BACKGROUND: Controversy exists as to whether or not inhalation anesthetics and intravenous anesthetics impair arterial oxygenation (PaO2) during one lung ventilation (OLV). Accordingly, we examined the effect of enflurane and propofol on PaO2 and pulmonary vascular resistance (PVR) during OLV. METHODS: Forty patients, who had prolonged periods of OLV anesthesia with minimal trauma to the nonventilated lung were studied in a cross over design. Patients were randomized to four groups; Group 1 received 1 MAC of enflurane and oxygen from induction until the first 20 min after complete lung collapse, then were switched to propofol 100 g/kg/min (P100). In group 2, the order of the anesthetics was reversed. Group 3, Group 4 received the same order of the anesthetics as Group 1, Group 2, respectively but received propofol 200 g/kg/min (P200). RESULTS: During OLV, the PaO2 values were lower than those with two lung ventilation (TLV), there were no significant differences among each groups and between propofol and enflurane in PaO2, but in the selected patients (n=10, PaO2<120 mmHg during OLV), PaO2 in propofol group was higher than that of enflurane group (p<0.05). Conversion from TLV to OLV caused a significant increase in PVR, but there were no difference in PVR between propofol and enflurane group. CONCLUSIONS: These results suggest that the usual clinical dose of propofol affords no advantage over 1 MAC of enflurane anesthesia except low PaO2 patients during OLV. Propofol might be of value in risk patients of hypoxemia during thoracic surgery when OLV is planned.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Anoxia ; Cross-Over Studies ; Enflurane* ; Humans ; Lung ; One-Lung Ventilation* ; Oxygen* ; Propofol* ; Pulmonary Atelectasis ; Thoracic Surgery ; Vascular Resistance ; Ventilation

Purposes of the study were to : (a) measure the levels of job satisfaction, (b) investigate the degree of job characteristics, (c) determine the levels of organizational commitment, (d) investigate relationships between demographic variables and job satisfaction, and (e) examine the relationship between organizational commitment, job characteristics and job satisfaction. Questionnaire was developed and mailed to 300 dietitians who are currently working in school, hospital and industry foodservices. A total of 177 questionnaires were usuable : resulting in a 59% response rate. Results of this study were summarized follows: 1. Approximately half of the respondents(46.9%) indicated that the were 26 to 30 years old. A total of 112 respondents(63.3%) were unmarried. A bachelor's degree was reported as the most common education level(46.9%) while 6.2% of the participants reported a master's degree. Years of employment in professional practices were ranged from 2 to 5. Approximately 40% of the respondents had earned over 900,000 won per month. 2. Work itself of the JDI was with the highest job satisfaction mean score followed by supervision, co-workers, wage and promotion. 3. In total job satisfaction score, dietitians in school foodservices were a significant lower than dietitians in industry foodservices and hospital foodservices. 4. A significant relationship was found for demographic factors and four job facets in terms of job itself, co-workers, and promotion. 5. A work itself was the most improtant facet th the dietitian followed by wage and promotion. 6. Task identity of the JCI facets was the most prevalent job characteristics followed by variety, dealing with others, feedback and friendship. 7. Three groups of dietitians had no significant difference in total job characteristics score. 8. A group of dietitians with a higher job satisfaction score had a significant higher score in job variety and job autonomy. 9. Organizational commitment mean score with dietitians was 1.88. 10. Job satisfaction score for five facets and total job satisfaction were significantly correlated with organizational commitment score. 11. Job charateristics with job variety, job autonomy, feedback, task identity, friendship were positively correlated with organizational commitment.
Adult ; Surveys and Questionnaires ; Demography ; Education ; Employment ; Friends ; Humans ; Job Satisfaction* ; Nutritionists* ; Organization and Administration ; Postal Service ; Professional Practice ; Salaries and Fringe Benefits ; Single Person

