In the late 1950, Greifenstein and associates have studied the properties of phenylcyelohexylamine derivatives and reported that these chemicals produced amnesia, analgesia, catatonia and catalepsy. Phencyclidine was the first of these drugs used in clinical anesthesia, but convulsive movement as well as excitatory behavior discouraged the use of the agent in human beings. Continued research for a more suitable derivative of phencyclidine with similar analgesic action, but shorter duratoin and lesser psychotomimetic action led McCarthy and Chen to investigate the pharmacologic properties of a large series of compounds. One of these, 2-ochlorophenylcyclohexylamine, was shown to have some advantages. Ketamine hydrochloride, chemically related to both phencyclidine and cyclohexylamine, proved to be more satisfactory for clinical anesthesia. Clinical investigations were begun in 1965 by Dominos group who first termed it dissociative anesthesia. As noted by Pender, the clinical signs of anesthesia with ketamine are completely different from those seen with conventional intravenous agents and gaseous compounds. Ketamine acts rapidly on intravenous or intramuscular administration to produce a state chracterized by catalepsy, analgesia and amnesia. It is devoid of sedation, hypnotic or convulsive properties. Normal pharyngeal-laryngeal reflexes are maintained and skeletal tone remains normal or increased. Since the introduction of ketamine by Domino's group, numerous reports have appeared to explain various aspects of the cardiovascular response(increased cardiac output, hypertention, little or no change in peripheral resistance) and respiratory response. However there are few reports on the effect of ketamine on intestinal motility. Thus we have made a study to observe the effect of ketamine on the intestinal motility of chickens. Strips of isolated muscle, 1 cm long, from adult fowl weighing l.2-1.5 kg and isolated smooth muscle of a patient with stomach cancer, were suspended in a muscle chamber containing Tyrode's solution into which was bubbled oxygen gas. The solution was. kept constant at 38 degrees C and contraction of the preparations was recorded on a polygraph. After being washed several times with fresh solution, the muscle strips attained constant motility and tonus. Ketamine and other drugs were added in various concentrations to the chamber. The results are as follows: 1) Ketamine did not exert any effect on human intestinal motility. It relaxed fowl intestinal muscle strips and potentiated the effect of epinephrine, norepinephrine, and isoproterenol. 2) The relaxing effects of ketamine on fowl intestinal muscle strips were not abolished by adrenergic blocking agents. 3) Ketamine demonstrated anticholinergic effect on the intestinal motility of the human and fowl. From the above results, it may be concluded that ketamine exerts a anticholinergic effect and depressant effect on intestinal motility of fowl without relation to adrenergic receptors.
Adrenergic Antagonists ; Adult ; Amnesia ; Analgesia ; Anesthesia ; Cardiac Output ; Catalepsy ; Catatonia ; Chickens* ; Cyclohexylamines ; Epinephrine ; Gastrointestinal Motility* ; Humans ; Isoproterenol ; Ketamine* ; Muscle, Smooth ; Norepinephrine ; Oxygen ; Phencyclidine ; Receptors, Adrenergic ; Reflex ; Stomach Neoplasms

The Guillain-Barre syndrome is characterized by Bymmetrical rapidly, ascending paralysis that occasionally leads to respiratory embarrassment and death. We atudied 16 patients diagnosed as Guillain-Barre syndrome admitted to ICU at Severance Hospital from, January 1981 to April 1986. All patients were managed by respirators and 10 cases were tracheostomised. In addition to antibioticts with steroid therapy, rigid or fiheroptic bronchoscopy and plasma exchange were performed. The results were as follows ; 1) The 16 cases consist of 9 males and 7 females. 2) Prodromal symptoms were URI, fever, and gastrointestinal symptoms. 3) Diagnosis was 7ased on clinical symptoms, CSF studios and nerve conduction study. 4) Treatments included airway maintenance with ventilators, trachestomy, antibiotics with steroid therapy, rigid or fiberoptic bronchoscopy and plasma exchange. 5) Pulmonary complications (aspiration pneumonia, pneumoia, atelectasis, laryngeal ede-ma) and cardiovascular complications (hypertension, tachycardia, bradycardia, fever) were observed. However, there was no death in this group. ln conclusion, respiratory care and otter supportive therapy are of prime importance in the management of Guillain-Barre Syndorme.
Anti-Bacterial Agents ; Bradycardia ; Bronchoscopy ; Diagnosis ; Female ; Fever ; Guillain-Barre Syndrome* ; Humans ; Male ; Neural Conduction ; Otters ; Paralysis ; Plasma Exchange ; Pneumonia ; Prodromal Symptoms ; Pulmonary Atelectasis ; Tachycardia ; Ventilators, Mechanical

