BACKGROUND: Congenital aortic stenosis in children is characterized by "excessive" left ventricular hypertrophy with reduced left ventricular systolic wall stress that allows for supernormal ejection performance. We hypothesized that left ventricular wall stress was decreased immediately after surgical correction of pure congenital aortic stenosis. Also measuring postoperative left ventricular wall stress was a useful noninvasive measurement that allowed direct assessment for oxygen consumption of myocardium than measuring the peak systolic pressure gradient between ascending aorta and left ventricle for the assessment of surgical results. MATERIAL AND METHOD: Between September 1993 and August 1999, 8 patients with isolated congenital aortic stenosis who underwent surgical correction at Yonsei cardiovascular center were evaluated. There were 6 male and 2 female patients ranging in age from 2 to 11 years(mean age, 10 years). Combined Hemodynamic-Ultrasonic method was used for studying left ventricular wall stress. We compared the wall stress peak systolic pressure gradient and ejection fraction preoperatively and postoperatively. RESULT: After surgical correction peak aortic gradient fell from 58.4+/-17.6, to 23.7+/-17.7 mmHg(p=0.018) and left ventricular ejection fraction decreased but it is not statistically significant. In the consideration of some factors that influence left ventricular end-systolic wall stress excluding one patient who underwent reoperation for restenosis of left ventricular outflow tract left ventricular end-systolic pressure and left ventricular end-systolic dimension were fell from 170.6+/-24.3 to 143.7+/-27.1 mmHg and from 1.78+/-0.4 to 1.76+/-0.4 cm respectively and left ventricular posterior wall thickness was increased from 1.10+/-0.2, to 1.27+/-0.3cm but it was not statistically singificant whereas left ventricular end-systolic wall stress fell from 79.2+/-24.9 to 57.1+/-27.6 kdynes/cm2(p=0.018) in 7 patients. For one patient who underwent reoperation peak aortic gradient fell from 83.0 to 59.7 mmHg whereas left ventricular end-systolic wall stress increased from 67.2 to 97.0 kdynes/cm2 The intervals did not change significnatly. CONCLUSION: We believe that probably some factors that are related to left ventricular geometry influenced the decreased left ventricular wall stress immediately after surgical correction of isolated congenital aortic stenosis. Left ventricular wall stress is a noninvasive measurement and can allow for more direct assesment than measuring peak aortic gradient particularly in consideration of the stress and oxygen consumption of the myocardium therefore we can conclude it is a useful measurement for postoperative assessment of congenital aortic stenosis.
Aorta ; Aortic Valve Stenosis* ; Blood Pressure ; Child ; Equidae ; Female ; Follow-Up Studies* ; Heart Ventricles ; Humans ; Hypertrophy, Left Ventricular ; Male ; Myocardium ; Oxygen Consumption ; Reoperation ; Stroke Volume

No abstract available.
Capsaicin*

BACKGROUND AND OBJECTIVES: The purpose of this research was to evaluate physiological significances of expression of immediate early gene proteins in the vestibular nuclear complex by change of arterial pressure (AP) in adult Sprague-Dawley rats. MATERIALS AND METHOD: Record AP and inject either sodium nitroprusside (SNP) or phenylnephrine to change AP. Either fast or slow removal of blood from the femoral artery was made to induce different rapidity in reduction of AP. Blood supply to the inner ear was temporally blocked by clamping anterior inferior cerebellar artery (AICA). Immunohistochemical staining and image analysis for cFos, FosB, Krox, and JunB proteins were performed 2, 6, 12 hours after change of AP. RESULTS: The selective expression of cFos protein was observed in the medial vestibular nucleus (MVN) following reduction of AP. The number of cFos positive neurons peaked at 2 hours and then rapidly reduced, returning to the normal value 24 hours after SNP injection. And cFos protein expression was also well correlated with that of AP reduction at 2 hours of SNP injection. The rapid falling of AP caused a significant expression of cFos protein but slow withdrawal of blood did a minimal change of cFos protein expression. In addition, there was a significant expression of cFos protein following the increase of AP by single injection of phenylnephrine. Unilateral occlusion of AICA resulted in the significant expression of cFos protein in bilateral MVN. Furthermore, bilateral ablation of vestibular endorgans resulted in significant reduction of cFos expression by AICA occlusion in MVN. CONCLUSION: These results suggest that cFos protein is a marker for neuronal excitation in vestibular complex in response to rapid changes in the arterial blood pressure and that medial vestibular nuclei plays an important role in signaling the process of cardiovascular information coming from the peripheral vestibular apparatus.
Adult* ; Animals ; Arterial Pressure* ; Arteries ; Blood Pressure ; Constriction ; Ear, Inner ; Femoral Artery ; Humans ; Neurons ; Nitroprusside ; Proteins ; Rats* ; Rats, Sprague-Dawley ; Reference Values ; Vestibular Nuclei ; Vestibule, Labyrinth

