Deliberate hypotension reduces bleeding into a wound, thereby providing the surgeon with both better visilibility and technical freedom for a more definitive dissection and minimizes the need for blood transfusion, thereby reducing the risks of transfusion reasctions, hepatitis and acquired immunodeficiency syndrome (AIDS). In this study we evaluated the hypotensive anesthesia induced by sodium nitroprusside for maxillofacial reconstruction and plastic surgery performed at Seoul Paik Hospital from March 19S8 to February 1989: The results of our study were as follows: 1) Halothane and enflurane were used as the main anesthetics in 77 and 6 cases respectively. Nitroprusside was used for inducing hypotension and the mean amount infused was 10.5+/-7.7 mg. 2) The mean arterial pressure at 30min after inducing hypotension was 64.5+/-5.3mmHg. 3) The mean blood loss was 736.9+/-394.5ml and the mean amount of transfused blood was 497.1+/-451.1 ml. 4) The intraoperative arterial blood gas analysis shoueds no significant abnormality. 5) There were no significant perioperative and postoperative complications due to induced hypotension itself. In conclusion, the technique of using induced hypotension with inhalation anesthesia supplemented by nitroprusside under 10 head up position is relatively safe and useful one to use in performing maxillofacial reconstruction and plastic sugery.
Acquired Immunodeficiency Syndrome ; Anesthesia* ; Anesthesia, Inhalation ; Anesthetics ; Arterial Pressure ; Blood Gas Analysis ; Blood Transfusion ; Enflurane ; Freedom ; Halothane ; Head ; Hemorrhage ; Hepatitis ; Hypotension ; Nitroprusside ; Postoperative Complications ; Seoul ; Surgery, Plastic ; Wounds and Injuries

No abstract available.
Chromosome Aberrations*

BACKGROUND: To investigate the occurrence of falls and their consequences in a representative population and to identify risk factors of falls in the elderly. METHODS: The study participants were community-dwelling elderly people aged 65 years or old as a population based sample of one large city. A total of 828 people 65 years or older participated in this study. They were interviewed over the telephone by a trained interviewer using a structured questionnaire to obtain a fall history and details of their most recent fall including date, time, place, circumstances, and associated injury. As for risk factors for falls, we asked about living arrangement (with family or alone), alcohol intake, exercise, visual and hearing impairments, memory and sensory problems, lower limb weakness, and arthritis symptoms. Fear of falling and fear-related activity restriction were also evaluated. RESULTS: The incidence of falls during the last one year was 13.0%. Women experienced falls more frequently. Falls occurred mainly in spring and summer and from 10 AM to 3 PM. Common causes of falls were slipping and tripping. 14.9% of those who fell suffered consequent fractures. Being female was a significant risk factor for falls; and females tended to get injured more severely following a fall. During the recent one year, decreased proprioception in the lower extremity was a significant risk factor for falls. Those with histories of falls, and especially women, tended to limit their activities due to the fear of falling. CONCLUSION: Overall, it appears that elderly women are more greatly affected by falls at several levels. Female participants fell more frequently and suffered more severe consequences. Fall-related injuries and risk factors for falls disproportionately affected women. And, being female and any amount of decreased sensation in the feet were significant risk factors for falls.
Aged ; Arthritis ; Female ; Foot ; Hearing ; Humans ; Hypogonadism ; Incidence ; Lower Extremity ; Memory ; Mitochondrial Diseases ; Ophthalmoplegia ; Proprioception ; Surveys and Questionnaires ; Residence Characteristics ; Risk Factors ; Sensation ; Telephone

PURPOSE: Approximately 29% of patients visiting the emergency department are children and teens. Training emergency medicine (EM) residents for treatment of pediatric emergency patients is essential. We conducted a survey of the status of pediatric emergency medicine (PEM) education and made recommendations with regard to the direction of educational programs for PEM using the Delphi method. METHODS: We conducted a survey of 93 emergency medicine training hospitals and conducted the Delphi study with the first and second round. Variables of educational status included general information on the hospital, educational contents, and method for PEM. The Delphi method was used to obtain the consensus of experts with regard to which objectives, essential procedures, and necessary components for PEM training should be included. RESULTS: The rate of response for PEM educational status was 60(62.4%). The type of pediatric department rotation was essential 40.5%, optional 21.4%, and no rotation 38.1%. Capability of EM residents was 33.3% in PEM objectives and 45% in PEM procedures. Each rate of response for the Delphi study was 65% in the first round and 56.9% in the second round. We obtained the consensus of experts, with 52 of 59 objectives and 18 of 20 procedures. The appropriate period for pediatric emergency rotation was three months and the appropriate staff members for pediatric emergency education were the pediatric emergency physician, pediatric physician, and emergency physician, in order. CONCLUSION: Pediatric emergency training was not appropriate for an EM residency program. Experts agreed with 52 objectives and 18 procedures for PEM training of EM residents. We recommended a training period of three months and the appropriate staff member for PEM was the pediatric emergency physician.
Adolescent ; Child ; Consensus ; Curriculum ; Delphi Technique ; Educational Status ; Emergencies ; Emergency Medicine ; Humans ; Internship and Residency ; Pediatrics

