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

Chronic fatigue of the respiratory muscles has contributed to the decreased ventilatory capacity and reduced excercise tolerance of individuals with COPD, especially in kyphoscoliosis. Nasal mask BiPAP has been shown to be useful for the patient with nocturnal muscle fatigue and COPD. A 35-year-old man with severe kyphoscoliosis was admitted to ICU due to acute respiratory failure. He had been diagnosed of COPD and had been intubated with mechanical ventilatory support for 7 times. This time he was intubated with ventilatory support, too, in ICU and readmitted to the ICU for severe hypoxemia and hypercarbia from general ward. Thereafter he refused the intubation. Nasal mask BiPAP ventilatory support system was applied and IPAP, EPAP level being adjusted to the 12, 4 cmH2O under monitoring vital signs and arterial blood gas analysis. His condition was improved and discharged home with support of nasal mask BiPAP system after 33 day-stay in the ICU.
Adult ; Anoxia ; Blood Gas Analysis ; Fatigue ; Humans ; Intubation ; Masks* ; Muscle Fatigue ; Patients' Rooms ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Insufficiency ; Respiratory Muscles ; Vital Signs

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*

Phrenic nerve palsy is a well-known complication following cardiac surgery in children. The incidence is approximately 1~2%. In infants and young children, it often causes a life-threatening respiratory distress. They must be treated with mechanical ventilation in the ICU. Many patients with phrenic nerve injury who is impossible to wean from a ventilator are candidates of diaphragmatic plication. Diaphragmatic plication is performed to restore the normal pulmonary parenchymal volume by replacing the diaphragm to its proper location. This is a case of 2-months-old infant who had phrenic nerve palsy after the removal of cavernous lymphangioma of the chest. He underwent 4 operations to remove the mass and to have pericardiotomy. We tried to wean him from the ventilator but failed several times in the ICU. After 4th operation, right diaphragmatic elevation was noted from the chest X ray. Phrenic nerve palsy was confirmed with fluoroscopy and he underwent diaphragmatic plication on 42 days after his 4th operation. Three days after the diaphragmatic plication, weaning was successfully carried out.
Child ; Diaphragm ; Fluoroscopy ; Humans ; Incidence ; Infant* ; Lymphangioma* ; Paralysis* ; Pericardiectomy ; Phrenic Nerve* ; Respiration, Artificial ; Thoracic Surgery ; Thorax ; Ventilators, Mechanical ; Weaning*

PURPOSE: Epilepsy affects more than 0.5% of the world's population. It has a large genetic component and is caused by electrical hyperexcitability in the central nervous system. Despite its prevalence, the disease lacks definitive diagnostic serological biomarkers. To identify potential biomarkers for epilepsy by a convenient method, we analyzed the expression of serum proteins, reflecting alterations in the patient's proteomes. METHODS: We compared two-dimensional electrophoretic band patterns of human sera from eight patients with temporal lobe epilepsy (TLE) with those of eight control subjects. The differentially expressed bands were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and electrospray ionization quadrupole time-of-flight mass spectrometry. RESULTS: Twelve proteins were differentially expressed in the TLE group, of which 6 were identified. Expression of haptoglobin Hp2, PRO2675, immunoglobulin heavy chain constant region gamma 2, an unnamed protein, and three unidentified proteins were upregulated in serum from the patients with TLE, whereas those of major histocompatibility complex (MHC) class I antigen, plasma retinol-binding protein precursor, and three unidentified proteins were downregulated in these patients. After resection of the epileptogenic zone, the expressions of MHC class I antigen, immunoglobulin heavy chain constant region gamma 2, two of the downregulated unidentified proteins, and one of the upregulated unidentified proteins returned to the normal range. CONCLUSIONS: The 12 serum proteins in this study are potentially useful biomarkers for the diagnosis and monitoring of TLE.
Biomarkers ; Blood Proteins ; Central Nervous System ; Epilepsy ; Epilepsy, Temporal Lobe ; Haptoglobins ; Humans ; Immunoglobulin Heavy Chains ; Major Histocompatibility Complex ; Mass Spectrometry ; Plasma ; Prevalence ; Proteins ; Proteome ; Proteomics ; Reference Values ; Temporal Lobe

PURPOSE: Epilepsy affects more than 0.5% of the world's population. It has a large genetic component and is caused by electrical hyperexcitability in the central nervous system. Despite its prevalence, the disease lacks definitive diagnostic serological biomarkers. To identify potential biomarkers for epilepsy by a convenient method, we analyzed the expression of serum proteins, reflecting alterations in the patient's proteomes. METHODS: We compared two-dimensional electrophoretic band patterns of human sera from eight patients with temporal lobe epilepsy (TLE) with those of eight control subjects. The differentially expressed bands were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and electrospray ionization quadrupole time-of-flight mass spectrometry. RESULTS: Twelve proteins were differentially expressed in the TLE group, of which 6 were identified. Expression of haptoglobin Hp2, PRO2675, immunoglobulin heavy chain constant region gamma 2, an unnamed protein, and three unidentified proteins were upregulated in serum from the patients with TLE, whereas those of major histocompatibility complex (MHC) class I antigen, plasma retinol-binding protein precursor, and three unidentified proteins were downregulated in these patients. After resection of the epileptogenic zone, the expressions of MHC class I antigen, immunoglobulin heavy chain constant region gamma 2, two of the downregulated unidentified proteins, and one of the upregulated unidentified proteins returned to the normal range. CONCLUSIONS: The 12 serum proteins in this study are potentially useful biomarkers for the diagnosis and monitoring of TLE.
Biomarkers ; Blood Proteins ; Central Nervous System ; Epilepsy ; Epilepsy, Temporal Lobe ; Haptoglobins ; Humans ; Immunoglobulin Heavy Chains ; Major Histocompatibility Complex ; Mass Spectrometry ; Plasma ; Prevalence ; Proteins ; Proteome ; Proteomics ; Reference Values ; Temporal Lobe

