• Title/Summary/Keyword: Cardiovascular stability

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A Clinical Study of Succinylcholine-Atracurium for Cesarian Section (제왕절개환자에 있어서 Succinylcholine-Atracurium의 임상적 고찰)

  • Park, Dae-Pal
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.49-51
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    • 1986
  • Atracurium was used in 10 parturients undergoing elective cesarian section under general Anesthesia. An initial bolus of 0.4 mg/kg of the atracurium was injected after recovery from succinylcholine block. Complete neuromuscular block resulted in all cases. Muscular relaxation was maintained by incremental dose of 0.2mg/kg of atracurium. Administration of atracurium did not cause significant change in blood pressure, pulse rate and infants Apgar score. The residual neuromuscular block could be antagonized at the end of the procedure by mixture of 0.005mg/kg glycopyrrolate and 0.03 mg/kg of neostigmine. In all parturients, antagonism was adequate as evidenced by respiratory response and head lift test. Atracurium may be advantageous in parturients undergoing cesarian section under general anesthesia cause it maintained cardiovascular stability, is non-cumulative, is readily antagonized by neostigmine and has no deleterious effect on the newborn.

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Successful Damage Control Resuscitation with Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pediatric Patient

  • Heo, Yoonjung;Chang, Sung Wook;Kim, Dong Hun
    • Journal of Trauma and Injury
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    • v.33 no.3
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    • pp.170-174
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    • 2020
  • Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.

Occupational Stress and Related Factors among Aged Security Guards (고령 경비원의 직무스트레스와 관련요인)

  • Choi, Eun-Sook;Shin, Dong-Soo
    • Korean Journal of Occupational Health Nursing
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    • v.18 no.1
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    • pp.106-115
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    • 2009
  • Purpose: Occupational stress is a determinant risk factor for cardiovascular disease and work disability. This study aims to describe occupational stress and identify its related factors among aged security guards. Methods: A random sample of 76 aged security guards were interviewed by three research assistants. The criteria of the subjects were as follows : 50 or older male with 40 or more working hours a week working with colleagues ranged from 3 to 50. The data were collected in September, 2007 and analyzed by multiple regression using SAS Version 9.1. Results: The mean score of occupational stress among aged security guards was 47.2. The mean scores of its sub-scales were 31.3(physical environment), 33.8(occupational demand), 80.8occupational control), 44.6(interpersonal conflict), 51.3 (occupational insecurity), 53.6(occupational system), 57.5(lack of reward), and 30.3(work environment). The scores of occupational control, interpersonal conflict, and occupational insecurity were higher than the scores of Korean average occupational stress sub-scales. Significant variables affecting occupational stress and its sub-scales were work place, work type, and employment type. Conclusion: In order to reduce occupational stress among security guards, sufficient occupational control and interpersonal conflict control, appropriate reward, and employment stability should be considered. Also long working hours and work shift should be improved.

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Evaluation of Usefulness according to Environmental Change of Auditory and Visual in Pediatric X-ray (소아 X선 촬영에서 청각과 시각의 환경변화에 따른 유용성 평가)

  • Baek, Sung-Wook;Song, Jong-Nam;Kim, Jeong Hun;Han, Jae-Bok
    • Journal of the Korean Society of Radiology
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    • v.11 no.7
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    • pp.605-610
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    • 2017
  • Unlike adults, cognitive ability and communication are not accurate in pediatric patients. Therefore movement due to psychological anxiety in X-ray photography is one of the factors that increase repeated irradiation. In order to minimize the rejection of X-ray and to improve the satisfaction of medical service, it is necessary to improve the environment of the radiological room to help psychological stability and to find a positive measure for reduction of radiation dose, including unnecessary. The subjects of this study were 186 pediatric patients from May to July, 2017, who were from 6 months to 36 months, The study group was set up a radiological room without auditory and visual environment changes is A group, except for changes in visual environment, the room where only auditory environmental changes were applied was group B, the auditory environment changes were excluded, and the room where only the visual environment change was applied was divided into group C, the auditory and visual environment changes were applied to the D. In group A, 10 retrospectives were obtained, 7 in group B, 5 in group C, and 2 in group D. Especially in group A and group D, statistically significant at p <0.053 In conclusion, hearing and visual environment changes affected the psychological stability of pediatric patient, and the repeated irradiation was reduced, thus improving the quality of medical services.

