The tourniquet is usually applied for the orthopedic surgeries on the lower extemity to obtain the bloodless surgical field and to reduce blood loss.However, there are various complications such as nerve and tissue damage from compression, hemodynamic changes, and metabolic changes from ischemia after applieation of the tourniquet. Release of the tourniquet with reperfusion of the lower limb results in transient core body temperature change and other important hemodynamic, respiratory, and metabolic changes. I observed the mild core temperature drop following the release of the tourniquet at the surgical procedure of the lower extremity during inhalation anesthesia. The results were as follows ; The mean drop in temperature of 0.5 degree (about 11.9 min ; mean) was observed following the tourniquet release. Compared with the baseline value, the decreases in temperature at 8, 10 and 15 min, were statistically significant. There was significant correlation between the duration of tourniquet application and temperature drop (r= 0.293).
Anesthesia, Inhalation* ; Body Temperature Changes ; Hemodynamics ; Inhalation* ; Ischemia ; Lower Extremity ; Orthopedics ; Reperfusion ; Tourniquets*

BACKGROUND: Peripheral nerve injury may produce a syndrome consisting of spontaneous pain, allodynia and hyperpathia. Cholinesterase inhibitors are known to have an antinociceptive effect in hot plate and tail flick tests and to be mediated by spinal muscarinic system. The purpose of the current study was to determine the effect of intrathecally (i.t.) administered edrophonium and neostigmine on the touch-evoked allodynia and to identify the antagonism of antiallodynia in a rat model of neuropathic pain. METHODS: Sprague Dawley rats were prepared with tight ligation of left L5/L6 spinal nerves with 6~0 black silk and chronic lumbar intrathecal catheters. After obtaining the baseline hindpaw withdrawal scores, edrophonium (3~100ug) or neostigmine (0.3~10ug) was administered intrathecally. Tactile allodynia was measured using von Frey filaments and allodynic threshold was calculated by updown method. Motor dysfunction was assessed by observing righting/stepping reflex responses and abnormal weight bearing. To examine the reversal of antiallod ynia, muscarinic receptor antagonist atropine (10ug) or nicotinic receptor antagonist mecamylamine (10ug) was injected intrathecally 5 min. prior to injection of edrophonium or neostigmine. RESULTS: I.t. edrophonium and i.t. neostigmine produced a dose dependent antagonism of allodynic state but had moderate to severe effect on motor weakness at doses of 3 and 10 g of neostigmine. Pretreatment with i.t. atropine yielded a complete antagonism of antiallodynia in both drugs, but i.t. mecamylamine did not significantly reverse incresed allodynic threshold. CONCLUSIONS: These experiments suggest that i.t. edrophonium or i.t. neostigmine produces a dose dependent antagonism on touch-evoked allodynia at the spinal level and this antagonism is likely due to spinal muscarinic system.
Atropine ; Catheters ; Cholinesterase Inhibitors ; Edrophonium* ; Hyperalgesia ; Ligation ; Mecamylamine ; Models, Animal ; Neostigmine* ; Neuralgia* ; Peripheral Nerve Injuries ; Rats, Sprague-Dawley ; Receptors, Muscarinic ; Receptors, Nicotinic ; Reflex ; Silk ; Spinal Nerves ; Weight-Bearing

No abstract available.
Cervix Uteri* ; Conization* ; Female ; Pregnancy*

No abstract available.
Animals ; Rats* ; Urinary Bladder*

Hyperglycemia has been noted to occur in pediatric patients undergoing cardiac surgery with hypothermia. Because even moderate hyperglycemia during cerebral ischemia may predispose patients to an increased risk of neurologic deficit, the authors wished to determine whether the large dosage of fentanyl might contribute significantly to the decrease in blood glucose, The authors examined 20 infants who underwent cardiac surgery with small dosage of fentanyl(Group I, n= l0) or large dosage of fentanyl (Group II, n=10), none of whom received dextrose in the clear cardiopulmonary bypass pump prime, maintenance iv fluids, or cardioplegic solution. Blood samples were obtained after induction, during cardiopulmonary by-pass, after cardiopulmonary bypass and after operation. There was no hypoglycemia during the entire surgical periods in all patients. During cardio-pulmonary bypass in group I and group II, after cardiopulmonary bypass, after operation in group II, blood glucose levels were significantly decreased compared with after induction values(p<0.05). Compared with group L the rates of changes from the values after induction were significant during cardiopulmonary bypass and after operation in group II(p<0.05). In conclusion, large dosage of fentanyl is valuable in control the hyperglycemia during open heart surgery in infants.
Blood Glucose* ; Brain Ischemia ; Cardioplegic Solutions ; Cardiopulmonary Bypass ; Fentanyl ; Glucose ; Heart* ; Humans ; Hyperglycemia ; Hypoglycemia ; Hypothermia ; Infant* ; Neurologic Manifestations ; Thoracic Surgery*

We have analyzed 785 ICU patients admitted between May 24, 1989 and April 30, 1990, to obtain better guidance and management in the ICU. The results of analysis are as follows: 1) Total number of patients was 785; 459 male and 326 female. The number of patients admitted was 337 (42.9%) from the Department of neurosurgery, 259 (33.0%) from internal medicine and 70 (8.9%) from genreal surgery. 2) 183 patients were involved in 51~60 age group, 166 in 61~70 age group, 138 in 41-50 age group and 85 in over 71 age group. 3) The number of patients by admission days was 223 (28.4%) in 3~4 days group, 197 (250%) in 1~2 days group and 128 (16.3%) in 5~6 days group. 4) The total number of expired patients was 103 (mortality rate, 13,1%); 66 male and 37 female. The expired 63 patients admitteed in ICU due to medical problems and 40 patients due to surgical problems. The number of expired patients was 54 (52.4%) from the Department of internal medicine, 31 (30.1%) from neurosurgery and 5 (4.9%) from general surgery. 5) The highest mortality group was 51~60 age group by age and 1~2 days group by duration of admission.
Female ; Humans ; Intensive Care Units* ; Critical Care* ; Internal Medicine ; Male ; Mortality ; Neurosurgery

