No abstract available.
Renal Dialysis* ; Urea*

This study was designed to evaluate the potential applications of magnetic resonance imaging for the diagnosis of early and sequential changes of acute renal ischemia. Renal isehmia was induced in seventeen rabbits by surgical ligation of the left renal artery. Magnetic resonance imaging(MRI) was performed with a 2.0T super conductive MR system and s pin-echo technique was used with echo times(TE) of 30 and 80 msec and repetition times(TR) or 0.5 and 2.5 seconds. Kidneys were evaluated before and up to 48 hours after left renal artery ligation, and the spin echo images were analyzed for intensity difference and T1, T2 relaxation times between the cortex and the medulla of both kidneys. After one, and one and half hour following ligation of the left renal artery, the kidneys showed a 4-20% decrease in the left cortex compared to the right cortex contrast uptake(CCC) (P<01). There was a 14-29% decrease in left medulla to right medulla contrast uptake(MMC) (P<01). A 29-147% increase in contrast uptake was noted when the left cortex was compared to the left medulla(P<05). There was a 51-68% decrease in CMC of the right kidney (P<05) on three different spin echo images. In the cortex of the left kidney, T2 relaxation time decreased 14% (P<01). CCC and MMC showed more prominent changes than CMC, and sequential changes of CCC and MMC were most prominent on T2 weighted images with TR = 2.5sec and TE=80msec when compared with T1 weighted and proton density weighted images. Twelve hours after renal arterial ligation. T2 relaxation time, CMC, CCC, and MMC returned to normal values and these findings were believed to be due to congestion and collateral blood supply. In renal ischemia, the most useful MRI findings for diagnosis were fund to be changes of CCC and MMC on T2 weighted image, and T2 relaxation time of the cortex in the ischemic kidney.
Diagnosis ; Estrogens, Conjugated (USP) ; Financial Management ; Ischemia* ; Kidney ; Ligation* ; Magnetic Resonance Imaging* ; Protons ; Rabbits ; Reference Values ; Relaxation ; Renal Artery*

This study was designed to evaluate the potential applications of magnetic resonance imaging for the diagnosis of early and sequential changes of acute renal ischemia. Renal isehmia was induced in seventeen rabbits by surgical ligation of the left renal artery. Magnetic resonance imaging(MRI) was performed with a 2.0T super conductive MR system and s pin-echo technique was used with echo times(TE) of 30 and 80 msec and repetition times(TR) or 0.5 and 2.5 seconds. Kidneys were evaluated before and up to 48 hours after left renal artery ligation, and the spin echo images were analyzed for intensity difference and T1, T2 relaxation times between the cortex and the medulla of both kidneys. After one, and one and half hour following ligation of the left renal artery, the kidneys showed a 4-20% decrease in the left cortex compared to the right cortex contrast uptake(CCC) (P<01). There was a 14-29% decrease in left medulla to right medulla contrast uptake(MMC) (P<01). A 29-147% increase in contrast uptake was noted when the left cortex was compared to the left medulla(P<05). There was a 51-68% decrease in CMC of the right kidney (P<05) on three different spin echo images. In the cortex of the left kidney, T2 relaxation time decreased 14% (P<01). CCC and MMC showed more prominent changes than CMC, and sequential changes of CCC and MMC were most prominent on T2 weighted images with TR = 2.5sec and TE=80msec when compared with T1 weighted and proton density weighted images. Twelve hours after renal arterial ligation. T2 relaxation time, CMC, CCC, and MMC returned to normal values and these findings were believed to be due to congestion and collateral blood supply. In renal ischemia, the most useful MRI findings for diagnosis were fund to be changes of CCC and MMC on T2 weighted image, and T2 relaxation time of the cortex in the ischemic kidney.
Diagnosis ; Estrogens, Conjugated (USP) ; Financial Management ; Ischemia* ; Kidney ; Ligation* ; Magnetic Resonance Imaging* ; Protons ; Rabbits ; Reference Values ; Relaxation ; Renal Artery*

