No abstract available.
Intracranial Aneurysm*

An analytical observation was carried out on clinical symptoms, physical findings, etiology, precipitating factors, pulse rate, and blood pressure manifested by 115 patients admitted to the Kyung hee university Hospital under the diagnosis of congestive heart failure for a period of October 1971 to September 1974. The results were as follows: 1. The disease affected female 1.4 times more frequently than male and occured most frequently in the 6th decade (26.1%), and its incidence decreased in the 7th decade (22.6%). 2. The important causes of congestive heart failure were hypertensive heart disease (39.7%), rheumatic heart disease (26.1%), cor pulmonale (13.9%), atherosclerotic heart disease (6.1%), postpartum heart failure (6.1%) and pericardial disease (3.5%). The unknown etiology was 3.5% of all cases. 3. The most common precipitatiog factors of the 106 patients of congestive heart failure were infections (59.5%), especially in the upper respiratory tract infection (37.8%). The physical exertion, pregnancy and labor, psychic stress, angina, myocardial infarction, and discontinuation of Tapazol and digitalis were followed. 4. The most common symptoms and signs were the dyspnea (93%), and the next common were pulmonary rales (65.2%), hepatomegaly (59.1%), distention of cervical vein (55.7%), pitting edema (44.3%) and cardiac murmur (38.3%) on admission. 5. The increased pulse rate over 101/min. was about 38.3%, but less than 60/min. was found in 4.3% only. 6. The electrocardiographic findings were abnormal except one case out of 107 cases. The left ventricular hypertrophy (48.1%), atrial fibrillation (24.5%), and bundle branch block (21.7%) were frequently observed. 7. The range of systolic blood pressure measured in 43 patients who had been suffered from hypertensive heart disease were disclosed that 221-240 mmHg (23.3%), 161-180mmHg (20.9%), and 181-200mmHg (20.9%) in order.
Atrial Fibrillation ; Blood Pressure ; Bundle-Branch Block ; Diagnosis ; Digitalis ; Dyspnea ; Edema ; Electrocardiography ; Estrogens, Conjugated (USP)* ; Female ; Heart Diseases ; Heart Failure* ; Heart Murmurs ; Heart Rate ; Hepatomegaly ; Humans ; Hypertrophy, Left Ventricular ; Incidence ; Male ; Myocardial Infarction ; Physical Exertion ; Postpartum Period ; Precipitating Factors ; Pregnancy ; Pulmonary Heart Disease ; Respiratory Sounds ; Respiratory Tract Infections ; Rheumatic Heart Disease ; Veins

An analytical observation was carried out on clinical symptoms, physical findings, etiology, precipitating factors, pulse rate, and blood pressure manifested by 115 patients admitted to the Kyung hee university Hospital under the diagnosis of congestive heart failure for a period of October 1971 to September 1974. The results were as follows: 1. The disease affected female 1.4 times more frequently than male and occured most frequently in the 6th decade (26.1%), and its incidence decreased in the 7th decade (22.6%). 2. The important causes of congestive heart failure were hypertensive heart disease (39.7%), rheumatic heart disease (26.1%), cor pulmonale (13.9%), atherosclerotic heart disease (6.1%), postpartum heart failure (6.1%) and pericardial disease (3.5%). The unknown etiology was 3.5% of all cases. 3. The most common precipitatiog factors of the 106 patients of congestive heart failure were infections (59.5%), especially in the upper respiratory tract infection (37.8%). The physical exertion, pregnancy and labor, psychic stress, angina, myocardial infarction, and discontinuation of Tapazol and digitalis were followed. 4. The most common symptoms and signs were the dyspnea (93%), and the next common were pulmonary rales (65.2%), hepatomegaly (59.1%), distention of cervical vein (55.7%), pitting edema (44.3%) and cardiac murmur (38.3%) on admission. 5. The increased pulse rate over 101/min. was about 38.3%, but less than 60/min. was found in 4.3% only. 6. The electrocardiographic findings were abnormal except one case out of 107 cases. The left ventricular hypertrophy (48.1%), atrial fibrillation (24.5%), and bundle branch block (21.7%) were frequently observed. 7. The range of systolic blood pressure measured in 43 patients who had been suffered from hypertensive heart disease were disclosed that 221-240 mmHg (23.3%), 161-180mmHg (20.9%), and 181-200mmHg (20.9%) in order.
Atrial Fibrillation ; Blood Pressure ; Bundle-Branch Block ; Diagnosis ; Digitalis ; Dyspnea ; Edema ; Electrocardiography ; Estrogens, Conjugated (USP)* ; Female ; Heart Diseases ; Heart Failure* ; Heart Murmurs ; Heart Rate ; Hepatomegaly ; Humans ; Hypertrophy, Left Ventricular ; Incidence ; Male ; Myocardial Infarction ; Physical Exertion ; Postpartum Period ; Precipitating Factors ; Pregnancy ; Pulmonary Heart Disease ; Respiratory Sounds ; Respiratory Tract Infections ; Rheumatic Heart Disease ; Veins

