BACKGROUND: A long-term objective is to understand the pathogenesis of neurologic injuries associated with cardiac surgery, cardiopulmonary bypass, and circulatory arrest. Our specific aims are to establish a dose of air which results in moderate to severe neurologic defects in normothermic (37degrees C) rabbits. METHODS: To first establish a dose of air which would cause unequivocal neurologic impairment, anesthetized rabbits received either 0, 50, 100 or 150 microgram l/kg of air into the internal carotid artery(n=5 in each group). One hour later, anesthesia was discontinued and animals were recovered. Animal were neurologically evaluated at 24 hours using a zero(normal) to 97(coma) point scale. RESULTS: There was a clear relationship between the dose of air injected and the severity of neurologic impairment at 24 hours, p=1.1x10(-7). Rabbits receiving 50 micrograml/kg of air were minimally affected and were difficult to distinguish from controls. In contrast, rabbits receiving 150 micrograml/kg of air were uniformly and unequivocally impaired. CONCLUSION: we recommend for future cerebral air embolism studies, 150 microgram l/kg as the optimal dose of air which would reliably produce viable subjects for 24 hours with marked unequivocal, neurologic impairment.
Anesthesia ; Animals ; Brain ; Cardiopulmonary Bypass ; Embolism ; Embolism, Air* ; Rabbits ; Thoracic Surgery

The purpose of this study was to investigate the micro-implant height and anterior hook height to prevent maxillary six anterior teeth from lingual tipping and extruding during space closure. We manufactured maxillary dental arch form, bracket and wire, using the computer aided three-dimensional finite element method. Bracket was .022" x .028" slot size and attached to tooth surface. Wire was .019" x .025" stainless steel and .032" x .032" stainless steel hook was attached to wire between lateral incisor and canine. Length of hook was 8mm and force application points were marked at intervals of 1mm. Four micro-implants were implanted on alveolar bone between second premolar and first molar. The heights of them were 4, 6, 8, 10mm starting from wire. We analyzed initial displacement of teeth by various force application point applying force of 150gm to each micro-implant and anterior hook. The conclusions of this study are as the following : 1. When the micro-implant height was 4mm and the anterior hook height was 5mm and below, anterior teeth were tipped lingually. When the anterior hook height was 6mm and above, anterior teeth were tipped labially. 2. When the micro-implant height was 6mm and the anterior hook height was 5mm and below, the anterior teeth were tipped lingually. When the anterior hook height was 6mm and above, the anterior teeth were tipped labially. But lingual tipping of anterior teeth decreased and labial tipping increased when the micro-implant height was 6mm, compared with 4mm micro-implant height. 3. When the micro-implant height was 8mm and the anterior hook height was 2mm, the anterior teeth were tipped lingually. When the anterior hook height was 3mm and above, labial tipping movement of the anterior teeth increased proportionally. 4. When the micro-implant height was 10mm and the anterior hook height was 2mm and above, labial tipping of the anterior teeth increased proportionally. 5. As the anterior hook height increased, anterior teeth were tipped more labially. But extrusion occurred on canine and premolar area because of the increase of wire distortion. 6. Movement of the posterior teeth was tipped distally during maxillary six anterior teeth retraction using micro-implant because of the friction between bracket and wire. Based on the results of this study, we could predict the pattern of the tooth movement according to position of micro-implant and height of anterior hook. It seems that we can find the force application point for proper tooth movement in consideration of inclination of maxillary anterior teeth, periodontal condition, overjet and overbite
Bicuspid ; Dental Arch ; Finite Element Analysis* ; Friction ; Incisor ; Molar ; Orthodontics ; Overbite ; Stainless Steel ; Tooth Movement ; Tooth*

