Many patients,especially in certain high risk groups, undergo operative procedures under regional anesthesia in belief that this approach is safer than general anesthesia. During the regional anesthesia, sedation is often provided with intravenous agents, such as diazepam even if diazepam has some dipressant effects on respiration and hemodynamics. To evaluate the effects of diazepam on spinal anesthesia, arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), arterial oxygen saturation (SaO2) and mean arterial pressure (MAP) were measured at 1,3,5.10,15,20and 30min. following diazepam iv (0.2 mg/kg) under spinal anesthesia (group 2), and were compared with the changes in the control group (group 1), who received spinal anesthesia without diazepam administration. The results were as follows: 1) MAP revealed no significant decrease in the control group, and decreased significantly in the group 2 from 3 to 30 min. after diazepam iv under spinal anesthesia. 2) PaO2 did not change significantly in the control group, but PaO2 in group 2 decreased significantly at 1 and 10 min. after intravenous administration of diazepam. And the changes from 3 to 20 min. after intravenous administration of diazepom were significantly different from changes in the group 3) PaO2 increased significantly in grorp 2 from 3 min. after diazepam iv which were significantly different from the changes in the control group. 4) SaO2 decreased significantly in group 2 from 1 to 30 min. after diazepam iv which were significantly different from the changes in the control group. From the above results, diazepam administration under spinal anesthesia affects the respiratory function and hemodynamics, so oxygen inhalation technique may be needed in most cases of sedatives administration after spinal anesthesia.
Administration, Intravenous ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Arterial Pressure* ; Carbon Dioxide ; Diazepam* ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Inhalation ; Oxygen ; Respiration ; Surgical Procedures, Operative

OBJECTIVE: Nitric oxide(NO) is implicated in a wide range of biological processes in tumors and is produced in glioma. To investigate the role of NO and its interaction with the tumoricidal effects of anticancer drugs, we study the antitumor activities of NO donors, with or without anticancer drugs, in human glioma cell lines. METHODS: U87MG and U373MG cells were treated with the NO donors sodium nitroprusside(SNP) and S-nitroso-N-acetylpenicillamine(SNAP), alone or in combination with the anticancer drugs 1, 3-bis(2-chloroethyl)-1-nitrosourea(BCNU) and cisplatin. Cell viability, cell proliferation, DNA fragmentation, nitrite level, and the expression of Bcl-2 and Bax were determined. RESULTS: NO was markedly increased after treatment with SNP or SNAP; however, the addition of the anticancer drugs did not significantly affect NO production. NO donors or anticancer drugs reduced glioma cell viability and, in combination, acted synergistically to further decrease cell viability in a dose- and time-dependent manner. Cell proliferation was inhibited and apoptosis were enhanced by combined treatment. Bax expression was increased by combined treatment, whereas Bcl-2 expression was reduced. The antitumor cytotoxicity of NO donors and anticancer drugs differed according to cell type. CONCLUSION: BCNU or cisplatin can inhibit cell viability and proliferation of glioma cells and can induce apoptosis. These effects are further enhanced by the addition of a NO donor which modulates the antitumor cytotoxicity of chemotherapy depending on cell type. Further biological, chemical, and toxicological studies of NO are required to clarify its mechanism of action in glioma.
Apoptosis ; Biological Processes ; Carmustine ; Cell Line ; Cell Proliferation ; Cell Survival ; Cisplatin ; DNA Fragmentation ; Drug Therapy ; Glioma* ; Humans ; Nitric Oxide Donors* ; Nitric Oxide* ; Sodium ; Tissue Donors

