Association between lead exposure and increased risk of bronchial asthma in Korean adolescents

PURPOSE: Several studies have reported an association between lead exposure and increased risk of allergic sensitization and asthma. According to the Centers for Disease Control and Prevention guidelines, An elevated blood lead level (BLL) is defined as a BLL of ≥5 µg/dL. However, no safe BLL has been identified, and it is controversial whether a BLL of <5 µg/dL affects the risk of asthma. METHODS: We examined asthma prevalences and BLLs using data from the 2010–2013 Korea National Health and Nutrition Examination Survey (KNHANES), which was a cross-sectional survey of 1,478 adolescence (aged 10–19 years) throughout the country. The adjusted odds ratios (ORs) (with 95% confidence intervals [CIs]) for the prevalence of asthma in adolescence with elevated BLLs were calculated by complex samples multivariate logistic regression analysis. The presence of asthma was based on self-reported, physician-diagnosed asthma in the Health Interview Surveys. RESULTS: The mean of total BLLs was 1.33 µg/dL. Overall, 5.1% (n=71) of the subjects were physician diagnosed asthma. In the model controlling for population characteristics, the adjusted odds ratio for asthma per 1 µg/dL increase in blood lead was 1.94, 95% CI (1.06, 3.57), and stronger associations were observed among boys (adjusted OR, 2.31; 95% CI, [1.18, 4.51]). The group of BLL≥2 µg/dL was associated with an OR of 2.84 (95% CI, 1.06, 7.63) for asthma, after adjusting for potential confounding factors in boys. CONCLUSION: Our results suggest an association between total BLLs and asthma in Korean adolescent boys, although confirmation is warranted in further prospective studies.

Recovery from Rocuronium-induced Neuromuscular Blockade during Sevoflurane or Propofol Anesthesia in Pediatric Patients / 대한마취과학회지

BACKGROUND: Potent inhalation anesthetics potentiate the neuromuscular blocking effects of non-depolarizing muscle relaxants. Therefore, sevoflurane may increase the safety margin at the end of anesthesia by reducing the muscle relaxant dose requirements. We studied the recovery from rocuronium-induced neuromuscular blockade during sevoflurane- versus propofol-based anesthesia in children. METHODS: Fifty pediatric patients were randomly allocated to maintenance of anesthesia with sevoflurane (n = 25) or propofol (n = 25). Neuromuscular block was maintained with rocuronium and monitored by acceleromyography (TOF-Watch?) using train-of-four (TOF) stimulation every 12 seconds. Anesthetic agent administration was gradually reduced and then stopped toward the end of procedure. At the end of surgery, neostigmine 0.04 mg/kg was administered. Time of tracheal extubation, time of arrival in PACU, amount of rocuronium given were recorded. RESULTS: TOF ratio at the end of surgery was greater in sevoflurane group (73.0 +/- 30.0) than in propofol group (50.0 +/- 37.1)(P < 0.05). The dose of rocuronium administered as supplemental increments in sevoflurane group was significantly smaller than that in propofol group (0.9 +/- 1.6 vs 2.8 +/- 2.4microgram/kg/min)(P < 0.05). Time to extubation (7.3 +/- 2.0 vs 9.0 +/- 2.6 min), and time to arrival in PACU (11.5 +/- 2.9 vs 13.9 +/- 2.6 min) from end of surgery were shorter in sevoflurane group than in propofol group (P < 0.05). CONCLUSIONS: These results support the postulate that the potentiation of neuromuscular block by sevoflurane may provide additional safety for pediatric patients by reducing the muscle relaxant dose requirements.

Morbidity and Mortality Analysis after Noncardiac Surgery in Patients with Prior Myocardial Infarction / 대한마취과학회지

BACKGROUND: Patients with a prior myocardial infarction who undergo noncardiac surgery have a higher risk of perioperative morbidity and mortality. Therefore, this study was designed to assess the outcomes after non-cardiac surgery in patients who had a previous myocardial infarction. METHODS: Ninety three patients who had a prior myocardial infarction and underwent noncardiac surgery were included in this study. The patients were divided as follows: the Complication group versus the Non-Complication group. A retrospective analysis was performed to determine if age, gender, ejection fraction, prior coronary revascularization, ASA physical status, operation time and type, perioperative vital signs, cardiac risk factor, preoperative medications and coronary multivessel disease influence the perioperative morbidity and mortality. RESULTS: Fourteen of the 93 patients (15.1%) had perioperative complications, of which 3 (3.2%) were fatal. All fatal patients had undergone noncardiac surgery within 3 months after the previous coronary revascularization. The incidence of intraoperative tachycardia and oliguria, operation time and the ASA physical status were longer and greater in the Complication group (P<0.05). Otherwise there were no significant differences between the two groups. CONCLUSIONS: The incidence of intraoperative tachycardia and oliguria, the operation time and ASA physical status influence the outcomes after noncardiac surgery of patients with a prior myocardial infarction. In addition, the interval between the coronary revascularization procedure and the noncardiac surgery has a major impact on postoperative mortality. However, prospective multi-center studies will be needed to determine the effects of several variables.

