The purposes of the study was to identify the depression of women after a hysterectomy and to clarify the factors related to depression. This was a cross-sectional descriptive study. The data was collected by a mailed questionnaire that was composed of the Zung Self-Rating Depression Scale(SDS), support scale of husband and socio-demographic variables from 255 women undergoing hysterectomies for any nonmalignant condition in S. University Hospital. They also must have lived with their spouses from 3 months to 2 years after the operation. The results were as follows: 1. The SDS mean was 42.25 and range was 21 to 67. The incidence of clinical depression (over SDS 50) was 20.8% from 3 months to 2 years after a hysterectomy. 2. The depression of women in 18-24 months after surgery (39.80) was lower than that of any other periods such as 3-5 months, 6-12 months, and 13-17 months (p<0.01). 3. The support form husband was negatively correlated with the depression of women after a hysterectomy. 4. Depression among women had hysterectomies were associated with lower income, less sexual satisfaction, the feeling of being asexual, and the bias of concept the uterus controlling general health.
Bias (Epidemiology) ; Depression* ; Female ; Humans ; Hysterectomy* ; Incidence ; Postal Service ; Surveys and Questionnaires ; Spouses ; Uterus

The purposes of the study was to identify the depression of women after a hysterectomy and to clarify the factors related to depression. This was a cross-sectional descriptive study. The data was collected by a mailed questionnaire that was composed of the Zung Self-Rating Depression Scale(SDS), support scale of husband and socio-demographic variables from 255 women undergoing hysterectomies for any nonmalignant condition in S. University Hospital. They also must have lived with their spouses from 3 months to 2 years after the operation. The results were as follows: 1. The SDS mean was 42.25 and range was 21 to 67. The incidence of clinical depression (over SDS 50) was 20.8% from 3 months to 2 years after a hysterectomy. 2. The depression of women in 18-24 months after surgery (39.80) was lower than that of any other periods such as 3-5 months, 6-12 months, and 13-17 months (p<0.01). 3. The support form husband was negatively correlated with the depression of women after a hysterectomy. 4. Depression among women had hysterectomies were associated with lower income, less sexual satisfaction, the feeling of being asexual, and the bias of concept the uterus controlling general health.
Bias (Epidemiology) ; Depression* ; Female ; Humans ; Hysterectomy* ; Incidence ; Postal Service ; Surveys and Questionnaires ; Spouses ; Uterus

BACKGROUND: Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU. METHODS: Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE. RESULTS: The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE. CONCLUSIONS: To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.
Adult ; Heart Arrest ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Mortality ; Multivariate Analysis ; Respiration, Artificial ; Risk Factors

Chronic alcohol intake can profoundly modify the neuronal activity and the morphologic structure of hypothalamic nucleus in the rat brain. The aim of the present study is to observe the effects of chronic alcohol intake on expression of vasopressin and oxytocin in the paraventricular and supraoptic nucleus in the rat hypothalamus. Experimental rats (n=14) were divided into control group and chronic alcohol group. Chronic alcohol group was induced via daily liquid alcohol intake for 6 months beginning at 8 weeks of age. As a result, the number of vasopressin and oxytocin-containing neurons was decreased in the paraventricular and supraoptic nucleus in chronic alcohol group. Especially, the number of vasopressin-containing neurons of chronic alcohol group was significantly decreased in the paraventricular nucleus. Chronic alcohol intake produced significant changes in the volume of the cell bodies and their nucleus in neurons of the paraventricular and supraoptic nucleus. Particularly, the size of nucleus of vasopressin-containing neurons in chronic alcohol group was larger than in control group. These results show that chronic alcohol intake may affect the synthesis of vasopressin and oxytocin in the neurons of hypothalamic nuclei. Whereas, chronic alcohol intake induces an enlargement of the cell size of surviving neuron to compensate.
Animals ; Brain ; Cell Size ; Hypothalamus* ; Neurons* ; Oxytocin ; Paraventricular Hypothalamic Nucleus ; Rats* ; Supraoptic Nucleus* ; Vasopressins*

