follow-up period. Multivariate Cox regression analysis revealed that increased DTA-IMT was associated with stroke (OR, 4.29; 95% CI, 1.076-17.181; p=0.039) and peripheral vascular disease (OR, 9.37; 95% CI, 1.571-55.499; p=0.014), whereas increased CIMT was associated with peripheral vascular disease (OR, 14.365; 95% CI, 1.050-196.540; p=0.046). CONCLUSION: This study suggests that descending thoracic aorta IMT is more closely associated with prognosis in patients with coronary atherosclerosis than CIMT.
Aorta ; Aorta, Thoracic* ; Atherosclerosis ; Carotid Arteries ; Chest Pain ; Coronary Artery Disease* ; Echocardiography, Transesophageal ; Follow-Up Studies ; Heart Failure ; Humans ; Mortality ; Myocardial Infarction ; Peripheral Vascular Diseases ; Prognosis ; Renal Insufficiency, Chronic ; Stroke ; Syncope

BACKGROUND AND OBJECTIVES: Whether uric acid is a predictor of cardiovascular events remains controversial. We sought to evaluate the effects of the serum uric acid levels on major adverse cardiovascular events (MACEs) in the patients with coronary artery disease (CAD). SUBJECTS AND METHODS: The study population consisted of 660 consecutive patients with CAD, and they were followed up for a mean of 27 months (maximum: 62 months). The recorded MACEs included acute myocardial infarction (AMI), stroke, coronary artery bypass graft, percutaneous coronary intervention (PCI) due to de novo lesion during follow up, congestive heart failure (CHF) and sudden cardiac death. RESULTS: In the CAD patients with a uric acid level < or =3.88 mg/dL (the lowest quartile), as compared with those CAD patients with uric acid levels >5.74 mg/dL (the highest quartile), the MACE rate increased from 7.2% to 20.1%. On univariate Cox regression analysis, the highest uric acid quartile was a predictor of AMI, CHF and MACE. The absolute serum uric acid level was predictive of PCI, CHF and MACE. Multivariate Cox regression analysis showed that the independent predictors of MACE were presentation with acute coronary syndrome (HR 1.70, 95% CI: 1.04 to 2.78, p=0.033), multi-vessel disease (HR 2.43, 95% CI: 1.44 to 4.12, p=0.001), and the uric acid levels (HR 1.22, 95% CI: 1.05 to 1.43, p=0.010), and the highest uric acid quartile (HR 2.54, 95% CI: 1.58 to 4.10, p<0.001). CONCLUSION: The serum uric acid level and multi-vessel disease are associated with subsequent cardiovascular events in the patients with CAD.
Acute Coronary Syndrome ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Death, Sudden, Cardiac ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Stroke ; Transplants ; Uric Acid*

An anomalous systemic arterial supply to the normal basal segments of the left lower lobe without sequestration is a rare congenital anomaly. It differs from classical bronchopulmonary sequestration in that the involver lung retains a normal connection to the bronchial tree, although some place this entity exists within the broad framework of pulmonary sequestration. We experienced a case of a woman who presented with a nodular lesion on a chest X-ray. Contrast-enhanced CT diagnosed her as having an anomalous systemic arterial supply to the normal basal segments of the left lower lobe. This case is reported with a brief literature review.
Bronchopulmonary Sequestration ; Female ; Humans ; Lung* ; Thorax ; Tomography, X-Ray Computed ; Trees

