BACKGROUND: Electroconvulsive therapy (ECT) that works by electrically inducing grand mal seizure is an effective therapy for patients with major psychosis and affective disorders. But ECT may produce intense stimulation of the central nervous system resulting in hypertension and tachycardia. Such an acute hyperdynamic state may be undesirable because of possible cardiovascular complications. We compared the ability of different bolus doses of esmolol to blunt the hemodynamic effects of ECT. METHODS: Twenty ASA physical status 1~2 patients were enrolled in a crossover design study to determine the effects of two standard esmolol bolus doses (0.5 mg/kg and 1.0 mg/kg) on the hemodynamic response and seizure duration during ECT. In each patients receiving esmolol or placebo, arterial pressure, heart rate, seizure duration and peripheral oxygen saturation (SpO2) were recorded. RESULTS: The seizure duration with placebo was 43 +/- 9 sec, esmolol 0.5 mg/kg bolus dose was 39 +/- 14 sec and esmolol 1.0 mg/kg bolus dose was 39 +/- 12 sec, but it was not significant. Compared with esmolol 0.5 mg/kg bolus dose, esmolol 1.0 mg/kg bolus dose decreased blood pressure and heart rate during ECT more effectively. CONCLUSIONS: Esmolol 1.0 mg/kg bolus dose was considered to be the better dose in blunting the hyperdynamic response during ECT without shortening of seizure duration.
Arterial Pressure ; Blood Pressure* ; Central Nervous System ; Cross-Over Studies ; Electroconvulsive Therapy* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Mood Disorders ; Oxygen ; Psychotic Disorders ; Seizures ; Tachycardia

No abstract available.
Respiratory Insufficiency* ; Ventilators, Mechanical* ; Weaning*

