Do You Follow The ACLS Guideline?

PURPOSE: In 2000, the American Heart Association and International Liaison Committee on Resuscitation published guidelines for CPR (Cardiopulmonary Resuscitation), and these guidelines were revised in 2005. Many physicians perform CPR differently than suggested by these guidelines. We investigated guideline conformation rates for CPR by non-emergency physicians. METHODS: From January 1st, 2005, to December 31st, 2005, and from January 1st, 2007, to September 30th, 2007, 103 in-hospital CPR cases were enrolled. We separated the 103 cases into two groups: 2005 patients and 2007 patients. Fifty-two cases in the 2005 group and 51 cases in the 2007 group were enrolled. The defibrillation method, defibrillation energy, epinephrine use, and atropine use were analyzed. RESULTS: Nineteen cases (82.6%) in the 2005 group and three cases (21.4%) in the 2007 group were performed using the appropriate defibrillation method (p=0.0002). Seventeen cases (73.9%) in the 2005 group and four cases (28.6%) in the 2007 group received the appropriate defibrillation energy (p=0.0069). Seven cases (14.0%) in the 2005 group and 16 cases (32.0%) in the 2007 group used the appropriate epinephrine dose (p=0.0325). Fourteen cases (28.0%) in the 2005 patient group and 14 cases (29.2%) in the 2007 patient group used the appropriate atropine dose (p=0.8983). CONCLUSION: Although CPR guidelines were renewed in 2005, many physicians do not follow these guidelines. We suggest that adequate information, education, feedback, and further study are needed for guideline conformation.

Respiratory Assist by Use of Electrical Diaphragmatic Pacing / 대한흉부외과학회지

BACKGROUND: Electrical breathing pacing has many advantages over mechanical ventilation. However, clinically permanent diaphragmatic pacing has been applied to limited patients and few temporary pacing has been reported. Our purpose is to investigate the feasibility of temporary electrical diaphragm pacing in explothoracotomy canine cases. METHODS: Five dogs were studied under the general anesthesia. Left 5th intercostal space was opened. Self designed temporary pacing leads were placed around the left phrenic nerve and connected to the myostimulator. Chest wall was closed after tube insertion with underwater drainage. Millar catheter was introduced to the aorta and right atrium. Swan-Ganz catheter was introduced to the pulmonary artery. When the self respiration was shallow with deep anesthesia, hemodynamic and tidal volume were measured with the stimulator on. RESULTS: Tidal volume increased from 143.3 +/- 51.3 ml to 272.3 +/- 87.4 ml(p=0.004). Right atrial diastolic pressure decreased from 0.7 +/- 4.0 mmHg to -10.5 +/- 4.7 mmHg(p=0.005). Pulmonary arterial diastolic pressure decreased from 6.1 +/- 2.5 mmHg to 1.2 +/- 4.8 mmHg(p<0.001). The height of water level in chest tube to show intrathoracic pressure change was from 10.3 +/- 6.7cmH2O to 20.0 +/- 5.3 cmH2O. CONCLUSION: Temporary electrical diaphragmatic pacing is a simple method to assist respiration in explothoracotomy canine cases. Self designed pacing lead is implantable and removable. Negative pressure ventilation has favorable effects on the circulatory system. Therefore, clinical application of temporary breathing pacing is feasible in thoracotomy patients to assist cardiorespiratory function.

