• Tuberculosis and Respiratory Diseases
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• v.40 no.2
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• pp.135-146
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• 1993

Background: In acute pulmonary embolism it has been postulated that the constriction of bronchi and pulmonary artery secondary to neurohumoral response plays an important role in cardiopulmonary dysfunction in addition to the mechanical obstruction of pulmonary artery. Serotonin is considered as the most important mediator. Positive end expiratory pressure (PEEP) stimulates $PGI_2$ secretion from the vascular endothelium, but its role in acute pulmonary embolism is still in controversy. Methods: To study the cardiopulmonary effect and therapeutic role of Ketanserin, selective antagonist of 5-HT2 receptor, and PEEP in acute pulmonary embolism experimental acute pulmonary embolism was induced in dogs with autologous blood clot. The experimental animals were divided into 3 groups, that is control group, Ketanserin injection group and PEEP application group. Results: Thirty minutes after embolization, mean pulmonary arterial pressure and pulmonary vascular resistance increased and cardiac output decreased. $PaO_2,\;P\bar{v}O_2$ and oxygen transport decreased and physiological shunt and $PaCO_2$ increased. After injection of Ketanserin, comparing with control group, mean pulmonary arterial pressure, pulmonary vascular resistance and physiological shunt decreased, while cardiac output, $PaO_2$ and oxygen transport increased. All these changes sustained till 4 hours after embolization. After PEEP application pulmonary vascular resistance, $PaO_2$ and $PaCO_2$ increased, while physiological shunt, cardiac output and oxygen transport decreased. After discontinuation of PEEP, mean pulmonary arterial pressure and pulmonary vascular resistance decreased and were lower than control group, while $PaO_2$ and cardiac output increased and higher than control group. $PaCO_2$ decreased but showed no significant difference comparing with control group. Conclusion: It can be concluded that Ketanserin is effective for the treatment of acute pulmonary embolism. With PEEP hemodynamic status deteriorated, but improved better than control group after discontinuation of PEEP. Thus PEEP may be applied carefully for short period in acute pulmonary embolism if the hemodynamic status is tolerable.

• 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.

• Journal of muscle and joint health
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• v.22 no.3
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• pp.160-166
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• 2015

Purpose: The purpose of this study is to examine the effect of leg crossing on reducing orthostatic hypotension and orthostatic hypotension symptoms in hemodialysis patients. Methods: A one-group pretest-posttest design was used. A total of 40 post-hemodialysis adult patients were enrolled, excluding the case of intradialysis hypotension, unbalance of standing with leg crossing, adding antihypertensive medications. Blood pressure (BP) and heart rate (HR) were measured in supine and standing positions. After a week, BP and HR were measured in supine and standing with leg crossing position. Orthostatic hypotension symptoms were also measured by self-reported structured questionnaire in standing without leg crossing and with leg crossing position. Results: We found out that systolic blood pressure, diastolic blood pressure, and mean arterial pressure increased significantly in standing with crossing leg position applied (p=.006, p=.001, p=.006). However, presences of orthostatic hypotension symptoms were not significantly decreased in standing with leg crossing position (p=.500, p=.318, p=.306, p=.241, p=.356, p=.500, p=.241, p=.308). Conclusion: This study shows that leg crossing is effective for reducing orthostatic hypotension without additional cost or instruments. Leg crossing as one of the preventive interventions to reduce orthostatic hypotension is easier and simpler to be implemented in hemodialysis patients.

• Biomolecules & Therapeutics
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• v.8 no.4
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• pp.325-331
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• 2000

The present study was designed to assess the role of spinal adenosine $A_2$ receptor in the regulation of cardiovascular functions such as mean arterial pressure (MAP) and heart rate (HR) in male Sprague-Dawley rats. Rats (250~300 g) were anesthetized with urethane and paralyzed with d-tubocurarine and artificially ventilated. blood pressure and HR were continuously monitored via a femoral catheter connected to a pressure transducer and a polygraph. Drugs were administered intrathecally using injection cannula through guide cannula which was inserted inthrathecally at lower thoracic level through a puncture of an atlantooccipital mombrane. Intrathecal injection of an adenosine $A_2$ receptor agonist, 5'-(N-cyclopropyl)-carboxamaidoadenosine (CPCA; 1, 2 and 3 nmol, respectively), produced a dose-dependent decrease in MAP and HR. Pretreatment with $N^{G}$-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor or 10 nmol of MDL-12,330, an adenylate cyclase inhibitor blocked significantly the depressor and bradycardic effect of 2 nmol of CPCA. But, Pretreatment with 3 nmol of bicuculline, gamma-aminobutyric acid A (GAB $A_{A}$) receptor antagonist, or 50 nmol of 5-aminovaleric acid, GAB $A_{B}$ receptor antagonist did not inhibit the depressor and bradycardic effect of 2 nmol of CPCA. These results indicate that adenosine $A_2$ receptor in the spinal cord plays an inhibitory role in the regulation of cardiovascular function and that the depressor and bradycardic action of adonosine $A_2$ receptor are mediated via the synthesis of nitric oxide and the activation of adenylate cyclase in the spinal cord of rats.s.s.s.

