Esmolol is rapid ultrashort-acting, cardioselective beta1-adrenergic blocker and that is used for attenuation of acute hypertension associated with rapid sequence induction of general anesthesia. A 35-year-old severe preeclamptic patient was scheduled for elective cesarean section. After preoxygenation, anesthesia induced with using penthotal sodium 250 mg, esmolol 25 mg, and succinylcholine 62.5 mg for endotrachial intubation. We detected to increase airway resistance during manual ventilation. Breathing sound was auscultated wheezing and ronchi. And then cyanosis was developed and oxygen saturation was decreased to below 75%. After 20 min, patient's color was returned to pink and patient's self-respiratory function was good. Bronchospasm occured because that beta-adrencergic blockade with esmolol, by leaving the parasympathetic and alpha-adrencrgic influence relatively unopposed. We report bronchospasm after esmolol 25 mg was injeected for attenuation of acute hypertensive response for cesarean section of preeclamptic patient with rapid sequence induction of general anesthesia.
Adult ; Airway Resistance ; Anesthesia ; Anesthesia, General ; Bronchial Spasm* ; Cesarean Section ; Cyanosis ; Female ; Humans ; Hypertension ; Intubation ; Oxygen ; Pregnancy ; Respiratory Sounds ; Sodium ; Succinylcholine ; Ventilation

Esmolol is rapid ultrashort-acting, cardioselective beta1-adrenergic blocker and that is used for attenuation of acute hypertension associated with rapid sequence induction of general anesthesia. A 35-year-old severe preeclamptic patient was scheduled for elective cesarean section. After preoxygenation, anesthesia induced with using penthotal sodium 250 mg, esmolol 25 mg, and succinylcholine 62.5 mg for endotrachial intubation. We detected to increase airway resistance during manual ventilation. Breathing sound was auscultated wheezing and ronchi. And then cyanosis was developed and oxygen saturation was decreased to below 75%. After 20 min, patient's color was returned to pink and patient's self-respiratory function was good. Bronchospasm occured because that beta-adrencergic blockade with esmolol, by leaving the parasympathetic and alpha-adrencrgic influence relatively unopposed. We report bronchospasm after esmolol 25 mg was injeected for attenuation of acute hypertensive response for cesarean section of preeclamptic patient with rapid sequence induction of general anesthesia.
Adult ; Airway Resistance ; Anesthesia ; Anesthesia, General ; Bronchial Spasm* ; Cesarean Section ; Cyanosis ; Female ; Humans ; Hypertension ; Intubation ; Oxygen ; Pregnancy ; Respiratory Sounds ; Sodium ; Succinylcholine ; Ventilation

