During general anesthesia, removal of exhaled carbon dioxide by rebreathing appliances is provided by chemical absorption and this carbon dioxide absorption during anesthesia would at first glance seem to be a simple problem. The problem, however, is far more complicated and much attention must be given to details of rebreathing appliances. Incomplete removal of carbon dioxide in circle absorber systems, which are commonly used today must be carefully monitored to prevent hypercapnea caused by accumulation of carbon dioxide in the breathing circuits. Although circle absorbers have been developed through clinical trials anesthesiologists have no reliable indication of the end point of useful life of the absorbent. This study was undertaken to investigate the useful life of the soda lime used in two type of canisters (type A: canister of anesthesia machine. Quantiflex, USA. 12.9cmX16.6cm, tbye B: canister of anesthesia machine, International 2. U.K., 13.1cmX16.9cm). the effect of flow rate on this useful life and the relations between indicator change and the endpoint of useful life of the soda lime. The control group used a as total flow rate of fresh gases at 2.0 liters per minute and the experimental group used a total flow rate of 4.0 liters per minute. The carbon dioxide concentration of 0.1% at the canister exit was employed as the end point of useful life of the absorbent and the exit carbon dioxide concentration were monitored continuously by intra-red carbon dioxide monitor apparatus(Datex Normocap CD-102, Pinland). Also the carbon dioxide concentration in the respiratory circuit of exhaling side was examined. The results were as follows: 1) In type A, the average useful life of soda lime was 1,885 minutes in the control group and 2,514 minutes in the experimental group. In type B, the average useful life of soda lime was 1,587 minutes in the control group and 1,980 minutes in the experimental group. 2) At the end point of useful life of the absorbent the level of the color change of the indicator of the absorbent in all types was above the three-fourth height of two chambered canister. 3) At the end point, end tidal CO2 concentration was 3.5 vol% in the control group 2.88 vol% in the experimental group. The data obtained from this observation indicated that the increase of total flow rate of gas and the type A canister prolonged the useful life of soda lime and that the double chambered canister could be used safely until the color change of the indicator reached the level of three fourth the height of the canister.
Absorption ; Anesthesia ; Anesthesia, General ; Carbon Dioxide ; Exhalation ; Gases ; Respiration

No abstract available.
Blood Cells* ; Humans ; Infant, Newborn*

Primary carcinoma of the bile duct is uncommon but not rare and its prognosis is poor even though long-termsurvival had been reported. The authors presented 62 cases of bile duct cancer, which were confirmed at YUMC fromJan. 1971 to Dec. 1981. The results were as follows; 1. The most prevalent age group was 6th decade and a male-tofemale ratio was 1.9:1. 2. Jaundice was the most common clinical manifestations(84%), and followed by right
Bile Duct Neoplasms ; Bile Ducts ; Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Diagnosis ; Dilatation ; Hepatomegaly ; Humans ; Jaundice ; Prognosis ; Ultrasonography

BACKGROUND: Pacing-induced atrial electrical remodeling (AER) is characterized by shortening of atrial effective refractory period (A-ERP) and its altered rate adaptation. In paroxysmal atrial fibrillation (AF), periods of AF occur with interveneing normal sinus rhythm (NSR) when atria recover from the preceding AER. Previous episodes of AF may precondition the atrial myocardium and cause different time course of AER in subsequent episodes of AF. But the influence of the preceding AER on the subsequent AER has not been described. METHODS: Four mongrel dogs were anesthetized with enflurane. After thoracotomy, silicon band with 3 pairs of electrodes was sutured to the lateral wall of the left atrium. Atrial pacing was performed after 2 wks of recovery and autonomic blockade. Pacing protocol consisted of rapid atrial pacing (RAP) at 500 bpm (for 60 min) and recovery in NSR (for 60 min) which was repeated three times. A-ERP was measured every 10 min. The same pacing protocol was repeated after pretreatment with verapamil (0.1 mg/kg/hr). RESULTS: 1) With 60 min of RAP, A-ERP decreased significantly (126+/-6 ms vs. 105+/-7 ms, p<0.005). 2) After cessation of pacing, A-ERP returned to 98% of baseline value in 15 minutes. Recovery from AER occurred faster than AER (78 vs 21 ms/h). 3) After pretreatment with verapamil, RAP decreased A-ERP from 127+/-5 ms to 116+/-5 ms. AER, the reduction in A-ERP, was significantly attenuated by pretreatment with verapamil (deltaERp=17+/-7 vs. 9+/-0.2 %, p<0.05). 4) When RAPs were repeated, AER showed a tendency of acceleration, but it was not statistically significant (deltaERp=22 ms, 24 ms, 28 ms at the end of 60 min pacing for the 1st, 2nd, 3rd pacing). CONCLUSION: RAP induced AER in conscious dog atria and it was reduced by pretreatment with calcium channel blocking agent, verapamil. Upon repeated atrial stimulations, AER did not accelerate or decelerate when the atria recovered from the preceding AER.
Acceleration ; Animals ; Atrial Fibrillation ; Atrial Remodeling* ; Calcium ; Calcium Channels ; Dogs* ; Electrodes ; Enflurane ; Heart Atria ; Myocardium ; Silicones ; Thoracotomy ; Verapamil