• Journal of Electrical Engineering and Technology
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• v.2 no.1
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• pp.136-141
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• 2007

The Purpose Of This Paper Is To Use A Tactile Sensor To Compensate The Error Rate. Most Automated Sphygmomanometers Use The Oscillometric Method And Characteristic Ratio To Estimate Systolic And Diastolic Blood Pressure. However, Based On The Fact That Maximum Amplitude Of The Oscillometric Waveform And Characteristic Ratio Are Affected By Compliance Of The Aorta And Large Arteries, A Method To Measure The Artery Stiffness By Using A Tactile Sensor Was Chosen In Order To Integrate It With The Sphygmomanometer In The Future Instead Of Using Photoplethysmography. Since Tactile Sensors Have Very Weak Movements, Efforts Were Made To Maintain The Subject's Arm In A Fixed Position, And A 40hz Low Pass Filter Was Used To Eliminate Noise From The Power Source As Well As High Frequency Noise. An Analyzing Program Was Made To Get Time Delay Between The First And Second Peak Of The Averaged Digital Volume Pulse(${\Delta}t_{dvp}$), And The Subject's Height Was Divided By ${\Delta}t_{dvp}$ To Calculate The Stiffness Index Of The Arteries($Si_{dvp}$). Regression Equations Of Systolic And Diastolic Pressure Using $Si_{dvp}$ And Mean Arterial Pressure(Map) Were Computed From The Test Group (60 Subjects) Among A Total Of 121 Subjects(Age: $44.9{\pm}16.5$, Male: Female=40:81) And Were Tested In 61 Subjects To Compensate The Error Rate. Error Rates Considering All Subjects Were Systolic $4.62{\pm}9.39mmhg$, And Diastolic $14.40{\pm}9.62mmhg$, And Those In The Test Set Were $3.48{\pm}9.32mmhg,\;And\;14.34{\pm}9.67mmhg$ Each. Consequently, Error Rates Were Compensated Especially In Diastolic Pressure Using $Si_{dvp}$, Various Slopes From Digital Volume Pulse And Map To Systolic-$1.91{\pm}7.57mmhg$ And Diastolic $0.05{\pm}7.49mmhg$.

• Journal of Chest Surgery
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• v.54 no.2
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• pp.81-87
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• 2021

Background: Artificial grafts such as polyethylene terephthalate (Dacron) and expanded polytetrafluoroethylene (ePTFE) are used for various cardiovascular surgical procedures. The compliance properties of prosthetic grafts could affect hemodynamic energy, which can be measured using the energy-equivalent pressure (EEP) and surplus hemodynamic energy (SHE). We investigated changes in the hemodynamic energy of prosthetic grafts. Methods: In a simulation test, the changes in EEP for these grafts were estimated using COMSOL MULTIPHYSICS. The Young modulus, Poisson ratio, and density were used to analyze the grafts' material properties, and pre- and post-graft EEP values were obtained by computing the product of the pressure and velocity. In an in vivo study, Dacron and ePTFE grafts were anastomosed in an end-to-side fashion on the descending thoracic aorta of swine. The pulsatile pump flow was fixed at 2 L/min. Real-time flow and pressure were measured at the distal part of each graft, while clamping the other graft and the descending thoracic aorta. EEP and SHE were calculated and compared. Results: In the simulation test, the mean arterial pressure decreased by 39% for all simulations. EEP decreased by 42% for both grafts, and by around 55% for the native blood vessels after grafting. The in vivo test showed no significant difference between both grafts in terms of EEP and SHE. Conclusion: The post-graft hemodynamic energy was not different between the Dacron and ePTFE grafts. Artificial grafts are less compliant than native blood vessels; however, they can deliver pulsatile blood flow and hemodynamic energy without any significant energy loss.

• Journal of Life Science
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• v.19 no.11
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• pp.1568-1574
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• 2009

The purpose of this study was to investigate whether group III muscle afferents play an important role eliciting abnormal blood pressure response mediated during passive muscle stretch in prehypertensive individuals. Eleven middle-aged prehypertensive men (average BP 133/80 mmHg) and nine middle-aged normotensive men (average BP 119/74 mmHg) participated in this study. After 1 min rest baseline data collection, the subject's foot was flexed (dorsiflexion) by an automated cybex for one minute. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate, stroke volume, cardiac output, and total peripheral resistance were continuously measured on a beat-by-beat basis from a finger via a Finapres device for 1 minute. To evaluate the role of mechanoreflex, a component of exercise pressor reflex, SBP, DBP, and MAP responses over the course of time were examined. The results showed that the pressor response mediated by the muscle mechanoreflex was faster in prehypertensive individuals compared to the normotensive individuals. The substantial pressor response was observed within mean 20 sec of the onset of passive stretch in prehypertension, while mean 45 sec in normotension (p<0.05). It is concluded that excessive pressor response produced during exercise in prehypertension may be due to the dysfunction of the mechano-receptors.