The writers have conducted the investigation to assess the nutritional status of young rural Korean children aged form 0 to 4 years old in August 1971. The survey areas were Kaejong-myon, Daeya-myon, Okku-gun, Jeonra-bukdo, Korea. These survey areas were typical agriculture plain areas. The total numbers of children examined were 2,706 comprising 1,394 male and 1,312 female. the weight, height, and chest circumference of children were measured and means and standard deviations were calculated for each measurement. In addition, the nutritional status of each child was classified by the four levels of malnutrition and the Gomez classification. The examination of red blood cell count, haematocrit value, and intestinal parasite infection were carried out at the same time. In general, recent work tend to suggest that environment influences, especially nutrition, are of great importance than genetic background or other biological factors for physical growth and development. Certainly the physical dimensions of the body are much influenced by nutrition, particularly in the rapidly growing period of early childhood. Selected body measurements can therefore give valuable information concerning protein-calory malnutrition. Growth can also be affected by bacterial, viral, and parasite infection. For the field workers in a developing country, therefore, nutritional anthropometry appears to be of greatest value in the assessment of growth failure and undernutrition, principally from lack of protein and calories. In order to compare and evaluate the data obtained, the optimal data of growth from the offspring of the true well-fed, medically and socially protected are needed, So-called "Standards" that have been compiled for preschool children in Korea, However, are based on measurement of children from middle or lower socio-economic groups, sho are in fact, usually undernourished from six months of age onwards and continuously exposed to a succession of infective and parasitic diseases. So that, the Harvard Standards which os one of the international reference standards was used as the reference standards in this study. Findings of the survey were as follows: A. Anthropometric data: 1) Comparing the mean values for body weight obtained with the Korean standard weight of the same age, the rural Korean children were slightly haevier than the Korean standard values in both sexes. Comparing with the Japanese children values, the rural Koran children were slightly haevier in male and in the infant period of female but lighter in female of the period of 1 to 4 years old than Japanese children. 2) Comparing the mean values for height obtained with the Korean standard height of the same age, the rural Korean children were taller than the Korean standard values except the second half of infant period in both sexes. Comparing with the Japanese children, the rural Korean children were slightly smaller than Japanese children except the first half of infant period in both sexes. 3)Mean values of chest circumference of rural Korean children obtained were less than the Korean standard values of the same ages in birth sexes. B. Prevalence of Protein-Calory Malnutrition: Children examined were divided into two groups, i. e. , infant (up to the first birthday) and toddler (1 to $ years old). 1) Percentage of four levels of malnutrition: a) when the nutritional status of each child was classified (1) by body weight value, the percentages for male and female of children attained standard value, the percentages for male and female of children attained standard growth were 52.8%(infant 83.3%, toddler 44.4%) and 39.7%(infant 74.5%, toddler 30.5%), the first level of malnutrition were 31.9% (infant 13.7%,toddler 36.9%) and 31.7%(infant 15.3%, toddler 36.0%), the second level of malnutrition were 12.3%(infant 1.7%, toddler 15.3%) and 23.3% (infant 7.7%, toddler 27.5%), the third level of malnutrition were 2.7%(infant 0.7%, toddler 3.2%) and 4.6%(infant 1.8%, toddler 5.3%) the fourth level of malnutrition were 0.3% (infant 0.7%, toddler 0.2%) and 0.7%(0.7% for infant and toddler) respectively. (2)by height value, the percentages for male and female of children attained standard growth were 80.3%(infant 97.3%, toddler 75.6%) and 75.1%(infant 96.4%, toddler 69.5%), the first levels of malnutrition were 17.9%(infant 2.0%, toddler 22.3%) and 23.6%(infant 3.6%, toddler 28.8%), the second level of malnutrition were 1.2%(infant 0.3%, toddler 1.5%) and 1.1%(infant 0%, toddler 1.4%), the third level of malnutrition were 0.4%(infant 0.3%, toddler 0.5%) and 0.2%(infant 0%, toddler 0.3%), the fourth level of malnutrition were 0.1%(infant 0%, toddler 0.1%) and 0% respectively. (3) By body weight in relation to height, the percentages for male and female of children attained standard growth were 87.9%(infant 77.6%, toddler 87.9%) and 78.2%(infant 77.4%, toddler 78.2%), the first level if malnutrition were 12.2%(infant 18.4%, toddler 10.6%) and 18.2%(infant 17.9%, toddler 18.3%), the second level of malnutrition were 1.9%(infant 3.3%, toddler 1.5%) and 3.0%(infant 3.3%, toddler 2.9%), the third level of malnutrition of malnutrition were 0.1%(infant 0.7%, toddler 0%)and 0.3%(infant 1.5%, toddler 0%) respectively. b) When the nutritional status of each child according to the mother's aged mother (31 to 40 years old) and old aged mother (41 years of above) was classified. (1) By body weight, among infants and toddlers, at each year of age, with increasing the mother's age, there was an increase in percentage of subjects underweight. This tendency of increasing percentage f underweight was more significant in the infant period than the toddler period. (2) By height value, no significant differences between each mother's age group were found. c) When the nutritional status of each child according to the birth rank, i. e. , lower birth rank(first to third) an higher birth rank(fourth of above) was classified. (1) By weight value, children of higher birth rank were slightly more often underweight than those of lower birth rank, but not significant. (2) By height value, no differences were found between children of lower and higher birth rank. 2) Gomez Classification: When the nutritional status of each child was classified a) By body weight value, the percentages for male and female of children, attained standard growth were 53.1%(infant 82.6%, toddler 44.9%) and 39.2%(infant 73.4%, toddler 30.1%), the first degree of malnutrition were 39.4%(infant 14.7%, toddler 46.2%) and 47.1%(infant 21.9%, toddler 53.8%), the second degree of malnutrition were 7.3%(infant 2.3%, toddler 8.6%) and 12.9%(infant 4.0%, toddler 15.2%), and the third degree of malnutrition were 0.2%(infant 0.3%, toddler 0.2%) and 0.8%(infant 0.7%, toddler 0.9%) respectively. b)By body weight value, the percentages for male and female of children, attained standard growth were 80.8%(infant 97.0%, toddler 76.3%) and 73.8%(infant 95.6%, toddler 68.0%), the first degree of malnutrition were 18.5%(infant 2.7%, toddler 22.9%) and 24.6%(infant 4.4%, toddler 30.0%), the second degree of malnutrition were 0.6%(infant 0.3%, toddler 0.7%) and 0.5%(infant 0.1%, toddler 0.7%), and the third degree of malnutrition were 0.1%(infant 0%, toddler 0.1%) and 1.1%(infant 0%, toddler 1.3%) respectively. C. Results of clinical laboratory examination: 1) Red blood cells: The range of mean red blood counts for male and female were 3,538,000/m3 to 4,483,000/m3 respectively. The lowest red cell counts were seen at the age of 0-3 months for male and 1-2 months for female. 2) Haematocrit value: The ranges of haematocrit value of male and female were 35.1% to 38.8% and 34.7% to 38.8% respectively. The lowest haematocrit values were seen at the age of 2-3 months for male and 1-2months for female. 3)The prevalence rates of intestinal parasites for male and female children with Ascaris lumbricoides were 34.1%(infant 18.8%, toddler 38.1%) and 36.0%(infant 18.4%, toddler 40.7%), with Trichocephalus trichiuris were 6.8%(infant 2.9%, toddler 7.9%) and 9.0%(infant 3.0%, toddler 10.6%), with Hookworm were 0.3%(infant 0.5%, toddler 0.2%)and 0.3%(infant 0.5%, toddler 0.3%), with Clonorchis sinensis were 0.4%(infant 0%, toddler 0.5%) and 0.1%(infant 0%, toddler 0.1%)respectively.
Agriculture ; Ancylostomatoidea ; Anthropometry ; Ascaris lumbricoides ; Asian Continental Ancestry Group ; Biological Factors ; Body Weight ; Cell Count ; Child* ; Child, Preschool ; Classification ; Clonorchis sinensis ; Developing Countries ; Erythrocyte Count ; Erythrocytes ; Female ; Growth and Development ; Health Personnel ; Humans ; Infant ; Korea* ; Male ; Malnutrition ; Mothers ; Nutritional Status* ; Parasites ; Parasitic Diseases ; Parturition ; Prevalence ; Thinness ; Thorax ; Trichuris