No abstract available.
Cystadenocarcinoma, Mucinous* ; Mucins*

The goal of surgical stone management is to achieve maximal stone clearance with minimal morbidity to the patient. Because of its efficacy, efficiency and low morbidity, extracorporeal shock wave lithotripsy(ESWL) is the first-line treatment for almost all urinary calculi. However, stone clearance after ESWL has been shown to be affected by the stone burden, location, chemical composition and kidney anatomy. Especially, the success rate for ESWL is reduced in lower pole stone(LPS). Percutaneous nephrolithotomy(PNL) and retrograde ureteroscopic intrarenal surgery(RIRS) are alternative treatment options for stones refractory to ESWL such as LPS. Although effective, PNLsubjects the patient to increased morbidity compared to ESWL and RIRS. Because of its low morbidity and relatively high success rate, RIRS for LPS is an attractive treatment modality in selective patients. We report a case of multiple renal pelvis and lower calyceal stones treated with ureteroscopy.
Humans ; Kidney ; Kidney Calculi ; Kidney Pelvis* ; Shock ; Ureteroscopy ; Urinary Calculi

BACKGROUND: It is doubtful that aging causes deteriorated glucose metabolism and insulin resistance of skeletal muscle. Some researchers had different results about it. So we have studied the mechanism responsible for the abnormal glucose tolerance associated with aging in rapidly growing and matured rats. MATERIALS AND METHODS: Animals were used S.D. rats. Growing rats were 7 weeks old (BW: 160-190 gm) and matured rats were 28 weeks old (BW: 420-525 gm). RESULTS: Fasting blood glucose and plasma insulin levels were significantly elevated in matured rat compared with growing rats. And during oral glucose tolerance test the glucose level was also significantly elevated in matured rats. These results confirmed an insulin resistant state of aging. Insulin levels at 30 minutes of oral glucose tolerance test was significantly elevated in growing rat. But at 120 minutes it was maintained at higher level in matured rats than in growing rats. It suggested the possibility of increased insulin secretion by initial stimulation of beta-cells in growing rats, and increased secretion and decreased catabolic rate of insulin in matured rats. Glucose uptake rate of soleus muscle in matured rats was lower than that of growing rats, but the difference was not statistically significant. The dose(insulin)- responsive (glucose uptake) curve of soleus muscle was only slightly deviated to the right side. CONCLUSION: Glucose metabolism of rat skeletal muscle was worsened by aging. The data of glucose uptake experiments suggested the possibility of insulin resistance of skeletal muscle in matured rats, but the mechanism of insulin resistance of skeletal muscle need further studies.
Aging ; Animals ; Blood Glucose ; Fasting ; Glucose Tolerance Test ; Glucose* ; Insulin ; Insulin Resistance ; Metabolism* ; Muscle, Skeletal* ; Plasma ; Rats*

