No abstract available.
Hemispherectomy*

BACKGROUND: It is well known that the prone position affects hemodynamics. In this study, we investigate whether the prone position will affect the heart rate variability compared with the supine position. METHODS: Sixty five pediatric patients were assigned to supine group (n = 36) and prone group (n = 29) according to position during surgery. The patients were induced with thiopental and vecuronium and maintained with O2-enflurane-N2O. ECG data was collected for 15 minutes after saturation at the end tidal concentration of the inhalent agent. From the ECG data, power spectral analysis was performed and approximate entropy was calculated. RESULTS: In the prone group, low frequency power and ratio of low to high frequency power were lower and approximate entropy was higher than those in the supine group. Mean heart rate and blood pressure were no different between the two groups. CONCLUSIONS: In the prone position, sympathetic autonomic activity and balance of the autonomic nervous system decreased. However the complexity of regulation of heart rate variability was maintained in the prone position.
Anesthesia, General* ; Autonomic Nervous System ; Blood Pressure ; Child* ; Electrocardiography ; Entropy ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Prone Position* ; Supine Position ; Thiopental ; Vecuronium Bromide

BACKGROUND: It is well known that the prone position affects hemodynamics. In this study, we investigate whether the prone position will affect the heart rate variability compared with the supine position. METHODS: Sixty five pediatric patients were assigned to supine group (n = 36) and prone group (n = 29) according to position during surgery. The patients were induced with thiopental and vecuronium and maintained with O2-enflurane-N2O. ECG data was collected for 15 minutes after saturation at the end tidal concentration of the inhalent agent. From the ECG data, power spectral analysis was performed and approximate entropy was calculated. RESULTS: In the prone group, low frequency power and ratio of low to high frequency power were lower and approximate entropy was higher than those in the supine group. Mean heart rate and blood pressure were no different between the two groups. CONCLUSIONS: In the prone position, sympathetic autonomic activity and balance of the autonomic nervous system decreased. However the complexity of regulation of heart rate variability was maintained in the prone position.
Anesthesia, General* ; Autonomic Nervous System ; Blood Pressure ; Child* ; Electrocardiography ; Entropy ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Prone Position* ; Supine Position ; Thiopental ; Vecuronium Bromide

BACKGROUND: It is well known that there is wide individual variation of responsiveness when parasympathetic nervous system is stimulated physiologically, pathologically, and therapeutically. But no appropriate explanation is present for that yet. So the purpose of this study is to verify individual diversity of vagal tone during resting state and after vagal stimulation and to find factor that may significantly contribute to it. METHOD: We serially measured variation of heart period(VHP : sec) which had been known to be an accurate index of cardiac parasympathetic tone during resting state(VHPb) and after vagal stimulation by ice water application to face(VHPv). And we analyzed correlation between VHPb, VHPv and ratio of VHPv to VHPb(ratio). RESULT: There was wide variation of vagal tone both in resting state (VHPb : 0.025-0.161) and after vagal stimulation (VHPv : 0.087-0.661). VHPb could be classified into 3 groups according to stem and leaf distribution(group A : VHPb could be classified into 3 groups according to stem and leaf distribution(group A : VHPb<0.07, B : 0.07-0.1, C : >0.1). The low VHPb group A showed dramatic increase in vagal tone after vagal stimulation (ratio 2.21-20.24 mean 7.7), on the other hand high VHPb group C did not (ratio 0.80-2.55 mean 1.39). There ws also a significant negative correlation between VHPb and ratio (r=0.69, p<0.001). CONCLUSION: These results suggest that there is wide individual diversity of responsiveness to vagal stimulation and magnitude of vagal tone in resting state is an important factor to determine the responsiveness to vagal stimulation.
Child* ; Hand ; Heart ; Humans ; Ice ; Parasympathetic Nervous System ; Water

