BACKGROUND: The analgesic properties of the nonsteroidal antiinflammatory drugs (NSAIDs) have been attributed to their effects on the peripheral synthesis of prostaglandins. Although the preoperative use of NSAIDs has been increasing because of concerns regarding the side effects of opioid analgesics but results of clinical preemptive analgesia studies remain inconclusive. So, we studied the efficacy of preemptive analgesic effects of tenoxicam, new NSAID, on postoperative continuous intravenous analgesia with morphine. METHODS: We studied 40 parturients, undergoing cesarean section, ASA class I or II, randomly divided into two groups. Tenoxicam group were injected tenoxicam 0.3 mg/kg and control group were injected normal saline 3 ml at ten min. before induction. For both groups morphine 0.1 mg/kg was administered as loading dose and 0.015 mg/kg/hr as maintenance dose. We examined verbal quantitative score (VQS) at postoperative 30 min, 1, 6, 12, 24 and 48 hr. Maternal satisfaction, side effects, hepatic and renal function also evaluated after pain control. RESULTS: The values of VQS showed no significant differences between two groups 30 min, 1 and 6hr after start of morphine infusion, but there was significant decrease in tenoxicam group compared to control group 12, 24 and 48 hr after start of morphine infusion (p<0.05). There was no significant difference in maternal satisfaction between two groups and also there were no significant differences in the overall incidences of side effects between two groups. CONCLUSIONS: Preoperative single injection of tenoxicam showed incomplete preemptive analgesic effects on postoperative pain control after cesarean section.
Analgesia* ; Analgesics, Opioid ; Anti-Inflammatory Agents, Non-Steroidal ; Cesarean Section* ; Female ; Incidence ; Morphine* ; Pain, Postoperative ; Pregnancy ; Prostaglandins

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) has long been recognized as a random phenomenon. Recent studies, however, suggest that activation sequence during atrial fibrillation is not entirely disorganized and organized activations as the transitional rhythm exists in the process of conversion from atrial fibrillation to atrial flutter. The purpose of this study is to characterize the process and significance of transitional rhythm during conversion of atrial fibrillation to atrial flutter. MATERIALS AND METHODS: In 9 patients with paroxysmal atrial fibrillation, 13 episodes that atrial fibrillation spontaneously converted to atrial flutter during electrophysiological study were analyzed. To map the right atrium (RA), 10 bipolar Halo catheter was positioned in the lateral free wall of the RA and multielectrode catheters were positioned in the coronary sinus, high RA, and His bundle area, respectively. Calculation of cycle length (CL) was performed with digital caliper during atrial fibrillation and atrial flutter. Direction of activation sequences was compared between transitional rhythm and following atrial flutter. RESULTS: During conversion of atrial fibrillation to atrial flutter, characteristic findings were observed as follows. 1) There was a gradual increase in atrial fibrillation cycle length before transitional rhythm. 2) A pause appeared in atrial fibrillation immediately prior to transitional rhythm, and between transitional rhythm and following atrial flutter. 3) Direction of activation sequences of the transitional rhythm to atrial flutter was concordant in 9 episodes and discordant in 4 episodes. 4) Spontaneous termination of atrial flutter (n=3) was also preceded by organized rhythm showing different sequence of activations from those of atrial flutter. CONCLUSION: A stereotypical pattern of activation sequence exists in the process of conversion of atrial fibrillation to atrial flutter. The occurrence of transitional rhythm influences the activation sequence of atrial flutter. Spontaneous termination of atrial flutter also preceded by transiently changing pattern of activation.
Atrial Fibrillation* ; Atrial Flutter* ; Bundle of His ; Catheters ; Coronary Sinus ; Heart Atria ; Humans

