No abstract available.
Reye Syndrome*

No abstract available.
Intussusception*

BACKGROUND: Bag and mask devices are used frequently to provide patients with positive-pressure-assisted ventilation. One of the disadvantages is the fact that they do not deliver high concentrations of oxygen without special adaptors or attention to technique. In order to investigate the variables affecting oxygen delivery, we designed a study to determine the fractions of delivered oxygen (FDO2) under varying ventilating techniques and conditions. METHODS: We designed special wooden box, in which the Laerdal resuscitator bag had been. We measured the fractions of delivered oxygen with or without reservoir bag in various tidal volumes, respiration rates and oxygen flows. RESULTS: Without reservoir bag, the fractions of delivered oxygen were increased up to only 73% in spite of 15 l/min oxygen flow. With reservoir bag, the fractions of delivered oxygen were increased up to nearly 96% in 5-7.5 l/min oxygen flow. CONCLUSIONS: While using the Laerdal resuscitator bag, it is desirable to adapt reservoir bag and supply 5 l/min oxygen in conventional ventilation and 7.5 l/min in hyperventilation minimally for higher fraction of delivered oxygen.
Humans ; Hyperventilation ; Masks ; Oxygen* ; Respiratory Rate ; Tidal Volume ; Ventilation

BACKGROUND: Propofol inhibits postoperative bronchospasm. Ketamine prevents bronchospasm in asthmatic patients. The present study was designed to evaluate the effects and mechanisms of propofol and ketamine on tracheal smooth muscles. METHODS: After isolating guinea-pig tracheal preparations, the maximal tracheal tones were induced by smooth muscle constrictors(2 10 7 M carbachol, 10 5 M histamine, 30 mM K+ Krebs solution, 124 mM K+ Krebs solution). When tracheal tones stabilized, propofol or ketamine was added cumulatively to obtain the concentration-relaxation curves, and calculated the ED50 and ED95. RESULTS: Propofol and ketamine decreased maximal tracheal tones in the concentration-dependent manners. The ED50 and ED95 of propofol were lowest in the histamine group, highest in the 30 mM K+ Krebs solution group. The ED50 and ED95 of ketamine were lowest in the 124 mM K+ Krebs solution group, highest in the histamine group. CONCLUSIONS: The relaxant effects of propofol and ketamine involve with all receptors in nonspecific way. However, propofol may inhibit more strongly the histamine mediated mechanism of tracheal contraction and ketamine may involve more strongly with Ca++ channel.
Bronchial Spasm ; Carbachol ; Histamine ; Humans ; Ketamine* ; Muscle, Smooth* ; Propofol*

BACKGROUND: Methylmethacrylate monomer (MMA) bone cement has been associated with sudden systemic hypotension. The present study was aimed to explore the mechanism of direct myocardial depressant actions of MMA. METHODS: The isometric contraction of isolated guinea pig's right ventricular papillary muscle was measured. Normal and slow action potentials were evaluated by a conventional micro-electrode technique. The effects of MMA on sarcoplasmic reticulum (SR) function were evaluated by its effect on: rapid cooling contractures, rested state contraction of rat papillary muscle in normal Tyrode's solution and of guinea pig's papillary muscle in low Na+ Tyrode's solution. To measure the inward calcium currents (ICa), whole cell patch clamp techniques were applied. RESULTS: MMA caused a dose-dependent depression of the peak force (PF) and maximal rate of peak force (dF/dt-max). About a 30% depression of PF was shown at rested state (RS) contraction in rat myocardium and under low Na+ Tyrode's solution in guinea pig myocardium, respectively. In the 26 mM K+ Tyrode's solution, MMA caused dose-dependent depression of late force development without alteration in early force development. MMA depressed rapid cooling contracture accompanied by prolongation of time to peak contracture. MMA did not alter the amplitude or maximum depolarization rate of normal and slow action potentials. Action potential durations were significantly reduced. In patch clamp studies, MMA reduced ICa in a dose-dependent manner. CONCLUSIONS: MMA depressed cardiac contractility in a dose-dependent manner and may be partly related to the depression of Ca2+ influx through the cardiac membrane. SR Ca2+ release seems to be mildly inhibited by MMA. Based on common clinical concentrations, the direct myocardial depressant effect of MMA may not be a main cause of hypotension during an operation.
Action Potentials ; Animals ; Calcium ; Contracture ; Depression ; Guinea ; Guinea Pigs ; Hypotension ; Isometric Contraction ; Membranes ; Methylmethacrylate* ; Myocardium ; Papillary Muscles ; Patch-Clamp Techniques ; Rats ; Sarcoplasmic Reticulum

PURPOSE: Colorectal cancer (CRC) has a high risk for postoperative thromboembolic complications such as venous thromboembolism (VTE) compared to other surgical diseases, but the relationship between VTE and CRC in Asian patients remains poorly understood. The present study examined the incidence of symptomatic VTE in Korean patients who underwent surgery for CRC. We also identified risk factors, incidence and survival rate for VTE in these patients. MATERIALS AND METHODS: The patients were identified from the CRC database treated from January 2011 to December 2012 in a single institution. These patients were classified into VTE and non-VTE groups, their demographic features were compared, and the factors which had significant effects on VTE and mortality between the two groups were analyzed. RESULTS: We analyzed retrospectively a total of 840 patients and the incidence of VTE was 3.7% (31 patients) during the follow-up period (mean, 17.2 months). Histologic subtype (mucinous adenocarcinoma) and previous history of VTE affected the incidence of VTE on multivariate analysis. There was a statistically significant difference in survival rate between the VTE and non-VTE group, but VTE wasn't the factor affecting survival rate on multivariate analysis. Comparing differences in survival rate for each pathologic stage, there was only a significant difference in stage II patients. CONCLUSION: Among CRC patients after surgery, the incidence of VTE was approximately 3% within 1 year and development of VTE wasn't a significant risk factor for death in our study but these findings are not conclusive due to our small sample size.
Asian Continental Ancestry Group ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Prognosis* ; Retrospective Studies ; Risk Factors ; Sample Size ; Survival Rate ; Venous Thromboembolism*