Gastrointestinal (GI) dysfunction in Parkinson's Disease is common, but its pathophysiology is poorly understood. We performed esophageal manometry, radionuclide oropharyngeal and esophageal transit study in order to obtain the objective data of the frequency of dysphagia in the patients with Parkinson's and to evaluate the subjective symptoms and motor dysfunction of oropharynx and esophagus. Seventeen idiopathic Parkinson's disease patients(7 men and 10 women) and twenty age-matched controls were subjects for esophageal manometry , radionuclide oropharyngeal(O'IT) and esophageal transit study(ETT). Among 17 patients group, 10 patients were abnormal in esophageal manometry, and 14 were abnormal in radionuclide transit time(ETT). At the results of OTT & E'IT, there is significant difference between patient group and age-matched control group(contror group OTT ;2.64+1.9, ETT ;14.33+9.4 : patient group OTT ;34.21+ 71.6, ETT ; 115.98+116. Lsec) (P < 0. 05). However, there was no significant difference between those with complain of dysphagqa and those without complain of dysphagia. Moreover, there was no correlation among the results of O'IT & EIT, the findings of esophageal manometry, those with complain. Of dysphagia, and H-Y stage. In conclusion, it showed the oropharyngeal and esophageal dysfunction in most of Parkinson's disease patients, which was not related with the severity of dysphagia. The causable lesion of dysphagia involved diffusely throughout oropharynx, body of esophagus and lower esophageal sphincter. And, esophageal manometry and radionuclide transit study might be objective tools for evaluation of dysphagia. The relationship between motor dysfunction of oropharynx and esophagus and the severity of Parkinson's disease is remained to be clear.
Deglutition Disorders* ; Esophageal Sphincter, Lower ; Esophagus ; Humans ; Male ; Manometry ; Oropharynx ; Parkinson Disease*

BACKGROUND: Heart rate is tightly controlled by brain. If activity of brain and electroencephalograph (EEG) are changed by anesthetics, electrocardiograph (ECG) might be changed. We investigated whether there is a correlation between EEG and ECG, ECG could replace EEG as a monitor for depth of anesthesia. METHODS: We recruited 50 patients, aged 2-8 years. Inspired and expired end-tidal sevoflurane concentrations were held constant at 1.0 or 2.5 vol%, after which ECG and EEG were obtained for 15 minutes. Total power (TP), low-frequency power (LFP), high-frequency power (HFP), approximate entropy (ApEn), and Hurst exponent (H) were calculated from the ECG. The relationship between EEG and ECG indices at the two sevoflurane concentrations was measured by Pearson's correlation coefficient. RESULTS: As anesthesia deepened, ApEn, H of ECG and beta wave decreased and those of delta and theta increased in 4 channels. In FP2, changes of beta and theta wave were negatively correlated with ApEn and H of ECG (P < 0.05), and changes of delta wave was positively correlated with ApEn (P < 0.05) and H (P < 0.01). In F8, changes of beta and theta wave were negatively correlated with ApEn (P < 0.05) and only theta wave was negatively correlated with H (P < 0.05). In C4, change of delta wave was positively correlated with ApEn (P < 0.001) and H (P < 0.05). CONCLUSIONS: EEG and ECG indices are correlated during sevoflurane anesthesia in children, and ECG-derived indices could possibly be used to monitor depth of anesthesia.
Aged ; Anesthesia ; Anesthetics ; Brain ; Child ; Electrocardiography ; Electroencephalography ; Entropy ; Heart Rate ; Humans ; Methyl Ethers ; Organothiophosphorus Compounds

BACKGROUND: The bispectral index (BIS) is based on changes in the electroencephalogram, and is commonly used to monitor depth of anesthesia. The central nervous system (CNS) controls heart rate variability (HRV). The purpose of this study was to examine the relationship between heart rate variability and changes in BIS. METHODS: We recruited 33 patients, aged 2-12 years. On arrival at the operating room, electrocardiograph (ECG), SpO2, noninvasive blood pressure, and BIS were monitored. After induction and intubation, patients were ventilated with sevoflurane in 35% oxygen in air. At a tidal volume of 7 ml/kg, the respiratory rate was adjusted to maintain an end-tidal CO2 of 35-40 mmHg. Inspired and expired end-tidal sevoflurane concentrations were held constant at 1.0 or 2.5 vol% for more than 10 minutes, after which ECG and BIS data were obtained for 15 minutes. Low-frequency power (LFP), highfrequency power (HFP), approximate entropy (ApEn), maximum layered behavior indices (MaxLI), and mean layered behavior indices (MeanLI) were calculated from the ECG. The relationship between mean BIS and variability indices at the two sevoflurane concentrations was measured by Pearson's correlation coefficient. RESULTS: MaxLI and MeanLI were positively correlated to BIS; whereas LFP, HFP, and ApEn were not. CONCLUSIONS: BIS and ECG indices are correlated during sevoflurane anesthesia in children, and thus ECG-derived indices could be used to monitor depth of anesthesia.
Aged ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Central Nervous System ; Child ; Electrocardiography ; Electroencephalography ; Entropy ; Heart ; Heart Rate ; Humans ; Intubation ; Methyl Ethers ; Operating Rooms ; Organothiophosphorus Compounds ; Oxygen ; Respiratory Rate ; Tidal Volume

