Selection of Antihypertensive Drugs in Hypertensive Patients with Diabetes Mellitus: In Pohang-Gyeongju Primary Care Research Network

BACKGROUND: Angiotensin converting enzyme inhibitor or Angiotensin II type 1 receptor blocker is usually recommended for hypertensive patients with diabetes mellitus. No reports have been made on antihypertensive agents prescribed for these patients in private practice. METHODS: During a one month period of December 2004, 169 hypertensive patients with diabetes mellitus on their prescribed antihypertensive agents by ten family physicians were analyzed. The influencing factors for such prescriptions were analyzed by directly visiting each physicians who prescribed them. RESULTS: A total of 21 antihypertensive agents were prescribed by these family physicians. Single calcium channel blocker therapy was the most common with 55 cases (32.5%), followed by 20 cases (11.8%) of single angiotensin converting enzyme inhibitor therapy and 16 cases of single therapy of Angiotensin II type 1 receptor blocker. The low frequency of prescribing the Angiotensin II type 1 receptor blocker was due to insufficient effect (7), lack of information (5), resistance from the patients from changing the medications (4) and expensive costs (4). CONCLUSION: In prescribing antihypertensive agents for patients with diabetes mellitus, angiotensin converting enzyme inhibitor or Angiotensin II type 1 receptor blocker were chosen less. In order to decrease the incidence of complications in these patients, such agents should be prescribed more.

Effects of Blood-Brain Barrier Disruption on Cerebral Oxygen Balance / 대한구급학회지

BACKGOUND: Disruption of the blood-brain barrier (BBB) can alter the internal milieu and may increase the release of excitatory amino acid neurotransmitters or catecholamines, which may affect metabolic rate or coupling. This study was performed to evaluate whether disruption of BBB by unilateral intracarotid injection of hyperosmolar mannitol would alter oxygen supply/consumption balance in the ipsilateral cortex. METHODS: Rats were anesthetized with 1.4% isoflurane using mechanical ventilation via tracheostomy. 25% mannitol was administered at a rate of 0.25 mlxkg-1s-1 for 30 s through unilateral internal carotid artery. The BBB transfer coefficient (Ki) of 14C-alpha-aminoisobutyric acid was measured in one group (N=7) after administering mannitol. Regional cerebral blood flow (rCBF), regional arterial and venous O2 saturation and O2 consumption were measured in another group using a 14C-iodoantipyrine and microspectrophotometry (N=7). RESULTS: Vital signs were similar before and after administering mannitol. Ki was significantly higher in the ipsilateral cortex (IC) than in the contralateral cortex (CC), (22.3+/-8.4 vs 4.4+/-1.1 microliterxg-1min-1). rCBF was similar between IC (105+/-21 mlxg-1min-1) and the CC (93+/-20). Venous O2 saturation was lower in the IC (43+/-7%) than in the CC (55+/-4). O2 consumption was higher in the IC (9.6+/-3.0 mlx100 g-1min-1) than in the CC (6.7+/-1.5). CONCLUSIONS: Our data suggested that increasing permeability of the BBB increased cerebral O2 consumption and deteriorated cerebral oxygen balance.

Incidence of Pulmonary Aspiration in Patients with Tracheostomy / 대한구급학회지

BACKGOUND: Patients with tracheostomy tubes have altered glottic closure in deglutition that may result in aspiration and may cause dangerous pulmonary complication including bronchopneumonia and atelectasis. The incidence of pulmonary aspiration in patients with tracheosomy may be high but difficult to determine because investigators often apply different criteria. The present study was prepared to document the incidence of aspiration in patients with tracheostomy using a simple dye-marker test. METHODS: Thirty six surgical and medical patients (14 male and 22 female) in ICU with tracheostomy tube (high volume, low pressure cuffed tube) were included in this study. Mental status (presence of response to verbal command), the presence of nasogastric tube and the presence of ventilatory support were recorded in each patients to evaluate the effect of these factors on the incidence of aspiration. 1% solution of methylene blue dye was applied on the both side of posterior tongue and then any evidence of the blue dye-marker obtained microscopically on secretion through the tracheostomy tube at every 2 hours during 72 hours was considered the positive evidence of aspiration. RESULTS: Aspiration was detected by a positive methylene blue dye test in 11 of the 36 patients (30.5%) and average length of time before blue dye was obtained on tracheal secretion was 8.2 7.3 hours.The presence of response to verbal command, nasogastric tube and ventilatory support had no apparent effect on the incidence of aspiration. CONCLUSIONS: This observation suggests that a simple test using dye-maker is helpful to detect aspiration in patients with tracheostomy. Tracheostomy should be done under discreet decision because the high incidence of aspiration in trcheostomized patients.

Detection and 3D Reconstruction of Brain from MR Images / 대한의료정보학회지

In this paper, we propose a brain detection algorithm of cross-sectional images through a 3D volume. The proposed brain detection algorithm uses several steps. They are as follows; In the first step, the standard value and downward from input image data are removed. in the second step, the pixels with maximum intensity are removed but undesirable many small areas were appeared as by-products. In order to detect brain, these small areas need to be removed. In the third step, many small areas are removed by masking but some small areas still remained. In the fourth step, they are removed using three-dimensional connectivity. The proposed algorithm was applied to real human MRI data and the brain area was successfully detected.

