BACKGROUND: Pulse transit time (PTT), the time it takes a pulse wave to travel from one arterial site to another, is a noninvasive indicator of arterial stiffness. The main objective of our study was to compare two common anesthetic techniques using PTT in order to explore which technique would bring more vascular distention. METHODS: Sixty female patients, ages 18-65, classified by ASA 1 or 2 undergoing general anesthesia, were randomly allocated into two groups, S and P. Group S (n = 30) was inducted with 2 mg/kg of propofol and remifentanil 5.0 ng/ml. Group P (n = 30) was inducted with propofol 4.0 ug/ml and remifentanil 4.0 ng/ml using a target controlled infusion (TCI) pump. Group S was anesthetically maintained with sevoflurane at 1.0 MAC and 1.0 ng/ml remifentanil while group P was anesthetically maintained with propofol 3.0 ug/ml and remifentanil 1.0 ng/ml for 10 minutes. PTT values were obtained by measuring the distance between the electrocardiographic R wave, which approximates the opening of the aortic valve, to the radial artery. Three consecutive values of prePTT, postPTT, and corresponding vital signs were measured and recorded before and 10 minutes after anesthetic induction. RESULTS: PrePTT in group S and group P was 240.18 +/- 3.66 and 239.32 +/- 3.69 ms, respectively. Ten minutes after anesthetic induction, postPTT in group S increased to 284.16 +/- 4.37 ms while postPTT in group P increased to 278.7 +/- 4.53 ms (P > 0.05). However, despite the slope of group S (43.98 +/- 22.18) being greater than group P (39.38 +/- 18.39), the difference between the two groups was statistically insignificant (P = 0.2239). CONCLUSIONS: Changes in PTT values were statistically insignificant regarding arterial distension in patients anesthetized with target controlled infusion of propofol compared to those with balanced anesthesia with sevoflurane.
Anesthesia, General ; Aortic Valve ; Balanced Anesthesia ; Electrocardiography ; Female ; Humans ; Inhalation* ; Propofol* ; Pulse Wave Analysis* ; Radial Artery ; Ultrasonography ; Vascular Stiffness ; Vital Signs

BACKGROUND: Reactive oxygen species (ROS) such as superoxide radicals, hydrogen peroxide, nitric oxide, and nitroperoxide, cause oxidative stress which interferes with normal cell functioning, resulting in cell damage. It is reported to be associated with chronic pain, especially neuropathic pain, and inflammatory pain. ROS is also closely related to central sensitization. Therefore, this study was designed to explore the effects of Phenyl N-tert-butylnitrone (PBN), an ROS scavenger, in acute, continuous, and increasing pain caused by central sensitization. METHODS: Male Sprague-Dawley rats were divided into 2 groups, an intraperitoneal group (IP) and an intrathecal group (IT), and once again divided into an experimental group and a control group. The experimental group was injected with Phenyl N-tert-butylnitrone (PBN), a free radical scavenger, either intraperitoneally or intrathecally. After inducing pain by injecting formalin into the hind paw, pain behaviors were measured. Lumbar enlargement immmunohistochemistry was performed to assess nitrotyrosine, an oxidative stress marker, to identify the degree of protein nitration. RESULTS: Both experimental groups of IP and IT showed statistically significant decreases in the number of flinches compared to the control group in phase 1 and 2. Immunohistochemical evaluation in the control group revealed an increase in nitrated proteins in the gray matter of the lumbar spinal cord, but a significant decrease in nitrated proteins in the gray matter of lumbar spinal cord of the experimental group. CONCLUSIONS: Intraperitoneal and intrathecal administration of PBN decreases analgesic behaviors, allowing us to believe that ROS is mainly responsible for acute pain and central sensitization.
Acute Pain ; Animals ; Central Nervous System Sensitization ; Chronic Pain ; Formaldehyde ; Humans ; Hydrogen Peroxide ; Male ; Neuralgia ; Nitric Oxide ; Oxidative Stress ; Pain Measurement ; Proteins ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species ; Spinal Cord ; Superoxides ; Tyrosine

