BACKGROUND: It used to induce hypercarbia that carbon dioxide insufflated into the peritoneum in laparoscopic surgery. It might stimulate sympathetic nervous system, and decrease splanchnic circulation, hepatic function, and metabolism of anesthetics. The purpose of the present study was to examine the influence of hypercarbia on concentrations of propofol at the time of eye opening and recovery of orientation after propofol target controlled infusion (TCI) during a laparoscopic cholecystectomy. METHODS: Fifty patients were divided randomly into a laparoscopic group (group 1, n = 25) and an exploratory group (group 2, n = 25). A propofol infusion was started at a propofol target concentration of 6microgram/ml, and anesthesia was maintained at 4microgram/ml by using a Diprifusor (TM) turing the operation, intraabdominal pressure was maintained automatically at 12 14 mmHg by a CO2 insufflator and controlled ventilation settings were adjusted about 50 mmHg of PaCO2 after peritoneal insufflation. This ventilatory setting was not changed throughout the operation. We evaluated the estimated plasma concentrations of propofol at the time of eye opening and recovery of orientation in each group using user interface of a Diprifusor (TM). RESULTS: In the laparoscopic group, PaCO2, and PetCO2 increased significantly at 5, 15, 30 minutes after carbon dioxide insufflation, but there was no significant difference in concentrations of propofol at eye opening and orientation after propofol TCI between the two groups. CONCLUSIONS: Hypercarbia induced by insufflation of carbon dioxide into peritoneum didn't give rise to an influence on awakening concentrations after propofol TCI during a laparoscopic cholecystectomy.
Anesthesia ; Anesthetics* ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Humans ; Insufflation ; Laparoscopy ; Metabolism ; Peritoneum ; Plasma ; Propofol* ; Splanchnic Circulation ; Sympathetic Nervous System ; Ventilation

PURPOSE: The chest radiograph is useful and reliable in assessing the severity and progression of neonatal respiratory distress syndrome. To evaluate the effect of exogenous surfactant r eplacement therapy, we performed sequential observation of chest radiogratphic findings in neonates with respiratory distress syndrome. METHODS: Two groups of infant with RDS in mechanical ventilation therapy were studied. Surfactant(S-Tx) group(n=36) was treated with Surfactant-TA and control group(n=19) was without use of surfactant. Observation of gestational age, birth weight, clinical severity by ventilatory index, sequential change of radiographic findings and radiological complications in RDS patients were performed. RESULTS: In RDS patients, there was correlation in the radiologic grading and clinical severity. In surfactant treated infants, change of chest radiographic finding was significantly improved than control group. Incidence of pneumothorax and or pulmonary interstial emphysema in S-Tx group was less than that of control group. CONCLUSIONS: Exogenous pulmonary surfactant replacement therapy may contribute the improvement of the clinical and radiological severity and reduction of the incidence of clinical complications. We suggest that surfactant replacement therapy is effective and important useful therapeutic method in neonates with respiratory distress syndrome.
Birth Weight ; Emphysema ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn* ; Pneumothorax ; Pulmonary Surfactants ; Radiography, Thoracic* ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn ; Thorax*

PURPOSE: The present study was performed to determine the optimum conditions(RPM, load, sharpness of drill) for drilling human cortical bone with standard drill, and to evaluate the histological changes occuring in bone after drilling. MATERIALS AND METHODS: in experiment I, we measured temperature elevations and the durations of temperature elevation in cadaveric femoral cortices at specific distances from the drill hole wall while drilling. The effects of drilling force, speed and new versus worn drill on the termperature were determined. In experiment II, we also measured temperature elevations in the same manner in porcine femoral cortices and evaluated the histological changes occuring in bone after drilling. RESULTS: In experiment I, the most significant temperature elevation(68.4degrees C ) was found when worn drill was used. The lower drilling force and faster speed resulted in 55.1degrees C and 45.8degrees C temperature elevation, respectively. However, drill diameter was not a significant factor for temperature elevation. In experiment II, greater heat production was measured with worn drill, at lower drilling forces, at faster drill speed. The acute histologic reactions in bone were hyperemia, degeneration of osteocytes, change in bone stainability, tears, and fragmentation of the bone edges around the drill holes. The observed histological changes were proportional to the amount of trauma produced, that is, the greater the degree of thermal irritation, the greater the degree of histologic activity. CONCLUSION: In cortical drilling, greater heat production was measured with worn drill, at lower drilling forces, at faster drill speed and the greater the degree of thermal irritation, the greater the degree of histologic activity. A further study of the reaction of bone to drilling at longer intervals of time at different conditions may possibly show whether aseptic thermal necrosis could be prevented.
Cadaver ; Hot Temperature* ; Humans ; Hyperemia ; Necrosis* ; Osteocytes ; Thermogenesis*

