Background: The major complications of spinal anesthesia are hypotension and bradycardia. In normal condition, hypotension stimulates baroreceptor reflex and compensatory tachycardia is occured. But during spinal anesthesia, there is possibility of a blockade of cardiac sympathetic nerve fibers which would result in increased vagal tone and depress compensatory baroreceptor reflex which is activated during hypotension. Atropine is an anticholinergic agent whose predominant cardiovascular effect was known as increasing heart rate at clinical dose. The purpose of this study was to evaluate hemodynamic effect of atropine during spinal anesthesia. Methods: We compared heart rate, systolic, diastolic and mean arterial pressures and cardiac output in 26 patients of ASA physical status 1, 2 before and after intravenous injection of atropine sulfate 0.01 mg/Kg during spinal anesthesia. Hemodynamic parameters were measured just prior to and 1, 2, 3, 4, 5, 10 minutes after atropine sulfate intravenous injection. The data were analyzed by repeated measures ANOVA. Results: Heart rate, mean blood pressure and diastolic blood pressure after atropine sulfate injection increased with significance. Conclusion: These findings suggest that during spinal anesthesia atropine is effective to produce tachycardia with a dosage of 0.01 mg/Kg in humans. Also hypotension might be improved because atropine makes mean blood pressure and diastolic blood pressure increase.
Anesthesia, Spinal* ; Arterial Pressure ; Atropine* ; Baroreflex ; Blood Pressure ; Bradycardia ; Cardiac Output ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Injections, Intravenous ; Nerve Fibers ; Tachycardia

Study of filariasis to determine important factors involved in its ecology was carried out on Che Ju Island for three consecutive years from 1968 to 1970 in seven villages, three coastal villages and four islets remote from the main island. One village which was located in mountainous area far from the coast was surveyed to serve as control area. About 90% of population inhabiting the study area had at least one blood smear during the three-year period; about one third had three blood smears, and a little over one third had two, and the rest only one examination. Animal and mosquito surveys were carried out at the same period. Followings are the results obtained: All human cases but several had microfilariae identical to the description of B. malayi. The several cases who had morphologically different microfilariae from that of B. malayi need further study for definite conclusion. Five persons randomly sampled from Mf positives and bled every two hours demonstrated nocturnal periodicity between 9 p.m. and 3 a.m. Human is considered to be only reservoir host for human filariasis in the area since animal survey and experimental exposure to the infective larvae of human filaria species showed failure to infect animals. Microfilaria rate, microfilaria density, prevalence of elephantiasis varied by area and age with correlation, which indicated cumulative process of the parasite by repeated exposure and development of host immunity to certain extent. Clinical manifestation of filariasis (symptom complex and elephantiasis ) taken from history and inspection was low in its prevalence with range of 0.9% 11.8% of total population. Only 5.2% of 517 Mf positives had the clinical manifestation. 24.8% of 109 persons with clinical manifestation had microfilaria; 42.9% with symptom complex only, 23.1% with both symptoms and elephantiasis, and none with elephantiasis only were microfilaria positive. Ae. togoi was the only species infected with the filaria. Mosquito infection rate by area showed positive correlation to the Mf rate and density of human population; where the Mf rate and density were high, the mosquito infection rate also high.
parasitology-helminth-nematoda ; ecology ; epidemiology ; Brugia malayi ; filariasis

No abstract available.
Hypoglycemia*

This study was carried out for three years from 1968 to 1970. Three coastal villages and four remote islets of Che Ju Island were surveyed and 90% of all inhabitants were blood smeared. These study areas were grouped into five according to its characteristic for evaluation of mass treatment with diethylcarbamazine citrate (Hetrazan U.S.P.) and insecticide spray in control of human filariasis. To set baseline up for control group, placebo was administered. Followings are the results obtained: 81.1% of all mf positives accepted and completed the mass chemotherapy; main reason for refusal was side reactions told by neighboring villagers who experienced them. 6 mg of hetrazan/kg B.W. x 12 doses given every day turned mf postives to mf negative in 92.1%. The patients who had high mf density remained mf positive in 16.5% whereas only 2.1% for low mf density. 73.8% of mf positives after the treatment showed marked decrease in mf density. Most of them to less than 15n mg/20 mm(3) of blood that can not infect mosquito effectively. Mosquito infection rates were also dropped markedly in areas where mf positive were mass treated. Side reaction induced by diethylcarbamazine was frequent(64%-90%) and various. The most frequent symptom was headache and fever. DDT spray did not influence human mf rate and mosquito infection rate.
parasitology-helminth-nematoda ; chemotherapy-diethylcarbamazine citrate ; epidemiology ; Brugia malayi ; filariasis ; diethylcarbamazine citrate