Dynorphin A (1-17) was Selective tomicro-Opioid Receptor in Agonist-Stimulated 35S GTPgammaS Binding in Cortical and Thalamic Membranes of Monkey / 대한마취과학회지

BACKGROUND: Dynorphin A (1-17) is conceived as an endogenous opioid peptide with a high degree of selectivity forkappa- opioid receptor even though it has been reported to sometimes act like amicro- opioid agonist. The aim of this study was to investigate [35S] GTPgammaS binding stimulated activation by dynorphin A (1-17) in the cerebral and thalamic membranes of a rhesus monkey. METHODS: The rhesus monkey (Macaca mulatta, male, n = 1) was euthanized for the preparation of the cerebral and thalamic membranes. Protein concentrations were determined by the Bradford method. In the dynorphin A (1-17)-stimulated [35S] GTPgammaS binding dose-response curve, EC50 (effective concentration 50 nM) and maximum stimulation (% over basal) were determined in the absence or presence of themicro-andkappa-opioid receptor antagonists naloxone (20 nM) and norbinaltorphimine (nor-BNI, 3 nM), respectively. E2078-stimulated [35S] GTPgammaS binding was also determined in the absence or presence ofmicro-andkappa-opioid receptor antagonists in the cortical membrane and compared with dynorphin A (1-17). RESULTS: Values of EC50 and maximum stimulation of dynorphin A (1-17)-stimulated [35S] GTPgammaS binding were as follows: cortex (474 nM/32.0%) and thalamus (423 nM/45.3%). Nor-BNI (3 nM) did not antagonize dynorphin A (1-17)-stimulated [35S] GTPgammaS binding at all in cortical or thalamic membrane, but naloxone (20 nM) produced a 12.2 fold rightward shift of the dynorphin A (1-17)-stimulated [35S] GTPgammaS binding dose-response curve in the thalamic membrane. The EC50 and the maximum stimulation of E2078-stimulated [35S] GTPgammaS binding were 65.6 nM and 22.7%, respectively. In E2078-stimulated [35S] GTPgammaS binding, the dose-response curve was antagonized not by nor-BNI but by naloxone but in the cortical membrane (a 14.2 times rightward shift). CONCLUSIONS: Dynorphin A (1-17) is selective formicro-opioid receptor in agonist-stimulated [35S] GTPgammaS binding in the cortical and thalamic membranes of rhesus monkey.

Effect of Laryngoscopic and Tracheal Intubation Duration on Hemodynamic Response during Anesthetic Induction with Thiopental, Fentanyl and Rocuronium / 대한마취과학회지

BACKGROUND: Laryngoscopic and tracheal intubation often causes an increase in blood pressure and heart rate. The purpose of this study was to evaluate the influence of the duration of laryngoscopy and tracheal intubation on hemodynamic response. METHODS: We studied 110 patients undergoing elective surgery. Anesthesia was induced with fentanyl 1microgram/kg and thiopental 5 mg/kg, and rocuronium 0.6 mg/kg was administrated prior to intubation. The duration of laryngoscopy and tracheal intubation was defined as the interval between the insertion of a laryngoscope into a patient's mouth and its removal after successful tracheal intubation. Patients were divided into three groups according to the duration of intubation: Group 1 (duration 30 seconds). Systolic blood pressure, diastolic blood pressure and heart rate were measured before intubation, after induction, immediately after intubation, and 1 min and 3 min after intubation. RESULTS: Systolic blood pressure at 1 min after intubation was significantly higher in Group 3 than in Group 1, but no significant differences were observed in diastolic blood pressure or heart rate. Regarding the correlation between systolic blood pressure and the duration of laryngoscopy and tracheal intubation, the linear regression r2 value was 0.03. CONCLUSION: This study suggests that the duration of laryngoscopy and tracheal intubation is not significantly correlated with blood pressure. However, it also shows that when the time to intubation exceeds 30 seconds, that the systolic blood pressure is significantly increased. Thus, when the duration of tracheal intubation is anticipated to be prolonged, attempts to attenuate hemodynamic response to tracheal intubation are necessary.

Meniere's Attack after Stellate Ganglion Block: A case report / 대한통증학회지

Stellate ganglion block (SGB) is one of the most widely used treatment modalities for a broad range of disorders, including otolaryngologic indications such as Meniere's disease and sudden hearing loss. We present a case of a vertiginous attack following SGB for the management of Meniere's disease. A 31-year-old female, suffering from Meniere's disease, underwent repeated right side SGBs with 6 ml of 1% mepivacaine after negative aspiration tests for blood. The eleventh block was performed in the usual manner. Several seconds after injection, she showed agitation, anxiety, nystagmus, and left-sided tinnitus. Two minutes later, her tinnitus and nystagmus were resolved. Fifteen minutes after injection, she experienced acute onset of severe vertigo, nausea, and vomiting. However, her symptoms were gradually alleviated within two hours.