BACKGROUND: Hemodynamic derangement during the displacement of the beating heart in off-pump coronary artery bypass graft surgery (OPCAB) might be related with right ventricular (RV) dysfunction. This study evaluated the influence of displacing and stabilizing the heart, for the anastomosis of coronary arteries, on hemodynamic alterations and RV function in patients undergoing OPCAB. METHODS: Twenty patients with triple vessel coronary artery disease underwent OPCAB using single pericardial sutures: a tissue stabilizer was included. The hemodynamic variables and right ventricular ejection fraction (RVEF) were obtained using a right-heart ejection fraction thermodilution pulmonary artery catheter after the induction of anesthesia, before and after anastomosis of each coronary artery and after sternal closure. RESULTS: No significant hemodynamic changes were observed during the displacement of the heart or the placement of a stabilizer on all of the coronary arteries, except the obtuse marginal artery (OM) before anastomosis. RVEF, left ventricular stroke work index (LVSWI), stroke volume index and cardiac index (CI) decreased and mean pulmonary artery pressure increased significantly whist positioning the graft to the OM. Right ventricular volumes were not significantly changed, although central venous pressure and pulmonary capillary wedge pressure increased. Changing CI had a close relationship with LVSWI (r2 = 0.537, P <0.05) but not with RVEF (r2 = 0.118). These hemodynamic compromises recovered to baseline values after sternal closure. CONCLUSIONS: The displacement of the beating heart for positioning during anastomosis of the graft to the OM caused significant hemodynamic instability and LV functional changes in addition to RV functional changes seemed to be responsible for hemodynamic derangements.
Anesthesia ; Arteries ; Catheters ; Central Venous Pressure ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; Coronary Vessels ; Heart* ; Hemodynamics* ; Humans ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Stroke ; Stroke Volume ; Sutures ; Thermodilution ; Thoracic Surgery* ; Transplants ; Ventricular Function, Right*

Because most of modern peoples are busy with many their task according to specialization and complexity of society, it is impportant to determine optimal and comfortable time of colonoscopy. So this study was designed to compare efficacy of colonic cleansing and patient acceptance according to the time of colonoseopy. Among 140 peoples who underwent colonoscoyy in Busan St. Benedict Hospital between March 1995 to August 1995, two groups of 70 peoples were randomly assigned to undergo colonoscopy either at A.M. or ~P.M. The results were as follows: 1) In view of efficacy rate of colonic cleansing, the group at P.M, was superior to the group at A.M.. 2) In view of patients acceptance and side effects, the group at P.M. showed better acceptance and less side effects than the group at A.M.. In conclusion, this study showed that the colonoscopy at P.M. is better than at A.M., especially when patient is poor systemic condition or low acceptance to colonoscopic cleansing preparation. However, it may be also acceptable undergoing colonoscopy at A.M. if patient condition is good and patient is busy with his task.
Busan ; Colon* ; Colonoscopy* ; Humans ; Prospective Studies*

BACKGROUND: Induction of anesthesia with a high dose of fentanyl and vecuronium decreases the heart rate and blood pressure. This study was designed to evaluate the effect of preinduction atropine on these hemodynamic changes in patients undergoing coronary artery bypass graft surgery (CABG). METHODS: Forty-one patients who underwent CABG were randomly divided into two groups. After insertion of a radial artery cannula and a Swan-Ganz catheter, normal saline 1 ml (control group, n = 20) or atropine 0.5 mg (atropine group, n = 21) was injected intravenously 1 min before the induction of anesthesia. Anesthesia was induced with a first dose of fentanyl (5-8 microgram/kg) and vecuronium (0.12 mg/kg) and a second dose of fentanyl (5-10 microgram/kg). The patient was then intubated. Hemodynamic variables were measured before the induction of anesthesia, 1 min after the administration of each drug during the induction of anesthesia and 5, 10, and 30 min after the intubation. RESULTS: There was no significant differences between the two groups in terms of demographic data except that the number of patients with diabetes mellitus was greater in the control group than in the atropine group. The number of patients treated for hypotension or bradycardia during the induction of anesthesia was greater in the control group than in the atropine group, but this was not statistically significant. Heart rates significantly decreased in the control group but were maintained in the atropine group without any significant tachycardia. Blood pressure significantly decreased in both groups. CONCLUSIONS: Intravenous injection of atropine before anesthetic induction in patients undergoing CABG attenuates the decrease in heart rate resulting from anesthetic induction with high dose fentanyl and vecuronium. However, it didn't prevent the decrease in blood pressure nor did it reduce the incidence of treatment for hypotension.
Anesthesia ; Atropine* ; Blood Pressure ; Bradycardia ; Catheters ; Coronary Artery Bypass* ; Coronary Vessels* ; Diabetes Mellitus ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Incidence ; Injections, Intravenous ; Intubation ; Radial Artery ; Tachycardia ; Transplants ; Vecuronium Bromide*

