ABSTRACT
In the past decade, in addition to using traditional naked-eye morphological analysis, two-dimensional measurement and data comparison, more and more scholars placed great emphasis on the application of new technologies available and supported the study of ancient human remains from a multi-disciplinary perspective. Through outlining recent advances in the application of new techniques on research of ancient human remains, this paper briefly summarized the characteristics of present research and gave an outlook on future research of ancient human remains in China.
ABSTRACT
JUSTIFICATIVA E OBJETIVOS: Tem sido atribuída à anestesia regional diminuição significativa das complicações tromboembólicas no pós-operatório, provavelmente por sua ação atenuadora sobre a resposta neuroendócrino-metabólica. As gestantes, que apresentam aumento importante da coagulabilidade sangüínea, podem, teoricamente, beneficiar-se desse efeito por ocasião do parto. O objetivo deste estudo foi verificar o efeito da anestesia regional sobre a coagulação sangüínea em gestantes. MÉTODO: Foram estudadas 30 pacientes no terceiro trimestre de gestação, sendo dez submetidas à anestesia peridural para cesariana, com 150 mg de bupivacaína a 0,5 por cento sem epinefrina e 2 mg de morfina (grupo PD); dez à anestesia subaracnóidea para cesariana com 15 mg de bupivacaína hiperbárica a 0,5 por cento e 0,2 mg de morfina (grupo SA); e dez a bloqueio de pudendo para parto vaginal, com doses de até 100 mg de bupivacaína a 0,5 por cento sem epinefrina (grupo BP). A coagulação sangüínea foi avaliada por meio de coagulograma (tempo de protrombina, tempo de trombina, tempo de tromboplastina parcial ativada) e de tromboelastograma (tempo r, tempo k, tempo r + k, ângulo alfa e amplitude máxima) nos seguintes momentos: antes e após a anestesia, após o nascimento do feto e 24 horas após a anestesia nos grupos PD e SA. No grupo BP a avaliação foi realizada antes da anestesia, após o nascimento do feto e 24 horas após a anestesia. RESULTADOS: Os resultados mostraram que nenhuma das técnicas anestésicas utilizadas teve influência na coagulação sangüínea das gestantes. Demonstraram, também, que durante o trabalho de parto tem início um processo de ativação da coagulação que é responsável pelas alterações encontradas nos três grupos estudados. CONCLUSÕES: Nas condições do presente estudo o bloqueio simpático e o anestésico local não influíram sobre a coagulação em gestantes de termo submetidas à anestesia peridural, subaracnóidea ou bloqueio pudendo.
BACKGROUND AND OBJECTIVES: The significant reduction in postoperative thromboembolic complications has been attributed to the use of regional block, probably due to attenuation of the neuroendocrine-metabolic response. Pregnant women, who demonstrate important hypercoagulability, can in theory benefit from this effect during labor. The objective of this study was to determine the effects of regional block on coagulation of pregnant women. METHODS: Thirty patients in the 3rd trimester were enrolled; ten patients underwent epidural block for cesarean section with 150 mg of 0.5 percent bupivacaine without epinephrine and 2 mg of morphine (PD group); ten underwent subarachnoid block for cesarean section with 15 mg of 0.5 percent hyperbaric bupivacaine and 0,2 mg of morphine (SA group); and ten, pudendal block for vaginal delivery with up to 100 mg of 0.5 percent bupivacaine without epinephrine (BP group). Coagulation tests (prothrombin time, thrombin time, activated partial thromboplastin time) and thromboelastography (r-time, k-time, r+k-time, alpha-angle, maximum amplitude) were performed in the following moments: before and after the blockade, after delivery, and 24 hours after the blockade in PD and SA groups. In the BP group, the evaluation was done before the blockade, after delivery, and 24 hours after the blockade. RESULTS: The results indicate that the anesthetic technique did not influence coagulation of pregnant women. They also demonstrate that coagulation is activated during labor, which is responsible for the changes seen in all the study groups. CONCLUSIONS: In the conditions of the present study, the sympathetic blockade and the local anesthetic did not have any influence on the coagulation of pregnant women at term undergoing epidural, subarachnoid, or pudendal nerve block.
