Transient increases in blood pressure and heart rate(HR) at the end of anesthesia and during extubation are common. Tomori and Widdicombe observed that mechanical stimulation of four areas of the upper respiratory tract (nose, epipharynx, laryngopharynx, tracheobnchial tree) induced reflex cardiovascular responses associated with enhanced neuronal activity in the cervical sympathetic efferent fibers. In susceptible patients, even this short period of hypertension and tachycardia can result in myocardial ischemia or increased intracranial pressure. The purpose of present study was to evaluate the effect of esmolol in attenuating cardiovascular responses to extubation under general anesthesia with endotracheal intubation. A sixty healthy patients who underwent elective noncardiac operation under general anesthesia (N2O-O2-enflurane) with endotracheal intubation were randomly divided into two groups : one was placebo group that received intravenous injection of 0.1 cc/kg normal saline, the other was esmolol group that received intravenous injection of 1 mg/kg esmolol. Extubation was performed when the patients could breathe spontaneously and open their eyes on command. In practice extubation was done between 2 and 4 minutes after drug(esmolol or saline) injection. The measurement of systolic blood pressure and heart rate was obtained one minute before extubation and every minute for 5 minutes after extubation, then rate-pressure product was calculated. The results were as follows; 1) When compared to pre-extubation systolic blood pressure, systolic blood pressure for 2 minutes after extubation in both groups increased significantly but systolic blood pressure was more rapidly returned to pre-extubation level in the esmolol group than in the placebo group. When compared to pre-extubation systolic blood pressure, after extubation the number of patients in whom systolic blood pressure increased more than 20% was significantly fewer in the esmolol group than in the saline group. 2) When compared to pre-extubation heart rate, heart rate at 1 minute after extubation in the placebo group increased significantly but heart rate after extubation in the esmolol group did not change significantly. 3) When compared to pre-extubation rate-pressure product, rate-pressure product for 2 minutes after extubation in both group increased significantly. At 4 minutes after extubation, rate-pressure product in the saline group increased significantly when compared to rate-pressure product in the esmolol group. These results suggest that intravenous injection of 1 mg/kg esmolol before extubation blocks heart rate elevation following extubation under general anesthesia and is effective for rapid return to the pre-extubation level of systolic blood pressure.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Heart ; Heart Rate ; Humans ; Hypertension ; Hypopharynx ; Injections, Intravenous ; Intracranial Pressure ; Intubation, Intratracheal ; Myocardial Ischemia ; Neurons ; Reflex ; Respiratory System ; Tachycardia

BACKGROUND: The SF-6D, derived from the SF-36, is a preference-based instrument measuring health-related quality of life (HRQOL). Using this tool, we measured the HRQOL of persons disabled by stroke dwelling in Gyeongju city and identified factors affecting the HRQOL. METHODS: As of March 2008, 991 persons who had had a stroke and were aged 50 and over were identified on the Gyeongju city disabled registry. Interviewers specifically trained for this face-to-face survey gathered pertinent information including general and clinical characteristics from June to October 2008. In addition, the health status was measured using the Modified Rankin Scale, the Barthel ADL index, and the SF-36. The SF-6D index was derived from the SF-36. We analyzed the known-group construct validity and convergent validity. Finally, we performed multiple regression analyses to identify factors affecting the HRQOL. RESULTS: Of the 991 potential subjects, 498 persons participated in the interviews (response rate: 50.3%). The SF-6D indices for females and those aged 70 and over were lower than indices for males and those aged 60 and less. Correlation coefficients between the Modified Rankin Scale, the Barthel index, and the SF-6D index were relatively high (-0.533 and 0.555, respectively) and statistically significant (P<0.001). Multiple regression analyses showed that sex, age, smoking, alcohol use, comorbidity, the Modified Rankin Scale, and the Barthel index had an effect on the SF-6D index of persons with stroke, and the Barthel index was the most important factor. CONCLUSIONS: Our results indicate that the SF-6D can be a valid tool for evaluating health states of persons disabled by stroke, and functional limitation was the main factor affecting the HRQOL.
Activities of Daily Living ; Aged ; Comorbidity ; Disabled Persons ; Female ; Humans ; Male ; Quality of Life ; Smoke ; Smoking ; Stroke ; Value of Life ; Surveys and Questionnaires