BACKGROUND: Reactive oxygen species (ROS) such as superoxide radicals, hydrogen peroxide, nitric oxide, and nitroperoxide, cause oxidative stress which interferes with normal cell functioning, resulting in cell damage. It is reported to be associated with chronic pain, especially neuropathic pain, and inflammatory pain. ROS is also closely related to central sensitization. Therefore, this study was designed to explore the effects of Phenyl N-tert-butylnitrone (PBN), an ROS scavenger, in acute, continuous, and increasing pain caused by central sensitization. METHODS: Male Sprague-Dawley rats were divided into 2 groups, an intraperitoneal group (IP) and an intrathecal group (IT), and once again divided into an experimental group and a control group. The experimental group was injected with Phenyl N-tert-butylnitrone (PBN), a free radical scavenger, either intraperitoneally or intrathecally. After inducing pain by injecting formalin into the hind paw, pain behaviors were measured. Lumbar enlargement immmunohistochemistry was performed to assess nitrotyrosine, an oxidative stress marker, to identify the degree of protein nitration. RESULTS: Both experimental groups of IP and IT showed statistically significant decreases in the number of flinches compared to the control group in phase 1 and 2. Immunohistochemical evaluation in the control group revealed an increase in nitrated proteins in the gray matter of the lumbar spinal cord, but a significant decrease in nitrated proteins in the gray matter of lumbar spinal cord of the experimental group. CONCLUSIONS: Intraperitoneal and intrathecal administration of PBN decreases analgesic behaviors, allowing us to believe that ROS is mainly responsible for acute pain and central sensitization.
Acute Pain ; Animals ; Central Nervous System Sensitization ; Chronic Pain ; Formaldehyde ; Humans ; Hydrogen Peroxide ; Male ; Neuralgia ; Nitric Oxide ; Oxidative Stress ; Pain Measurement ; Proteins ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species ; Spinal Cord ; Superoxides ; Tyrosine

BACKGROUND: Recently, the amiodarone has emerged as a promising antiarrhythmic agent and its efficacy and safety has been widely accepted with many literatures. But there was no general agreement regarding the dosage and indication of intravenous (IV) amiodarone in acute myocardial infarction with life-threatening refractory ventricular tachyarrhythmias. METHOD: From October 1995 through October 1997, we recruited retrospectively 9 patients of acute myocardial infarction who had received IV amiodarone for life-threatening refractory ventricular tachyarrhythmias and analyzed the initial response, adverse effect, and loading dose. RESULTS: 1) Acute efficacy:Eight of 9 patients promptly restored normal sinus rhythm immediately after intravenous amiodarone administration. 2) In-Hospital Mortality:One patients died due to ventricular tachyarrhythmias refractory to aggressive management and 5 in 8 patients who had responded promptly with IV amiodarone discharged alive and other 3 patients died due to cardiogenic shock with normal sinus rhythm. 3) Immediate adverse effects:Five patients experienced immediate adverse effects after IV amiodarone; 3 patients of hypotension, 1 patient of first degree AV block, and the other of Morbitz type 2 AV block. 4) Long term follow-up:Among 5 patients discharged alive, one died as unexpected consequence. Other 4 patients have been still alive without maintenance medication. CONCLUSION: The IV amiodarone for suppression of life-threatening ventricular tachyarrhythmias in patients with acute myocardial infarction seemed to be an effective second-line therapeutic drug and have acceptable adverse effects. In the future, the large scale study regarding the dosage and indication might be warrented.
Amiodarone* ; Atrioventricular Block ; Humans ; Hypotension ; Myocardial Infarction* ; Retrospective Studies ; Shock, Cardiogenic ; Tachycardia*