JUSTIFICATIVA Y OBJETIVOS: La ha sido atribuida a la anestesia regional la disminución significativa de las complicaciones trombo embolicas en el postoperatorio, probablemente por su acción atenuante sobre la respuesta neuroendocrina-metabólica. Las embarazadas, que presentan aumento importante de la coagulabilidad sanguínea, pueden teóricamente, beneficiarse con ese efecto en ocasión del parto. El objetivo de este estudio fue verificar el efecto de la anestesia regional sobre la coagulación sanguínea en embarazadas. MÉTODO: Se estudiaron 30 pacientes en el 3° trimestre de embarazo, siendo diez sometidas a la anestesia peridural para cesárea, con 150 mg de bupivacaína a 0,5 por ciento sin epinefrina y 2 mg de morfina (grupo PD); diez a la anestesia subaracnoidea para cesárea con 15 mg de bupivacaína hiperbárica a 0,5 por ciento y 0,2 mg de morfina (grupo SA); y diez a Bloqueo de pudendo para parto vaginal, con dosis de hasta 100 mg de bupivacaína a 0,5 por ciento sin epinefrina (grupo BP). La coagulación sanguínea se evaluó a través del coagulograma (tiempo de protrombina, tiempo de trombina, tiempo de tromboplastina parcial activada) y del tromboelastograma (tiempo r, tiempo k, tiempo r+k, ángulo alfa y amplitud máxima) en los siguientes momentos: antes y después de la anestesia, después del nacimiento del feto y 24 horas después de la anestesia en los grupos PD y SA. En el grupo BP la evaluación fue realizada antes de la anestesia, después del nacimiento del feto y 24 horas después de la anestesia. RESULTADOS: Los resultados mostraron que ninguna de las técnicas anestésicas utilizadas tuvo influencia en la coagulación sanguínea de las embarazadas. También quedó demostrado que durante el trabajo de parto se inicia un proceso de activación de la coagulación, que es responsable por las alteraciones encontradas en los tres grupos estudiados. CONCLUSIONES: En las condiciones del presente estudio el Bloqueo simpático y el anestésico local...
Subject(s)
Adult , Female , Humans , Pregnancy , Anesthesia, Epidural , Anesthesia, Obstetrical , Blood Coagulation , Nerve Block , Cesarean Section , Subarachnoid SpaceABSTRACT
BACKGROUND: A volumetric caudal epidural steroid injection has been advocated to facilitate the delivery of medications to a lesion site. This study was aimed to examine the actual spreading patterns of this technique, using an epidurogram. METHODS: A total of 32 patients with chronic low back pain with a radiculopathy of various causes (degenerative spondylosis, herniated nucleus pulposus, spondylolisthesis, and spinal stenosis) were included. A volumetric caudal epidural injection of a 10 ml mixture of contrast medium 5 ml, 0.5% bupivacaine 1 ml, triamcinolone 1.5 ml (60 mg) and normal saline 2.5 ml was performed. Immediately after the cessation of the first spread, the subsequent solution of another 10 ml of contrast medium 5 ml, 0.5% bupivacaine 1 ml and normal saline 4 ml was injected. This procedure was repeated serially until the total volume equaled 50 ml. Continuous fluoroscopic imaging was obtained after each injection. RESULTS: Average time taken to complete the study was 37 seconds per every 10 ml. The spreading levels of the mixture were distributed mainly at the mid to lower lumbar area in the majority of the investigated patients. During the subsequent injections, these levels did not increase significantly. CONCLUSIONS: We concluded that the multiple small volume caudal epidural injections retraced their own tract repeatedly. This was thought to be due to the minimal resistance in the cephalad direction, anatomic variations and the Starling effect of epidural space.