No abstract available
Dermatitis, Atopic* ; Eczema* ; Humans ; Nipples*

PURPOSE: To investigate accommodation and progress of patients who showed myopia on manifest refraction in the early postoperative period after LASEK. METHODS: Forty-one eyes were included in the present study which had undergone LASEK surgery from February to March 2012. Seven eyes showed myopia over -0.25 D on manifest refraction at 1 month postoperatively, but showed decreased amount of myopia at 2 months postoperatively and were classified as group 1. The other 34 eyes were classified as group 2. The differences between cycloplegic and manifest refraction (CRSE-MRSE) were defined as the amount of latent accommodation and compared between the 2 groups. RESULTS: Amount of latent accommodation was 0.179 +/- 0.426 D in group 1 (7 eyes), 0.265 +/- 0.303 D in group 2 (34 eyes) preoperatively, 1.286 +/- 0.664 D in group 1, 0.368 +/- 0.536 D in group 2 at 1 month postoperatively, and 0.500 +/- 0.520 D in group 1, and 0.489 +/- 0.546 D in group 2 at 2 months postoperatively. The amount of latent accommodation in group 1 was significantly greater than that of group 2 one month postoperatively. As the amount of latent accommodation decreased, the amount of myopic shift decreased gradually over 2 months in group 1 after surgery. CONCLUSIONS: Transient myopic shift due to increased latent accommodation was observed in several patients one month postoperatively and the amount of myopic shift decreased with time without treatment. Thus, surgeons should consider cycloplegic refraction when planning treatment for patients with myopic regression.
Humans ; Keratectomy, Subepithelial, Laser-Assisted* ; Myopia ; Postoperative Period

BACKGROUND: It has been documented that certain prognostic factors may affect the outcomes of the old aged victims by trauma. Considering that trauma is the sixth most common cause of death in people over the age of 65 years and there is a rapid growth of elderly population, it is paramount to understand the prognostic factors when dealing with geriatric trauma patients. Hypothesis and Goals : It can be hypothesized that the prognostic factors should be determined independently between populations being consisted of different races, countries, socio-economic states, cultures, or so on. Thus, study was designed to evaluate the factors affecting the outcomes of elderly Korean trauma patients. METHODS: One hundred forty six patients aged over 65 years were retrospectively reviewed, who visited the Emergency Canter of Korea University from January, 1997 to June, 1998. Of 146 patients, 7 were excluded due to discharge against advice or transfer to the other hospitals. Parameters analysed were age, sex, mechanism of injuries, body region injured, Injury Severity Score (ISS), previous medical illness, hospital morbidity, duration of hospital stay, and cost. Each patient was classified into improved or not-improved groups depending on the outcomes, and young-old or old-old group depending on the age. The factors affecting the hospital stay in improved patients were analyzed in the parameters of previous medical illness, hospital morbidity, multiple injuries, ISS, and age. All statistical tests were conducted with two-tailed levels of 0.05. RESULTS: Of 139 patients, the mean age was 74+/-7.1 years, mean ISS 9.3+/-7.26, mean hospital stay 27+/-27.1 days. Most commonly injured body region was the extremities due to fall from a level surface. Rate of previous illness showed 0.94 medical diseases per person and were aggravated after trauma in 39 patients (60.9%). Hospital morbidity rate was 0.46 incidents per person. There were no differences in age and duration of hospital stay between the improved and the not-improved group. Substantial differences were noted in affected body region, incidence of previous illness, and hospital morbidity between the groups (p=NS). Not-improved group had higher ISS (p<0.05). ISS, previous illness and hospital morbidity affected the duration of hospital stay in the improved group. Hospital stay was 40+/-25.1 days in patients with ISS over 6 while 6+/-8.6 days in those with ISS 5 (p<0.05). Hospital stay in the improved was 26+/-26.9 days while 31+/- 24.8 days in the improved old-old group (P=NS). Hospital stay in the young-old minor trauma (ISS5) patients with previous illness and hospital morbidity was 26+/-10.1 days while 4+/-7.3 days in those without previous illness and hospital morbidity (p<0.05). CONCLUSION: Previous medical illness and hospital morbidity, not age, are predictive of outcomes of geriatric trauma patients with respect to hospital stay. As most of the hospital morbidity was a trauma-induced aggravation of previous medical illness and hospital morbidity contributing poor outcomes can be potentially avoidable, routine aggressive care far the geriatric trauma patients with previous medical illnesses is needed.
Aged ; Body Regions ; Cause of Death ; Continental Population Groups ; Emergencies ; Extremities ; Humans ; Incidence ; Injury Severity Score ; Korea ; Length of Stay ; Multiple Trauma ; Retrospective Studies

