High-flow gas insufflation to get a bloodless field during off-pump coronary artery bypass may have adverse effects on the coronary endothelium. This study was designed (1) to elucidate the effect of carbon dioxide gas insufflations on the coronary endothelium at different flow rates and (2) to assess the protective effect of humidifcation against the coronary endothelial damage. Material and Method: In nine pigs, the left anterior descending coronary artery (LAD) was exposed after a median sternotomy. The LAD was divided into 4 segments and a coronary arteriotomy was made in each LAD segment in the beating heart. The far distal arteriotomy was exposed to room air for 10 minutes and was harvested as a control. Non-humidified carbon dioxide gas at a continuous flow rate of 5 L/min (Group I), humidified carbon dioxide gas at a continuous flow rate of 5 L/min (Group II), and humidified carbon dioxide gas at a continuous flow rate of 10 L/min (Group III) were insufflated for 10 minutes on each coronary arteriotomy site, respectively. After harvesting the coronary segments, hematoxylin-eosin staining, elastic fiber staining, and immunostaining with a CD34 monoclonal antibody were performed to evaluate the depth of endothelial damage and to count the residual endothelial cells, Result: In all three groups (Group I, II, and III), internal elastic laminae were preserved, however, the endothelial layers were significantly damaged by carbon dioxide gas insufflation. The mean percentages of remaining endothelial cells were 20,9$\pm$16.7%, 39.3$\pm$19.6%, and 6.8$\pm$5.3%, in groups I, II, and III, respectively. The percentages of remaining cells were significantly higher in group II than in groups I and III (p=0.008). The percentages of remaining cells were significantly higher in group I than in group III (p=0.008). Conclusions: The harmful effect of carbon dioxide gas insufflation on the coronary endothelium was dependent on the flow rate. The addition of humidification did not protect the coronary endothelium from denudation injury caused by high flow carbon dioxide gas insufflations.
Background: The aim of this study is to evaluate the long term results of creating various right ventricle to pulmonary artery conduits for treating complex congenital heart disease. Material and Method: Between June 1986 and July 2006, we retrospectively reviewed 245 patients who underwent reconstruction of the right ventricular outflow tract with various kinds of conduits. 410 operations were done in 245 patients, the mean age at operation was $3.2{\pm}4.9$ years (range: 7 days$\sim$45 years) and the mean body weight was $12.5{\pm}8.7\;kg$ (range: $2.4\sim76.3\;kg$). Result: We used the following conduits: Polystan conduit, Shelhigh conduit, Carpenter-Edward conduit, Dacron graft with an artificial valve, valveless Gore Tex vascular graft, homograft and hand-made bovine or autologous pericardial conduit. The mean follow up duration was $6.3{\pm}5.2$ years. Redo operation for RV-PA conduit dysfunction was performed in 131 patients, a second redo was done in 31 and a third redo was done in 3. The reoperation free rates were 67.3%, 48.5% and 39.4% for 5 years, 10 years and 15 years, respectively. The homograft showed the best durability, followed by the Dacron graft with artificial valve and the Carpentier-Edward conduit. The larger sized conduit showed better durability. Conclusion: The homograft showed lowest reoperation rate and a smaller size of conduit showed the highest reoperation rate. The reoperation rate for the RV-PA conduit was about 35% at 5 years, so it is mandatory to develop the more durable conduit for RV outflow.
Background : Bronchoscopy is an important diagnostic and a therapeutic tool in chest medicine. However, most patients feel that a bronchoscopy is an unpleasant procedure, and it is important to sedate the patients appropriately, particularly where repetitive examinations are required. Midazolam is a sedative drug with amnestic qualities and a rapid 2 hour half-life. This study have attempted to determine the safety, appropriate dosage, and the effect of midazolam premedication in patients who underwent a bronchoscopy. Methods : One hundred and eighty consecutive patients undergoing bronchoscopy were enrolled in this study. The patients received a midzolam doses of 0.03 mg/kg, 0.06 mg/kg, or a placebo. An additional dose of lidocaine, the total number of coughs, and the duration of the procedures were recorded with monitoring the the blood pressure, heart rate, and oxygen saturation. The level of satisfaction was assessed by the patient, bronchoscopist, and the nurse. Results : The blood pressure, pulse rates, oxygen saturation, number of coughs, lidocaine dose, and procedure time in the 3 groups were similar. There was a trend for the midazolam 0.03 mg/kg group to satisfy bronchoscopists more than the other two groups. The nurses' acceptability was lower in the midazolam 0.06 mg/kg group than the other groups. The patients' acceptablity was greater in both the midazolam 0.03 mg/kg and 0.06 mg/kg groups than in the control group. Conclusion : Sedation with low doses of intravenous midazolam is a safe technique for fiberoptic bronchoscopy with a low morbidity and high acceptable to patients and bronchoscopists.
