BACKGROUND: A tourniquet is commonly used to achieve a bloodless field in surgery of the extremities. However, the anesthesiologist is concerned about the adverse effects of hypertension which occur during general anesthesia. In this study, we assessed the effects of lidocaine infiltration in the tourniquet site on blood pressure and heart rate during tourniquet inflation under general anesthesia. METHODS: Forty patients of ASA class I or II, scheduled for knee surgery, were randomly divided into two groups. In group 1 underwent general anesthesia and in group 2 also underwent general anesthesia and combined with 1% lidocaine infiltration in the tourniquet site. The changes of systolic and diastolic blood pressure and heart rate were measured before and after toumiquet inflation, after skin incision and 30 min after inflation. RESULTS: Comparing group 1 with group 2, there were significant increases after tourniquet inflation to 30 min after inflation in systolic and diastolic blood pressure in group 1 (p<0.05). However, there were no significant changes in heart rates in either group. CONCLUSIONS: The above results demonstrate that patients who received lidocaine infiltration in the tourniquet site showed less increase in blood pressure during tourniquet inflation.
Anesthesia, General ; Anesthetics ; Blood Pressure* ; Extremities ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Inflation, Economic ; Knee ; Lidocaine* ; Skin ; Tourniquets*

OBJECTIVE: The use of methotrexate for the treatment of cervical pregnancy is now common practice. Our study was performed to determine the risk factors when the primary methotrexate treatment of cervical pregnancy was failed. METHODS: From January 1985 to December 1999, we studied 32 women with cervical pregnancies who were treated with methotrexate intramuscularly according to a repeated intramuscular injections protocol. For evaluation of the efficacy of therapy, pretreatment serum concentrations of human chorionic gonadotropin, the size of the gestational mass, fetal cardiac activity, and the presence of fluid in the peritoneal cavity were measured. This findings were analyzed and compared by means of the chi-square test, Fisher exact test, and student's t-test between the success and failure. RESULTS: There was no relation between the women's age, parity, the size of the conceptus, or the presence of fluid in the peritoneal cavity and the efficacy of treatment. A cervical pregnancy that presented with a serum human chorionic gonadotropin concentration of >or= 10,000mIU/ml, fetal cardiac activity was considered to be associated with a higher failure rate of primary methotrexate treatment. CONCLUSION: Among cervical pregnancies, a high serum human chorionic gonadotropin concentration and fetal cardiac activity were the important factors associated with failure of treatment with methotrexate.
Chorionic Gonadotropin ; Female ; Humans ; Injections, Intramuscular ; Methotrexate* ; Parity ; Peritoneal Cavity ; Pregnancy* ; Risk Factors

PURPOSE: The purpose of this study was to examine the effects of a stress-management program on stress coping methods, interpersonal relations and quality of life in patients with chronic mental illness. METHODS: A nonequivalent control group pre-posttest design was used for this quasi-experimental study. The study was conducted from May 1 to December 30, 2010. The 41 participants in this study were selected from patients with chronic mental illness (20 for the experimental group and 21 for the control group). Datas were analyzed chi2-test, t-test, paired t-test, and one-way ANCOVA with the SPSS/WIN 15.0 program. RESULTS: There were significant changes in stress coping methods scores, interpersonal relations scores and quality of life scores in the experimental group before and after treatment, which were significantly different from those in the control group. CONCLUSION: The results of the study indicate that the stress-management program resulted in significant improvement in stress coping methods, interpersonal relations and quality of life for patients with chronic mental illness. Therefore, this study shows stress-management programs are useful in clinical practice as effective nursing interventions in patients with chronic mental illness.
Humans ; Interpersonal Relations* ; Nursing ; Quality of Life*