The purpose of this study was to compare the eating habit, food intake frequency and preferred food and taste of juvenile delinquents (100 numbers) and male high school students (100 numbers), using questionnaires from August to October 2004. 1) It was shown that the juvenile delinquents took more unbalanced diet (p <0.05), smoking (p <0.001) and drinking (p <0.001) than general students, while general students had more eating between meals (p <0.01). 2) The intake of food was a significant difference in white rices (p <0.01), bibimbab (p <0.001), kimbab (p <0.001), fried rice (p <0.001), ramen (p <0.001), jajangmyun (p <0.001), jambong (p <0.001), hamburger (p <0.001), pizza (p <0.001) and breads (p <0.05). The juvenile delinquents took more major food than that of general students in all the items except for white rice. It was observed, then, that the juvenile delinquents showed more intake of such subsidiary foods as bulgoki (p <0.001), roasted thin pork chops (p <0.001), grilled pork belly (p <0.001), pork cutlet (p <0.01), sweet and sour pork (p <0.001), chicken with ginseng (p <0.001), fried chicken (p <0.001), kimchi pot stew (p <0.01) and zucchini (p <0.05) than general students, with general students taking more kimchi (p <0.01) and fried or boiled soybean curd (p <0.01). The intake of dessert was a significant difference in yogurt (p <0.01), orange juice (p <0.001), cola (p <0.001), soft drinks (p <0.001), ion drinks (p <0.001), coffee (p <0.001), apple (p <0.01), banana (p <0.001), orange (p <0.001), cake (p <0.001), hot dog (p <0.001), ddokbokgi (p <0.01), mandu (p <0.001), fried fish paste (p <0.05), steamed korean sausage (p <0.001), fried foods (p <0.05), hem & sausage (p <0.001), cheese (p <0.001), ice-cream (p <0.001), candy (p <0.01), chocolate (p <0.001), mayonnaise (p <0.05), jam (p <0.01) and butter & margarine (p <0.01). Then, the juvenile delinquents were shown to entirely have more intake of all the desserts than those of general students. 3) Regarding preference of foods, it was shown that the juvenile delinquents preferred cereals (p <0.05), grilled pork belly (p <0.001), chicken with ginseng (p <0.01), anchovies and small fish (p <0.05), chicken with ginseng (p <0.05), seasoned spinach (p <0.001), seasoned zucchini (p <0.001), milk (p <0.05), coffee (p <0.001) and butter & margarine (p <0.05) while general students did egg (p <0.01), soybean sprout soup (p <0.001), boiled or fried potato (p <0.05), seasoned soybean sprout (p <0.05), boiled or fried soybean curd (p <0.01), fried foods (p <0.01) and snack (p <0.05). For their preference of tastes, hot taste (p <0.01) was higher in the juvenile delinquents. 4) Under general environments there was a change of the difference in their behaviour of pork cutlet (p <0.01) intake in accordance with other family and of milk (p <0.001) and butter & margarine (p <0.05) preference in accordance with growth in a big city between the two groups.
Animals ; Bread ; Butter ; Cacao ; Candy ; Carbonated Beverages ; Edible Grain ; Cheese ; Chickens ; Citrus sinensis ; Coffee ; Cola ; Diet ; Dogs ; Drinking ; Eating* ; Food Habits* ; Food Preferences ; Humans ; Male* ; Margarine ; Meals ; Milk ; Musa ; Ovum ; Panax ; Seasons ; Smoke ; Smoking ; Snacks ; Solanum tuberosum ; Soybeans ; Spinacia oleracea ; Steam ; Surveys and Questionnaires ; Yogurt

BACKGROUND: Epidural anesthesia is thought to be relatively indicated for cesarean section in patients with severe preeclampsia. In contrast, avoidance of spinal anesthesia is recommended, postulating excessive hypotensive risks. In addition, general anesthesia is often avoided in this population because malignant hypertension following tracheal intubation is common and risks for difficult airway management are excessive. METHODS: In this study, we compared hemodynamic changes in patients with severe preeclampsia and normal pregnant women during spinal anesthesia for elective cesarean section. Spinal anesthesia was performed with 10 mg of 0.5% heavy bupivacaine mixed with 25 microgram fentanyl in 18 patients with severe preeclampsia and 17 normal pregnant women. We compared MAP, CI, and SVRI changes before and after spinal anesthesia. RESULTS: MAP responses following induction of spinal anesthesia for elective cesarean section in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. CI responses following induction of spinal anesthesia in patients with severe preeclampsia showed a statistically significant increase from 8 min after and normal pregnant women also showed a statistically significant increase from 4 min after spinal anesthesia. SVRI responses from induction of spinal anesthesia in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. Incidence of hypotension before delivery and used total dose of ephedrine during operation were statically insignificant between severe preeclamptic and normal pregnant women. CONCLUSIONS: We conclude that changes of MAP, CI and SVRI following spinal anesthesia for elective cesarean section in the severely preeclamptic and normal pregnant women are clinically similar. We suggest that spinal anesthesia for cesarean section is not contraindicated in the severely preeclamptic patient.
Airway Management ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal* ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Female ; Fentanyl ; Hemodynamics* ; Humans ; Hypertension, Malignant ; Hypotension ; Incidence ; Intubation ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women

Better medical management, together with a number of newer surgical techniques, has enable more girls with congenital heart disease to reach childbearing age. Congenital heart lesions now constitute at least half of all cases of heart disease encountered during pregnancy. Pregnancy is characterized by marked increase in stroke volume and cardic output during the antepartum period. The hemodynamic demands of pregnancy dangerously stress the impaired cardiovascular reserve. We experienced that a case of cardiac arrest in a preeclamptic patient with unrecognized heart failure during induction of the general anesthesia for cesarean section. We found out later that she had an operation because of patent ductus arteriosus at the age of 15 and then already had mitral valve regurgitation and LVH findings in the echocardiogram. We suggested that heart failure was enhanced by the hyperdynamic cardiovascular changes of normal pregnancy and further aggrevated by preeclampsia and anemia.
Anemia ; Anesthesia, General* ; Cesarean Section* ; Ductus Arteriosus, Patent ; Female ; Heart Arrest* ; Heart Defects, Congenital ; Heart Diseases ; Heart Failure* ; Heart* ; Hemodynamics ; Humans ; Mitral Valve Insufficiency ; Pre-Eclampsia ; Pregnancy ; Stroke Volume