BACKGROUND: Arterial switch operation (ASO) has been the most effective surgical option for transposition of the great arteries. But, the inappropriate dilation of the neoaortic root has been reported and its effect on neoaortic valve function and growth of aorta has not been well documented. MATERIAL AND METHOD: Forty-eight patients who underwent cardiac catheterization during follow up after arterial switch operation were included in this study. Arterial switch operation was performed at a median age of 18 days (range 1~211 days). Preoperative cardiac catheterization was performed in 26 patients and postoperative catheterization was performed in all patients at 15.8+/-9.6 months after ASO. Postoperative ratios of the diameters of neoaortic annulus, root and aortic anastomosis against the descending aorta were compared to the size of preoperative pulmonary annular, root and sinotubular junction. Preoperative and operative parameters were analyzed for the risk factors of neoaortic insufficiency. RESULT: There were two clinically significant neoaortic insufficiencies (grade> or =II/IV) during follow up, one of which required aortic valve replacement. Another patient required reoperation due to aortic stenosis on the anastomosis site. Postoperatively, neoaortic annulus/DA ratio increased from 1.33+/-0.28 to 1.52+/-.033 (p=0.01) and neoaortic root/DA ratio increased form 2.02+/-0.40 to 2.56+/-0.38 (p<0.0001). However, the aortic anastomosis/DA ratio showed no statistically significant difference (p=0.06). There was no statistically significant correlation between the occurrence of neoaortic insufficiency and neoaortic annulus/DA ratio and neoaortic root/DA ratio. Non-neonatal repair (age>30 days) (p= 0.02), preopeative native pulmonaic valve stenosis (p=0.01), and bisuspid pulmonic valve (p=0.03) were the risk factors for neoaortic insufficiency in univariate risk factor analysis. CONCLUSION: After ASO, aortic anastomosis site showed normal growth pattern proportional to the descending aorta, but neoaortic valve annulus and root were disproportionally dilated. Significant neoaortic valve insufficiency rarely developed after ASO and neoaortic annulus and root size do not correlate with the presence of postoperative neoarotic insufficiency. ASO after neonatal period, preoperative native pulmonary valve stenosis, and bicuspid native pulmonic valve are risk factors for the development of neoaortic insufficiency.
Aorta ; Aorta, Thoracic ; Aortic Valve ; Aortic Valve Stenosis ; Arteries ; Bicuspid ; Cardiac Catheterization ; Cardiac Catheters ; Catheterization ; Catheters ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Preoperative Period ; Pulmonary Valve Stenosis ; Reoperation ; Risk Factors