The Effects of Nitric Oxide on Oxygen Balance in Cerebral Ischemia / 대한구급학회지

Bockground: Nitric oxide (NO) is an important regulator of blood flow and also works as a neuronal messenger via cyclic GMP. Recent studies regarding the therapeutic utility of nitric oxide synthase (NOS) inhibitors in reducing ischemia-induced neuronal damage are very controversial. The possible neuroprotective effect of NO or NOS inhibitors in ischemic neuronal damage could occur at the vascular and or neuronal level. This study investigated whether the NOS inhibitor, NG-nitro-L-arginine-methyl ester (L-NAME) would alter oxygen balance in ischemic cerebrocortex of isoflurane-anesthetized rats. METHODS: Fifteen minutes after middle cerebral artery occlusion, L-NAME (1.5 mgxmin-1kg-1) was infused intravenously to the L-NAME group (n=14), and normal saline was given to the control group (n=14) for 45 minutes. Regional cerebral blood flow was determined with [14C]iodoantipyrine, and arterial and venous oxygen saturations were determined by microspectrophotometry. RESULTS: Regional cerebral blood flow of the ischemic cortex was significantly lower than that of the contralateral cortex in both groups. In the control group, ischemic cortex; 55+/-13, contralateral cortex; 110+/-29 mlxmin-1100 g-1, and in the L-NAME group, ischemic cortex; 35+/-13, contralateral cortex; 90+/-24 mlxmin-1100 g-1. Compared with the blood flow in the ischemic cortex of the control group, L-NAME significantly reduced ischemic blood flow by 36%. Venous oxygen saturation was significantly increased in the ischemic cortex (41+/-1% in control, 44+/-3% in L-NAME) but decreased in the contralateral cortex (65+/-3% in control, 61+/-3% in L-NAME) by L-NAME. Ischemic cortical oxygen consumption in the L-NAME group was 39% lower than that in the corresponding control group, whereas the difference was only 11% in the contralateral sides between groups. The ratio of oxygen supply to consumption was lower in the ischemic than in the nonischemic regions in both groups. In the ischemic cortex, this ratio was significantly lower in the control group (1.7+/-0.1) than in the L-NAME group (1.9+/-0.1). In contrast, the ratio tended to be decreased by L-NAME in nonischemic regions. CONCLUSIONS: These observations suggest that despite a decrease in cerebral blood flow, inhibition of nitric oxide synthesis mildly improves the oxygen supply and consumption balance in the ischemic cortex.

Effects of Intravenous Lidocaine on Intra-abdominal Pressure during Endotracheal Suctioning / 대한구급학회지

BACKGOUND: We evaluated the effect of intravenous lidocaine (1 mg/kg and 2 mg/kg) on intra-abdominal pressure (IAP) during endotracheal suctioning. METHODS: We studied 40 patients undergoing endotracheal intubation during mechanical ventilation. Group I (1 mg/kg) and group II (2 mg/kg)were given lidocaine double fashion. The endotracheal suctioning (ETS) was done 1, 3, 5 and 7 min after the injection of lidocaine. IAP, systolic blood pressure (SBP), diastolic blood preassure (DBP), and heart rate (HR) during ETS were recorded, IAP was measured using a transurethral bladder catheters. The cough response to ETS was classified as " cough score". RESULTS: Before administration of lidocaine, ETS produced significant increase in SBP, DBP, IAP and HR compared with baseline values in the two groups (p<0.05). Both groups showed no significant changes in SBP, DBP, and HR during the study. In group I, ETS produced a significant increase in IAP 5 and 7min after lidocaine treatment (p<0.05). There were significant differences between the two groups 5 and 7 min after lidocaine treatment (p<0.05). The score of cough decreased significantly in both groups 3 min after lidocaine treatment but there was a significant difference between the two groups at 7 min. CONCLUSIONS: We concluded that lidocaine pretreatment significantly blunted the increase in IAP, SBP DBP and HR caused by ETS and this effect lasts for 3 min in group I and 7 min in group II.

A Comparative Study of Epidural Administration of Morphine and Fentanyl on Analgesic Effects and Complications / 대한마취과학회지

The discovery of the 1970s, that morphine acts on the spinal cord, opened a new field of neuropharmacological inquiry and exploration of the greatest analgesic power of intraspinal narcotics. However not only hydrophilic and poorly lipid-soluble drugs such as morphine may be expected to travel slowly to pass out of the CSF into the lipid tissues of the neuraxis but also many adverse side-effects such as respiratory depression, urinary retention, pruritus,nausea and vomiting may be expected to develop in the morphine treated patients. In contrast to morphine, highly lipid-soluble narcotics such as fentanyl pass relatively freely between the dura and pia-arachnoid, rapid onset of action and fewer adverse effects may be expected to develop in the fentanyl-treated patients. To assess the clinical usefulness of epidural administration of fentanyl rather than morphine, we compared the onset and duration of analgesic action, self-satisfactory of analgesia and adverse side-effects between morphine and fentanyl treated 27 surgical patients. The results were as follows: 1) The onset time of analgesia in the epidurally fentanyl 50 ug treated group (F50 group) and 100 ug treated group (F100 group), 12+/-3 and 9+/-3 min respectively, were significantly shortened as compared with those in the morphine 5 mg treated group (morphine group), 21+/-2 min (p<0.05). 2) The duration of analgesic action in the F50 and F100 groups, 2.58+/-0.39 and 5.43+/-1.33 hours respectively, were significantly shortened as compared with morphine group, 14.30+/-2.16 (p<0.05). 3) Among 9 morphine treated patients, 8 patients feeled excellent or good analgesia. Also 9 of 10 fentanyl 50 ug treated and 7 of 8 fentanyl 100 ug treated patients feeled excellent or good analgesia. 4) Major complications in the morphine group were urinary retention 4 cases, nausea and vomiting 4 cases and pruritus 3 cases. Whereas only 1 patient in the F100 group complained of nausea and vomiting.