• Childhood Kidney Diseases
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• v.1 no.2
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• pp.101-108
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• 1997

Purpose : The clinical characteristics of renovascular hypertension (RVHT) in children were analyzed. Methods : Medical records of 16 children diagnosed as RVHT on the basis of angiography during Jan. '86 to Jun. 94 in our hospital were reviewed retrospectively. Results : The mean age at the onset was 8.5 yrs and the sex ratio(M:F) was 7:9. The causes of RVHT were Takayasu arteritis in 6, Moyamoya disease in 5, and fibromuscular dysplasia in 3 patients. Abdominal bruit was noted in 6 patients (38%). Peripheral renin activity was raised in all tested patients. Bilateral renal arterial involvemnent was found in 9 patients (56%). Captopril renal scans showed good correlation with angiographic findings. Five patients were treated with antihypertensives only, and blood pressure was controlled completely in 2 and incompletely in 3. Percutaneous transluminal angioplasty was performed in 10 patients with 50% of success rate. However, hypertension was recurred due to restenosis or accompaning aortic stenosis in 3 patients. Surgical treatment was performed in 4 patients, and the blood pressure was controlled partially in 1 and poorly in the remaining 3. Conclusions : Takayasu arteritis, Moyamoya disease and fibromuscular dysplasia are the major causes of childhood RVHT in our country. The diagnosis of RVHT in children should be based on a set of tests individually selected for case by case. For the low curability of the current treatment modalities available, RVHT in children should not be regarded as 'curable' so far. We expect, however, that the outcome will be improved by more extensive application of the newly developed surgical technique.

• The Korean Journal of Physiology
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• v.23 no.2
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• pp.363-375
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• 1989

It has been well known that peripheral infusion of angiotensin II results in an increase of blood pressure, and an elevation of aldosterone secretion, and an inhibition of renin relase. However, the direct effect of angiotensin II on renal function has not been clearly established. In the present study, to investigate the effect of angiotensin II on renal function and renin release, angiotensin II (0.3, 3 and 10 ng/kg/min) was infused into a unilateral renal artery of the unanesthetized rabbit and changes in renal function and active and inactive renin secretion rate (ARSR, IRSR) were measured. In addition, to determine the relationship between the renal effect of angiotensin II and adenosine, the angiotensin II effect was evaluated in the presence of simultaneously infused 8-phenyltheophylline (8-PT, 30 nmole/min), adenosine A 1 receptor antagonist. Angiotensin II infusion at dose less than 10 ng/kg/min decreased urine flow, clearances of para-amino-hippuric acid and creatinine, and urinary excretion of electrolytes in dose-dependent manner. The changes in urine flow and sodium excretion were significantly correlated with the change in renal hemodynamics. Infusion of angiotensin II at 10 ng/kg/min also decreased ARSR, but it has no significant effect on IRSR. The change in ARSR was inversely correlated with the change in IRSR. The plasma concentration of catecholamine was not altered by an intarenal infusion of angiotensin II. In the presence of 8-PT in the infusate, the effect of angiotensin II on renal function was significantly attenuated, but that on renin secretion was not modified. These results suggest that the reduction in urine flow and Na excretion during intrarenal infusion of angiotensin II was not due to direct inhibitions of renal tubular transport systems, but to alterations of renal hemodynamics which may partly be mediated by the adenosine receptor.

