BACKGROUND: The effect of arterial carbon dioxide tension (PaCO2) during ischemia and reperfusion has been a controversial issue. In this study, the effect of PaCO2 during ischemia and reperfusion was evaluated by 31P magnetic resonance spectroscopy (MRS). METHODS: Incomplete global cerebral ischemia was induced by ligation of carotid artery under lowered mean blood pressure (mean blood pressure= 40 mmHg) for 30 minutes followed by 2 hours of reperfusion. Eighteen cats were divided into 3 groups: For group 1 (n=6) (control group), animals were subjected to normocarbia (PaCO2=28~33 mmHg) during ischemia and reperfusion, for group 2 (n=6), animals were subjected to hypocarbia (PaCO2=18~23 mmHg) during ischemia and reperfusion, and for group 3 (n=6), animals were subjected to normocarbia during ischemia and hypocarbia during reperfusion. RESULTS: For group 1, the energy metabolism measured by [PCr/Pi] was recovered about 74.7 6.4%. For group 2, the energy metabolism failed to be completely recovered by 120 minutes of reperfusion (69.3 7.3%), whereas for group 3, the energy matabolism was completely recovered by 120 minutes of reperfusion (97.6 2.4%). There were statistically significant differences between group 1 and group 3 (p<0.05). The changes in pH were not significantly different among the groups. CONCLUSION: In this study, a condition of hypocarbia during reperfusion seems better for the energy metabolism after incomplete global ischemia of cats.
Animals ; Blood Pressure ; Brain Ischemia ; Brain* ; Carbon Dioxide ; Carotid Arteries ; Cats* ; Energy Metabolism* ; Hydrogen-Ion Concentration ; Ischemia ; Ligation ; Magnetic Resonance Spectroscopy ; Reperfusion

PURPOSE: To evaluate the CT findings of histopathologically proven pulmonary hamartoma MATERIALS AND METHODS: CT findings of 16 patients with pulmonary hamartoma, histopatologically proven between 1990 and 1996, wereretrospectively reviewed. Diagnosis was based on thoracotomy9n=11) or fine-needle aspiration biopsy(n=5). Weanalyzed the location, margin discreteness, shape, and size of the mass, and the presence of calcification or fatdensity, as seen on CT scan. RESULTS: All 16 tumors showed a discrete and smooth margin and there was nopredilection for any specific site. They were lobulated(11/16, 69%), round(4/16, 25%) or oval(1/16, 6%) and wereless than 1cm(2/16), 1~ < 2cm(4/16), 2~ < 3cm(5/16), 3~ < 4cm(3/16) or 4~5cm(2/16) in size. Nine of 16 cases(56%)showed calcification;this was either popcorn-type(n=3), stippled(n=3), eccentric(n=2), or diffuse(n=1). Five of 16cases(31%) showed fat attenuation. CONCLUSION: On CT, pulmonary hamartomas showed a discrete margin, werelobulated (rather than round or oval) and varied in size. calcification was more common than fat density. These CTfindings may be useful for the differential diagnosis of pulmonary hamartoma.
Biopsy, Fine-Needle ; Diagnosis ; Diagnosis, Differential ; Hamartoma* ; Humans ; Tomography, X-Ray Computed

Radiofrequency ablation (RFA) is a new, minimally invasive modality that serves as an alternative to surgery in patients with thyroid tumors. The Task Force Committee of the Korean Society of Thyroid Radiology developed recommendations for the optimal use of RFA for thyroid tumors in 2012 and revised them in 2017. Herein, we review and summarize the 2017 thyroid RFA guideline and compare it with the 2012 thyroid RFA guideline.
Advisory Committees ; Catheter Ablation ; Humans ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography

OBJECTIVE: To understand the difference of defecation physiology between postpartum and postoperative women. METHODS: Between July 1998 to April 1999, we performed defecogram and pudendal nerve motor latency to 31 women, who were 8 postoperative women, 9 post cesarean-section state women, and 14 normal vaginal delivery-state women. RESULTS: According to the defecogram results, only squeezing angles of the anorectal angle were significantly increased(96.0 vs 72.3, 74.9 degree) in normal vaginal delivery-state women compared to post cesarean-section state and postoperative women, but rest and evacuation angles were not. And to pudendal nerve latency, there were no statistically significant difference. CONCLUSION: We concluded that the pudendal plexus was damaged during labor, therefore its ability to control puborectalis muscle was damaged. So, the anorectal angles of squeezing of postpartum women were significantly increased, compared to those of post cesarean section women or postoperative women.
Cesarean Section ; Defecation* ; Female ; Humans ; Physiology* ; Postpartum Period* ; Pregnancy ; Pudendal Nerve*

