Dexmedetomidine Improves Locomotor Function and Alleviates Thermal Hyperalgesia Following Sciatic Nerve Crush Injury in Rats / 대한배뇨장애요실금학회지

Purpose@#The effects of dexmedetomidine on locomotor function and thermal hyperalgesia in sciatic nerve crush injury (SNCI) were investigated using rats. @*Methods@#After exposing the right sciatic nerve, the sciatic nerve was crushed for 1 minute by a surgical clip. One day after nerve injury, dexmedetomidine (5, 25, and 50 µg/kg) was directly applied to the injured sciatic nerve once a day for 14 days. Walking track analysis was used to assess locomotor function and plantar test was conducted to assess thermal pain sensitivity. Immunohistochemistry was performed to determine the expression of c-Fos in the ventrolateral periaqueductal gray (vlPAG) and paraventricular nucleus (PVN). Western blot was used to evaluate the expression level of nerve growth factor (NGF) and myelin basic protein (MBP) in the sciatic nerve. @*Results@#SNCI resulted in deterioration of locomotor function and increased thermal pain sensitivity. The level of c-Fos expression in the PVN and vlPAG was increased and the level of NGF and MBP expression in the sciatic nerve was enhanced by SNCI. Dexmedetomidine treatment improved locomotor function and upregulated expression of NGF and MBP in the sciatic nerve of SNCI. Dexmedetomidine treatment alleviated thermal hyperalgesia and downregulated expression of c-Fos in the vlPAG and PVN after SNCI. @*Conclusions@#Dexmedetomidine may be used as a potential new treatment drug for recovery of locomotion and control of pain in peripheral nerve injury.

Evaluation of the Effectiveness and the Level of Self-Management Support on the Metabolic Syndrome Management Program at Public Health Centers in Seoul Metropolitan City / 보건행정학회지

BACKGROUND: The purpose of this study was to evaluate the effectiveness and the level of self-management support on the Metabolic Syndrome Management Program at public health centers in Seoul metropolitan city. METHODS: The effectiveness on the Metabolic Syndrome Management Program were analyzed using secondary data from 1,312 community residents who were receiving program. The level of self-management support on Metabolic Syndrome Management Program was evaluated using an ‘Assessment of Primary Care Resources and Supports for Chronic Disease Self-Management’ from four public health centers. RESULTS: The effectiveness on the Metabolic Syndrome Management Program was showed that decreased smoking (p=0.044) and drinking (p<0.001), and increased healthy dietary habit (p<0.001) in health behaviors. It was showed that decreased triglyceride (p=0.002) and increased high-density lipoprotein cholesterol (p<0.001) in clinical indicators. The level of self-management support on Metabolic Syndrome Management Program was 98.1 points and it meaned that implementation is done in an organized and consistent manner using a team approach. There was difference in the level of self-management support by public health centers (p=0.003). CONCLUSION: The Metabolic Syndrome Management Program in public health centers was effective, and level of self-management support was done as organizational level, but patient input and mental health were insufficient.

Airway management of an ankylosing spondylitis patient with severe temporomandibular joint ankylosis and impossible mouth opening / 대한마취과학회지

No abstract available.

Cementless Total Hip Arthroplasty for Patients with Crowe Type III or IV Developmental Dysplasia of the Hip: Two-Stage Total Hip Arthroplasty Following Skeletal Traction after Soft Tissue Release for Irreducible Hips