The Changes of Sweating Area, Temperature and Blood Flow in the Upper and Lower Extremity after Hyperhidrosis Operations (다한증수술후 발한분포 및 상하지의 온도변화와 혈류량변화)

  • 김용환;장윤희;문석환;조건현;왕영필;김세화;곽문섭;김학희;장혜숙
    • Journal of Chest Surgery
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    • v.32 no.5
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    • pp.456-460
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    • 1999
  • Background: Thoracic sympathectomy for hyperhidrosis has been recognized as an effective treatment using thoracoscopic devices and operative techniques, but the satisfaction has decreased due to a compensatory hyperhidrosis. Therefore, the postoperative results and compensatory hyperhidrosis were analyzed. We also measured the temperature differences in the hand and foot during the preoperative and postoperative periods and measured the blood flow of upper and lower extremities. Material and Method: From December 1995 to July 1998, total of 47 patients with hyperhidrosis underwent sympathectomy via VATS at the Department of Thoracic and Cardiovascular Surgery, Kangnam St. Mary's Hospital. The patients were evaluated for preoperative and postoperative temperature changes on the finger and toe, and preoperative and postoperative blood flows were measured by the Doppler examination on the digital artery, radial artery and dorsalis pedis artery. Result: There were no operative deaths but some complications existed: 7 pneumothorax, 3 recurrence and 1 Honor syndrome. Ninety-five percent of the patients also had compensatory sweating especially in the trunk. There were 5 patients who regretted recurring the operation because of the compensatory sweating. Sweating decreased in 46% of the sole hyperhidrosis patients. The temperature difference between preoperation and postoperation was 1$^{\circ}C$ on the right hand side and 1.9$^{\circ}C$ on the left hand side(P<0.05). There was no significant temperature difference on the sole. Blood flow increased significantly in the palm, but no difference in the sole. Conclusion: In conclusion, thoracic sympathectomy for hyperhidrosis is a safe and effective treatment but satisfaction has been decreased by the compensatory sweating; therefore, it is important to thoroughly explain the compensatory sweating prior to surgery. Improvement of the plantar hyperhidrosis is not due to a physiological change, but to a psychological stability.

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The Second Animal Tests of Artificial Heart Valves (인공심장판막의 개발과 동물실험 -인공심장판막의 2차 동물실험-)

  • 김형묵
    • Journal of Chest Surgery
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    • v.23 no.4
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    • pp.617-621
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    • 1990
  • A heart supplies blood of about 15, 000 liters to each human organ in a day. A normal function of heart valves is necessary to accomplish these enormous work of heart. The disease of heart valve develops to a narrowness of a closure, resulting in an abnormal circulation of blood. In an attempt to eliminate the affliction of heart valves, the operative method to replace with artificial heart valves has developed and saved numerous patients over past 30 years. This replacement operation has been performed since early 1960`s in Korea, but all the artificial heart valves used are imported from abroad with very high costs until recent years. New artificial heart valves have been developed in Korea Advanced Institute of Science and Technology since early 1980`s. The first developed valve was designed with a free-floating pyrolytic carbon disk that is suspended in a titanium cage. The design of the valve was tested in vitro, and in animals in 1987. The results from this study was that the eccentrically placed struts creates a major and minor orifice when the disc opens and stagnation of flow in the area of the minor orifice has led to valve thrombosis. In this work, the design of the valve was changed from a single - leaflet valve to double - leaflet one in order to resolve the problems observed in the first - year tests. Morphological and hemodynamic studies were made for the newly designed valves through the in vitro and in vivo tests. The design and partial materials of the artificial heart valve was improved comparing with first - year`s model. The disc in the valve was modified from single - leaflet to bi - leaflet, and the material of the cage was changed from titanium metal to silicon - alloyed pyrolytic carbon. A test was made for the valve in order to examine its mechanical performance and stability. Morphological and hemodynamic studies were made for the valve that had been implanted in tricuspid position of mongrel dogs. All the test animals were observed just before the deaths. A new artificial heart valve was designed and fabricated in order to resolve the problems observed in the old model. The new valve was verified to have good stability and high resistance to wear through the performance tests. The hemodynamic properties of the valve after implantation were also estimated to be good in animal tests. Therefore, the results suggest that the newly designed valve in this work has a good quality in view of the biocompatibility. However, valve thrombosis on valve leaflets and annulus were found. This morphological findings were in accordance with results of surface polishing status studies, indicating that a technique of fine polishing of the surface is necessary to develop a valve with higher quality and performance.

