In order to evaluate the efficacy of adenosine triphosphate (ATP) in the reduction of left ventricular afterload, we studied the hemodynamic and intrapulmonary shunt effects of intravenous ATP during ethrane-N2O anesthesia. Hemodynamic measurements and arterial and mixed venous blood gas analyses were made in ten patients before (baseline) and 10 min after. ATP infusion at 80,60,120 and 250 mcg/kg/min, respective. The results were as follows: 1) ATP produced a rapid and stable reduction in mean arterial pressure resulting from a marked decrease in systemic vascular resistance. 2) Cardiac index increased significantly by 14, 47 and 72% from baseline value after intravenous infusion of ATP at rates of 60, 120 and 250 mcg/kg/min, respectively. 3) Stroke volume index, heart rate, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and central venous pressure increased significantly, whereas systemic vasular resistance and pulmonary vascular resistance decreased significantly in a dose related fashion during ATP infusion. 4) Intrapulmonary ehunt fraction increased from 5.67% to 6.73, 8.28, 9.85 and 13.38% after intra- venous infusion of ATP at rates of 30, 60, 120 and 250 mcg/kg/min, respectively. 5) Arterial oxygen tension decreased significantly after ATP infusion. These results suggest that ATP might be of value in augmentation of cardiac performance in patients with low cardiac output with high peripheral vascular resistance.
Adenosine Triphosphate* ; Adenosine* ; Anesthesia ; Arterial Pressure ; Blood Gas Analysis ; Cardiac Output, Low ; Central Venous Pressure ; Enflurane* ; Heart Rate ; Hemodynamics* ; Humans ; Infusions, Intravenous ; Lung ; Oxygen ; Pulmonary Wedge Pressure ; Stroke Volume ; Vascular Resistance

In effort to determine whether aircraft noise can have health effects such as hearing loss, hypertension and psychological stress, a total of 111 male professors and administrative officers working a college near a military airport in Korea(exposed group) and a total of 168 males and 112 females matched by age groups(control groups) were analyzed. Personal noise exposure and indoor and outdoor sound level of jet aircraft noise were measured at the exposed area. And pure tone, air conduction test and measurement of blood pressure were given to the exposed(males) and matched control groups(males and females). BEPSI(Brief Encounter Psychological Instrument) and psychological response to aircraft noise were examined for the exposed group. The noise dosimetry results revealed time-weighted averages(TWAs) that ranged from 61 to 68 dBA. However the levels encountered during taking off jet airplanes reached 126 dBA for two half minutes time period. The audiometric test showed that mean values of HTL(hearing threshold level) in exposed group at every frequency(500, 1,000, 2,000, 4,000, and 8,000 Hz were much lower than them of male and female control groups. And in old age groups, interaction of age and noise was observed at 8,000 Hz in both ears(p< 0.05). Conclusively, aircraft noise does not appear to induce hearing loss directly, but may decreased hearing threshold level by interaction of aging process and noise exposure. However, difference of mean values of exposed and control groups on blood pressure was not significantly. In psychological test, annoyance was the most severe psychological response to noise in exposed group, but mean value of BEPSI was not correlated with job duration in exposed group
Aging ; Aircraft* ; Airports ; Blood Pressure* ; Female ; Hearing Loss* ; Hearing* ; Humans ; Hypertension ; Male ; Military Personnel ; Noise* ; Presbycusis ; Psychological Tests ; Stress, Psychological*

Many patients,especially in certain high risk groups, undergo operative procedures under regional anesthesia in belief that this approach is safer than general anesthesia. During the regional anesthesia, sedation is often provided with intravenous agents, such as diazepam even if diazepam has some dipressant effects on respiration and hemodynamics. To evaluate the effects of diazepam on spinal anesthesia, arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), arterial oxygen saturation (SaO2) and mean arterial pressure (MAP) were measured at 1,3,5.10,15,20and 30min. following diazepam iv (0.2 mg/kg) under spinal anesthesia (group 2), and were compared with the changes in the control group (group 1), who received spinal anesthesia without diazepam administration. The results were as follows: 1) MAP revealed no significant decrease in the control group, and decreased significantly in the group 2 from 3 to 30 min. after diazepam iv under spinal anesthesia. 2) PaO2 did not change significantly in the control group, but PaO2 in group 2 decreased significantly at 1 and 10 min. after intravenous administration of diazepam. And the changes from 3 to 20 min. after intravenous administration of diazepom were significantly different from changes in the group 3) PaO2 increased significantly in grorp 2 from 3 min. after diazepam iv which were significantly different from the changes in the control group. 4) SaO2 decreased significantly in group 2 from 1 to 30 min. after diazepam iv which were significantly different from the changes in the control group. From the above results, diazepam administration under spinal anesthesia affects the respiratory function and hemodynamics, so oxygen inhalation technique may be needed in most cases of sedatives administration after spinal anesthesia.
Administration, Intravenous ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Arterial Pressure* ; Carbon Dioxide ; Diazepam* ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Inhalation ; Oxygen ; Respiration ; Surgical Procedures, Operative