In order to decide on appropriate treatment strategy against gastric cancer, an accurate preoperative evaluation of the depth of cancer invasion is essential. We studied 165 cases(19%) of early gastric cancer among 706 cases of gastric cancer. resected over a 6 year period. A retrospective study of early gastric cancer was done to evaluate the endoscopic accuracy and lymph node metastasis status, the following results were obtained: 1) The proportion of EGC according to macroscopic type was 68.5% of depressed type(II, III, IIa+III, IIc+III, III+IIc, IIb+IIc), 26% of elevated type(I, IIa, IIa+ IIb, IIa+IIc), 5.5% of flat type(IIb). 2) In the view of accuracy of endoscopic diagnosis, the rate of accurate diagnosis suitable for postoperative macroscopic type was 37.5%, the rate of unsuitable typed EGC was 33.3%, overestimation(diagnosed to AGC) was 20.6% and underestimation(diagnosed to benign diseases)was 8.6%. Overall accuracy of endoscopic diagnosis was 70.8%. 3) The cases confined to the mucosa were 40.6% and others were submucosal cancers(59.4%). 4) Positive lymph node metastasis was found in 1.5% of M-cancer and 18.4% of SM-cancer(overall 11.5%). 5) Node positive rate of differentiated cancer was 10.5%, undifferentiated carcinoma was 15.4%. There was no signficant difference in frequency of nodal metastasis according tumor size and macroscopic type. 6) Tumors which satisfy the following criteria may not metastasize to lymph nodes:(1) confined to the mucosa; (2) less than 2.0cm in diameter; (3) macroscopically elevated or flat; (4) histologically well or moderately differentiated.
Carcinoma ; Diagnosis ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Retrospective Studies ; Stomach Neoplasms*

BACKGROUND: Pediatric epilepsy can result in a heavy burden of illness for the family and the role of family caregivers is becoming more important for the management of the disease. However, there are only few studies about care-giver burden of pediatric epilepsy. This study examined the factors which may influence care-giver burden of pediatric epilepsy patients METHODS: We surveyed 87 care-givers of pediatric epilepsy patients. The demographic and social data of the care-givers, along with the social and clinical data of the patients were obtained. The Korean version of the Burden Interview (KBI) and the Korean version of the Beck Depression Inventory (KBDI) were used. The relationship between the demographic and social data of care-givers, the clinical factors of the patients and KBI score were evaluated. RESULTS: Of the 87 participants, sixty-nine (79.3%) were the mothers. The mean age of caregivers was 41.3 years and the mean score on the KBI was 20.2 (+/-16.8) points. The mean age of the patients was 11.1 years and 48 patients (55.8%) were male. The number of antiepileptic drugs prescribed, severity of the disease and school record had a significant correlation with KBI in a multivariate linear regression analysis. CONCLUSIONS: We suggest that in addition to the strict control of the seizure, that the consideration for the academic functions of pediatric patients is also important for reducing care-giver burden in the treatment of pediatric epilepsy.
Anticonvulsants ; Caregivers ; Cost of Illness ; Depression ; Epilepsy* ; Humans ; Linear Models ; Male ; Mothers ; Seizures

BACKGROUND/AIMS: Data are lacking regarding the management of chronic hepatitis B (CHB) with resistance to clevudine (CLV). This study evaluated the efficacy of different rescue therapies for CLV-resistant CHB. METHODS: Patients with CLV-resistant CHB were enrolled in the cohort, and all patients developed virologic breakthrough during CLV therapy and had confirmed-genotypic resistance to CLV (rtM204I mutation) before enrollment. RESULTS: Of the 107 patients, 12 received adefovir (ADV), 21 received a CLV plus ADV combination (CLV+ADV), 34 received a lamivudine plus ADV combination (LAM+ADV), and 40 received entecavir (ETV) therapy for 48 weeks. The CLV+ADV group had the lowest hepatitis B virus (HBV) DNA level (p<0.0001) and showed the greatest reduction of HBV DNA levels from baseline compared to all other groups (p=0.004) at week 48. HBV DNA was undetectable (<70 IU/mL) in 0%, 57.1%, 21.2%, and 27.5% (p=0.003) of the patients in each group, respectively, at week 48. At the end of the study, the mean alanine transaminase (ALT) level, rate of ALT normalization, and rate of hepatitis B envelope antigen loss or seroconversion did not differ between groups. CONCLUSIONS: CLV+ADV combination therapy in patients with CLV-resistant CHB more effectively suppresses HBV replication than ETV, ADV, or LAM+ADV therapy.
Alanine Transaminase ; Cohort Studies* ; DNA ; Hepatitis B ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Lamivudine ; Seroconversion