The potential mechanism of the detrimental effect of defibrillation prior to cardiopulmonary resuscitation in prolonged cardiac arrest model / 한국실험동물학회지

Defibrillation is no longer universally recommended as initial intervention for the reversal of ventricular fibrillation (VF) after a prolonged and untreated cardiac arrest. We sought to examine this issue in an animal model where a prolonged untreated VF was induced. The aim of this study was to investigate the potential mechanism of the detrimental effect of defibrillation prior to cardiopulmonary resuscitation (CPR) in prolonged cardiac arrest model. VF was electrically induced in 32 domestic male swine weighing 40+/-3 kg and remained untreated for 15 minutes. The animals were then randomly allocated to either the initial defibrillation group or the chest compression group. Mean aortic pressure, right atrial pressure and coronary perfusion pressure (CPP) were continuously measured during the performance. The dimensions of the left ventricle (LV) were assessed by echocardiographic methods. The CPP induced by CPR after defibrillation was significantly lower in the initial defibrillation group than in the chest compression group; 1 minute after defibrillation (9+/-3 mmHg vs. 14.8+/-7 mmHg (P<0.05)), and after 5 minutes 16+/-5 mmHg vs. 21.7+/-1 mmHg (P<0.05). The LV volumes were reduced from 18+/-2 mmHg to 14+/-1 mmHg after defibrillation (P<0.05). In brief, this study showed that the conducting defibrillation prior to chest compression may cause a contracture of the LV, resulting in lowering CPP, thus dropping the efficiency of chest compression in a prolonged cardiac arrest model.

A Case of Aconitum Intoxication After Ingestion of a Large Amount of Aconitine Decoction in a Suicide Attempt

Aconitine has been used as a folk remedy for centuries to treat pain and as an inotropic agent. However, because its therapeutic range is very narrow, it often causes many side effects when not controlled carefully. These include nausea, vomiting, paresthesia, cardiac arrhythmia and hypotension. Most of the aconitine intoxication cases have been attributed to accidental overdose of aconitine-containing medicines. In this case, a 53-year-old woman attempted suicide by intentionally overdosing herself with an aconitine decoction. She suffered paresthesia in both arms and showed junctional rhythm on an electrocardiogram at admission. Here we report that early gastric lavage and other symptomatic therapies were helpful for treating aconitine intoxication. Similar to intoxication with other drugs, these supportive measures can prevent the patient's hospitalization.

Comparison of Quality of Cardiopulmonary Resuscitation in Manikins with a Change in the Compression to Ventilation Ratio from 30:2 to 15:1

PURPOSE: To minimize an interruption in chest compression, reduce the hands-off time, the American Heart Association has recommended changing the ratio of chest compression to ventilation ratio to 30:2. However, current studies have shown that the hands-off time was >10 seconds with that method. For this reason, we reasoned that a chest compression to ventilation ratio of 15:1 would be a more suitable way to reduce hands-off time because this ratio will not change the total compression and ventilation count. METHODS: The subjects were asked to perform CPR for 5 cycles with a compression to ventilation ratio of 30:2. The subjects rested for 5 minutes, then performed CPR with a compression to ventilation of 15:1. The skill performance was measured and analyzed using a statistical program. RESULTS: In the group which performed CPR with a chest compression to ventilation ratio of 30:2, the average number of compressions per minute was 76+/-9, while at a chest compression to ventilation ratio of 15:1, the average number of compressions per minute was 68+/-9. Between the compression to ventilation ratios of 30:2 and 15:1, the count gap was 8.3+/-3.2. When CPR was performed at a chest compression to ventilation ratio of 30:2, the average hands-off time was 9.3+/-1.9. When CPR was performed at a chest compression to ventilation ratio of 15:1, the average hands-off time was 6.7+/-1.3. Between chest compression to ventilation ratios of 30:2 and 15:1, the time gap of the average hands-off time was 2.7+/-1.2 seconds. CONCLUSION: When the chest compression to ventilation ratio was 15:1, the hands-off time was significantly reduced, but the compressions per minute were also reduced.