BACKGROUND: trial fibrillation (AF) causes electrical remodeling of the atrium that plays an important role in increasing atrial vulnerability and the perpetuation of AF. The regional variation and heterogeneities of AF-induced electrical remodeling in patients with AF remain unclear. The purpose of present study was to test the hypothesis that regional heterogeneity of the atrial electrical properties including sinus node dysfunction is more apparent in patients with chronic AF than in patients with paroxysmal AF. METHODS: The study group consisted of chronic AF (CAF, n=19), paroxysmal AF (PAF, n=19) and control group (CON, n=13). Monophasic action potential duration 90% (MAPD90) and atrial effective refractory period (AERP) were measured at 9 different sites in the right atrium using MAP catheter. Dispersion of MAPD90 and AERP were calculated from the difference between the maximum and minimum value at 9 sites, respectively. Intra-atrial conduction time (IACT) was calculated from the distance between the earliest activation and the latest one of the electrograms by 20-pole steerable catheter with 2-mm interelectrode distance which was positioned along the tricuspid annulus anterior to the crista terminalis. To evaluate sinus node function, post shock sinus node recovery time (PSRT) was measured. A rate corrected PSRT (PSRTc) was calculated from the difference between PSRT and basic sinus cycle length. RESULTS: MAPD90 significantly shortened in patients with CAF (227.0+/-32.6 ms) compared with PAF (246.8+/-38.3 ms, p<0.05) and CON (239.1+/-39.3 ms, p<0.05), but AERP was not significantly different among 3 groups. The regional changes and dispersion of MAPD90 and AERP in patients with CAF did not differ from those of PAF and CON. IACT was prolonged in CAF group (73.8+/-22.5 ms) compared with PAF (58.2+/-8.0 ms, p<0.05) and CON groups (51.6+/-12.3 ms, p<0.05). IACT in CAF group (73.8+/-22.5 ms) was significantly prolonged compared with CON groups (51.6+/-12.3 ms, p<0.05) and was longer than that of PAF groups (58.2+/-8.0 ms) without statistical significance. PSRTc was longer in CAF group (758.3+/-525.8 ms) than in PAF group (209.5+/-125.0 ms, p<0.05). CONCLUSION: Electrical changes defined as shortened MAPD90, prolonged IACT and PSRTc were more apparent in patients with CAF compared with PAF. However, these were neither accompanied by the regional variations nor dispersion of refractoriness of the atrium. These findings suggest that regional heterogeneities of electrical properties are not related to the chronicity of atrial fibrillation.
Action Potentials ; Atrial Fibrillation* ; Atrial Remodeling ; Catheters ; Heart Atria ; Humans ; Population Characteristics ; Shock ; Sick Sinus Syndrome ; Sinoatrial Node

BACKGROUND AND OBJECTIVES: Although aortic intramural hemorrhage (AIH) is different from classic aortic dissection (AD) in terms of absence of continuous direct flow communication through intimal tear, the same treatment strategy, emergent surgical repair, has been applied for patients with AIH involving the ascending aorta. The impact of different false lumen hemodynamic has not been seriously investigated and clinical features of AIH and AD have not been directly compared. METHODS: From 1990 to December 1998, clinical evaluation with various imaging modalities confirmed the diagnosis of proximal AD and AIH in 73 and 18 patients, respectively. Direct comparison of clinical data including clinical features, hospital course, and follow-up data was performed retrospectively. RESULTS: Patients with AIH were older (69+/-10 years-old 49+/-14, p<0.05) and female was predominant in AIH (15/18 vs. 26/73, p<0.05). The development of mediastinal hemorrhage, pericardial and pleural effusion was more frequent in AIH than in AD. In-hospital mortality was same in both groups (11% in AIH vs. 17% in AD, p=NS). Although medical treatment was more frequently selected in AIH group (61% vs. 12%, p<0.05) due to old age and other associated medical diseases, mortality rate with medical treatment was much lower in AIH than in AD (9% vs. 66%, p<0.05). Among 11 patients with AIH, in whom medical treatment was chosen, 10 patients were discharged without any event. In follow-up imaging studies of 8 survived AIH patients without surgical repair, 4 patients showed complete resolution. Typical AD developed in 2 about 2 months after the acute event, and the other 2 patients showed focal AD only in the descending aorta. The 3-year survival rate of AIH group was 89+/-7%, which was not significantly different from that of AD group (75+/-6%, p>0.05). CONCLUSIONS: Patients with proximal AIH shows different clinical features and much better prognosis with medical treatment compared to those with AD. These results support our initial hypothesis that AIH is not just a precursor of overt AD but a distinct disease entity and absence of continuous flow communication in AIH can have different clinical impact. This should encourage systematic investigations to find out the predictors of development of complications and to assess the role of elective surgery with frequent imaging follow-up in proximal AIH.
Aorta* ; Aorta, Thoracic ; Diagnosis ; Female ; Follow-Up Studies ; Hemodynamics ; Hemorrhage* ; Hospital Mortality ; Humans ; Mortality ; Natural History ; Pleural Effusion ; Prognosis ; Retrospective Studies ; Survival Rate