Succinylcholine is used most widely for tracheal intubation during induction for general anesthesia. However adverse effects following the administration of succinylcholine which include an increase of serum potassium, creatine phosphokinase, abdominal pressure and the presence of fasciculation are well known to anesthesiologists. Many investigators have studied the influence of pretreatment with d-tuhocurarine and diazepam to prevent the adverse effects following administration of succinylcholine. We studied the effects of serum potassium and creatine phophokinase with midazolam(0.25 mg/kg) the most newly introduced benzodiazepine derivatives and thiopental sodium(4-5mg/kg) the most widely used induction agent for anesthesia in 33 adult healthy surgical patients. We also observed the onset of loss of eyelash reflex and fasciculation, the degree of fasciculation and the adequacy of relaxation for intubation comparing the two agents. The results are as follows: 1) There were no significant increases in serum potassium and creatine phosphokinase levels before succinylcholine and after 10 minutes administration in both agents groups. 2) Loss of eyelash reflex occurred immediately with thiopental and at 63+/-43 seconds with midazolam one minute after administration. 3) Fasciculation appeared at 14.4+/-4.9 seconds with thiopental and at 21.3+/-11.9 seconds with midazolam and continued 66.3+/-20.1 seconds with thiopental and 43.5+/-l8.5 seconds with midazolam. 4) The adequacies of relaxation for intubation were good enough in both agents groups but midazolam seems to be better. Midazolam seems to be a good induction agent for general anesthesia and prevents an increase of serum potassium level after administration of succinylcholine without pretreatment of non-depolarizing muscle relaxants or diazepam.
Adult ; Anesthesia ; Anesthesia, General ; Benzodiazepines ; Creatine Kinase* ; Creatine* ; Diazepam ; Fasciculation ; Humans ; Intubation ; Midazolam* ; Neuromuscular Nondepolarizing Agents ; Potassium* ; Reflex ; Relaxation ; Research Personnel ; Succinylcholine ; Thiopental

In contrast to younger patients, old peoples frequently mainfest more than one pathologic process, mainly degenerative diseases and neoplasia. Nearly all have some degree of arteriosclerosis, even if this is not clinically diagnosed, and many have associated chronic cardiac, renal, hepatic, or pulmonary disease. The surgeon and the anesthesiologist must see theat their clinical decisions are tied to a physiologic understanding based on exact quantification of the specific hemodynamic, respiratiory, renal, and metabolic factors which may play a decisive role in influencing the final outcome to a major operative procedure. From May 1972 to Dec 1980, the Department of Anesthesiology, Hanyang University, College of Medicine had 517 geriatric patients(above 65 years) who received anesthesia and these were analyzed clinically according to age, sex, department, physical status, anesthetic technique and agent, anesthesia time, length of admission, laboratory studies(chest X-ray, EKG, arterial blood gas), and postoperative complications(mortality and causes of deathe). The results are as follows. 1) Out of 25,857 anesthetized patients 517(2.0%) were over 64 years of age and 290 were males(56.1%) and 227 females(43.9%). 2) In the surgical group, 246 cases (47.6%) were from general sugery: 81 cases(15.7%), orthopedic surgery: 78 cases (15.1%), urology: and 67 cases (12.9%), neurosurgery respectively. 3) In the classification of physical status, 33 cases(6.4%) were class 1, 269 cases(52.0%) class 2, 181 cases (35.0%) class 3, 28 cases (5.4%) class 4, and 6 cases (1.2%) class 5. Emergency cases were 137 cases(26.5%) and 380 cases (73.5%) were elective. 4) Concerning premedication-150cases(29.0%) were premedicated with atropine sulfate plus valium and 93 cases had no premedication. 5) There were 425 cases of general anesthesia (82.2%) and 92 cases of regional anesthesia (17.8%). The major anesthetic was halothane, 362 cases (70.0%). The technic in 419 cases( 81.0%) was circle type with endotracheal intubation. Anesthesia duration was within 1hour for 70 cases(13.5%), within 2 hours for 158 cases(30.0%), and within 3hours in 144 cases(27.9%). 6) Preoperative laboratory findings were as follows: The chest X-ray suggested that 199 cases (45.9%) were within normal limits, 56 cases (12.9%) had hypertensive heart disease, 56 cases (12.9%) had pulmonary tuberculosis, and 38 cases (5.1%) had senile lung fibrosis. The EKG which was done on 85% of the patients, ravealed that 193 cases (44.0%) were within normal limits, 61 cases(13.9%) showed left ventricular hypertrophy, and 38 cases(8.7%) had myocardial ischemia. In the preoperative arterial blood gas studies of 56 cases the results were almost all within normal limits. 7) Postoperative complications were as follows: 52 cases showed wound infection or bleeding, 20 cases had pneumonia, and 18 cases atelectasis. There were a number of miscellaneous complications. 8) The overall mortality rate was 5.8%. The difference of mortality rate related to the age was not statistically significant,(p>0.1) and the mortality rate related to physical status was statistically significant(p<0.005). 9) As the cause of death-11 cases (36.7%) had transtentorial herniation, 2 cases (6.7%) sepsis, 2 cases (6.7%) hypovolemia, and 1 case (3.3%) had pulmonary edema.
Anesthesia* ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesiology ; Arteriosclerosis ; Atropine ; Classification ; Diazepam ; Electrocardiography ; Emergencies ; Fibrosis ; Halothane ; Heart Diseases ; Hemodynamics ; Hemorrhage ; Humans ; Hypertrophy, Left Ventricular ; Hypovolemia ; Intubation, Intratracheal ; Lung ; Lung Diseases ; Mortality ; Myocardial Ischemia ; Neurosurgery ; Orthopedics ; Pneumonia ; Postoperative Complications ; Premedication ; Pulmonary Atelectasis ; Pulmonary Edema ; Sepsis ; Surgical Procedures, Operative ; Thorax ; Tuberculosis, Pulmonary ; Urology ; Wound Infection