• Journal of Chest Surgery
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• v.25 no.3
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• pp.307-314
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• 1992

The internal mammary artery has been advocated for use in bypass grafting owing to its superior long-term patency when compared to saphenous vein grafts. Concern exists that the flow through internal mammary artery may be inadequate during periods of peak myocardial demand when the internal mammary artery graft was used for proximal left anterior descending artery stenosis. This flow adequacy was investigated in 13 consecutive patients with a mean proximal left anterior descending artery stenosis of 84.2% who were selected for coronary bypass using internal mammary artery. We checked flow and diameter of left internal mammary artery without intraluminal dilatation just before anastomosis to left anterior descending artery during cardiopulmonary bypass. Clinical results were evaluated postoperatively with clinical symptoms, echocardiographies, stress tests, and coronary angiographies. The mean internal mammary artery flow measured just before anastomosis was 38ml/ min[range of 20 to 80ml /min] and its mean internal diameter 1.4mm. Maximal workload was improved from preoperative value of 6.3$\pm$2.5METS to postoperative value of 9.1$\pm$1.4 METS in 9 patients who Paired-test can be used. Cardiac symptoms recurred in two patients after bypass surgery, but they were not related to left internal mammary artery grafts. All patients were discharged in postoperatively 9.3 days[range of 7 to 20 days] after operation without mortality. Thus, on the basis of these findings, the internal mammary artery is a reasonable graft that we can routinely use for proximal left descending artery stenosis if internal diameter of the internal mammary artery is more than 1.0mm and its flow is more than 20ml /min at mean arterial pressure of 50 to 60mmHg during cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.22 no.2
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• pp.179-190
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• 1989

The experimental study for extracorporeal preservation of the heart-lung preparation by autoperfusion system was performed in 10 dogs. Under intravenous Pentothal endotracheal anesthesia bilateral thoracotomies were performed. A 24F cannula connected to a plastic reservoir bag located 100 cm above the level of the heart was introduced into the aortic arch. Left subclavian, innominate artery, and descending aorta were ligated and divided. Both vena cavae were ligated and divided after the bag was half filled with blood. A 24F catheter inserted into right atrium and connected to the plastic bag in order to keep constant the preload. The thoracic trachea was intubated and the lungs were ventilated. The heart-lung preparations were removed en bloc and floated in a $34^{\circ}C$ bath of Hartmann solution. The preparations were observed for from 2 hours to 8 hours, with the average of 5.2 hours. Hemodynamic and hematologic variables were measured during preharvest and autoperfusion. The pH revealed severe respiratory alkalosis due to very low $PaCO_2$ during autoperfusion ; $PaO_2$ remained constant for 130-140 mmHg; $A-aDO_2$ increased markedly. The static inspiratory pressure [SIP] at late autoperfusion [6hr] increased significantly as compared with at early autoperfusion [2hr]. There was no difference between white blood cell counts from right atrium and those of left atrium. Heart rates remained constant for 110-120/min; cardiac outputs maintained to approximately 0.6L/min; mean aortic pressures, 75 mmHg; mean pulmonary arterial pressures, 15-18 mmHg; mean right atrial pressures, 9-13 mmHg; mean left atrial pressures, 12 mmHg lower than those of right atrium. Serum Na maintained with normal range during autoperfusion; K increased significantly; Ca decreased progressively. Hemoglobin and hematocrit decreased significantly during autoperfusion. The study demonstrated that stable hemodynamics could be maintained throughout the experiment and the preparation of the lung seemed to be inadequate, especially after 3-4 hours, such as high $A-aDO_2$, increased SIP, and scattered atelectasis and edema in their gross appearances.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.574-581
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• 1985

Surgical treatment for PDA has been pivotal in historical development of surgery for congenital heart disease. A clinical study on 36 cases of operated PDA were performed during period from Aug. 1981 to Jul. 1985 at the Department of Thoracic & Cardiovascular Surgery in Chonbuk University. The following results are obtained. 1. The 8 males and 28 females ranged in age from 2 yrs, to 24 yrs, [mean 11 yrs.] 2. Chief complaints of the patients were dyspnea on exertion in 61%, palpitation in 39%, frequent URI in 12%, and no subjective symptoms in 11%. 3. On auscultation, continuous machinery murmur heard in 94% and systolic in 14%. 4. Radiologic findings of chest P-A showed increased density of pulmonary vascularity in 94%, cardiomegaly in 69%, and within normal limits in 5% of the patients. 5. EKG findings of the patients revealed LVH in 69%, RVH in 6%, BVH in 6%, and within normal limits in 17%. 6. Of the 36 patients, cardiac catheterization was performed in 34 patients. The results showed mean Qp/Qs = 2.25, mean Pp/Ps=0.42, and mean systolic pulmonary arterial pressure=53mmHg. 7. Surgical methods were as followed: The 32 case of ductal ligation and one case of division & suture technique for PDA through the left posterolateral thoracotomy were done. And 2 cases of ductal ligation one suture closure through the pulmonary artery were performed under the cardiopulmonary bypass. 8. Intraoperative complication was ductal rupture with division 8< suture for PDA and transient hoarseness in 1, recanalization in 1, and urethral stricture in 1 case postoperatively. 9. One patient died due to ductal rupture intraoperatively and operative mortality was 2.8%.