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1.
Article in English | WPRIM | ID: wpr-927030

ABSTRACT

Background/Aims@#The safety of direct oral anticoagulants (DOACs) compared with warfarin in patients with both nonvalvular atrial fibrillation (AF) and clinically confirmed liver cirrhosis (LC) has not been well studied. We compared the risk of a major bleeding event between DOAC and warfarin treatments in this patient population. @*Methods@#A total of 238 cirrhotic patients with AF were retrospectively analyzed. The major bleeding event risk was compared between DOAC- and warfarin-treated groups. The median follow-up duration was 5.6 years. @*Results@#Among the 238 study patients with LC and AF, 128 (53.8%) received DOACs and 110 (46.2%) received warfarin. The mean patient age was 68.8 years, and 78.2% were men. A major bleeding event occurred in 10 and 20 patients in the DOAC and warfarin groups, respectively, most commonly caused by gastrointestinal bleeding (70.0%). The cumulative risk of major bleeding did not differ between the groups by log-rank test (p = 0.12). This finding did not change when using 60 propensity score-matched pairs. A multivariable Cox regression model indicated that the concomitant use of antiplatelet agents (adjusted hazard ratio [aHR], 2.06; 95% confidence interval [CI], 1.00 to 4.30; p = 0.048) and presence of esophageal or gastric varices confirmed by endoscopic examination (aHR, 2.31; 95% CI, 1.03 to 5.17; p = 0.04) were associated with major bleeding in the entire cohort. @*Conclusions@#A major bleeding event risk is not increased by DOAC compared with warfarin treatment. Antiplatelet agent use and varices are independently associated with a higher risk of major bleeding during anticoagulation.

2.
Article in English | WPRIM | ID: wpr-903555

ABSTRACT

Background/Aims@#Steatohepatitis related to metabolic syndrome is a chronic liver disease prevalent in patients not only with non-alcoholic steatohepatitis but also with alcoholic liver disease and chronic viral hepatitis. On the other hand, there is limited data on the effects of hepatotonic agents in these patients. Therefore, this study evaluated the efficacy of a combined hepatotonic agent in this population. @*Methods@#Thirty-three adults with chronic hepatitis and one or more components of metabolic syndrome were assigned randomly to receive biphenyl dimethyl dicarboxylate/ursodeoxycholic acid or a placebo for 24 weeks. The primary outcome was the normalization of ALT (≤40 U/L). The secondary outcomes were the change in controlled attenuation parameter, transient elastography, and Chronic Liver Disease Questionnaire score. @*Results@#The 33 patients were assigned randomly to two groups. Eight (50%) of 16 patients who received the intervention drug showed the normalization of ALT, whereas only one (6%) of 17 patients in the placebo group did so. In contrast, the change in controlled attenuation, transient elastography, and Chronic Liver Disease Questionnaire were similar in the two groups. ALT was changed significantly during the four assessment periods, and this change was affected by the group. The interaction between the group and time was also significant. AST was changed significantly during the same period. This change was not affected by the group. @*Conclusions@#Biphenyl dimethyl dicarboxylate/ursodeoxycholic acid combination reduced ALT in chronic liver disease related to metabolic syndrome. On the other hand, there is no evidence that this leads to improved hepatic steatosis and fibrosis within 6 months.