PURPOSE: To evaluate the postoperative higher-order aberrations (HOAs) and factors affecting postoperative changes in HOAs in eyes that underwent wavefront-guided LASEK (laser-assisted subepithelial keratectomy), compared with the eyes that underwent conventional LASEK. METHODS: We reviewed the medical records of 221 patients who had undergone LASEK or wavefront guided LASEK with VISX WaveScan and VISX Star S4 eximer laser by a single surgeon (427 total eye operations). We matched 29 eyes of the LASEK and the wavefront LASEK groups (58 eyes total) according to the guideline: preoperative refractive power differences must be within 1 diopter and preoperative root-mean-square (RMS) of total HOAs differences must be within 0.01 micrometer. Preoperative wavefront aberrations and two-months postoperative wavefront aberrations and associated factors were compared and analyzed. RESULTS: Postoperative total HOAs, comas, and spherical aberrations increased significantly from 0.36+/-0.10 micrometer to 0.49+/-0.16 micrometer (p=.001), 0.21+/-0.09 micrometer to 0.31+/-0.14 micrometer (p=.003), and 0.03+/-0.10 micrometer to 0.10+/-0.20 micrometer (p=.043), respectively, in the conventional LASEK group. In the wavefront LASEK group, postoperative HOAs, comas, and spherical aberrations significantly increased from 0.36+/-0.10 micrometer to 0.46+/-0.14 micrometer (p=.004), 0.18+/-0.10 micrometer to 0.29+/-0.14 micrometer (p=.002), and 0.09+/-0.14 micrometer to 0.19+/-0.14 micrometer (p=.006), respectively. There were no significant differences in HOAs between the two groups. A strong negative correlation between preoperative total HOAs and a multiple of increase in total HOAs postoperatively was found, with the negative correlation being stronger in the wavefront-guided LASEK group (Pearson's correlation coefficient =-0.697, p<.001) than in the LASEK group (Pearson's correlation coefficient =-0.632, p<.001). CONCLUSIONS: There were no significant decreases in HOAs in the eyes that underwent wavefront-guided LASEK compared with the matched control eyes of patients that underwent conventional LASEK. Analyzing the tendency of a multiple of increase in total HOAs according to the preoperative HOAs, it suggests that the wavefront-guided LASEK may be more effective in suppressing an increase in total HOAs in the eyes with higher preoperative HOAs.
Case-Control Studies ; Coma ; Humans ; Keratectomy, Subepithelial, Laser-Assisted* ; Medical Records

PURPOSE: To evaluate the effects of intrastromal air injection and intrastromal balanced salt solution (BSS) injection on corneal keratocyte apoptosis. METHODS: Twelve right eyes of New Zealand White rabbits were divided into an air-injected group (n=6) and a hydro-injected group (n=6). Contralateral eyes served as a control. Air or Balanced salt solution (BSS(R), Alcon, USA) was injected into the deep corneal stroma at the paracentral area to propagate into nearly the entire cornea. To reduce the intraocular pressure, anterior chamber paracentesis was performed. The animals were sacrificed 4 hours (n=6) and 24 hours (n=6) after surgery. Central cornea buttons were retrieved to stain with Hematoxylin & Eosin and TUNEL (Apoptag(R), Chemicon). The mean number of apoptotic keratocytes was counted in 24.67+/-4.04 consecutive high power field (HPF). RESULTS: The mean number of TUNEL-positive cells at 4 hours was 12.85+/-7.25/HPF and 0.25+/-0.44/HPF in air-injected and hydro-injected eyes, respectively. It was reduced to 6.25+/-4.02/HPF and 0.15+/-0.37/HPF in air-injected and hydro-injected eyes after 24 hours. The air-injected group showed significantly more TUNEL-positive cells compared with the hydro-injected or control group until 24 hours (p=0.001, p=0.001, Mann-Whitney U test). CONCLUSIONS: Intrastromal air injection induces significant apoptosis of keratocytes suggesting some damages in the peripheral cornea when used in deep lamellar keratoplasty.
Animals ; Anterior Chamber ; Apoptosis* ; Cornea ; Corneal Keratocytes ; Corneal Stroma ; Corneal Transplantation ; Eosine Yellowish-(YS) ; Hematoxylin ; In Situ Nick-End Labeling ; Intraocular Pressure ; Paracentesis ; Rabbits

