The data obtained from present experiments demonstrated that among several inhalation anesthetics, ether was the most irritable, resulting in marked irregularity of respiratory movement, and halothane depressed respiratory rate more than the other. The pulse rate and blood pressure were decreased marked1y in ether and the halothane anesthesia. the rate of beat of the isolated atria was not greately altered after anesthesia with ether or trichlore-thylene, while it was reduced after chloroform or halothane inhalation. The response of isolated atria to exogeneous norepinephrine was most prominent in the atria isolated from halothane anesthetized rabbits. Myocardial catecholamine contents were reduced uniformly after anesthesia with each anesthetics and most significantly with the halothane inhalation. From the above results, it may be concluded that the increasing cardiac activity with general inhalation anesthetics is closely related to the quantitative changes of the endogenous myocardial catecholamine contents.
Anesthesia, Inhalation/adverse effects ; Anesthetics/*toxicity ; Animals ; Catecholamines/*metabolism ; Heart/*drug effects ; Myocardium/*metabolism ; Norepinephrine/*pharmacology ; Rabbits

This study describes magnetic resonance imaging (MRI) results and changes in lateral ventricular size over time in a canine ischemic stroke model. T1- and T2-weighted (T1W, T2W) imaging and fluid-attenuated inversion recovery (FLAIR) sequence MRI were performed at 3 h and 3, 8, and 35 days after brain infarct induction. Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping were performed at 8 and 35 days. A total of 29 brain lesions were induced successfully in 12 of 14 beagle dogs. At 3 h, T2W and FLAIR detected hyperintense lesions in three randomly selected dogs. On T1W, all lesions appeared hypointense to isointense at 3 h, isointense (18/29) or hypointense (11/29) at 3 days, hypointense to isointense with peripheral hyperintensity (24/26) at 8 days, and hypointense (18/26) at 35 days. Infarcts on DWI/ADC were hypointense to isointense centrally, with the periphery hyperintense/hyperintense (17/26) at 8 days and hypointense/hyperintense (19/26) at 35 days. A marked increase in lateral ventricular size was observed in dogs with cerebral infarcts. In conclusion, T2W and FLAIR were useful for detecting early stage (3 h to 3 days) brain infarction. T1W and DWI were useful for detecting neuronal necrosis and providing supplemental information for phase evaluation.
Animals ; Brain Infarction ; Brain ; Diffusion ; Dogs ; Lateral Ventricles ; Magnetic Resonance Imaging ; Necrosis ; Neurons ; Stroke

Purpose: Patients with gastric cancer who receive neoadjuvant therapy are staged before treatment (cStage) and after treatment (ypStage). We aimed to compare the prognostic reliability of cStage and ypStage, alone and in combination. Materials and Methods: Data for all patients who received neoadjuvant therapy followed by surgery for gastric adenocarcinoma from 2004 to 2015 were extracted from the National Cancer Database. Kaplan-Meier (KM)curves were used to model overall survival based on cStage alone, ypStage alone, cStage stratified by ypStage, and ypStage stratified by cStage. P-values were generated to summarize the differences in KM curves. The discriminatory power of survival prediction was examined using Harrell's C-statistics. Results: We included 8,977 patients in the analysis. As expected, increasing cStage and ypStage were associated with worse survival. The discriminatory prognostic power provided by cStage was poor (C-statistic 0.548), while that provided by ypStage was moderate (C-statistic 0.634). Within each cStage, the addition of ypStage information significantly altered the prognosis (P<0.0001 within cStages I–IV). However, for each ypStage, the addition of cStage information generally did not alter the prognosis (P=0.2874, 0.027, 0.061, 0.049, and 0.007 within ypStages 0–IV, respectively). The discriminatory prognostic power provided by the combination of cStage and ypStage was similar to that of ypStage alone (C-statistic 0.636 vs. 0.634). Conclusions The cStage is unreliable for prognosis, and ypStage is moderately reliable.Combining cStage and ypStage does not improve the discriminatory prognostic power provided by ypStage alone. A ypStage-based prognosis is minimally affected by the initial cStage.