BACKGROUND: The induced hypotension was used to decrease blood loss, thereby decreasing the need for blood transfusion and/or improving operating conditions at the surgical site. It was hypothesized that SNP-induced hypotension with fixed concomitant esmolol infusion(75 ug/kg/min) might prevent side effects such as reflex tachycardia and reduce SNP dose requirement during SNP-induced hypotension. METHOD: The concomitant infusion of 75 ug/kg/min esmolol was used to potentiate hypotension(30% reduction of mean arterial blood pressure) induced with sodium nitroprusside in six dog during halothane(lvo1%)-N2O(50%)-O2(50%) anesthesia. Mean arterial blood pressure, heart rate, cardiac output, mean pulmonary arterial blood pressure, central venous pressure, arterial blood gas analysis, and mixed venous oxygen saturation were measured and systemic vascular resistance was calculated in the each periods. RESULT: The results run as follows; 1) Compared to SNP-induced hypotension, there was significant reduction in SNP dose requirement to maintain a 30% reduction of mean arterial pressure at the concomitant infusion of 75 ug/kg/min esmolol. 2) There were significant reduction in heart rate, mixed venous oxygen saturation and cardiac output, but significant increase in systemic vascular resistance and mean pulmonary arterial pressure at the coneomitant infusion of 75 ug/kg/min esmolol. 3) No rebound hypertension was observed at 30 minute after SNP and esmolol infusions were simultaneously discontinued. CONCLUSION: The result of present study suggests that esmolol infusion is a safe and effective pharmacologic means of potentiating SNP-induced hypotension during halothane-N2O-O2 anesthesia. Probably esmolol may act by counteracting side effects such as acute tolerance during SNP-induced hypotension.
Anesthesia* ; Animals ; Arterial Pressure ; Blood Gas Analysis ; Blood Transfusion ; Cardiac Output ; Central Venous Pressure ; Dogs* ; Halothane* ; Heart Rate ; Hemodynamics* ; Hypertension ; Hypotension* ; Nitroprusside* ; Oxygen ; Reflex ; Sodium* ; Tachycardia ; Vascular Resistance

