To 48 surgical patients (23-62 years of age, physical status 1-2), the newest banzodiazepine derivative, flunitrazepam (Ro 5-4200), in the dosage of 0.03 mg/kg was administered intravanously at a rate of 2 mg/min. as an intravenous anesthetic induction agent. All patients inhaled 100%, oxygen during induction except where blood-gas studies were conducted, in which case they breathed room air. Thereafter anesthesia was maintained with nitrous oxicle-oxygen-halothane with or without muscle relaxant following endotracheal intubation. Respiratory rate, pulse rate, tidal volume and blood pressure were measured during the pre- operative visit, immediately prior to and again after induction. All patients were premedicated with 1 mg/kg meperidine and atropine. The lead II ECG and fronto-occipital lead EEG were continuously monitored on an oscilloscope throughout the procedure. In 12 patients femoral artery and central venous catheters were inserted prior to induction and the ECG, EEC, arterial pressure and central venous pressure were recorded continuously on a Beckman Type RM 4-channel recorder. Blood samples were taken before and again 5 minutes after induction and PaO2, PaCO2 and pH were measured with a Beckman Blood Gas Measurement System. Arterial-central vanous O2 coutent difference was calculated from the computer-produced physiological table of Kellmann and Nune. To rule out the possible cardiorespiratory effects of meperidin and atropine, blood pressure, pulse rate, respiratory rate and tidal volume were also measured in 10 young resident volunteers in this department. The results are as follows: 1) Moderate respiratory depression was obvious in most patient.. Tidal volume decreased 12.9 per cent (p<0. 01) with concomitant increase (17.6 per cent, p<0.01) in respiratory rate. There was an insignifincat rise in PaCO2, accompanied by slight fall in pH and a significant fall PaO2 (17. 7 per cent, p<0. 01), which was probably due to hypoventilation and/or ventilation/perfusion irregularities. 2) It is mandatory to assist or control respiration with 100% oxygen in case of hypov ntilation or apaea during induction with flunitrazepam. 3) A slight and insignificant fall in blood pressure and increase in pulse rate were observed. No cardiac arrhythmias were noted. A fall in central venous pressure (13.3 per cent, p<0.05) was uniformly demonstrated in 12 patients in whom CVP was measured. These findings suggest that the fall in blood pressure was not due to negative inotropic effect but rather to peripheral vasodilatation caused by the sedative effect and decreased sympathetic tone produced by flunitrazepam. 4) The arterial-central venous oxygen content difference decreased by 12.1 per cent (p<0.05). It seems reasonable to assume that during induction no rnajor changes in oxygen consumption occurs. It has been shown that the central venous oxygen content or right atrial oxygen content are slightly lower but still an accurate reflection of mixed venous oxygen content. Under these circumstances the arterial-central venous oxygen content difference may be inversely related to the cardiac output. These results seem, to indicate that cardiac output increased during induction with flunitrazepam. 5) It appears that because of its minimal circulatory depressant effects flunitrazepam may be recommended in seriously ill patients, especially those with cardiac disease, in whom it is advisable to avoid hypotension and tachycardia. 6) Subjects not premedicated with meperidine required more flunitrazepam for induction of sleep to result in prolonged drowsiness. To use flunitrazepam as an intravenous anesthetic induction agent, therefore, it is advisable to premedicate the patient with meperidine to keep the dose of flunitrazepam as low as possible.
Anesthesia ; Arrhythmias, Cardiac ; Arterial Pressure ; Atropine ; Blood Pressure ; Cardiac Output ; Central Venous Catheters ; Central Venous Pressure ; Electrocardiography ; Electroencephalography ; European Union ; Femoral Artery ; Flunitrazepam* ; Heart Diseases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypnotics and Sedatives ; Hypotension ; Hypoventilation ; Intubation, Intratracheal ; Meperidine ; Oxygen ; Oxygen Consumption ; Respiration* ; Respiratory Insufficiency ; Respiratory Rate ; Sleep Stages ; Tachycardia ; Tidal Volume ; Vasodilation ; Volunteers

1) Cardiac arrhythmias were produced in 8 mongrel dogs (weight, 13 3+/-1.5 kg) by injections of epinephrine (0.002+/-0.0002mg/kg) during inhalation of 25 per cent cyclopropane in oxygen. 2) Femoral arterial pressure was measured with a Statham transducer, and Lead II of the electrocardiogram recorded on a Sanborn Twin-Viso at a paper speed of 25 mm/sec. 3) Regitine (0.47+/-0.19 mg/kg), an alpha adrenergic blocking agent, significantly decreased the pressor response to epinephrine and consistently increased (4.8+/-1.8 times) the individual threshold doses of epinephrine required to produce cardiac arrhythmias. 4) In most instances the protective result was attributable to a modification by Regitine of the pressor effect of epinephrine. It is concluded in the light that cyclopropane-epinephrine cardiac arrhythmias are blocked by alpha adrenergic blockade.
Animals ; Arrhythmias, Cardiac* ; Arterial Pressure ; Dogs* ; Electrocardiography ; Epinephrine ; Inhalation ; Oxygen ; Phentolamine ; Transducers