BACKGROUND: Neurological injury after cerebral air embolism may be due to thromboinflammatory responses at sites of air-injured endothelium. Because heparin inhibits multiple thromboinflammatory processes. we hypothesized that heparin would decrease neurological impairment after cerebral air embolism. METHODS: Anesthetized rabbits received either heparin (n=14) or saline (n=13), 5 minutes before air injection (150 microliter/kg). Heparin was given as a 200 IU/kg bolus and followed by a constant infusion of 75 IU/kg/h for 2 hours. Equal volumes of salines were given to saline group. Two hours later, anesthesia was discontinued. Rabbits were neurologically evaluated 24 hours after air embolism. RESULTS: Heparin group had significantly less neurological impairment at 24 hours (34 14) than saline controls (52 8) (p=0.0013). CONCLUSIONS: When given prophylactically, heparin decreases neurological impairment caused by severe cerebral arterial air embolism.
Anesthesia ; Embolism, Air ; Endothelium ; Heparin* ; Rabbits*

BACKGROUND: This study was undertaken to evaluate the diagnostic sensitivity of several muscles in repetitive nerve stimulation test (RNST) for myasthenia gravis (MG) patients. MATERIALS AND METHODS: The study population consisted of 39 MG patients classified by modified Ossermann's classification. Using Stalberg's method, RNST was systematically performed in facial (orbicularis oculi and nasalis) and upper extremity (flexor carpi ulnaris, abductor digiti quinti and anconeus) muscles. RESULTS: The significant electrodecremental response of RNST were noted in orbicularis oculi (58.9%), nasalis (51.3%), flexor carpi ulnaris (42%), anconeus (41%) and abductor digiti quinti muscles (27%). Among the 3 muscles of upper extremity (abductor digiti quinti, flexor carpi ulnaris and anconeus), the positive electrodecremental response of anconeus muscles was significantly higher than other two muscles (p<0.05) in type IIa, IIb and there were no statistical differences of the positive electrodecremental response between orbicularis oculi and nasalis muscles. The facial muscles showed more prominent decremental responses than upper extremity muscles in type I MG(p<0.05). In type IIa MG patients, there were no significant statistical differences between facial and upper extremity muscles but significant statistical differences among upper extremity muscles. In type IIb MG patients, there were no significant statistical differences in all tested muscles in spite of the increased positive electrodecremental response of RNST. CONCLUSION: On the basis of this study, RNST would be initially performed for the orbicularis or nasalis in type I MG and for the anconeus in type IIa or IIb MG.
Classification ; Facial Muscles ; Humans ; Muscles* ; Myasthenia Gravis* ; Upper Extremity

For evaluating the reproductive performances of GTD patients, we found 115 cases of GTD patients, 77 HM and 38 GTT, who became pregnant after the completion of treatments and follow-up period. The results of this study suggest subsequent pregnancies after the completion of treatments may promise normal reproductive outcomes regardless of the chemotherapy.
Drug Therapy ; Follow-Up Studies ; Gestational Trophoblastic Disease* ; Humans ; Pregnancy

Bilateral vocal cord paralysis (VCP) is a rare, life-threatening complication of stroke. We described the clinical course and treatment of bilateral VCP by acute ischemic stroke. We confirmed 4 cases of VCP. Two cases had brain-stem lesions, one case showed bilateral cerebral lesions and the last one had brainstem and cerebral lesions. One of the 4 cases showed spontaneous improvement of unilateral vocal cord function after 2 months. Among the rest, one under-went laser cordotomy, one remained tracheostomized, one was lost. (J Korean Neurol Assoc 19(4):400~403, 2001)
Brain Stem ; Cerebral Infarction ; Cordotomy ; Hoarseness ; Laryngeal Nerves ; Stroke* ; Vocal Cord Paralysis* ; Vocal Cords*

