BACKGROUND: Bupivacaine is a amide type local anesthetic agent, widely used for its excellent quality of analgesia and long duration of action. But unintended intravenous injection causes severe complication such as convulsion and cardiovascular collapse, which is known for its difficulty in resuscitation. With all the study, the exact mechanism is still unclear and there are much debate on the method of resuscitation. METHOD: We studied the effect of clonidine pretreatment on bupivacaine-induced cardiac toxicity and resuscitation in anesthetized dog. Twelve dogs were divided into two groups. : saline pretreatment group (control, N=6) and clonidine pretreatment group (clonidine group, N=6). The dogs were anesthetized with N2O-O2-enflurane and vecuronium. Thoracotomy was done in 4th or 5th intercostal space for open cardiac massage. After confirming stability of vital signs, we administered clonidine (10 mcg/kg) or saline, and then administered bupivacaine with the rate of 2 mg/kg/min. When the electeocardiogram showed asystole, 20 mcg/kg of epinephrine was administered via central venous line and open cardiac massage with the rate of 120 beat/min. was performed. We observed electrocardiogram (lead II), arterial blood pressure, heart rate, dose of infused bupivacaine to be required for QRS widening and arrest, required time and administered dose of epinephrine for resuscitation. RESULTS: Clonidine group showed significant decrease of heart rate after pretreatment (p<0.05). There was no significant difference in required dose for QRS widening between two groups. The dose administered for inducing arrest was less in clonidine group than control group (p<0.05). The time required for resuscitation was shorter in clonidine group than control group (p<0.05). The total dose of epinephrine required for resuscitation was less in clonidine group than control group (p<0.05). The blood concentration of catecholamine did not showed significant difference during the whole course of experiment. CONCLUSIONS: Above results demonstrated that clonidine, a central nervous system-mediated sympatholytic agent, facilitated cardiac arrest when bupivacaine was infused intravenously and cardiac rescucitation.
Analgesia ; Animals ; Arterial Pressure ; Bupivacaine ; Clonidine* ; Dogs* ; Electrocardiography ; Epinephrine ; Heart Arrest ; Heart Massage ; Heart Rate ; Injections, Intravenous ; Resuscitation* ; Seizures ; Thoracotomy ; Vecuronium Bromide ; Vital Signs

PURPOSE: The purpose of this study was to identify risk factors of fall and to examine its results among patients aged 60 and over diagnosed with osteoporosis. METHODS: A retrospective descriptive survey was conducted with 91 patients admitted in a university hospital in a city. Data were collected using an interview method with a structured questionnaire, and were analyzed using descriptive statistics and multiple logistic regression. RESULTS: In patients with osteoporosis, the intrinsic risk factors of falls were aging (OR = 3.742), gait disturbance (OR = 12.565), taking one or fewer medicine (OR = 7.873), and having two or more diseases (OR = 5.173). The extrinsic risk factors included the use of a bed (OR = 3.093), slippery floors (OR = 12.130), bathroom mat without anti-slip rubber backing (OR = 3.564), and presence of a night light on the passage from the bedroom to the bathroom (OR = 2.980). CONCLUSION: For the elderly aged over 70 who are most vulnerable to falls, screening tests such as bone mineral density (BMD) should be conducted in health examinations and the risk of fracture caused by osteoporosis should be communicated to the vulnerable elderly. Besides, development of new exercise programs combining weightbearing exercise is needed to prevent bone loss and increase functional activities.
Aged ; Aging ; Bone Density ; Floors and Floorcoverings ; Gait ; Humans ; Light ; Logistic Models ; Mass Screening ; Osteoporosis ; Retrospective Studies ; Risk Factors ; Rubber ; Weight-Bearing ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to identify the nutritional status and to compare nutritional indicators by caloric intake for intensive care unit patients. METHODS: The participants for this descriptive investigation were 62 patients who were admitted to medical and surgical ICUs and started on enteral feeding. Data were collected in a tertiary hospital and the patients were followed for 7 days after enteral feeding was initiated. For analysis, patients who received 80% less calories than their required level were categorized as the underfed group and patients who received more than 80% to their required level, as the adequately fed group. RESULTS: Compared to daily requirements, the prescribed calories and protein for patients overall were 77.39% and 64.75% respectively. The level of calories and protein given was less than their prescription. However, a comparison of the underfed group and the adequately fed group, showed that there was no significantly difference in albumin, prealbumin and transferrin. Only body weight was significantly different between the groups. C-reactive protein had a significant correlation with prealbumin and transferrin. CONCLUSION: Underfeeding is a common phenomenon among ICU patients. Nutritional indicators such as prealbumin, albumin and transferrin may not sensitive indicators to assess nutritional status of ICU patients.
Body Weight ; C-Reactive Protein ; Energy Intake ; Enteral Nutrition ; Humans ; Critical Care ; Intensive Care Units ; Nutrition Assessment ; Nutritional Status ; Prealbumin ; Prescriptions ; Tertiary Care Centers ; Transferrin