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Characterization of Homocysteine ${\gamma}$-Lyase from Submerged and Solid Cultures of Aspergillus fumigatus ASH (JX006238)

  • El-Sayed, Ashraf S.;Khalaf, Salwa A.;Aziz, Hani A.
    • Journal of Microbiology and Biotechnology
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    • v.23 no.4
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    • pp.499-510
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    • 2013
  • Among 25 isolates, Aspergillus fumigatus ASH (JX006238) was identified as a potent producer of homocysteine ${\gamma}$-lyase. The nutritional requirements to maximize the enzyme yield were optimized under submerged (SF) and solid-state fermentation (SSF) conditions, resulting in a 5.2- and 2.3-fold increase, respectively, after the last purification step. The enzyme exhibited a single homogenous band of 50 kDa on SDS-PAGE, along with an optimum pH of 7.8 and pH stability range of 6.5 to 7.8. It also showed a pI of 5.0, as detected by pH precipitation with no glycosyl residues. The highest enzyme activity was obtained at $37-40^{\circ}C$, with a $T_m$ value of $70.1^{\circ}C$. The enzyme showed clear catalytic and thermal stability below $40^{\circ}C$, with $T_{1/2}$ values of 18.1, 9.9, 5.9, 3.3, and 1.9 h at $30^{\circ}C$, $35^{\circ}C$, $40^{\circ}C$, $50^{\circ}C$, and $60^{\circ}C$, respectively. Additionally, the enzyme $K_r$ values were 0.002, 0.054, 0.097, 0.184, and 0.341 $S^{-1}$ at $30^{\circ}C$, $35^{\circ}C$, $40^{\circ}C$, $50^{\circ}C$, and $60^{\circ}C$, respectively. The enzyme displayed a strong affinity to homocysteine, followed by methionine and cysteine when compared with non-S amino acids, confirming its potency against homocysteinuria-related diseases, and as an anti-cardiovascular agent and a specific biosensor for homocysteinuria. The enzyme showed its maximum affinity for homocysteine ($K_m$ 2.46 mM, $K_{cat}\;1.39{\times}10^{-3}\;s^{-1}$), methionine ($K_m$ 4.1 mM, $K_{cat}\;0.97{\times}10^{-3}\;s^{-1}$), and cysteine ($K_m$ 4.9 m M, $K_{cat}\;0.77{\times}10^{-3}\;s^{-1}$). The enzyme was also strongly inhibited by hydroxylamine and DDT, confirming its pyridoxal 5'-phosphate (PLP) identity, yet not inhibited by EDTA. In vivo, using Swiss Albino mice, the enzyme showed no detectable negative effects on platelet aggregation, the RBC number, aspartate aminotransferase, alanine aminotransferase, or creatinine titer when compared with negative controls.

Cervical stabilization exercise using the Sling system (슬링(Sling) 시스템을 이용한 경부 안정화 운동)

  • Kwon, Jae-Hoak;Cho, Mi-Ju;Park, Min-Chull;Kim, Suhn-Yeop
    • The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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    • v.8 no.2
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    • pp.57-71
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    • 2002
  • Cervical pain is a rapid increase that is owing to a flexion-extension whiplash injury, unappropriated posture, chronical repetition injury from abdominal position of head and neck, excessive repeating work, chronical deficiency of excercise. Because of that is bring about muscle unbalance, tightness of cervical extensor muscle, weakness of cervical deep flexor muscles, instability of cervical region and reduction of proprioceptive sensor. Recent the role of muscle is more emphasized for preservation of sine stabilization. And cognition of integrated muscular system, importance for the operation and relation is increased to maintain stability of the motor system and pertinent function. Therefore we are going to introduce the sling exercise and stabilization exercise method for advanced efficient of cervical and upper limb and for the muscle strengthening to importance cervical stabilization through neurological program as control the reaction of cervical stabilization. Sling exercise therapy(SET) concept consists of a system of diagnosis and treatment. The system of diagnosis involves testing the muscle's tolerance through progressive loading in open and close kinetic chains. The SET system contains elements such as relaxation, increasing the range of movement, traction, training the stabilizing musculature, sensory-motor exercises, training in open and close kinetic chains, dynamic training of the mobilizing musculature, cardiovascular exercise, group exercise, personal exercise at home Sensory-motor training is an essential element of the SET concept. The emphasis is on closed kinetic chain exercise on an unstable surface, there by achieving optimum stimulation of the sensory-motor apparatus.