OBJECTIVES: We sought to examine the diverse factors associated with aneurysms of the posterior circulation. In addition, the results of conventional craniotomy were compared with those of endovascular treatment. METHODS: One hundred and one patients with posterior circulation aneurysms were selected for study inclusion. The factors that might affect the clinical outcomes were studied , such as the initial Hunt-Hess (H-H) grade, aneurysm location, size of the aneurysm, and therapeutic modalities. In addition, the morbidity and mortality rates were analyzed. The treatment outcomes were evaluated using the Glasgow Outcome Scale (GOS) 6 months after the initial insult. RESULTS: The patient population consisted of 67 women and 34 men, with a mean age of 52 (range 28-81 years). The overall morbidity and mortality rates at 6 months were 13.9% (14/101) and 17.8% (18/101), respectively. Sixty-one operations (60.3%) were performed, and 32 patients were treated with endovascular therapy. Forty-two (85.7%) of the 49 patients that had initial H-H grades of I and II had a better prognosis (GOS more than 4) than those with poor H-H grades (P<0.001). Patients that underwent endovascular treatment had better outcomes than those that had clipping (P=0.032). There was no significant difference in outcome according to the size of the aneurysm, location of the aneurysm, or the age of the patients. CONCLUSIONS: The results of this study showed that the factors affecting the prognosis were the initial HH grade and treatment modality. Considering the very high mortality rate in patients with rebleeding, early management may help improve the prognosis of patients with posterior circulation aneurysms. Endovascular therapy should be considered the primary treatment modality in patients with posterior circulation aneurysms.
Aneurysm ; Craniotomy ; Female ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm ; Male ; Prognosis

One hundred sixty three patients were hysteroscoped for various reasons at our department over 10 year period. Ninety eight patients out of 163 who were diagnosed and treated for their intrauterine adhesions(IUAs) by hysteroscopy were analysed retrospectively. Patients were classified as having mild, moderate or severe stage of IUAs according to American Fertility Society classification. Twenty nine patients(29.6%) had mild IUAs, 43 patients (43.9%) had moderate IUAs, and 26 patients(26.5%) were classified as having severe stage IUAs. The predisposing causal factors of IUAs were abortion, full-term delivery, H. mole, pelvic tuberculosis and myomectomy in order of frequency but in eight cases no cause was identified. After hysteroscopic surgery, although high rate(83.9%) of restoration of normal menstruation was attained but term pregnancy rate was only 53.3% and rather high rate (32%) of preterm or abortion were identified and those pregnancy outcomes were correlated with the stage of IUAs. Complications of surgery consisted of uterine or bladder perforation, pulmonary edema and hemorrhage.
Classification ; Female ; Fertility ; Hemorrhage ; Humans ; Hysteroscopy ; Menstruation ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Pulmonary Edema ; Retrospective Studies ; Tuberculosis ; Urinary Bladder

PURPOSE: We reviewed the records of renal cell carcinoma (RCC) patients with brain metastases, analyzed about survival and prognosis after several palliative management. MATERIALS AND METHODS: Between June 1998 and January 2008, 22 patients diagnosed to have brain metastases from RCC. We retrospectively reviewed their medical records, and analyzed clinical properties. RESULTS: Of 278 patients with RCC, 22 patients (7.9%) diagnosed to have brain metastases. The pathological T stages and Fuhrman nuclear grade of RCC at the time of initial diagnosis were various (T1: 1 patient, T2: 5, T3: 8, T4: 3, Fuhrman grade 1: 0, 2: 4, 3: 10, 4: 6, unknown: 2). Most of RCC was clear cell carcinoma (17/22). Most symptoms suggesting brain metastases were neurologic. Median cancer specific survival (CSS) of WBRT, radiosurgery, or surgery group (13/22) was 4 months, conservative management group (9/22) was 1.5 months and CSS of the former group was significantly better. Median duration of development of brain metastasis after diagnosis of RCC was 28 month (1-120). There was no difference in CSS between patients with brain metastasis developed before and after 28 month (p=0.361). CONCLUSIONS: Brain metastases of RCC have poor prognostic course. Development interval of brain metastases did not affect survival. WBRT, radiosurgery or surgery group showed better survival. Active intervention may improve survival.
Brain ; Carcinoma, Renal Cell ; Follow-Up Studies ; Humans ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Radiosurgery ; Retrospective Studies