The cyclic burst effect of myostimulator on the thoracic aortomyoplasty

BACKGROUND: Descending thoracic aortomyoplasty (DTA) is a simple surgical procedure designed to use patient's own skeletal muscle based on the principle of aortic counterpulsation. Clinical application is limited. We have investigated the acute effect of DTA depending on the surgical configurations and cyclic bursts of stimulator parameter. METHODS: In 14 Mongrel dogs, the left latissimus dorsi muscle (LD) was wrapped around the descending aorta. Pacing leads were placed around the thoracodorsal nerve and sensing lead on the left ventricular apex. Cyclic burst 5-6 pulses were applied. Different surgical configurations are clockwise or counter-clockwise wrapping method of LD and whole type or band type of LD. Millar catheter and Swan-Ganz catheter were introduced to measure hemodynamics. Aorta pressure, right atrial pressure, mean aortic systolic and diastolic pressure, systolic and diastolic time, pulmonary wedge pressure, coronary perfusion pressure, endocardial viability ratio were measured in normal heart and pump failure heart. RESULTS: In normal heart, mean aortic diastolic pressure changed from 49.6+/-15.0mmHg to 55.5+/-17.1mmHg(p=0.012), endocardial viability ratio changed from 1.13+/-0.31 to 1.59+/-0.23 (p<0.001). In pump failure heart, mean aortic diastolic pressure changed from 40.0+/-12.8mmHg to 43.2+/-11.2mmHg(p=0.018), endocardial viability ratio changed from 0.69+/-0.22 to 1.01+/-0.40 (p=0.018). In clockwise configuration, mean aortic diastolic pressure changed from 50.3+/-14.0mmHg to 56.9+/-14.8mmHg(p=0.004). In whole type configuration, mean aortic diastolic pressure changed from 49.814.6mmHg to 57.1+/-15.6mmHg(p=0.003). CONCLUSIONS: Train stimulation of 5-6 pulses and surgical configurations of clockwise rotation with whole LD type play a role to maximize acute effect of DTA.

Emphysematous Cystic Pulmonary Metastasis of Angiosarcoma

Pulmonary metastatic angiosarcoma usually reveals multiple nodular lesions associated with parenchymal hemorrhage. It is presented, in rare cases, as multiple emphysematous cystic lesions, complicated by pneumothorax. We experienced a case of pulmonary metastastasis from angiosarcoma of the scalp in a 58-year-old male showing multiple thin-walled emphysematous cystic lesions. The tumor cells spread along the subpleural and interlobular septa, focally surrounding the cystic lesions. This case suggests that a rare metastatic pattern seen in angiosarcoma of the scalp should be considered as a differential diagnosis of bullous emphysematous lesion.

Forward-mode Na+ - Ca2+ exchange during depolarization in the rat ventricular myocytes with high EGTA

During depolarization, extrusion of Ca2+ from sarcoplasmic reticulum through forward-mode Na+ - Ca2+ exchange was studied in the rat ventricular myocytes patch-clamped in whole-cell configuration. In order to confine the Ca2+ responses in a micro-domain by limiting the Ca2+ diffusion time, rat ventricular myocytes were dialyzed with high (14 mM) EGTA. K+ current was suppressed by substituting KCl with 105 mM CsCl and 20 mM TEA in the pipette filling solution and by omitting KCl in the external Tyrode solution. Cl- current was suppressed by adding 0.1 mM DIDS in the external Tyrode solution. During stimulation roughly mimicking action potential, the initial outward current was converted into inward current, 47+/-1% of which was suppressed by 0.1 mM CdCl2. 10 mM caffeine increased the remaining inward current after CdCl2 in a cAMP-dependent manner. This caffeine-induced inward current was blocked by 1 muM ryanodine, 10 muM thapsigargin, 5 mM NiCl2, or by Na+ and Ca2+ omission, but not by 0.1 muM isoproterenol. The IapprxV relationship of the caffeine-induced current elicited inward current from -45 mV to +3 mV with the peak at -25 mV. Taken together, it is concluded that, during activation of the rat ventricular myocyte, forward-mode Na+ - Ca2+ exchange extrudes a fraction of Ca2+ released from sarcoplasmic reticulum mainly by voltage-sensitive release mechanism in a micro-domain in the t-tubule, which is functionally separable from global Cai2+ by EGTA.