Overtube provides a conduit for the passage of endoscope into the digestive tract. Esophageal perforation with mediastinitis is a rare overtube-related complication. Until now, no reports have been published regarding the esophageal perforation which developed many months after the original procedure using the overtube. A 56-year-old female visited our hospital complaining of chest pain and back pain that began 14 days ago. The patient underwent esophageal variceal ligation using the overtube 12 months earlier. She was diagnosed with esophageal perforation with mediastinitis which extended to intervertebral and epidural space. The cause of this condition was considered to have been related to the use of overtube. Management of delayed perforation remains controversial. Although surgical management might be the preferred mode of treatment, she underwent local N-butyl 2-cyanoacrylate injection therapy and temporary stent therapy with antibiotics due to high operative risk. Herein, we report a case of overtube-related delayed esophageal perforation with mediastinitis that was successfully treated by nonoperative management.
Anti-Bacterial Agents ; Back Pain ; Chest Pain ; Endoscopes ; Epidural Space ; Esophageal Perforation* ; Female ; Gastrointestinal Tract ; Humans ; Ligation ; Mediastinitis* ; Middle Aged ; Stents

BACKGROUND: The intestinal microbiota plays an important role in the pathogenesis of Clostridioides difficile-associated diarrhea, and regional and racial characteristics influence the microbiome composition and diversity. We investigated the intestinal microbiome characteristics of patients with C. difficile colitis (CD+) compared to those of patients with colitis not due to C. difficile (CD−), patients with vancomycin-resistant enterococci (VRE) colonization, and healthy controls, in Korea. MATERIALS AND METHODS: We collected stool samples from 24, 18, 11 and 13 subjects within CD+, CD−, VRE and healthy control groups, respectively. The microbial communities were evaluated by 454-pyrosequencing of bacterial 16s rRNA. RESULTS: The species richness and microbial diversity were significantly lower in the CD+ group compared to those in healthy controls, but not compared to those in CD− and VRE groups. Phylum-level analysis showed that the proportion of Actinobacteria in the CD+ group was significantly lower than in the healthy control, but was unchanged compared to that in CD− and VRE groups. At the genus level, compared to the healthy group, the CD+ group showed significantly lower proportions of Blautia, Bifidobacterium, Faecalibacterium et al. Compared to the VRE group, the CD+ group showed a significantly higher proportion of Anaerostipes. CONCLUSIONS We could identify the intestinal microbiome characteristics of Koreans with C. difficile colitis. It might help to develop microbiome based diagnostic and treatment modalities.

BACKGROUND: Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. While gastrointestinal surgery is relatively common in Korea, few studies have evaluated SSI in the context of gastric surgery. Thus, we performed a prospective cohort study to determine the incidence and risk factors of SSI in Korean patients undergoing gastric surgery. MATERIALS AND METHODS: A prospective cohort study of 2,091 patients who underwent gastric surgery was performed in 10 hospitals with more than 500 beds (nine tertiary hospitals and one secondary hospital). Patients were recruited from an SSI surveillance program between June 1, 2010, and August 31, 2011 and followed up for 1 month after the operation. The criteria used to define SSI and a patient's risk index category were established according to the Centers for Disease Control and Prevention and the National Nosocomial Infection Surveillance System. We collected demographic data and potential perioperative risk factors including type and duration of the operation and physical status score in patients who developed SSIs based on a previous study protocol. RESULTS: A total of 71 SSIs (3.3%) were identified, with hospital rates varying from 0.0 - 15.7%. The results of multivariate analyses indicated that prolonged operation time (P = 0.002), use of a razor for preoperative hair removal (P = 0.010), and absence of laminar flow in the operating room (P = 0.024) were independent risk factors for SSI after gastric surgery. CONCLUSIONS: Longer operation times, razor use, and absence of laminar flow in operating rooms were independently associated with significant increased SSI risk after gastric surgery.
Centers for Disease Control and Prevention (U.S.) ; Cohort Studies* ; Cross Infection ; Hair Removal ; Humans ; Incidence* ; Korea ; Multivariate Analysis ; Operating Rooms ; Prospective Studies* ; Risk Factors* ; Tertiary Care Centers