PURPOSE: Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is a rare genetic syndrome resulting from germline mutations in fumarate hydratase. The combination of bevacizumab plus erlotinib showed promising interim results for HLRCC-associated RCC. Based on these results, we analyzed the outcome of bevacizumab plus erlotinib in Korean patients with HLRCC-associated RCC. MATERIALS AND METHODS: We retrospectively reviewed the efficacy and safety of bevacizumab plus erlotinib in patients with HLRCC-associated RCC who were confirmed to have germline mutations in fumarate hydratase. The primary endpoint was the objective response rate (ORR), while the secondary endpoints were progression-free survival (PFS) and overall survival (OS). RESULT: We identified 10 patients with advanced HLRCC-associated RCC who received bevacizumab plus erlotinib. Median age at diagnosis was 41 years, and five of the patients had received the combination as first- or second-line treatments. The ORR was 50% and the median PFS and OS were 13.3 and 14.1 months, respectively. Most adverse events were predictable and manageable by conventional measures, except for one instance where a patient died of gastrointestinal bleeding. CONCLUSION: This is the first real-world outcome of the treatment of advanced HLRCC-associated RCC. Bevacizumab plus erlotinib therapy showed promising activity with moderate toxicity. We should be increasingly aware of HLRCC-associated RCC and bevacizumab plus erlotinib should be a first-line treatment for this condition, unless other promising data are published.
Bevacizumab ; Carcinoma, Renal Cell ; Diagnosis ; Disease-Free Survival ; Erlotinib Hydrochloride ; Fumarate Hydratase ; Germ-Line Mutation ; Hemorrhage ; Humans ; Leiomyomatosis ; Retrospective Studies

BACKGROUND/AIMS: Rupture of gastric varices was one of the most dreadful complications of cirrhosis. Recently, a new interventional procedure, balloon-occluded retrograde transvenous obliteration (B-RTO) was introduced for the treatment of gastric variceal bleeding. This study was performed to evaluate the therapeutic efficacy of B-RTO in the treatment of gastric varices with gastro-renal shunts. METHODS: From March 2000 to June 2003, we performed B-RTO in 17 patients with gastric varices and gastrorenal shunts. All patients had history or high risk factors of gastric variceal bleeding. For the evaluation of therapeutic efficacy, we performed esophagogastroduodenoscopy (EGD) and computed tomography (CT) at 1, 6 and 12 months after B-RTO. Successful B-RTO was judged by combined CT findings and EGD findings (disappearance of gastric varices or markedly reduced gastric variceal size or bleeding risk) during follow-up periods (1-14 months, mean:6.18). We analyzed the clinical factors related to clinical success of B-RTO. RESULTS: Technical success were achieved in all patients except one (94.1%). Gastric varices were disappeared or decreased after B-RTO in 13 patients (81.2%). Complications related to procedure included transient hematuria (n=5), puncture site oozing (n=1) and partial splenic infarction (n=1), and all were conservatively managed. During the follow up periods, neither significant hepatic nor renal functional damages occurred. Statistically, no significant factors related with B-RTO success. CONCLUSIONS: B-RTO is effective and safe in the management of gastric varices in cirrhotic patients with gastrorenal shunt.
Adult ; Aged ; *Balloon Occlusion ; Endoscopy, Digestive System ; English Abstract ; Esophageal and Gastric Varices/diagnosis/*therapy ; Female ; Gastrointestinal Hemorrhage/etiology/*therapy ; Humans ; Liver Cirrhosis/*complications ; Male ; Middle Aged

BACKGROUND: Since the 1980s, early ambulation and cardiac rehabilitation have been emphasized in clincal practice after myocardial infarction. This is based on the belief that cardiac rehabilitation can reduce cardiovascular mortality, improve functional capacity and reduce the risk of further coronary events. In this study, we investigate the effect of aerobic exercise-based cardiac rehabilitation on functiona capacity and cardiopulmonary response in patiets with myocardial infarction. METHODS: 19 patients were divided into two group(9 patients for training group and 10 patients for control group) at 4-6 weeks after acute myocardial infarction. Training group performed aerobic exercise for 8 weeks(3 sessions per week, mean 53mins per session) at 40-60% of heart rate(HR) reserve, while control group did not. Before and after 8 weeks, all patients performed symptom-limited exercise test using modified Bruce protocol. Also, breath by breath respiratory gas analysis was carried out throughout exercise test. RESULTS: For body composition, body weight(-2.7%, p<0.001), body mass index(-2.5%, p<0.001) and %body fat(-2.6%, p<0.05) were decrease significantly in training group after 8 week cardiac rehabilitation. Resting HR(-13%, p<0.05) was reduced significantly in training group, but no significant change occured in resting blood pressure between the two groups. Maximal oxygen uptake(18%, p<0.01) and anaerobic threshold(21%, p<0.05) were increased significantly in training group after 8 week cardiac rehabilitation as compared with the control group. There was no significant change in maximal O(2)pulse between the two groups. Submaximal rate-pressure product(-17%, p<0.05) and submaximal rate of perceived exertion (-2.6, p<0.001) were decreased significantly in training group after 8 week cardiac rehabilitation as compared with the control group. CONCLUSIONS: Our findings indicate that cardiac rehabilitation results in the significant improvement of functional capacity and cardiopulmonary response in patients with myocardial infarction. Cardiac rehabilitation for patients with myocardial infarction can contribute early return and readaptation to normal life, because myocardial oxygen consumption(or rate-pressure product) is decreased at the same exercise level after exercise training.
Blood Pressure ; Body Composition ; Early Ambulation ; Exercise ; Exercise Test ; Heart ; Humans ; Mortality ; Myocardial Infarction* ; Oxygen ; Rehabilitation*

