The effects of subarachnoid administration of 0.5% bupivacaine in 5% and 10% glucosesolution were investigated in a randomized 30 cases undergoing a low limb and low abdominal surgery in the Department of Anesthesiology at the Hanyang University Hospital from October 1st, 1984 to March 31st, 1985. The results are as follows: 1) These were no significant differences between the patients of the three groups in relation to sex, age, weight, height and operation time. 2) The oneset time of the maximum segmental spread of analygesia in the control group was 5 to 10 minutes and 10 to 15 minutes in the experimental groups. 3) The spread of sensory blockade in the experimental groups was lowered 2~3 segment compared with control group. 4) The onset time of complete motor blockade in the control group was 5 minutes and 5~10 minutes in the experimental group. 5) Duration of complete motor blockade in experimental groups was shorter than the control group. 6) The cardiovascular changes were investigated with no significant differences between the patients of the three groups. 7) The minimal complications such as mild hypotension in three cases, micturition difficulty in one case, mild translent headache in one case were investigated in the three groups. According to our investigation of subarachnoid blockade with 0.5% bupivacain 2ml in 5% and 10% glocose solution, it considered that the spread was limited and produced intense sensory and motor block of long duration which was suitable of the low limbs and low abdominal surgery.
Anesthesiology ; Bupivacaine ; Extremities ; Headache ; Humans ; Hypotension ; Urination

PURPOSE: It is now well recognized that reperfusion of ischemic tissues initiates a complex series of reactions that can paradoxically injure tissues. Apoptosis occurs in select cell populations during morphologic development and during cellular injury, including oxygen radical exposure, ischemia-reperfusion, and sepsis. Thus, in this study, we examined relation of the melatonin effect to the injection time and the dose, and role of melatonin in apoptosis. METHODS: Intestinal ischemia-reperfusion injury was induced in rats by clamping the superior mesenteric artery for 30 minutes. After reperfusion injury for 30 minutes, the experimental group was administered melatonin (10 mg/kg) intraperitoneally and the control group received saline and ethanol. At 30 minutes, 60 minutes, and 90 minutes, 1) pulmonary histological assessments (interstitial PMNs/10HPFs and lung (alveolar) injury score), 2) alveolar microvascular permeability assessments (wet-weignt to dry-weight ratio and lipid peroxidation activity, malondialdehyde, MDA), and 3) western blotting assessments (p53, p21, Bax, and bcl-2) were made. For comparison, long- time (60-minute) reperfusion and double- dosage melatonin (20 mg/kg) were also studied. RESULTS: The lung injury score was 1.00+/-0 in the melatonin group at 90 minutes and 3.28+/-0.30 in the saline group (p<0.01). The number of sequestered neutrophils was significantly higher in the control group at 90 minutes (34.38+/-16.76/10 HPFs) than in the melatonin-treated group (5.63+/-2.73/10 HPFs; p<0.01). In the melatonin group at 90 minutes, the wet-weight to dry-weight ratio was 4.69+/-0.16, and in the saline group, the ratio was 4.78+/-0.17 (p>0.05). A marked difference was found between the ischemia-reperfusion control group and the experimental group at 90 minutes regarding lipid peroxidation activity (Malondialdehyde, 16.45+/-0.19 micrometer vs 10.93+/-0.11 micrometer, p<0.01). In the melatonin group, p21 expressions were found to be much more than in the control group. But, p53, bcl-2, and Bax expressions were found to be in the control group. CONCLUSION: Melatonin injection within 60 min after reperfusion may promote recovery of reperfusion injury, but double-dose melatonin injection was inefficacious. Also, melatonin inhibit apoptosis by p21 expression.
Animals ; Apoptosis ; Blotting, Western ; Capillary Permeability ; Constriction ; Ethanol ; Intestines* ; Lipid Peroxidation ; Lung ; Lung Injury ; Malondialdehyde ; Melatonin* ; Mesenteric Artery, Superior ; Neutrophils ; Oxygen ; Rats ; Reperfusion ; Reperfusion Injury ; Sepsis

