BACKGROUND: Mannitol is widely used in neurosurgical patients and may induce an increase in serum potassium concentration according to doses and administration rates with unknown mechanism. The treatment of hyperkalemia is aimed at eliminating the causes and includes calcium, sodium bicarbonate, glucose with insulin, loop diuretics and hyperventilation. This study was undertaken to observe the effects of hyperventilation on the serum potassium concentration following infusion of mannitol (2.0 gm/kg). METHODS: We studied 30 patients who were operated brain aneurysm clipping surgery and were divided into 3 groups (n=10). In control group, mild hypocapnia was maintained (PaCO2, 32 2 mmHg) before and after mannitol infusion. In group I, moderate hypocapnia was maintained (PaCO2, 27 2 mmHg) before and after mannitol infusion. In group II, mild hypocapnia (PaCO2, 32 2 mmHg) was maintained before 30 minutes of mannitol infusion and moderate hypocapnia (PaCO2, 27 2 mHg) after mannitol infusion. We started infusion of 20% mannitol with a dosage of 2.0 gm/kg, 15~20 min after cranium was opened. RESULTS: The changes of serum potassium were as follows (Mean SD mEq/l) (just before and 15min, 30min, 60min after mannitol infusion): 3.79 0.48, 4.66 0.60, 4.44 0.48, 4.13 0.40 (Control group), 3.62 0.18, 3.63 0.42, 4.14 0.51, 3.95 0.33 (Group I), 3.76 0.20, 3.91 0.15, 4.11 0.30, 4.04 0.23 (Group II). After 15 minutes of mannitol infusion, the serum potassium levels of group I and II were lower than that of control group (p<0.05) and there was no significant difference between group I and II. CONCLUSIONS: These results suggest that hyperventilation may blunt the increase in serum potassium concentration following rapid infusion of high dose mannitol.
Calcium ; Glucose ; Humans ; Hyperkalemia ; Hyperventilation* ; Hypocapnia ; Insulin ; Intracranial Aneurysm ; Mannitol* ; Potassium* ; Skull ; Sodium Bicarbonate ; Sodium Potassium Chloride Symporter Inhibitors

Nonextraction camouflage treatment in mild Class III malocclusion is achieved by backward movement of the lower dentition and forward movement of the upper dentition. Many camouflage treatment modalities have been used for distal tipping and distal movement of mandibular posterior teeth. The amount of distal movement of mandibular dentition can be improved in cases of severe crowding, even without the patient's cooperation, by using miniscrews for anchorage. However, miniscrew insertion may be unsuccessful, and it may contact the adjacent root because of the distal movement of dentition. Distal tipping of mandibular dentition can be achieved using multiloop edgewise archwires and intermaxillary elastics. However, the complexity of this wire design causes discomfort to patients. Recently, a new treatment using improved superelastic NiTi wires (ISWs) and intermaxillary elastics has been introduced. ISWs can deliver orthodontic force more effectively, and their use with molar tip-back treatment has several advantages-this approach is effective, simple, and easy to use and reduces patient discomfort. The aim of this study was to report a case of camouflage treatment using ISW with tip-back and intermaxillary elastics for distal tipping of mandibular posterior dentition and to evaluate the effectiveness of this treatment in a clinical setting.
Crowding ; Dentition ; Humans ; Malocclusion ; Molar ; Tooth

Background: Many people use both combustible cigarette (CC) and electronic cigarette (EC). We compared nicotine dependence among CC, EC, and dual users using questionnaires and urinary cotinine levels. Methods: Data from the Korea National Health and Nutrition Examination Survey (2014–2017) databases were analyzed; 3,917 CC, EC, and dual users were administered the urinary cotinine test, and 1,045 current CC and dual users completed the Heaviness of Smoking Index (HSI) questionnaires. Weighted geometric means of urine cotinine levels were compared between exclusive CC, exclusive EC, and dual users. The distribution rate, based on time to first cigarette (TTFC), cigarettes per day (CPD), and the HSI was analyzed in two weighted groups, exclusive CC and dual users. Results: Among those who currently use any type of cigarette, 89.4%, 1.4%, and 9.2% were exclusive CC, exclusive EC, and dual users, respectively. Weighted geometric means of urine cotinine were highest in dual users (1,356.4 ng/mL), followed by exclusive CC (1,270.3 ng/mL), and exclusive EC (867.7 ng/mL) with significant differences between all three groups (P<0.05). There were no statistically significant differences in CPD between exclusive CC and dual users (P=0.626). The proportion of TTFC ≤5 minutes was 21.5% and 29.5% in the two groups, respectively (P=0.010); however, HSI differences in the two groups was marginal (P=0.557). Conclusion In this study, the urinary cotinine value could distinguish the three groups, CC, EC, and dual users, but the questionnaire using HSI could not distinguish the three groups.