BACKGROUND: Acutely induced hypoxia causes an increase in the mean arterial pressure, cardiac output and oxygen consumption. However, comparisons of hemodynamic changes and oxygen consumption between subjects with and without anesthesia are rare. The purpose of this study was to examine and compare the hemodynamic changes and oxygen availability after acute apnea between the dogs with and without anesthesia. METHODS: Apnea was induced to 19 healthy mongrel dogs. Group 1 (N=10) constituted dogs with anesthesia and group 2 (N=9) constituted dogs without anesthesia. Hemodynamic data and oxygen levels were rapidly measured with 1 minute intervals. RESULTS: The survival time of group 1 was longer than that of group 2. The mean arterial pressure increased in group 1. Although the cardiac outputs in both groups increased at the same time course in early phase of apnea, the preload values increased more rapidly in group 1. Systemic vascular resistance decreased at 2 and 3 minutes of apnea in group 1 but not in group 2. The oxygen extraction ratio increased significantly at 4 and 5 minutes of apnea in group 2. CONCLUSION: In this study the dogs with anesthesia had a prolonged survival time compared to the dogs without anesthesia. Most hemodynamic values did not differ significantly between the two groups, except for an increased mean arterial pressure and decreased systemic vascular resistance in the dogs with anesthesia. It was suggested that the cause of early death in the dogs without anesthesia was decreased oxygen delivery.
Anesthesia* ; Animals ; Anoxia ; Apnea* ; Arterial Pressure ; Cardiac Output ; Dogs ; Hemodynamics* ; Oxygen Consumption ; Oxygen* ; Vascular Resistance

The use of hyperventilation technique to reduce intracranial pressure for surgical intervention of cerebral aneurysm has been well documented and most common in general practice. The decrease of blood flow with hyperventilation may aggravate pre-existing ischemic region. On this occasion it was suggested that cerebral intracellular metabolic acidosis may be accentuated so that its metabolic status could be measured from the analysis of cerebrospinal fluid gases. Hyperventilation can cause an increase in PH of cerebrospinal fluid due to the decrease of PCO but if hyperventilation is induced chronically, an elevated PH returns gradually to its previous normal value by loss of HCO, from the cerebrospinal fluid. Anesthesia was maintained with hyperventilation throughout the cerebral aneurysm surgery then cerebrospinal fluid and arterial blood gases were measured at regular intervals. PH in cerebrospinal fluid at 1 hour after hyperventilation revealed severe metabolic acidosis and arterial blood gases showed respiratory alkalosis. At 6 hours after hyperventilation the PH in cerebrospinal fluid in-creased markedly but the changes of HCO2were not significant from its control value and accord-ingly metabolic acidosis in cerebrospinal fluid was improved. It was suggested that compensatory mechanism for PH of cerebrospinal fluid to return to its low value by decreasing HCO2was shown. If such mechaniwm does not exist cerebrospinal fluid HCO2must he increased theoretically.
Acidosis ; Alkalosis, Respiratory ; Anesthesia ; Cerebrospinal Fluid ; Gases ; General Practice ; Hydrogen-Ion Concentration ; Hyperventilation* ; Intracranial Aneurysm* ; Intracranial Pressure ; Reference Values

Morphine anesthesia for cardiac surgery became very popular since Lowenstein at al. reported that 1.5~3.0mg/kg of morphine administered intravenously during ventilating with 100% oxygen did not alter cardiovascular dynamics in patients without heart disease and improved them in patients with aortic valve disease. However, morphine anesthesia soon appeared to cause significant disadvantages and many problems such as intraoperative awareness, histamine reactions marked increases in intraoperative blood pressure and prolonges postoperative respiratory depression. This study was primarily undertaken to evaluate the effects of intraspinal morphine anesthesia and compare them with the problems resulting from intravenous morphine anesthesia. We had 25 patients scheduled for open heart surgery. They were anesthetized mainly by intraspinal morphine and intravenous tranquilizers. Spinal tapping using Whitacre pencil point needle was performed in a sitting position at a level between L2-L4 and spinal fluid was drawn and mixed with morphine by a 10cc syringe and was administered rapidly with barbotage 3 times. Then the patient was given pentothal and anectin, and was intubated, followed by intravenous administration of Ativan or valium. The patient's respiration was controlled with 100% oxygen throughout the entire surgery. 1) The dosages of intraspinal morphine ranged between 6~10mg which was bridfly calculated by 0.1mg/kg with some variation according to heights and patients conditions. 2) Activan or valium was administered intravenously to eliminate intraoperative awareness. Ativan was preferred to valium for valve surgery. 3) Cardiovascular dynamics appeared stable throughout the intraoperative, recovery and ICUcare periods. 4) Respiratory depression seemed to be most serious between 12~16hour after intraspinal injection of morphine. Therfore this technique is recommended only in patients who need a controlled respiration for more than 12 hours because respiratory arrest occurs more commonly at that hour. 5) Respiratory care in the ICU was very effective satisfactory without any further medication for synchronisation between patient and respiratior becauses of the length of respiratory depression. 6) Somnolence lasts 24~36hours with no inadvertent reactions. 7) Well documented complications such as respiratory depression, pruritis and urinary retention were not problems in patients for open heart surgery. 8) The anesthesia induced by intraspinal morphine injection was satisfactory in anesthesia practice for open heart surgery. Therefore, we have called this procedure which has not been reported yet intraspinal morphine anesthesia.
Administration, Intravenous ; Anesthesia* ; Aortic Valve ; Blood Pressure ; Diazepam ; Heart Diseases ; Heart* ; Histamine ; Humans ; Injections, Spinal ; Intraoperative Awareness ; Lorazepam ; Morphine* ; Needles ; Oxygen ; Pruritus ; Respiration ; Respiratory Insufficiency ; Spinal Puncture ; Syringes ; Thiopental ; Thoracic Surgery* ; Urinary Retention