In 10 anesthetized and paralyzed rabbits, cardiovascular variabled(blood pressure, pulse rate), rectal temperature and arterial blood gase tension were investigated during high frequency oscillatory ventilation(about 17hz). During high frequency oscillation(HFO) blood pressure, rectal temprerature and blood gas tension remained stable and were not different from the control values( intermittent positive pressure ventilation IPPV). The PaO2/FIO2 ratio remained unchanged during the experiment in spite of changing airway pressure. We observed that HFO provided adequate ventilation and oxygenation without altering cardiovascular dynamics. High frequency oscillatory ventilation appears to be a promising new way of achieving gas exchange with minimal risk of barotrauma to the lung.
Barotrauma ; Blood Pressure ; Intermittent Positive-Pressure Ventilation ; Lung ; Oxygen ; Rabbits ; Ventilation*

No abstract available.
Plasmapheresis* ; Postpartum Period* ; Pregnancy*

OBJECTIVES: To develop and evaluate time series models to predict the daily number of patients visiting the Emergency Department (ED) of a Korean hospital. METHODS: Data were collected from the hospital information system database. In order to develop a forecasting model, we used, 2 years of data from January 2007 to December 2008 data for the following 3 consecutive months were processed for validation. To establish a Forecasting Model, calendar and weather variables were utilized. Three forecasting models were established: 1) average; 2) univariate seasonal auto-regressive integrated moving average (SARIMA); and 3) multivariate SARIMA. To evaluate goodness-of-fit, residual analysis, Akaike information criterion and Bayesian information criterion were compared. The forecast accuracy for each model was evaluated via mean absolute percentage error (MAPE). RESULTS: The multivariate SARIMA model was the most appropriate for forecasting the daily number of patients visiting the ED. Because it's MAPE was 7.4%, this was the smallest among the models, and for this reason was selected as the final model. CONCLUSIONS: This study applied explanatory variables to a multivariate SARIMA model. The multivariate SARIMA model exhibits relativelyhigh reliability and forecasting accuracy. The weather variables play a part in predicting daily ED patient volume.
Crowding ; Emergencies ; Emergency Medical Services ; Forecasting ; Hospital Information Systems ; Humans ; Models, Statistical ; Seasons ; Weather

PURPOSE: The study purposes were to describe the process of developing the Korean versions of the Six Dimension Scale of Nursing Performance (Six-D) and Student Nurse Stress Index (SNSI) and psychometric evaluation of the two measurements. METHODS: This was a methodology study using a descriptive cross-sectional design with 51 nursing students in 4th year of university. Internal consistency reliability was assessed using Cronbach alphas. Construct validity was determined by exploring correlations among Six-D, SNSI, objective structured clinical examination (OSCE), self-efficacy and grade point average (GPA). RESULTS: Internal consistency reliability of Six-D and SNSI was acceptable with Cronbach's alpha of .95 and .82. Correlation analysis to determine construct validity revealed that Six-D presented positive correlations with OSCE (r=.109~.272) and self-efficacy (r=.005~.161) and negative correlation with GPA (r=-.246~-.394), although all were not statistically significant. SNSI presented all negative correlations with OSCE (r= -.007~-.238), self-efficacy (r=-.246~-.394), and GPA (r=-.092~-.426) and were mostly statistically significant except OSCE. CONCLUSION: Six-D needs more evidence to confirm validity to predict observed clinical competency and theoretical relationships with self-efficacy and GPA. However, SNSI presented trends of expected relationships with relevant variables. Therefore, further research is recommended in testing validity of Six-D with other student populations.
Asthma ; Humans ; Psychometrics ; Students, Nursing

PURPOSE: To evaluate whether or not previously known CT criteria for differentiating malignant and benign pleural diseases are useful in the differentiation of diffuse malignant pleural diseases and tuberculosis. MATERIALS AND METHODS: We retrospectively analyzed CT scans of 42 patients comprising 20 cases of malignant pleural diseases and 22 cases of tuberculous pleural diseases, according to previously known CT criteria for differentiating malignant and benign pleural diseases. RESULTS: The most common shape of pleural effusion was crescentic in malignant pleural diseases and loculated in tuberculosis. The aggressive nature of pleural effusion, pleural rind, and pleura thickenign was 1.5 times more frequently observed in malignant pleural diseases than in tuberculosis. Smooth thickening or smooth nodular pleural thickening and extrapleural deposition of fat were 1.5 times more frequently found in tuberculous than in malignant pleural diseases. Interruption of pleural thickening was found twice as frequently in malignant pleural diseases as in tuberculosis. Decreased lung volume was found twice as frequently in tuberculous as in malignant pleural diseases. Anatomical mediastinal pleural involvement was three times, and irregular nodular pleural thickening nine times more frequent in malignant pleural diseases than in tuberculosis. The sensitivity and specificity of CT findings above 70%, and thus suggesting malignant pleural diseases, were as follows: 1) aggressive nature of pleural fluid collection extending to the azygoesophageal recess or tongue of the lung (51.5%, 75%); 2) involvement of anatomical mediastinal pleura (69.2%,73.7%); 3) irregular nodular pleural thickening (87.5%, 69%). CONCLUSION: Although there in overlap between previously known CT criteria for the differentiation of benign and malignant pleural diseases, the aggressive nature of pleural fluid collection extending to the azygoesophageal recess or tongue of the lung, the involvement of anatomical mediastinal pleura and irregular nodular pleural thickening may suggest malignant pleural diseases.
Humans ; Lung ; Pleura ; Pleural Diseases* ; Pleural Effusion ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Tongue ; Tuberculosis*