PURPOSE: Hepatocellular carcinoma (HCC) is one of the most common cancers in many parts of the world, however the molecular mechanisms underlying liver cell transformation remain obscure. The instability of microsatellite sequences dispersed in the genome has been linked to a deficiency in cellular mismatch repair. This phenotype has been frequently observed in various human neoplasms and is regarded as a major factor in tumorigenesis. To investigate cumulative genetic changes related with apoptosis during development and progression of HCC, we examined DNAs isolated from 12 Korean HCCs and their adjacent non-tumorous parts to look for evidence of microsatellite instability (MSI). MATERIALS AND METHODS: Twelve microsatellite loci (D6S271, D6S426, D13S153, D13S263, D17S849, D17S938, D17S945, D18S474, D18S64, D19S420, D.19S418 and D19S210) were amplified by PCR from 12 Korean HCCs, and analyzed using an automated DNA analyzer. RESULTS: The high percentages of the MSI were found for the loci of D6S426 (33.3%) and D17S945 (25.0%). The related genes with high frequency of MSI were noted in the wafl (41.7%) and p53 (25.0%). From this study, fifty eight percent of HCCs (7/12) showed MSI with at least one marker. CONCLUSION: This results suggest that the analysis of MSI in HCC might be useful for identifying genes whose loss of function contributes to the development of liver cancer. Furthennore, this method may give a more rapid and accurate sizing of the PCR products of microsatellite; making the routine assessment of MSI possible in many clinical fields.
Apoptosis ; Carcinogenesis ; Carcinoma, Hepatocellular* ; DNA ; DNA Mismatch Repair ; Genome ; Humans ; Liver ; Liver Neoplasms ; Microsatellite Instability* ; Microsatellite Repeats* ; Phenotype ; Polymerase Chain Reaction*

A cross-sectional study was conducted to assess the association between perceived occu-pational psychosocial stress at work and the work-related musculoskeletal disorders (WRMSD) among employees using video display terminals. The study included 111 female telecommunication employees from three companies at ChungBuk province. Cases of WRMSD were defined using symptom questionnaire and physical examination conducted by rehabilitation specialist. Information on demographics, individual factors, and perceived psychosocial stress, were obtained by self-administered questionnaire. For assessing perceived psychosocial stress, we used variables from 'job strain model' proposed by Karasek. Associations between perceived psychosocial stress and WRMSD were assessed by multiple logistic regression models. Forty nine (44% to the total) subjects met our operational definition for WRMSD. Age, seniority, housing load were not associated with WRMSD. Perceived psychosocial stress was associated with WRMSD [odds ratio=3.28, 95% confidence interval: 1.05-10.19]. This study suggests that perceived occupational psychosocial stress is related to the prevalence of WRMSD.
Chungcheongbuk-do ; Computer Terminals* ; Cross-Sectional Studies ; Demography ; Female ; Housing ; Humans ; Logistic Models ; Physical Examination ; Prevalence ; Questionnaires ; Rehabilitation ; Specialization ; Telecommunications

