The chest radiographs and angiograms were retrospectively evaluated in 47 patients with pulmonary atresia (PA) and ventricular septal defect (VSD) to determine the characteristic findings of major aortopulmonary collateral arteries (MAPCSs) on the chest radiographs. Of 47 patients, 23 had MAPCAs and 24 had only PDA for blood supply of whole right and left lung. Chest radiographs enabled identification of 16 of 23 patients with MAPCAs. The most common finding of MAPCAs was inappropriately large peripheral pulmonary vasculature (n=16, 69.6%). The other findings were tortuosity of pulmonary vasculature (n=12, 52.2%), focal unevendistribution of pulmonary vasculature (n=12, 52.2%), and two descending pulmonary arteries (n=4, 17.4%). When chest radiographs showed two or more findings of MAPCAs, MAPCAs could be differentiated from PDA with statistical significance (p<0.005). It is concluded that chest radiographs may help to identify MAPCAs before angiography if two-dimensional echo ardiography suggests PA with VSD.
Angiography ; Arteries* ; Heart Septal Defects, Ventricular* ; Humans ; Lung ; Pulmonary Artery ; Pulmonary Atresia* ; Radiography, Thoracic ; Retrospective Studies ; Thorax*

BACKGROUND: We can usually see the yawning at induction of anesthesia, however, it has not been studied as such an indicator of anesthesia. The yawning is one means of changing arousal level, and a sign or marker that such a change is occurring, although its functions are not well understood. The purpose of the present study was to evaluate the yawning whether it could be used as an indicator of induction of anesthesia, using its property as a marker of changed arousal level. METHODS: In 60 adult patients, group 1 was done propofol target controlled infusion (TCI) with Stelpump software, while group 2 was done thiopental TCI similarly. Clinical indicators of induction of anesthesia were measured as follows: loss of verbal control (LOV), loss of eyelash reflex (LOE), the yawning. In addition, the occurrence of apnea (OOA) were measured, too. We assessed the hypnosis levels of indicators of induction of anesthesia including the yawning and demonstrate their effect site concentrations and elapsed time. Furthermore, we compared the incidences of yawning and apnea between both groups. RESULTS: Clinical indicators of induction occurred in the order of LOV > LOE > the yawning >> OOA in both groups. With respect to BIS, the yawning showed the lowest BIS and the highest effect site concentrations except OOA in both groups. The incidence of the yawning in group 2 was higher than in group 1 (about 82 vs 63%). On the contrary, the incidence of apnea in group 1 was higher than in group 2 (about 79 vs 53%). CONCLUSIONS: As far as the yawning could be shown, we could observe, it approximated most closely to their clinical impression of the 'true' induction in terms of the hypnosis level and its effect site concentration.
Adult ; Anesthesia* ; Apnea ; Arousal ; Humans ; Hypnosis ; Incidence ; Propofol ; Reflex ; Thiopental ; Yawning*

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest* ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced* ; Hysterectomy* ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Resuscitation

BACKGROUND: Silver has been used for disinfection and sterilization. We aimed to confirm the in-vitro antibacterial effects of nanocrystalline silver-coated gauze. METHODS: Fourteen clinical isolates each of Escherichia coli and Acinetobacter baumannii were used. Bacterial suspensions made in tryptic soy broth were exposed to Ordinary and silver-coated gauze. Bacteria were then harvested from the gauze immediately and after 24 h incubation, cultured on blood agar plates and eunmerated for viable counts. The number of colonies was converted into common logarithms for comparison. RESULTS: The number of colonies recovered from silver-coated gauze was significantly lower than those recovered from ordinary gauze when harvested immediately after exposure (E. coli, 3.06 vs 1.73; A. baumannii, 3.13 vs 1.98; P<0.001). After 24 h incubation of exposed gauze, silver-coated gauze produced less than 1 CFU/mL, whereas ordinary gauze produced a number of colonies significantly higher than it did immediately after exposure (E. coli, 4.13; A. baumannii, 4.46; P<0.001). Conclusion: Compared with ordinary gauze, silver-coated gauze was shown to have 99.99% antibacterial effect.
Acinetobacter baumannii ; Agar ; Bacteria ; Disinfection ; Escherichia coli ; Silver ; Sterilization ; Suspensions

No abstract available.
Humans* ; Ovarian Neoplasms* ; Tamoxifen*

BACKGROUND: Anesthesia induction time is related to speed of injection, injected volume, and Keo. In the case of target controlled infusion, induction time can be controlled by adjusting the induction time mode. The aim of this study was to estimate the effect of induction time mode on variable parameters and vital signs during anesthesia induction with propofol using a target controlled infusion (TCI). METHODS: Sixty unpremedicated adult patients (ASA class I or II, 18 55 yrs) scheduled for elective surgery were randomly allocated to four groups according to induction mode. Group 1 was assigned a flash induction mode, and groups 2, 3 and 4 were assigned 2, 3 and 4min respectively. The end point of anesthesia induction was loss of eyelash reflex. Various parameters including induction time, infused volume, current/effect concentration at induction, and vital signs were compared. RESULTS: As the induction time mode was prolonged, induction time was delayed, but there was no difference in infused volume. Also, the current concentration decreased gradually, but the effect concentration did not show any difference. The vital signs were more stable in groups 3 and 4 compared with groups 1 and 2. CONCLUSIONS: For anesthesia induction, a rapid induction mode showed more rapid induction and low current concentration, but vital signs were relatively unstable and the effect concentration at induction showed no difference. For critically ill patients or patients with unstable hemodynamics, a more gradual induction mode for anesthesia induction in propofol TCI is recommended.
Adult ; Anesthesia* ; Critical Illness ; Hemodynamics ; Humans ; Propofol* ; Reflex ; Vital Signs*