3.
Article in English | WPRIM | ID: wpr-902458

ABSTRACT

Objective@#It is uncertain why a b-value range of 1500–2000 s/mm2 is optimal. This study was aimed at qualitatively and quantitatively analyzing the optimal b-value range of synthetic diffusion-weighted imaging (sDWI) for evaluating prostatic index lesions. @*Materials and Methods@#This retrospective study included 92 patients who underwent DWI and targeted biopsy for magnetic resonance imaging (MRI)-suggested index lesions. We generated sDWI at a b-value range of 1000–3000 s/mm2 using dedicated software and true DWI data at b-values of 0, 100, and 1000 s/mm2 . We hypothesized that lesion conspicuity would be best when the background (i.e., MRI-suggested benign prostatic [bP] and periprostatic [pP] regions) signal intensity (SI) is suppressed and becomes homogeneous. To prove this hypothesis, we performed both qualitative and quantitative analyses.For qualitative analysis, two independent readers analyzed the b-value showing the best visual conspicuity of an MRIsuggested index lesion. For quantitative analysis, the readers assessed the b-value showing the same bP and pP region SI.The 95% confidence interval (CI) or interquartile range of qualitatively and quantitatively selected optimal b-values was assessed, and the mean difference between qualitatively and quantitatively selected b-values was investigated. @*Results@#The 95% CIs of optimal b-values from qualitative and quantitative analyses were 1761–1805 s/mm2 and 1640– 1771 s/mm2 (median, 1790 s/mm2 vs. 1705 s/mm2 ; p = 0.003) for reader 1, and 1835–1895 s/mm2 and 1705–1841 s/mm2 (median, 1872 s/mm2 vs. 1763 s/mm2 ; p = 0.022) for reader 2, respectively. Interquartile ranges of qualitatively and quantitatively selected optimal b-values were 1735–1873 s/mm2 and 1573–1867 s/mm2 for reader 1, and 1775–1945 s/mm2 and 1591–1955 s/mm2 for reader 2, respectively. Bland-Altman plots consistently demonstrated a mean difference of less than 100 s/mm2 between qualitatively and quantitatively selected optimal b-values. @*Conclusion@#b-value range showing a homogeneous background signal may be optimal for evaluating prostatic index lesions on sDWI. Our qualitative and quantitative data consistently recommend b-values of 1500–2000 s/mm2 .

4.
Article in English | WPRIM | ID: wpr-901709

ABSTRACT

Background@#The coronavirus disease-19 (COVID-19) was first reported in Wuhan, China, with Korea being subsequently exposed. In Korea, COVID-19 screening guidelines have been established in every hospital as an attempt to prevent its spread. There has been a previous report of a successful cesarean section of a confirmed mother; however, there remain no guidelines for suspected mothers. Cesarean section is often urgently operated without sufficient infection evaluations. We would like to suggest anesthetic management guidelines for cesarean section patients suspected of COVID-19.Case: Our hospital, which is located in Daegu, Korea, was designated as a quarantine and delivery facility for suspected mothers. We performed the cesarean section on seven suspected mothers and one confirmed mother. @*Conclusions@#This case report presents guidelines for infection control during surgery and anesthesia for cesarean section of mothers with suspected COVID-19 involving operating room preparation and protection strategy.

5.
Article in English | WPRIM | ID: wpr-899880

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission among non-close contacts is not infrequent. We evaluated the proportion and circumstances of individuals to whom SARS-CoV-2 was transmitted without close contact with the index patient in a nosocomial outbreak in a tertiary care hospital in Korea. From March 2020 to March 2021, there were 36 secondary cases from 14 SARS-CoV-2 infected individuals. Of the 36 secondary cases, 26 (72%) had been classified as close contact and the remaining 10 (28%) were classified as non-close contact. Of the 10 non-close contact, 4 had short conversations with both individuals masked, 4 shared a space without any conversation with both masked, and the remaining 2 entered the space after the index had left. At least one quarter of SARSCoV-2 transmissions occurred among non-close contacts. The definition of close contact for SARS-CoV-2 exposure based on the mode of droplet transmission should be revised to reflect the airborne nature of SARS-CoV-2 transmission.

6.
Gut and Liver ; : 546-552, 2021.
Article in English | WPRIM | ID: wpr-898443

ABSTRACT

Background/Aims@#Increased esophagogastric junction (EGJ) relaxation is the most important mechanism involved in gastroesophageal reflux disease (GERD). An endoscopic functional luminal imaging probe (EndoFLIP Ⓡ ) is a device used to quantify EGJ distensibility in routine endoscopy. The aim of the current study was to assess the usefulness of EndoFLIP Ⓡ for the diagnosis of GERD compared to normal controls. @*Methods@#We analyzed EndoFLIP Ⓡ data from 204 patients with erosive reflux disease (ERD), 310 patients with nonerosive reflux disease (NERD), and 277 normal subjects. EndoFLIP Ⓡ uses impedance planimetry to measure 16 cross-sectional areas (CSAs) in conjunction with the corresponding intrabag pressure within a 4.6 cm cylindrical segment of a fluid-filled bag. The EGJ distensibility was assessed using 40 mL volume-controlled distensions. @*Results@#The mean distensibility index values were 13.98 mm 2 /mm Hg in ERD patients, 11.42 mm2 /mm Hg in NERD patients, and 9.1 mm 2 /mm Hg in normal subjects. There were significant differences in EGJ distensibility among the three groups (p<0.001). In addition, the CSAs were significantly higher in the ERD (291.03±160.77 mm 2 ) and NERD groups (285.87±155.47 mm2 ) than in the control group (249.78±144.76 mm 2, p=0.004). We determined the distensibility index cutoff value of EGJ as 10.95 for the diagnosis of GERD by receiver operating characteristic curve analysis. @*Conclusions@#The EGJ distensibilities of GERD patients were higher than those of normal subjects, regardless of the presence of reflux esophagitis. Thus, the measurement of EGJ distensibility using the EndoFLIP Ⓡ system could be useful in the diagnosis of GERD.

