No abstract available.
Fractures, Open* ; Tibia*

No abstract available.
Diabetic Foot*

BACKGROUND: It has been suspected that laparoscopic surgery exacerbates hypothermia to a greater extent than open surgery. Thus, this study was designed to compare the intraoperative thermoregulatory profiles of three different operative techniques: open surgery, low pressure (LP: 8 mmHg) or conventional pressure (CP: 13 mmHg) laparoscopic surgery. METHODS: Forty five patients who were scheduled for radical hysterectomy were allocated to three groups, 15 in each group: group O (open surgery), group LP and group CP. Anesthesia was maintained with 2.5% sevoflurane. Intraoperative core temperature and forearm minus fingertip skin temperature gradients were measured at 15-min intervals during the first three hours. Vasoconstriction threshold was defined by the esophageal temperature at which the skin temperature gradient equalled 0 degree C. RESULTS: All groups were comparable in terms of the characteristics of patients and preoperative body temperatures. Core temperatures and forearm minus fingertip skin temperature gradients were not significantly different among the three groups at all measurements. Thermoregulatory vasoconstrictions were observed in 6 of group O and 6 of laparoscopic surgical patients (4 patients from group LP and 2 patients from group CP). These 12 patients were divided into open (n = 6) and laparoscopic (n = 6) surgery group. There were no significant difference between the groups with regard to the vasoconstriction threshold and threshold time. CONCLUSIONS: Laparoscopic procedures with conventional insufflation pressure have similar profiles in terms of intraoperative thermoregulation, when compared to open surgery. Lowering insufflation pressure to 8 mmHg can not reduce the risk of intraoperative hypothermia.
Anesthesia ; Body Temperature ; Body Temperature Regulation* ; Female ; Forearm ; Gynecologic Surgical Procedures* ; Humans ; Hypothermia ; Hysterectomy ; Insufflation* ; Laparoscopy ; Pneumoperitoneum ; Skin Temperature ; Vasoconstriction

OBJECTIVE: Helicopter ambulance transport (HAT) is a highly resource-intensive facility that is a well-established part of the trauma transport system in many developed countries. Here, we review the benefit of HAT for neurosurgical patients in Korea. METHODS: This retrospective study followed neurotrauma patients who were transferred by HAT to a single emergency trauma center over a period of 2 years. The clinical benefits of HAT were measured according to the necessity of emergency surgical intervention and the differences in the time taken to transport patients by ground ambulance transport (GAT) and HAT. RESULTS: Ninety-nine patients were transferred to a single university hospital using HAT, of whom 32 were taken to the neurosurgery department. Of these 32 patients, 10 (31.3%) needed neurosurgical intervention, 14 (43.8%) needed non-neurosurgical intervention, 3 (9.4%) required both, and 11 (34.4%) did not require any intervention. The transfer time was faster using HAT than the estimated time needed for GAT, although for a relatively close distance (<50 km) without ground obstacles (mountain or sea) HAT did not improve transfer time. The cost comparison showed that HAT was more expensive than GAT (3,292,000 vs. 84,000 KRW, p<0.001). CONCLUSION: In this Korean-based study, we found that HAT has a clinical benefit for neurotrauma cases involving a transfer from a distant site or an isolated area. A more precise triage for using HAT should be considered to prevent overuse of this expensive transport method.
Air Ambulances* ; Ambulances ; Developed Countries ; Emergencies ; Humans ; Korea ; Neurosurgery ; Retrospective Studies ; Trauma Centers ; Triage