No abstract available.
Aorta, Thoracic* ; Blood Flow Velocity* ; Female ; Hypertension, Pregnancy-Induced* ; Pregnancy ; Umbilical Arteries*

Prolonged intubation of the trachea in the treatment of acute respiratory failure has become commonplace in the Intensive Care Units during the last decade. We defined prolonged endotracheal intubation as cases in which endotracheal intubation is required more than 7 days, and then experiences 202 caaes out of 5,866 Intensive Care Unit patients from March 1981 to February 1986 in Severance Hospital, Yonsei Medical Complex were evaluated. The results were as follows ; 1) The number of patients were 202 cases in total, and male and females were 130 and 69 cases. The teen-age groups was most common,69 crises(33.7%) and fortiea was 35 cases (17.3%) . 2) The patients of internal medioine department was the mast common, 23.3% and pediatric an? neurosurgical department fellowed in order. 3) The moat common causes of acute respiratory failure is central nervous srstem disotraders and ARDS (Adult Respiratory Distress Syndrome) . 4) Average stay in Intensive Care Unit was 23.5 day, from 3 to 208 days. Nintr-nine cases(49%) were impreved and the remainder (103 caaes) were expired. 5) Orotracheal intubation is performed in 144 cases (71.4%) and tracheostomy was done in 48 cased, among them, in 39 crises oro-and nasotracheal intubation was changed to trac: heostomy after 12 days. 6) Oro-or nasotracheal tube was changed 2.5 timers every 6,3 days. Mean intubation and tracheostomy days was 15.5 and 76.3 darts. 7) Ventilatory support was maintained in 199 caaeg and 12.1 days in endotraeheal intubation patients and 29.1 days in tracheostomy patients. 8) Complication developed in 29 cased awang them 10 cases were in oro- or nasotracheal intubation patients and 19 cartes were in tracheoatomr patients. Horseness, laryngeal edema, and sore throat were deueloped in 3,2 and 1 cartes, respectively, in orotracheal intubation patients and granuloma, traoheal stenosis, tracheal ulceration, an? vocal cord palsy were developed in 9,5,2, and 2 cartes, respectively, in traoheoatomy patents. From the above results, it can be concluded that tracheal complication was serious for the patients who required ventilatory support under prolonged endotracheal incubation. So we must try to Prevent the complication which develop after prolonged endotracheal intu- bation 7nd maintaining the pationts with cardio-respiratory support.
Female ; Granuloma ; Humans ; Intensive Care Units ; Intubation ; Intubation, Intratracheal* ; Laryngeal Edema ; Male ; Pharyngitis ; Respiratory Insufficiency ; Trachea ; Tracheal Stenosis ; Tracheostomy ; Ulcer ; Vocal Cord Paralysis

