Urine discoloration occurs in the intensive care unit (ICU) due to many causes such as medications, metabolic disorders, and infections. Propofol is advocated as one of the first line sedatives in the ICU, but it is not well known to the intensivists that propofol can induce urine color change. We experienced two cases of green urine after propofol infusion. Propofol should be warranted as the cause of urine discoloration during ICU stay.
Hypnotics and Sedatives ; Intensive Care Units* ; Propofol*

No abstract available.
Dandy-Walker Syndrome* ; Prenatal Diagnosis* ; Trisomy*

Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.
Acute Lung Injury ; Anesthesia* ; Anesthesia, General ; Anoxia ; Blood Gas Analysis ; Extracorporeal Membrane Oxygenation* ; Female ; Gastrointestinal Tract ; Humans ; Incidence ; Intubation, Intratracheal ; Laparoscopy ; Middle Aged ; Mortality ; Pneumonia, Aspiration ; Respiration, Artificial ; Stomach Neoplasms

The Ross operation, a procedure of replacement of the diseased aortic valve with an autologous pulmonary valve, has many advantages such as no need for anticoagulation therapy and similar valve function and growth potential as native valves. However secondary aortic disease has emerged as a significant complication and indication for reoperation. We report a 48-year-old woman who had Ross operation in 1997 for a damaged bicuspid aortic valve and severe aortic regurgitation due to subacute bacterial endocarditis complicated by aortic root abscess. In 2009, 12 years later, progressive severe aortic regurgitation with incomplete coaptation and mild dilatation of the aortic root was shown on echocardiography and contrasted CT, while the pulmonary homograft retained normal function. She subsequently underwent aortic valve replacement. Histopathological examination of the explanted neo-aortic valve and neo-arterial wall revealed pannus formation at the nodulus Arantii area of the three valve cusps, ventricularis, and arterialis. The amount of elastic fibres in the neo-aorta media was less than usual for an aorta of this patient's age but was similar to a pulmonary artery. The pathological findings were not different from other studies of specimens removed between 7 to 12 years after Ross operation. However, the pathophysiology and long-term implications of these findings remain debatable. Considering the anatomical and physiological changes induced by the procedure, separate mechanisms for aortic dilatation and regurgitation are worthy of consideration.
Aorta/*pathology ; Aortic Valve/*surgery ; Aortic Valve Insufficiency/*etiology ; Cardiovascular Surgical Procedures/*adverse effects ; Dilatation, Pathologic ; Heart Valve Diseases/*surgery ; Prostheses and Implants ; Pulmonary Valve/*transplantation

Objectives: This study investigated sleep quality in female full-time homemakers and evaluated the relationship of sleep disturbance with psychological and socio-environmental factors. Methods: This cross-sectional study adopted a structured survey and sequential recruitment method for randomized participation of community-dwelling full-time female homemakers. Sleep quality and mental health were measured using the Korean version of the Pittsburgh Sleep Quality Index (K-PSQI), Korean version of the Beck Depression Inventory-II (K-BDI-II), Korean version of the Beck Anxiety Inventory (K-BAI), and Korean version of the Beck Hopelessness Scale (K-BHS). The willingness-to-pay (WTP) method was selected to measure the self-evaluated monetary value of household service work. The relationship among the main relevant factors was statistically analyzed through a mediation model. Results: A total of 166 participants were analyzed and classified having poor versus good sleep quality (poor : 24.1%, n = 40 ; good : 75.9%, n = 126 ; cut-off point = 9 on the K-PSQI). Significant between-group differences were observed in mental health status (K-BDI-II, p < 0.001 ; K-BAI, p < 0.001 ; K-BHS, p = 0.003). The moderated mediation model was verified, indicating that depression may mediate the association between nurturing burden and sleep disturbance. The path from nurturing burden to depression may be moderated by average monthly household income. Conclusion A relatively high portion of full-time female homemakers may suffer from sleep disturbance and interactions between psychological and socio-environmental factors might determine sleep quality, suggesting the need for public health policies targeting improvement of sleep quality and mental health among full-time homemakers.

Objectives: This study investigated sleep quality in female full-time homemakers and evaluated the relationship of sleep disturbance with psychological and socio-environmental factors. Methods: This cross-sectional study adopted a structured survey and sequential recruitment method for randomized participation of community-dwelling full-time female homemakers. Sleep quality and mental health were measured using the Korean version of the Pittsburgh Sleep Quality Index (K-PSQI), Korean version of the Beck Depression Inventory-II (K-BDI-II), Korean version of the Beck Anxiety Inventory (K-BAI), and Korean version of the Beck Hopelessness Scale (K-BHS). The willingness-to-pay (WTP) method was selected to measure the self-evaluated monetary value of household service work. The relationship among the main relevant factors was statistically analyzed through a mediation model. Results: A total of 166 participants were analyzed and classified having poor versus good sleep quality (poor : 24.1%, n = 40 ; good : 75.9%, n = 126 ; cut-off point = 9 on the K-PSQI). Significant between-group differences were observed in mental health status (K-BDI-II, p < 0.001 ; K-BAI, p < 0.001 ; K-BHS, p = 0.003). The moderated mediation model was verified, indicating that depression may mediate the association between nurturing burden and sleep disturbance. The path from nurturing burden to depression may be moderated by average monthly household income. Conclusion A relatively high portion of full-time female homemakers may suffer from sleep disturbance and interactions between psychological and socio-environmental factors might determine sleep quality, suggesting the need for public health policies targeting improvement of sleep quality and mental health among full-time homemakers.

Purpose: To assess the association between the choroidal vascularity index (CVI) and prelaminar tissue thickness (PTT) in healthy and glaucomatous eyes. Methods: The study included 86 eyes with perimetric glaucoma (PG), 86 with pre‐perimetric glaucoma (PPG), and 43 agematched healthy eyes. Total choroidal area (TCA) and CVI were measured by image binarization of spectral‐domain optical coherence tomography (SD‐OCT) 3.5 mm from the center of Bruch’s membrane opening. The CVI was the percentage of choroidal vasculature to choroidal tissue. The association between CVI and PTT measured on a center‐horizontal scan of enhanced depth imaging SD‐OCT was assessed. Results: The CVI was lowest in PG (61.67% ± 4.11%), followed by PPG (63.36% ± 3.54%), and healthy (64.84% ± 3.13%) eyes (p < 0.001). PG (102.05 ± 44.01 μm) had a significantly thinner PTT than PPG (106.16 ± 38.03 μm) and the healthy (154.98 ± 79.46 μm) eyes (p < 0.001). In a multivariate regression analysis, CVI was associated with PTT and TCA in all subjects, including healthy and glaucomatous eyes (p < 0.05). Conclusions The CVI and PTT had significantly lower values in glaucomatous eyes than in healthy eyes, and the two parameters were positively associated in all subjects, including healthy and glaucomatous eyes.