BACKGROUND: Pencil-point needle currently are used for spinal anesthesia because of an alleged lowered incidence of postdural puncture headache. Although the direction of the side hole is one of the important factors that might affect the level and the duration of anesthesia, those data are not readily available. The aim of this study was to assess if the side hole direction of pencil-point needle during hyperbaric tetracaine injection affects the level and the duration of anesthesia. METHODS: We induced spinal anesthesia in 80 young men presenting for elective orthopedic surgery. Patients were allocated randomly with the side hole direction of the 25 gauge pencil-point needle in one of the four directions; cephalad, caudad, left lateral, right lateral. Hyperbaric 0.5% tetracaine 15~17 mg (3 to 3.4 ml) was injected with the speed of 0.75 ml/sec. Maximum sensory block level, time to maximum sensory block level, duration of sensory block (2 segments regression time) were assessed by a blinded observer with the pin-prick test and degree of motor block were measured by Bromage motor scale. Data were analysed using the Kruskal-Wallis test followed by the Mann-Whitney U test and chi-square test as appropriate (SAS v. 6.04). RESULTS: Time to maximum sensory block level was significantly fast in group 'cephalad'. Other values have no statistical differences. Post-spinal headache was observed in one case in group 'caudad'. CONCLUSIONS: Using the pencil-point needle, the time to maximum sensory block level was fast in group cephalad but there were no differences in the maximum sensory block level and the duration of sensory block among the four groups.
Anesthesia ; Anesthesia, Spinal* ; Headache ; Humans ; Incidence ; Male ; Needles* ; Orthopedics ; Post-Dural Puncture Headache ; Tetracaine*

No abstract available.
Bony Callus* ; Fractures, Bone*

It is important that the clinical anesthetist pay attention to the interaction of anesthetic induction agents and succinylcholine chloride(S,C,C) on the elctrolyte level especially the plasma potassium ion concentration. For instance succinylcholine chloride has a marked effect upon specific conditions such as severe burns, multiple injury, deabetes insipidus and myopathy. Also secondary plasma changes may bring about non synchronous depolarizing action on the muscle and cause cardiac arrhythmai and even cardiac arrest by the increase of potassium concentration in the plasma. With this in mind the author has randomly selected 30 patients who belong to class l physical status by the classification of the American Society of Anesthesiologist had no abnormal symptoms in respiration, circulation or endocrine and metabolism defects. This paper covers the period from the 10th of April 1979 to the 10th of May 1980 in the Department of Anesthesiology, Hanyang University Hospital. The 30 subjects were divided into 3 groups: a) propanidid with S.C.C. b) thiopental sodium with S.C.C. c) diazepam with S.C.C. The plasma concentration of potassium, sodium and calcium were observed and compared in the pre-induction (control group) and two minute post-induction(study group). The results are follows: 1) The plasma potassium ion concentration showed no any significant changes in the whole group. 2) The plasma sodium and calcium ion concentration also showed no any significant changes in the whole group.
Anesthesiology ; Burns ; Calcium* ; Classification ; Diazepam ; Heart Arrest ; Humans ; Metabolism ; Multiple Trauma ; Muscular Diseases ; Plasma ; Potassium ; Propanidid ; Respiration ; Sodium* ; Succinylcholine* ; Thiopental

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as a sensorineural hearing loss which develops abruptly without definitive causes. Stellate ganglion block (SGB) has been used as one of the treatment modalities in ISSNHL. However, published data establishing the effect of SGB has been slim. We conducted this study to evaluate the effect of SGB according to the factors that may influence the prognosis of the disease. METHODS: We reviewed the records of 343 patients. The control group was managed with medications, and the SGB group was managed with SGB and the same medications. SGB was performed with 5 ml of 1.0% mepivacaine. The pure-tone audiogram was performed after the therapy and Siegel's criteria was used to define the recovery of hearing. RESULTS: The recovery rate of the SGB group was higher than that of the control group (58.1% vs. 42.1%, P < 0.05). The SGB group had a higher recovery rate than the control group in patients treated within 7 days from the onset of symptoms (66.9% vs. 44.1%, P < 0.05), without diabetes mellitus (58.5% vs. 44.9%, P < 0.05), without dizziness (61.6% vs. 44.6%, P < 0.05), or whose initial hearing loss was between 71 and 90 dB (69.4% vs. 38.9%, P < 0.05). CONCLUSIONS: SGB is thought to be a useful therapy for ISSNHL, especially in the patients treated within 7 days, without diabetes mellitus, dizziness, or whose initial hearing loss was severe.
Diabetes Mellitus ; Dizziness ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural* ; Humans ; Mepivacaine ; Prognosis ; Stellate Ganglion*

