We have studied the vasodilating effect of bolus doses of sodium nitroprusside (SNP), nitro- glycerin (NTG), and isosorbide dinitrate (ISDN) in 40 patients during cardiopulmonary bypass with a constant pump flow. Blood volume of the venous reservoir and mean arterial pressure were recorded for 10 minutes after drug administration to detect changes in venous capacitance and arteriolar resistance. SNP 500 ug decreased mean blood pressure significantly more than NTG and ISDN compared with placebo. NTG 500 ug decreased mean blood pressure transiently at 1-4 min but significantly reduced reservoir blood volume. ISDN 500 ug increased mean blood pressure after drug administration, decreased reservoir blood volume less than NTG. We could conclude that SNP was more effective arteriolar vasodilator than NTG and ISDN, but NTG and ISDN were effective as a venodilator during cardiopulmonary bypass.
Arterial Pressure ; Blood Pressure ; Blood Volume ; Cardiopulmonary Bypass* ; Glycerol ; Humans ; Isosorbide Dinitrate* ; Isosorbide* ; Nitroglycerin* ; Nitroprusside* ; Sodium* ; Vascular Access Devices

Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.
Anesthesia ; Cholecystectomy* ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Cost Control ; Health Expenditures ; Hospital Charges ; Humans ; Inpatients ; Insurance, Health ; Korea ; Specialization

BACKGROUND: Local anesthetics are often used for a regional block in patients who are being treated with calcium channel blockers (CCB). Bupivacaine is a local anesthetic with potential for serious cardiovascular toxicity. Ropivacaine is a relatively new local anesthetic. It is clinically equipotent and chemically similar to bupivacaine. Diltiazem (CCB) is a potent coronary and systemic vasodilator with antiarrhythmic properties. Local anesthetics such as bupivacaine and ropivacaine have been suggested to show drug interactions with diltiazem. Therefore, we tried to observe the drug interactions between bupivacaine, ropivacaine and diltiazem using an animal model. METHODS: This study was performed using an isolated rat heart (N = 40) by the Langendorff method. After a stabilization period, all hearts were subjected to the application of local anesthetics of a 1 microgram/ml or 3/ml concentration, respectively. Thereafter, they were subdivided into four groups; the bupivacaine (B) group, bupivacaine with diltiazem (BD) group, ropivacaine (R) group, and ropivacaine with diltiazem (RD) group. Parameters such as, LVP, dp/dt, heart rate (HR), coronary flow (CF), DO2, and MVO2 were measured. RESULTS: All parameters decreased in all groups, respectively (P < 0.05). The BD group and R group showed a lower LVP and dp/dt than those of the B group (P < 0.05). The BD group and B group showed lower HR than that of the R group (P < 0.05). The RD group showed a higher CF than other groups (P < 0.05). CONCLUSIONS: The negative inotropic potency of bupivacaine was enhanced in the presence of diltiazem. We suggest that diltiazem has a protective effect against reduction of CF by ropivacaine. Therefore, we should consider this when selecting local anesthetics for cardiovascular patients under the treatment of diltiazem.
Anesthetics, Local ; Animals ; Bupivacaine* ; Calcium Channel Blockers ; Diltiazem* ; Drug Interactions ; Heart Rate ; Heart* ; Humans ; Models, Animal ; Rats*

Pathologists and others have been calling the serous cystadenoma of the pancreas "microcystic cystadenoma", following Compagno and Oertel's proposal in l978 because it usually consists of innumerable small cysts (less than 2cm). However, unilocular or predominantly macrocystic types of serous cystadenoma have been occasionally reported. Therefore, they present a difficulty in precise preoperative and intraoperative diagnosis for their simi1ar gross appearance to other cystic lesions of the pancreas. We discovered two cases of macrocystic and unilocular serous cystadenomas of the pancreas which were lined by cuboidal to flattened epithelial cells. They contained PAS positive and D-PAS negative intracytoplasmic glycogen granules. The unilocular, macrocystic and microcystic patterns may represent a morphologic spectrum of a pancreatic neoplasm. So we propose to use the term "serous cystadenoma" rather than microcystic cystadenoma.
Cysts