A brief episode of ischemia and reperfusion termed 'ischemic preconditioning' has been established as rendering muscle tolerance to damage during a subsequent prolonged ischemia. The effects of ischemic preconditioning in the cardiac muscle are related to the stimulation of adenosine A1 receptor and the opening of KATP channel. The effect and mechanisms of ischemic preconditioning in the skeletal muscle are not known clearly. The superoxide radical injures the skeletal muscle during the ischemia and reperfusion. There are two types of SOD, which metabolizes the superoxide radicals to H2O2 and O2, in the cell. One of them is Cu, Zn-SOD in the cytoplasm and the other is Mn-SOD in the mitochondria. The activities of SOD are increased against the formation of superoxide radical during the reperfusion. The author performed the present study to investigate the effect and the mechanisms of ischemic preconditioning by measuring the expression of SOD mRNA on timely reperfused ischemic muscles. The healthy Sprague-Dawley rats weighing from 300 g to 350 g were used as experimental animals. Under pentobarbital (50 mg/kg) anesthesia, lower abdominal incision was done and left common iliac artery was occluded by vascular clamp for 2 hours. Rectus femoris muscles were obtained respectively at 3, 6, 12, 24 and 72 hours after reperfusion. The ischemic preconditioning group underwent three episodes of 5 minute occlusion and 5 minute reperfusion of common iliac artery followed by 2 hours of ischemia and timely reperfusion. Adenosine (50 microgram/kg) or pinacidil (1 mg/kg) was administered intravenously before ischemia. 8-cyclopentyl-1, 3-dipropylxanthine (15 mg/kg) or glibenclamide (0.5 mg/kg) was administered intravenously before ischemic preconditioning. Paraffin sections with 4 micrometer thickness in all groups were obtained. The expression of Cu, Zn- and Mn-SOD mRNA was observed by use of in situ hybridization. The results obtained were as follows. 1. The expression of SOD mRNA was seen only in small muscle fibers of the rectus femoris muscle of the rat. 2. Weak expressions of Cu, Zn- and Mn-SOD mRNA were observed in the normal control rat. 3. After 2 hours of ischemia, moderate expression of Cu, Zn-SOD mRNA was observed until 72 hours of reperfusion. Weak or moderate expression of Mn-SOD mRNA at 3 hours and 6 hours of reperfusion, weak or trace expression at 12 hours of reperfusion, moderate expression at 24 hours of reperfusion and weak or moderate expression at 72 hours of reperfusion were observed. 4. After ischemic preconditioning, moderate expressions of Cu, Zn-SOD mRNA were seen in the groups of 3, 6, 12 and 24 hours of reperfusion. Moderate expressions of Mn-SOD mRNA were seen in the group of 0, 3, 6 and 12 hours of reperfusion and strong expression was seen in the group of 24 hours of reperfusion after ischemic preconditioning. 5. After 2 hours of ischemia with ischemic preconditoining, moderate expressions of Cu, Zn-SOD mRNA were seen in the groups of 0, 3, 6, 12, 24 hours of reperfusion. Moderate expressions of Mn-SOD mRNA were observed in the groups of 0, 3, 6, and 12 hours of reperfusion and moderate or strong expression was seen in the group of 24 hours of reperfusion. 6. After 2 hours of ischemia with the pretreatment of adenosine, moderate expressions of Cu, Zn-SOD mRNA were seen in the group of 0, 3, 6, 12 and 24 hours of reperfusion. Moderate expression of Mn-SOD mRNA in the groups and 3 hours of reperfusion, strong expression in the group of 6 and 12 hours of reperfusion and moderate expression in the group of 24 hours of reperfusion were seen. 7. After 2 hours of ischemia with the pretreatment of pinacidil, moderate expressions of Cu, Zn-SOD mRNA were seen in the groups of 0, 3, 6 and 12 hours of reperfusion and those of Mn-SOD mRNA were seen in the groups of 3, 6, 12 and 24 hours of reperfusion. 8. After 2 hours of ischemia with ischemic preconditioning and the pretreatment of 8-cyclopentyl-1, 3- dipropylxanthine, moderate expression of Cu, Zn-SOD mRNA were observed in the groups of 0, 3, 6, and 12 hours of reperfusion and those of Mn-SOD were seen in the groups of 6, 12 and 72 hours of reperfusion. 9. After 2 hours of ischemia with ischemic preconditioning and the pretreatment of glibenclamide, moderate expressions of Cu, Zn- and Mn-SOD mRNA were seen in all groups of reperfusion. Consequently, these results suggest that the expression of Cu, Zn and Mn-SOD mRNA increases during 2 hours ischemia and reperfusion with or without ischemic preconditioning. The effects of ischemic preconditioning are closely related to the stimulation of adenosine A1 receptor and KATP channel.
Adenosine* ; Anesthesia ; Animals ; Cytoplasm ; Glyburide ; Iliac Artery ; In Situ Hybridization ; Ischemia* ; Ischemic Preconditioning* ; Mitochondria ; Muscle, Skeletal ; Muscles ; Myocardium ; Paraffin ; Pentobarbital ; Pinacidil* ; Quadriceps Muscle* ; Rats* ; Rats, Sprague-Dawley ; Receptor, Adenosine A1 ; Reperfusion* ; RNA, Messenger* ; Superoxide Dismutase* ; Superoxides