BACKGROUND: Keratinocytes are the major cells in epidermis, providing barrier components such as cornified cells through the sophisticated differentiation process. In addition, keratinocytes exerts their role as the defense cells via activation of innate immunity. It has been known that pathogen-associated molecular patterns (PAMPs) including double-strand RNA and nucleotides can provoke inflammatory reaction in keratinocytes. OBJECTIVE: The aim of this study is to evaluate the effect of Ampelopsis japonica Makino extract (AE) on PAMPs-induced inflammatory reaction of keratinocytes. METHODS: The effects of AE were determined using poly (I:C)-induced inflammation and imiquimod-induced psoriasiform dermatitis models. RESULTS: In cultured keratinocytes, AE significantly inhibited poly(I:C)-induced expression of inflammatory cytokines, such as interleukin (IL)-1β, IL-6, IL-8 and tumor necrosis factor-α. AE significantly inhibited poly(I:C)-induced release of caspase-1 active form (p20), and down-regulated nuclear factor-κB signaling pathway. In imiquimod-induced psoriasiform dermatitis model, topical application of AE resulted in significant reduction of epidermal hyperplasia. CONCLUSION: These results suggest that AE may be a potential candidate for the treatment of skin inflammation.
Ampelopsis* ; Cytokines ; Dermatitis ; Epidermis ; Hyperplasia ; Immunity, Innate ; Inflammation ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Keratinocytes* ; Necrosis ; Nucleotides ; Pathogen-Associated Molecular Pattern Molecules* ; RNA ; Skin

PURPOSE: Previously, Epstein-Barr virus (EBV) infection was diagnosed by serological examination; currently, many EBV antigen detection methods have been developed and applied clinically for diagnosing EBV infection. To delineate the clinical characteristics of EBV infection, clinical and laboratory findings were evaluated for patients who tested positive in EBV polymerase chain reaction (PCR). METHODS: EBV PCR was conducted in 352 patients admitted to the pediatric ward from January 2004 to December 2006, with more than 2 clinical signs such as fever (> or =37.5degrees C), exudative throat infection, lymphadenopathy, hepatitis of unknown etiology, and splenomegaly. The EBV viral gene was detected by PCR in 115 patients (32%), and the clinical characteristics of these patients were evaluated. Laboratory findings such as leukocytosis, thrombocytopenia, atypical lymphocyte, and alteration in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in peripheral blood were examined. The EBV-specific immunoglobulin M antibody (EBV-IgM Ab) was also tested. RESULTS: Most of the children were younger than 8 years (89%), and the male to female ratio was 1.3:1. Exudative throat infection and fever (> or =37.5degrees C) were observed in all patients. Cervical lymph node enlargement was seen in 36 patients (31%); leukocytosis (WBC> or =10,000/mm3), in 54 patients (47%); and atypical lymphocyte (> or =20%), in 28 patients (24%). EBV-IgM Ab was positive in 33 patients (29%). The younger patients had higher ALT levels and higher incidence of positive EBV-IgM Ab than the older patients. CONCLUSION: The cumulative number of patients diagnosed to have EBV infection by PCR increased markedly for those under 8 years. ALT was higher and EBV-IgM Ab was detected more in younger patients with EBV infection.
Alanine Transaminase ; Aspartate Aminotransferases ; Child ; Epstein-Barr Virus Infections ; Female ; Fever ; Genes, Viral ; Hepatitis ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Incidence ; Leukocytosis ; Lymph Nodes ; Lymphatic Diseases ; Lymphocytes ; Male ; Pharynx ; Polymerase Chain Reaction ; Splenomegaly ; Thrombocytopenia