Postpartum bleeding of the uterus is an important cause of maternal death. It is thought that the inhibitory effect of the majority of potent inhalation anesthetics on uterine contraction is often responsible (Munson, 1970; Lim et al., 1971; Kim, 1972). There have been numerous reports that ketamine stimulates uterine contraction clinically Chodoff and Stella, 1966; Little et al, 1972; Galbert and Gardner, 1973; Corssen, 1974). Jawalekar and associates(1972) reported that ketamine increased resting tension, contractile amplitude and frequency of the uterine strips of pregnant mice. And Kim(1975) reported research on the effects of ketamine on the isolated uterus of rabbits. According to Kim(1975), ketamine exerted .a stimulatory action on the uterus under the influence of progesterone. This progesterone-depenent uterine stimulatory action of ketamine is not concerned with adrenergic and cholinergic mechanisms but appears to have a direct effect on the uterine muscle. The present study was undertaken to determine whether or not ketamine also exerted a stimlatory action on the uterus of the guinea pig and to follow up whether or not stimulatory action of ketamine also depends upon progesterone in the guinea pig. Adult female non-pregnant guinea pigs and rabbits weighing approximately 0, 5 kg and 2. 0 kg respectively were employed in this experiment. At the end of 10 to 14 days following bilateral oophorectomy, non-pregnant guinea pigs and rabbits were injected intramusculary with estradiol benzoate (2,000 I.U./kg) or progesterone (Smg/kg) once a day for four consecutive days, A uterine strip, about 1.5~2,0cm in length, was carefully isolated from the experimental animals and suspended in a muscle chamber containing 50 ml of Lockes solution, maintained at constant temperature of 38C. It was aerated with 100% oxygen bubbling through the bathing fluid by means of a sintered glass plate at the bottom of the muscle chamber. One end of the uterine strip was attached to the bottom of the muscle chamber and the other end to a lever. Motility and tonus were recorded on kymograph paper. After being washed several times with fresh Locke's solution, the uterine strip attained a constant motility and tonus. Ketamine then was added in various concentrations to the chamber. The results are as follows: 1. The uterine mctility of guinea pig shows a higher amplitude and lower frequency compared with that of rabbit. 2. Effects of ketamine on isolated uterine strips of guinea pig pre-treated with estrogen showed no change using 1~20 gamma/ml of ketamine, but with 50 gamma/ml or more, the amplitude of uterine contractions was depressed. 3. On isolated uterine strips of guinea pig pre-treated with progesterone, there was no effect with 1100 gamma/ml of ketamine, depressed amplitude of uterine contractions with 150 gamma/ml and markedly depressed amplitude of uterine contraction with 200 gamma/ml. 4. On isolated uterine strips of rabbit pre-treated with estrogen, there was no effect with 20 gamma/ml of ketamine, but depressed amplitude of uterine contraction using 50 gamma/ml. 5. On isolated uterine strips of rabbit pretreated with progesterone, there was an increase in amplitude and frequency of uterine contractions with up to 150 gamma/ml of ketamine, but depressed amplitude with 200 gamma/ml or more. From the above results it may be concluded that ketamine exerted a stimulatory action on the uterus of rabbit under the influence of progesterone but not on the uterus of guinea pig. The large amount of ketamine depressed the amplitude of uterine contraction in guinea pig and rabbit and this depressing dose is higher in the animals (guinea pig and rabbit) pre-treated with pr ogesterone than with estrogen.
Adult ; Anesthetics, Inhalation ; Animals ; Baths ; Benzoates ; Estradiol ; Estrogens ; Female ; Follow-Up Studies ; Glass ; Guinea Pigs* ; Guinea* ; Hemorrhage ; Humans ; Ketamine* ; Maternal Death ; Mice ; Myometrium ; Ovariectomy ; Oxygen ; Postpartum Period ; Progesterone ; Rabbits ; Uterine Contraction ; Uterus*