BACKGROUND: This study was designed to review the cases of patients who had undergone diffusionweighted magnetic resonance imaging(DWI) in the emergency department(ED), and to investigate its clinical usefulness and current indications. METHODS: We analyzed the cases of 152 consecutive patients who underwent DWI in the ED from Jan to Mar 2001. DWI was obtained with the use of a multislice, single-shot, spin-echo plana imaging technique(GE Signa(R)). Imaging time was less than one minute. The medical records, the DWI films and the computed tomography results were reviewed. We investigated the chief complaint, initial findings of physical examination, final diagnosis, decision-making department, interval from admission to imaging, and DWI findings. RESULTS: DWI showed positive findings of high signal intensity in 84 patients(55.3%). Among the 68 patients who yielded a negative result, false negative occurred with 12 patients(17.6%): 10 lacunar infarctions, a pons infarction, and a brainstem infarction. Eleven patients were determined as having a cerebral hemorrhage, all of whom showed the abnormal finding of a mixed signal in DWI. The sensitivity and the specificity of DWI to rule out stroke were 85.5% and 98%, respectively. Current indications for DWI in our ED are age older than 60, alert mental status, and one of the symptoms or signs among lateralyzing sign, language disturbance, and dizziness/vertigo. CONCLUSION: DWI was highly specific to rule out stroke, so emergency care professionals should be familiar with this new technology. Further prospective study is required to determine the proper indications and clinical usefulness of DWI in the ED.
Brain Stem Infarctions ; Cerebral Hemorrhage ; Diagnosis ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Medical Records ; Physical Examination ; Pons ; Sensitivity and Specificity ; Stroke ; Stroke, Lacunar

BACKGROUNDS: The mortality of geriatric trauma patients is higher than that of other age groups. However, little research has been done the methods or criteria of triage for geriatric trauma patients. This study evaluated a clinical significance of the triage-revised trauma score(t-RTS) for triage of geriatric trauma patients. METHODS: We retrospectively analyzed clinical data on 528 trauma patients over 65 years of age who were treated from Jan 1999 to Dec 2000. The t-RTS was calculated utilizing the RR(respiratory rate), SBP(systolic BP), and GCS scores and the ISS was abstracted from the final diagnosis. The obtained t-RTS and ISS were evaluated using the measures of sensitivity, specificity, accuracy, and AUC curve. RESULTS: The overall mortality rate was 9%, and there was no significant differences between the survival group and the mortality group according to age and sex. The mean scores of SBP, RR and GCS of the survival group were significantly higher than those of mortality group(p=0.001). The mean of t-RTS and RTS of the survival group were also significantly higher(p=0.001), but the ISS was significantly higher in the mortality group(p=0.001). The t-RTS, RTS, and ISS showed good prediction rates on the ROC curve(p=0.001), and the AUC value was higher in the ISS than in the t-RTS and the RTS. The sensitivity and the accuracy were high in the t-RTS and the RTS, and the specificity was high in the ISS. The t-RTS is less than 10 for a survival probability of 50% or less CONCLUSONS: Implementation of the t-RTS in the triage of geriatric trauma patients in the field and in emergency room would be very useful. The probability of death in geriatric trauma patients is high when the t-RTS is less than 10.
Area Under Curve ; Diagnosis ; Emergency Service, Hospital ; Humans ; Mortality ; Retrospective Studies ; Sensitivity and Specificity ; Triage*

BACKGROUND: The ischemia responsive protein 94 kDa(irp94) gene belongs to the heat shock protein 110 family and was isolated in 1999 from rat brain by transiently induced forebrain ischemia. The PC12 cell is the pheochromocytoma cell line of rat, which is differentiated to a sympathetic neuron-like cell by the stimulation of a nerve growth factor. This study is to determine whether irp94 is expressed when an ischemia-like condition is induced by ATP depletion in cultured PC12 cells in vitro. METHODS: PC12 cells were maintained as monolayer cultures in RPMI-1640 medium(Sigma) supplemented with 10% horse serum, 5% fetal bovine serum, 5 mg/ml transferrin, and 1 mg/ml insulin in a humidified 5% CO2 incubator at 37degrees C. The ATP depleting agent antimycin A was added at concentrations of 1, 2.5, and 5 microM to simulate ischemia, and 10 microgram/ml of tunicamycin, which is expected to express heat shock protein maximally, was used as a positive control. The cells were harvested after a 60-minute incubation, and the total RNA was extracted. The reverse transcription polymerase chain reaction(RT-PCR) was performed to use 501 bp irp94 cDNA as a molecular probe, and the expression of irp94 mRNA was analyzed by northern blotting. RESULTS: The irp94 mRNA expression was enhanced, compared to the negative control group, as the concentration of antimycin A was increased. CONCLUSION: This study suggests that irp94 mRNA expression is enhanced as the severity of ischemia is increased. Thus, it is possible to investigate the mechanism of ischemic neuronal injury indirectly by using this in-vitro model of neuronal ischemia.
Adenosine Triphosphate ; Animals ; Antimycin A ; Blotting, Northern ; Brain ; Cell Culture Techniques* ; DNA, Complementary ; Gene Expression* ; Heat-Shock Proteins ; Horses ; HSP110 Heat-Shock Proteins ; Humans ; Incubators ; Insulin ; Ischemia* ; Molecular Probes ; Nerve Growth Factor ; Neurons* ; PC12 Cells ; Prosencephalon ; Rats ; Reverse Transcription ; RNA ; RNA, Messenger ; Transferrin ; Tunicamycin