PURPOSE: To evaluate the efficacy of two-phase dynamic helical CT, including the gastric mucosal phase, for the detection of atypical non-hyperattenuating early gastric carcinoma (EGC). MATERIALS AND METHODS: In 32 patients, we evaluated the two-phase helical CT findings of endoscopically suspected EGC for changes of the inner hyperattenuating mucosal layer, the hypoattenuating outer layer and the serosal surface. Two gastrointestinal radiologists working together reached their conclusions before pathologic diagnosis had been made. The first, so-called gastric mucosal, phase was obtained 38 -45 sec after the start of IV injection of 150 ml/sec contrast material at a rate of 4 ml/sec to obtain maximum enhancement of the mucosal layer. RESULTS: Among 32 patients, EGC was confirmed in 30 and AGC (T2) in two. Using two-phase helical CT, the detection rate for typical hyperattenuating EGC was 27 % (8/30). Lesions showing focal interruption of the mucosal layer without abnormal enhancement of the outer layer (EGC atypical enhancement pattern type 1) were detected in five patients during the mucosal phase, and were pathologically confirmed as 3 EGC IIc+III, 1IIc+IIa, and I IIb+IIc. Lesions showing a locally protuding lesion of the inner and preserved outer layers, with a smooth serosal surface (EGC atypical enhancement pattern type 2) and which could be distinguished from normal folds, were detected in six patients during the mucosal phase, and were pathologically confirmed as 2 EGC IIb+IIc, 1 IIc+IIa, and 3 IIc+IIb. Lesions were less distinct during the equilibrium phase, and there was no change in the enhancement pattern. The overall detection rate for EGC in which an atypical enhancement pattern was added to the typical one showed improvement (19/30, 63 % ). CONCLUSION: Helical CT using a two-phasic scan technique including the mucosal phase was efficient for various combinations of EGC II and/or III, including IIc. The findings were atypical and non-hyperattenvating, but reliable, and improved the overall detection rate.
Diagnosis ; Humans ; Stomach Neoplasms* ; Tomography, Spiral Computed*

PURPOSE: Cytomegalovirus (CMV) retinitis is common in patients with immunodeficient conditions caused by acquired immunodeficiency syndrome (AIDS), cytotoxic chemotherapy and immunosuppresive treatment. The purpose of this study was to assess the clinical manifestations and prognosis of CMV retinitis cases. METHODS: Thirty-one eyes of 21 patients who were diagnosed with CMV retinitis were retrospectively reviewed. The clinical manifestations and prognosis of all patients were analyzed. RESULTS: The average age of patients was 24.4+/-19.8 years. Eight patients were female and 13 patients were male. The predisposing conditions of patients were leukemia (nine patients), immunosuppressed conditions due to organ transplantation (three patients), AIDS (two patients) and other (seven patients). Eleven patients exhibited bilateral disease. The mean follow-up period was 31.3 months, and there were no differences between mean initial visual acuity (0.70+/-0.31) and mean visual acuity (0.77+/-0.20) at final visit. The major causes of visual loss were retinitis and atrophic changes involving the macula. Although retinitis was successfully treated with anti-viral agents in all cases, cataract (10 eyes, 31.3%), cystoid macular edema (four eyes, 12.5%), retinal detachment (two eyes, 6.3%), epiretinal membrane (two eyes, 6.3%) and immune recovery uveitis (two eyes, 6.3%) developed after the initial treatment. CONCLUSIONS: Although the visual prognosis of CMV retinitis was relatively good after administration of appropriate antiviral therapy, clinicians should remain alert for the development of late complications, including retinal detachment, cystoid macular edema and immune recovery uveitis.
Acquired Immunodeficiency Syndrome ; Cataract ; Cytomegalovirus ; Cytomegalovirus Retinitis ; Epiretinal Membrane ; Eye ; Female ; Follow-Up Studies ; Humans ; Leukemia ; Macular Edema ; Male ; Organ Transplantation ; Prognosis ; Retinal Detachment ; Retinitis ; Retrospective Studies ; Transplants ; Uveitis ; Visual Acuity