7.
Article in English | WPRIM | ID: wpr-895851

ABSTRACT

Background/Aims@#Steatohepatitis related to metabolic syndrome is a chronic liver disease prevalent in patients not only with non-alcoholic steatohepatitis but also with alcoholic liver disease and chronic viral hepatitis. On the other hand, there is limited data on the effects of hepatotonic agents in these patients. Therefore, this study evaluated the efficacy of a combined hepatotonic agent in this population. @*Methods@#Thirty-three adults with chronic hepatitis and one or more components of metabolic syndrome were assigned randomly to receive biphenyl dimethyl dicarboxylate/ursodeoxycholic acid or a placebo for 24 weeks. The primary outcome was the normalization of ALT (≤40 U/L). The secondary outcomes were the change in controlled attenuation parameter, transient elastography, and Chronic Liver Disease Questionnaire score. @*Results@#The 33 patients were assigned randomly to two groups. Eight (50%) of 16 patients who received the intervention drug showed the normalization of ALT, whereas only one (6%) of 17 patients in the placebo group did so. In contrast, the change in controlled attenuation, transient elastography, and Chronic Liver Disease Questionnaire were similar in the two groups. ALT was changed significantly during the four assessment periods, and this change was affected by the group. The interaction between the group and time was also significant. AST was changed significantly during the same period. This change was not affected by the group. @*Conclusions@#Biphenyl dimethyl dicarboxylate/ursodeoxycholic acid combination reduced ALT in chronic liver disease related to metabolic syndrome. On the other hand, there is no evidence that this leads to improved hepatic steatosis and fibrosis within 6 months.

8.
Article in English | WPRIM | ID: wpr-894754

ABSTRACT

Objective@#It is uncertain why a b-value range of 1500–2000 s/mm2 is optimal. This study was aimed at qualitatively and quantitatively analyzing the optimal b-value range of synthetic diffusion-weighted imaging (sDWI) for evaluating prostatic index lesions. @*Materials and Methods@#This retrospective study included 92 patients who underwent DWI and targeted biopsy for magnetic resonance imaging (MRI)-suggested index lesions. We generated sDWI at a b-value range of 1000–3000 s/mm2 using dedicated software and true DWI data at b-values of 0, 100, and 1000 s/mm2 . We hypothesized that lesion conspicuity would be best when the background (i.e., MRI-suggested benign prostatic [bP] and periprostatic [pP] regions) signal intensity (SI) is suppressed and becomes homogeneous. To prove this hypothesis, we performed both qualitative and quantitative analyses.For qualitative analysis, two independent readers analyzed the b-value showing the best visual conspicuity of an MRIsuggested index lesion. For quantitative analysis, the readers assessed the b-value showing the same bP and pP region SI.The 95% confidence interval (CI) or interquartile range of qualitatively and quantitatively selected optimal b-values was assessed, and the mean difference between qualitatively and quantitatively selected b-values was investigated. @*Results@#The 95% CIs of optimal b-values from qualitative and quantitative analyses were 1761–1805 s/mm2 and 1640– 1771 s/mm2 (median, 1790 s/mm2 vs. 1705 s/mm2 ; p = 0.003) for reader 1, and 1835–1895 s/mm2 and 1705–1841 s/mm2 (median, 1872 s/mm2 vs. 1763 s/mm2 ; p = 0.022) for reader 2, respectively. Interquartile ranges of qualitatively and quantitatively selected optimal b-values were 1735–1873 s/mm2 and 1573–1867 s/mm2 for reader 1, and 1775–1945 s/mm2 and 1591–1955 s/mm2 for reader 2, respectively. Bland-Altman plots consistently demonstrated a mean difference of less than 100 s/mm2 between qualitatively and quantitatively selected optimal b-values. @*Conclusion@#b-value range showing a homogeneous background signal may be optimal for evaluating prostatic index lesions on sDWI. Our qualitative and quantitative data consistently recommend b-values of 1500–2000 s/mm2 .