Seo, Hyobin;Nam, Ju-Ock;Jeon, Byung-Duk;Kim, Pan-Gi;Ryu, Sungpil
Journal of Korean Society of Forest Science
/
v.101
no.4
/
pp.626-634
/
2012
The purpose of this study was to investigate the potential of persimmon vinegar as a functional beverage by analyzing the effects of persimmon vinegar ingestion on the energy substrate during endurance exercise. The healthy male adolescents (n=8) drunk persimmon vinegar ingested trial (PSV) or purified water ingested trial as the control trial (CON) 1 h prior to the exercise with the 60% of maximal oxygen uptake ($\dot{V}O_{2max}$) for 1 h. The exercise intensity was increased to the 80% of $\dot{V}O_{2max}$ and remained until exhaustion. And, the physiological variables, blood components, and amounts of energy oxidation were analyzed. There was no significant difference between trials in physiological variables, and the heart rates after exhaustion were higher in PSV compared to CON. There was no significant difference between trials in blood glucose level, while the blood lactic acids decreased significantly in PSV 30 and 60 minutes after onset of exercise. The free fatty acids concentration increased significantly in PSV from 15 minutes to 60 minutes after onset of exercise. The carbohydrate oxidation decreased significantly in PSV from 45 minutes after exercise and, on the contrary, the fatty acids oxidation increased significantly for the same period. And, fatty acids oxidation was higher in PSV compared to CON even after exhaustion. The respiratory exchange ratio was lower significantly in PSV compared to CON from 30 minutes to 60 minutes after exercise, whereas lower in CON after total exhaustion. The exercise time to exhaustion was 41% longer in PSV compared to CON. These results showed that the persimmon vinegar increase the level of lipids metabolism and decrease sense of fatigue by inhibiting carbohydrate oxidation during moderate intensity exercise, suggesting the possibility of using of persimmon vinegar as exercise functional beverage when ingested 1 h prior to the endurance exercise performance.
Background: We tested the effect of indomethacine and total spinal anesthesia on the improvement of placental flow during cardiopulmonary bypass on fetal lamb. Material and Method: Twenty fetuses at 120 to 150 days of gestation were subjected to bypass via trans-sternal approach with a 12 G pulmonary arterial cannula and 14 to 18 F venous cannula for 30 minutes. All ewes received general anesthesia with ketamine. In all the fetuses, no anesthetic agents were used except muscle relaxant. Ten served as a control group in which placenta was worked as an oxygenator during bypass (Control group). The remainder worked as an experimental group in which pretreatment with indomethacine and total spinal anesthesia was performed before bypass with the same extracorporeal circulation technique as control group (Experimental group). Observations were made every 10 minutes during a 30-minute bypass and 30-minute post bypass period. Result: Weights of the fetuses ranged from 2.2 to 5.2 kg. In Control group, means of arterial pressure decreased from 44.7 to 14.4 mmHg and means of Pa$CO_2$ increased from 61.9 to 129.6 mmHg at each time points during bypass. Flow rate was suboptimal (74.3 to 97.0 $m\ell$/kg/min) during bypass. All hearts fibrillated immediately after the discontinuation of bypass. On the contrary, in Experimental group, means of arterial pressure reamined higher (45.8 to 30 mmHg) during bypass (p<0.05). Means of Pa$CO_2$ were less ranging from 59.8 to 79.4 mmHg during bypass (P<0.05). Flow rates were higher (78.8 to 120.2 $m\ell$/kg/min) during bypass (p<0.05). There were slower deterioration of cardiac function after cessation of bypass. Conclusion: In this study, we demonstrated that the placental flow was increased during fetal cardiopulmonary bypass in the group pretreated with indomethacine and total spinal anesthesia. However, further studies with modifications of the bypass including a creation of more concise bypass circuit, and a use of axial pump are mandatory for the clinical application.