PURPOSE: Anesthesia and surgery commonly cause hypothermia, and this caused by a combination of anesthetic-induced impairment of thermoregulatory control, a cold operation room environment and other factors that promote heat loss. All the general anesthetics markedly impair normal autonomic thermoregulatory control. The aim of this study is to evaluate the effect of two different types of propofol versus inhalation anesthetic on the body temperature. MATERIALS AND METHODS: In this randomized controlled study, 36 patients scheduled for elective laparoscopic gastrectomy were allocated into three groups; group S (sevoflurane, n=12), group L (lipid-emulsion propofol, n=12) and group M (micro-emulsion propofol, n=12). Anesthesia was maintained with typical doses of the study drugs and all the groups received continuous remifentanil infusion. The body temperature was continuously monitored after the induction of general anesthesia until the end of surgery. RESULTS: The body temperature was decreased in all the groups. The temperature gradient of each group (group S, group L and group M) at 180 minutes from induction of anesthesia was 2.5+/-0.6degrees C, 1.6+/-0.5degrees C and 2.3+/-0.6degrees C, respectively. The body temperature of group L was significantly higher than that of group S and group M at 30 minutes and 75 minute after induction of anesthesia, respectively. There were no temperature differences between group S and group M. CONCLUSION: The body temperature is maintained at a higher level in elderly patients anesthetized with lipid-emulsion propofol.
Aged ; Aging ; Anesthesia, General/*methods ; Anesthetics, Combined/administration & dosage ; Anesthetics, Inhalation/*administration & dosage ; Anesthetics, Intravenous/*administration & dosage ; Body Temperature/*drug effects ; Body Temperature Regulation/drug effects ; Fat Emulsions, Intravenous ; Female ; Humans ; Male ; Methyl Ethers/*administration & dosage ; Middle Aged ; Propofol/*administration & dosage

BACKGROUND: To evaluate the role of free fatty acids on the ischemic myocardium, influences of various free fatty acids upon transmembrane action potential and ATP-sensitive K+(KATP) channel activity were examined in the ventricular myocardium and single cardiac myocytes. METHODS: KATP channel activities were measured in the enzymatically (collagenase) isolated single rat ventricular cardiac myocytes by the method of the excised inside-out and the cell-attached patch clamp, and transmembrane action potentials were recorded using the conventional 3M-KCl microelectode techniques in the rat ventricular myocardium. RESULTS: Free fatty acids [FFAs; arachidonic acid (AA), linoleic acid (LA) and lysophosphatidylcholine (LPC)] reduced the KATP channel activity in a dose-dependent manner in the inside-out patch, and 50%-inhibition concentrations (IC50) were 88 +/- 11.2, 49 +/- 12.5, and 188 +/- 17.4 M respectively. Both frequency of channel opening and the mean open-burst duration were markedly decreased, but the amplitude of single channel currents were not changed by the FFAs. AA (50 micrometer) and LPC (50 micrometer) did not affect the dinitrophenol (DNP, 50 micrometer)-induced KATP channel activity, whereas LA (50 micrometer) had a tendency to reduce the activity. The channel inhibition effects by 10 micrometer AA in the inside-out patch were significantly augmented by diclofenac (10 micrometer), but was not changed by nordihydroguaiaretic acid. FFAs never stimulated KATP channel activity, even in the inside-out patch where KATP channel activity reduced in the presence of internal ATP (100 micrometer). Time for 90% repolarization (APD90) significantly increased during superfusion of the FFAs, to 22 (50 micrometer AA), 24 (50 micrometer LA), and 18 (50 micrometer LPC) % from those of the contol at the time of 10 min superfusion, but the other action potential characteristics were not changed by the FFAs. AA (10 micrometer) attenuated cromakalim (10 micrometer)-induced APD90 shortening effects. CONCLUSION: It was inferred that FFAs inhibit the KATP channel activity directly by themselves and/or indirectly by their metabolites in the rat ventricular cardiomyocytes, and therefore, duration of action potential lengthens to be a burden over the ischemic myocardium accounting for the injury of myocardium at the late stage of ischemia.
Action Potentials* ; Adenosine Triphosphate ; Animals ; Arachidonic Acid ; Cromakalim ; Diclofenac ; Fatty Acids, Nonesterified* ; Ischemia ; Linoleic Acid ; Lysophosphatidylcholines ; Masoprocol ; Myocardium* ; Myocytes, Cardiac ; Potassium Channels* ; Potassium* ; Rats*

