The Cardiovascular Effects of Thoracic Epidural Injection of Ropivacaine during Sevoflurane General Anesthesia / 대한마취과학회지

BACKGROUND: Thoracic epidural anesthesia (TEA) combined with general anesthesia is commonly used in major upper abdominal surgery. The advantages of this method is the suppression of the perioperative stress response, the improvement in endocardial perfusion, and the reduction of myocardial oxygen consumption, postoperative morbidity and mortality. In particular, this method reduces the level of postoperative ileus and intestinal anastomosis leakage during gastrointestinal surgery. However, there is the possibility of severe cardiovascular depression using this combination method. This study evaluates the cardiovascular effects of extensive TEA combined with sevoflurane general anesthesia. METHODS: Fifty patients scheduled subtotal gastrectomy were enrolled in this study. After administering a bolus injection of 20 ml of 0.375% ropivacaine through an epidural catheter during sevoflurane general anesthesia, mean arterial pressure, heart rate, stroke volume, cardiac output, and systemic vascular resistance measured by Hemosonic (HemoSonic(TM) 100, Arrow, USA) every 5 minutes over a 30-minute period after the injection. RESULTS: All the data showed a significant decrease from 5 minutes after the epidural bolus injection except for the stroke volume, but that was not important clinically. CONCLUSIONS: A thoracic epidural injection of 20 ml of 0.375% ropivacaine can be used safely during sevoflurane anesthesia without severe cardiovascular complications during upper abdominal surgery.

Transcutaneous Electrical Stimulation of the P6 Acupoint Reduces Postoperative Nausea after Minor Breast Surgery / 대한마취과학회지

BACKGROUND: The present study was undertaken to investigate whether the transcutaneous electrical stimulation of the P6 acupoint prevents postoperative nausea and vomiting (PONV) after minor breast surgery. METHODS: In this prospective, randomized, double-blind and placebo-controlled study, we investigated ASA I or II female patients who underwent minor breast surgery under general anesthesia using sevoflurane. We used a ReliefBand(R) device (NSTTM 600, Woodside Biomedical Inc, USA) for the transcutaneous electrical stimulation of the P6 acupoint. The patients were randomly divided into two groups; in the P6 group (n = 33) the activated ReliefBand(R) was placed at the P6 acupoint; in the placebo group (n = 33) the inactivated ReliefBand(R) was placed at the P6 acupoint. The ReliefBand(R) was applied 10 min before the end of surgery and it remained in place for 24 h. We evaluated the incidence and severity of PONV, and the need for palliative antiemetics during the first 6 h and 24 h after surgery. RESULTS: The incidence of nausea was significantly lower in the P6 group (33%) than in the placebo group (67%) during the first 24 h after surgery. The severity of nausea was also significantly lower in the P6 group than in the placebo group. However, the incidence of vomiting and the need for palliative antiemetics was not different between the two groups. CONCLUSIONS: Transcutaneous electrical stimulation of the P6 acupoint significantly reduced the incidence and severity of nausea, but not the incidence and severity of vomiting, for female patients undergoing minor breast surgery during the first 24 h after surgery.

The factors related with office worker's health perception

BACKGROUND: Recently, the concept of health is being extended to physical, mental and social aspects, which leads people to pursue health positively behavior. But the evaluation of health condition shows a tendency to be biased to functional side. It means the absence of well being sensation that anyone feels like he has poor health. In this case, even if he is in physically good health, he is not rated as healthy. We analyzed the relationship between one's health state and the factors related with health perception including health behavior, mind and social environment. METHODS: For a month of May 1996, we surveyed those who visited for Periodic medical check-up at one general hospital in Seoul. The questionnaire consisted of the total of 25 items ; diet behavior, weight control, coffee, coke, tea, drug use of, smoking, drinking, exercise, leisure, safety belts use, jay walking, sleep, stress, personality, anxiety, depression, occupational satisfaction, relationships with family and friends. Five point scale is used as the answer of each question item with high point as good living behavior. Among 406 who had sincerely answered the questionnaire, we divided them into healthy and unhealthy group and compared with the point of each question item and with the laboratory data(obesity, blood pressure, hemoglobin, fasting blood sugar, cholesterol and ALT). RESULTS: Among 406, the number of those who perceived themselves to be healthy was 175(43.1%, healthy group) and the one of those who did not was 231(56.9%, unhealthy group), The difference between both groups was not significant in distribution of sex, age, academic career, income and religion. In laboratory data and living behavior they showed same results, also. But the points of unhealthy group were significantly lower than those of healthy group in coffee, coke, tee, drugs usage, exercise, leisure, stress, personality, anxiety, depression, occupational satisfaction and relationship with family and friends. So was the total point of all items of unhealthy group in comparison with that of health group. In the case of male, the points of unhealthy group were significantly lower in smoking, safety belt use, fay walking, sleeping as well as the above items. On the contrary, in the case of female, both groups were not significantly different all item except exercise and leisure. CONCLUSIONS: Health perception is influenced by psychosocial factors and living behavior more than by physical health. Therefore family physician must be concerned about patient's living behavior, mental and social problems and must make an effort to change their perception of health as well as physical improvement.