Relationship between sarcoplasmic reticular calcium release and Na+-Ca2+ exchange in the rat myocardial contraction

Suppressive role of Na+-Ca2+ exchange in myocardial tension generation was examined in the negative frequency-force relationship (FFR) of electric field stimulated left atria (LA) from postnatal developing rat heart and in the whole-cell clamped adult rat ventricular myocytes with high concentration of intracellular Ca2+ buffer (14 mM EGTA). LA twitch amplitudes, which were suppressed by cyclopiazonic acid in a postnatal age-dependent manner, elicited frequency-dependent and postnatal age-dependent enhancements after Na+-reduced, Ca2+-depleted (26 Na-0 Ca) buffer application. These enhancements were blocked by caffeine pretreatment with postnatal age-dependent intensities. In the isolated rat ventricular myocytes, stimulation with the voltage protocol roughly mimicked action potential generated a large inward current which was partially blocked by nifedipine or Na+ current inhibition. 0 Ca application suppressed the inward current by 39 +/- 4% while the current was further suppressed after 0 Na-0 Ca application by 53 +/- 3%. Caffeine increased this inward current by 44 +/- 3% in spite of 14 mM EGTA. Finally, the Na+ current-dependent fraction of the inward current was increased in a stimulation frequency-dependent manner. From these results, it is concluded that the Ca2+ exit-mode (forward-mode) Na+-Ca2+ exchange suppresses the LA tension by extruding Ca2+ out of the cell right after its release from sarcoplasmic reticulum (SR) in a frequency-dependent manner during contraction, resulting in the negative frequency-force relationship in the rat LA.

Two Cases of Deep Neck Infection with Mediastinal Involvement / 대한이비인후과학회지

Deep neck space infections affect fascial compartments of the head and neck, and their contents. Acute mediastinitis occasionally occurs as a complication of neck infections resulting in neck sepsis, which spreads to the mediastinum via the cervical fascial planes, and this is best referred to as descending necrotizing mediastinitis (DNM). We recently experienced two cases of deep neck infection dissecting along cervical fascial planes into the mediastinum causing a virulent mediastinitis. Aggressive antibiotic treatment of the deep neck infections along with prompt complete mediastinal drainage are recommended for optimal outcome.

Treatment Modality in Patients with Traumatic Pericardial Effusion

BACKGROUND: Current guidelines of advanced trauma life support recommend open thoracotomy when pericardiocentesis reveals bloody pericardial effusion in patients with blunt chest trauma. However, open thoracotomy may not be always required for treating patients alive until arriving emergency department, because rapid accumulation of the blood into pericardial space results in immediate death at scene. We report our experiences of treating traumatic pericardial effusion, and discuss the therapeutic modality in patients with traumatic pericardial effusion. METHODS: The study consisted of 37 patients(20 males and 17 females with the mean age 42) sustaining traumatic pericardial effusion. The patients were divided according to treatment modality into 3 groups(group I : patients receiving conservative management, group II : patients treated with pericardiocentesis, group III : patients required emergency thoracotomy). We compared clinical presentations, hemodynamic profiles and echocardiographic findings among three groups. RESULTS: Cardiac tamponade was present in 14 of 37 patients. Pericardiocentesis was performed in 13 patients, and open thoracotomy in 4 patients. Pericardiocentesis was curative in 9 patients. Thoracotomy was performed in only 3(24%) of 13 patients required pericardiocentesis. 3(75%) of 4 patients having moderate or severe pericardial effusion from penetrating injury were required open thoracotomy. CONCLUSION: In selected patients who have traumatic pericardial effusion by blunt chest injury, pericardiocentesis may be curative, and thoracotomy may not be inquired as long as bleeding via indwelling pericardial catheter is not sustained after pericardiocentesis.

The effect of additives in the cardioplegic solution on the recovery of myocardium, comparison among albumin, mannitol, and glucose / 대한흉부외과학회지

No abstract available.

Thromboendarterectomy for chronic pulmonary embolism under cardiopulmonary bypass: report of a case / 대한흉부외과학회지

No abstract available.