In this article, the statement of ethical statement about animal experiment was omitted.

Pulmonary thromboembolism (PTE) is a common clinical condition related to significant mortality. Furthermore, patients with PTE presenting with right heart thrombus show higher mortality due to rapid hemodynamic deterioration. But the optimal treatment of massive PTE is controversial although various methods have been developed and improved. Here, we presented a case of 56-yr-old woman with massive PTE showing hemodynamic collapse, who was successfully treated with extracorporeal membrane oxygenation (ECMO) adjunct to thrombolytic therapy even without thrombectomy. ECMO was useful for resuscitation and stabilization of the cardiopulmonary function. In conclusion, thrombolytic therapy complemented by ECMO may be an effective treatment option for acute massive PTE with hemodynamic instability.
*Extracorporeal Membrane Oxygenation ; Female ; Heart/physiopathology ; Heparin/therapeutic use ; Humans ; Middle Aged ; Myocardium/pathology ; Pulmonary Artery/*physiopathology ; Pulmonary Embolism/*therapy ; *Thrombolytic Therapy ; Tissue Plasminogen Activator/therapeutic use ; Venous Thrombosis/*physiopathology ; Warfarin/therapeutic use

BACKGROUND AND OBJECTIVES: Life-threatening hypotension during percutaneous coronary interventions (PCI) is devastating for the patient and is associated with fatal adverse outcomes. The aim of our study was to assess the usefulness of intracoronary epinephrine in severe hypotension unresponsive to other measures during PCI. SUBJECTS AND METHODS: We analyzed the Pusan National University Yangsan hospital cardiac catheterization laboratory database to identify patients who underwent PCI from December 2008 to July 2012. The outcomes were changes of blood pressure (BP) and heart rate (HR) before and after intracoronary epinephrine and in-hospital mortality. RESULTS: A total of 30 patients who were initially stable and received intracoronary epinephrine for severe hypotension during PCI were included. Following administration of intracoronary epinephrine (dose 181+/-24.8 microgram), systolic and diastolic BP (from 53.8+/-13.0 mm Hg up to 112.8+/-21.2 mm Hg, from 35+/-7.6 mm Hg up to 70.6+/-12.7 mm Hg, respectively) and HR (from 39.4+/-5.1 beats/min up to 96.8+/-29.3 beats/min) were increased. Additionally, 21 patients (70%) showed hemodynamically acceptable responses to intracoronary epinephrine without the intraaortic balloon pump and temporary pacemaker during the PCI. In-hospital mortality was 17% (n=5). CONCLUSION: Although our study was small, intracoronary epinephrine was found to be well tolerated and resulted in prompt and successful recovery from severe hypotension in most patients when other measures were ineffective. Intracoronary epinephrine could be a safe and useful measure in patients developing severe hypotension during PCI.
Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Vessels ; Epinephrine* ; Heart Rate ; Hospital Mortality ; Humans ; Hypotension* ; Percutaneous Coronary Intervention*

BACKGROUND: Inappropriate sinus tachycardia(IST) manifests chronic nonparoxysmal sinus tachycardia in healthy individuals and is characterized by consistently elevated heart rate and exaggerated responses to minimal physical activity. Heart rate variability(HRV) using 24-hour Holter monitoring represents one of the methods of evaluating the harmony of autonomic nervous system activity. So, authors investigate the autonomic nervous system activity by the HRV in patients with IST. METHODS: We compared the pattern of cardiac sympathetic and parasympathetic activity through the time domain analysis of heart rate variability with 24-hour Holter monitoring between 23 patients with IST and 23 healthy control subjects. None of the patients had organic heart disease as determined by routine laboratory examination and echocardiography. And then, time domain measures(mean NN, SDNN, SDANN, SD, rMSSD, pNN50) were analyzed. RESULTS: The mean age of patients and control were 38+/-10 and 37 9 years, respectively(p=S). The mean clinical heart rate of patients and control was 104 5/min and 72+/-5/min, respectively(p<0.05). Among the time domain indices, mean of all normal RR intervals(mean NN), standard deviation of all normal RR intervals(SDNN), standard deviation of mean RR interval(SDANN), mean of standard deviations of all normal RR intervals(SD), root mean square successive differences between adjacent normal RR intervals(rMSSD), and percent of difference between adjacent normal RR intervals(pNN50) in the patient group were significantly shorter compared to control group(p<0.01). CONCLUSION: In IST, cardiac vagal influence on the heart rate is blunted.
Autonomic Nervous System ; Echocardiography ; Electrocardiography, Ambulatory ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Motor Activity ; Tachycardia, Sinus