In vivo 31P magnetic resonance spectroscopy (MRS) was used to evaluate the effect of nimodipine on changes of [H] (pH) and the ratio of [PCr]/[Pi] in cats subjected to an incomplete global cerebral ischemia-reperfusion under the pretreated condition of hyperglycemia. Animals were subjected to a transient (18 minutes) incomplete global cerebral ischemia; the systemic arterial hypotension was induced, and immediately followed by the bilateral carotid artery ligation. Twenty cats were divided into 3 groups; for group 1 (control), 7 cats were employed for a control group; for group 2 (hyperglycemia), 7 cats were a hyperglycemia group with infusion of 50% glucose prior to ischemia; for group 3 (Nimodipine), 6 cats were infused with 50% glucose prior to ischemia, and nimodipine after ischemia. The time course of changes in pH and [PCr]/ [Pi] was monitored before, during and after ischemia. The pH decreased immediately after ischemia in all three groups. After the reperfusion was made, the values of the pH did not retum to the baseline value for the group 2 (hyperglycemia) and 3 (nimodipine), in contrary to the group 1 (control). The ratio of [PCr]/[Pi] was dropped to 20% of the baseline value after ischemia in all three groups. The value was recovered progres- sively during reperfusion period for group 1 (control), whereas for group 2 (hyperglycemia) and group 3 (Nimodipine) the values were remained depressed. The results suggest that the condition of hyperglycemia induced by the infusion of 50% glucose prior to the incomplete global cerebral ischemia-reperfusion, may deteriorate the cerebral ischemia and the infusion of nimodipine during ischemia-reperfusion has no beneficial effects to improve the cerebral acidosis and the metabolic recovery.
Acidosis ; Animals ; Brain Ischemia ; Carotid Arteries ; Cats* ; Glucose ; Hydrogen-Ion Concentration ; Hyperglycemia* ; Hypotension ; Ischemia ; Ligation ; Magnetic Resonance Spectroscopy ; Nimodipine* ; Reperfusion

In vivo 31P magnetic resonance spectroscopy (MRS) was used to evaluate the effect of nimodipine on changes of [H] (pH) and the ratio of [PCr]/[Pi] in cats subjected to an incomplete global cerebral ischemia-reperfusion under the pretreated condition of hyperglycemia. Animals were subjected to a transient (18 minutes) incomplete global cerebral ischemia; the systemic arterial hypotension was induced, and immediately followed by the bilateral carotid artery ligation. Twenty cats were divided into 3 groups; for group 1 (control), 7 cats were employed for a control group; for group 2 (hyperglycemia), 7 cats were a hyperglycemia group with infusion of 50% glucose prior to ischemia; for group 3 (Nimodipine), 6 cats were infused with 50% glucose prior to ischemia, and nimodipine after ischemia. The time course of changes in pH and [PCr]/ [Pi] was monitored before, during and after ischemia. The pH decreased immediately after ischemia in all three groups. After the reperfusion was made, the values of the pH did not retum to the baseline value for the group 2 (hyperglycemia) and 3 (nimodipine), in contrary to the group 1 (control). The ratio of [PCr]/[Pi] was dropped to 20% of the baseline value after ischemia in all three groups. The value was recovered progres- sively during reperfusion period for group 1 (control), whereas for group 2 (hyperglycemia) and group 3 (Nimodipine) the values were remained depressed. The results suggest that the condition of hyperglycemia induced by the infusion of 50% glucose prior to the incomplete global cerebral ischemia-reperfusion, may deteriorate the cerebral ischemia and the infusion of nimodipine during ischemia-reperfusion has no beneficial effects to improve the cerebral acidosis and the metabolic recovery.
Acidosis ; Animals ; Brain Ischemia ; Carotid Arteries ; Cats* ; Glucose ; Hydrogen-Ion Concentration ; Hyperglycemia* ; Hypotension ; Ischemia ; Ligation ; Magnetic Resonance Spectroscopy ; Nimodipine* ; Reperfusion

