BACKGROUND: Recently, measurement of heart rate variability and the nonlinear complexity of heart rate dynamics have been used as indicators of cardiovascular health. Hypertensive patients showed alternation of cardiovascular homeostasis. We designed this study to evaluate the effect of anesthesia in hypertensive patients with approximate entropy (ApEn), representing the nonlinear complexity. METHODS: With informed consent, none premedicated normotensive (n=18) and hypertensive patients (n=18) were included in this study. ECG data were collected from 10 minutes before induction to 15 minutes after induction. Collected ECG data were stored into computer binary files. We calculated ApEn from the collected ECG data. RESULTS: Before induction, ApEn of hypertensive patients was significantly lower than that of normotensive patients (p<0.05). During induction and maintenance of anesthesia, there was no difference of ApEn between the two groups. ApEn of normotensive patients during induction and maintenance of anesthesia was significantly lower than that of pre-induction (p<0.05). ApEn during maintenance of anesthesia was lower than that of induction of anesthesia (p<0.05). ApEn of hypertensive group during maintenace of anesthesia was significantly lower than that of pre-induction of anesthesia (p<0.05). CONCLUSIONS: As the ApEn of hypertensive patients is lower than that of normotensive patients during pre-inducton period, the heart rate dynamics of hypertensive patients is more regular normotensive patients. The anesthesia is deepened, the heart rate dynamics of the both group is more regular. During the maintenance of anesthesia, the regularity of the heart rate dynamics that not different in both group from the results.
Anesthesia* ; Electrocardiography ; Entropy* ; Heart Rate ; Homeostasis ; Humans ; Hypertension* ; Informed Consent

No abstract available.
Intestinal Obstruction* ; Ultrasonography*

Many benefits are reported after laparoscopy. As experience, equipment, and techniques have improved, minimally invasive laparoscopic surgery is being applied to younger children. With the advent of this new surgical approach, specific modifications become necessary in anesthetic techniques. During laparoscopy, the pneumoperitoneum performed by peritoneal insufflation of CO2 may induce intraoperative ventilatory and hemodynamic changes that complicate anesthetic management. We present a case of laparoscopic Duhamel operation in a 10-month-old infant weighing 10 kg. After induction with thiopental sodium and vecuronium, anesthesia was maintained with enflurane and 50% nitrous oxide in oxygen. Rapid hypercarbia developed about 5 minutes after introduction of pneumoperitonium, so we gave intermittent manual hyperventilation to avoid hypercarbia untill we finished the surgery. In children, CO2 absorption may be more efficient due to the physiological properties of the immature peritoneum. The functional residual capacity (FRC) is low in children. During laparoscopy, FRC is decreased further due to a variety of factors. In spite of the changes in FRC, arterial oxygenation has not been shown to deteriorate in normal infants. In our case, the changes in end-tidal CO2 tension (PETCO2) during laparoscopy did not influence the hemodynamic change. But insufflation of CO2 induced a significant increase in PETCO2, and produced a fast reaction time of PETCO2.
Absorption ; Anesthesia ; Child ; Enflurane ; Functional Residual Capacity ; Hemodynamics ; Hirschsprung Disease* ; Humans ; Hyperventilation ; Infant* ; Insufflation ; Laparoscopy* ; Nitrous Oxide ; Oxygen ; Peritoneum ; Pneumoperitoneum ; Reaction Time ; Thiopental ; Vecuronium Bromide

BACKGROUND: Propofol is an intravenous anesthetic agent, which has a protective effect on cardiovascular and CNS toxicity of local anesthetics compared with an inhalational agent. Also lipids have a has protective effects on local anesthetic cardiovascular toxicity. So, we had questioned that the protective effect on local anesthetic toxicity comes from the lipid solvent of propofol or propofol itself. METHODS: Eighteen healthy rabbits, weighing 3.0 Kg, were divided into three groups during continuous intravenous infusion of bupivacaine: the control group received normal saline (n = 6), the propofol group received propofol (n = 6), and the intralipid group received intralipid (n = 6). The changes in mean arterial pressure, heart rate and the electrocardiogram were observed during the continuous intravenous infusion of bupivacaine. RESULTS: The onset time of QRS widening and dysrhythmia was significantly prolonged in the propofol group compared with the control and intralipids group. The time required for 25% and 50% decrease in mean arterial pressure and heart rate during bupivacaine infusion was significantly prolonged in experimental groups compared with the control group. In the propofol group compared with the intralipids group, the time required for a 25% and 50% decrease in mean arterial pressure and heart rate were prolonged. CONCLUSIONS: This study suggests that infusion of propofol protection on cardiac toxicity of intravenous infusion by an bupivacaine, the dosage for sedation without cardiovascular adverse effects, is more profound than intarlipids.
Anesthetics, Local ; Arterial Pressure ; Bupivacaine* ; Electrocardiography ; Heart Rate ; Infusions, Intravenous ; Propofol* ; Rabbits*