The serum cholinesterase level is influenced by a variety of disease states, especially in pregnancy as is well established now, although the reasons for the fall in the enzyme in certain conditions and its clinical significance are less clear. This known decrease in plasma cholinesterase activity could lead to the conclusion that the duration of paralysis from succinylcholine will be prolonged in pregnant patients. The purposes of this study were to evaluate the serum cholinesterase activity in nonpregnant women of the child-bearing age group and pregnant women and to evaluate the changes of serum cholinesterase following succinylcholine administration. The results were as follows: 1) The mean value of serum cholinesterase in 60 nonpregnant women of the child-bearing age group was 992.29-1,112.27 U/L. 2) The mean value of serum cholinesterase in 60 pregnant women was 769.40-826-27 U/L. 3) Pregnant women had a diminution of serum cholinesterase activity compared with nonpregnant women of the child-bearing age group, and this diminution was statistically very significant (p<0.01). 4) In Cesarean section patients treated with succinylcholine, there was further diminution of serum cholinesterase activity (P<0.01). With the above results, the possible clinical importance of marked diminution of a serum cholinesterase activity in pregnant women is outlined.
Cesarean Section* ; Cholinesterases* ; Female ; Humans ; Paralysis ; Plasma ; Pregnancy ; Pregnant Women ; Succinylcholine

Thyrotoxic periodic paralysis (TPP) occurs in 2% of the asian patients with hyperthyroidism and is characterized by bilateral flaccid paralysis of the extremity, especially lower limbs. It is well-known that hypokalemia is usually accompanied by TPP. However, hypophosphatemia is usually mild and well neglected. Although paralysis is generally recovered without treatment, in some cases, patients with TPP may die due to cardiopulmonary complications, such as cardiac arrhythmia. Therefore, proper and rapid replacement of potassium is essential. But it should be acknowledged that replacement may cause a rebound. TPP is often unrecognized and over-treated in the emergency room due to its non-specific symptoms. This is why clinicians must be familiar with this disease and its diagnostic clues such as Echocardiography change and clinical features. This is a case report of a 29-year-old male presenting with TPP accompanied by hypokalemia, hypophosphatemia and second degree atrioventricular block, who showed rebound hyperkalemia and hyperphosphatemia after rapid replacement of electrolytes. EKG changed to the normal sinus rhythm in the end after the correction of the electrolytes.
Adult ; Arrhythmias, Cardiac ; Asian Continental Ancestry Group ; Atrioventricular Block ; Echocardiography ; Electrocardiography ; Electrolytes ; Emergencies ; Extremities ; Humans ; Hyperkalemia ; Hyperphosphatemia ; Hyperthyroidism ; Hypokalemia ; Hypophosphatemia ; Lower Extremity ; Male ; Paralysis ; Potassium

Anesthesiologists should have close relationship with muscle relaxants and their reversals in clinical practice. Nowadays, the nondepolarizaing blocker is interested more than the depolarizing blocker and its reversibility. The composition of atropine, neostigmine and glycopyrrolate has been investigated for many years in korea. This study was undertaken to investigate the effects of glycopyrrolate(7ug/kg) and pyridostigmine(200ug/kg) mixture for pancuronium reversal on the heart rate and the blood pressure during halothane and enflurane anesthesia. The results were as follows: 1) In the halothane group: significantly increased mean blood pressure as compared with the enflurane group at 2,4,6 minutes and no significant difference was found after 8 minutes. 2) In the halothane group: significantly increased pulse rate at 2 and 4 minutes and decreased after 12 minutes. 3) In the Enflurane group: significantly increased pulse rate at 2,4 and 6 minutes and no increase after 8 minutes. 4) In the halothane group: significantly decreased pulse rate as compared with the enflurane group after 6 minutes and thereafter. 6) There was no significant arrhythmia but 2 cases of the bradycardia were observed in the halothane group at 14 minutes which were treated by atropine.
Anesthesia* ; Arrhythmias, Cardiac ; Atropine ; Blood Pressure* ; Bradycardia ; Cardiovascular System ; Enflurane* ; Glycopyrrolate ; Halothane* ; Heart Rate* ; Heart* ; Korea ; Neostigmine ; Pancuronium ; Pyridostigmine Bromide