Background: Many people use both combustible cigarette (CC) and electronic cigarette (EC). We compared nicotine dependence among CC, EC, and dual users using questionnaires and urinary cotinine levels. Methods: Data from the Korea National Health and Nutrition Examination Survey (2014–2017) databases were analyzed; 3,917 CC, EC, and dual users were administered the urinary cotinine test, and 1,045 current CC and dual users completed the Heaviness of Smoking Index (HSI) questionnaires. Weighted geometric means of urine cotinine levels were compared between exclusive CC, exclusive EC, and dual users. The distribution rate, based on time to first cigarette (TTFC), cigarettes per day (CPD), and the HSI was analyzed in two weighted groups, exclusive CC and dual users. Results: Among those who currently use any type of cigarette, 89.4%, 1.4%, and 9.2% were exclusive CC, exclusive EC, and dual users, respectively. Weighted geometric means of urine cotinine were highest in dual users (1,356.4 ng/mL), followed by exclusive CC (1,270.3 ng/mL), and exclusive EC (867.7 ng/mL) with significant differences between all three groups (P<0.05). There were no statistically significant differences in CPD between exclusive CC and dual users (P=0.626). The proportion of TTFC ≤5 minutes was 21.5% and 29.5% in the two groups, respectively (P=0.010); however, HSI differences in the two groups was marginal (P=0.557). Conclusion In this study, the urinary cotinine value could distinguish the three groups, CC, EC, and dual users, but the questionnaire using HSI could not distinguish the three groups.

Protein C exerts anticoagulant effects by inactivating factor Va and VIIIa and stimulating fibrinolysis. The homozygous protein C deficiency is extremely rare and often results in life threatening thrombosis and purpura fulminans with necrotic cutaneous lesions. A child with homozygous protein C deficiency was treated at 6 months by a living-related liver transplantaion. After induction of anesthesia, we started an FFP infusion for protein C replacement and a low molecular weight heparin continuous infusion to prevent thrombosis. A complete reconstitution of protein C activity and resolution of the thrombotic condition occured postoperatively. So we report this case with a brief review of the literature.
Anesthesia* ; Child ; Factor Va ; Fibrinolysis ; Heparin, Low-Molecular-Weight ; Humans ; Liver Transplantation* ; Liver* ; Protein C Deficiency* ; Protein C* ; Purpura Fulminans ; Thrombosis

OBJECTIVE: The purposes of this study were to evaluate the force and stress depending on the type, deflection and thickness of the materials and to evaluate the mechanical properties of thermoplastic materials after repeated loading. METHODS: Four types of thermoplastic products were tested. Force until the deflections of 2.0 mm and the stress when the materials were restoring to its resting position were evaluated. The mechanical properties of thermoplastic materials evaluated after 5 repeated loading cycles. RESULTS: The interaction was observed between the thickness and the deflection (p < 0.05) from the regression equation. Thickness and amount of deflection rather than products and materials showed the largest effect on force and stress. In all products, at least 159 gf of force was required for more than 1.0 mm deflection or when materials with 1.0 mm thickness were deflected. The stress recorded was more than 19 gf/mm2. During repeated loading, each group showed significant difference on the force and the stress p < 0.01), 10 - 17% reduction of force and 4 - 7% reduction of stress in average. CONCLUSIONS: Proper thickness of thermoplastic materials and deflection level of tooth movement should be decided for the physiologic tooth movement. Force decay after repeated loading should be considered for the efficient tooth movement.
Tooth Movement

BACKGROUND: The primary mode of conduction bldegrees Ckade by ldegrees Cal anesthetics degrees Ccurs through the inhibition of voltage-dependent sodium current and, inhibitory potency of ldegrees Cal anesthetics are correlated with their hydrophobicity, expressed as degrees Ctanol/buffer partition coefficients(PC). The homologous structural bidegrees Chemistry and analogous physiology of voltage-dependent sodium and calcium channels prompted us to examine the relationship between potency of various ldegrees Cal anesthetics for the inhibition of voltage-dependent calcium channels(VDCC) and their PC values. METHODS: Whole cell patch clamp recordings were made from acutely dissdegrees Ciated rat dorsal root ganglion neurons, and voltage dependent calcium current(ICa) was evoked by depolarizing pulse. The concentrations of various ldegrees Cal anesthetics(bupivacaine, liddegrees Caine, prildegrees Caine, prdegrees Caine, tetracaine) that bldegrees Ck 50% of the control ICa(IC50) were calculated from dose-response curves. The relationship between IC50 and PC values of various ldegrees Cal anesthetics were investigated. RESULTS: Ldegrees Cal anesthetics inhibited ICa with neglegible effect on the current- voltage relatonship. IC50 values of tetracaine, bupivacaine, liddegrees Caine, prildegrees Caine and prdegrees Caine were 98, 142, 2710, 10400, 16900 uM respectively, and linear regression of the plot of log(IC50) against log(PC) was statistically significant (p<0.001). CONCLUSIONS: It is speculated that inhibitory effects of ldegrees Cal anesthetics on the VDCC when used in epidural and spinal anesthesia may contribute to their analgesic and anesthetic actions. Inhibitory potency of ldegrees Cal anesthetics on the VDCC, as for voltage-dependent sodium channels, was correlated with their hydrophobicity.
Anesthesia, Spinal ; Anesthetics* ; Animals ; Bupivacaine ; Calcium Channels ; Calcium* ; Chemistry ; Ganglia, Spinal ; Hydrophobic and Hydrophilic Interactions* ; Inhibitory Concentration 50 ; Linear Models ; Neurons ; Physiology ; Rats ; Sodium ; Sodium Channels ; Tetracaine