A 33-yr old female patient with coagulation factor VII deficiency was scheduled for laparoscopic oophorectomy under the diagnosis of ovarian teratoma. Plasma concentration of factor VII of this patient was 9 IU/dl (normal range; 60-140 IU/dl) and the prothrombin time INR (International Normalization Ratio) was 1.79 (normal range; 0.8-1.2) on the day before the operation. Total 1,200microgram (30microgram/kg) of recombinant activated factor VII (rFVIIa) was administered just before the start of the laparoscopic procedure, which was accomplished safely without severe hemorrhage or other complications. Postoperative course was uneventful. In addition, this article provides the clinical implication of rFVIIa in terms of hemostasis management in hemophiliacs and surgical patients.
Blood Coagulation ; Blood Coagulation Factors* ; Diagnosis ; Factor VII* ; Factor VIIa* ; Female ; Hemorrhage ; Hemostasis ; Humans ; International Normalized Ratio ; Ovariectomy ; Plasma ; Prothrombin Time ; Teratoma

OBJECTIVE: Bone mineral loss in the upper extremity of hemiplegic patients can increase the prevalence of fractures that interrupt the rehabilitation program and lower the level of activity. The aim of this study was to investigate any difference between the affected and unaffected forearm's bone mineral density (BMD) and evaluate the relationship between several clinical variables and osteoporosis of hemiplegic forearm. METHOD: Sixty-seven hemiplegic patients (42 males, 25 females, mean age 55.2 years) were enrolled. The BMD of radius was measured using dual energy X-ray absorptiometry in 67 hemiplegic subjects. RESULTS: The BMD of affected forearm was significantly lower than unaffected side (p<0.05). The reduction of BMD in the hemiplegic forearm well correlated with duration of hemiplegia, self care of functional independence measure score, complex regional pain syndrome-type 1 (CRPS-1) (p<0.05). But, there was no correlation between BMD and modified Ashworth scale, muscle power of wrist extension. CONCLUSION: Hemiplegic forearm had high prevalence of osteoporosis like lower extremity. Therefore, increasing level of ADL and early detection of CRPS-1 was necessary for prevention of osteoporosis of forearm.
Absorptiometry, Photon ; Activities of Daily Living ; Bone Density* ; Female ; Forearm ; Hemiplegia ; Humans ; Lower Extremity ; Male ; Osteoporosis ; Prevalence ; Radius ; Rehabilitation ; Self Care ; Upper Extremity* ; Wrist

Uterine rupture is usually associated with previous uterine scar. Although intrapartum rupture of unscarred uterus is very rare, it may cause catastrophic outcomes to both the mother and the newborn infant compared with that of a scarred uterus. The present case describes our experience of anesthesia for an emergency cesarean section due to the arrest of fetal descent in a 36-year-old parturient who had undergone external cephalic version for the breech presentation of her fetus. We detected the rupture of her unscarred uterus during the operation under epidural anesthesia, which was changed to general anesthesia. Despite the uterine rupture the newborn infant survived uneventfully. At the postoperative twelfth day she was discharged from hospital with her baby.
Adult ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Breech Presentation ; Cesarean Section* ; Cicatrix ; Emergencies ; Female ; Fetus ; Humans ; Infant, Newborn ; Mothers ; Oxytocin ; Pregnancy ; Rupture* ; Uterine Rupture ; Uterus* ; Version, Fetal