BACKGROUND: Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is a technically demanding procedure for arthroplasty surgeons, and it is often difficult to reduce the hip joint without soft tissue release due to severe flexion contracture. We performed two-stage THAs in irreducible hips with expected lengthening of the affected limb after THA of over 2.5 cm or with flexion contractures of greater than 30 degrees in order to place the acetabular cup in the true acetabulum and to prevent neurologic deficits associated with acute elongation of the limb. The purpose of this study is to evaluate the outcomes of cementless THA in patients with severe DDH with a special focus on the results of two-stage THA. METHODS: Retrospective clinical and radiological evaluations were done on 17 patients with Crowe type III or IV developmental DDH treated by THA. There were 14 women and 3 men with a mean age of 52.3 years. Follow-ups averaged 52 months. Six cases were treated with two-stage THA followed by surgical hip liberalization and skeletal traction for 2 weeks. RESULTS: The mean Harris hip score improved from 40.9 to 89.1, and mean leg length discrepancy (LLD) in 13 unilateral cases was reduced from 2.95 to 0.8 cm. In the patients who underwent two-stage surgery, no nerve palsy was observed, and the single one-stage patient with incomplete peroneal nerve palsy recovered fully 4 weeks postoperatively. CONCLUSIONS: The short-term clinical and radiographic outcomes of primary cementless THA for patients with Crowe type III or IV DDH were encouraging. Two-stage THA followed by skeletal traction after soft tissue release could provide alternative solutions to the minimization of limb shortenings or LLD without neurologic deficits in highly selected patients.

The correlation of cerebrospinal fluid pressure according to the degree of flexion and spinal block level in spinal anesthesia for Cesarean section

BACKGROUND: The use of neuraxial anesthesia for Cesarean section has dramatically increased. There was little information about the relationship of cerebrospinal fluid (CSF) pressure according to the position and spinal block level in pregnant women. The aims of this study are to investigate the cerebrospinal fluid pressure according to the degree of flexion in the lateral position and block height after spinal anesthesia in pregnant women undergoing Cesarean section. METHODS: We enrolled 40 patients, American Society of Anesthesiologists physical status I-II, aged 22-40 years, undergoing Caesarean section under spinal anesthesia. Patients were randomly divided into two groups. In group I, patients were placed in a full flexed position, and 10 mg of 0.5% hyperbaric bupivacaine was injected. In group II, the same dose of bupivacaine was injected when the hip and neck was straightened slowly. Following injection, the patients were immediately placed in supine position. The level of spinal anesthesia was checked by pinprick at 5, 10, 15, and 30 min after the subarachnoid injection. RESULTS: There was significant difference in the cerebrospinal fluid pressure between full-flexed position and non-full-flexed position. The spinal block height level was T3-T5 in both groups, and there was no significant difference in the spinal block height level in both groups. CONCLUSIONS: CSF pressures according to the degree of flexion in the lateral position during the subarachnoid injection have no significant correlation with the block level in spinal anesthesia for Cesarean section.

An Exploratory Study of Factors associated with the Health Behavior of Working Elderly with Chronic Diseases

PURPOSE: This study aimed to identify the health behaviors of working elderly Koreans aged 65 over and examined the socio-demographic and disease-related factors by health behaviors. METHODS: This study used data obtained from the 2nd basic survey of the 2008 Korean Longitudinal Study of Ageing. We selected 381 working elderly having one or more of the diseases hypertension, diabetes, heart disease or cerebrovascular disease. RESULTS: 78.9% out of the subjects have hypertension, 31.2% have diabetes, 12.3% have heart disease, and 6.3% have cerebrovascular disease. Compared to the health behaviors of the general elderly, the rate of the practice of regular exercise among the subjects was lower, but the smoking and drinking rate were higher. The significant variables associated with health behavior practice rates were gender, type of work, subjective health status and chronic diseases. CONCLUSION: The type of work of the elderly with chronic diseases was significantly associated with health behaviors. Consequently, this study found that continuous care programs for the working elderly with chronic diseases should be developed and provided as an occupational health service when the jobs are offered to them.

Anesthetic management of penetrating neck injury patient with embedded knife: A case report / 대한마취과학회지

Penetrating neck injuries can be a fatal event and they are difficult to manage for both surgeons and anesthesiologists. So, adequate preoperative evaluation is important to improve the patients' outcomes, but this can not be done for hemodynamically unstable or uncooperative patient. Here we present our clinical experience with a patient with a penetrating neck injury and who was hemodynamically stable, but she was uncooperative and the knife was still embedded in her neck. The surgical exploration and bronchoscopic examination were successfully done under monitored anesthesia care.