The concept of intensive care has developed from experience in recovery rooms, in anesthetic work, and in early specialized units in different fields of medicine. Between the First and the Second World Wars special units were created in some German hospitals. Intensive care often means a combination of recovery-room service and intensive therapy. Intensive care, especially respiratory care is an important part of the responsibility of the anesthesiologist. So, we have analyzed statistically 3, 072 I.C.U. patients who were admitted during a period of 7 years beginning October 18, 1968 when the I.C.U. at Severance Hospital was opened, The results are as follows: I. Cases admitted to the I.C.U. (March,1970-August, 1975 ) 1) For 5 and a half years, the total number of patients was 2, 479. These patients were 2.7% of 91,400 patients who were admitted into Severance Hospital. 2) The mortality rate was 20.0% . Mortality rate was highest in 1970 (23. 7%) and lowest in 1975 (13. 5%). It has gradually decreased every year. 3) Total occupied bed days were 9,840 days (average 4,0 days). The occupied bed days of the majority of the patients (83.6%) were below 5 days comprising 88.3% of the total expired patients. 4) 50% of the patients were in the 21 to 50 year age group. The highest mortality rate occurred in the 51 to 60 age group (24.3%). 5) The number of patients admitted in the department of internal medicine was 702 cases (28.3%) which was the highest among all departments. The mortality rates of the departments of pediatric and neurosurgery were 40. 3% and 34. 7% respectively and those were relatively high values. 6) All I.C.U. patients have been divided into two categories, operative and non-operative. The operative cases were 1, 264 (51. 0%) and non-operative 1, 215 (49. 0%,). The mortality ,The Journal of The Korean Society of Anesthesiologists VoI. 9, No. 2, 1976 rate of the non-operative cases (22. 5%) was higher than operative (17. 6%). 73 Cardiovascular disease was the commonest cause of death of I.C.U, patients (107 cases) admitted from March, 1974 to August, 1975 (30 cases, 28. 0%). Respiratory support cases (October 18, 1968-August 31, 1975) ;. During the 7 year period, of all I.C.U. admission cases (3,072) 423 cases (13.8%) received respiratory support. These patients gradually increased every year. 2) The mortality rate was 44. 0% which was more than twice the over-all mortality rate of. I.C.U. admission patients. 3) The mortality rate was highest in the 21 30 age group (18. 7%). 4) The department of internal medicine admitted the largest number of cases (153 cases, 36. 2%). 5) Of all conditions, cardiovascular disease was most frequent (126 cases, 29. 8%). Here we have discussed the definition of I.C.U., the responsibility and important role of the anesthesiologist in the I.C.U. by illustrating present situations and presenting problems at the I.C.U. in Severance Hospital.
Cardiovascular Diseases ; Cause of Death ; Critical Care* ; Humans ; Intensive Care Units* ; Internal Medicine ; Mortality ; Neurosurgery ; Recovery Room ; World War II

PURPOSE: To determine the ability of a novel palpation device to differentiate between benign and malignant tissues of the kidney and bladder by measuring tissue elasticity. MATERIALS AND METHODS: A novel palpation device was developed, mainly composed of a micromotor, a linear position sensor, a force transducer, and a hemisphere tip and cylindrical body probe. Motion calibration as well as performance validation was done. The tissue elasticity of both benign and malignant tissues of the kidney and bladder was measured using this device. A single investigator performed the ex-vivo palpation experiment in twelve kidneys and four bladder specimens. Malignant tissues were made available from partial nephrectomy specimens and radical cystectomy specimens. Palpations for benign renal parenchyma tissue were carried out on nephroureterectomy specimens while non-involved areas in the radical cystectomy specimens were used for benign bladder samples. Elastic modulus (Young's modulus) of tissues was estimated using the Hertz-Sneddon equation from the experimental results. These were then compared using a t-test for independent samples. RESULTS: Renal cell carcinoma tissues appear to be softer than normal kidney tissues, whereas tissues from urothelial carcinoma of the bladder appear to be harder than normal bladder tissues. The results from renal cell carcinoma differed significantly from those of normal kidney tissues (p=0.002), as did urothelial carcinoma of the bladder from normal bladder tissues (p=0.003). CONCLUSION: Our novel palpation device can potentially differentiate between malignant and benign kidney and bladder tissues. Further studies are necessary to verify our results and define its true clinical utility.
Adult ; Aged ; Elastic Modulus ; Elasticity Imaging Techniques/*instrumentation ; Equipment Design ; Female ; Humans ; Kidney/physiology ; Kidney Neoplasms/*diagnosis/physiopathology ; Male ; Middle Aged ; Palpation/*instrumentation ; Phantoms, Imaging ; Pilot Projects ; Urinary Bladder/physiology ; Urinary Bladder Neoplasms/*diagnosis/physiopathology

PURPOSE: This study aimed to evaluate vitamin D status at birth in very-low-birth-weight infants (VLBWIs: <1,500 g) and to determine the association between vitamin D level and respiratory morbidity. METHODS: A retrospective study was conducted at Soonchunhyang University Bucheon Hospital between November 2013 and November 2017. We collected blood samples and data on respiratory morbidity from 230 VLBWIs on the first day of life. Patients who were transferred to other hospitals (n=19), died before 36 weeks of gestational age (n=18), or whose blood samples were not collected immediately after birth (n=5) were excluded. Finally, 188 patients were enrolled. VLBWIs with different vitamin D levels were compared with respect to demographic features, maternal diseases, respiratory morbidities, and other neonatal diseases. RESULTS: The mean serum vitamin D level, as measured by 25-hydroxyvitamin D (25(OH)D), was 13.4±9.3 ng/mL. The incidence of vitamin D deficiency (<20 ng/mL) was 79.8%, and 44.1% of preterm infants had severe vitamin D deficiency (<10 ng/mL). Logistic analysis shows that a low serum 25(OH)D level (<20 ng/mL) was a risk factor for respiratory distress syndrome (odds ratio [OR], 4.32; P=0.010) and bronchopulmonary dysplasia (OR, 4.11; P=0.035). CONCLUSION: The results showed that 79.8% of preterm infants in this study had vitamin D deficiency at birth. Low vitamin D status was associated with respiratory morbidity, but the exact mechanism was unknown. Additional studies on the association between vitamin D level and neonatal morbidity are required.
Bronchopulmonary Dysplasia ; Gestational Age ; Gyeonggi-do ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Parturition ; Retrospective Studies ; Risk Factors ; Vitamin D Deficiency ; Vitamin D ; Vitamins