Halothane was introduced in 1956. It has been used worldwidely as a relatively safe inhalation anesthetic but it is generally accepted that it can cause decrease of liver function. But the causative factor has not yet been pinpointed. Enflurane also seems to decrease liver function but the exact cause is not yet known. In order to study the effects of enflurane and halothane on liver function, we used 10 cases of spinal anesthesia as a control group, and 20 cases each of enflurane and halothane anesthesia respectively as experimental group. We then checked serum GOT, GPT, total bilirubin, alkaline phosphatase, and eosinophil count in peripheral venous blood before oeration and 6 days after operation and looked for the existence of high fever of more than 39 degrees C 3 days postoperatively. The results are as follows: 1) We found statistical significant change of serum GOT, GPT, total billirubin alkaline phosphatase and eosinophil count in spinal, enflurane, or halothane anesthesia beofre and after operation. There was no statistically significance between the control and experimental groups. 2) No patient developed high fever of more than 39 degrees C until 3 days after anesthesia in any group. 3) No significant change of mean arterial blood pressure was observed before and during anesthesia in each group. In this study no definite conclusion that enflurane and halothane might have affected the liver function.
Alkaline Phosphatase ; Anesthesia ; Anesthesia, Spinal ; Anesthetics* ; Arterial Pressure ; Bilirubin ; Enflurane* ; Eosinophils ; Fever ; Halothane* ; Humans ; Inhalation ; Liver*

PURPOSE: The purpose of the present study was to evaluate the potential association of the G1691A mutation of factor V (factor V Leiden), which is a main causative factor of activated protein C resistance leading to intravascular coagulation, with osteonecrosis (ON) of the femoral head. MATERIALS AND METHODS: Genomic DNA was extracted from peripheral blood leukocytes of 116 consecutively identified patients with nontraumatic ON of the femoral head and 59 healthy controls. The region in exon 10, that encodes an APC cleavage site in factor V gene, was amplified by polymerase chain reaction (PCR) with use of the 2 primers (Korea Biotech Inc., Daejeon): 5'-GGA ACA ACA CCA TGA TCA GAG CA-3' (forward primer) and 5'-TAG CCA GGA GAC CTA ACA TGT TC-3'(reverse primer). Amplified product was subjected to MnlI restriction enzyme digestion and resulting fragments were separated by electrophoresis on 3% agarose gel. The homozygous and heterozygous patterns of DNA fragments of 1691G-A mutation in the factor V gene was investigated. RESULTS: The prevalence of factor V Leiden was 0% in the patients group and in the control group. CONCLUSIONS: The data suggested that thrombophilia by the G1691A mutation of factor V (factor V Leiden) was less likely to be associated with the development of ON of the femoral head in Koreans.
Activated Protein C Resistance ; Digestion ; DNA ; Electrophoresis ; Exons ; Factor V* ; Head* ; Humans ; Leukocytes ; Osteonecrosis* ; Polymerase Chain Reaction ; Prevalence ; Sepharose ; Thrombophilia