PURPOSE: This study was undertaken to evaluate methods of reconstruction and their functional outcomes for segmental resections of the long bones of the lower extremity . MATERIALS AND METHODS: Eighteen cases were eligible for this study. There were 11 femoral lesions and there were 7 tibial. Lesions that had a good bone stock were reconstructed by means of a combination of rigid fixation and heat treated autogenous bone (Group1: in which there were 11 cases). Osteolytic lesions and those that necessitate a pathologic analysis underwent a temporary fixation procedure using intramedullary nail and bone cement (Group 2:7 cases). The average follow-up period was 49 (12-160) months. RESULTS: At the final follow-up examination, 15 patients were disease free, 2 had died of disease and remaining one was alive with disease. There were a total of 10 complications, 7 occurred in Group 1 and 3 in Group 2. Four cases of nonunion in Group 1 had a solid union after augumentation bone graft and a change of fixation device. Average union time for the recycled bone was 15 (9-35) months and their average functional score was 25.8. CONCLUSION: Although reconstruction by heat treated bone is a feasible, inexpensive method that has a low infection rate, the union process is not always successful. A rigid initial fixation is essential for a primary union. Temporal fixation using an IM nail and cement is a relatively sound method both functionally and technically and it might be useful in cases where the prognosis is unpredictable.
Follow-Up Studies ; Hot Temperature ; Humans ; Lower Extremity* ; Prognosis ; Transplants

A 66 year old male with a suprarenal pheochromocytoma on the left side was treated preoperatively with oral phenoxybenzamine 20 mg, b. i. d. for 2 weeks. The night before surgery, phenobarbital 100 mg & diazepam 5 mg were given orally. One hour before induction, diazepam 10 mg i. m. was given. Preinduction BP was 210/140 and HR was 130/min. After diazepam 20 mg i. v, BP lowered to 200/130 and HR lowered to 126/min. With commencement of sodium nitroprusside i. v. dripping, a BP of 160/100 and HR of 118 were maintained. Following Thiopental sodium 250 mg i. v., mask induction was started with N2O-O2-Enflurane and pancuronium 4 mg i. v., after 5 minutes, a #8.5 tube was intubated and pindolol 0.16 mg was injected to prevent tachycardia. We maintained a tolerable BP and pulse by repeatedly adding a bolus i. v. injection of phenoxybenzamine 1 to 2 mg during tumor manipulation and removal. No arrhythmia was noted throughout the procedure, except tachycardia. After removal of the tumor, with rapid blood transfusion and fluid infusion plus dopamine i. v. dripping, a tolerable BP and pulse was maintained.
Aged ; Anesthesia* ; Arrhythmias, Cardiac ; Blood Transfusion ; Diazepam ; Dopamine ; Enflurane* ; Humans ; Male ; Masks ; Nitroprusside ; Pancuronium ; Phenobarbital ; Phenoxybenzamine ; Pheochromocytoma* ; Pindolol ; Tachycardia ; Thiopental

Clinical application of the cartilage formed by tissue engineering is of no practical use due to the failure of long-term structural integrity maintenance. One of the important factors for integrity maintenance is the biomaterial for a scaffold. The purpose of this study is to evaluate the difference between polylactic-co-glycolic acids (PLGA) and chitosan as scaffolds. Human auricular chondrocytes were isolated, cultured, and seeded on the scaffolds, which were implanted in the back of nude mice. Eight animals were sacrificed at 4, 8, 12, 16, and 24 weeks after implantation respectively. In gross examination and histological findings, the volume of chondrocyte-PLGA complexes was decreased rapidly. The volume of chondrocyte-chitosan complexes was well maintained with a slow decrease rate. The expression of type II collagen protein detected by immunohistochemistry and western blots became weaker with time in the chondrocyte-PLGA complexes. However, the expression in the chondrocyte-chitosan complexes was strong for the whole period. Collagen type II gene expressions using RT-PCR showed a similar pattern. In conclusion, these results suggest that chitosan is a superior scaffold in cartilage tissue engineering in terms of structural integrity maintenance. It is expected that chitosan scaffold may become one of the most useful scaffolds for cartilage tissue engineering.
Animals ; Blotting, Western ; Cartilage* ; Chitosan* ; Chondrocytes ; Collagen Type II ; Gene Expression ; Humans ; Immunohistochemistry ; Mice ; Mice, Nude ; Tissue Engineering*