PURPOSE: Pouch dilatation and band slippage are the most common long-term complications after laparoscopic adjustable gastric banding (LAGB). The aim of the study is to present our experience of diagnosis and management of these complications. MATERIALS AND METHODS: The pars flaccida technique with anterior fixation of the fundus was routinely used. All band adjustments were performed under fluoroscopy. We analyzed the incidence, clinico-radiologic features, management, and revisional surgeries for treatment of these complications. We further presented the outcome of gastric plication techniques as a measure for prevention of these complications. RESULTS: From March 2009 to March 2012, we performed LAGB on 126 morbidly obese patients. Among them, 14 patients (11.1%) were diagnosed as having these complications. Four patients (3.2%) had concentric pouch dilatations, which were corrected by band adjustment. Ten (7.9%) had eccentric pouch with band slippage. Among the ten patients, there were three cases of posterior slippage, which were corrected by reoperation, and seven cases of eccentric pouch dilatation with anterior slippage. Three were early anterior slippage, which was managed conservatively. Two were acute anterior slippage, one of whom underwent a revision. There were two cases of chronic anterior slippage, one of whom underwent a revision. The 27 patients who underwent gastric plication did not present with eccentric pouch with band slippage during the follow-up period. CONCLUSION: The incidence of pouch dilatation with/without band slippage was 11.1%. Management should be individualized according to clinico-radiologic patterns. Gastric plication below the band might prevent these complications.
Adult ; Female ; Gastroplasty/adverse effects/*methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Obesity, Morbid/*surgery ; Postoperative Complications ; Treatment Outcome

PURPOSE: The out-of-hospital cardiac arrest (OHCA) survival rate of patients in Korea is lower than the global average and it might be caused by an extremely low rate of return of spontaneous circulation in the prehospital field. The authors identified obstacles that disturb on-scene performance of cardiopulmonary resuscitation (CPR) for a certain period from 119 emergency medical technicians (EMTs) through a nation-wide paper survey. METHODS: A total of 1273 first grade EMTs and nurses were surveyed. CPR time performed on the scene (without transfer), CPR experiences, self-assessment of CPR skill performance, and both obstacles to performance of CPR on the scene and solutions to overcoming them for continuous on-scene CPR were investigated using a 28-item questionnaire. RESULTS: The average for work experience and the number of CPR experiences of subjects was 6.8+/-4.5 years and 1.9+/-1.7 times/month, respectively. Survey results for CPR times on the scene showed an average of 4.2+/-2.4 minutes, approximately two periods of CPR (30:2x5 cycles). Obstacles to CPR on the scene were investigated as complaints of family members in 791(62.1%) and fatigue lowering CPR quality due to lack of human resources in 536(41.0%); 627(49.3%) of the subjects answered that they had received complaints due to a long stay on the scene. CONCLUSION: In order to increase the survival rate of OHCA patients, CPR on the scene is needed during a certain period in order to achieve a return of spontaneous circulation. Education, amelioration of guidelines, and support for the EMT administrative system are also needed.
Cardiopulmonary Resuscitation* ; Education ; Emergencies* ; Emergency Medical Technicians* ; Fatigue ; Humans ; Korea ; Out-of-Hospital Cardiac Arrest ; Self-Assessment ; Survival Rate ; Surveys and Questionnaires

PURPOSE: The out-of-hospital cardiac arrest (OHCA) survival rate of patients in Korea is lower than the global average and it might be caused by an extremely low rate of return of spontaneous circulation in the prehospital field. The authors identified obstacles that disturb on-scene performance of cardiopulmonary resuscitation (CPR) for a certain period from 119 emergency medical technicians (EMTs) through a nation-wide paper survey. METHODS: A total of 1273 first grade EMTs and nurses were surveyed. CPR time performed on the scene (without transfer), CPR experiences, self-assessment of CPR skill performance, and both obstacles to performance of CPR on the scene and solutions to overcoming them for continuous on-scene CPR were investigated using a 28-item questionnaire. RESULTS: The average for work experience and the number of CPR experiences of subjects was 6.8+/-4.5 years and 1.9+/-1.7 times/month, respectively. Survey results for CPR times on the scene showed an average of 4.2+/-2.4 minutes, approximately two periods of CPR (30:2x5 cycles). Obstacles to CPR on the scene were investigated as complaints of family members in 791(62.1%) and fatigue lowering CPR quality due to lack of human resources in 536(41.0%); 627(49.3%) of the subjects answered that they had received complaints due to a long stay on the scene. CONCLUSION: In order to increase the survival rate of OHCA patients, CPR on the scene is needed during a certain period in order to achieve a return of spontaneous circulation. Education, amelioration of guidelines, and support for the EMT administrative system are also needed.
Cardiopulmonary Resuscitation* ; Education ; Emergencies* ; Emergency Medical Technicians* ; Fatigue ; Humans ; Korea ; Out-of-Hospital Cardiac Arrest ; Self-Assessment ; Survival Rate ; Surveys and Questionnaires