Postoperative Residual Curarization either after Continuous Infusions or Intermittent Bolus of Rocuronium or Vecuronium / 대한마취과학회지

BACKGROUND: Although the incidence of postoperative residual curarization (PORC) following the use of intermediate-acting neuromuscular blocking agents is lower than that of longer-acting neuromuscular blocking agents, it has been reported in many studies. We compared the incidence of PORC following either rocuronium or vecuronium given by intermittent bolus or continuous infusion dosing. METHODS: Ninety-eight patients were included in this study. Neuromuscular blocking drugs were administered based solely on clinical criteria, and the reversal agent pyridostigmine was given to all patients. Residual block following rocuronium infusion (Group R-I), rocuronium bolus (Group R-B), vecuronium infusion (Group V-I), or vecuronium bolus dosing (Group V-B) was evaluated on arrival in the postanesthesia care unit. Neuromuscular function was assessed acceleromyographically (using TOF-Watch(R) to measure the train-of-four (TOF) ratio) and also clinically. PORC was defined as a TOF ratio of < 0.8. RESULTS: The incidence of PORC on arrival in the postanesthesia care unit was 20% in Group R-I, 23% in Group R-B, 42% in Group V-I, and 19% in Group V-B. Mean TOF ratio in Group V-I was less than those of the other groups (P < 0.05). CONCLUSIONS: PORC is still common following vecuronium or rocuronium, even after the block is antagonized, if neuromuscular blocking agents are administered according to clinical criteria alone.

The Arthroscopic Treatment of Lipoma Arborescens of Knee: A Case Report

Lipoma arborescens is a rare intra-articular lesion consisting of a villous lipomatous proliferation of the synovial lining. We experienced one case of lipoma arborescens of knee which was associated with avascular necrosis of femoral head. This case report draws the attention to history, physical findings, MR images, pathologic findings and arthroscopic appearance of this rare lesion. Arthro;copically, the lesion appears as a synovial lesion with numerous fatty-appearing globules and villous projections. Although the etiology is unknown, lipoma arborescens has been described in association with osteoarthritis, rheumatoid arthritis and diabetes mellitus. MR imaging is diagnostic choice to differentiate the lesion from rheumatoid arthritis, pigmented villonodular synovitis and synovial chondromatosis in those patients who present with chronic, swollen and painfui joint. Arthroscopic removal was effective in this case and we think that treatment choice of this lesion is arthroscopic removal.

The tibial plateau fractures / 대한정형외과학회잡지

No abstract available.

A Comparison of Bone Mineral Density in Korean Between Noraml Population Group and Fracture Risk Group by Photon Absorptiometry / 대한정형외과학회잡지

The mineral content and width of bone can be determined noninvasively by “bone densitometer”, which measures the absorption by bone of a monoenergetic photon beam that originates in a radioactive source(Iodine-125 at 27.3 Kev). The intensity of the beam transmitted by the bone is measured by a scintillation detector. The bone mineral density is obtained from dividing the bone mineral content by bone width. Since Cameron and Sorenson, in 1963, first described the photon absorptiometry, many investigators have studied this method and applied it clinically. In order to determine the bone density of normal koreans, and compare it with that of fracture risk group, we measured the bone density of the distal one third of the nondominant radius in 152 normal persons(55 male, 97 female), and 54 patients(23 male, 31 female) having the risk of spontaneous fracture from the third to seventh decades. This data were also compared with those of normal Caucasians. The results were as follows. 1. The average bone densities(gm/cm2) of normal men from the third to the seventh decades were 0.773 ±0.055, 0.749 ±0.070, 0.770 ±0.060, 0.797 ±0.053, 0.664 ±0.126, respectively and those of normal women were 0.680 ±0.058, 0.680 ±0.036, 0.674 ±0.052, 0.608 ±0.084, 0.523 ±0.093, respectively. 2. The average bone densitied(gm/cm2) of fracture risk men from the third to seventh decades were 0.647 ±0.072, 0.719 ±0.050, 0.729 ±0.085, 0.699 ±0.064, 0.562 ±0.049, respectively and those of fracture risk women were 0.603 ±0.049, 0.061 ±0.021, 0.326 ±0.034, 0.494 ±0.045, 0.430 ±0.035, respectively. 3. There were statistically significantly differences in the bone densities between the normal population group and the fracture risk group. 4. The average bone densities(gm/cm2) of normal koreans were lower than those of normal Caucasians by 0.115 ±0.023 in male, and 0.091 ±0.005 in female. 5. We belive that bone densitometer is an effective tool in early detection and treatment in metabolic bone deseass including osteoporosis.