BACKGROUND: The lockout interval is a safe guard to prevent patients from taking additional dose before the full effect of the preceding dose. Therefore, it should correlate with the time-to-peak effect of the opioid selected. The time-to-peak effect of meperidine is known to be different from that of morphine and fentanyl. But there have been few reports about the influence of varying lockout interval on IV-PCA using meperidine. So we studied the influence of varying lockout interval with constant hourly maximum dose on IV-PCA using meperidine. METHODS: This study included sixty patients undergoing low abdominal surgery under general anesthesia. After administration of initial dose of meperidine (0.5 mg/kg) they were randomly assigned to three groups according to the lockout interval; Group 1 (6-min lockout interval, 0.2 mg/kg bolus dose), Group 2 (9-min lockout interval, 0.3 mg/kg bolus dose), Group 3 (12-min lockout interval, 0.4 mg/kg bolus dose). We examined NRS pain score, sedation score, satisfaction score, PCA measurements and the incidence of side effects during 24 hours. RESULTS: There were no significant differences in NRS pain score, sedation score, satisfaction score, the amount of meperidine consumed, injections/attempts ratio and the incidence of side effects among three groups. The numbers of injections and attempts were significantly higher in Group 1 than in Group 2 and Group 3 (P<0.05). CONCLUSIONS: The lockout intervals chosen for this study (6-min, 9-min, 12-min) do not influence pain, side effects, satisfaction and meperidine consumption in IV-PCA using meperidine when hourly maximum dose is constantly 2 mg/kg.
Analgesia, Patient-Controlled* ; Anesthesia, General ; Fentanyl ; Humans ; Incidence ; Meperidine* ; Morphine ; Passive Cutaneous Anaphylaxis

OBJECTIVE: We assessed the prognostic factors and the efficacy of adjuvant therapy and reviewed randomized studies carried out on patients receiving adjuvant therapy with early endometrial carcinoma. METHODS: One hundred and five patients that received primary surgical treatment for stage IB, IC and II endometrial cancer were enrolled in this study. The clinical outcomes were compared among the patients with variable prognostic factors and adjuvant treatments. RESULTS: One hundred and five patients fulfilled the eligibility criteria and 46 patients (43.8%) underwent adjuvant therapy. Disease recurrence occurred in nine patients within a median time of 24 months. Cervical involvement was an independent prognostic factor for the disease-free survival rates. Eight of 16 patients with FIGO stage II disease received adjuvant chemotherapy consisting of cisplatin and etoposide (or cyclophosphamide) or combined chemoradiation. The 5-year disease-free survival rate for these patients was 87.5%, a value significantly higher than for patients that received radiation therapy alone (30%). CONCLUSION: Adjuvant chemotherapy or combination chemo-radiotherapy might be superior to radiation therapy alone in high-risk early endometrial cancer patients.
Chemotherapy, Adjuvant ; Cisplatin ; Disease-Free Survival ; Endometrial Neoplasms ; Etoposide ; Female ; Humans ; Recurrence ; Retrospective Studies

OBJECTIVE: We assessed the prognostic factors and the efficacy of adjuvant therapy and reviewed randomized studies carried out on patients receiving adjuvant therapy with early endometrial carcinoma. METHODS: One hundred and five patients that received primary surgical treatment for stage IB, IC and II endometrial cancer were enrolled in this study. The clinical outcomes were compared among the patients with variable prognostic factors and adjuvant treatments. RESULTS: One hundred and five patients fulfilled the eligibility criteria and 46 patients (43.8%) underwent adjuvant therapy. Disease recurrence occurred in nine patients within a median time of 24 months. Cervical involvement was an independent prognostic factor for the disease-free survival rates. Eight of 16 patients with FIGO stage II disease received adjuvant chemotherapy consisting of cisplatin and etoposide (or cyclophosphamide) or combined chemoradiation. The 5-year disease-free survival rate for these patients was 87.5%, a value significantly higher than for patients that received radiation therapy alone (30%). CONCLUSION: Adjuvant chemotherapy or combination chemo-radiotherapy might be superior to radiation therapy alone in high-risk early endometrial cancer patients.
Chemotherapy, Adjuvant ; Cisplatin ; Disease-Free Survival ; Endometrial Neoplasms ; Etoposide ; Female ; Humans ; Recurrence ; Retrospective Studies

We experienced one case of anesthesia for liver transplantation in 32-year-old male patient with liver cirrhosis. The liver donor was 27-year-old male patient who was diagnosed brain death due to car accident. The operation was finished successfuly for 12 hours with intensive monitoring and treatrnent with using TEG and RIS. Patient was transfered to ICU after operation with intubated state. Extubation was done 2 days after operation and patient discharged without complication about 2 months later.
Adult ; Anesthesia* ; Brain Death ; Humans ; Liver Cirrhosis ; Liver Transplantation* ; Liver* ; Male ; Tissue Donors