9.
Gut and Liver ; : 546-552, 2021.
Article in English | WPRIM | ID: wpr-890739

ABSTRACT

Background/Aims@#Increased esophagogastric junction (EGJ) relaxation is the most important mechanism involved in gastroesophageal reflux disease (GERD). An endoscopic functional luminal imaging probe (EndoFLIP Ⓡ ) is a device used to quantify EGJ distensibility in routine endoscopy. The aim of the current study was to assess the usefulness of EndoFLIP Ⓡ for the diagnosis of GERD compared to normal controls. @*Methods@#We analyzed EndoFLIP Ⓡ data from 204 patients with erosive reflux disease (ERD), 310 patients with nonerosive reflux disease (NERD), and 277 normal subjects. EndoFLIP Ⓡ uses impedance planimetry to measure 16 cross-sectional areas (CSAs) in conjunction with the corresponding intrabag pressure within a 4.6 cm cylindrical segment of a fluid-filled bag. The EGJ distensibility was assessed using 40 mL volume-controlled distensions. @*Results@#The mean distensibility index values were 13.98 mm 2 /mm Hg in ERD patients, 11.42 mm2 /mm Hg in NERD patients, and 9.1 mm 2 /mm Hg in normal subjects. There were significant differences in EGJ distensibility among the three groups (p<0.001). In addition, the CSAs were significantly higher in the ERD (291.03±160.77 mm 2 ) and NERD groups (285.87±155.47 mm2 ) than in the control group (249.78±144.76 mm 2, p=0.004). We determined the distensibility index cutoff value of EGJ as 10.95 for the diagnosis of GERD by receiver operating characteristic curve analysis. @*Conclusions@#The EGJ distensibilities of GERD patients were higher than those of normal subjects, regardless of the presence of reflux esophagitis. Thus, the measurement of EGJ distensibility using the EndoFLIP Ⓡ system could be useful in the diagnosis of GERD.

10.
Article in English | WPRIM | ID: wpr-894005

ABSTRACT

Background@#The coronavirus disease-19 (COVID-19) was first reported in Wuhan, China, with Korea being subsequently exposed. In Korea, COVID-19 screening guidelines have been established in every hospital as an attempt to prevent its spread. There has been a previous report of a successful cesarean section of a confirmed mother; however, there remain no guidelines for suspected mothers. Cesarean section is often urgently operated without sufficient infection evaluations. We would like to suggest anesthetic management guidelines for cesarean section patients suspected of COVID-19.Case: Our hospital, which is located in Daegu, Korea, was designated as a quarantine and delivery facility for suspected mothers. We performed the cesarean section on seven suspected mothers and one confirmed mother. @*Conclusions@#This case report presents guidelines for infection control during surgery and anesthesia for cesarean section of mothers with suspected COVID-19 involving operating room preparation and protection strategy.

11.
Article in English | WPRIM | ID: wpr-892176

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission among non-close contacts is not infrequent. We evaluated the proportion and circumstances of individuals to whom SARS-CoV-2 was transmitted without close contact with the index patient in a nosocomial outbreak in a tertiary care hospital in Korea. From March 2020 to March 2021, there were 36 secondary cases from 14 SARS-CoV-2 infected individuals. Of the 36 secondary cases, 26 (72%) had been classified as close contact and the remaining 10 (28%) were classified as non-close contact. Of the 10 non-close contact, 4 had short conversations with both individuals masked, 4 shared a space without any conversation with both masked, and the remaining 2 entered the space after the index had left. At least one quarter of SARSCoV-2 transmissions occurred among non-close contacts. The definition of close contact for SARS-CoV-2 exposure based on the mode of droplet transmission should be revised to reflect the airborne nature of SARS-CoV-2 transmission.