BACKGROUND: Not rarely we can find young people with acute myocardial infarction(AMI), many studies revealed they have fewer risk factors and less severe coronary angiographic abnormalities than middle and old aged group. METHODS: We studied clinical characteristics and coronary angiographic findings of 5 young men with AMI treated at Masan Koryo General Hospital from June 1986 June 1992. RESULTS: The age ranged between 19 and 32 years(mean 25.4). They had no other risk factors except cigrarette smoking(4 out of 5). Their coronary angiograms revealed no significant lesion in each infarct related artery. After discharge, all patient remained asymptomatic. CONCLUSION: AMI in young man might be related with cigarette smoking, and coronary artery spasm and/or thrombosis may play a significant role in its pathogenesis.
Arteries ; Coronary Vessels ; Hospitals, General ; Humans ; Male ; Myocardial Infarction* ; Risk Factors ; Smoking ; Spasm ; Thrombosis

Comflicting results have been reported on whether ketamine potentiates the neuromuscular effect of succinylcholine or other non-depolarizing agents. Notably, there has been no reported clinical evatuation of the influence of ketamine upon the neuromuscular action of vecuronium a new muscle relaxant. The present study was undertaken to estimate the influence of ketamine upon the neuromuscular action of vecuronium with a single bolus injection of ED95. Forty-five ASA class l or ll surgical patients were divided into three groups: l, ll and lll and were given thiopental sodium(5mg/kg), ketamine 3mg/kg and ketamine 5mg/kg as induction agents, respectively. The duration and recovery index of group ll and lll (35.20+/-2.30 and 16.20+/-1.37 min., 52.60+/-3.98 and 25.47+/-3.78min., respectively) were longer than those in group l (24.87+/-1.59 and 10.66 +/- 1.23 min.). But group l had a lower TOF ratio(27.40+/-3.09%) at 75% single twitch recovery than group ll and lll (41.87+/-3.25 and 45.27+/-3.67%, respectively). The increase in duration and the recovery index of group lll were greater than that of group ll. It was concluded that ketamine woudly potentiate the neuromuscular action of vecuronium in a dose-dependent manner. We suggest that combination of ketamine and vecuronium requires careful postoperative neuromuscular monitoring for the recovery from a vecuronium induced neuromuscular block.
Humans ; Ketamine* ; Neuromuscular Agents ; Neuromuscular Blockade* ; Neuromuscular Monitoring ; Succinylcholine ; Thiopental ; Vecuronium Bromide