BACKGROUND: Fractures should be actively prevented in the elderly because recovery from the damage of fractures is slow and fractures can cause both physical and psychological pain in the elderly. Previous studies have reported that depression is related to falls or low bone mineral density (BMD). This study aimed to evaluate the risk of fracture according to the depression status among the elderly.METHODS: This study used the National Health Insurance Corporation cohort data to examine 96,188 elderly people aged >65 years who were examined in 2007 and 2008. The chi-square test was used to determine the general characteristics and fracture incidence in patients with depression and healthy controls, and the hazard ratio was calculated using the Cox proportional hazards model corrected for general characteristics. The Kaplan-Meier method predicted the risk of fracture in two groups during the observation period.RESULTS: In the depressed group, 23.2% (441 of 1,904) of the patients had a fracture during the 5-year follow-up period; however, in the control group, only 17.5% (16,470 of 94,284) had a fracture (P < 0.001). In addition, multivariate analysis of the adjusted variables showed that the risk of fracture in the depressed group was 1.34 times higher than that in the control group. The risk of fracture in women was 1.71 times higher than that in men, and the risk of fracture increased with age.CONCLUSION: The risk of fracture in the elderly who were depressed was significantly higher than that in the elderly who were not depressed.
Accidental Falls ; Aged ; Bone Density ; Cohort Studies ; Depression ; Depressive Disorder ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Methods ; Multivariate Analysis ; National Health Programs ; Proportional Hazards Models

School foodservice employees are involved with every aspect of ensuring that high quality meals are prepared and they influence student satisfaction. The objective of this study was to identify whether job satisfaction of cooks is affected by their relationships with management. Survey forms that were developed for foodservice dietitians and employees were interviewed. Questionnaires to measure job satisfaction were distributed to 30 schools in the Gyeonggi province and completed by 30 dietitians and 323 cooks. Foodservice cooks' job satisfaction was evaluated by measuring attitudes towards aspects of their job using the modified Smith method(1969). All items in the scales were coded by 4 Likert scale(1: nerver satisfied, 4: very satisfied), then grouped by using factor analyses. Statistical methods used in this study were a x2-test, t-test with SPSS software(version 12.0). The study results were as follows; 1) The demographic data showed that 65.3% of respondents were in their 40s, 96% were married, 68.8% were high school graduates, and 93.5% were contracted employees. Regarding overall experience in their current workplace, 27.9% had been in their position over 5 years and 25.7% said less than 2 years. 2) Most of the school lunches was served in the classroom(73.3%). The cook working was rotated among the employees(90%). Most employees did not use a day's leave of absence per month because they were averse to burdening their coworkers. 3) There were no significant differences in job satisfaction between the cooks' self-evaluation scores(2.92) and those of the dietitians(2.92). Among the factors influencing job satisfaction, dietitians(2.10) perceived that cooks(1.99) were more satisfied with their salaries than was actually the case. The cooks(3.19) rated their level of work satisfaction higher than the dietitians(3.03) perceived it to be. Employees rated their relationship satisfaction as 3.50, but dietitians on the other hand rated it 3.37. Most of the cook respondents want a higher salary and a some kind of employment guarantee. This study provides foodservice managers information useful for design positions that will increase productivity. Future study is needed to determine the factors that will improve job satisfaction and satisfy the employees' needs, which in turn will improve school food service quality.
Surveys and Questionnaires ; Diagnostic Self Evaluation ; Efficiency ; Employment ; Food Services ; Gyeonggi-do* ; Hand ; Humans ; Job Satisfaction* ; Lunch ; Meals ; Nutritionists* ; Salaries and Fringe Benefits ; Weights and Measures

The pattern of thickening of the extrahepatic bile duct on computed tomography was analysed in 30 cases with recurrent pyogenic cholangitis diagnosed by surgery (n=19) or clinical basis (n=11). The mean wall thickness of the extrahepatic bile duct was 3.3mm (range, 1-6.3mm). Diffuse thickening of the extrahepatic bile ductal wall was demonstrated in 26 of 30 cases. Diffuse thickening of the extrahepatic bile duct in recurrent pyogenic cholangitis may be differentiated from focal thickening of duct in a common duct cancer or pancreatic cancer.
Bile Ducts, Extrahepatic* ; Cholangitis* ; Pancreatic Neoplasms

The pattern of thickening of the extrahepatic bile duct on computed tomography was analysed in 30 cases with recurrent pyogenic cholangitis diagnosed by surgery (n=19) or clinical basis (n=11). The mean wall thickness of the extrahepatic bile duct was 3.3mm (range, 1-6.3mm). Diffuse thickening of the extrahepatic bile ductal wall was demonstrated in 26 of 30 cases. Diffuse thickening of the extrahepatic bile duct in recurrent pyogenic cholangitis may be differentiated from focal thickening of duct in a common duct cancer or pancreatic cancer.
Bile Ducts, Extrahepatic* ; Cholangitis* ; Pancreatic Neoplasms