Patients treated with peritoneal dialysis have increased intra-abdominal pressure and a high prevalence of abdominal wall complications. Hernias can lead to significant morbidity in patients on peritoneal dialysis. Hernias are clinically important because of the risk of incarceration, strangulation and subsequent bowel obstruction, rupture, and peritonitis. In this paper, a case of incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis (CAPD) patient is reported. The small bowel obstruction improved after herniorrhaphy, and the peritoneal dialysis was resumed 2 weeks after the herniorrhaphy. The patient had been undergoing CAPD without technical failure until the 2 months follow-up after the herniorrhaphy. This case shows that early detection of incarcerated umbilical hernia and herniorrhaphy can prevent resection of a strangulated small bowel so that it can remain on CAPD without post-operative technical failure. Umbilical hernias should be carefully observed and intestinal obstruction should be considered when a CAPD patient with an umbilical hernia has abdominal pain.
Abdominal Pain ; Abdominal Wall ; Follow-Up Studies ; Hernia ; Hernia, Umbilical* ; Herniorrhaphy ; Humans ; Intestinal Obstruction ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Prevalence ; Rupture

BACKGROUND: Transcranial Doppler ultrasonography (TCD) can detect microembolic signals (MES) in the patients with a potential embolic source. Clinical significance of MES has not been demonstrated in patients with prosthetic mechanical heart valves. We studied the correlation between cerebral thromboemoblic events after the mechanical heart valve surgery (MHVS) and residual MES during TCD monitoring with 100% oxygen inhalation in patients with mechanical heart valves. MATERIAL AND METHOD: Twenty patients with previous cerebral thromboemoblic events after MHVS and a sex- and age-matched control group (n=30) were studied. TCD monitoring was performed from unilateral middle cerebral artery. After baseline monitoring for 20 minutes, 6L of oxygen was inspired for 40 minutes. RESULT: The site of valve and the duration after MHVS of the patients did not differ from those of controls. During baseline monitoring, there was no significant difference in MES prevalence or counts compared to controls. During oxygen inhalation, patients showed a higher MES prevalence (55%, 27.6%, p=0.045) and a more frequent MES counts (p=0.027) compared to controls. CONCLUSION: TCD monitoring with oxygen inhalation may be useful to differentiate clinically significant MES in patients with mechanical heart valve.
Embolism ; Heart Valve Prosthesis ; Heart Valves* ; Heart* ; Humans ; Inhalation* ; Middle Cerebral Artery ; Oxygen* ; Prevalence ; Ultrasonography ; Ultrasonography, Doppler, Transcranial

The nerves innervating the auricle of the rat were investigated using PRV (pseudorabies virus) as a neural tracer. The neural tracer was injected into rostral part of the right auricle of the rat. The PRV immunoreactive neurons were labeled bilaterally and more densely labeled in the brain than spinal cord. In the brain, PRV immunoreactive neuronal cell bodies and fibers were observed in thalamus, periaqueductal gray matter, reticular formation, spinal trigeminal nucleus, spinal tract of trigeminal nerve and facial nucleus. The more densely labeled PRV immunoreactive neurons were found in thalamus, reticular formation, spinal tract of trigeminal nerve and facial nucleus. In the spinal cord, PRV immunoreactive neurons were extended from T8 to L2 segments. The more densely labeled PRV immunoreactive neurons were found from T11 to L2 segments. Above results, the nerves innervating the auricle of the rat were widely distributed in brain and spinal cord and may have many connections with other nerves. These results may provide a neuroanatomical data on the nerves innervating the auricle of the rat in the central nervous system.
Animals ; Brain* ; Central Nervous System ; Herpesvirus 1, Suid ; Neurons ; Periaqueductal Gray ; Rats* ; Reticular Formation ; Spinal Cord* ; Thalamus ; Trigeminal Nerve ; Trigeminal Nucleus, Spinal