12.
Article | WPRIM | ID: wpr-835100

ABSTRACT

BACKGROUND/OBJECTIVES@#Brain senescence causes cognitive impairment and neurodegeneration. It has also been demonstrated that curcumin (Cur) and hesperetin (Hes), both antioxidant polyphenolic compounds, mediate anti-aging and neuroprotective effects. Therefore, the objective of this study was to investigate whether Cur, Hes, and/or their combination exert anti-aging effects in D-galactose (Dg)-induced aged neuronal cells and rats.MATERIALS/METHODS: SH-SY5Y cells differentiated in response to retinoic acid were treated with Cur (1 μM), Hes (1 μM), or a combination of both, followed by 300 mM Dg.Neuronal loss was subsequently evaluated by measuring average neurite length and analyzing expression of β-tubulin III, phosphorylated extracellular signal-regulated kinases, and neurofilament heavy polypeptide. Cellular senescence and related proteins, p16 and p21, were also investigated, including their regulation of antioxidant enzymes. In vivo, brain aging was induced by injecting 250 mg/kg body weight (b.w.) Dg. The effects of supplementing this model with 50 mg/kg b.w. Cur, 50 mg/kg b.w. Hes, or a combination of both for 3 months were subsequently evaluated. Brain aging was examined with a step-through passive avoidance test and apoptosis markers were analyzed in brain cortex tissues. @*RESULTS@#Cur, Hes, and their combination improved neuron length and cellular senescence by decreasing the number of β-gal stained cells, down-regulated expression of p16 and p21, and up-regulated expression of antioxidant enzymes, including superoxide dismutase 1, glutathione peroxidase 1, and catalase. Administration of Cur, Hes, or their combination also tended to ameliorate cognitive impairment and suppress apoptosis in the cerebral cortex by downregulating Bax and poly (ADP-ribose) polymerase expression and increasing Bcl-2 expression. @*CONCLUSIONS@#Cur and Hes appear to attenuate Dg-induced brain aging via regulation of antioxidant enzymes and apoptosis. These results suggest that Cur and Hes may mediate neuroprotective effects in the aging process, and further study of these antioxidant polyphenolic compounds is warranted.

13.
Article | WPRIM | ID: wpr-834067

ABSTRACT

Background/Aims@#With the improvement of hygiene, the incidence of amebic liver abscess is decreasing in South Korea. On the other hand, there is little data on the status of amebic liver abscess compared to pyogenic liver abscess. @*Methods@#Patients with an amebic liver abscess, in whom Entamoeba histolytica (E. histolytica) IgG was positive, were identified retrospectively in a university hospital. The clinical, laboratory, and radiological characteristics of amebic liver abscess were compared with those of pyogenic liver abscess in the same period. @*Results@#Between March 2010 and October 2016, 413 patients with a liver abscess were identified. Among them, the serologic test for E. histolytica was performed in 209 patients. Fifteen (7.2%) were classified as an amebic liver abscess, and the remainder were diagnosed with a pyogenic liver abscess. The age, gender, white blood cell, and CRP was comparable between the two groups. Procalcitonin was lower in amebic liver abscess than the pyogenic one. On CT, peripheral rim enhancement was more frequent, but cluster signs were not observed in amebic liver abscess compared to pyogenic liver abscess. None of the patients with amebic liver abscess died. In contrast, the mortality of pyogenic liver abscess was 4.7%. @*Conclusions@#Amebic liver abscess should still be considered as one of the causes of liver abscess in Korea. It is difficult to discriminate an amebic liver abscess from a pyogenic liver abscess only according to the clinical, laboratory, and radiologic findings. Therefore, it is necessary to perform a serologic test for E. histolytica for a precise evaluation of liver abscess in a high-risk group.

14.
Article | WPRIM | ID: wpr-834060

ABSTRACT

A diagnosis of alcohol-related liver disease (ALD) requires information on the history of excessive alcohol consumption (averageintake of 40 g or more in men and 20 g or more in women a day). Furthermore, blood tests, such as GGT, AST, ALT, and mean corpuscularvolume, and imaging studies, including abdominal ultrasound or transient elastography, are also useful. A liver biopsycan be useful for confirming the diagnosis and has prognostic value. ALD includes alcoholic fatty liver, alcoholic hepatitis, and alcoholiccirrhosis, and in most cases, clinical manifestations can overlap. The prognostic scoring systems of ALD are limited mainlyto alcoholic hepatitis, and the early mortality and treatment response can be predicted using various scoring systems. This reviewsummarizes how to diagnose and evaluate the severity of ALD in clinical practice.