OBJECTIVES: In Korea, the National Health Insurance Service (NHIS) covers essential healthcare expenses, including cataract surgery. To address concerns that private health insurance (PHI) might have inflated the need for such procedures, we investigated the extent of the PHI-attributable increase in cataract surgery and its impact on NHIS-reimbursed expenses. METHODS: This retrospective, observational study uses nationwide claims data for cataract surgery from 2016 to 2020. We examined trends in utilization and cost, and we estimated the excess numbers of (1) cataract operations attributable to PHI and (2) types of intraocular lenses used for cataract surgery in 2020. RESULTS: Between 2016 and 2020, a 36.8% increase occurred in the number of cataract operations, with increases of 63.5% and 731.8% in the total healthcare costs reimbursed by NHIS and PHI, respectively. Over a 5-year period, the surgical rate per 100,000 people doubled for patients aged <65 years (from 328 in 2016 to 664 in 2020). Among the 619,771 cases in 2020 of cataract surgery reimbursed by the Korean diagnosis-related group system, more non-NHIS-covered intraocular lenses were used for patients aged <65 years than ≥65 years (68.1 vs. 14.2%). In 2020 alone, an estimated 129,311 excess operations occurred, accounting for an excess cost of US$115 million. CONCLUSIONS A dramatic increase in the number and cost of cataract operations has occurred over the last 5 years. The PHI-related increase in operations resulted in increased costs to NHIS. Measures to curtail the non-indicated use of cataract surgery should be implemented regarding PHI.

OBJECTIVE: A growing body of literature has documented that job stress is associated with the development of cardiovascular disease. Nevertheless, the pathophysiological mechanism of this association remains unclear. Therefore, we tried to elucidate the relationship between job stress, heart rate variability and metabolic syndrome. METHOD: The study design was cross-sectional, and 169 industrial workers were recruited. A structured-questionnaire was used to assess the general characteristics and job characteristics (work demand, decision latitude). Heart rate variability (HRV) was recorded using SA-2000 (medi-core). HRV was assessed by time-domain and by frequency-domain analyses. Time domain analysis was performed for SDNN (Standard Deviation of NN interval), and spectral analysis for low-frequency (LF), high-frequency (HF) and total frequency power. Metabolic syndrome was defined on the basis of clustering of risk factors, when three or more of the following cardiovascular risk factors were included in the fifth quintile: glucose, systolic blood pressure, HDL-cholesterol (bottom quintile), triglyceride and waist-hip ratio. RESULTS: The results showed that job characteristics were not associated with cardiovascular risk factors. The high strain group had a less favorable cardiovascular risk profile with higher levels of blood pressure, glucose, homocysteine, and clotting factor than the lower strain group (low strain+passive+active group), but the difference was not statistically significant. The SDNN of HRV was significantly lower in the high strain group than in the low strain group. The prevalence of metabolic syndrome in the low strain, passive, active and high strain groups was 9.7%, 13.9%, 14.9% and 23.8%, respectively. In the high strain group, the metabolic syndrome was significantly related to a decreased SDNN. However, we could not find a significant association in LF/HF ratio. CONCLUSION: This result suggests that decreased HRV does not play a role in the development of disease; however, it can induce cardiovascular abnormalities or dysfunctions related to the onset of heart disease among high risk groups.
Blood Pressure ; Cardiovascular Abnormalities ; Cardiovascular Diseases ; Glucose ; Heart Diseases ; Heart Rate* ; Heart* ; Homocysteine ; Prevalence ; Risk Factors ; Triglycerides ; Waist-Hip Ratio

To understand protozoan, viral, and bacterial infections in diarrheal patients, we analyzed positivity and mixed-infection status with 3 protozoans, 4 viruses, and 10 bacteria in hospitalized diarrheal patients during 2004-2006 in the Republic of Korea. A total of 76,652 stool samples were collected from 96 hospitals across the nation. The positivity for protozoa, viruses, and bacteria was 129, 1,759, and 1,797 per 10,000 persons, respectively. Especially, Cryptosporidium parvum was highly mixed-infected with rotavirus among pediatric diarrheal patients (29.5 per 100 C. parvum positive cases), and Entamoeba histolytica was mixed-infected with Clostridium perfringens (10.3 per 100 E. histolytica positive cases) in protozoan-diarrheal patients. Those infected with rotavirus and C. perfringens constituted relatively high proportions among mixed infection cases from January to April. The positivity for rotavirus among viral infection for those aged < or = 5 years was significantly higher, while C. perfringens among bacterial infection was higher for > or = 50 years. The information for association of viral and bacterial infections with enteropathogenic protozoa in diarrheal patients may contribute to improvement of care for diarrhea as well as development of control strategies for diarrheal diseases in Korea.

Background: and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. Methods: This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). Results: Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. Conclusions In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.

Background: and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. Methods: This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). Results: Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. Conclusions In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.