Anesthetic management of an adult patient with Rett syndrome and limited mouth opening: A case report / 대한마취과학회지

Rett syndrome is a neurological disease that occurs only in females and it manifests with mental retardation, seizures, movement disorders, autistic behavior and abnormal breathing. A 19-year-old female with Rett syndrome underwent ophthalmologic surgery under general anesthesia at our institution. Airway control was difficult due to her limited mouth opening. We recommend that anesthesiologists should have proper knowledge about this disease and the patients to avoid the complications and problems that can be encountered during the perioperative period.

Remifentanil alleviates transient cerebral ischemia-induced memory impairment through suppression of apoptotic neuronal cell death in gerbils / 대한마취과학회지

BACKGROUND: During neurosurgical procedures, patients are often exposed to hypoxic and ischemic brain damage. Cerebral ischemia leads to neuronal cell death and eventually causes neurological impairments. Remifentanil is a new ultra-short acting phenylpiperidine opioid analgesic. In this study, we evaluated remifentanil to determine if it exerts an anti-apoptotic effect in the hippocampal dentate gyrus following transient global ischemia in gerbils. METHODS: Step-down avoidance task, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, and immunohistochemical staining for caspase-3 were performed. RESULTS: The numbers of TUNEL-positive cells and caspase-3-positive cells in the dentate gyrus were increased by ransient global ischemia. Latency in the step-down avoidance task was increased by transient global ischemia. Results revealed that apoptotic cell death in the dentate gyrus was increased significantly following transient global ischemia, resulting in memory impairment. However, treatment with remifentanil suppressed ischemia-induced apoptosis in the dentate gyrus, thereby alleviating the memory impairment that was induced by ischemic cerebral injury. CONCLUSIONS: These results indicate that remifentanil may exert a neuroprotective effect on ischemic brain damage during surgery.

Treatment of Unstable Intertrochanteric Fracture Using Short Barrel Compression Hip Screws and a Trochanteric Stabilizing Plate / 대한정형외과학회잡지

PURPOSE: To assess the effectiveness of additional fixation using a trochanter stabilizing plate for the case of an unstable intertrochanteric fracture of the femur. MATERIALS AND METHODS: Between February 2003 and February 2009, one hundred twenty-one consecutive patients with unstable intertrochanteric fractures were treated with CHSs and a TSP with or without additional screws and wiring. The follow up period was an average of twenty-eight months (range: six to sixty-one months). The fractures were classified according to the Jensen classification. We retrospectively evaluated the fracture healing time, the sliding length, the incidence of fixation failure and clinical failure, and the functional recovery. RESULTS: The mean time to radiologic bony union was 16.2weeks. The average amount of lag screw sliding was 8.4 mm. Overall, 119 of 121 patients had bony union and 2 patients showed nonunion. Mechanical failure was noted in 5 patients and 8 patients showed clinical failure. Ninety-four patients (78%) had at least returned to their pre-fracture level of walking ability. CONCLUSION: Fixation with compression hip screws (CHSs) and a trochanter stabilizing plate (TSP) for treating unstable intertrochanteric fracture of the femur seemed to be helpful for decreasing excessive sliding and the rate of fixation failure. Short barrel CHSs and TSP fixation with additional screws and wiring are necessary for treating unstable intertrochanteric fracture of the femur, and especially for the cases with a large posterior greater trochanteric fragment or a displaced lesser trochanter.

Surgical Approach to the Hip: Direct Lateral Approach

The direct lateral approach was first described and named the transgluteal approach by Bauer in 1979 and was popularized by Hardinge K in 1982. In total hip arthroplasty, the direct lateral approach offers distinct advantages for the orientation of implants, access to both the acetabulum and proximal femur, and the preservation of soft tissue continuity between the gluteus medius and vastus lateralis muscle group. It can also be quite versatile, even in cases requiring extensive exposure, such as revision arthroplasty. The disadvantages include a risk of superior gluteal nerve injury, disruption of the repaired abductor mechanism, and postoperative heterotopic ossification. This review describes the surgical exposure of the direct lateral approach as well as the advantages and potential complications of the direct lateral approach.