Subject(s)
Humans , Bupivacaine , Epidural Space , Injections, Epidural , Low Back Pain , Radiculopathy , Spondylolisthesis , Spondylosis , Starlings , TriamcinoloneABSTRACT
BACKGROUND: This study was conducted to survey the incidences, severity, and variables influencing depression and the correlation between pain and depression in Korean cancer patients. METHODS: The results of a survey were collected from 142 patients, 79 male and 63 female (mean age 51.9 years), who were hospitalized at a major metropolitan tertiary care hospital for cancer treatment from January to June of 1999. Factors of depression and the level of pain were examined by a self-reported survey employing the Korean version of the Beck Depression Inventory (BDI) and an abridged version of the Brief Pain Inventory respectively. Demographic and clinical characteristics of patients were compiled by reviewing their medical records. The difference in the level of depression among patient groups was analyzed with the t-test and ANOVA, and the correlation between variables with the Pearson correlation coefficient. RESULTS: The mean scores of the worst pain for the last 24-hours was 6.1 +/- 2.2, the average pain for the last 24-hours 4.4 +/- 1.9, and the mean scores of pain at the time of the survey was 3.5 +/- 2.3, while the mean scores of the least pain for the last 24 hours was 2.3 +/- 1.8. The mean BDI scores were 23.7 +/- 1.0, and 55.6% of the patients were found to be in depression (cut off point 21). Scores of depression for cancer patients were higher than in the normal population. The correlations between the worst pain for the last 24 hours and depression, average pain for the last 24-hours and depression, pain at present and depression were significant. Significant differences were found among groups of cancer patients with pain with respect to gender, level of education, and ECOG. There was a significant positive correlation between depression and pain. CONCLUSIONS: More than 50% of cancer patients with pain were suffering from depression. The variables like the degree of pain, gender, level of education, ECOG, and age were significantly related to depression in cancer patients. The findings of this study could be used for identifying high-risk patients in need of intervention and planning effective therapeutic strategies for cancer patients.
Subject(s)
Female , Humans , Male , Depression , Education , Incidence , Medical Records , Tertiary HealthcareABSTRACT
BACKGROUND: After peripheral nerve injury in human, a syndrome of events (spontaneous pain, allodynia and hyperalgesia) may be observed that includes no response of morphine and dependency of this pain state on intact sympathetic function. Spinally delivered 2-adrenoceptor agonist and cholinergic agonist or cholinesterase inhibitors have been shown to have actions attenuating the hyperalgesia in rat models of nerve injury-induced pain. Using a fixed-dose analysis and an isobolographic paradigm, the spinal interaction between the 2-adrenoreceptor agonist, clonidine and cholinergic agonist, carbachol is characterized in rat model of nerve injury-induced tactile hyperalgesia. METHODS: Male Sprague Dawely rats were anesthetized with halothane, and the left L5 and L6 spinal nerve were ligated (Chung model). After recovery, a polyethylene tubing catheter was implanted into lumbar intrathecal space. After recovery from catheter implantation, intrathecal dose-response curves were established for the antiallodynic effect of carbachol (0.1, 0.3, 1.0, 3.0 microgram) and clonidine (0.3, 1.0, 3.0, 10 microgram) alone to obtain the ED50 for each agent. ED50 fractions (1/2, 1/4, 1/8, 1/16) of drug combinations of carbachol-clonidine were administered and thresholds for left hind limb paw withdrawal to von Frey hair application were assessed. The ED50 of carbachol-clonidine combination was established and isobolographic analysis of the drug interactions was carried out.c RESULTS: Intrathecal carbachol and clonidine alone produced dose-dependent reductions of tactile allodynia: ED50 of 66 ng (12~367 ng) and 39 ng (1~1452 ng), respectively. With the fixed dose analysis, the log dose-response curves showed a left shift that considerably exceeds the theoretical curves made by a simple sum of the effects of carbachol alone and clonidine. With the isobolographic analysis, ED50 of mixture was found to be statistically less than the theoretical additive ED50 of mixture. CONCLUSION: The experiments suggest that intrathecal carbachol and clonidine alone produce a dose dependent antagonism on touch evoked allodynia and intrathecal carbachol is synergistic when combined with intrathecal clonidine.