BACKGOUND: This study was purposed to evaluate the effects of Mg2+ pretreatment on cerebral ischemic injury in cats. METHODS: Global cerebral ischemia was induced by ligation of both innominate arteries following ligation of inferior vena cava under lowered mean blood pressure for 20 minutes followed by 3 hrs of reperfusion. Ten cats were divided into 2 groups: Group 1 (n=5) is the control group, for group 2 (n=5) (Mg2+ group), the animals were pretreated with 90 mg/kg of Mg2+ intravenously before subjected to ischemia. RESULTS: Phosphocreatine/inorganic phosphate (Pcr/Pi) and pH decreased after ischemia and did not recovered during reperfusion. And there were no significant differences between the two groups. The ratios of lactate/N-acetyl aspartate (Lac/NAA) and lactate/creatine (Lac/Cr) increased after ischemia and not recovered during reperfusion. But the ratios were higher for the group 2 than the group 1 during reperfusion (p<0.05). For the Mg2+ group, blood pressure during reperfusion was lower than the control group. CONCLUSIONS: Mg2+ intravenous pretreatment had no protective effect on this global cerebral ischemia animal model. Even it deteriorated brain energy metabolism by lowering blood pressure.
Animals ; Aspartic Acid ; Blood Pressure ; Brachiocephalic Trunk ; Brain Ischemia ; Brain* ; Cats* ; Energy Metabolism* ; Hydrogen-Ion Concentration ; Ischemia ; Ligation ; Metabolism ; Models, Animal ; Pharmacology ; Reperfusion ; Vena Cava, Inferior

BACKGROUND: Preoperative autologous donation is one of the most widely used methods of autotransfusion. However donation of predetermined units cannot often be achieved because of falling hematocrit with donations going on. We studied on the minimal effective dosage of recombinant human erythropoietin(rhEPO) used in preoperative autologous donation. METHODS: We conducted randomized trial of rhEPO in 45 adults for posterior spinal fusion procedures who had basal hematocrit less than 40 percent. The patients received either nothing(control group) or rhEPO(25 or 50 units/kg) intravenously twice a week for 21 days, during which time up to 3 units of blood was collected. Patients were excluded from donation when their hematocrit values were less than 33 percent. All patient received iron sulfate(256mg orally three times daily). RESULTS: The mean number of units collected per patient(mean+/-SD) was 3+/-0 for the 50-unit group(P<0.05 when compared with control group), 2.84+/-0.36 for the 25-unit group and 2.67+/-0.49 for the control group. The red cell volume donated by the patients who received rhEPO(347 ml, 325 ml) was greater than that donated by the control group(255 ml, P<0.05). The differences between hematocrits of the first and the third preoperative donations were significantly less in 50-unit group(1.50+/-2.05) and 25-unit group(1.51+/-1.85) than that of control group(3.73+/-1.66). Two patients of the 25-unit group and 5 patients of the control group required additional homologous blood postoperatively. And there were no significant differences in the pattern of postoperative changes of hemoglobin and hematocrit among each group. CONCLUSIONS: Fifty units per kilogram of body weight is considered appropriate to be the minimal effective dosage for preoperative autologous donation.
Adult ; Blood Transfusion, Autologous ; Body Weight ; Cell Size ; Erythropoietin* ; Hematocrit ; Humans* ; Iron ; Spinal Fusion

BACKGROUND AND PURPOSE: To evaluate changes in cortical excitability induced by zonisamide (ZNS) in focal epilepsy patients. METHODS: Twenty-four drug-nasmall yi, Ukrainianve focal epilepsy patients (15 males; overall mean age 29.8 years) were enrolled. The transcranial magnetic stimulation parameters obtained using two Magstim 200 stimulators were the resting motor threshold, amplitude of the motor-evoked potential (MEP), cortical silent period, short intracortical inhibition, and intracortical facilitation. These five transcranial magnetic stimulation parameters were measured before and after ZNS, and the findings were compared. RESULTS: All 24 patients were treated with ZNS monotherapy (200-300 mg/day) for 8-12 weeks. After ZNS, MEP amplitudes decreased (-36.9%) significantly in epileptic hemispheres (paired t-test with Bonferroni's correction for multiple comparisons, p<0.05), whereas the mean resting motor threshold, cortical silent period, short intracortical inhibition, and intracortical facilitation were unchanged (p>0.05). ZNS did not affect cortical excitability in nonepileptic hemispheres. CONCLUSIONS: These findings suggest that ZNS decreases cortical excitability only in the epileptic hemispheres of focal epilepsy patients. MEP amplitudes may be useful for evaluating ZNS-induced changes in cortical excitability.
Epilepsies, Partial ; Humans ; Isoxazoles ; Transcranial Magnetic Stimulation