A clinical study was made on 14 cases of coronary sinus rhythm and 17 cases of left atrial rhythm seen at the Kyungpook University Hospital during the past 13 years. The incidence of coronary sinus rhythm among 23, 137 electrocardiograms was 0.07% and that of left atrial rhythm was 0.08%. Among the various types of left atrial rhythm as diagnosed by Mirowski's criteria, type III, posterior type and inferior type were far more common than others. The most common underlying diseases were heart diseases in both coronary sinus rhythm and left atrial rhythm: five cases out of 14 in the former and 11 cases out of 17 in the latter were cardiac cases, respectively.
Coronary Sinus* ; Electrocardiography ; Gyeongsangbuk-do ; Heart Diseases ; Incidence

Carotid endarterectomy is the preferred treatment for a patient with transient ischemic attacks (TIAs) in whom carotid artery stenosis is present. This patient was a 58-year-old male associated with 60 kg in body weight and 172 cm in height. He was scheduled for elective carotid endarterectomy in ASA physical status III. For premedication, he was administered triflupromazine (Veprin ) 10 mg and glycopyrrolate 0.2 mg IM 1 hour prior to induction. Induction was established with thiopental sodium, succinylcholine after preoxygenation. N2O/O2 (2:1), isoflurane and pancuronium were administered for maintenance. For monitoring, ECG, EEG, direct arterial pressure, ETCO2, CVP and rectal temperature were performed. A primary goal of the intraoperative management is the prevention of the cerebral ischemia. He was challenged to maintain adequate cerebral perfusion without causing myocardial ischemia. The EEG is the reliable indication of cortical function during general anesthesia. No signs of the cerebral ischemia were occurred at the time of the carotid occlusion. Minute ventilation was kept mild hypo-or normocapnia. He had no new neurologic deficits and myocardial ischemia, and discharged on 14 day postoperation.
Anesthesia, General ; Arterial Pressure ; Body Weight ; Brain Ischemia ; Carotid Stenosis ; Electrocardiography ; Electroencephalography ; Endarterectomy, Carotid* ; Glycopyrrolate ; Humans ; Ischemic Attack, Transient ; Isoflurane ; Male ; Middle Aged ; Myocardial Ischemia ; Neurologic Manifestations ; Pancuronium ; Perfusion ; Premedication ; Succinylcholine ; Thiopental ; Triflupromazine ; Ventilation

Carotid endarterectomy is the preferred treatment for a patient with transient ischemic attacks (TIAs) in whom carotid artery stenosis is present. This patient was a 58-year-old male associated with 60 kg in body weight and 172 cm in height. He was scheduled for elective carotid endarterectomy in ASA physical status III. For premedication, he was administered triflupromazine (Veprin ) 10 mg and glycopyrrolate 0.2 mg IM 1 hour prior to induction. Induction was established with thiopental sodium, succinylcholine after preoxygenation. N2O/O2 (2:1), isoflurane and pancuronium were administered for maintenance. For monitoring, ECG, EEG, direct arterial pressure, ETCO2, CVP and rectal temperature were performed. A primary goal of the intraoperative management is the prevention of the cerebral ischemia. He was challenged to maintain adequate cerebral perfusion without causing myocardial ischemia. The EEG is the reliable indication of cortical function during general anesthesia. No signs of the cerebral ischemia were occurred at the time of the carotid occlusion. Minute ventilation was kept mild hypo-or normocapnia. He had no new neurologic deficits and myocardial ischemia, and discharged on 14 day postoperation.
Anesthesia, General ; Arterial Pressure ; Body Weight ; Brain Ischemia ; Carotid Stenosis ; Electrocardiography ; Electroencephalography ; Endarterectomy, Carotid* ; Glycopyrrolate ; Humans ; Ischemic Attack, Transient ; Isoflurane ; Male ; Middle Aged ; Myocardial Ischemia ; Neurologic Manifestations ; Pancuronium ; Perfusion ; Premedication ; Succinylcholine ; Thiopental ; Triflupromazine ; Ventilation

BACKGROUND: Aging is a significant issue worldwide, and Korea is one of the most rapidly aging countries. Along with the demographic transition, the age structure of intensive care unit (ICU) patients changes as well. METHODS: The aim of this study was to analyze the change in age distribution of the ICU patients over the last 10 years and its effect on clinical outcomes. Single-center, retrospective analysis of all patients aged ≥18 years admitted to either the medical or surgical ICU at St. Paul's Hospital, The Catholic University of Korea, between January 2005 and December 2014 was conducted. For clinical outcome, in-hospital mortality, duration of ICU stay, and hospital stay were analyzed. Cost analysis was performed to show the economic burden of each age strata. RESULTS: A total of 10,366 ICU patients were admitted to the chosen ICUs during the study period. The proportion of elderly patients aged ≥65 years increased from 47.9% in 2005 to 63.7% in 2014, and the proportion of the very elderly patients aged ≥80 years increased from 12.8% to 20.7%. However, this increased proportion of elderly patients did not lead to increased in-hospital mortality. The percent of ICU treatment days attributable to elderly patients increased from 51.1% in year 2005 to 64.0% in 2014. The elderly ICU patients were associated with higher in-hospital mortality compared to younger age groups. CONCLUSIONS: The proportion of elderly patients admitted to ICUs increased over the last decade. However, overall in-hospital mortality has not increased during the same period.
Age Distribution ; Aged* ; Aging ; Costs and Cost Analysis ; Critical Care* ; Hospital Mortality ; Humans ; Intensive Care Units* ; Korea* ; Length of Stay ; Mortality ; Population Dynamics ; Retrospective Studies*