A reliable intravenous route is extremely important not only in surgical patients for prolonged administration of fluid and massive transfusion but also in patients with peripheral vascular collapse for hyperalimentation and critical patients. Since the subclavian vein catheterisation in a supraclavicular approach was introduced by J.K. Jeon in 1974 in our institution, it has been extremely popular for prolonged intravenous administration of fluids ratehr than for the measurement of central venous pressure. Therefore, the method of supraclavicular cannulation was modified by was of a more simple and easier method, using a 2inch Angiocath instead of an 8 inch intracath. We had 300 cases of supraclavicular subclavian vein cannulation which were done in various surgical patients of all ages. We have observed the following advantages of this method(2inch Angiocath) over the previous method. 1) No bleeding around the catheter 2) Simple and easy technique 3) Easy to fix the catheter 4) No need to wear gloves 5) Less complications such as air and catheter embolism 6) Bigger internal diasmeter in the Angiocath even with the sam size 7) Easy to keep the catheter open 8) Cheaper The subclavian vein is located within the costo-clavicular-scalene triangle and is approximately 3 to 4cm long and 1 to 2 cm in diameter in adults. The patient is placed in a supine and trendelenburg position to allow the subclavian vein to distend and to help prevent an air compolism when the vessel is cannulated. Follwing the preparation of the supraclavicular foses, a 2 inch Anglocath with a 10 cc syringe attached is inserted and advanced in the direction of the innominate vein, approximately 1cm from the junction of the clavicle and the lateral border of the sternocleidomastoid muscle(Clavisternomastoid angle. Fig.2). It is important to maintain a negative pressure while advancing the needle until a free flow of blood is observed in the syringe. When blood is observed in the syringe, a catheter is inserted and threaded all the way to the end then the needle is removed. The tip of the catheter is connected to the intravenous solution and fixed with adhesive tape. There is no need to press the puncture site or change the position in order to prevent bleeding around the catheter. The complications of a subclavian vein cannulation with an Anglocath are the same as with an Intracath. Those are pneumothorax, hydrothorax, hemothorax, catheter embolism, thrombosis and sepsis but the incidence is lower in this method. In the supraclavicular cannulation in our series, we have not experienced any of the above complications among the 300 cases done her due to the fact that only a few well qualified doctors have performed this technique.
Adhesives ; Administration, Intravenous ; Adult ; Brachiocephalic Veins ; Catheterization* ; Catheters ; Central Venous Pressure ; Clavicle ; Embolism ; Head-Down Tilt ; Hemorrhage ; Hemothorax ; Humans ; Hydrothorax ; Incidence ; Needles ; Pneumothorax ; Punctures ; Sepsis ; Subclavian Vein* ; Syringes ; Thrombosis

PURPOSE: Due to its size and locatin, the liver is frequently injured in abdominal trauma. Recently, nonoperative management for liver injuries has been extended due to the development CT imaging, intensive care units, and their equipment and techniques. Herein, patients with traumatic liver injury were analyzed to evaluate its treatment and prognostic factors. METHODS: From 2001, January to 2003, July, 65 patients at our facility were confirmed to have traumatic liver injury. The operative or nonoperative managements were decided on the basis of the systolic blood pressure if no peritoneal irritation sign was noted. If the systolic blood pressure was stable, or recovered to within the normal range following hydration and transfusion at the emergency room, patients were managed nonoperatively. Hemodynamically unstable patients were managed operatively. The data were analysed using the SPSS program (Chi-squared tests and logistic regression analyses). RESULTS: 48 patients were treated nonoperatively, with 3 mortalities. The overall mortality rate was 15.8%, but only 6.4% in the nonoperative management group, compared to 67% in operative management group. In a Multivariate analysis the systolic blood pressure was found to be a reliable factor in traumatic liver injury and the mentality and ISS (injury severity score) reliable in finding complications in the nonoperative management group. The mentality was found statistically reliable for determining mortality in the operative management group, with the exception for the systolic blood pressure. CONCLUSION: The systolic blood pressure was an important indicator when considering the treatment plan in traumatic liver injury. An extensive study will be required that incorporates both nonoperative and operative management groups.
Blood Pressure ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Liver* ; Logistic Models ; Mortality ; Multivariate Analysis ; Reference Values