This study was designed to evaluate the possibility of esmolol to attenuate the cardiovascular reflex due to the induction of general anesthesia, tracheal intubation and/or surgical stimulations during open heart surgery. Esmolol was infused continuously to each patient by 150 ug/kg/min from 2 minutes prior to the completion of the induction of anesthesia and then by 75 ug/kg/min throughout the skin-incision. In patients undergoing coronary bypass grafts, esmolol group of 5 individuals did not show any significant change in hemodynamics in contrast to the control group of 5 individuals, which showed singificant decreases in systolic and mean arterial pressure(p<0.05). The plasma concentrations of the catecholamines in the esmolol group were not significantly different from those in control. In patients undergoing valve replacement, esmolol group did not show any significant difference in hemodynamics from control. The plasma concentrations of the catecholamines in the esmolol group were not changed by the anesthetic and surgical procedures in contrast to the control group, which showed 3 times increase (p<0.05) in norepinephrine level and 8 times increase (p<0.05) in epinephrine level. The results of these experiments demonstrate that esmolol can suppress the hemodynamic refiex and catecholamine-release due to the stimulations of anesthetic and surgical procedures under the general anesthesia by a high concentration of fentanyl, and that esmolol can be administered safely to attenuate the hazardous sympathetic reflexes.
Anesthesia ; Anesthesia, General ; Catecholamines ; Epinephrine ; Fentanyl ; Heart* ; Hemodynamics* ; Humans ; Intubation ; Norepinephrine ; Plasma ; Reflex ; Thoracic Surgery ; Transplants

BACKGROUND: There has been no report about the effects of blood pressure (BP) on the change of blood flow (BF) to major organs when pump flow is maintained during cardiopulmonary bypass (CPB). We evaluated the changes of the BF and oxygen consumption of major organs when BP was controlled by vasopressors or vasodilators during CPB. METHODS: Carotid, femoral, hepatic and renal arteries and veins were exposed and arteries were cannulated for pressure monitoring, except the hepatic artery and arteries on the opposite side were exposed for the measurement of BF in 7 dogs. Temperature was lowered to 30oC after initiation of CPB and phenylephrine or sodium nitroprusside was infused to increase or decrease BP about 30% under the same pump flow. BP and BF were measured before CPB, before the infusion of drugs and when BP was changed by vasoactive drugs. Blood gas analyses were performed from the artery and each vein while the BF was measured. RESULTS: The change of BP didn't affect carotid and renal BF. However, hepatic BF decreased about 50% when BP was reduced and femoral BF changed in the opposite way of BP change. Oxygen consumption of each organ wasn't influenced by BP. CONCLSIONS: When pump flow was constantly maintained, changes in BP redistributed BF to major organs but didn't affect oxygen consumption. The brain and kidney have the ability of autoregulation of BF unlike the liver or legs. Hepatic BF was dependent on perfusion pressure and a decrease in BP by vasodilators during CPB may be not good for the liver.
Animals ; Arteries ; Blood Gas Analysis ; Blood Pressure ; Brain ; Cardiopulmonary Bypass* ; Dogs ; Hepatic Artery ; Homeostasis ; Kidney ; Leg ; Liver ; Nitroprusside ; Oxygen Consumption ; Perfusion* ; Phenylephrine ; Renal Artery ; Vasodilator Agents ; Veins

BACKGROUND: It is difficult to choose the appropriate drug when hypotension develops in patients with pulmonary hypertension (PH). There is no known drug to increase the systemic blood pressure (BP) without an increase of pulmonary arterial pressure (PAP). We observed the effects of phenylephrine (PE) and norepinehrine (NE) on systemic and pulmonary hemodynamics when hypotension was treated in patients with PH. METHODS: Patients with PH (mean PAP > or = 25 mmHg, n = 28) were studied. When hypotension occurred (systolic BP < or = 100 mmHg, T1) after the induction of anesthesia, PE or NE was randomly infused to raise the systolic BP above 130 mmHg (T2) and 150 mmHg (T3). Hemodynamic variables were measured at T1, T2 and T3, and the ratio (RBP) of mean PAP to mean BP was calculated. The measurements were performed before skin incision to avoid the effects of surgical stimulation. RESULTS: NE increased BP concomitantly with relatively small increase of PAP, meaning a decrease of RBP (P < 0.05) without any other changes of hemodynamic variables in all patients. However, PE could not raise BP above 130 mmHg in one third of patients, and decreased the cardiac index without a significant decrease of RBP. CONCLUSIONS: NE increased BP and decreased RBP without tachycardia or any other hemodynamic disturbances. NE is considered to be a proper and safe drug to raise BP when hypotension occurs in patients with PH.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Hypotension ; Norepinephrine* ; Phenylephrine* ; Skin ; Tachycardia