Positive end expiratory pressure (PEEP) has been used to prevent and treat venous air embolism in patients in the sitting position undergoing neurosurgical operations However, the safety of PEEP has recently been questioned, because of concern that PEEP might incresae right atrial pressure more than left atrial pressure, thereby predisposing patients with a probe-patent foramen ovale to paradoxical air embolism. But it is controversial and needs further evaluation. In a prior study in rabbits with various venous air volume, the authors found that suddenly decreased mean arterial pressure and arterial PO2 showed peaked P wave, arrhythmias, ST depression and premature ventricular contraction on the EKG. In the present study, the authors examined the effects of 0, 3 and 5 cmHO PEEP (PEEP0, PEEP3, and PEEP5,) in 30 rabbits positioned supine with intravenous 0.5 mg/kg of air injection. In a prior study, we found that 0.5 mg/kg of air injection has serious change but showed low mortality. The measurements were obtained by the precordial doppler ultrasound, end tidal PCO2, mean arterial pressure, arterial PCO2, arterial PO2, and EKG. The results were as follow; 1) Doppler ultrasound was the most sensitive device even with PEEP and end tidal PCO2 was higher with PEEP5 than with PEEP3 and PEEP0 after suddenly decreased by the air injection. In PEEP statistic singnificance was observed (p<0.05). 2) The mean arterial pressure was significantly decreased by the air injection in PEEP0 PEEP3 and PEEP5 but there were no significant differences in all groups. It seemed likely due to low PEEP. 3) In PaCO2, slightly higher PaCO2 was observed in PEEP5 than in PEEP3 and PEEP. No statistic significance was obaerved. In PaO2, significant decrease was observed in all group but in PEEP3 small decrease was observed. 4) The incidence of bradycardia and ST depression was less in PEEP3 and PEEP5 than in PEEP0. In PEEP5, PVC was appeared relatively short duration than other group due to the air lock phenomenon. It was suspeeted that air was more freely passed according to increased right ventricular pressure after air lock. Authors conclude that PEEP has a benefit effect for the prevention of venous air embolism but after the occurence there is little benefit in the treatment.
Arrhythmias, Cardiac ; Arterial Pressure ; Atrial Pressure ; Bradycardia ; Depression ; Electrocardiography* ; Embolism, Air* ; Foramen Ovale ; Humans ; Incidence ; Mortality ; Positive-Pressure Respiration ; Rabbits* ; Ultrasonography ; Ventricular Premature Complexes ; Ventricular Pressure

The supine hypotensive syndrome occurs when the parturients near term in supine, enlarged uterus compresses the inferior vena cava and partially obstructs the lower aorta and venous return to the heart and arterial blood flow to the pelvic organs and lower extremities are decreased. Major supine hypotensive syndrome was defined as a fall greater than 30% or a value less than 80mmHg in systolic blood pressure. Many studies in Western countries have reported that up to 50% of parturients near term develop signs of shock including fainting, nausea, vomiting, loss of consciousness or sudden death when they assume supine position. The haxards of obstruction the aorta by the gravid uterus in pregnancy are well documented. Compression of the aorta is not associated with maternal symptoms but does cause arterial hypotension in the lower extremities and uterine arteries, so it can cause fetal distress and asphyxia. Most parturients are able to compensate for mild to moderate dupine hypotensive syndrome by increase in collateral circulation via azygos venous system and vertabral venous system and peripheral resistance or heart rate. But the anesthesiologists must recognize the importance of the supine hypotensive syndrome and the potential hazard of anesthesia in augmenting its effects. We have investigates the incidence of supine hypotensive syndrome in 171 parturients were Cesarean sectioned. We have investigated the correlating factors such as fetal body weight and parturient's physical status, body weight and age among the 36 cases of decreased blood pressure in supine position and also we have investigated the relationship between blood pressure changes and parturient's associated diseases. We have measured the arterial blood pressure indiredctly by the Rira-Rocci method when they are lying on the operating table in supine and compared it with arterial blood pressure in their comfortable position in ward. The results are as follows: 1) Among the 171 parturenits, the incidence of decreased arterial blood pressure in supine position was 21%(36casese). However the incidence of increased arterial blood pressure in supine position was 79%(135 caese). No case of severe blood pressure changes defined as a fall greater than 30% was notice but there was one case with less than 80 mmHg in systolic blood pressure which would be a rate of 0.6%. 2) The realationship between decreased blood pressure in supine posction and fetal body weight and parturient's physical status, body weight and age was not statistically significant(p>0.05). 2) The relationship between decreased blood pressure in supine position and parturient's associated diseases especially preechlampsia or eclampsia was statistically significant (p<0.05).
Anesthesia ; Aorta ; Arterial Pressure ; Asphyxia ; Blood Pressure ; Body Weight ; Collateral Circulation ; Death, Sudden ; Deception ; Eclampsia ; Female ; Fetal Distress ; Fetal Weight ; Heart ; Heart Rate ; Hypotension ; Incidence ; Lower Extremity ; Nausea ; Operating Tables ; Pregnancy ; Shock ; Supine Position ; Syncope ; Unconsciousness ; Uterine Artery ; Uterus ; Vascular Resistance ; Vena Cava, Inferior ; Vomiting