BACKGROUND: Heart rate variability (HRV) is characterized by a variety of linear, non-linear, periodic and non-periodic oscillations. The aim of the present study was mainly to investigate the characteristics of nonlinear dynamics of HRV of the hypertensive patients by anesthesia comparing with the normotensive patients. METHODS: With informed consent, unpremedicated normotensive (n=20) and the hypertensive patients (n=22) were included in this study. ECG data were collected from 10 minutes before induction to 15 minutes after induction. Collected ECG data were stored into computer binary files. We calculated correlation dimensions (CD, degree of freedom of system), 1/f noise (beta, nonlinearity) and Hurst exponents (HE, roughness of signals) from the collected ECG data. RESULTS: During resting state, CD of the hypertensive patients was significantly lower than that of the normotensive patients (P<0.05). During maintenance of anesthesia, there was no difference of CD between the two groups. CD of two groups were decreased significantly after anesthesia (P<0.001). The values of and HE of two groups were not different during resting state and maintenance of anesthesia. But the values of and HE of two groups were increased significantly after anesthesia (P<0.001). CONCLUSION: As the CD of the hypertensive patients is lower than of the normotensive patients during resting state, the degree of freedom of heart rate control system of the hypertensive patients is more smaller than that of the normotensive patients. Decreasing of CD after anesthesia in two groups means that degree of freedom of heart rate control system is decreased by anesthesia. Increasing of 1/f noise after anesthesia in two groups means that nonlinearity of heart rate variability is decreased by anesthesia. Increasing of HE after anesthesia in two groups means that roughness of heart rate variability is decreased by anesthesia.
Anesthesia* ; Electrocardiography ; Freedom ; Heart Rate* ; Heart* ; Humans ; Informed Consent ; Noise ; Nonlinear Dynamics*

PURPOSE: To evaluate the quantitative accuracy of three-dimensional (3D) images by means of comparing distance measurements on the 3D images with direct measurements of dry human skull according to slice thickness and scanning modes. MATERIALS AND METHODS: An observer directly measured the distance of 21 line items between 12 orthodontic landmarks on the skull surface using a digital vernier caliper and each was repeated five times. The dry human skull was scanned with a Helical CT with various slice thickness (3, 5, 7 mm) and acquisition modes (Conventional and Helical). The same observer measured corresponding distance of the same items on reconstructed 3D images with the internal program of V-works 4.0 TM (Cybermed Inc., Seoul, Korea). The quantitative accuracy of distance measurements were statistically evaluated with Wilcoxons' two-sample test. RESULTS: 11 line items in Conventional 3 mm, 8 in Helical 3 mm, 11 in Conventional 5 mm, 10 in Helical 5 mm, 5 in Conventional 7 mm and 9 in Helical 7 mm showed no statistically significant difference. Average difference between direct measurements and measurements on 3D CT images was within 2 mm in 19 line items of Conventional 3 mm, 20 of Helical 3 mm, 15 of Conventional 5 mm, 18 of Helical 5 mm, 11 of Conventional 7 mm and 16 of Helical 7 mm. CONCLUSION: Considering image quality and patient's exposure time, scanning protocol of Helical 5 mm is recommended for 3D image analysis of the skull in CT.
Cephalometry ; Humans ; Imaging, Three-Dimensional* ; Seoul ; Skull* ; Tomography, Spiral Computed ; Tomography, X-Ray Computed*

OBJECT: There are lots of studies on the cognitive impairments in patients with dementia of Alzheimer type in our country, but those on the psychopathology in them are very scanty. We investigated the psychopathology such as psychotic symptoms, depression, and anxiety and their correlations with the severity of cognitive impairments in our urban subjects with dementia of Alzheimer type. METHODS: Our subjects(N=34) with dementia of Alzheimer type in an area of Pusan, aged over 65, are screened with MMSE-K(below 24) and Hachinski's Ischemic Scale(below 4) and enrolled in this study when they met with the criteria of dementia of DSM-IV. They were devided into the mild(N=16) and severe dementic group(N=18) according to their scores of MMSE-K(cut-off point 20/21). The severities of psychiatric symptoms in the two groups were evaluated by using sets of clinical symptom rating scales such as BPRS, HAM-D, and HAM-A and the frequencies of aggressive behaviors and sleep disturbances in them were also rated at that time by two psychiatrists. Data of the two dementic groups were compared with those of healthy control subjects(N=40). RESULTS: The mean total score of BPRS, scores of thinking disturbance and withdrawal retardation subscale were lowest in the healthy control group and highest in the severe dementic group(p<0.05). Mean score of anxious depression subscale of mild dementic group was higher than that of other two groups(p<0.05). There were no ststistical differences in the mean score of hostile suspiciousness subscale among the three groups. The mean total scores of HAM-D and HAM-A tended to be higher in mild dementic group than in other two groups, but the differences were not reached to the statistical significance. These findings were thought to be identical with those of following. The total frequency of insomnia only tended to be higher, but the frequency of initial insomnia and that of using hypnotics were highest in mild dementic group(p<0.05). The frequency of aggressive behaviors tended to be higher in mild dementic group than in other two groups, but the differences were not reached to the statistical significance. CONCLUSION: Patients with dementia of Alzheimer type suffered from several psychiatric problems such as psychotic symptoms, depression, anxiety, insomnia, and aggressive behaviors from the initial stage of the illness. Clinicians should be more aware of those symptoms which need proper pharmacological and social interventions, especially in patients with mild cognitive impairment.
Anxiety ; Busan ; Dementia* ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Hypnotics and Sedatives ; Mild Cognitive Impairment ; Psychiatry ; Psychopathology* ; Sleep Initiation and Maintenance Disorders ; Thinking ; Weights and Measures