The use of the Montgomery T-tube in postprocedural subglottic stenosis repair / 대한마취과학회지

The Montgomery T-tube is a device that supports the trachea and facilitates ventilation after laryngotracheal surgery. Because its use is sporadic, many anesthesiologists may not be familiar with this device, and its anesthetic management requires careful planning and discussion with surgeons. We describe the techniques of anesthetic management of exchanging endotracheal tube to Montgomery T-tube in case where upper tracheal stenosis exists.

Pseudomeningocele after lumbar discectomy treated with fibrin glue and epidural blood patch: A case report / 대한마취과학회지

Pseudomeningocele is rare complication after lumbar discectomy. Most pseudomeningoceles are asymptomatic, but sometimes can cause headaches, infection, back pain, and radicular pain. Treatment modalities include conservative management, epidural blood patch, lumbar subarachnoid drainage, and surgery. We report a successful treatment of pseudomeningocele with epidural blood and fibrin glue patch, which did not treated with conservative management and epidural blood patch alone.

Anesthetic care for living donor auxiliary partial orthotopic liver transplantation in the treatment of adult-onset type II citrullinemia: A case report / 대한마취과학회지

A deficiency of the urea cycle enzyme, argininosuccinate synthetase which is produced in liver, makes citrullinemia, which is an autosomal recessive disorder. As the liver is the only organ which transforms ammonia into urea, liver transplantation has been considered as an effective alternative therapy to classical dietary and medical therapy. We have experienced perioperative anesthetic care for a 27-year-old male with citrullinemia undergoing successful living donor auxiliary partial orthotopic liver transplantation (APOLT). After the liver transplantation, the postoperative clinical courses of the patient were uneventful, and the neurological symptoms were completely resolved. The plasma concentrations of ammonia and citrulline normalized rapidly without any kinds of protein dietary restrictions. We present this case with a brief review of literature.

Peripartum Cardiomyopathy Presenting at Cesarean Section : A case report / 대한마취과학회지

Peripartum cardiomyopathy (PPCM) is defined as the onset of acute heart failure without any demonstrable cause in the last trimester of pregnancy or within the first 6 months after delivery. It is characterized by ventricular dilatation and poor ventricular contractility but it is often unrecognized because the symptoms of normal pregnancy commonly mimic those of mild heart failure. The incidence varies from 1 in 1,300 to 1 in 15,000 pregnancies. We encountered a patient, who developed sudden pulmonary edema during an elective cesarean section. Echocardiography performed after the surgery showed a low ejection fraction (20%). The patient was treated with diuretics and inotropic agents and mechanical ventilation with positive end-expiratory pressure. She was discharged uneventfully on the postoperative 11th day.

Comparison of Student Nurses Graduating from a Junior College or a University on Observation and Performance of Nursing Roles / 기본간호학회지

PURPOSE: This study was done to identify observation and performance of nursing role activities by student nurses graduating from 3 year junior colleges or 4 year universities. METHOD: A descriptive design was used and the participants were 295 student nurses who were graduating. Data were collected using a structured questionnaire. RESULTS: The average score for observation of nursing role activity was 2.16+/-0.29, and for performance 1.61+/-0.29. Among the college students, the mean item score for observation was highest for medication administrator and lowest for provider of spiritual & bereavement care, while for the university students the highest was for provider of care during surgery and lowest for provider of spiritual & bereavement care. The college students had higher scores for observation, and the university students for performance. CONCLUSION: It is concluded that standardized practice learning programs need to be designed in schools and in clinical practice areas, in order to further develop adaptability to nursing roles.