The study was aimed at developing an independent hospice center model that would be best suited for Korea based on a literature review and the current status of local and international hospices. For the study, five local and six international hospice organizations were surveyed. Components of the hospice center model include philosophy, purpose, resources (workers, facilities, and equipment), allocation of resources, management, financial support and hospice team service. The following is a summary of the developed model: Philosophies for the hospice center were set as follows: based on the dignity of human life and humanism, help patients spend the rest of their days in a meaningful way and accept life positively. On the staff side, to pursue a team-oriented holistic approach to improve comfort and quality of life for terminally ill persons and their families. The hospice center should have 20 beds with single, two, and four bed rooms. The center should employ, either on a part-time or full-time basis, a center director, nurses, doctors, chaplains, social workers, pharmacists, dieticians, therapists, and volunteers. In addition, it will need an administrative staff, facility managers and nurses aides. The hospice should also be equipped with facilities for patients, their families, and team members, furnished with equipment and goods at the same level of a hospital. For the organizational structure, the center is represented by a center director who reports to a board and an advisory committee. Also, the center director administers a steering committee and five departments, namely, Administration, Nursing Service, Social Welfare, Religious Services, and Medical Service. Furthermore, the center should be able to utilize a direct and support delivery systems. The direct delivery system allows the hospice center to receive requests from, or transfer patients to, hospitals, clinics, other hospice organizations (by type), public health centers, religious organizations, social welfare organizations, patients, and their guardians. On the other hand, the support delivery system provides a link to outside facilities of various medical suppliers. In terms of management, details were made with regards to personnel management, records, infection control, safety, supplies and quality management. For financial support, some form of medical insurance coverage for hospice services, ways to promote a donation system and fund raising were examined. Hospice team service to be provided by the hospice center was categorized into assessment, physical care, emotional care, spiritual care, bereavement service, medication, education and demonstrations, medical supplies rental, request service, volunteer service, and respite service. Based on the results, the study has drawn up the following suggestions: 1. The proposed model for a hospice center as presented in the study needs to be tested with a pilot project. 2. Studies on criteria for legal approval and license for a hospice center need to be conducted to develop policies. 3. Studies on developing a hospice charge system and hospice standards that meet local conditions in Korea need to be conducted.
Advisory Committees ; Education ; Equipment and Supplies ; Financial Management ; Financial Support ; Fund Raising ; Hand ; Hospice Care ; Hospices* ; Humanism ; Humans ; Infection Control ; Insurance Coverage ; Korea ; Licensure ; Nurses' Aides ; Nursing Services ; Nutritionists ; Personnel Management ; Pharmacists ; Philosophy ; Public Health ; Quality of Life ; Resource Allocation ; Social Welfare ; Social Workers ; Terminally Ill ; Volunteers

PURPOSE: The identification of risk factors for bronchial hyperresponsiveness (BHR) is important in furthering the understanding of the cause of asthma. BHR is known to be related to atopy. We investigated the relations of BHR to sensitization to the five allergen groups in children aged 6-8 years. METHODS: Four hundred and seven 6-8 year old children with acute or chronic respiratory symptoms were enrolled. Each subject underwent methacholine bronchial challenge and skin-prick tests with airbone allergens. BHR was defined as PC20< or =8 mg/mL methacholine. Multiple logistic regression analysis was performed to study the independent relationship between BHR and sensitization to individual allergen group. RESULTS: The significant associations between BHR and skin-test response were against house dust mites (odds ratio=1.64, 95% confidence interval=1.02-2.65) and pollen (3.47, 1.18- 10.17) in total subjects, all after adjustment by sex, age, FEV1/FVC, total IgE, and a positive response to any of the other four allergen groups measured. In subjects with asthma, the significant association between BHR and positive skin-test response was observed only for house dust mites (2.53, 1.11-5.77). CONCLUSION: BHR was found to be related to atopy against house dust mite and pollen in subjects with respiratory symptoms, and against only house dust mites in subjects with asthma. These findings suggest atopy, especially against house dust mites, is an important risk factor for bronchial hyperresponsiveness in this age group.
Allergens ; Asthma ; Child* ; Humans ; Immunoglobulin E ; Logistic Models ; Methacholine Chloride ; Pollen ; Pyroglyphidae ; Risk Factors