INTRODUCTION: Several methods, including loss of eye lash (eyelash) reflex and loss of verbal contact, have heen used as criteria for estimating the optimal hypnosis for anesthesia induction. However, these methods are too objective. We examined the hypnotic dose response of etomidate, using a bispectral index as a more subjective criterion for anesthesia induction. METHODS: Fourty-Five ASA I or II adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to induction dose of etomidate. They were Group 1: 0.1 mg/kg ; Group 2: 0.15 mg/kg; Group 3: 0.2 mg/kg (n = 15 for each group), respectively. Etomidate diluted as 10 ml in a syringe injected through an 18G forearm intravenous catheter, using a syringe pump at the rate of 20 ml/min. Observer's Assessment of Alertness/sedation (OAA/S) scale of 1 was considered optimal for hypnosis. Bispectral index, OAA/S scale, and vital signs were checked every minute until spontaneous eye opening after end of drug infusion. Also, the correlation coefficient between BIS and OAA/S scale was checked for evaluating the bispectral index; this was a useful tool for estimating the degree of hypnosis. RESULTS: BIS and OAA/S showed their lowest scores around 60 sec. after the etomidate injection, which was very different from time to peak effect known to be the 2 min. The correlation coefficient (r) between BIS and OAA/S was 0.84 on average, suggesting the BIS as an good subjective indicator of optimal hypnosis for anesthesia induction. Vital signs were stable in all groups. Hypnotic ED50 and ED95 were 0.12 and 0.19 mg/kg, respectively. CONCLUSIONS: Bispectral index can be a useful tool for estimating the optimal hypnosis for anesthesia induction. Hypnotic ED50 of etomidate was 0.12 mg/kg.
Adult ; Anesthesia* ; Catheters ; Etomidate* ; Forearm ; Humans ; Hypnosis ; Orthopedics ; Reflex ; Syringes ; Vital Signs

INTRODUCTION: Several methods, including loss of eye lash (eyelash) reflex and loss of verbal contact, have heen used as criteria for estimating the optimal hypnosis for anesthesia induction. However, these methods are too objective. We examined the hypnotic dose response of etomidate, using a bispectral index as a more subjective criterion for anesthesia induction. METHODS: Fourty-Five ASA I or II adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to induction dose of etomidate. They were Group 1: 0.1 mg/kg ; Group 2: 0.15 mg/kg; Group 3: 0.2 mg/kg (n = 15 for each group), respectively. Etomidate diluted as 10 ml in a syringe injected through an 18G forearm intravenous catheter, using a syringe pump at the rate of 20 ml/min. Observer's Assessment of Alertness/sedation (OAA/S) scale of 1 was considered optimal for hypnosis. Bispectral index, OAA/S scale, and vital signs were checked every minute until spontaneous eye opening after end of drug infusion. Also, the correlation coefficient between BIS and OAA/S scale was checked for evaluating the bispectral index; this was a useful tool for estimating the degree of hypnosis. RESULTS: BIS and OAA/S showed their lowest scores around 60 sec. after the etomidate injection, which was very different from time to peak effect known to be the 2 min. The correlation coefficient (r) between BIS and OAA/S was 0.84 on average, suggesting the BIS as an good subjective indicator of optimal hypnosis for anesthesia induction. Vital signs were stable in all groups. Hypnotic ED50 and ED95 were 0.12 and 0.19 mg/kg, respectively. CONCLUSIONS: Bispectral index can be a useful tool for estimating the optimal hypnosis for anesthesia induction. Hypnotic ED50 of etomidate was 0.12 mg/kg.
Adult ; Anesthesia* ; Catheters ; Etomidate* ; Forearm ; Humans ; Hypnosis ; Orthopedics ; Reflex ; Syringes ; Vital Signs

BACKGROUND: The aging of the patient population is one of rhe most important factirs influencing health care delivery. Currently 5% of the Korean population is elderly, defined as older than 65years of age, with this group projected to increase to 13.1% by the year 2021. Cardiovascular disease is the leading cause of death and of disability in the elderly age group. mong them, coronary heart disease is the most importane. METHOD: Study population composed of 216 patients who were admittied to the hospital with first acute myocardial infarction and they were divided into two groups according to the age(older than 65 years of age vs younger). Clonical features, risk factors of coronary heart disease, in-hospital outcome and complication were compared in elderly patients and others group. Results : 1) The risk factors of coronary heart disease is similar to younger patients but pattern of chest pain is less typical than younger patients. 2) Clinical presentation of elderly patients is similar to younger patients except Killip class on admission.(1.66vs 1.91,P=0.04) 3) In-hospital mortality of elderly patients in higher than younger patients. In addition to an increased incidence of death, recurrent ischemia, stroke, AV block, ventricular arrythmia, pulmonary edema occured more frequently with advanced age. 4) Especially in the thrombolytic therapy group, in-hospital death, reinfarction and recurrent ischemia is higher than primary PTCA group in elderly patients. CONCLUSIONS: Diagnosis of acute chest pain is difficult in elderly patients and in-hospital mortality and morbidity is higher than in younger patients. Thus more accurate diagnosis and discriminative therapeutic modality is needed.
Aged ; Aging ; Arrhythmias, Cardiac ; Atrioventricular Block ; Cardiovascular Diseases ; Cause of Death ; Chest Pain ; Coronary Disease ; Delivery of Health Care ; Diagnosis ; Hospital Mortality ; Humans ; Incidence ; Ischemia ; Myocardial Infarction* ; Pulmonary Edema ; Risk Factors ; Stroke ; Thrombolytic Therapy