BACKGROUND AND OBJECTIVES: Although percutaneous coronary intervention (PCI) is recommended to improve symptoms in patients with stable ischemic heart disease (SIHD), improvement of exercise performance is controversial. This study aimed to investigate changes in exercise duration after PCI according to functional completeness of revascularization by comparing pre- and post-PCI exercise stress test (EST).METHODS: Patients with SIHD were enrolled from a prospective PCI registry, and divided into 2 groups: 1) functional complete revascularization (CR) group had a positive EST before PCI and negative EST after PCI, 2) functional incomplete revascularization (IR) group had positive EST before and after PCI. Primary outcome was change in exercise duration after PCI and secondary outcome was major adverse cardiac events (MACE, a composite of any death, any myocardial infarction, and any ischemia-driven revascularization) at 3 years after PCI.RESULTS: A total of 256 patients (149 for CR group, and 107 for IR group) were eligible for analysis. Before PCI, exercise duration was not significantly different between the functional CR and IR groups (median 540 [interquartile range; IQR, 414, 602] vs. 480 [402, 589] seconds, p=0.091). After PCI, however, the CR group had a significantly higher increment of exercise duration than the IR group (median 62.0 [IQR, 12.0, 141.0] vs. 30.0 [−11.0, 103.5] seconds, p=0.011). The functional CR group also had a significantly lower risk of 3-year MACE (6.2% vs. 26.1%; adjusted hazard ratio, 0.19; 95% confidence interval, 0.09–0.41; p<0.001).CONCLUSIONS: Functional CR showed a higher increment of exercise duration than functional IR.
Angina, Stable ; Exercise Test ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Prognosis ; Prospective Studies

BACKGROUND AND OBJECTIVES: Although percutaneous coronary intervention (PCI) is recommended to improve symptoms in patients with stable ischemic heart disease (SIHD), improvement of exercise performance is controversial. This study aimed to investigate changes in exercise duration after PCI according to functional completeness of revascularization by comparing pre- and post-PCI exercise stress test (EST). METHODS: Patients with SIHD were enrolled from a prospective PCI registry, and divided into 2 groups: 1) functional complete revascularization (CR) group had a positive EST before PCI and negative EST after PCI, 2) functional incomplete revascularization (IR) group had positive EST before and after PCI. Primary outcome was change in exercise duration after PCI and secondary outcome was major adverse cardiac events (MACE, a composite of any death, any myocardial infarction, and any ischemia-driven revascularization) at 3 years after PCI. RESULTS: A total of 256 patients (149 for CR group, and 107 for IR group) were eligible for analysis. Before PCI, exercise duration was not significantly different between the functional CR and IR groups (median 540 [interquartile range; IQR, 414, 602] vs. 480 [402, 589] seconds, p=0.091). After PCI, however, the CR group had a significantly higher increment of exercise duration than the IR group (median 62.0 [IQR, 12.0, 141.0] vs. 30.0 [−11.0, 103.5] seconds, p=0.011). The functional CR group also had a significantly lower risk of 3-year MACE (6.2% vs. 26.1%; adjusted hazard ratio, 0.19; 95% confidence interval, 0.09–0.41; p<0.001). CONCLUSIONS Functional CR showed a higher increment of exercise duration than functional IR.