PURPOSE: The change of the joint line is associated not only with bone cutting levels but also balance of soft tissue. The main objective of this study analyze to compare the changes of the coronal joint line levels between PCL retaining total knee arthroplasty and PCL-substituting total knee arthroplasty, using the new method designed by authors. MATERIAL AND METHODS: A total 44 knees of 22 patients who received both TKA, of whom the one side was CR TKA and the other side was PS TKA, were analysed on pre- and post-operative weight-bearing anteroposterior radiopraphy of the knee. The joint line levels were measured two times by one author and one time by different author. RESULTS: The proximal shift of the joint line showed differently in both groups. The average of shifting values were 2.4+/-4.1 mm in CR TKAs, and 5.4+/-5.8 mm in PS TKAs. PS TKAs had significantly larger shifting value than CR TKAs for all times(p<0.05). CONCLUSION: The results of this study showed that the joint line level proximally shifted after TKA, using measured resection technique and gap technique. The shifting level in PS TKA was larger than CR TKA. But it is difficult to predict the change of joint line level after TKA, because of deviation between case by case and the standard deviation of the measured value was 4~6 mm.
Arthroplasty* ; Humans ; Joints* ; Knee Joint ; Knee* ; Weight-Bearing

BACKGROUND: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy. METHODS: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST), Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded. RESULTS: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P < 0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05). CONCLUSIONS: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50's side effects.
Analgesia ; Anesthesia ; Anesthesia, Local ; Biopsy ; Breast ; Dizziness ; Humans ; Incidence ; Outpatients ; Piperidines ; Propofol ; Vital Signs

BACKGROUND AND OBJECTIVES: Dobutamine stress echocardiography (DSE) with 2D echocardiography (2DE) is one of the time-consuming procedures in the diagnosis of coronary artery disease (CAD). Moreover, the accuracy of DSE with 2DE depends on the operator's skill or bias during the image acquisition. This study was conducted to determine the feasibility and accuracy of DSE with real-time 3D echocardiography (RT3DE) for the diagnosis of CAD. SUBJECT AND METHODS: 62 patients (RT3DE: 36, 2DE: 26), suspected of angina pectoris and post-revascularization ischemia, underwent DSE and coronary angiography (CAG). Image acquisition was performed at the baseline, and at 4 times during the dobutamine infusion and recovery stages. The procedure time (from the baseline to the end of the peak dose stage) was recorded. Off-line analyses of the volumetric images acquired with RT3DE were performed using 3D computer software (TomTec, Co.). Digitized quad-screen images acquired with 2DE were analyzed using the 2DE review system (ProSolv 4.0). >50% luminal diameter stenosis of any coronary artery on CAG was defined as significant coronary artery stenosis. RESULTS: The procedure time of DSE with RT3DE was significantly shorter than that of DSE with 2DE (25+/-4 vs. 37+/-4 mins, p<0.001). There was no significant difference in the sensitivity (p>0.05) or specificity (p>0.05) between the two procedures. CONCLUSION: DSE with RT3DE seems to be a feasible and less time consuming diagnostic procedure, probably providing comparable sensitivity and specificity for the detection of coronary artery stenosis, than DSE with 2DE.
Angina Pectoris ; Bias (Epidemiology) ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis* ; Dobutamine* ; Echocardiography* ; Echocardiography, Stress* ; Echocardiography, Three-Dimensional* ; Humans ; Ischemia ; Phenobarbital ; Sensitivity and Specificity

BACKGROUND: Stress can be induced from minor daily life event, and it is widely accepted that this daily minor stress is better predictive factor for relationship between disease and stress. In a number of laboratory studies, investigator reported that perception of stress can be reduced by physical exercise. So in this study, we observed relationship between exercise and stress from minor daily life event, and tried to clarify the effect of exercise on daily stress. METHODS: Volunteer was recruited from health promotion center of one university hospital. and they were doing regular exercise in more than three days per week. Participants completed measures of daily stress inventory and amount of daily exercise for seven days. To compare the daily stress amount between exercise day and no exercise day, we used repeated measures analysis of variance. We used the Wilcoxon signed rank test to compare difference of stress in different sex and different trait anxiety group. RESULTS: There was significant difference in appraisal of daily stress between exercise days and no exercise days. The amount of daily stress was significantly reduced in continuous low level of anxiety group and male by exercise. CONCLUSION: Exercise is associated with a reduction of daily stress appraisal from minor life event. And there is different effect of exercise on daily minor stress in the different anxiety level group and different sex group.
Anxiety ; Exercise ; Health Promotion ; Humans ; Male ; Research Personnel ; Volunteers

