BACKGROUND: We performed electrical cardioversion for the patients with chormic nonvalvular atrial fibrillation under the transesophageal echocardiographic guidance after anticoagulation to evaluate the safety of this procedure and the effects of electrical cardioversion on the atrial function. METHODS: After anticoagulation therapy with coumadine for three weeks, we tried chemical cardioversion with amiodarone first. Failed cases were included in this study. Pre-cardioversion transesophageal echocardiographic parameters were measured after exclusion of thrombi. After sedation with intravenous midazolam, direct-current cardioversion was done with the transesophageal echocardiographic probe in situ. Immediately after sinus conversion, we measured echocardiographic parameters again. Spontaneous echo contrast(SEC), left atrial appendage flow velocity, pulmonary vein flow velocity and time-velocity-integral(TVI), transmitral flow velocity, TVI and deceleration time were measured. All patients were anticoagulated for at least 4 weeks after cardiovesion. RESULTS: The total number of patients was forty one(24 males, 17 females) with the mean age of 58 years(range : 39-70). Mean duration of atrial fibrillation was 65 months(range : 1-360). Hypertension(12), dilated cardiomyopathy(10), cerebrovascular accidents(6), ischemic heart disease(2) and chronic lung disease(1) were associated. There were no complications. SEC increased or newly appeared in 18(43.9%) patients after sinus conversion. The left atrial appendage emptying velocity decreased(32.8+/-17.4 vs. 22.1+/-11.4cm/sec, p=0.020) and systolic TVI of both upper pulmonic vein increased significantly after sinus conversion. In two cases, early systolic forward flow(S1) of pulmonic vein appeared after sinus conversion. Transmitral E velocity decreased(86.9+/-28.8 vs. 76.3+/-30.6cm/sec, p=0.006) and the deceleration time increased(164+/-49 vs. 206+/-53msec, p=0.000) after sinus conversion. Transmitral A velocity was still low(34.9+/-19.5cm/sec) and E/A ratio was high(2.6+/-1.4) immediately after sinus conversion. CONCLUSION: After appropriate anticoagulation therapy and exclusion of left atrium and left atrial appindage thrombi with TEE we could perform electrical cardioversion safety without complications. The changes in transesophageal echocardiographic parameters after sinus conversion revealed the appearance of atrial mechanical activity in concordance with electrical activity. But these findings suggested atrial stunning or electromechanical dissociation which necessitates extended anticoagulation therapy until the full recovery of atrial mechanical function.
Amiodarone ; Atrial Appendage ; Atrial Fibrillation* ; Atrial Function ; Deceleration ; Echocardiography* ; Echocardiography, Transesophageal ; Electric Countershock* ; Heart ; Heart Atria ; Humans ; Lung ; Male ; Midazolam ; Pulmonary Veins ; Veins ; Warfarin

No abstract available.
Gemfibrozil* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory*

Purpose: To evaluate the pre- and post-operative refractive powers of patients undergoing sutured and sutureless scleral fixation (the latter: the Yamane technique). Methods: Patients who had undergone sutured or sutureless scleral fixation to treat intraocular lens (IOL) dislocation or phacodonesis at Dong-A University Hospital from January 2017 to December 2021 were retrospectively investigated. The preoperatively predicted spherical equivalents (derived using the radii of corneal curvature) were measured via optical coherence topography and the axial lengths were determined using an IOL master ® (Zeiss, Carl Zeiss Meditec, Jena, Germany) device and A-scan biometry (AL-100; Tomey, Nagoya, Japan) ultrasound. The spherical equivalent was measured 1 month after surgery employing an automatic refractive keratometer. The extent of agreement between the predicted and actual spherical equivalents were compared between the sutured and sutureless scleral fixation groups. Results: The sutured scleral fixation group included 20 eyes and the sutureless group 12 eyes. The preoperatively predicted spherical equivalent of the sutured group was -0.158 ± 0.577 diopters (D) on A-scan (Tomey) ultrasound and -0.143 ± 0.617 D employing the IOL master ® (Carl Zeiss Meditec); both correlated poorly with the postoperatively measured spherical equivalent of -0.400 ± 0.923 D (p = 0.903, 0.563). However, the predicted spherical equivalent of the group undergoing sutureless fixation was -0.340 ± 0.368 D on A-scan ultrasound and -0.183 ± 0.251 D using the IOL master ® (Carl Zeiss Meditec); both correlated significantly with the postoperatively measured spherical equivalent of -0.313 ± 1.129 D (p = 0.038, 0.005). Conclusions The preoperatively predicted refractive power correlated significantly with the postoperative refractive power after sutureless but not sutured scleral fixation. Sutureless fixation was safe and the postoperative refractive power was comparable to that of sutured fixation.