Subject(s)
Animals , Humans , Male , Rats , Carbachol , Catheters , Cholinergic Agonists , Cholinesterase Inhibitors , Clonidine , Drug Combinations , Drug Interactions , Extremities , Hair , Halothane , Hyperalgesia , Models, Animal , Morphine , Neuralgia , Peripheral Nerve Injuries , Polyethylene , Spinal NervesABSTRACT
BACKGREOUND: When a double-lumen endotracheal tube (DLT) is used for one-lung ventilation, its position should be accurate. But only a few studies has been performed about how to predict the depth of insertion for DLT preoperatively. The purpose of this study is to investigate which physical measurements are correlated with the depth of insertion for left-sided DLT and how the depth of insertion for DLT can be explained with these physical measurements. METHODS: After placing a 5 cm-high pillow under the patient's head, we intubated left-sided disposable DLT (BronchocathTM, Mallinckrodt medical Ltd, USA) in 65 adults. We tape-measured sternocleidomastoid muscle (SCM) length and sternal length. We positioned the proximal margin of the bronchial cuff of DLT just below carinal bifurcation through fiberoptic bronchoscope, and recorded the depth of insertion for DLT at the upper incisor level. RESULTS: The depth of insertion for DLT was correlated with both height (y=3.96+0.15x, r2=0.51, p=0.0001) and SCM length (y=16.73+0.82x, r2=0.49, p=0.0001). Sternal length (r2=0.11, p=0.0081) was weakly correlated with the depth of insertion for DLT. The best regression model was depth of insertion for DLT (cm)=6.88+0.09 height (cm)x0.46 SCM length (cm). CONCLUSIONS: The depth of insertion for DLT is correlated with SCM length as well as height. So we may use them in predicting the depth of insertion for DLT.
Subject(s)
Adult , Humans , Bronchoscopes , Head , Incisor , One-Lung VentilationABSTRACT
BACKGROUND: Steroid therapy has been considered as co-analgesic for palliative treatment of metastatic bone pain in terminal cancer. We designed prospective study to observe analgesic efficacy of dexamethasone, to evaluate different analgesic assessment methods and its correlation to actual improvement of quality of life. METHODS: Thirty seven men with symptomatic bone pain of prostate cancer were treated with dexamethasone infusions (10mg twice a day) for 2 weeks. Response to treatment was assessed by daily analgesic intake, by the McGill-Melzack pain questionnaire (MPQ), and by a series of 17 linear analog self-assessment scales (LASA) relating to pain and to various aspects of quality of life. Biochemical and radiological markers were measured. RESULTS: Fourteen patients (38%) had improvement in indices used to assess pain at 2 weeks after starting dexamethasone. Reduction in pain indices was associated with improvement in other dimensions of quality of life and in the scale for overall well-being. Even though radiological and biochemical markers showed no correlation, symptomatic relief of pain was associated with a decrease in serum concentration of adrenal androgens. CONCLUSION:g We conclude that 1) dexamethasone treatment may cause useful relief of pain in some of patients with bone pain of prostate cancer; 2) this relief of pain is associated with suppression of adrenal androgens; 3) measures of pain and quality of life can be used to assess benefits of systemic therapy with dexamethasone; and 4) this effects of dexamethasone should be further investigated in bone pain of other metastatic cancer.
Subject(s)
Humans , Male , Androgens , Biomarkers , Dexamethasone , Palliative Care , Prospective Studies , Prostate , Prostatic Neoplasms , Quality of Life , Self-Assessment , Weights and MeasuresABSTRACT
Nerve damage is the second most common complication related to anesthesia. Peripherial nerve block may be implicated in the etiology of such injury but it has been reported infrequently. Injury to a nerve occurring from the other causes such as patient positioning, surgical trauma or tourniquet, might be mistakenly attributed to the anesthetic. Although the precise mechanism is unknown in most instances, it is important to identify the probable cause since the prognosis for recovering directly depends on the underlying nature of the neurological deficit. We report a case of median, ulnar and radial nerve palsy after axillary block using paresthesia approach. The electromyography (EMG) was performed to evaluate the extent and location of lesion. The EMG findings suggest that nerve lesion was the level of right middle upper arm. So, we suspected tourniquet injury was the most probable cause of neuropathy in spite of adequate pressure and brief application time.