Background: Although great concerns have been raised regarding the suitability of the use of the radial artery as a bypass conduit after transradial catheterization, there has been no studies that examined this issue in Korea. The purpose of this study was to compare clinical and angiographic results of radial artery grafting between patients with and without previous transradial catheterization. Material and Method: From January 2000 to February 2004, a total of 93 patients underwent coronary artery bypass grafting using the radial artery: 49 patients received preoperative transradial catheterization for coronary angiography (group I) and 44 patients did not (group II). These patients were retrospectively reviewed. Result: There was no significant difference in sex ratio, age, clinical diagnosis, risk factors, ejection fraction and early clinical outcomes between two groups. The graft patency rates in groups I and II were both 100% in the internal thoracic artery and in the radial artery, and 85% and 86% in the saphenous vein. respectively. The stenosis-free graft patency in groups I and II were 93% and 81% in the radial artery respectively but no statistical significance was shown. Conclusion: There was no significant difference in graft patency at postoperative coronary angiography between two groups. Radial artery graft after transradial catherization seems to be suitable for bypass conduit in short-term analysis.
We reviewed our 18-year surgical experience of biventricular repair for double-outlet right ventricle. Material and Method: One hundred twelve consecutive patients (80 males and 32 females) who underwent biventricular repair for double-outlet right ventricle between May 1986 and September 2002 were included. We assessed risk factors for early mortality and reoperation. Reoperation-free survival rate and actual survival rate were analysed. Result: Most common type of ventricular septal defect was subaortic (n=58, 52%) and non-committed type was second most common (n=32, 29%). Four different surgical methods were used: intraventricular baffle repair (n=71 , 63%): right ventricle to pulmonary ariery conduit interposition or REV with left ventricle to aorta baffle repair (n=24, 21 .4%): arierial switch operation with left ventricle to pulmonary artery baffle (n=14, 12.5%): Senning atrial switch operation with left ventricle to pulmonary artery baffle (n=3, 2.7%). Thirty four patients(30%) underwent palliative procedures before definite repair. Twenty three patients (21%) required reoperations. There were 12 (10.7%) early deaths and 4 late deaths. Age younger than 3 months at repair (p=0.003), cardiopulmonary bypass and aortic cross clamp time (p=0.015, p=0.067), type of operation (arterial switch operation) (p <0.001) and type of ventricular septal defect (subpulmonic type) (p=0.002) were revealed as risk factors for early death in univariate analysis, while age under 3 months was the only significant risk factor in multivariate analysis. Patients younger than 1 year of age (p=0.02), pulmonary artery angioplasty at definitive repair (p=0.024), type of ventricular septal defect (non-committed) (p=0.001), type of operation (right ventricle to pulmonary artery conduit interposition and REV operation) (p=0.028, p=0.017) were risk factors for reoperation in univariate analysis but there was no significant risk factor in multivariate analysis. Follow-up was available on 91 survivals with a mean duration of 110.8$\pm$56.4 (2~201) months. 5, 10 and 15 year survival rates were 86.5%, 85% and 85% and reoperation free survival were 85%, 71.5%, 70%. Conclusion: Age under 3 months at repair, subpulmonic ventricular septal defect and arterial switch operation were significant risk factors for early mortality. Patients with non-committed ventricular septal defect and who underwent conduit interposition or REV operation were risk factors for reoperation. With careful attention to chose best timing and surgical approach depending on morphologic characteristics, biventricular repair for double outlet right ventricle can be achieved with good long-term outcome.