PURPOSE: This study is to define the structural patterns of pregnancy motivation of married women. METHOD: Q-methodology was used on 110 statements collected from interviews with women and a literature review. 38 Q-samples were selected. The Q-samples were administerd to 30 randomized P-sample. RESULT: Data analysis of Q-type obtained by QUANL program shows three types of subjectivity in the perception of pregnancy motivation. Type 1, "Family-connection strengthening", Pregnancy motivation is characterized by the tendency to make home, to tie family member, to connect couple firmly. Type 2,"Self-satisfaction", Women of this type take pleasure and happiness from child rearing in terms of being a mother and having maternal affection. Type 3, "Self-centered", This type of pregnancy motivation puts on high emphasis on self achievement and they make a family planning suitable for the maternal role. CONCLUSION: The stronger was women's pregnancy motivation, the more positive were women's pregnancy experience and maternal role attainment. Therefore, When nurses take care of pregnancy women, they should understand the women's psycho-social aspects and then apply a program of nursing intervention to the pregnant women, It is necessary to continue to study on social and psychological problems related to pregnancy.
Child ; Child Rearing ; Family Planning Services ; Female ; Happiness ; Humans ; Korea* ; Mothers ; Motivation* ; Nursing ; Pleasure ; Pregnancy* ; Pregnant Women ; Statistics as Topic

Purpose: Photobiomodulation (PBM), encompassing low-energy laser treatment and light-emitting diode (LED) phototherapy, has demonstrated positive impacts on skin rejuvenation and wound healing. Organic light-emitting diodes (OLEDs) present a promising advancement as wearable light sources for PBM. However, the biological and biochemical substantiation of their skin rejuvenation and wound healing effects remains limited. This study aimed to ascertain the safety and efficacy of OLEDs as a nextgeneration PBM modality through comprehensive in vitro and in vivo investigations. Materials and Methods: Cell viability assays and human ex vivo skin analyses were performed after exposure to OLED and LED irradiation to examine their safety. Subsequent evaluations examined expression levels and wound healing effects in human dermal fibroblasts (HDFs) using quantitative reverse transcription-polymerase chain reaction, enzyme-linked immunosorbent assay, and wound healing assays post-irradiation. Additionally, an in vivo study was conducted using a ultra violet (UV)-irradiated animal skin model to explore the impact of OLED exposure on dermal collagen density and wrinkles, employing skin replica and tissue staining techniques. Results: OLED irradiation had no significant morphological effects on human skin tissue, but caused a considerably higher expression of collagen than the control and LED-treated groups. Moreover, OLED irradiation reduced the expression levels of matrix metalloproteinases (MMPs) more effectively than did LED on HDFs. OLED irradiation group in HDFs had significantly higher expression levels of growth factors compared to the control group, but similar to those in the LED irradiation group. In addition, OLED irradiation on photo-aged animal skin model resulted in increased collagen fiber density in the dermis while reducing ultra violet radiation-mediated skin wrinkles and roughness, as shown in the skin replica. Conclusion This study established comparable effectiveness between OLED and LED irradiation in upregulating collagen and growth factor expression levels while downregulating MMP levels in vitro. In the UV-irradiated animal skin model, OLED exposure post UV radiation correlated with reduced skin wrinkles and augmented dermal collagen density. Accelerated wound recovery and demonstrated safety further underscore OLEDs’ potential as a future PBM modality alongside LEDs, offering promise in the realms of skin rejuvenation and wound healing.