BACKGROUND: The APACHE II score system that evaluates prognosis has been widely applied for ICU patients. As the advent of APACHE III approaches, a comparison of effectiveness between APACHE II and APACHE III is demanded. The purpose of this study is to evaluate the relationships between APACHE II score and mortality rates, and between APACHE III scores and mortality rates in intensive care unit patients. METHODS: 289 adult ICU patients participated in this study. Their mortality rates and scores on APACHE II and APACHE III were calculated. The scores of the APACHE II and APACHE III systems were also compared between survivor and non-survivor groups. RESULTS: APACHE II scores at admission and discharge were 9+/-5, 6+/-4 in the survivor group and 20+/-9, 28+/-11 in the non-survivor group. APACHE III scores at admission and discharge were 29+/-19, 20+/-14 in the survivor group 75+/-37, 111+/-41 in the non-survivor group. The odds ratio between the mortality rate and the APACHE II score was EXP (0.2167) and the odds ratio between mortality rate and APACHE III score was EXP (0.0621). The determinant coefficient (R2) was 0.73 between the APACHE II and APACHE III scores. CONCLUSIONS: The results showed that both the APACHE II and APACHE III score systems are effective in predicting mortality rates in intensive care unit patients.
Adult ; APACHE* ; Humans ; Intensive Care Units* ; Critical Care* ; Mortality* ; Odds Ratio ; Prognosis ; Survivors

This is a case report of the accidental insertion of an entire catheter into the right femoral vein during central venous catheterization through the right femoral vein. The risks of accidental guide wire or catheter breakage and migration of resulting fragments to the heart or intravascular or extravascular space has been increased with the frequent diagnostic and therapeutic use of central venous catheters. We used a single lumen polyurethane central venous catheter (SECALON UNIVERSAL, Viggo-Spectramed, UK). During central venous catheterization under general anesthesia, the catheter was disconnected from its hub and accidentally inserted into the right femoral vein. The catheter was retrieved by using a snare under fluoroscopic guidance without any complications.
Anesthesia, General ; Catheterization, Central Venous* ; Catheters* ; Central Venous Catheters* ; Femoral Vein* ; Heart ; Polyurethanes ; SNARE Proteins

OBJECTIVE: The number of elderly patients with cerebral aneurysm has markedly increased. We investigated the clinical characteristics and the surgical outcomes of cerebral aneurysms among elderly patients more than 65 years of age compared to a control group including patients less than 65. MATERIALS AND METHODS: From March 2001 to May 2007, 590 patients with aneurysmal subarachnoid hemorrhage (SAH) were treated; among them, 88 patients (14.9%) more than 65 were candidates for this study. The variables included in the analysis were: age, gender, size and site of the aneurysm, the Hunt-Hess grade, size of the hematoma on the CT scan, and comorbidities. RESULTS: The mean age was 69 (range 65-84 years), 72 patients (81%) were female, 72 of the patients had a Hunt-Hess grade of I-III, 37 patients (42%) had anterior communicating artery bleeds, and 13 patients (16.7%) had multiple aneurysms. The treatments consisted of neck clipping for 77 aneurysms and endovascular therapy for 11 aneurysms. Fifty eight patients (65.9%) had a favorable outcome and the overall mortality was 11.4%. The main causes of unfavorable outcomes among the elderly patients included a poor Hunt-Hess grade on admission and a concurrent intracerebral hematoma. CONCLUSIONS: The results of this study showed that advanced age was not a contra-indication to aneurysm surgery and early craniotomy can lead to a better outcome in elderly patients.
Aged ; Aneurysm ; Arteries ; Comorbidity ; Craniotomy ; Female ; Hematoma ; Humans ; Intracranial Aneurysm ; Neck ; Subarachnoid Hemorrhage

OBJECTIVES: We sought to examine the diverse factors associated with aneurysms of the posterior circulation. In addition, the results of conventional craniotomy were compared with those of endovascular treatment. METHODS: One hundred and one patients with posterior circulation aneurysms were selected for study inclusion. The factors that might affect the clinical outcomes were studied , such as the initial Hunt-Hess (H-H) grade, aneurysm location, size of the aneurysm, and therapeutic modalities. In addition, the morbidity and mortality rates were analyzed. The treatment outcomes were evaluated using the Glasgow Outcome Scale (GOS) 6 months after the initial insult. RESULTS: The patient population consisted of 67 women and 34 men, with a mean age of 52 (range 28-81 years). The overall morbidity and mortality rates at 6 months were 13.9% (14/101) and 17.8% (18/101), respectively. Sixty-one operations (60.3%) were performed, and 32 patients were treated with endovascular therapy. Forty-two (85.7%) of the 49 patients that had initial H-H grades of I and II had a better prognosis (GOS more than 4) than those with poor H-H grades (P<0.001). Patients that underwent endovascular treatment had better outcomes than those that had clipping (P=0.032). There was no significant difference in outcome according to the size of the aneurysm, location of the aneurysm, or the age of the patients. CONCLUSIONS: The results of this study showed that the factors affecting the prognosis were the initial HH grade and treatment modality. Considering the very high mortality rate in patients with rebleeding, early management may help improve the prognosis of patients with posterior circulation aneurysms. Endovascular therapy should be considered the primary treatment modality in patients with posterior circulation aneurysms.
Aneurysm ; Craniotomy ; Female ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm ; Male ; Prognosis