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

BACKGROUND: In emergency rooms or intensive care units, we have shown delivery of higher fractions of oxygen promptly for respiratory or cardiac arrest patients by using resuscitating instruments, especially the resuscitator bag. Previously we studied the variables affecting the fraction of delivered oxygen (FDO2) under varying ventilating techniques and conditions. In this paper, using corrugated tubes as substitute for reservoir bag, we measured FDO2 and compared two. METHODS: We designed a special wooden box, which held the Laerdal resuscitator bag. We measured the FDO2 with or without reservoir bags and corrugated tubes at various tidal volumes, respiration rates and oxygen flows. RESULTS: With a 500 ml corrugated tube, FDO2 were higher than with a 250 ml corrugted tube but lower than with a reservoir bag. CONCLUSIONS: Corrugated tube is less effective to deliver high fractions of oxygen than the reservior bag, but it is acceptable to use corrugated tube as a substitute for a reservior bag than not to use it at all.
Emergency Service, Hospital ; Heart Arrest ; Humans ; Intensive Care Units ; Oxygen* ; Respiratory Rate ; Tidal Volume

We have performed 10 primary liver transplantations between August 1993 and September 1995 in patients with end stage liver disease at Department of Surgery, Catholic University, Medical College. Donor and recipient operations were performed using modified techniques described by Starzl et al. Cyclosporine and prednisone were used as the principal immunosuppressive regimen and cyclosporine levels were monitored daily with dosage adjustment. when acute rejection was suspected based on clinical parameters, methylprednisolone was given for 2 days and if there was no response, we treated with the OKT3 monoclonal antibody. Our clinical results were as follows : 1. Mean age of donors was 32 years, ranging from 17 to 50 years, eight males, 2 females. The causes of brain death were traffic accident in 5 cases, falling down in 3 cases, and others (CVA, brain tumor). 2. Mean age of recipient was 41 years, ranging from 18 to 57 years and all were male. The indications of liver transplantation were liver circhosis related to viral hepatitis in 9 cases and alcoholic cirrhosis in one. 3. In arterial reconstruction, aortic carrel patch of common hepatic artery was sewn to hepatic-gastroduodenal bifurcation (5 transplants), to supraceliac aorta (3 transplants), and to infrarenal aorta (2 transplants). The biliary anastomosis was a choledochocholedochostomy with T-tube stent in nine and Roux-en-Y choledochojejunostomy in one transplant. 4. Average length of operation was 9 hours 28 minutes (range 7. 6-12 hours), and liver ischemia 6 hours 14 minute. An average requirements of packed red cell were 21.2 unit (range 12-31 units) 5. The surgical complication occurred in 3 patients (postoperative bleeding, hepatic arterial thrombosis and bile peritonitis), acute rejection in 5 patients, bacterial infection in 5 patients and coma in 2 patients. 6. Of the 10 patients, 6 are alive ranging from 15 days to 27 month and four patients died in the early postoperative period : one of postoperative bleeding, one of hepatic arterial thrombosis, one of acute rejection and one of neurologic complication. 7. In the consideration of prognostic factors from donor, the dosage of vasopressor and liver enzyme but not donor age were significant in early postoperative mortality. As perioperative parameters of recipients, preoperative general status, serum BUN, bilirubin, and reversibility of respiratory, renal and graft function within the first week following transplant were important.
Accidents, Traffic ; Aorta ; Bacterial Infections ; Bile ; Bilirubin ; Brain ; Brain Death ; Choledochostomy ; Coma ; Cyclosporine ; End Stage Liver Disease ; Female ; Hemorrhage ; Hepatic Artery ; Hepatitis ; Humans ; Ischemia ; Liver Cirrhosis, Alcoholic ; Liver Transplantation* ; Liver* ; Male ; Methylprednisolone ; Mortality ; Muromonab-CD3 ; Postoperative Period ; Prednisone ; Stents ; Thrombosis ; Tissue Donors ; Transplants

The etiology of several motility disorders, including persistent megacolon after definitive surgery for Hirschsprung's disease, meconium ileus which is not associated with cystic fibrosis and idiopathic megacolon, is still unclear. Interstitial cells of Cajal (ICC) are thought to modulate gut motility as gastrointestinal pace maker cells. The aim of this study was to evaluate the role of ICC in the bowel walls of the patients (n=15) who had variable motility disorders. The ICC were identified by immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. The ICC were identified by immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. Whereas ICC were evenly distributed in the ganglionic bowels of G2, they were not seen or scarecely distributed in the ganglionic bowels of G3. Two patients (G4) who suffered from idiopathic megacolon showed absence or decrease of ICC in spite of presence of ganglion cells in their colons. Four neonates (G5) who underwent ileostomy because of meconium obstruction showed absent or markedly decreased ICC in the colon at the time of ileostomy and the distribution of ICC was changed to a normal pattern at the time of ileostomy closure between 39-104 days of age and their bowelmotility were restored after that. The results suggest that lack of ICC caused reduce motility in the ganglionic colons and it may be responsible for the development of various motility disorders. Delayed maturity of ICC may also play a role in the meconium obstruction of neinates.
Colon ; Cystic Fibrosis ; Ganglion Cysts ; Hirschsprung Disease* ; Humans ; Ileostomy ; Ileus ; Infant, Newborn ; Interstitial Cells of Cajal* ; Meconium ; Megacolon*