The effects of lorazepam on cerebral function, metabolism, and hemodynamics were studied in eight dogs receiving a general anesthesia with isoflurane(0.5 vo1%)-50% nitrous oxide-oxy-gen. The effects of benzodiazepine antaronist, flumazenil, were also examined. Lorazepam(0.5 mg/kg) administration did decrease mean arterial pressure(MAP) and herat rate(HR). It did significantly decrease cerebral blood flow(CBF)(measured by posterior sagittal sinus outflow method) by 25% of control value(68+/-l3 vs. 51+/-12ml/100gm/min, meanSD) and cereberal metabolic rate for oxygen(CMRO ) by 17% (3.96+/-1.04 vs. 3.30+/-0.92ml/l00gm/min, mean+/-SD). Electroencephalogram(EEG) converted to high amplitude, predominantly theta and delta activity. Intracranial pressure(ICP) increased markedly. Following flumazenil(0.06 mg/kg) administration, HR recovered completely to control level but MAP increased only at 5 min. compared to pre-flumazenil value and returned to pre-flumazenil level. CBF recovered to control level for 15 min. and deereased after 30 min. compared to control level but higher than pre-flumazenil level about 9-15%. CMRO recovered completely to control leveL EEG changed to an awake pattern after fluamzenil administration. It is concluded that lorarepam decreased cerebral function and metabolism and depressed hemodynamic fuction. Benzodiazepine antag- onist, flumazenil, was effective in reversing cerebral and hemodynamic effects, may be in dose related manner.
Anesthesia, General ; Animals ; Benzodiazepines ; Dogs* ; Electroencephalography ; Flumazenil* ; Hemodynamics ; Lorazepam* ; Metabolism

PURPOSE: Groove pancreatitis is a rare specific form of chronic pancreatitis that extends into the anatomical area between the pancreatic head, the duodenum, and the common bile duct, which are referred to as the groove areas. We present the diagnostic modalities, pathological features and clinical outcomes of a series of symptomatic patients with groove pancreatitis who underwent pancreaticoduodenectomy. METHODS: Six patients undergoing pancreaticoduodenectomy between May 2006 and May 2009 due to a clinical diagnosis of symptomatic groove pancreatitis were retrospectively included in the study. RESULTS: Five cases were male and one case was female, with a median age at diagnosis of 50 years. Their chief complaints were abdominal pain and vomiting. Abdominal computed tomography, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography were performed. Preoperative diagnosis of all patients was groove pancreatitis. Histological finding was compatible with clinically diagnosed groove pancreatitis in five patients and the pathologic diagnosis of the remaining patient was adenocarcinoma of distal common bile duct. Following pancreaticoduodenectomy, four living patients experienced significant pain alleviation. CONCLUSION: The diagnostic imaging modalities of choice for groove pancreatitis are computed tomography and endoscopic ultrasonography. If symptomatic groove pancreatitis is suspected, careful follow-up of patients is necessary and pancreaticoduodenectomy seems to be a reasonable treatment option.
Abdominal Pain ; Adenocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Chronic Disease ; Common Bile Duct ; Diagnostic Imaging ; Duodenum ; Endosonography ; Female ; Head ; Humans ; Male ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Pancreatitis ; Pancreatitis, Chronic ; Retrospective Studies ; Vomiting

Necrotizing fasciitis is a rapidly spreading subcutaneous infection. It can occur in patients after solid organ transplantation. But, the reports for necrotizing fasciitis after liver transplantation are very unusual. We report 2 patients with necrotizing fasciitis caused by bacterial and Aspergillus species infection. Their pre-transplantation condition was very poor due to hepatic encephalopathy, pressure sore, and admission for several months. Patients had a fulminant course for early potent immunosuppression period, despite of aggressive surgical debridement, withdrawal of immunosuppression, and adequate antibacterial and antifungal therapy. Therefore, necrotizing fasciitis has to be recognized as a potential complication after liver transplantation and Aspergillus species has to be added to the list of potential pathogens of surgical wound infections, especially in the setting of liver transplantation.
Aspergillus ; Debridement ; Fasciitis ; Fasciitis, Necrotizing ; Hepatic Encephalopathy ; Humans ; Immunosuppression ; Liver ; Liver Transplantation ; Necrosis ; Organ Transplantation ; Pressure Ulcer ; Surgical Wound Infection ; Transplants