PURPOSE: To evaluate the quality of the emergency medical care during doctors' strike at a hospital in Korea. METHODS: During a period of 7 consecutive days, from 20th to 26th June 2000, the training physicians in Korea were on strike against medical reform and the emergency medical care was provided by medical staffs without training physicians. We drew out convenient samples by systematic allocation method and reviewed the medical records. We evaluated the patients' severities, the number of diagnostic tests and therapeutic procedures, the admission rates, and the lengths of stay at emergency department(ED) in the strike period(SP) compared to control period(NSP) from 20th to 26th June, 1999. RESULTS: The two groups(SP: 191 vs NSP: 202 patients) showed significant differences in the proportion of emergent patients(17.3 vs 32.7%), ED length of stay(1.98 vs 4.47 hours), the number of diagnostic tests(1.47 vs 3.92), the injection rates(17.3 vs 35.1%), and the adverse event rates(4.5 vs 6.5%). CONCLUSION: This study suggested that the ED administration by medical staffs without training physicians improves medical quality of emergency care.
Diagnostic Tests, Routine ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Humans ; Korea ; Medical Records ; Medical Staff ; Strikes, Employee*

PURPOSE: Diffusion-weighted magnetic resonance imaging (DWI) has been known to visualize hyperacute ischemic stroke. And it takes only a few minutes to do. Moreover only a small amount of time and little cost is required to add T2-weighted imaging (T2WI) to DWI. The purpose of this study is to determine the usefulness of T2WI in addition to DWI as a primary imaging modality for patients with suspected ischemic stroke. METHODS: DWI plus T2WI was performed from January to May 2001 on the patients with suspected ischemic stroke. Two emergency physicians reviewed the films and medical records. The sensitivity and the specificity of DWI and T2WI for acute ischemic stroke were calculated. The agreement between DWI and T2WI was calculated using kappa statistics. RESULTS: A total of 241 patients were enrolled. Acute ischemic stroke was confirmed in 86 (35.7%) patients. The sensitivity and the specificity of DWI for acute ischemic stroke were 94.2% and 98.7%, and those for T2WI were 60.5% and 94.2%, respectively. The kappa value was 0.721 (p<0.01). Among the 86 acute ischemic stroke patients, the number of cases who presented less than 6 hours after symptom onset was significantly lower in the T2WI positive group (31% vs. 68.7%, p<0.05). CONCLUSION: This study suggests that the addition of T2WI to DWI as a primary imaging modality for acute ischemic stroke has little benefit compared to DWI alone, especially, when the symptom duration has been less than 6 hours.
Emergencies ; Humans ; Magnetic Resonance Imaging* ; Medical Records ; Sensitivity and Specificity ; Stroke*