It has been well known that successful anesthesia is provided by rendering patients free from apprehension and fear prior to operation. This report is concerned with a new sedative compound which appears to reduce anxiety-tension and relax skeletal muscles. Preanesthetic usefulness of diazepam, which is a derivative of benzodia-zepine and has a high safety index as a preanesthetic medication agent, has been clinically assessed by a standard double blind study on 288 patients in this hospital. They received diazepam(0.3mg/ kg), meperidine hydrochloride (1.0~1.5mg/kg) or saline (1.0ml) via intramuscular route. The following are the results: 1) Diazepam was effective in producing a sound sleep during the preoperative night. 2) Diazepam was effective in reducing apprehension and fear immediately prior to induction of anesthesia. 3) Less nausea and vomiting as well as better sedation were produced by diazepam than by meperidine hydrochloride.
Anesthesia ; Diazepam* ; Double-Blind Method ; Humans ; Meperidine ; Muscle, Skeletal ; Nausea ; Preanesthetic Medication* ; Vomiting

PURPOSE: The scaffold is essential for cartilage tissue engineering. Collagen, chitosan, or glycosaminoglycan( GAG) has separately been proposed as in vitro scaffolds. However, the influence of collagen:chitosanchondroitin sulfate(Col:Chi-CS) composites on cell behavior has not yet been thoroughly examined. Therefore, the aim of this study is to develop a novel Col:Chi-CS blended scaffold that binds covalently with CS for cartilage tissue engineering. MATERIALS AND METHODS: The behavior of rabbit chondrocytes seeded in vitro into collagen/chitosan/GAG scaffolds with different chitosan contents (collagen:chitosan ratios of 20:1, 5:1, and 1.25:1) was investigated. The porous scaffolds containing collagen and chitosan were fabricated by using a freeze drying technique and crosslinked using 1-ethyl-3-(3-dimethyl aminopropyl)carbodiimide(EDC) in the presence of CS. The physicochemical/ mechanical properties of scaffolds were determined by analyzing scanning electron microscopy, compression modulus, immobilized GAG content, and water-binding capacity. Rabbit chondrocytes seeded onto these scaffolds were cultured for 1, 3, 7, and 14 days. The cell proliferation rate was evaluated with 3H-thymidine uptake and total GAG content assay was done via DMB assay using ELISA method. For the histological assessment of extracellular matrix, staining with safranin-O/fast green and immunohistochemistry were used. RESULTS: Scanning electron microscope(SEM) views of the scaffolds showed that all three had interconnected pores of mean diameter 164, 353, and 567 micrometer at collagen:chitosan ratios of 20:1, 5:1, and 1.25:1. GAG was covalently bound onto these scaffolds at 6.4%(w/w) in all three cases, i.e., regardless of chitosan content. However, increased chitosan content resulted in enhanced mechanical properties and increased pore size. Biochemical analysis of these scaffolds showed that proliferation rate and GAG synthesis increased with time, and this became most significant in the collagen:chitosan(20:1)-CS scaffold on day 14. The histology of the cell-seeded constructs showed a significantly higher percentage of cells with spherical morphology, which is specific to mature chondrocyte, especially in the collagen:chitosan(20:1)-CS scaffold at each time point. This finding was consistent with the observation that the pericellular matrix was stained positive for proteoglycans and type II collagen on day 14. CONCLUSION: The novel collagen:chitosan(20:1)-CS scaffold seems to be a useful carrier material for cartilage tissue engineering.
Cartilage* ; Cell Proliferation ; Chitosan ; Chondrocytes ; Chondrogenesis* ; Collagen ; Collagen Type II ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Freeze Drying ; Immunohistochemistry ; Microscopy, Electron, Scanning ; Proteoglycans ; Tissue Engineering*