• The Korean Journal of Physiology
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• v.27 no.2
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• pp.185-197
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• 1993

The rostral ventrolateral medulla (RVLM) includes vasopressor neurons, which transmit activation signals to the intermediolateral nucleus (IML) of the spinal cord, where the preganglionic sympathetic nucleus is located, to raise arterial blood pressure (BP). However, controversy exists as to the possible depressor area in the RVLM and the pathway involved. The present study persued evidence far the location of depressor neurons and the pathway by simultaneously observing changes in BP and the firing rate (FR) of cardiovascular neurons (CVNs) in the RVLM during the somatosympathetic reflex (SSR) elicited by peripheral nerve stimulation, since CVNs are known to contribute to the generation of the sympathetic nerve discharge. In 42 cats, anaesthetized with $\alpha-chloralose$, single unit recording was performed, using carbon filament electrodes inserted into the RVLM, enabling estimation of the post R wave unit histogram (PR-UNlT) and the spike triggered average of sympathetic nerve discharge (STA-SND), allowing identification of CVNs. Antidromic stimulation of spinal $T_2$ segment was followed to determine whether the identified CVN projects axonal endings to the spinal cord (reticulospinal neuron). The sciatic nerve was electrically stimulated at $A\delta-intensity$ (1 mA, 0.1 ms), 1 Hz and C-intensity (10 mA, 0.5 ms), 20 Hz to elicit the depressor, and pressor responses of the SSR, respectively. Simultaneous measurement of CVN firing rate was made. Experimental results are summarized as follows. 1) 20 out of 98 CVNs had axonal projections to the spinal cord and 17 out of 98 CVNs showed FR changes during SSR. 2) Response patterns of FR and BP during SSR were classified into 8 types. 3) These 8 different response patterns could be further classified into those from pressor and depressor neurons. These results demonstrate that some CVNs were identifiable as reticulospinal neurons responding to anti-dromic stimulation and that CVNs operating as depressor neurons as well as pressor neurons exist in the RVLM, both of which are involved with SSR mediation. Therefore, evidence was found that an independent depressor pathway might be involved in the mediation of SSR.

• The Korean Journal of Pharmacology
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• v.28 no.1
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• pp.49-60
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• 1992

This study was designed to evaluate the responses of cardiovascular system to endothelin (ET) and neuropeptide Y (NPY) in 12 week-old SHR treated with or without enalapril (ENP) for 6 weeks. The diastolic blood pressure and heart rate were lower in ENP-treated SHR than in control. The pressor response to intravenous, but not intracerebroventricular, ET or NPY was attenuated by ENP treatment. The chronotropic action induced by electrical stimulation was attenuated by ENP or ET. The negative chronotropic action of ET was blocked by yohimbine. The increase in aortic tension induced by electrical field stimulation (EFS) was depressed in ENP-treated group as compared with non-treated group, and enhanced by ET, but not NPY, in the non-treated group. The ET-induced increase in tension was enhanced by removal of endothelium in the control group but not in ENP-treated group. The plasma concentration of norepinephrine and ET-induced increase in concentration of norepinephrine and epinephrine in plasma were decreased in ENP-treated group. These results suggest that preventive effect of enalapril on the development of hypertension may result from depressing vasoactive action of endothelin and neuropeptide Y, and sympathetic neurotransmission at peripheral nervous system.

• The Korean Journal of Pharmacology
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• v.18 no.2
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• pp.59-67
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• 1982

1) Oxymetazoline, which has been known as an agonist for${\alpha}_1-adrenoceptor$ in various peripheral tissues, caused a pressor response in urethane-anesthetized rabbits when given intra-ventricularly. This pressor response was little affected by pretreatment of rabbits with i.v. guanethidine or chlorisondamine, but it was weakened in rabbits pretreated with either of i.v. phentolamine or guanethidine and chlorisondamine and in guanethidine-pretreated adrenal-ligated rabbits. 2) The pressor to intraventricular oxymetazoline was markedly attenuated by intraventricular pretreatment with prazosin, whereas intraventricular pretreatment with yohimbine or piperoxan did not affect this response. 3) Reserpine-pretreated rabbits also responded with hypertension to intraventricular oxymetazoline, which was markedly diminished by pretreatment with intraventricular prazosin but not affected by yohimbine. 4) Oxymetazoline, given intravenously, produced a pressor response in both whole and spinal rabbits. Intravenous prazosin, phentolamine and yohimbine, in this order, showed greater antagonizing effect to this pressor response. 5) The results indicate that oxymetazoline acts an agonist for ${\alpha}_1-adrenoceptors$ in the rabbit brain participating in the regulation of the blood pressure and in the vasculature of rabbits.

• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.1
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• pp.1-7
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• 2013

Background: Intravenous sedation is effective for dental patients who are anxious. Recently, target-controlled infusion (TCI) has begun to be used widely to administer and titrate propofol and remifentanil during sedation. To investigate the effect and safety of the pharmacologic agents used in anesthetic department, we performed a retrospective study. Methods: Retrospective study of a series of dental procedure under intravenous sedation performed in department of anesthesiology in Dental Hospital of Dankook University was carried out with propofol or propofol/remifentanil between January and August 2011 and January and April 2012. All patients received oxygen by nasal cannula. The average propofol and remifentanil target was 0.5 ${\mu}g/ml$ and 1.0 ng/ml, respectively using a TCI pump. The average peripheral oxygen saturation ($SpO_2$), heart rate, blood pressure, respiratory rate, nasal end-tidal $CO_2$ were recorded at 5-10 minute intervals. The age, gender, weight, procedure and sedation time, type of procedure were also recorded. Results: We included 22 cases of 19 adults (group A) and 6 cases of children (group B). In group A, 4 patients received propofol (group A-P), and 15 patients received propofol with remifentanil (group A-PR). In group B, 6 patients received propofol only. The mean age of group A was 41.1 years old and that of group B was 9.5 years old. No clinically significant complications were noted. There were no case of de-saturation <90%. The median respiratory rate was 13.1 (range 6 to 36) in group A and 19 (range 13 to 25) in group B. The median end tidal $CO_2$ was 36.7 mmHg(range 8 mmHg to 56 mmHg) in group A and 41.7 mmHg (range 30 mmHg to 53 mmHg) in group B. Conclusions: Based on our results, dental sedation using propofol/remifentanil in adult and propofol in children with TCI pump seems to appear as a safe and effective procedure while performing dental procedure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.4
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• pp.229-238
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• 2017

Objectives: The primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intravenous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction. Materials and Methods: Clinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer's assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the P-value was set at 0.05. Results: Most patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; however, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; P=0.005) and higher dental anxiety (OR, 5.744; P=0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; P=0.002) and higher BIS right before MDZ administration (OR, 1.379; P=0.029) had relevance to patient dissatisfaction. Conclusion: The preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral surgery under IVS. The amnesia about the procedure affects patient satisfaction positively.

• Proceedings of the KOSOMBE Conference
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• v.1996 no.05
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• pp.84-87
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• 1996

We have been developed electrohydraulic left ventricular assist device and done various in vivo evaluation on the device. Through the in vivo experiment conducted from Jan. 23, 1996 to Feb. 8, we could have experience of long-term evaluation fur the first time. The sheep used in this experiment had survived for 16 days. We used new actuator with reduced size and linear motion guide replacing oil box and ball bearings. Also, we used improved blood chamber with reduced size, reduced weight facilitating fixing the chamber to animal's body, and polymer sac having improved folding pattern. Against suction problem, we used absolute pressure limiter only. Motor current for driving this new actuator was not much higher than older one. Effective stroke volume was about 48 cc. Thrombosis was found around top area and peripheral boundary of the sac and valves. There was no sign of damage from suction problem in the atrium observed at autopsy. Main cause of death was presumed to be progressive formation of thrombosis in the cannulae. In this paper, the results of this experiment are documented.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.191-198
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• 1996