We report a rare case of vascular injury secondary to a damaged Hot Shearstrade mark tip cover. Two 1 mm holes in the tip cover resulted in perforations in the obturator and external iliac veins during pelvic node dissection. Bleeding was controlled with bipolar coagulation and a 5 mm metal clip in the obturator and iliac vein, respectively. The rest of the procedure was completed uneventfully. Frequent integrity assessment of this accessory is necessary. Its function is important in order to carry out safe dissection in proximity to delicate structures. When injuries arise from areas not directly involved in the dissection, immediate inspection of the instruments should be mandatory.
Humans ; Iliac Vein/*injuries ; Male ; Middle Aged ; Prostatectomy/*adverse effects/instrumentation/methods ; Prostatic Neoplasms/surgery ; Robotics/instrumentation

Background: Maldistribution and dearth of primary care practitioners is a continuing health human resource problem of many countries particularly in developing countries like the Philippines. The call to strengthen primary care for better health outcomes is a battle-cry that has never been resolved due to lack of physicians, trained and untrained, serving the rural areas. Family physicians are primarily the workforce in primary care settings but few medical graduates pursue this kind of career track. This study aimed to describe the career choices of medical students and factors that influenced them including their perspectives of family medicine as career choice. Methods: On-line survey using google form was used to reach a total of 1800 medical students from 41 medical schools across the country in November 2016. Purposive sampling was done to allocate at least 40 students per school coordinated through the APMC Student Network representatives. They were sent with a link of the pre-validated questionnaire on career choices after medical school and reasons influencing their career choices based from prior studies. Results: Of the 1,800 students, 1010 (81%) completed the questionnaire. Majority opted residency training (92%) after graduation and few pursue rural health practice (14%). Family medicine ranked 10th as first choice for training with IM and surgery consistently the top choices regardless if it is the first, second or third choice. Family medical needs influenced these choices. Family medicine was considered by majority as the primary care providers (94.1%) but lack of emphasis on it in their curriculum was experienced by most. Conclusion Most of the medical students want to pursue residency training in internal medicine and surgery while few in family medicine. Their choice of training is influenced by medical needs of the family. Family medicine as primary care provider was recognized but most experienced of lack emphasis in their medical curriculum.
Career Choice ; Primary Health Care

INTRODUCTIONDeveloping effective exercise programmes for the paediatric population is a strategy for decreasing obesity and is expected to help in eventually limiting obesity-associated long-term health and societal impact. In this study, the effects of a 12-week twice weekly additional exercise training, which comprised a combination of circuit-based resistance training and aerobic exercises, in additional to typical physical education sessions, on aerobic fitness, body composition and serum C-reactive protein (CRP) and lipids were analysed in 13- to 14-year-old obese boys contrasted with a control group.

MATERIALS AND METHODSBoth the exercise group (EG, n = 12) and control group (CG, n = 12) participated in the typical 2 sessions of 40-minute physical education (PE) per week in schools, but only EG participated in additional 2 sessions per week of 45 to 60 minutes per session of exercise training, which comprised a combination of circuit-based resistance training and aerobic exercises maintained at 65% to 85% maximum heart rate (HRmax = 220 - age). Body composition was measured using dual energy X-ray absorptiometry (DEXA). Fasting serum CRP and blood lipids were analysed pre- and postexercise programme. Aerobic fitness was measured by an objective laboratory submaximal exercise test, PWC170 (Predicted Work Capacity at HR 170 bpm).

RESULTSExercise training significantly improved lean muscle mass, body mass index, fitness, resting HR, systolic blood pressure and triglycerides in EG. Serum CRP concentrations were elevated at baseline in both groups, but training did not result in a change in CRP levels. In the CG, body weight increased significantly at the end of the 12-week period.

CONCLUSIONThis study supports the value of an additional exercise training programme, beyond the typical twice weekly physical education classes, to produce physiological benefits in the management of obesity in adolescents, including prevention of weight gain.

Adolescent ; C-Reactive Protein ; analysis ; metabolism ; Exercise Therapy ; Humans ; Lipids ; analysis ; blood ; Male ; Obesity ; physiopathology ; therapy ; Physical Fitness ; physiology