PURPOSE: Headache is a frequent symptom in pediatric practice, but the prevalence of chronic recurrent headache was estimated in several studies with wide variations, because of inadequate expression and differences in case definition in children. Headache classification of International Headache Society is usually used in adults, but the application of it to children is uncommon, so we tried to diagnosis children with headache by using International Headache Society Classification. METHODS: We analyzed the clinical pictures, physical examinations including neurologic examination, PNS series, EEG and CT or MRI in 53 children with nonprogressing recurrent headache over than one month, who visited to pediatric department of Dong-A University hospital from January, 1995 to Feburary, 1996 and diagnosed them by using International Headache Society Classification. RESULTS: 1) The sex ratio between male and female was 1:1.2. 2) Diagnosed groups consisted of children with migraines in 22 cases(41.5%), tension-type headache in 19 cases(35.9%), coexisting migraine and tension-type headaches in 5 cases(9.4%), miscellaneous headaches not associated with structual lesion in 1 case(1.9%), headache associated with vascular disorders in 2 cases(3.8%), headache associated with nonvascular intracranial disorder in 1 case(1.9%), headache due to facial pain in 3 cases(5.6%). 3) Of 22 migraine cases, 13 cases(59.1%) had migraine with aura, 8 cases(40.9%) have migraine without aura and of 19 tension-type headache cases, 8 cases(42.1%) have episodic type, 11(57.9%) cases have chronic type. 4) Of 53 cases with recurrent headache, 3 cases(6%) had abnormal findings in CT or MRI. 5) Of 53 cases with recurrent headache, 9 cases(17%) had abnormal findings in EEG. CONCLUSIONS: International Headache Society Classifications are useful, but the diagnostic criteria are too strict for children, especially in migraine and tension type headache.
Adult ; Child* ; Classification* ; Diagnosis ; Electroencephalography ; Facial Pain ; Female ; Headache* ; Humans ; Magnetic Resonance Imaging ; Male ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Neurologic Examination ; Physical Examination ; Prevalence ; Sex Ratio ; Tension-Type Headache

Voiding difficulty has been well documented as a complication after spinal anesthesia. This occurs somewhat more frequently after spinal anesthesia than after general anesthesia. However, the cause and mechanism of postspinal voiding difficulty has not been clarified, so in this study we have attempted to discover the mechanism of the voiding difficulty. Cystometry was performed on 30 healthy women who were scheduled for simple hystrectomy and the results were compared in three different groups. In the first group, cystometry was performed on 30 cases under only the premedication before the induction of anesthesia. In the second group, it waa performed on 14 cases under general anesthesia and in the 3 rd group, performed on 16 cases under spinal anesthesia. The results were as follows: 1) In the first group of 30 cases before anesthesia, the first voiding desire starts at approximately 150-250 ml (24 cases) and the average pressure of the bladder at the first voiding desire is approximately 5-10 cm H2O(19 cases). The volume at the maximum voiding desire is about 450-550ml(20 cases) and its pressure was 16-20cm H2O(12 patients). The average pressure tension curve of the cystometry was very similar to the normal one. 2) In the 2nd group of 16 cases under general anesthesia, measurement was not obtainable at the first and maximum voiding desire because they were under the effect of the anesthesia. The average pressure tension curve of the cystometry was lower than Group I (Fig. 1) and the critical volume which is designated as the volume at the point where the pressure of the bladder increased sharply in cystometry, was about 700ml which was larger than Group I. 3) In the 3 rd group of 16 cases, the cystornetry showed on the average pressure tension curve that the increase of the pressure was proportional to the volume in the bladder and no critical volume seems to be observed. It means that there is no contraction of the bladder muscle due to the paralysis of the sacral parasympathetic nerves which innervate the detrusor muacle of bladder. As a result of this study, we came to the conclusion that a cause of post-spinal urinary retension is the residual effect of local anesthetics prolonging the depression of the autonomic parasympathetic innervation system. These fibers from S2-S4 are very susceptible to analgesic solutions.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal* ; Anesthetics, Local ; Depression ; Female ; Humans ; Paralysis ; Premedication ; Urinary Bladder