Amrinone is a non-glycosidic, non-adrenergic positive inotropic agent with peripheral and coronary vasodilator effect. It inhibits phosphodiesterase F-III, the cardiac cyclic-AMP specific phosphodiesterase, selectively and potently. In this study, the effects of IV administered amrinone and dopamine were compared in 40 patients who had open heart surgery. Amrinone was administered as a bolus of 1 5~2mglkg for several minutes, followed by continuous infusion at 5~1 Oug/kg/min. The hemodynamic measurements including heart rate, systolic and diastolic pressure, cardiac index, pulmonary wedge pressure, and systemic vascular resistance were recorded immediately for 12~24 hours awl 7th day following operation. In amrinone group, cardiac index increased from 3.73$\pm$1.39 L/min/m2 to 5.44$\pm$2.65 L/min/m2 at the time of posterative 48 hours (n=20, p< 0.05). The decrease in systemic vascular resistance from 1237.5 $\pm$ 637.7 dyne/sec/cm2 to 1000.8 $\pm$ 608.5 dyne/sec/cm2(p<0.05). In Dopamine group, the heart rate increased from 92.1 $\pm$ 13.0/min to 101.0 $\pm$ 13.1/min and the cardiac index decreased from 3.40 $\pm$ 0.50 L/min/m2 to 2.53 $\pm$ 1.15 L/min/m2 at the time of postoperative 12 hours(p<0.05). Systemic vascular resistance increased from 1058.5 $\pm$ 234.6 dyne/sec/cm2 to 1979.7 $\pm$ 759.2 dynelsec/cm2 The comparison of the hemodynamic effects of amrinone and dopamine, both drugs improved cardiac performance. But the administration of amrinone results in a higher cardiac index, diastolic blood pressure and lower systemic vascular resistance than those achieved with dopamine (p<0.05). The uniqueness of the action of amrinone on the heart and its sustained hemodynamic effect suggest it has clinical promise, pos operative care of cardiac surgery

• Tuberculosis and Respiratory Diseases
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• v.40 no.1
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• pp.16-22
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• 1993

Background: The Microbicidal and cytotoxic activities of neutrophils are to a large extent dependent on a burst of oxidative metabolism which generates superoxide anion, hydrogen peroxide, and other reactive products of oxygen. The respiratory burst of PMN is initiated by intracellular calcium mobilization that follows immune or particular stimulation and is very sensitive to modulation by c-AMP or adenosine. Despite its antagonism against adenosine, earlier study has demonstrated potent theophylline inhibition of the PMN respiratory burst at variable ranges of blood concentrations of theophylline in the healthy normal volunteers and in the septic animals pretreated or early post-treated with aminophylline (AMPH) or pentoxifylline. However it is unclear whether theophylline inhibits the superoxide generation or not in the established human sepsis caused by acute pneumonia, as taking into consideration of the fact that full activation of neutrophils have occurred within minutes after the septic insult in the animal experiments. Methods: We measured the $O_2$ generation of peripheral arterial neutrophils obtained from 11 human septic subjects caused by acute pneumonia before and 1 hour after completion of continuous AMPH infusion. Patients were identified and studied within 48 hour of admission. All subjects were administered an intravenous loading and maintenance dose of AMPH. The generation of $O_2$ was measured at a discrete time point (60 min) by the reduction of ferricytochrome c.PMA (10 ${\mu}g/ml$) was used as a stimulating agent. PMNs were isolated at a concentration of $2{\times}10^6$ cells/ml. The arterial oxygen tension, blood pressure and heart rates were also checked to evaluate the systemic effects of AMPH in the acute pneumonia. Results: The mean serum concentration of AMPH at 60 minutes was $8.8{\pm}0.6{\mu}g/ml$. Sixty minutes after AMPH infusion the generatition of $O_2$ was decreased from $0.076{\pm}0.034$ to $0.013{\pm}0.004$(OD) (p<0.05) and from $0.177{\pm}0.044$ to $0.095{\pm}0.042$(OD) (p<0.01) in the resting and stimulated PMNs respectively. $PaO_2$ was not changed after AMPH infusion. Conclusion: AMPH may compromise host defense by significant inhibition of neutrophil release of superoxide anion and it had no effect on improving $PaO_2$ in the acute pneumonia.