No abstract available.
Free Tissue Flaps* ; Lower Extremity* ; Soft Tissue Injuries*

BACKGROUND: The main disadvantage of rocuronium is the pain associated with vascular injection. We evaluated the efficacy of palonosetron for reducing pain after rocuronium injection. METHODS: Eighty patients scheduled for elective surgery were randomly divided into two groups: Group C (normal saline 1.5 ml, n = 40) and Group P (palonosetron 0.075 mg, n = 40). Anesthesia was induced with thiopental 5 mg/kg and the test drug was injected over 10 seconds. Thirty seconds after the injection of the test drug, rocuronium 0.6 mg/kg was injected over 30 seconds and the response was recorded. Injection pain was graded using a 4-point scale. The grade was 0 points for no movement, 1 point for wrist movement, 2 points for elbow or shoulder movement, and 3 points for whole body movement. Mean arterial pressure and heart rate were recorded on arrival in the operating room and before and 30 seconds after rocuronim injection. RESULTS: There was no significant difference in the grade 1 response between the two groups; however, the grade 2 and 3 responses in Group P were 5 (12.5%) and 4 (10%), respectively, which were significantly lower than in Group C, with 13 (32.5%) responses for each grade. There were no significant differences in hemodynamic changes within each group. However, the difference in mean arterial pressure before and after the injection of rocuronium was significantly larger in Group C compared to Group P. CONCLUSIONS: Pretreatment with palonosetron 0.075 mg reduced the incidence and severity of withdrawal movement after rocuronium administration.
Anesthesia ; Arterial Pressure ; Elbow ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Operating Rooms ; Shoulder ; Thiopental ; Wrist

BACKGROUND: Although traumatic implantation of epidermis into the dermis has been suggested as a possible mechanism of formation of palmoplantar epidermal cysts, most cases develop without a trauma history. Recently, human papillomavirus (HPV) was detected in palmoplantar epidermal cysts in some reports. OBJECTIVE: The purpose of this study was to find out the presence of HPV in palmoplantar epidermal Cysts. METHODS: Seven cases of palmoplantar epidermal cysts were studied using clinical, histopathological, and immunohistochemical examinations. They were also examined by the polymerase chain reaction (PCR) method with general primers and HPV 60 type specific primers. RESULTS: On histological examination, all three characteristic findings, that is, intracytoplasmic eosinophilic bodies in the cyst wall, parakeratosis within the cyst cavity, and the vacuolar structures, were not observed. Immnunohistochemical staining was negative for the papillomavirus common antigen. HPV DNA was not detected in these cases by PCR. CONCLUSION: We could not detect any evidence of HPV infection in our cases of palmoplantar epidermal cysts. It is suggested that either our cases could have developed through a different pathogenesis or our study was done after the disappearance of HPV.
Dermis ; DNA ; Eosinophils ; Epidermal Cyst* ; Epidermis ; Humans* ; Parakeratosis ; Polymerase Chain Reaction

