BACKGROUND: This study examined hemodynamic variables, oxygen delivery, extraction, and consumption in response to acute progressive hypoxia and hypercarbia in the setting of apnea. METHODS: Apnea was induced in 9 healthy mongrel dogs by disconnecting animals from mechanical ventilation of 30 minutes with pure oxygen. Hemodynamic variables, oxygen transport, extraction, and consumption were rapidly and repeatedly measured using pulmonary arterial and arterial catheters until cardiac output was undetectable. RESULTS: The baseline PaO2, PaCO2, pH, base excess were 318 +/- 137 mm Hg, 36 +/- 3.5 mm Hg, 7.30 +/- 0.06, 6.81 +/- 2.65 mmol/l respectively. Hypercarbia and hypoxemia (76 +/- 33 mm Hg) was first noted at 1 and 4 minute respectively. Base excess was not changed. Indices of preload (PCWP and CVP) were increased early in the time course (p<0.05). In contrast, indices of afterload (SVR) increased later, just before cardiac decompensation began (p<0.05). No significant reduction of cardiac output, oxygen delivery, extraction, and consumption was detected just until abrupt cardiac decompensation started, 5 minute. CONCLUSIONS: These data suggest that the early increase in preload was primarily due to hypercarbia whereas the late increase in afterload was due to hypoxemia, but the main cause of acute cardiac decompensation was a critical decrease in arterial oxygen tension with some contribution of increased preload and afterload.
Animals ; Anoxia ; Apnea* ; Cardiac Output ; Catheters ; Dogs* ; Hemodynamics* ; Hydrogen-Ion Concentration ; Oxygen* ; Respiration, Artificial

No abstract available.
Dislocations*

Addisons disease is relatively rare than secondary adrenal insufficiency and result from progressive adrenocortical destruction. The common causes are idiopathic autoimmune atrophy and tuberculosis of adrenal glands. It is generally regarded as incurable in the sense that substitution therapy is required for the rest of the patients life. We report a case of tuberculous primary adrenal insufficiency which was confirmed by biopsy. This case was treated with antituberculous medication and showen to have improved adrenocortical function after six months.
Addison Disease* ; Adrenal Glands ; Adrenal Insufficiency ; Atrophy ; Biopsy ; Humans ; Tuberculosis

STATEMENT OF PROBLEM: Recently, titanium has become popular as superstructure material in implant dentistry because titanium superstructure can be easily milled by means of computer-aided design and manufacture (CAD/CAM) technique. But retention form such as nail head or bead cannot be cut as a result of technical limitation of CAD/CAM milling and bond strength between titanium and porcelain is not as strong as that of conventional gold or metal alloy. PURPOSE: The objective of this study was to evaluate the shear bond strength of three different materials: heat curing resin, composite resin, porcelain which were bonded to grade II commercially pure Titanium (CP - Ti). MATERIAL AND METHODS: Thirty seven CP - Ti discs with 9 mm diameter, 10 mm height were divided into three groups and were bonded with heat curing resin (Lucitone 199), indirect composite resin (Sinfony), and porcelain (Triceram) which were mounted in a former with 7 mm diameter and 1 mm height. Samples were thermocycled for 1000 cycles at between 5 - 55 degrees C. Shear bond strength (MPa) was measured with Instron Universal Testing Machine with cross head speed of 1 mm/min. The failure pattern was observed at the fractured surface and divided into adhesive, cohesive, and combination failure. The data were analyzed by one-way ANOVA and Scheffe's multiple range test (alpha= 0.05). RESULTS: Lucitone 199 (17.82 +/- 5.13 MPa) showed the highest shear bond strength, followed by Triceram (12.97 +/- 2.11 MPa), and Sinfony (6.00 +/- 1.31 MPa). Most of the failure patterns in Lucitone 199 and Sinfony group were adhesive failure, whereas those in Triceram group were combination failure. CONCLUSION: Heat curing resin formed the strongest bond to titanium which is used as a CAD/CAM milling block. But the bond strength is still low compared with the bond utilizing mechanical interlocking and there are many adhesive failures which suggest that more studies to enhance bond strength are needed.
Acrylic Resins ; Adhesives ; Alloys ; Ceramides ; Collodion ; Computer-Aided Design ; Dental Porcelain ; Dentistry ; Head ; Hot Temperature ; Nails ; Retention (Psychology) ; Titanium

Effect of diltiazem hydrochloride on cardiac performance with particular reference to the antianginal action was studied in 17 patients with ischemic heart disease, including 12 cases of effort angina, by means of clinical and mechanocardiographic evaluations. All patients were kept on the same medications from at least 2 weeks prior to diltiazem administration until the end of the study, and were prescribed no other antianginal drugs except for liberal use of sublingual nitroglycerin. Diltiazem was given 90mg a day in three divided doses for two weeks. Clinical and mechanocardiographic evaluations, including calculations of pressure rate product(PRP), triple product(TP) and tension time index(TTI), were made before and at a weekly interval after diltiazem administration. After the medication, heart rate, blood pressure and the pre-ejection period(PEP) with its ratio to the ejection time tended to decrease, and the decreases in heart rate and the PEP at the end of two weeks were significant. The PRP, TP and TTI were also significantly decreased at the end of the second week, and the decrease in the TTI was significant even a week after the medication. An antianginal effect, which appeared within few days, was excellent to good in over 90 percent of the cases. These facts suggest that diltiazem hydrochloride has no negative inotropic action and its antianginal effecti in its early stage of the drug administration is primarily due to coronary vasodilation and, as the drug is continued, is contributed to possibly by the decrease in the myocardial oxygen consumption as well.
Angina Pectoris* ; Blood Pressure ; Diltiazem* ; Heart Rate ; Humans ; Myocardial Ischemia* ; Nitroglycerin ; Oxygen Consumption ; Vasodilation