PURPOSE: The purpose of this study is to determine for upper abdominal pain, the accuracy of emergency abdominal ultrasonography (EAU) performed by emergency physicians with limited training. METHODS: Two PGY-3 emergency physicians, who had received 2 hours of hands-on training, including the normal anatomy of a biliary system, liver, kindney, spleen, and pancreas, and who had studied the pathologic findings for another month were the subjects of this study. They used a Sonosite 180 R to perform EAU on patients with upper abdominal pain within 2 months after training. We determined the agreement between the radiologist 's abdominal ultrasonography(RAU) and EAU by using Kappa statistics. RESULTS: A total of 59 patients were enrolled. The agreement between the EAU and the RAU findings was 0.97, 0.88, 0.79, 0.73, 0.62, and 0.57 for gall bladder (GB) distension, cholelithiasis, GB wall thickening, duct dilatation, choledocholithiasis, and pericholecystic fluid, respectively (p<0.05). CONCLUSION: The results of EAU, performed by emergency physician with limited training on patients suffering from upper abdominal pain had a significant agreement with the RAU. However, more educations and cautions are warranted for diagnosing pericholecystic fluid and choledocholithiasis.
Abdominal Pain ; Biliary Tract ; Choledocholithiasis ; Cholelithiasis ; Dilatation ; Emergencies* ; Humans ; Liver ; Pancreas ; Spleen ; Ultrasonography* ; Urinary Bladder

PURPOSE: This study was designed to investigate the predictors of long-term admission in patients with acute diarrhea at an early stage of their emergency department (ED) visit. METHODS: We retrospectively analyzed clinical data of 125 patients who visited our ED with complaints of acute diarrhea and abdominal pain and underwent a stool test during one year (Jan. to Dec. 2001). We excluded patients who were transferred out or were self-discharged and those with another illness. We checked the numbers of cases of diarrhea, the presence of fever and abdominal pain, the stool cell counts, the blood cell counts, platelets, blood urea nitrogen, and creatinine on admission. We also counted the length of stay and defined a stay of over 4 days in the hospital as a long-term admission. We tried to find parameters that could predict long-term admission at an early stage. RESULTS: A total of 125 patients were enrolled (men : 56 ; women : 69), and their mean age was 44 +/- 0.25 years. The mean length of stay was 3.0 +/- 0.02 days. The length of stay had a statistically significant correlation with the stool WBC (p<0.01, R=0.361). Only the stool WBC a the discriminative variable for long-term admission (p<0.01). CONCLUSION: The stool WBC was a statistically significant predictive variable to determinate the long-term admission and the severity of acute diarrhea, and we think it could be used to make an early decision for the close medical attention.
Abdominal Pain ; Blood Cell Count ; Blood Platelets ; Cell Count ; Creatinine ; Diarrhea* ; Emergency Service, Hospital ; Female ; Fever ; Humans ; Length of Stay ; Nitrogen ; Retrospective Studies ; Urea

PURPOSE: Periostin was originally identified as a secreted factor during screening of a mouse osteoblastic library. In a recent study, periostin was found to directly regulate eosinophil accumulation in allergic mucosal inflammation. Chronic eosinophilic inflammation is related to the development of remodeling. The present study examined the expression of periostin and evaluated its role in the inflammatory process and remodeling associated with allergic rhinitis. METHODS: A murine model of allergic rhinitis was established in periostin knockout mice. We analyzed the expression of periostin, manifestation of nasal symptoms, eosinophilic inflammation, and subepithelial fibrosis as well as the expression of MMP-2, TIMP-1, and type 1 collagen in nasal tissue. RESULTS: Periostin was mainly distributed in the subepithelial tissue of the nasal mucosa. The subepithelial tissue was thinner in the knockout group than in the control group. No differences in the expression of MMP-2 or TIMP-1 were found in the knockout group. However, after a month of allergen challenge, type I collagen in the nasal tissue was lower in the knockout group than in the control group. The number of eosinophils and the symptom score were also lower in the knockout group. CONCLUSIONS: Periostin is expressed in nasal tissues of murine models of allergic rhinitis. Periostin deficiency may affect the remodeling of nasal tissue with reduced subepithelial fibrosis, and lead to less eosinophilic inflammation.
Airway Remodeling ; Animals ; Collagen Type I ; Eosinophils ; Fibrosis ; Hypersensitivity ; Inflammation ; Mass Screening ; Mice ; Mice, Knockout ; Nasal Mucosa ; Osteoblasts ; Rhinitis ; Rhinitis, Allergic, Perennial ; Tissue Inhibitor of Metalloproteinase-1