The propensity to depression and anxiety in children

BACKGROUND: The goals of this study are to investigate the propensity to depression and anxiety in children, and also, to investigate its relationship to the family structure, their life events, and school achievement. We have attempted to aid the continuous and comprehensive management of children with depression and anxiety in a field of family practice. METHODS: A group of 797 boys and girls in 5th and 6th were selected grades a elementary school in their, In the area of ll-san and In-cheon city in August, 1997. Making use of the Kovacs' Children's Depression Inventory(CDI, 1977) and the Spielberger's State-Trait Anxiety Inventory for Children(STAIC, 1973), we investigated the propensity to depression and anxiety by self-rating. At the same time, the general characteristics(gender, age, resideuce, family structure), life events(death single parent, divorced family, death of a sibling, family discord between husband), and school achievement were investigated and assessed their relationship. RESULTS: The Children's Depression Inventory score was 11.69, the State Anxiety Inventory score was 31.51, and the Trait Anxiety Inventory score was 31.49. The CDI score were significantly higher in females, sixth year students, residents execpt for those living in an apartment or villa, and low school achievement group(P<0.01, P<0.05), There was no significance between CDI score and age, whether or not a dual-income family, death of a sib, hospitalization within 6 months, and family discord between husband and wife. The STAIC score was significantly higher for old age, female, sixth year students, and low school achieve menu group(P<0.01), and there was no significance between the STAIC score and residence, whether or not a dual-income family, death of a sibling, hospitalization within 6 months, and family discord between husband and wife. CONCLUSIONS: According to our results, there was a significant correlation between gender, school years, school achievement and a propensity to depression and anxiety. Therefore, family physician should be more involved in family intervention and anticipatory guidance upon medical examination and treatment, if he or she has a symptoms of anxiety and depression.

Influence of weight gain to cardiovascular risk factors

BACKGROUND: The obese patients increased recently in Korea due to excessive energy intake and decreased physical activity. We are well known that obesity is associted with an increased risk of cardiovascular disease, angina pectoris, hypertension, but not known to influence of weight gain to change in cardio-vascular risk factors. Once, the study of obesity are many but the study of influence of weight gain are small in Korea. This study investigated to influence of weight gain in cardio-vascular risk factors. METHODS: We gatherd case and control group among persons who has taken twice medical examination except disease person from October 1990 to October 1995 at SungAe General hospital. In our study, total 167 case, compare weight gain group(>3kg) with control group to change in cardiovascular risk factor. RESULTS: Sex, age, smoking history, obesity index were not statistically significant difference between two group in the first medical examination. systolic blood pressure, diastolic blood pressure, fasting blood sugar, HDL, total cholesterol/HDL were not statistically significant difference between two group for weight gain. Total cholesterol and triglyceride, LDL were stastistically significant increased. CONCLUSIONS: Weight gain was increased of total cholestrol and triglyceride, LDL, so weight control was important.

Zonulolytic Effects of Alpha-Chymotrypsin and Trypsin

Zonulolytic effects of alpha-chymotrypsin and trypsin were examined on rabbits' eyes using an apparatus which enables one to press the enucleated eyeballs. The time interval between the applications of enzymes and the protrusion of the lens was measured. The results showed that the trypsin was 4 to 5 times more effective than alpha-chymotrypsin.

Exophthalmos Inhibitory Effect of Anti-EPS Serum

Gold fishes were used to determine exophthalmos-inhibitory effect of anti-EPS serum. Anti-EPS Serum was obtained by repeated injection of serum from a patient of malignant exophthalmos to a guinea pig. The exophthalmos-inhibitory effect on fish was determined by measuring the intercorneal distance of fishes by the use of a micrometer before and after the injection of sera, and the percentage in that distance were calculated. The responsiveness of fishes was partly controlled by the injections of normal guinea pig serum and the serum from a patient of endocrine exophthalmos. The injections of the serum from the patient provoked exophthalmos. The injections of the serum from the patient, followed by the injections of normal serum of guinea pig provoked no exophthalmos. The injections of the patient's serum followed by injections of antiserum of guinea pig resulted in marked enophthalmos. These results suggest that the normal guinea pig serum and the antiserum from the guinea pig contains exophthalmos-inhibitory factor, and that this effect was greater in the serum treated by patient's serum.

Two Cases of Malignant Melanomas of Choroid

Two cases of malignant melanomas of the choroid were reported. The first case was 43 years old male. The tumor was found to be a mixed type with heavy pigmentation. The second case was 3 years old girl. The tumor cells infiltrated the sclera and the optic nerve with complete destruction of the choroid and extension to the extra-ocular portion was noted without encapsulation. The tumor was composed of spindle A type cells with scanty pigmentation. This second case was interesting due to the reported rare incidence of malignant melanoma in childhood. The statistics in Japan point to the relativelyfrequent occurrence in childhood suggesting the racial differences in the frequency of malignant melanomas in childhood.