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Fatty Acid Modulation of Atherosclerosis by Peroxisome Proliferator- Activated Receptors

  • Erickson, Kent L.;Hubbard, Neil E.;Meinecke, Lynette M.
    • Preventive Nutrition and Food Science
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    • v.7 no.4
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    • pp.454-460
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    • 2002
  • While atherosclerosis is a major killer, there is now concern that mortality from the disease will increase due to the rising incidence of type II diabetes. Because diet can potentially influence both diseases, it is important to elucidate the role of diet in the progression of atherosclerosis. In addition, the mechanisms involved in dietary-related alterations of the disease need to be defined to guide public health recommendations to reduce athero-sclerosis incidence and limiting unwanted side effects. Since diet is thought to play a role in atherosclerosis even without added complications due to type II diabetes, reducing the incidence of that metabolic disease will not be enough. While evidence is increasing that high intake of carbohydrate can lead to type II diabetes and atherosclerosis, the preponderance of existing evidence indicates that intake of specific fats as a major dietary causal factor. It has recently been hypothesized that a dietary fat link to atherosclerosis may depend partly on the activity of a transcriptional regulator, the peroxisome proliferator activated receptors (PPAR). Thusfar, PPAR $\alpha$, $\beta$/$\delta$ and ${\gamma}$, have been shown to play a major role in metabolism, inflammation, and cancer. Furthermore, PPAR may regulate specific processes associated with atherosclerosis such as triglyceride and low density lipoprotein (LDL) metabolism; the reverse cholesterol transport pathway; lipid accumulation within plaques; the local inflammatory response and plaque stability. Synthetic ligands for PPAR have been developed; however, natural ligands include specific fatty acids and their metabolites. Though the role of PPAR in atherosclerosis has been reported with respect to synthetic ligands, additional studies need to be done with established and possible natural ligands. In this review, we will focus on the relation of dietary fat to PPAR alteration of atherosclerosis.

Plate and Screw Removal after Orthognathic Surgery, under Intravenous Sedation with Dexmedetomidine and Pethidine (Dexmedetomidine과 Pethidine을 이용한 정맥내 진정하에 시행된 악교정수술 후 금속나사제거)

  • Kang, Hee-Jea;Kim, Jong-Ryoul;Kim, Si-Yeob;Choi, Tea-Sung;Chang, Kwang-Uk
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.34 no.4
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    • pp.260-266
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    • 2012
  • Purpose: The purpose of this study is to identify the changes of a physiologic nature and the sedative parameters associated with dexmedetomidine and pethidine, in patients undergoing plate and screw removal surgery, after orthognathic surgery. Methods: Twenty-three patients were sedated with dexmedetomidine and pethidine during plate and screw removal, after orthognathic surgery. An initial loading dose of dexmedetomidine ($1.0{\mu}g/kg$ infused over 10 minutes) was followed by a maintenance dose ($1.0{\mu}g/kg/hr$). Systolic blood pressure, diastolic blood pressure, mean arterial pressure, oxygen saturation, and heart rate were monitored. Perioperative amnesia and anxiety were recorded. Results: Significant changes were found in the blood pressure and heart rate (Freidman test, P<0.05), but not in oxygen saturation (Freidman test, P>0.05). Amnesia during local injection was observed in eight patients (34.8%). Compared with the preoperative anxiety score, the intraoperative anxiety score was decreased. Conclusion: In this study, we found cardiovascular and respiratory stability in intravenous sedation using dexmedetomidine with pethidine, in plate and screw removal, after orthognathic surgery. Furthemore, intravenous sedation using dexmedetomidine with pethidine shows adequate analgesic and sedative effects.