Though extremely rare, teratoma must also be considered in the differential diagnosis of abdominal mass in the first year of life. The kidney is among the least frequent of the various anatomic location in which teratoma and other germ cell tumors have been reported. One of the earliest cases reported by McCurd(1934) in a 7 week old male with multiple anomalies. The intrarenal teratoma simulated nearly all of the preoperative features including the roentgenographic findings of Wilm's tumor. A histologic examination was required to reverse the clinical and operative impression. We report an anesthetic experience of a 3 month old infant with hypertension being admitted to our hospital with the chief complaint of abdominal mass, which was clinically diagnosed as Wilms' tumor. However postoperative pathologic diagnosis was found to be intrarenal teratoma.
Diagnosis ; Diagnosis, Differential ; Humans ; Hypertension* ; Infant ; Kidney ; Male ; Neoplasms, Germ Cell and Embryonal ; Teratoma* ; Wilms Tumor

Post-intubation croup and tidal volme leak during ventilator support may occur when unsuitable size of endotracheal tube is used. Malposition of endotracheal tubes(ETT) are particularly common in pediatric ICU patients, and may lead to serious complications such as inadvertent endobronchial intubation and accidental extubation. Due to the inaccuracy of physical examination for ETT placement and although there is additional time consumption and expense, the chest X-ray is still considered the gold standard for ETT position evaluation. We assessed the predetermined endotracheal tube size and the distance from the incisor to the carina according to the patient's age, weight and height. The chest X-ray was used for evaluation of these patients who were admitted to the intensive care unit of Severance Hospital Yonsei Medical Center from March to August, 1990. We divided the 430 intubated patients into two groups. Group 1 included 163 patents who were intubated by a endotracheal tube without a cuff. Group 2 included 237 patients who were intubated by a endotracheal tube with a cuff. The conclusion from our results were as follows: 1) The coefficient of determination of the endotracheal tube size, R(2), was highest according to weight, 0.40 and 0.50 in Group 1 and 2. The regression equation of endotracheal tube size using weight was Y=0.11X+3.42 and Y=0.04X+5.46 in Group 1 and Group 2. 2) The coefficient of determination of the distance from the incisor to the carina was highest according to weight 0.57 and 0.33 in Group I and 2. The regression equation of the distance from the incisor to the carina using weight was Y=0.47+10.74 and Y=0.11X+20.17.
Croup ; Humans ; Incisor* ; Intensive Care Units ; Intubation ; Physical Examination ; Thorax* ; Ventilators, Mechanical

The Bain circuit system was first used by Bain and Spoerel in 1972. It is a type of nonrebreathing system which is a variation of the Mapleson D or E system. Its total length, diameter of the inner tube and diameter of the outer tube are 1.8m, 7mm and 22 mm respectively. It's CO2 retension and fresh gas flow requirements were already studied by Bain in 1972. This study suggested that most patients were maintained in normocarbia when fresh gas inflow of 70 ml/kg was used under controlled ventilation. This was confirmed by Henville and Adams in 1976. If the respiratory depression did not .appear, normocarbia could be maintained with the same fresh gas inflow under spontaneous ventilation. The authors performed this study using the same fresh gas inflow in order to understand he problem of fresh gas requirement and CO2 retension under controlled and spontaneous ventilation. The results of our study showed that the CO2, retension was not seen in both groups and complications were not seen during the operation and postoperative period. The Bain circuit system was used satisfactorily at all age groups using low fresh gas flow. Especially in neurosurgery and obstetric anesthesia for maintaining a normal range of PaCO2, the Bain circuit system may be valuable.
Anesthesia, Obstetrical ; Humans ; Neurosurgery ; Postoperative Period ; Reference Values ; Respiratory Insufficiency ; Ventilation