BACKGROUND: Ketamine and dexmedetomidine are commonly used for sedation and analgesia in patients. We tried to compare the effects of intravenous ketamine and dexmedetomidine infusion on spinal block with bupivacaine. METHODS: Ninety American Society of Anesthesiologists physical status class I or II patients, who were scheduled to spinal anesthesia were randomly assigned to one of three groups (n = 30). Normal saline 10 ml, 5 ml/hr (loading dose for 10 minutes, infusion) (Group NS), dexmedetomidine 1 microg/kg, 0.5 microg/kg/hr (Group DEX), or ketamine 0.2 mg/kg, 0.5 mg/kg/hr (Group KET) was infused intravenously before spinal anesthesia. We recorded the time to highest sensory block level, sensory and motor regression, and hemodynamic changes. RESULTS: Patients in Groups KET had a significantly faster onset time of sensory block than patients in Group NS. The highest sensory block levels were not significantly different between groups. Average time of sensory regression and knee flexion, was significantly longer in the Group KET and Group DEX than the Group NS. CONCLUSIONS: Intravenous dexmedetomidine and ketamine were found to have a similar synergistic effect with intrathecal bupivacaine. Hemodynamic stability showed better results in Group KET.
Analgesia ; Anesthesia, Spinal ; Bupivacaine* ; Dexmedetomidine* ; Hemodynamics ; Humans ; Ketamine* ; Knee

OBJECTIVE: To determine whether the size of a perfusion defect seen at myocardial perfusion MR imaging represents the extent of irreversibly damaged myocardium in acute reperfused myocardial infarction. MATERIALS AND METHODS: In nine cats, reperfused myocardial infarction was induced by occlusion of the left anterior descending coronary artery for 90 minutes and subsequent reperfusion for 90 minutes. At single-slice myocardial perfusion MR imaging at the midventricular level using a turbo-FLASH sequence, 60 short-axis images were sequentially obtained with every heart beat after bolus injection of gadomer-17. The size of the perfusion defect was measured and compared with both the corresponding unstained area seen at triphenyl tetrazolium chloride (TTC) staining and the hyperenhanced area seen at gadophrin-2-enhanced MR imaging performed in the same cat six hours after myocardial perfusion MR imaging. RESULTS: The sizes of perfusion defects seen at gadomer-17-enhanced perfusion MR imaging, unstained areas at TTC staining, and hyperenhanced areas at gadophrin-2-enhanced MR imaging were 20.4+/-4.3%, 29.0+/-9.7%, and 30.7+/-10.6% of the left ventricular myocardium, respectively. The perfusion defects seen at myocardial perfusion MR imaging were significantly smaller than the unstained areas at TTC staining and hyperenhanced areas at gadophrin-2-enhanced MR imaging (p < .01). The sizes of both the perfusion defect at myocardial perfusion MR imaging and the hyperenhanced area at gadophrin-2- enhanced MR imaging correlated well with the sizes of unstained areas at TTC staining (r = .64, p = .062 and r = .70, p = .035, respectively). CONCLUSION: In this cat model, the perfusion defect revealed by myocardial perfusion MR imaging underestimated the true size of acute reperfused myocardial infarction. The defect may represent a more severely damaged area of infarction and probably has prognostic significance.
Animal ; Cats ; Contrast Media ; Gadolinium ; Gadolinium DTPA/diagnostic use ; *Magnetic Resonance Imaging ; Mesoporphyrins/diagnostic use ; Metalloporphyrins/diagnostic use ; Myocardial Infarction/*pathology/therapy ; *Myocardial Reperfusion ; Myocardium/pathology ; Support, Non-U.S. Gov't

No abstract available.
Pyelonephritis*

A pulmonary blastoma is a rare malignant tumor of the lung that is composed of epithelial and mesenchymal elements and resembles the structure of an embryonic lung. Pulmonary blastomas have a very poor prognosis and make up 0.25 to 0.5 percent of all primary malignant lung tumors. A pulmonary blastoma usually manifests as a solitary parenchymal mass or nodule and multiple subpleural mass with effusion on chest X-ray and computed tomography. We encountered a very rare case of pulmonary blastoma in a 52 years old male. He complained of abdominal pain, fullness, and dyspnea. The radiology examination revealed a huge lung mass invading the mediastinum, heart, diaphragm, and liver. The percutaneous needle biopsies were performed, and this tumor was diagnosed as a pulmonary blastoma. We report a biopsy confirmed case of a huge pulmonary blastoma invading multiple organs.
Abdominal Pain ; Biopsy ; Biopsy, Needle ; Diaphragm ; Dyspnea ; Heart ; Humans ; Liver ; Lung ; Lung Neoplasms ; Male ; Mediastinum ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Pulmonary Blastoma* ; Thorax