Forty children were anesthetized with either thiopental 5mg/kg followed by succinylcholine 1.5mg/kg I.V. or with isoflurane 3.5 vol% in 66% nitrous oxide in oxygen via a face mask followed by succinylcholine 1.5mg/kg I.V.. The study was randomized, in the thiopental group, fasciculation were seen in all children and in the isoflurane group, in 10 of 20 children(p<0.001). The intensity of the fasciculation was 1.6+/-0.7 in the thiopental group and 0.6+/-0.4 in the isoflurane group(p<0.001). The duration of fasciculstion was 35.6+/-13.6sec in the thiopental group and 9.0+/-8.0 sec in the isoflurane group(p<0.001). No cardiac arrhythmias were noted in either group, but heart rates were inereased significantly after intubation in both group(p<0.001). ln conclusion, isoflurane in nitrous oxide may inhibit succinylcholine-induced muscle fasciculation in children.
Anesthesia* ; Arrhythmias, Cardiac ; Child* ; Fasciculation* ; Heart Rate ; Humans ; Intubation ; Isoflurane* ; Masks ; Nitrous Oxide ; Oxygen ; Succinylcholine* ; Thiopental

Propofol is limited in clinical use for induction of anesthesia, because of its high incidence of pain on injection. We sought to determine whether different methods could prevent this pain. 150 patients were allocated randomly into five groups. Group 1 was received room-air temperature propofol 2.5 mg/kg. Group 2 was received room-air temperature propofol 2.5 mg/kg mixed with 1 ml of 1%(10 mg) lidocaine. Group 3 was received room-air temperature propofol 2.5 mg/kg just after the injection of l ml of 1%(10 mg) lidocaine. Group 4 was received room-air temperature propofol 2.5 mg/kg mixed with 1 ml of 0.5%(5 mg) lidocaine. Group 5 was received propofol 2.5 mg/kg cooled to 0-4degrees C. The pain was classified as none, mild, moderate, or severe. All patients were questioned the degree of pain in an identical manner both at induction of anesthesia and as recalled in the recovery room. There was a significant reduction in the incidnce and severity of pain in the Groups 2 and 3, which were used 10 mg of lidocaine. But 23.3% of patients in the Group 2 and 30.0% of patients in the Group 3 still suffered unpleasant pain during the induction, and 20.0% and 26.7% of patients, respectively recalled in the recovery room. From the above results, we concluded that the pain from injection of propofol can be prevented by 1 ml of 1%(10 mg) lidocaine mixed with propofol or preinjection before propofol.
Administration, Intravenous* ; Anesthesia ; Humans ; Incidence ; Lidocaine ; Propofol* ; Recovery Room

PURPOSE: The most important consideration for therapy using MSCs is the differentiation of the target organ's cell type. For in-vitro hepatogenic differentiation of MSCs, the main focus is efficient induction of the MSCs into the endoderm stage. Activin A, which is a signaling molecule that is similar to Nodal, promotes the induction of definitive endoderm from both ESs and MSCs. The protocols for induction into definitive endoderm have shown different efficiency and reproducibility depending on the researchers or the sources of the MSCs. Thus, a study on the various conditions of Activin A is needed to efficiently differentiate MSCs into the definitive endoderm lineage of MSCs. METHODS: MSCs were isolated from human adipose tissues and these were cultured in MCM (MSCs Culture Medium) on a human fibronectin coated plate. At 70~80% confluence, the MSCs were harvested and cultured in MCM supplemented with Activin A, at a 50 ng/mL concentration, and FGF4. The expression of the genes related with MSCs or primitive endoderm were analyzed by RT-PCR. The changes of cell morphology for differentiation were also observed by a light microscope & a SEM. RESULTS: The expression of genes related with primitive foregut endoderm was seen in the groups that were treated with a higher concentration of Activin A. The morphology of the cells that differentiated into definitive endoderm were not different from those of the undifferentiated MSCs. The expression of genes related with functional primitive hepatocytes was seen in the early phase during hepatic differentiation. The cell morphology was changed to a similar cuboidal form in a time-dependent manner. CONCLUSION: Activin A promotes a more rapid induction of definitive endoderm. It also makes an efficient condition for the differentiation into primitive foregut endoderm at a higher concentration.
Activins ; Endoderm ; Fibronectins ; Hepatocytes ; Humans ; Light