STATEMENT OF PROBLEM: According to the fracture pattern in several reports, fractures most frequently occur in the interface between the ceromer and the substructure. PURPOSE: The aim of this in vitro study was to compare the macro shear bond strength and microshear bond strength of a ceromer bonded to a fiber reinforced composite (FRC) as well as metal alloys. MATERIAL AND METHODS: Ten of the following substructures, type II gold alloy, Co-Cr alloy, Ni-Cr alloy, and FRC (Vectris) substructures with a 12 mm in diameter, were imbedded in acrylic resin and ground with 400, and 1, 000-grit sandpaper. The metal primer and wetting agent were applied to the sandblasted bonding area of the metal specimens and the FRC specimens, respectively. The ceromer was placed onto a 6 mm diameter and 3 mm height mold in the macro-shear test and 1 mm diameter and 2 mm height mold in the micro-shear test, and then polymerized. The macro- and micro-shear bond strength were measured using a universal testing machine and a micro-shear tester, respectively. The macro- and micro-shear strength were analyzed with ANOVA and a post-hoc Scheffe adjustment (alpha= .05). The fracture surfaces of the crowns were then examined by scanning electron microscopy to determine the mode of failure. Chi-square test was used to identify the differences in the failure mode. RESULTS: The macro-shear strength and the micro-shear strength differed significantly with the types of substructure (P< .001). Although the ceromer/FRC group showed the highest macro and micro-shear strength, the micro-shear strength was not significantly different from that of the base metal alloy groups. The base metal alloy substructure groups showed the lowest mean macro-shear strength. However, the gold alloy substructure group exhibited the least micro-shear strength. The micro-shear strength was higher than the macro-shear strength excluding the gold alloy substructure group. Adhesive failure was most frequent type of fracture in the ceromer specimens bonded to the gold alloys. Cohesive failure at the ceromer layer was more common in the base metals and FRC substructures. CONCLUSION: The Vectris substructure had higher shear strength than the other substructures. Although the shear strength of the ceromer bonded to the base metals was lower than that of the gold alloy, the micro-shear strength of the base metals were superior to that of the gold alloy.
Adhesives ; Alloys* ; Crowns ; Fungi ; Gold Alloys ; Metals ; Microscopy, Electron, Scanning ; Nerve Fibers, Myelinated ; Polymers ; Shear Strength

In monolayer culture, articular chondrocytes are well known to proliferate and dedifferentiate by seum and transforming growth factor-beta(TGF-beta). These dedifferentiated cells regain the ability to express type II collagen in alginate bead culture. In this study, the effects of human serum and TGF-beta on the proliferation and phenotypical change of human chondrocytes were examined in both monolayer and alginate bead culture. Proliferation was measured by 3H-thymidine incorporation and cell counting, chondrocytic phenotype by Western blot analysis of type II collagen expression, and proteoglycan synthesis by dimethylmethylene blue assay. Both human serum and TGF-beta synergistically increased the proliferation of chondrocytes in monolayer culture. Human serum had effect to maintain the type II collagen expression, even with enhanced level, in monolayer culture and showed redifferentiation in alginate culture, similar to fetal bovine serum control. TGF-beta enhanced the production of proteoglycan in monolayer culture. In conclusion, the present study demonstrated that human serum and TGF-beta could be used as potent additives to increase chondrocyte proliferation and maintain its phenotype.
Blotting, Western ; Cell Count ; Chondrocytes* ; Collagen Type II ; Humans* ; Phenotype ; Proteoglycans ; Transforming Growth Factor beta*