BACKGROUND: The effects of subclinical hyperthyroidism on bone mineral density (BMD) induced by thyroid-stimulating hormone (TSH) suppression therapy in patients with differentiated thyroid cancer (DTC) remains unclear. We conducted a meta-analysis to determine the influence of TSH suppression therapy on BMD. METHODS: We performed a systematic search to identify studies which included BMD measurement of femoral neck, total hip or lumbar spine in patients on TSH suppression therapy for DTC. Main outcome measures were difference of BMD of femoral neck, total hip or lumbar spine measured by dual energy X-ray absorptiometry between patients and controls. RESULTS: A systematic search yielded a total of 11 published controlled cross-sectional studies (including about 571 patients and 836 controls). TSH suppression therapy was associated with the lower BMD of total hip (weighted mean difference [WMD], −0.023; 95% confidence interval [CI], −0.047 to 0.000; P=0.050) and spine (WMD, −0.041; 95% CI, −0.057 to −0.026; P < 0.001) in postmenopausal women with DTC, while it was not associated with that in premenopausal women and men with DTC. CONCLUSIONS: Although the included studies were limited by small numbers, results suggested possible association between chronic TSH suppression therapy and the lower BMD of spine and total hip in postmenopausal women (but not in premenopausal women and men) with DTC. A large, well-designed study with long-term follow-up would provide further insight into the influence of TSH suppression therapy and loss of BMD.
Absorptiometry, Photon ; Bone Density ; Cross-Sectional Studies ; Female ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Hyperthyroidism ; Male ; Osteoporosis ; Outcome Assessment (Health Care) ; Spine ; Thyroid Gland ; Thyroid Neoplasms ; Thyrotropin

BACKGROUND: Intravenous injection of rocuronium is associated with withdrawal responses which are attributable to the pain from the injection of rocuronium. Several methods have been proposed to abolish and attenuate rocuronium-induced pain. We hypothesized priming dose of rocuronium could reduce withdrawal responses associated with administering a second large dose of rocuronium for tracheal intubation. We compared the efficacy of the priming dose technique of rocuronium with intravenous lidocaine as a pre-treatment for the prevention of withdrawal responses associated with rocuronium injection. METHODS: We recruited 150 patients aged between 18 and 60 years, ASA physical status 1 or 2, who were going to undergo elective surgery requiring general anesthesia. Patients were allocated into three groups. Group C received normal saline, Group L received lidocaine 1 mg/kg, and Group P received rocuronium 0.06 mg/kg 2 minutes before administering a second large dose of rocuronium for tracheal intubation. After the loss of consciousness, rocuronium 0.6 mg/kg was administered intravenously over 10 seconds for tracheal intubation. The withdrawal responses to the injection of rocuronium were evaluated. RESULTS: The incidence of withdrawal responses associated with rocuronium injection for tracheal intubation was 56, 50, 24% in group C, group L, and group P, respectively. The incidence of withdrawal responses was lower in group P than group C and group L, but there was no difference between group L and group C. CONCLUSIONS: Priming dose technique is a useful clinical method to alleviate withdrawal responses associated with rocuronium injection.
Administration, Intravenous ; Aged ; Androstanols ; Anesthesia, General ; Humans ; Incidence ; Injections, Intravenous ; Intubation ; Lidocaine ; Unconsciousness