No abstract available.
Intensive Care Units ; Sepsis ; Critical Illness ; Chronic Disease ; Hospital Mortality

BACKGROUND: The purpose of this study is to delineate hemodynamic changes resulting from endotracheal intubation under the effects of thiopental sodium and propofol using the thoracic electrical bioimpedance device. METHODS: Thirty healthy adult patients, scheduled for elective surgery under general anesthesia were randomly assigned to receive thiopental sodium 5 mg/kg (Group I, N=15), or propofol 2 mg/kg (Group II, N=15) for induction. Endotracheal intubation was performed following injection of succinylcholine 1 mg/kg. Anesthesia was maintained with enflurane 1.5-2.0% and 50% nitrous oxide in oxygen. Cardiovascular parameters were measured before induction of anesthesia, at the time of pre-intubation and immediate, 1, 2, 3 and 5 minutes after intubation. RESULTS: The mean arterial pressure was significantly decreased in the propofol group compared to that of the thiopental sodium group just after the post-intubation period (p<0.05). The heart rate were decreased in both groups but there were no significant changes in heart rate and cardiac output between group I and II. In group I, systemic vascular resistance was decreased but there was no significant changes between two groups. CONCLUSION: The data suggest that the usual doses of propofol could prevent the increase in mean arterial pressure following intubation due to systemic vascular maintenance. But the intubation of anesthesia using thiopental sodium could not prevent the increase in mean arterial pressure following intubation.
Adult ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Cardiac Output ; Enflurane ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Intubation, Intratracheal* ; Nitrous Oxide ; Oxygen ; Propofol* ; Succinylcholine ; Thiopental* ; Vascular Resistance

We report a case of priapism secondary to bilateral rupture of the cavernosal arteries following perineal blunt trauma in a 34 year old man. He complained of painless but persistent erection for the period of 1 week. We confirmed non-ischemic high-flow priapism by arterial blood gas analysis, Doppler ultrasonography and arteriography. Arteriography showed a leakage on both sides of the end of the cavernosal arteries and the leakage was blocked by superselective cavernosal artery embolization. After the embolization, tumescence began to disappear and the detumescence process was completed on the third day. The examination of the patient after 4 months following embolization revealed that the patient was fully free of priapism and returned to the normal erectile status like before his priapism. During 2 years of follow up, the patient had no complications such as priapism or impotence.
Adult ; Angiography ; Arteries* ; Blood Gas Analysis ; Erectile Dysfunction ; Follow-Up Studies ; Humans ; Male ; Priapism* ; Rupture ; Ultrasonography, Doppler

Hepatocellular carcinoma (HCC) is one of the most common fatal malignancies worldwide, especially in Korea. The recent advances in diagnostic techniques, such as serum tumor marker assay, ultrasonography, computerized tomography (CT), magnetic resonance imaging (MRI), and angiography, allow us to detect HCC at early stage. Even though, it remains difficult to distinguish malignant nodules from benign space-ccupying lesions of liver. Distinction of HCC from benign entities such as liver abscess is important because failure of prompt diagnosis could result in a missed opportunity for curative treatment. The differential diagnosis of HCC and liver abscess, especially HCC presenting as abscess, is sometimes very difficult. We report a case of HCC with liver abscess caused by secondary infection of CBD stone and cholangitis, that mimicked the dynamic CT findings of liver abscess, in an elderly patient with chronic hepatitis C virus infection.
Abscess ; Aged ; Angiography ; Carcinoma, Hepatocellular* ; Cholangitis* ; Coinfection ; Diagnosis ; Diagnosis, Differential ; Hepatitis C, Chronic ; Humans ; Korea ; Liver Abscess* ; Liver* ; Magnetic Resonance Imaging ; Ultrasonography

Takotsubo cardiomyopathy (TTC) is defined as a reversible, acute ventricular dysfunction without any evidence of coronary artery obstruction. There have been reports of TTC caused by emotional or physical stress, drug use, hormone imbalance, or medical conditions such as pulmonary disease, sepsis, and trauma, but a relationship between TTC and pulmonary tuberculosis has not previously been reported. From our knowledge, this is the first report of TTC caused by pulmonary tuberculosis.
Catecholamines ; Coronary Vessels ; Lung Diseases ; Sepsis ; Takotsubo Cardiomyopathy* ; Tuberculosis, Pulmonary* ; Ventricular Dysfunction

Takotsubo cardiomyopathy (TTC) is defined as a reversible, acute ventricular dysfunction without any evidence of coronary artery obstruction. There have been reports of TTC caused by emotional or physical stress, drug use, hormone imbalance, or medical conditions such as pulmonary disease, sepsis, and trauma, but a relationship between TTC and pulmonary tuberculosis has not previously been reported. From our knowledge, this is the first report of TTC caused by pulmonary tuberculosis.
Catecholamines ; Coronary Vessels ; Lung Diseases ; Sepsis ; Takotsubo Cardiomyopathy* ; Tuberculosis, Pulmonary* ; Ventricular Dysfunction