Subject(s)
Anesthesia , Arm , Electromyography , Nerve Block , Paralysis , Paresthesia , Patient Positioning , Prognosis , Radial Nerve , TourniquetsABSTRACT
BACKGROUND: The univent tube is an endotracheal tube with a movable bronchial blocker for one lung ventilation. The purpose of this study was to measure the appropriate cuff volume sealing the mainstem bronchus by three different techniques. METHODS: This study was performed in 60 adult patients undergoing thoracotomy. 1) The negative pressure was applied to the end of blocker causing loss of volume in the breathing system. The blocker cuff volume was measured at the point of the bag ceased to deflate. 2) The blocker cuff volume was measured when breathing sound is not heard on blocked lung. 3) Then the capnometer was applied to the blocker and the cuff volume was measured at the point of the CO2 wave ceased abruptly. The bronchial blocker volumes from these three methods were compared with the volume which was measured when the lung was completely collapsed in operation field. RESULTS: Left bronchial sealing volume was 2.7+/-?0.8 ml with negative pressure technique, 3.5+/-0.8 ml with auscultation, 3.2?1.2 ml with CO2 technique and 3.0+/-0.7 ml with complete lung collapse at operation field. Right bronchial sealing volume ranged 3.5+/-0.9 ml with negative pressure technique, 4.6+/-1.0 ml with auscultation, 3.9+/-0.6 ml with CO2 technique and 4.2+/-0.9 ml with complete lung collapse at operation field. CONCLUSIONS: We concluded that right bronchial blocker volume was 4.2+/-0.9 ml and left bronchial blocker volume was 3.0+/-0.7 ml. The right bronchial blocker volume was larger than the left.
Subject(s)
Adult , Humans , Auscultation , Bronchi , Lung , One-Lung Ventilation , Pulmonary Atelectasis , Respiration , Respiratory Sounds , ThoracotomyABSTRACT
BACKGROUND: The portable glucose meter is useful in operating rooms and intensive care units (ICUs), where blood glucose concentration must be analyzed frequently and rapidly, and provides immediate information for clinical decisions. At present, the glucose-oxidase(GOD) method is used extensively among many glucose measurement methods but blood oxygen concentration affects this blood glucose value because oxygen, at increased concentration, consumes blood glucose which cannot then be measured by GOD method. The purpose of this study is to investigate the effect of blood oxygen pressure on the blood glucose value by GOD method by the comparison of arterial and venous blood glucose values. METHOD: Patients are randomly assigned to FiO2. 0.33(group1; n=15), FiO2 0.5(group2; n=15) and FiO2 1.0(group3; n=15) groups. 20 minutes after intubation, the samples were obtained from artery and vein. Blood glucose concentrations were measured by portable glucose meter, respectively. RESULT: The value of arterial blood glucose when measured by the GOD method could be underestimated more than the value of venous blood glucose by 3~5 mg/dl. CONCLUSION: The blood glucose value obtained by GOD method is certainly affected by increased blood oxygen pressure. The underestimation is not a clinical problem when blood glucose is high, but anesthesiologist should pay attention to hypoglycemia by the GOD method when blood oxygen pressure is high.
Subject(s)
Humans , Arteries , Blood Glucose , Glucose , Hypoglycemia , Intensive Care Units , Intubation , Operating Rooms , Oxygen , VeinsABSTRACT
It is well known that suprasternal notch is at the midpoint between the carina and vocal cords. We evaluated the distance from the endotracheal tube tip on the suprasternal notch to upper incisor using flexible lightwand. 97 male(height 155~187 cm) and 100 female(height 144~167 cm) patients of undergoing elective surgery were included in the study. After adjust the lamp of the tracheal lightwand at the tube tip, endotracheal tube was placed under anesthesia at the suprasternal notch using the light glow. The distance between upper incisor to suprasternal notch was recorded. The average distance from upper incisor to suprasternal notch was 20.0(+/-1.0)cm in males, 17.9(+/-0.7)cm in females. We demonstrated that the placing the tracheal tube at the suprasternal notch using lightwand was rapid and reliable method for identification of proper tube positioning. We have shown that securing endotracheal tube at upper incisor 23 cm in males and 21 cm in females are positioned distally.
Subject(s)
Adult , Female , Humans , Male , Anesthesia , Incisor , Trachea , Vocal CordsABSTRACT
Aim To investigate the changes of [Ca2+]i in the pulmonary artery smooth muscle cells of PAH rats induced by MCT.Methods PAH rat model was established by MCT intraperitoneal injection.The PASMCs were primarily cultured and loaded with Fura-2/AM.Effects of Ryanodine receptor agonists on intra-cellular calcium were measured by Fluorescence microscopy Results After being given 10 nmol?L-1 Ryanodine,the concentration of [Ca2+]i in control group increased by(93.31?12.41)nmol?L-1;and the concentration in PAH group increased by(141.71?13.59)nmol?L-1(P