15.
Article | WPRIM | ID: wpr-833986

ABSTRACT

Background@#Since the first case of severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) occurred in Wuhan in December 2019, the virus has spread globally. The World Health Organization declared the virus outbreak a pandemic on March 11, 2020. On January 19, 2020, a 35-year-old woman who returned from China was confirmed as the first SARS-CoV-2 infected case in Korea. Since then, it has spread all over Korea.Case: We report the first case of a SARS-CoV-2 positive woman delivering a baby through cesarean section at 37+6 weeks of pregnancy in the Republic of Korea. @*Conclusions@#This case suggested that negative pressure operating room, skillful medical team, and enhanced personal protective equipment including N95 masks, surgical cap, double gown, double gloves, shoe covers, and powered air-purifying respirator are required at the hospital for safe delivery in such a case.

16.
Article | WPRIM | ID: wpr-833969

ABSTRACT

Background@#Acetylcholinesterase inhibitors (e.g., pyridostigmine bromide) are used for neuromuscular blockade (NMB) reversal in patients undergoing surgery under general anesthesia (GA). Concurrent use of anticholinergic agents (e.g., glycopyrrolate) decreases cholinergic side effects but can impede bowel movements. Sugammadex has no cholinergic effects; its use modifies recovery of gastrointestinal (GI) motility following laparoscopic cholecystectomy compared to pyridostigmine/glycopyrrolate. This study evaluated the contribution of sugammadex to the recovery of GI motility compared with pyridostigmine and glycopyrrolate. @*Methods@#We conducted a prospective study of patients who underwent laparoscopic cholecystectomy. Patients were randomly allocated to the experimental group (sugammadex, Group S) or control group (pyridostigmine-glycopyrrolate, Group P). After anesthesia (propofol and rocuronium, and 2% sevoflurane), recovery was induced by injection of sugammadex or a pyridostigmine-glycopyrrolate mixture. As a primary outcome, patients recorded the time of their first passage of flatus (‘gas-out time’) and defecation. The secondary outcome was stool types. @*Results@#One-hundred and two patients participated (Group S, 49; Group P, 53). Mean time from injection of NMB reversal agents to gas-out time was 15.03 (6.36–20.25) h in Group S and 20.85 (16.34–25.86) h in Group P (P = 0.001). Inter-group differences were significant. Time until the first defecation as well as types of stools was not significantly different. @*Conclusions@#Sugammadex after laparoscopic cholecystectomy under GA resulted in an earlier first postoperative passage of flatus compared with the use of a mixture of pyridostigmine and glycopyrrolate. These findings suggest that the use of sugammadex has positive effects on the recovery of GI motility.

17.
Article | WPRIM | ID: wpr-833827

ABSTRACT

Background/Aims@#Integrated relaxation pressure (IRP) is a critical diagnostic criterion to define achalasia. However, there are some cases with typical symptoms and signs of achalasia but with normal IRP. The aim of this study is to evaluate the clinical characteristics of patients with achalasia with normal IRP and outcomes after peroral endoscopic myotomy (POEM). @*Methods@#Patients with achalasia were collected in whom POEM was performed from November 2014 to April 2018 at CHA Bundang Medical Center. Achalasia with normal IRP was defined by findings compatible to achalasia in Eckardt score, endoscopy with endoscopic ultrasound, high-resolution manometry, impedance planimetry (EndoFlip), and timed esophagogram. @*Results@#POEM was performed in 89 patients with achalasia; among them, 24 (27%) patients were diagnosed with achalasia with normal IRP. Patients with achalasia with normal IRP were older, had longer duration of symptom, and had a more tortuous esophagus. In EndoFlip, the distensibility index and cross-sectional area were higher in patients with normal IRP. Therapeutic outcomes showed no statistically significant differences. On correlation analysis, IRP had negative correlations with age, disease duration, and distensibility index. @*Conclusions@#Patients with achalasia of normal IRP value were older and had longer disease duration and higher distensibility index and crosssectional area than patients with achalasia with abnormal relaxation of lower esophageal sphincter. Therapeutic outcomes were not different between the 2 groups.