This study was initiated to investigate the effect of ultrasound(US) stimulation on therapeutic effects on human osteoarthritic cartilage repair. Cartilage explants from human osteoarthritic knee were sonicated for 10 minutes every day using continuous wave at frequency 1 MHz US signals with spatial and temporal average intensities of 0, 40, 200, 500 and 700mW/cm2. One group of explants was exposed to sham ultrasound as a control. After 1 week of culture, the intensity-dependent effects of US on DNA, proteoglycan (PG) and collagen synthesis were measured by 3H-thymidine, 35S-sulfate, 3H-proline incorporation, respectively. The expression of PG and type II collagen released into medium were measured by DMB (dimethylmethylene blue) method and western blot analysis. Safranin O/fast green and immunohistochemical staining with anti-collagen type II antibody were performed using the serial sections of cartilage explants. The histochemical examination showed that the expression of PG at the pericellular area in the deep layer increased continuously up to 700mW/cm2. In contrast, the depth of the superficial layer significantly decreased after treatment of sonication at 500 and 700mW/cm2. The expression of PG and type II collagen assessed by the isotope incorporation was significantly enhanced to the level up to 140%, 120% respectively, although US had no stimulatory effect on cell proliferation. These results suggest that optimum intensity of US for the effective expression of extracellular matrix in osteoarthritic cartilage may be around 200mW/cm2. In conclusion, our study suggests the possibilities that sonication may be therapeutically utilized for the repair of human osteoarthritic cartilage.
Blotting, Western ; Cartilage* ; Cell Proliferation ; Collagen ; Collagen Type II ; DNA ; Extracellular Matrix ; Humans* ; Knee ; Osteoarthritis* ; Proteoglycans ; Sonication* ; Ultrasonography

BACKGROUND: A right thoracoscopic thoracic sympathicotomy involves the removal of T2 and T3 sympathetic chains. Since part of the sympathetic fibers to the heart traverse these two ganglia, we examined the hemodynamic changes during a thoracoscopic thoracic sympathicotomy in primary hyperhidrosis. METHODS: Noninvasive cardiac output monitoring was done on the both side of the neck and chest. A physiograph for measuring of continuous blood flow was taken from the right index finger and a thermometer was placed in the right palm. Following endotracheal intubation was done with double lumen endotracheal tube, anesthesia was maintained with isoflurane. Sympathicotomies were done for T2-3 during one lung ventilation. Heart rate (HR), mean arterial pressure (MAP), systemic vascular resistance index (SVRI), cardiac index (CI), accelerated contractility index (ACI), end-diastolic index (EDI), and temperature were recorded at arrival, before sympathicotomy, after sympathicotomy at 1, 2, 3, 4 and 5 minuets. The blood flow of the right index finger was recorded before and after the sympathicotomy. RESULTS: Concurrent with initiation of the sympathicotomy, MAP and SVRI were reduced, but the CI was elevated. It was accompanied with right palmar temperature elevation and an increase in the blood flow of the right index finger. CONCLUSIONS: A thoracoscopic thoracic sympathicotomy reduces MAP and SVRI and elevates CI, palmar temperature, and blood flow. We concluded that the hemodynamic changes during a thoracoscopic thoracic sympathicotomy seems to be the peripheral vasodilatation.
Adrenergic Fibers ; Anesthesia ; Arterial Pressure ; Cardiac Output ; Fingers ; Ganglia ; Heart ; Heart Rate ; Hemodynamics* ; Hyperhidrosis* ; Intubation, Intratracheal ; Isoflurane ; Neck ; One-Lung Ventilation ; Thermometers ; Thorax ; Vascular Resistance ; Vasodilation

Background: The aim of this study was to evaluate the short-term and long-term results of surgical treatment for native valve endocarditis (NVE) and to investigate the risk factors associated with mortality. Methods: Data including patients’ characteristics, operative findings, postoperative results, and survival indices were retrospectively obtained from Hallym University Sacred Heart Hospital. Results: A total of 29 patients underwent surgery for NVE (affecting the mitral valve in 20 patients and the aortic valve in 9) between 2003 and 2017. During the follow-up period (median, 46.9 months; interquartile range, 19.1–107.0 months), the 5-year survival rate was 77.2%. In logistic regression analysis, body mass index (p=0.031; odds ratio [OR], 0.574; 95% confidence interval [CI], 0.346–0.951), end-stage renal disease (ESRD) (p=0.026; OR, 24.0; 95% CI, 1.459–394.8), and urgent surgery (p=0.010; OR, 34.5; 95% CI, 2.353–505.7) were significantly associated with in-hospital mortality. Based on Cox proportional hazard regression analysis, the statistically significant predictors of long-term outcomes were hypertension, ESRD, and urgent surgery. Conclusion Surgical treatment for NVE is associated with considerable mortality. The in-hospital mortality and 5-year survival rates of this study were 13.8% and 77.2%, respectively. Underlying conditions, including hypertension and ESRD, and urgent surgery were independent risk factors for unfavorable outcomes.