BACKGROUND AND OBJECTIVES: Metabolic syndrome (MetS) increases the risk of heart failure (HF). The purpose of this study was to identify the prevalence of MetS in patients with HF and determine the syndrome's association with HF in clinical and laboratory parameters. SUBJECTS AND METHODS: A total of 3200 HF patients (67.6+/-14.5 years) enrolled in a nationwide prospective Korea HF Registry between Jan. 2005 and Oct. 2009. Patients were divided into two groups according to the presence or absence of MetS at admission: group I (presence, n=1141) and group II (absence, n=2059). RESULTS: The prevalence of MetS was 35.7% across all subjects and was higher in females (56.0%). The levels of white blood cells, platelets, creatinine, glucose, and cholesterol were significantly higher in group I than in group II. Left ventricular dimension and volume was smaller and ejection fraction was higher in group I than in group II. An ischemic cause of HF was more frequent in group I. The rates of valvular and idiopathic cause were lower in group I than in group II. The rate of mortality was lower in group I than in group II (4.9% vs. 8.3%, p<0.001). CONCLUSION: Despite the increased cardiovascular risks in MetS, MetS was found to be associated with decreased mortality in HF.
Blood Platelets ; Cholesterol ; Creatinine ; Female ; Glucose ; Heart ; Heart Failure ; Humans ; Korea ; Leukocytes ; Prevalence ; Prospective Studies

BACKGROUND AND OBJECTIVES: Acute heart failure (AHF) is associated with a poor prognosis and it requires repeated hospitalizations. However, there are few studies on the characteristics, treatment and prognostic factors of AHF. The aims of this study were to describe the clinical characteristics, management and outcomes of the patients hospitalized for AHF in Korea. SUBJECTS AND METHODS: We analyzed the clinical data of 3,200 hospitalization episodes that were recorded between June 2004 and April 2009 from the Korean Heart Failure (KorHF) Registry database. The mean age was 67.6+/-14.3 years and 50% of the patients were female. RESULTS: Twenty-nine point six percent (29.6%) of the patients had a history of previous HF and 52.3% of the patients had ischemic heart disease. Left ventricular ejection fraction (LVEF) was reported for 89% of the patients. The mean LVEF was 38.5+/-15.7% and 26.1% of the patients had preserved systolic function (LVEF > or =50%), which was more prevalent in the females (34.0% vs. 18.4%, respectively, p<0.001). At discharge, 58.6% of the patients received beta-blockers (BB), 53.7% received either angiotensin converting enzyme-inhibitors or angiotensin receptor blockers (ACEi/ARB), and 58.4% received both BB and ACEi/ARB. The 1-, 2-, 3- and 4-year mortality rates were 15%, 21%, 26% and 30%, respectively. Multivariate analysis revealed that advanced age {hazard ratio: 1.023 (95% confidence interval: 1.004-1.042); p=0.020}, a previous history of heart failure {1.735 (1.150-2.618); p=0.009}, anemia {1.973 (1.271-3.063); p=0.002}, hyponatremia {1.861 (1.184-2.926); p=0.007}, a high level of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) {3.152 (1.450-6.849); p=0.004} and the use of BB at discharge {0.599 (0.360-0.997); p=0.490} were significantly associated with total death. CONCLUSION: We present here the characteristics and prognosis of an unselected population of AHF patients in Korea. The long-term mortality rate was comparable to that reported in other countries. The independent clinical risk factors included age, a previous history of heart failure, anemia, hyponatremia, a high NT-proBNP level and taking BB at discharge.
Anemia ; Angiotensin Receptor Antagonists ; Angiotensins ; Female ; Heart ; Heart Failure ; Hospitalization ; Humans ; Hyponatremia ; Korea ; Multivariate Analysis ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Peptide Fragments ; Prognosis ; Registries ; Risk Factors ; Stroke Volume

BACKGROUND: Various eccrine tumors are rather common diseases in clinicians. However, data on the clinicopathologic features of eccrine tumors in Korea are limited. OBJECTIVE: The purpose of this study was to investigate the clinicopathologic characteristics of eccrine tumors in Korea. METHODS: Two hundred and sixty five cases of eccrine tumors, seen from 2002 to 2004 in Korea, were retrospectively analyzed clinically and histopathologically. RESULTS: The most common eccrine tumors identified within Koreans were syringoma (61%), followed by eccrine poroma (13%), eccrine hidrocystoma (9%), and nodular hidradenoma (6%). Moreover, eccrine tumors were usually found to occur in middle-aged woman as multiple asymptomatic skin-colored papules. The most common site of occurrence was the face (45%), followed by the neck (9%), scalp (5%), foot (5%), abdomen (4%), and vulvar (3%). CONCLUSION: The results of this study will be useful and fundamental data on eccrine tumors for clinicians and pathologists.
Abdomen ; Acrospiroma ; Female ; Foot ; Hidrocystoma ; Humans ; Korea ; Neck ; Poroma ; Retrospective Studies ; Scalp ; Syringoma