19.
Article in English | WPRIM | ID: wpr-762278

ABSTRACT

BACKGROUND: Maternal hypotension is a common complication during obstetric spinal anesthesia. This study was conducted to investigate the role of autonomic function testing in predicting maternal hypotension during spinal anesthesia induced to conduct Cesarean sections (C-section). METHODS: This study was conducted on 32 parturients undergoing C-section under spinal anesthesia. Sympathetic function tests included measuring diastolic blood pressure changes in response to hand gripping and systolic blood pressure changes response to moving from a supine to a standing position. Sympathetic dysfunction is said to exist when there are abnormal responses to both sympathetic function tests. Parasympathetic function tests included measuring heart rate responses to deep breathing and heart rate responses to moving from a supine to a standing position. Parasympathetic dysfunction is said to exist when there are abnormal responses to both parasympathetic function tests. After the onset of spinal anesthesia, blood pressure was measured every minute until childbirth. RESULTS: Hypotension occurred in 22 of the 32 parturients. There was no correlation between sympathetic dysfunction and hypotension incidence, but 12 of the 12 (100%) of the positive group and 10 of the 20 (50%) of the negative group experiencing parasympathetic dysfunction, respectively, experienced hypotension with a significant difference of P = 0.004. The group experiencing parasympathetic dysfunction had statistically significantly higher phenylephrine requirements were also greater in the parasympathetic dysfunction positive group (P < 0.003). CONCLUSIONS: This study's findings suggested that the parasympathetic function tests may be useful methods for predicting the incidence of maternal hypotension during spinal anesthesia induced for C-section.


Subject(s)
Anesthesia, Spinal , Autonomic Nervous System , Blood Pressure , Cesarean Section , Female , Hand , Hand Strength , Heart Rate , Humans , Hypotension , Incidence , Parasympathetic Nervous System , Parturition , Phenylephrine , Pilot Projects , Posture , Pregnancy , Respiration , Sympathetic Nervous System
20.
Article in English | WPRIM | ID: wpr-762274

ABSTRACT

BACKGROUND: Sugammadex reverses rocuronium-induced neuromuscular blockade quickly and effectively. Herein, we compared the efficacy of sugammadex and pyridostigmine in the reversal of rocuronium-induced light block or minimal block in pediatric patients scheduled for elective entropion surgery. METHODS: A prospective randomized study was conducted in 60 pediatric patients aged 2–11 years who were scheduled for entropion surgery under sevoflurane anesthesia. Neuromuscular blockade was achieved by administration of 0.6 mg/kg rocuronium and assessed using the train-of-four (TOF) technique. Patients were randomly assigned to 2 groups receiving either sugammadex 2 mg/kg or pyridostigmine 0.2 mg/kg and glycopyrrolate 0.01 mg/kg at the end of surgery. Primary outcomes were time from administration of reversal agents to TOF ratio 0.9 and TOF ratio 1.0. Time from the administration of reversal agents to extubation and postoperative adverse events were also recorded. RESULTS: There were no significant differences in the demographic variables. Time from the administration of reversal agents to TOF ratio 0.9 and TOF ratio 1.0 were significantly shorter in the sugammadex group than in the pyridostigmine plus glycopyrrolate group: 1.30 ± 0.84 vs. 3.53 ± 2.73 min (P < 0.001) and 2.75 ± 1.00 vs. 5.73 ± 2.83 min (P < 0.001), respectively. Extubation time was shorter in the sugammadex group. Adverse events, such as skin rash, nausea, vomiting, and postoperative residual neuromuscular blockade (airway obstruction), were not statistically different between the two groups. CONCLUSIONS: Sugammadex provided more rapid reversal of rocuronium-induced neuromuscular blockade in pediatric patients undergoing surgery than did pyridostigmine plus glycopyrrolate.


Subject(s)
Anesthesia , Delayed Emergence from Anesthesia , Entropion , Exanthema , Glycopyrrolate , Humans , Nausea , Neuromuscular Blockade , Neuromuscular Monitoring , Pediatrics , Prospective Studies , Pyridostigmine Bromide , Vomiting
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