BACKGROUND: Since November 2012, some of over-the-counter (OTC) medications have been sold in convenience store without pharmacist' s supervision. We purposed to examine if the product labels of OTCs provide sufficient information that is appropriate for consumers who may have low health literacy. METHODS: We compared the difficulty of words that are utilized in pharmaceutical product labels of interest (intervention) with those in the 6th grade textbook (control). Pharmaceutical products of interest were comprised of 13 OTCs which have been sold currently in convenience stores. We grouped words into the 4 levels of difficulty based on the Korean Vocabulary Classification for Education, and statistically tested words frequency in each level between OTCs and control. RESULTS: The 13 OTC labels included lay language (easier or equal to language used in primary school) about 10% less; professional language about 10% more (p < 0.001 in all). Labels for analgesics had the longest and most difficult information, followed by common cold preparations, muscle pain relievers as plaster or cataplasma and digestives. CONCLUSION: The 13 OTC labels might fail to provide appropriate information for safety use by consumers in terms of the difficulty level of words. The improvement of labels of OTC medications and consumer education strategies are called for safety use of OTC medications sold in convenience stores.
Analgesics ; Classification ; Common Cold ; Comprehension* ; Education ; Health Literacy ; Myalgia ; Organization and Administration ; Pharmaceutical Preparations ; Product Labeling* ; Vocabulary

End-stage liver disease is often accompanied by portal vein thrombosis (PVT) and large spontaneous splenorenal shunts (SRS). Recently, renoportal anastomosis (RP-A) of spontaneous splenorenal shunts in liver transplantation was reported as an effective method of portal vein reconstruction in cases of PVT with SRS. Here we report a successful case of RP-A in living donor liver transplantation (LDLT). A 46-year-old female with a large spontaneous splenorenal shunt and a portal vein thrombosis propagated to the superior mesenteric vein underwent living donor liver transplantation. At the operation, a side-to-end renoportal anastomosis was done using an interposing cadaveric iliac vein graft. Adequate portal venous blood flow was demonstrated by intraoperative and postoperative Doppler ultrasound studies. She has recovered well with normal graft function and renal function. Renoportal anastomosis for patients with large splenorenal shunts and expansive portal vein thrombosis to the superior mesenteric vein can be an effective and safe technique in patients PV thrombectomy.
Cadaver ; Female ; Humans ; Iliac Vein ; Liver ; Liver Diseases ; Liver Transplantation ; Living Donors ; Mesenteric Veins ; Middle Aged ; Portal Vein ; Splenorenal Shunt, Surgical ; Thrombectomy ; Thrombosis ; Transplants

Securing the source of hepatic artery inflow is essential for living donor liver transplantation. However, sometimes, the hepatic arteries of the recipients are in poor condition for a good anastomosis in living donor liver transplantation; problems include severe arteriosclerosis, intimal dissection, and significant intimal injuries caused by previous transarterial procedures. In these conditions, the right gastroepiploic artery has generally been the preferred artery because of its anatomical location, size and length. Here, a case of successful hepatic artery reconstruction is reported using the right gastroepiploic artery in living donor liver transplantation. The recipient's hepatic arterial intima was severely injured by multiple transarterial chemoembolization and unsuitable for reconstruction. Instead, the right gastroepiploic artery was anastomosed to the hepatic artery of the graft. Arterial blood flow was satisfactory on Doppler ultrasonography during the operation, and complications related to the hepatic artery were not detected during the follow-up period. Therefore, the right gastroepiploic artery may be considered as a suitable alternative for hepatic artery reconstruction in living donor liver transplantation.
Arteries ; Arteriosclerosis ; Follow-Up Studies ; Gastroepiploic Artery ; Hepatic Artery ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Transplants ; Tunica Intima ; Ultrasonography, Doppler