Renal biopsy is a crucial method in the diagnosis and treatment of acute renal failure of unknown origin, nephrotic syndrome, suspicious interstitial nephritis, and glomerulonephritis as a possible cause of hematuria or proteinuria. Complications occur in 2% to 8% of patients after percutaneous renal biopsy. Complications include gross hematuria, perirenal hematoma, arteriovenous fistula, aneurysm, injury of other organs, and urine leakage. Urine leakage as a complication after kidney biopsy is rare. We experienced a case of urine leakage into the intra-abdominal cavity after renal biopsy.
Acute Kidney Injury ; Aneurysm ; Arteriovenous Fistula ; Biopsy ; Glomerulonephritis ; Hematoma ; Hematuria ; Humans ; Kidney ; Nephritis, Interstitial ; Nephrotic Syndrome ; Proteinuria ; Urinoma

PURPOSE: We evaluated the pathologic characteristics and prognosis of pathologic T0 (pT0) prostate cancer (PC). MATERIALS AND METHODS: Of 1,196 consecutive men who underwent radical prostatectomy (RP) between January 1992 and November 2008, 34 patients (mean age, 68.8+/-7.9 years; range, 48-85) had pT0 PC. They were categorized into 4 groups according to neoadjuvant hormone therapy (NHT) and diagnostic methods. The initial PSA, 5 alpha-reductase inhibitor (5alphaRI), Gleason score of prostatic needle biopsy (PNB) or transurethral resection of the prostate (TURP), clinical stage, and presence of high-grade prostatic intraepithelial neoplasia were evaluated. Clinical and biochemical progression were also evaluated. RESULTS: 34 patients were categorized into 4 groups (Group I: 9 without NHT, diagnosed by PNB [1.1%]; Group II: 8 without NHT, diagnosed by TURP [11.3%]; Group III: 16 with NHT, diagnosed by PNB [5.5%]; Group IV: 1 with NHT, diagnosed by TURP [3.8%]). Group I had serum prostate-specific antigen (PSA)<15.0 ng/ml, one positive biopsy core, and a Gleason score< or =7. Group II had serum PSA<10.1 ng/ml, chips involved with cancer<10.0%, and a Gleason score< or =6. There were more patients taking 5alphaRI and high-grade PIN among patients without NHT. None of patients with pathologic pT0 PC had clinical or biochemical progression during follow-up, except 3 patients with NHT (mean, 22 months; range, 2-105 months). CONCLUSIONS: Patients without NHT had more favorable clinical and pathologic results. In our study, except for 3 patients with NHT, all patients had undetectable PSA levels after RP. We need more time for follow-up to conclude whether the prognosis of pT0 PC is favorable.
Biopsy ; Biopsy, Needle ; Cholestenone 5 alpha-Reductase ; Follow-Up Studies ; Humans ; Male ; Neoplasm Grading ; Prognosis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms ; Transurethral Resection of Prostate

PURPOSE: To analyze the clinical characteristics of renal cell carcinoma (RCC) in Korean patients with von Hippel-Lindau(VHL) disease. MATERIALS AND METHODS: The clinical characteristics of 21 patients who were diagnosed with VHL disease were analyzed. In patients with RCC related to VHL disease, the clinical characteristics of the tumor, type of pathology and survival were investigated. RESULTS: There were 1,396 patients diagnosed with RCC during the same period. A total of 21 patients were diagnosed with VHL disease. Among the 21 patients with VHL disease, 6(28.6%) patients had retinal angioma, 18(85.7%) had cerebellar hemangioblastoma, 15 had pancreatic lesions, including 13 with a pancreatic cyst and two with a pancreatic mass. The mean age of the patients diagnosed with VHL disease was 39.1+/-13.5 years and for those that were diagnosed with VHL disease with RCC it was 42.5+/-11.5 years. Thirteen patients(61.9%) had renal lesions and nine (42.9%) had RCC. Five had bilateral RCC and four had unilateral RCC. The presenting symptoms were gross hematuria and flank pain in two patients. The treatment of the RCC included radical nephrectomy in two, radical nephrectomy and target therapy in one, partial nephrectomy in two, IL-2 immunotherapy in one, and target therapy in one. Two were observed without treatment because of severe complications of a cerebellar hemangioblastoma. The pathology of the seven patients that had surgery or a biopsy was that of the conventional type RCC. The survival of the patients with VHL with and without RCC was not significantly different. CONCLUSIONS: The incidence of RCC in patients with VHL disease was 42.9%, and the incidence of VHL disease in RCC patients was 0.64% in Korea. However, VHL disease in Korea is rare; further extended multi-institutional studies are needed to determine the characteristics of VHL disease in Korea.
Incidence ; Cysts ; Hemangioma ; Biopsy