To evaluate the clinical significance of atrioventricular blocks in acute inferior myocardial infarction, we reviewed the clinical recordes of 75 patients who were diagnosed as acute inferior myocardial infarction with or without associated atrioventricular conduction blocks and compared the difference in clinical observation and laboratory data including coronary angiography between these two groups of patients. We also followed the clinical courses of atrioventrticualr block during admission among the patients with blocks. 1) 40% of 75 patients had atrioventricualr block associated with acute inferior myocardial infarction and there were 7 first-degree, 8 second-degree and 15 third-degree atrioventricular blocks. 2) There was no statistically significant differences between two groups in mean age ; Killip classification : incidence of previous prodromal angina ; incidende of associated initial symptoms such as dyspnea, nausea, and syncope ; risk factors such as smoking, hypertension and previous muocardial infarction and incidence of complication such as ventricular arrhythmias and heart faliure. 3) The peak serum CK(1,442.9+/-1,703.6 vs. 1,942.8+/-2,022.9IU/L, P<0.01)and LDH(1,014.7+/-429.7 vs. 1,579.2+/-1,544.9 IU/L, P<0.01) levels were significantly higher in the patients group with atrioventricualr blocks than in the patient grouop without blocks. 4) Left ventricualr resting ejection fraction obtained by radinuclide geted blood pool heart scan was significantly less in the patient group with atrioventricular blocks than in the patient group without blocks. 5) The prevalence of multivessel disease and that of associated left anterior descending artery lesion showe no differences between two patient groups. 6) Hospatal mortality of two patient groups were 9.8% and 16.6% respectively and had no statistical significance. 7) Among the patients who had associated atrioventricualr blocks, 70% of patients showed temporary course of block for mean 4.8days, and 6.7% developed permanent first degree block.
Arrhythmias, Cardiac ; Arteries ; Atrioventricular Block ; Classification ; Coronary Angiography ; Dyspnea ; Heart ; Humans ; Hypertension ; Incidence ; Infarction ; Inferior Wall Myocardial Infarction* ; Mortality ; Nausea ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Syncope

BACKGROUND: There is increasing evidence that more aggressive pain management is needed in patients undergoing craniotomy in Korea. However, no consensus or standardized analgesic regimen has been established to date. To achieve this consensus, we undertook a survey of the current state of post-craniotomy pain management in Korea. METHODS: A postal questionnaire was sent to anesthesiologists, neurosurgeons and nurses of neurosurgical departments at 44 university hospitals in Korea. Of the 44 centers that were sent questionnaires, 35 centers returned these from their anesthesiology department resulting in a response rate of 73%, and 25 returned the questionnaires from their neurosurgery department (response rate: 57%). RESULTS: Fifty-three percent of neurosurgeons answered that current postoperative pain management was adequate after craniotomy, whereas only 8% of anesthesiologists agreed. However, 72% of neurosurgeons also agreed that a more aggressive pain management was needed for post-craniotomy patients. Fifty-two percent and 23% of neurosurgeons used non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen as a first-line analgesic, respectively. Twenty-five percent of neurosurgeons used opioids as a first-line analgesic. Fifty percent of anesthesiologists used strong opioids alone or with NSAIDs as a first-line analgesic. About 10% of both groups used weak opioids as a first-line drug. CONCLUSIONS: Many clinicians agree that post-craniotomy pain is not adequately managed and more aggressive strategies are needed. Nevertheless, opioid analgesics are still avoided because of the concern of side effects despite no evidence to suggest increased risk when use carefully.
Acetaminophen ; Analgesia ; Analgesics, Opioid ; Anesthesiology ; Anti-Inflammatory Agents, Non-Steroidal ; Consensus ; Craniotomy ; Hospitals, University ; Humans ; Korea ; Neurosurgery ; Pain Management ; Pain, Postoperative ; Surveys and Questionnaires

PURPOSE: This study was performed to identify the mediating effect of empowerment in the relationship between head nurses' servant leadership and organizational commitment among clinical nurses. METHODS: A cross-sectional survey design was used. A convenience sample of 249 nurses was recruited from three hospitals located in J province, South Korea. Data were collected by self-report questionnaires, including general characteristics, servant leadership, empowerment, and organizational commitment. Data were analyzed with descriptive statistics, Pearson correlation coefficients, independent t-test, One-way ANOVA, and linear regression using the SPSS 22.0 program. RESULTS: Head nurses' servant leadership perceived by clinical nurses significantly influenced their organization commitment. Empowerment partly mediated the effect of servant leadership on organizational commitment. CONCLUSION: The findings suggest the importance of improving nurse managers' servant leadership and empowering nurses to increase their organizational commitment.
Cross-Sectional Studies ; Head* ; Korea ; Leadership* ; Linear Models ; Negotiating* ; Power (Psychology)*