Since 1920, when Harvey Cushing first used radiofrequency in electrosurgery, the procedural technique has developed rapidly. Even though this procedure is minimally invasive and safer than other neurodestructive procedures, it is still not free of complications. A 72-year-old female patient had constant facial pain, despite several operations and radiotherapies for her maxillary cancer. The region innervated ophthalmic branch and maxillary branch of the trigeminal nerve was involved, with radiofrequency procedure of the gasserian ganglion for pain control also performed at the area. After the procedure, her blood pressure became elevated and she complained of a headache, and six hours later, she became irritable and distracted. Bacterial meningitis was diagnosed by a spinal tap, with third-generation cephalosporin administered as the treatment. The following day, her symptoms had improved and the pain was also reduced. She was discharged from hospital after 14 days, without any sequelae.
Aged ; Blood Pressure ; Electrosurgery ; Facial Pain ; Female ; Headache ; Humans ; Meningitis ; Meningitis, Bacterial* ; Radiotherapy ; Spinal Puncture ; Trigeminal Ganglion ; Trigeminal Nerve

Objective: Fiberoptic endoscopic evaluation of swallowing (FEES) is a standard diagnostic tool for swallowing disorders. However, it has not been used frequently in Korea because of the long test time, low cost, and the absence of a standard evaluation system. The purpose of this study was to suggest a standard fill-out form for the FEES result. Methods: From February 2019 to June 2020, a total of 98 FEES tests were performed by an otolaryngologist (JYJ) at the Wonkwang University Hospital. After the exclusion of 68 cases, 30 cases were analyzed twice by 4 raters with over 5 years of experience as otolaryngologists working in various hospitals. The results were measured for the rater’s test-retest reliability and inter-rater consistency. Results: Cohen’s kappa values for measuring the intra-rater consistency of the four raters were 0.984, 0.887, 0.848, and 0.930, respectively, meaning very good alignment of 0.8 or more, respectively. The Fleiss Kappa value for measuring inter-rater consistency was 0.276, meaning ‘fair’ for values of 0.2 or more. To examine consistency, an intraclass correlation coefficient (ICC) analysis conducted by assuming the grading score to be a constant continuous variable gave an ICC value of 0.729 (P＜0.001), showing a very reliable tendency. Conclusion In this study, all the items of the fill-out form were rated using a three-step grading scale, so the degree of agreement was high when performed twice by the same rater, but the degree of agreement among raters was relatively low. Therefore, our fill-out form for FEES will be useful in evaluating the improvement of a patient over the course of clinical treatment.

Eisenmenger's syndrome is the presence of high pulmonary vascular resistance associated with pulmonary hypertension at or near systemic values, with a reversed or bidirectional shunt. When patients with this syndrome become pregnant, these anatomic and physiologic changes can become additionally altered. An understanding of these changes along with anesthesia and pharmacologic interventions is necessary for the successful management of delivery and puerperium in such a disease entity associated with high maternal and fetal mortality. We report the successful anesthetic management of a pregnant patient with Eisenmenger's syndrome, whose baby was delivered by elective cesarean section under general anesthesia. Anesthesia was induced with ketamine, and maintained with ketamine, midazolam, and fentanyl. The patient was ventilated with 100% O2. Invasive hemodynamic monitoring such as systemic and pulmonary artery pressure was continued throughout delivery and puerperium in pregnant patients with this syndrome. The mother and baby were discharged home 10 days later without complication.
Anesthesia ; Anesthesia, General* ; Cesarean Section* ; Eisenmenger Complex* ; Female ; Fentanyl ; Fetal Mortality ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Ketamine ; Midazolam ; Mothers ; Postpartum Period ; Pregnancy ; Pregnant Women* ; Pulmonary Artery ; Vascular Resistance