PURPOSE: To analyse the level of C-reactive protein (CRP) after total knee arthroplasty (TKA) with antibiotic-loaded bone cement (ABLC) and plain bone cement (PBC). MATERIAL AND METHODS: In the 75 primary TKAs, 35 cases with risk factors for infection were fixed with ABLC and 36 cases without risk factors were fixed with PBC. We did comparative analysis of the changing trends of the level of CRP up to 6 months after TKA in the 2 groups. RESULTS: The CRP levels at 5th,7th, 10th, 14th day and 1.5 th, 3 th, 6 th months after TKA were average 3.03, 1.50, 1.00, 0.60, 0.48, 1.04 and 0.60 mg/dl in the ABLC group, and 3.71, 2.16, 1.08, 0.78, 0.58, 0.27 and 0.31 mg/dl in the PBC group. The results were ALBC group, even having some risk factors for infection, showed the lower levels of CRP in early recovery period after TKA than PBC group. But two group has no significant difference statistically (p=0.08). CONCLUSION: Even though some risk factors for infection, statistically same returning patterns of the CRP levels in the ABLC group compare with the PBC group would be informative for observation about infection in TKA.
Arthroplasty ; C-Reactive Protein* ; Knee ; Risk Factors

PURPOSE: We performed this study to assess pain in patients seen in member outpatient orthopaedic clinics of the Korean Knee Society (KKS). MATERIALS AND METHODS: We organized a committee for the study of knee joint pain. The committee designed a questionnaire form consisting of 11 items related to pain. One hundred thirty-five regular members of the KKS asked all patients visiting their respective outpatient clinics during May 2007 to complete the questionnaire form. Although 12,418 patients agreed to fill out the questionnaire form, we only analyzed the questionnaire forms of 9,578 patients who answered completely. RESULTS: 1. Approximately 85% of patients visiting outpatient orthopaedic clinics complained of pain. 2. The average degree of pain was more than moderate, and 72% of patients simply desired to be free of pain. 3. Seventeen percent of patients thought their physicians underestimated their pain. 4. Regarding agreement in the assessment of pain between physicians and patients, there was low level of agreement by numeric rating scale, but a high level of agreement based on a mild/moderate/severe grading scale. 5. Approximately one-third (36.2%) of patients had used additional treatments for pain relief on top of their prescribed medications. CONCLUSION: Eighty-five percent of patients complained of pain, and two-thirds of them were primarily focused on its relief in their visit to the outpatient clinic. Hence, we should heed pain management itself as an important goal in treating orthopaedic patients.
Ambulatory Care Facilities ; Humans ; Knee ; Knee Joint ; Outpatients ; Pain Management ; Surveys and Questionnaires

Castleman's disease is a rare disorder characterized by tumorous masses that may develop in the lymph node tissue throughout the body. Most common location is mediastinum, but it can also affect retroperitoneum, neck, pelvis, and/or axilla. It may exceptionally affect extranodal sites like striated muscle, thoracic wall, lungs, skull, larynx, and/or vulva. The presentation is varied and diagnosis is difficult. There are two main types of Castleman's disease: hyaline-vascular type and plasma cell type. The hyaline vascular type accounts for approximately 90% of the cases. Most individuals exhibit no symptoms of this form of the disorder or they may develop non-cancerous growths in the lymph nodes. The plasma cell type is often associated with fever, weight loss, skin rash, early destruction of red blood cells, leading to unusually low levels of circulating red blood cells (hemolytic anemia), and/ or abnormally increased amounts of certain immune factors in the blood (hypergammaglobulinemia). We here report a case of Castleman's disease of ileal mesentery in 30-years old female patient. Abdominal mass, 4.7x3.6 cm in size, was completely removed from ileal mesentery without complication, and confirmed histologically mesenteric Castleman's disease of the mixed type.
Adult ; Axilla ; Diagnosis ; Erythrocytes ; Exanthema ; Female ; Fever ; Giant Lymph Node Hyperplasia* ; Humans ; Hyalin ; Immunologic Factors ; Larynx ; Lung ; Lymph Nodes ; Mediastinum ; Mesentery ; Muscle, Striated ; Neck ; Pelvis ; Plasma Cells ; Skull ; Thoracic Wall ; Vulva ; Weight Loss