Cold-stress Test Involving Finger Skin Temperature Measurement for Evaluation of Raynaud's Disease and Nonspecific Cold Sensitive Patients / 대한마취과학회지

BACKGROUND: Cold-stress test is used for the objective diagnosis of Raynaud's disease and phenomenon, and the value of such test based on detection of recovery time of finger skin temperature, finger systolic blood pressure and finger color. We evaluate the finger skin temperature of recovery time after cold-stress test for Raynaud's disease and nonspecific cold sensitive patients. METHODS: Thirty-six subjects participated in the study: 9 Raynaud's disease (group 1), 13 nonspecific cold-sensitive patients (group 2) and 14 healthy adults (group 3). Subjects were adapted for 10 min in the test room, temperature 22-24degrees C, prior to measurements. Thermistor probe were attached to tips of both middle phalanges. After recording the baseline temperature, both hands were immersed to the level of the wrist in water controlled at 4degrees C. After 1 min immersion, both hands were removed from the water, recording the skin temperature at 5 min interval. RESULTS: Group 1 had the two types of recovery pattern. One; group 1 (-) was delayed recovery and the other; group 1 (+) was early recovery and hyperemic response. Group 2 showed delayed recovery. Recovery time to preimmersion temperature in group 3 were 20 min. CONCLUSIONS: Unlike results of prior report, some of Raynaud's disease (44%) with typical tricolor change had early recovery and hyperemic response after cold stress test in our study. It is suggested that Raynaud's disease has a different pathophysiology from nonspecific cold-sensitive patients. And appropriate check time is 20 min after cold immersion for the evaluation of vascular dysfunction of cold sensitive patients.

Differential Analgesic and Adverse Effects of 0.125% Bupivacaine vs. Ropivacaine Coadministered Epidurally with Morphine / 대한마취과학회지

BACKGROUND: This study aimed to compare analgesic efficacy and occurance of motor block and other side effects of a 48 hr postoperative continuous epidural infusion of 0.125% bupivacaine or ropivacaine with morphine. METHODS: Forty patients undergoing a Cesarean section were allocated randomly into two groups. Both groups received an epidural injection of 2.0% lidocaine 18 20 ml and 0.5% bupivacaine 2 5 ml with fentanyl 50microgram 20 minutes before surgical incision and received 2 mg of epidural morphine by bolus 40 minutes after surgical incision. For post-operative pain control, a continuous epidural infusion was started using a two day infusor containing 6 mg of morphine in 100 ml of 0.125% bupivacaine (Group 1, n = 20) or 100 ml of 0.125% ropivacaine (Group 2, n = 20). Visual analog scale (VAS) for pain during rest and movement, sensory change and motor blockade were assessed for 48 hrs. after surgery. RESULTS: There were no significant differences in VAS for pain during rest and movement. The incidences of side effect were similar in both groups. CONCLUSIONS: Using 0.125% bupivacaine with morphine via the epidural route provided similar pain relief and side effects as 0.125% ropivacaine with morphine.

Growth Factors Influencing the Morphology and Growth Rate of Hair Follicles in a Human Hair Organ Culture / 대한피부과학회지

BACKGROUND: In order to study hair biology, a hair organ culture system is necessary. However satisfactory hair culture systems have not been established. OBJECTIVE: The purpose of this study was to examine the effectiveness of growth factors and to establish a hair organ culture system for studying hair biology and to evaluate the effectiveness of growth factors. METHOD: After the healthy human anagen hair follicles were collected without any visible damage, they were cultured in William E medium with several combinations of growth factors including insulin, hydrocortisone, sodium selenite, human transfemn, fetal calf serum and epidermal growth factor at 37C in an atmosphere of 5% CO2/air incubation. The culture medium was changed every 3 days. The results were evaluated by measuring hair growth and hair follicle morphology. RESULTS: The results of this study are summarized as follows; 1) In the medium composed of insulin, hydrocortisone,sodium selenite and human transferrin, the human hair follicles continued to grow at an in vivo rate of 0.3mm in a day over 10 days without change of gross and microscopic morphology. 2) In the medium containing insulin and/or hydrocortisone the growing rate of the human hair follicles was similar to that in vivo, but the follicles revealed premature entry into catagen at 2-6 days in the culture macroscopically and microscopically. 3) Adding fetal calf serum to the above medium made the hair follicles retain the freshly isolated hair follicles morphology for 10 days in culture, even though they grew somewhat slower than the in vivo rate from 6 days in culture. 4) The effectiveness of EGF mimics the in vivo depilation of EGF in sheep. CONCLUSION: To supplement insulin, hydrocortisone, sodium selenite, transferrin as growth factors, William E medium was necessary for maintenance of an in vivo growth rate and the morphology the anagen hair follicles. This culture system is not enough, but it might be useful for investigation of the physiology, biology of hair follicles as well as pharmacology and toxicology in hair.