BACKGROUND: Epidural analgesia, via either a thoracic or lumbar route, is commonly used to provide postoperative analgesia following thoracotomy for pulmonary resection, but little data indicate which location is better in terms of postoperative analgesia, side effects, or associated complications. METHODS: 54 patients, who undergo a lateral thoracotomy, were randomized to receive a mixture of fentanyl and 0.15% bupivacaine at 0.5microgram/kg/hr of fentanyl via either a thoracic (Group T) or a lumbar (Group L) catheter. Postoperative pain was assessed 6hrs after the operation and everyday for 5 days on a visual analog scale (VAS). Postoperative side effects and patients satisfaction of epidural analgesia were assessed by 4 grades system. RESULTS: The VAS scores during coughing were higher than those of resting state without intergroup differences. The incidences and severity of side effects (nausea, vomiting, pruritus, sedation) were not different between group T and group L, but the incidence of urinary retention attributable to use of the lumbar epidural route was significantly higher than with the thoracic route (p<0.05). CONCLUSIONS: The authors conclude that there is no clinical advantage of thoracic over lumbar epidural fentanyl in the thoracotomy patients with respect to analgesia and incidences of most side effects except urinary retention.
Analgesia ; Analgesia, Epidural* ; Bupivacaine ; Catheters ; Cough ; Fentanyl* ; Humans ; Incidence ; Pain, Postoperative ; Pruritus ; Thoracotomy* ; Urinary Retention ; Visual Analog Scale ; Vomiting

Esophageal perforation continues to be associated with high mortality - 20% to 30% - despite advances in surgical techniques. Traditional surgery has been the mainstay of treatment for perforation, but recent advances in endoscopic closure devices has increased therapeutic options for selected patients. Our patient had a fishbone-induced esophageal perforation. He was treated successfully with endoscopic clipping, antibiotics and parenteral nutrition. We report this case and provide a review of the relevant literature.
Anti-Bacterial Agents ; Esophageal Perforation ; Foreign Bodies ; Humans ; Parenteral Nutrition

BACKGROUND/AIMS: EUS can detect bile duct stones (BDS) that are undetectable on multidetector computed tomography (MDCT). BDS associated with acute biliary pancreatitis (ABP) are small and tend to be excreted spontaneously. This study evaluated the usefulness of early EUS in patients with ABP and undetectable BDS on MDCT. METHODS: Forty-one patients with ABP and undetectable BDS on MDCT underwent EUS within 24 hours of admission and were diagnosed with BDS, sludge, dilated common bile duct (CBD), or normal CBD. ERCP was performed in patients with BDS, sludge, or clinical deterioration. The diagnostic yield and the effects of early EUS on morbidity, mortality, and the length of hospitalization were evaluated. RESULTS: EUS detected BDS or sludge in 48.8% of patients examined. BDS was the diagnosis in 13 patients, sludge in seven, and neither for 21 patients. ERCP was performed in 20 patients with BDS or sludge, in two patients with coexisting cholangitis, and in one patient with worsening liver function tests. ERCP identified BDS in 12 patients and sludge in seven. No lesions were diagnosed in four patients by ERCP. All patients improved, and the length of hospitalization in patients with ERCP was 9.0 days, without ERCP 7.1 days. Two patients with major complications by ERCP were hospitalized for a prolonged time. CONCLUSIONS: Early EUS may be useful to select patients for therapeutic ERCP in cases of suspected ABP with undetectable BDS on MDCT.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledocholithiasis* ; Common Bile Duct ; Diagnosis ; Endosonography* ; Gallstones ; Hospitalization ; Humans ; Liver Function Tests ; Mortality ; Multidetector Computed Tomography* ; Pancreatitis* ; Sewage

BACKGROUND/AIMS: We aimed to determine the clinical features of patients with common bile duct (CBD) stones with high serum levels of AST or ALT. METHODS: A retrospective review of 93 patients with CBD stones was done. Clinical characteristics, diameters of CBD, and prior diagnosis before endoscopic retrograde cholangiopancreatography (ERCP) were assessed between two groups (group 1 with serum AST or ALT levels 400 IU/L and group 2 with AST and ALT < or = l00 IU/L). RESULTS: Nineteen patients in group 1 and 17 patients in group 2 were enrolled. The most common presenting symptom was abdominal pain in both groups. Patients in group 1 was about 14 years younger than group 2 (p=0.003). The duration of symptoms in group 1 and group 2 were 4.1 and 36.8 days, respectively (p=0.005). The diameter of CBD was smaller in group 1 (11.4 mm) than in group 2 (16.3 mm) (p=0.001). Most patients were diagnosed as CBD stones by abdominal ultrasound or computed tomography before ERCP, except two patients in group 1 who were diagnosed as hepatitis initially. All of the patients were recovered by stone removal through ERCP and antibiotics treatment. There were inverse correlations between the diameter of CBD and AST or ALT levels (r=-0.517, p=0.002 and r=-0.504, p=0.002, respectively). CONCLUSIONS: CBD stones with high levels of AST or ALT are frequently observed in younger patients with shorter duration of symptoms and a smaller diameter of CBD. ERCP seems to be a valuable method in the diagnosis and treatment of these patients.
Aged ; Alanine Transaminase/*blood ; Aspartate Aminotransferases/*blood ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis/*diagnosis/enzymology ; Female ; Humans ; Male ; Middle Aged