Purpose: Clinical factors affecting the recovery period in patients with vascular or idiopathic paralytic strabismus were evaluated. Methods: This study involved a retrospective review of medical records of patients diagnosed with vascular and idiopathic acquired paralytic strabismus. Vascular paralysis was defined in cases of hypertension, diabetes mellitus, or cardiovascular disease. The angle of deviation and limitation of extraocular movement were evaluated at each visit. Recovery was defined as the absence of diplopia and complete resolution of limitation of extraocular movement. Factors affecting recovery success and recovery period were analyzed. Results: We retrospectively reviewed data of 145 patients consisting of 87 with vascular paralytic strabismus (cranial nerve [CN] III: 21, CN IV: 28, CN VI: 38) and 58 with idiopathic paralytic strabismus (CN IV: 20, CN VI: 24, CN III: 14). The recovery rate did not significantly differ between vascular (60.9%) and idiopathic (63.8%) groups (p = 0.15). The recovery period was longer in the vascular group (130.1 ± 145.1 days) than in the idiopathic group (92.6 ± 76.6) (p = 0.02). Age at onset was significantly associated with the recovery period in both vascular and idiopathic groups. In the vascular group, the recovery periods were 107.4 ± 74.8 days in CN III palsy, 97.2 ± 51.9 days in CN IV palsy, and 159.3 ± 194.1 days in CN VI palsy. The recovery period was significantly longer in patients with CN VI palsy (p = 0.03). Hypertension was significantly influencing the recovery period in patients with vascular CN VI palsy (odds ratio = 2.54, p = 0.01). Conclusions The recovery period was longer in patients with vascular paralytic strabismus than in patients with idiopathic paralytic strabismus. Recovery rates were not significantly different between groups. In patients with vascular CN VI palsy, a history of hypertension was significantly associated with the recovery period.

The authors report a case of superficial femoral arterial trauma caused by external fixator in 53 year-old male patient who had supracondylar fracture of femur due to automobile accident. After removal of external fixator, autogenous bypass graft was perfomed with reversed great saphenous vein. The occlusion of the graft occurred 3 months later, we thought that interposition graft in the chronic inflammatory and fibrotic tissue should be avoided.
Automobiles ; External Fixators ; Femoral Artery ; Femur ; Humans ; Male ; Middle Aged ; Rupture ; Saphenous Vein ; Transplants

Femoral neuropathy may be associated with various etiologies and can cause severe walking disability. We present the case of a 25-year-old woman who underwent surgical repair for a patella fracture and complained of lower extremity pain, paresthesia, and weakness postoperatively. Electromyography and magnetic resonance imaging (MRI) revealed partial peripheral neuropathy of the left femoral nerve associated with the patella fracture. To our knowledge, this is the first reported case of femoral neuropathy associated with a patella fracture.
Adult ; Electromyography ; Female ; Femoral Nerve ; Femoral Neuropathy ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle Weakness ; Paralysis ; Paresthesia ; Patella ; Peripheral Nervous System Diseases ; Walking

Purpose: Clinical factors affecting the recovery period in patients with vascular or idiopathic paralytic strabismus were evaluated. Methods: This study involved a retrospective review of medical records of patients diagnosed with vascular and idiopathic acquired paralytic strabismus. Vascular paralysis was defined in cases of hypertension, diabetes mellitus, or cardiovascular disease. The angle of deviation and limitation of extraocular movement were evaluated at each visit. Recovery was defined as the absence of diplopia and complete resolution of limitation of extraocular movement. Factors affecting recovery success and recovery period were analyzed. Results: We retrospectively reviewed data of 145 patients consisting of 87 with vascular paralytic strabismus (cranial nerve [CN] III: 21, CN IV: 28, CN VI: 38) and 58 with idiopathic paralytic strabismus (CN IV: 20, CN VI: 24, CN III: 14). The recovery rate did not significantly differ between vascular (60.9%) and idiopathic (63.8%) groups (p = 0.15). The recovery period was longer in the vascular group (130.1 ± 145.1 days) than in the idiopathic group (92.6 ± 76.6) (p = 0.02). Age at onset was significantly associated with the recovery period in both vascular and idiopathic groups. In the vascular group, the recovery periods were 107.4 ± 74.8 days in CN III palsy, 97.2 ± 51.9 days in CN IV palsy, and 159.3 ± 194.1 days in CN VI palsy. The recovery period was significantly longer in patients with CN VI palsy (p = 0.03). Hypertension was significantly influencing the recovery period in patients with vascular CN VI palsy (odds ratio = 2.54, p = 0.01). Conclusions The recovery period was longer in patients with vascular paralytic strabismus than in patients with idiopathic paralytic strabismus. Recovery rates were not significantly different between groups. In patients with vascular CN VI palsy, a history of hypertension was significantly associated with the recovery period.