Subaortic left brachiocephalic vein is a rare congenital anomaly that is sometimes found in the normal population. We report here on a case of subaortic left brachiocephalic vein that was detected incidentally by performing contrast transesophageal echocardiography (TEE) with using agitated saline and computed tomography (CT).
Brachiocephalic Veins* ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Dihydroergotamine ; Echocardiography, Transesophageal

OBJECTIVE: To determine the incidence of HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome and assess the relationship between the maternal-fetal complications and the severity of HELLP syndrome, classified based on platelet count nadir. METHODS: We reviewed the maternal and neonatal charts of ten pregnancies complicated by HELLP syndrome, managed at Dankook University Hospital between January, 1995 and December, 2002. Women were divided into 2 groups as class I HELLP which had a maternal platelet nadir 50,000 and 100,000/mm3. We compared the maternal and fetal complications between class I and class II HELLP syndrome. But we did not analyze statistically due to small number of patients. RESULTS: There were four cases of class I HELLP and six cases of class II HELLP syndrome. The incidence of HELLP syndrome was 0.10% (10/10,238) in total deliveries and was 2.26% (10/443) in women with severe pre-eclampsia or eclampsia. The mean level of platelet counts nadir was 41,500/mm3 in class I and 64,000/mm3 in class II HELLP. The mean platelet recovery days (more than 100,000/mm3) were 6.0 and 4.2 days in each class. The mean values of the maximal aspartate aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT) and uric acid might show no differences, but there might be difference in lactate dehydrogenase (LDH) levels which were 5854 and 1388 IU/L in each class. All patients with class I HELLP syndrome showed maternal complications, but only one patient with class II HELLP showed maternal complications. There might be no differences in the mean gestational ages and birth weights. The neonatal complications were similar in each class. CONCLUSION: Our data suggest that patients with class I HELLP syndrome may be at increased risk for serious maternal complications, but the neonatal complications may be associated with gestational ages.
Alanine Transaminase ; Aspartate Aminotransferases ; Birth Weight ; Blood Platelets* ; Eclampsia ; Female ; Gestational Age ; HELLP Syndrome* ; Humans ; Incidence ; L-Lactate Dehydrogenase ; Liver ; Platelet Count* ; Pre-Eclampsia ; Pregnancy ; Uric Acid

PURPOSE: To analyze the risk factors for posterior migration of a single cage after transforminal lumbar interbody fusion (TLIF). MATERIALS AND METHODS: This study was conducted retrospectively on 48 patients (60 discs) who were followed-up for 1 year after TLIF from January 2015 to January 2017. The patients were divided into two groups: group 1 containing 16 patients (17 discs) with cage migration and group 2 containing 32 patients (43 discs) without it. Information related to cage migration, such as the demographic factors, shape of disc, level and location of the cage inserted, and disc height change, was acquired from the medical records and radiologic images, and the possibility for generating posterior migration of cage was evaluated statistically. RESULTS: The demographic factors and cage-inserted level were similar in the two groups (16 patients in group 1, 32 patients in group 2). In the migration group, number of patients with a pear-type disc, 9 patients, was significantly larger; the disc height change, 1.8 mm, was significantly smaller; and the cage was located frequently on non-center in the anteriorposterior view and center in the lateral view in 9 and 15 out of 16 patients, respectively. CONCLUSION: A pear-type disc shape, small disc height change, cage with non-center on the anteriorposterior view and non-anterior on the lateral view are the risk factors for posterior migration. These factors are important for preventing posterior migration of the cage.
Demography ; Humans ; Medical Records ; Retrospective Studies ; Risk Factors

PURPOSE: To compare the clinical outcomes of single injection adductor canal block (SACB), continuous adductor canal block (CACB), and the concomitant use of transdermal buprenorphine after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 125 patients who underwent TKA were divided into three groups and the clinical results were retrospecitively compared. Group I was comprised of patients with pain controlled by SACB (n=41). Group II consisted of patients with pain controlled by both SACB and transdermal buprenorphine (10 µg/h) (n=44). Group III contained patients with pain controlled by CACB (n=40). The visual analogue scale (VAS) was used as the pain control indicator and the patients were measured on a VAS for resting on the bed (VAS-Rest) at 12 hours, 24 hours, and 48 hours after surgery. The VAS while doing continuous passive motion (VAS-CPM) on the first and second postoperative day was also measured. In addition, the total amount of medications used (Butopahn, Tridol, and Ketorac) for the intravenous patient controlled analgesia (PCA) was counted for 48 hours after surgery. As the indicator of the functional recovery outcome, the incidence of nausea and vomiting was observed for 48 hours after surgery. The maximum knee joint flexion range and maximum walking distance on the first and second postoperative day, and the total length of stay at the hospital were compared. RESULTS: The VAS-Rest was similar in the three groups at 12 hours after surgery, but at 24 hours and 48 hours after surgery, group II and III a lower VAS-CPM and total amount of medications used for PCA than group I (p<0.05). The three groups showed a low incidence of nausea and vomiting, maximum knee joint flexion range, and similar walking distance and total length of stay at the hospital. CONCLUSION: The combination of SACB and transdermal buprenorphine has great pain control effect initially. On the other hand, it is not associated with catheter complications and it is convenient to use and safety toward the renal function. Therefore, the concomitant use of SACB and transdermal buprenorphine can be an effective pain control method after TKA.
Analgesia, Patient-Controlled ; Arthroplasty, Replacement, Knee ; Buprenorphine ; Catheters ; Hand ; Humans ; Incidence ; Knee Joint ; Length of Stay ; Methods ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Vomiting ; Walking

No abstract available.
Female ; HELLP Syndrome* ; Pregnancy