PURPOSE: To compare forward shift of posterior corneal surface and higher-order aberration (HOA) changes after LASIK, LASEK, and wavefront-guided LASEK surgery in moderate myopia METHODS: One hundred eighty four eyes undergoing LASIK, LASEK and wavefront-guided LASEK with VISX STAR S4 were included in this study. The posterior corneal elevation was measured with Orbscan before, 2 and 4 months after surgery. Changes of the elevation were assessed using the difference map generated from preoperative and postoperative elevation maps. The values of higher-order aberrations were evaluated preoperatively and 2 months postoperatively with Wavefront aberrometer. RESULTS: The posterior corneal surface displayed forward shift of 27.2+/-11.45 micrometer, 24.3+/-9.76 micrometer in LASIK group, 23.4+/-10.5 micrometer, 23.6+/-10.55 micrometer in LASEK group, 24.0+/-14.95 micrometer, 28.4+/-14.72 micrometer in wavefront-guided LASEK group at 2 months and 4 months, respectively. There were no statistically significant differences among those three groups, and between 2 and 4 months. The root mean score (RMS) of HOA was increased after LASIK and LASEK (p=0.000, p=0.000, respectively). The mean change of HOA-RMS was significantly smaller in wavefront-guided LASEK than LASIK or LASEK (p=0.000, p=0.000, respectively, Bonferroni-corrected). CONCLUSIONS: The changes of posterior corneal surface forward shift showed no difference among LASIK, LASEK and wavefront-guided LASEK in moderate myopia. HOAs were significantly increased after LASIK and LASEK. The changes of HOAs were significant smaller in wavefront-guided LASEK than LASIK or LASEK.
Adult ; *Corneal Topography ; Humans ; Myopia/diagnosis/*physiopathology/*surgery ; Postoperative Period ; *Refractive Surgical Procedures ; Severity of Illness Index

BACKGROUND/AIMS: It is generally believed that cholecystokinin (CCK) stimulates colonic motility, although there are controversial reports. It has also been suggested that postprandial peptide YY (PYY) release is CCK-dependent. Using a totally isolated, vascularly perfused rat colon, we investigated: (1) the roles of CCK and PYY on colonic motility, (2) to determine if CCK modulates PYY release from the colon to influence the motility and (3) to clarify whether the action of CCK and PYY on colonic motility is mediated via the influence of cholinergic input. METHODS: An isolated whole rat colon was used. Luminal pressure was monitored via microtip catheter pressure transducers from proximal and distal colon. After a control period, CCK-8 or PYY was administerd intraarterially with or without an anti-PYY serum, loxiglumide or atropine at 12, 60 and 240 pM. Each dose was given for a period of 15-minute and the contractile response was expressed as % changes over basal. PYY concentration in the portal effluent was determined by radioimmunoassay. RESULTS: Exogenous CCK-8 increased colonic motility which paralleled the increase in PYY release in the portal effluent. Exogenous PYY also significantly increased colonic motility although it was less potent than CCK. The stimulating effect of CCK-8 was significantly inhibited by an anti-PYY serum, and was completely abolished by loxiglumide, and almost completely abolished by atropine. CONCLUSIONS: CCK increases colonic motility via CCK1 receptor and it is mediated partly by PYY. Cholinergic input is required for the increased motility by either PYY or CCK.
Animals ; Atropine ; Catheters ; Cholecystokinin ; Colon ; Peptide YY ; Phenobarbital ; Proglumide ; Rats ; Sincalide ; Transducers, Pressure