The Effect of Obesity on Awareness in General Anesthesia with Propofol / 대한마취과학회지

BACKGROUND: Recently obesity population is epidemically rapidly increasing. But, in the anesthetic field the study for obesity patients is not good enough. So, we designed the study to see the effect of obesity on awareness in general anesthesia with propofol. METHODS: The 52 subjects were between 20 to 60 years old and ASA physical status 1, 2 undergoing general anesthesia for elective surgery. According to asia pacific obesity criteria, we divided the patients into the obesity group (BMI > or = 25) and the non-obesity group (BMI < 25). Propofol was infused using TCI for induction and maintenance. BIS was used for monitoring the depth of anesthesia. During operation, we tried to keep BIS between 40-49 by manipulate the target concentration of TCI. After the operation, without stimulating patients, we measured the time (T-BIS(5070)) from the BIS passes 50 then goes to 70. We compare the T-BIS(5070) between the obesity and the non-obesity group. RESULTS: The obesity and the non-obesity group do not show significant difference in age, sex, height, body temperature, anesthesia time, and total used propofol amounts. BMI in obesity group was 27.3 +/- 1.9 kg/m(2) and in non-obesity group was 22.2 +/- 1.8 kg/m(2). T-BIS(5070), the awareness time was significantly different between the obesity group (170.3 +/- 54.8 sec) and the non-obesity group (212.7 +/- 81.8 sec). CONCLUSIONS: Our data suggest that in general anesthesia with propofol the obesity group's awareness time is shorter compared with the non-obesity group and the effects may come from the uniqueness of the propofol's pharmacokinetics and the obesity patient's physical characteristics.

Role-Identity of Home Care Nurse Practitioners / 간호학회지

INTRODUCTION: It is important to understand the nature of the identity through the live experiences of Home Care Nurse Practitioner(HCNP) because the role identity of a professional is constructed by continuous social interactions, This study aims to understand the construction of the role identity of HCNP. METHOD: Data was collected from 12 hospital based HCNPs. This study involved two focus group discussion sand four in-depth individual interviews. The main question was "what is the role of HCNP?" The debriefing notes and field notes were analyzed using consistent comparative data analysis method. RESULT: First, Home care (HC) is a small clinic. HCNP brings it to home to provide various services. Second, HC is the real nursing and HCNP is the 'genuine' nurse who actualizes the essence of nursing in practice. Third, HC is empowering activity to promote self-care ability of the patients and their caregivers. Forth, HC is like the dish-spinning required high-level mastery and HCNP is an expert who provides the most appropriate services to the patients. CONCLUSION: HCNPs have the role identity as a highly qualified professional who delivers services from hospital to home, actualizes the essence of nursing in practice, empowers the patients and their caregivers to have self-efficacy to recover, and offers the most appropriate nursing care.

Role-Identity of Home Care Nurse Practitioners / 간호학회지

INTRODUCTION: It is important to understand the nature of the identity through the live experiences of Home Care Nurse Practitioner(HCNP) because the role identity of a professional is constructed by continuous social interactions, This study aims to understand the construction of the role identity of HCNP. METHOD: Data was collected from 12 hospital based HCNPs. This study involved two focus group discussion sand four in-depth individual interviews. The main question was "what is the role of HCNP?" The debriefing notes and field notes were analyzed using consistent comparative data analysis method. RESULT: First, Home care (HC) is a small clinic. HCNP brings it to home to provide various services. Second, HC is the real nursing and HCNP is the 'genuine' nurse who actualizes the essence of nursing in practice. Third, HC is empowering activity to promote self-care ability of the patients and their caregivers. Forth, HC is like the dish-spinning required high-level mastery and HCNP is an expert who provides the most appropriate services to the patients. CONCLUSION: HCNPs have the role identity as a highly qualified professional who delivers services from hospital to home, actualizes the essence of nursing in practice, empowers the patients and their caregivers to have self-efficacy to recover, and offers the most appropriate nursing care.

The Effects of Exercise Program for the Elderly

No abstract available.