Background: Vocabularies originating from Chinese characters constitute an important common factor in the medical terminologies used 3 eastern Asian countries; Korea, China and Japan. This study was performed to comparatively analyze the medical terminologies of these 3 countries in the field of cardiopulmonary bypass (CPB) and; thereby, facilitate further understanding among the 3 medical societies. Material and Method: A total of 129 English terms (core 85 and related 44) in the field of CPB were selected and translated into each country's official terminology, with help from Seoul National University Hospital (Korea), Tokyo Michi Memorial Hospital(Japan), and Yanbian Welfare Hospital and Harbin Children Hospital (China). Dictionaries and CPB textbooks were also cited. In addition to the official terminology used in each country, the frequency of use of English terms in a clinical setting was also analyzed. Result and Conclusion: Among the 129 terms, 28 (21.7%) were identical between the 3 countries, as based on the Chinese characters. 86 terms were identical between only two countries, mostly between Korea and Japan. As a result, the identity rate in CPB terminology between Korea and Japan was 86.8%; whereas, between Korea and China and between Japan and China the rates were both 24.8%. The frequency of use of English terms in clinical practices was much higher in Korea and Japan than in China. Despite some inherent limitations involved in the analysis, this study can be a meaningful foundation in facilitating mutual understanding between the medical societies of these 3 eastern Asian countries.
This study was performed to evaluate cardiopulmonary depressant effects of enflurane (1.0 vol%) combined with propofol(0.25 mg/kg/min) compared with enflurane inhalation, and propofol infusion, respectively, in 18 healthy dogs premedicated with acepromazine and atropine. After bolus injection of propofol 5 mg/kg for induction and tracheal intubation, they were randomly assigned to 3 groups: propofol 0.5 mg/kg/min infusion (Group I, n=6), enflurane 2.5 vol% (Group II, n=6) and enflurane 1.0 vol% combined with propofol 0.25 mg/kg/min (Group III, n=6). Mean arterial Pressure (MAP), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) were depressed significantly in all groups, especially in Group II. MAP, SAP and DAP values of Group IIIwere higher than those of Group II, but lower than those of Group I. The changes of PaO$_2$, Pa$CO_2$and pHa were similar in all groups. Respiration rates were decreased in all groups 5 minutes after induction but maintained in normal range. Those of Group I were less depressant than those of Group II and Group III. Concentrations of $Na^+ and Cl^-$ were increased and those of $K^+$ were decreased in all groups, but their values were quitely similar. Heart rate was changed in small range and the value of Group I was higher than those of Group II and Group III. Body temperature was decreased significantly in all groups. Adverse effects like as muscle rigidity, nausea or vomiting and shivering were not appeared and apnea at induction was occured 6 dogs. From the these results, enflurane 1.0 vol% combined with propofol 0.25 mg/kg/min also could be applied for anesthesia in dogs.
The Journal of Korean Institute of Communications and Information Sciences
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v.38C
no.9
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pp.822-829
/
2013
Hypertension is one of the most common clinical diseases, with an increasing prevalence globally. Hypertension triggers various harmful consequences and affects multiple organs. Life-long care may be required in some cases. According to the Korea Center for Disease Control and Prevention, the prevalence of hypertension is gradually increasing. A 2011 survey revealed that 28.9% of Korean adults had hypertension. The prevalence rates were slightly higher among men than women. Accurate measurement of blood pressure(BP) is crucial to classify patients, to identify BP-related risks, and to inform correct treatment. For accurate blood pressure measurement, the use of a cuff bladder size appropriate for the mid-upper arm circumference(MUAC) is essential. Incorrect sized cuff bladder is one of the main causes of equipment error affecting sphygmomanometer accuracy. When commercial sphygmomanometers were examined, the cuff bladders differed from the dimensions specified in the ISO 81060-1:2007 standards. Undercuffing is responsible for a spurious overestimation of BP in patients with large arms leading to overdiagnosis of hypertension, whereas overcuffing (that is, use of relatively large cuffs with small arms), may be responsible for an opposite problem, leading to erroneous underestimation of BP levels. The cuff bladder sizes recommended by the American Heart Association(AHA) are an arm circumference(AC) of 17-25 cm for small-sized adults, AC of 24-32 cm for adults, AC of 32-42 cm for normal-sized adults, and AC of 42-50 cm for obese adults. In contrast, the AC of Korean adults ranges from 23-31 cm, belonging to a single type of adult bladder. Three types of bladders are necessary for Korean adults with an AC of 23-31cm. Hospitals often use one or two differently-sized Western cuffs for adult patients, which can yield inaccurate BP determinations. Cuff bladders with dimensions based on anthropometric reference data obtained from Koreans will aid hospitals to measure BP more accurately.
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