BACKGROUND: There is concem about the rising incidence of skin cancer. However, few articles have reported the change in the clinical and epidemiological aspects of skin cancer. OBJECTIVE: We performed this study in order to clarifiy the recent changes in cutaneous premalignant and malignant lesions. METHODS: A statistical analysis was made using 101 cases of cutaneous premalignant lesions and 205 cases of ma]ignant tumors out of a total number of 20,175 new outpatients that visited the Department of Dermatology at the Seoul National University Hospital during a 6 year period(1990-1995). RESULTS: The frequency of premalignant lesions was 0.50% and that of malignant tumors was 1.02%. The frequency showed an increasing tendency compared to previous reports. In the premalignant lesion cases, actinic keratosis was most common and represented a figure of 82.2%. Among the malignant tumors, basal cell carcinoma was most frequent at 24.4%. Age, sex and anatomical site distribution of basal cell carcinoma, malignant melanoma was no different. The mean age of squamous cell carcinoma was greater than in previous reports and main preceding lesions were actinic keratosis and cheilitis. The frequency of lymphoma was markedly increased but the reason for this remains to be determined. CONCLUSION: Our findings showed the continous increasing incidence of skin cancers and emphasize the need for public eduacation, early diagnosis and proper treatment.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cheilitis ; Dermatology ; Early Diagnosis ; Humans ; Incidence ; Keratosis, Actinic ; Lymphoma ; Melanoma ; Outpatients ; Seoul ; Skin Neoplasms ; Statistics as Topic*

No abstract available.
Spinal Cord*

Induction of general anesthesia with tracheal intubation is routine proeedure but causes varying degrees of sympathetic stimulation such as increases in blood pressure and heart rate. Many approaches have been tried to attenuate these hemodynamic responses To evaluate the effects of clonidine, a-2 adrenergic receptor agonist, on the hemodynamic changes induced by intubation, we administered clonidine(5 ug/kg, P.O.) 90 minutes before induction of anesthesia. We measured systolic pressure, diastolic pressure and heart rate before premedication, before induction, after intubation and 5, 10 minutes after intubation and compared with control group. The results were as follows: 1) After intubation systolic and diastolic blood pressures increased significantly in both group(P<0.05) but the increasing rate was significantly less than in clonidine group. (P<0.05) 2) After intubation the increaae in heart rate in clonidine group was significantly less than in control group (p<0.05). 3) The trend of increase in heart rate in clonidine group was more stabilized than control group. 4) Systolic blood pressure and heart rate in clonidine group were significantly decreased in preinduction period after premedication.
Adrenergic Agonists ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Clonidine* ; Heart Rate ; Hemodynamics ; Intubation* ; Premedication

BACKGROUND: Peripheral nerve injury may produce a syndrome consisting of spontaneous pain, allodynia and hyperpathia. In previous study, we examined the antiallodynic action produced by intrathecal (i.t.) cholinesterase inhibitors (ChEi) in a neuropathic pain rat model and the reversal of antiallodynic state by i.t. atropine, muscarinic antagonist, but not by nicotinic antagonist mecamylamine. The purpose of this study was to determine the selective antagonistic action of four subtypes of muscarinic receptor on antiallodynic state by i.t. ChEi in a rat model of neuropathic pain. METHODS: Sprague Dawley rats were prepared with tight ligation of left L5/L6 spinal nerves with 6-0 black silk and chronic lumbar intrathecal catheters. After obtaining the baseline hindpaw withdrawal scores, edrophonium (100 microgram) or neostigmine (10 microgram) was administered intrathecally. Tactile allodynia was measured using von Frey filaments and allodynic threshold was calculated by the up-down method. Allodynic changes were tested at 15, 30, 45, 60, 90, 120 and 180 minutes. To examine the reversal of antiallodynia and to compare the antagonizing action of antiallodynic state produced by i.t. administration of ChEi, non-selective muscarinic receptor antagonists atropine (10 microgram), M1 antagonist pirenzepine (3 microgram), M2 antagonist methoctramine (3 microgram), M3 antagonist 4-DAMP (3 microgram) and M4 antagonist tropicamide (3 microgram) were injected intrathecally respectively 5 minutes prior to the injection of edrophonium or neostigmine. RESULTS: Antiallodynia produced by i.t. edrophonium was reversed by pretreatment with i.t. methoctramine, 4-DAMP, tropicamide and pirenzepine (P<0.05). On the contrary, antiallodynic state made by i.t. neostigmine was not antagonized by methoctramine, 4-DAMP and tropicamide. M1 antagonist pirenzepine had a moderate, statistically significant (P<0.05) effect on reversal of increased allodynic threshold while atropine showed a complete antagonism. CONCLUSION: These experiments suggest that antialllodynic action of cholinesterase inhibitors is likely due to mediation of spinal muscarinic system and M1 receptor subtype is more likely involved in this mechanism.
Animals ; Atropine ; Catheters ; Cholinesterase Inhibitors ; Edrophonium ; Hyperalgesia ; Ligation ; Mecamylamine ; Models, Animal* ; Negotiating ; Neostigmine ; Neuralgia* ; Peripheral Nerve Injuries ; Pirenzepine ; Rats* ; Rats, Sprague-Dawley ; Receptors, Muscarinic* ; Silk ; Spinal Nerves ; Tropicamide