A 30-year-old primigravida with gestational age of 25 weeks and 4 days was admitted for emergency cesarean section. She was diagnosed as pre-eclampsia with fetal distress. We anesthetized the patient through the combined spinal-epidural anesthetic technique, and there was no specific event throughout the surgical procedures and in post anesthetic care unit. Subsequently, she complained of unilateral hearing difficulty in the ward and an otolaryngology consultation was obtained. She was diagnosed with left sudden sensorineural hearing loss in full frequency range after an acoustic examination. She received intravenous and local steroid treatments for 4 weeks. She showed 32 dB on pure tone audiometry after 5 months. However, we could not continue follow-up testing on the patient because she stopped visiting the hospital since the last examination. We reported a case of uncommon unilateral sudden sensorineural hearing loss after a combined spinal-epidural anesthesia for emergency cesarean section.
Acoustics ; Adult ; Anesthesia* ; Audiometry ; Cesarean Section* ; Emergencies* ; Female ; Fetal Distress ; Follow-Up Studies ; Gestational Age ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural* ; Humans ; Otolaryngology ; Pre-Eclampsia ; Pregnancy

The antifungal effect of pine needle extract prepared by a distinguishable extraction method and the dry distillation method, was examined. The effect of this extract itself was insignificant. The chemical components of pine needle extract were then investigated by gas chromatographic analysis, and four chemical components, acetol, furfural, 5-methyl furfural, and terpine-4-ol, were identified. The antifungal effects of those four chemical components against Alternaria mali (A. mali), an agent of Alternaria blotch of apple, were then examined. It was observed that the minimum inhibitory concentrations (MICs) were 6.25, 0.78, 0.78, and 12.5 (mg/ml) of acetol, furfural, 5-methyl furfural, and terpine-4-ol, respectively. MICs of furfural and 5-methyl furfural had the same order of magnitude as that of an antifungal agrochemical, chlorothalonil. Although furfural itself can not be completely substituted for an antifungal agrochemical, a partial mixture of furfural and antifungal agrochemical may be used as a substitute. The use of agrochemicals for the prevention of plant disease caused by pathogenic fungus such as A. mali could be partially reduced by the application of this mixture.
Agrochemicals ; Alternaria* ; Distillation ; Fungi* ; Furaldehyde* ; Mali* ; Microbial Sensitivity Tests ; Needles* ; Plant Diseases ; Plants*

Early post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prediction may allow safe same-day outpatients discharge after ERCP and earlier proper management. This study aimed to assess the usefulness of the 4-hour post-ERCP serum amylase and lipase levels for PEP early prediction and to investigate predictive cut-off values for 4-hour post-ERCP serum amylase and lipase levels for safe discharge and urgent initiation of resuscitation. The data of 516 consecutive patients with native papilla who underwent ERCP between January 2013 and August 2014 were retrospectively reviewed. Serum amylase and lipase levels were measured before, and 4 and 24 hours after ERCP. PEP occurred in 16 (3.1%) patients. The receiver-operator characteristic curve for 4-hour post-ERCP serum amylase and lipase levels showed that the areas under the curve were 0.919 and 0.933, respectively, demonstrating good test performances as predictors for PEP (both P values < 0.001). The amylase level > 1.5 × the upper limit of reference (ULR) was found useful for PEP exclusion with a sensitivity of 93.8%, while 4 × ULR was found useful to guide preventive therapy with the best specificity of 93.2%. Similarly, the lipase level 2 × ULR showed best sensitivity, while 8 × ULR had the best specificity. Logistic regression analysis showed that 4-hour post-ERCP amylase level > 4 × ULR, lipase level > 8 × ULR, precut sphincterotomy, and pancreatic sphincterotomy were significant predictors for PEP. In conclusion, 4-hour post-ERCP amylase and lipase levels are useful early predictors of PEP that can ensure safe discharge or prompt resuscitation after ERCP.
Amylases* ; Cholangiopancreatography, Endoscopic Retrograde ; Humans ; Lipase* ; Logistic Models ; Outpatients ; Pancreatitis* ; Resuscitation ; Retrospective Studies ; Sensitivity and Specificity