Recent studies in western countries have reported that the mechanism pf pain are concorded with gate control opiage receptor binding sites and the release of intrinsic morphine like substances, sodium glutamate and also with bradykinin, seroconin, histamine and prostaglandin E. Otherwise the mechanism of the stimulstion producing analgesia has been reported to involve a neurophysiologic and neurohumoral inhibitory effect at the level of spinal cord, brain stem, thalamus and cortex. This has been clarified but further study should improve the chance of understanding the mechanism of pain. From the standpoint of pain management, medications used to manage pain have some unfortunate side effects. nerve blocks cause anesthesia toxicity, major neurosurgical procedures have many complications. Subarachnoidal and epidural analgesics have unknown irritation pneumonia and drug toxicity, and plexus or pituitary gland block with phenol or alcohol has uneventful complication. From January 1980 to December 1982, electrical acupuncture stimulation has been used on 210 cases at HANYANG university hospital in the pain clinic. I found it useful in relieving pain which has not responded to various conventional methods which included medications, nerve blocks, neurosurgical intervantion and neuropolytics. The results are as follows: 1) There are two kinds of treated patients: One is consultation case-12 from internal medicine, 16 from orthopedic surgery, 10 from neurosurgical and 2 from psychiatry. Another 170 cases were patients who directly to the clinic. And the age distribution shows the highset number of patients in the 3rd decade(21%) and in the 4th decade(24.8%). 2) The region of pain was 21% lumbar, 13.8% shoulder, 10% lower leg and head or face with 9.5%. 3) The duration of the pain showed 10 days 25.7%, 1~2 month 18.6%, one year 11.4% and the longest up to 20 years. 4) Patients who were able to walk into the clinic were 19.5%, moderate cases who to be accompanied were 58.6% and bedridden cases were 21.9%. 5) Treatment was conducted mainly on low frequency stimulation with various waves that included the general dynamic activity point plus reactive electro permeable point (REPP) 81.9% and REER plus head in situ needle 18.1%. 6) In 16.7% only one treatment was administered, in 46.1% 2~5 treatments were given, in 28.6% 6~10 treatments were given and in 3 cases more than 100 treatments were administered. 7) Of the 210 cases, 43.3% showed marked improvement, 41.4% were improved, 13.8% showed translent improvement and there were 3 cases of no improvement. The total confidence was 84.7%. 8) There are no serious complications except hypertensive shock case, submucosal hemorrhagic petechia 7 cases and generalized fatigue 18 cases. In conclusion, electrical acupuncture stimulation of the peripheral nervous system can be used to relieve pain replacing such conventional means as medications, nerve blocks, major neurosurgical procedures, neuroytics and physiopsychic therapy which are generally less effective.
Acupuncture ; Age Distribution ; Analgesia ; Analgesics ; Anesthesia ; Binding Sites ; Bradykinin ; Brain Stem ; Drug-Related Side Effects and Adverse Reactions ; Electric Stimulation* ; Fatigue ; Head ; Histamine ; Humans ; Internal Medicine ; Leg ; Morphine ; Needles ; Nerve Block ; Neurosurgical Procedures ; Orthopedics ; Pain Clinics ; Pain Management ; Peripheral Nerves* ; Peripheral Nervous System ; Phenol ; Pituitary Gland ; Pneumonia ; Shock ; Shoulder ; Sodium Glutamate ; Spinal Cord ; Thalamus