The localized eosinophilic granulomatous lesions of the stomach are rare benign tumorous conditions resembling submucosal tumors. They can be divided into two types. One is an inflammatory fibroid polyp. The other is an eosinophilic granuloma due to migration of Anisakis-type larva in the alimentary tract. The latter is usually found in the gastric body and anterior wall of the angle, and appears as a submucosal tumor. Histologically, the granuloma exhibits a characteristic lamellated structure consisting of a necrotic center with or without the worm, surrounded by layers of granulation tissue and eosinophilic infiltration. The present case is a 50 year-old male presenting with an episode of profuse melena. An emergency esophagogastroduodenoscopy revealed a 2x1.5cm sized, irregularly shaped ulcerative lesion with elevated margins and prominent folds convergence. Despite the endoscopic injection of hypertonic saline-epinephrine solution due to a recent bleeding stigmata, the patient experienced a rebleeding during hospitalization, The locally excised specimen showed an eosinophilic granuloma having a central necrosis. Although the larval body of Anisakis was not found, the lesion was diagnosed as a parasitic eosinophilic granuloma of the stomach.
Anisakis ; Christianity ; Emergencies ; Endoscopy, Digestive System ; Eosinophilic Granuloma* ; Eosinophils* ; Granulation Tissue ; Granuloma ; Hemorrhage* ; Hospitalization ; Humans ; Larva ; Leiomyoma ; Male ; Melena ; Middle Aged ; Necrosis ; Polyps ; Stomach* ; Ulcer

Induction of general anesthesia with tracheal intubation is routine procedure but causes significant tarchycardia and hypertension. Many approaches have been tried to attenuate these circulatory response. The effects of small dose fentanyl on arterial pressure and heart rate increase during intubation were studied in 40 normotensive patients, who were randomly allocated to two groups, receiving saline (Control group) or fentanyl 2ug/kg (Fentanyl group), in a double blind fashion during anesthetic induction with thiopental 5mg/kg. Systolic, diastolic, mean arterial pressure and heart rate were measured and rate pressure product was calculated. All parameters were significantly different between two groups (p<0,05) and control group was significant increase in blood pressure and heart rate compared with pre-induction value but fentanyl group was relatively small changes of blood pressure and heart rate (p<0.01). After tracheal intubation, incresed blood pressure was returned to pre-induction value within two to three minutes in fentanyl group but heart rate was not returned pre-induction value within 5 minutes. Dose of fentanyl that are low enough to cause any side effects of drug itself, no notable side effects were observed during study and recovery.
Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Fentanyl* ; Heart Rate ; Humans ; Hypertension ; Intubation* ; Thiopental

Background and Objectives: Large clinical studies of sodium/glucose cotransporter 2 (SGLT2) inhibitors have shown a significant beneficial effect on heart failure-associated hospitalization and cardiovascular events. As SGLT2 is known to be absent in heart cells, improved cardiovascular outcomes are thought to be accounted for by the indirect effects of the drug. We sought to confirm whether such benefits were mediated through SGLT2 expressed in the heart using myocardial infarction (MI) model. Methods: Mice pre-treated with empagliflozin (EMPA), an SGLT2 inhibitor, showed a significantly reduced infarct size compared with the vehicle group three days post-MI.Interestingly, we confirmed SGLT2 localized in the infarct zone. The sequential changes of SGLT2 expression after MI were also evaluated. Results: One day after MI, SGLT2 transiently appeared in the ischemic areas in the vehicle group and increased until 72 hours. The appearance of SGLT2 was delayed and less in amount compared with the vehicle group. Additionally, there was a significant difference in metabolites, including glucose and amino acids in the 1 H nuclear magnetic resonance analysis between groups. Conclusions Our work demonstrates that SGLT2 is transiently expressed in heart tissue early after MI and EMPA may directly operate on SGLT2 to facilitate metabolic substrates shifts.