Rat Intestinal Acetic Acid and Butyric acid and Effects of Age, Sex, and High-fat Diet on the Intestinal Levels in Rats

BACKGROUND: High-fat diet is known to be implicated in the pathogenesis of various metabolic disorders related to an inflammatory response. The aim of this study was to investigate the influence of high-fat diet for intestinal acetic acid and butyric acid concentrations which are related to inflammation-associated colon cancer risk. METHODS: Both male and female rats of 6, 31, 74 and 104-week of age were fed chow diet or high-fat diet for 8 weeks. Body weight and food intake were measured weekly during the feeding period. Intestinal acetic acid and butyric acid levels were measured by high-performance liquid chromatography from luminal contents of ileum and cecum. RESULTS: Male rats showed greater weight change than female rats in every age. Calorie-adjusted food intake was also higher in male rats compared to female rats. Male rats showed similar intake of food in every age while 31-week old female rats showed increased intake, which was decreased at 74-week and 104-week of age. The ileal acetic acid concentration was increased in male rats fed high-fat diet, while female rats fed high-fat diet showed no significant change in the ileal acetic acid level. On the other hand, butyric acid almost disappeared in high-fat diet fed rats regardless of sex. CONCLUSIONS: High-fat diet increases the intestinal acetic acid concentration while reducing the butyric acid concentration which may account for increased risk of inflammation-associated colon cancer.

The Comparison of Blood Acid-Base Changes in Severe Burn Patients Resuscitation with Hartmann Solution and Plasma Solution-A

PURPOSE: Intravenous infusion of crystalloid solution is very important in the treatment of severe burn patients. But variable blood acid-base differences can be induced due to crystalloids. The aim of this study was to compare, in severe burn patients, the effects of two balanced fluids (Hartmann solution and plasma solution-A) on blood chemical differences. METHODS: A retrospective review was performed on 21 patients from January 2010 to December 2012 who admitted as severe burn patients to KEPCO Medical Center burn care unit. One group was resuscitated with Hartmann solution according to Parkland formula. The other one was resuscitated with plasma solution-A. RESULTS: 21 patients were enrolled. 14 patients belonged to plasma solution-A group and 7 patients belonged to Hartmann solution group. Bicarbonate, pH, serum lactate and serum electrolytes showed no statistic differences between plasma solution-A and Hartmann solution group (P>0.05). As time went by, pH and bicarbonate increased and serum lactate level decreased in both group. CONCLUSION: In this study, plasma solution-A had equally alkalinizing effect as Hartmann solution in severe burn patient resuscitation.

Gynecomastia induced by H1-antihistamine (ebastine) in a patient with idiopathic anaphylaxis

H1-antihistamine is generally a well-tolerated and safe drug. However, in resemblance with all other drugs, H1-antihistamines can also prompt adverse drug reactions (ADRs). We recently encountered the very unusual ADR of H1-antihistamine-induced gynecomastia. A 21-year-old man with idiopathic anaphylaxis was treated with ebastine (Ebastel), a second-generation H1-antihistamine, for the prevention of anaphylaxis. Three months later, the patient remained well without anaphylaxis, but had newly developed gynecomastia. Because anaphylaxis recurred after the cessation of H1-antihistamine, the preventive medication was changed to omalizumab. A few months later, his gynecomastia had entirely disappeared. Physicians should be aware of this exceptional ADR of H1-antihistamine.

The Effect of Silk Fibroin Particles Coated with Hydroxyapatites on Bone Regeneration in the Rat Calvarial Defect Model

A Comparison of the Effectiveness of Before and After the Trauma Team's Establishment: Treatment Outcomes and Lengths of Stay in the Emergency Department

PURPOSE: The aim of this study was to analyze the influence of a trauma team's management. METHODS: A total of 181 patients with severe trauma were retrospectively divided into two groups. Of these 181 patients, 81 patients without a trauma team admitted between April and October 2008 were assigned to Group 1, and 100 patients with a Trauma team admitted between April and October 2009 were assigned to Group II. We compared general characteristics, the length of stay in the emergency department (ED) and treatment outcomes (24-h packed RBC transfusion, length of intensive care unit (ICU) stay, length of hospital stay, in-hospital mortality, 24-h mortality) between these two groups. RESULTS: The length of stay in the ED was significantly reduced in Group II compared to Group I (p=0.025). No significant differences were found in mean arterial pressure, Glasgow Coma Scale, Revised Trauma Score, Injury Severity Score, in-hospital mortality and 24-h mortality between the two groups. However, Group II had a lower amount of 24-h packed RBC transfusion and a shorter length of ICU and hospital stay than Group I, although these differences were not statistically significant. CONCLUSION: Through the establishment of a trauma team, the length of stay in the ED can be reduced remarkably. Furthermore, the need for 24-h packed RBC transfusions and the length of stay in the ICU and hospital were found to be decreased in patients managed by a trauma team.

The Effect of Emergency Department Treatment Time on Outcomes in Acute Stroke Patients / 대한구급학회지

BACKGROUND: Stroke is a disease that leads to a long period of disability and death. Accordingly, the initial treatment is so influential on the prognosis of a patient that shortening the time to initial treatment after hospital admission has a very important role in the entire treatment regimen. This study aimed to demonstrate the effect of the Emergency Department treatment time at Bundang CHA Hospital for acute stroke patients to improve the treatment regimen through six sigma activities. METHODS: The outcomes for 246 patients with suspected acute strokes who were admitted to the Emergency Department of Bundang CHA Hospital, the flow of the emergency department process divided into 11 phases, and the duration of each phase were determined. Patients were classified as before and after six sigma activities and compared. RESULTS: The five phases statistically demonstrated the effect of meaningful improvement in the duration of visit-receiving CT prescriptions, visit-receiving lab prescriptions, consult request-arriving to the emergency department, visit-CT angiography results, and visit-the issue of hospital admissions. In the next 2 phases, the sigma level also improved by 0.71sigma and 0.06sigma. However, the total emergency department stay time was not statistically meaningful. The time required time was increased and the sigma level was decreased by 0.19sigma. CONCLUSIONS: The result of six sigma activities showed the effect of the treatment system improvement with a partial decrease in the duration of each phase, but the total emergency department stay time was not improved owing to environmental factors. For better results, continuous improvement of the treatment system and expansion of hospital facilities will be required.

The Effect of Six Sigma Activity in Major Trauma Patients on the Time Spent in the Emergency Department

PURPOSE: This study was conducted to shorten the time spent at each stage of treatment and to reduce the total amount of time patients spend in the emergency department (ED) by applying Six Sigma in the treatment of major trauma patients. METHODS: This is a comparative study encompassing 60 patients presenting to the ED of Bundang CHA Hospital from January 2008 to December 2008 and from July 2009 to March 2010. The stages of treatment for major trauma patients were divided into six categories (T1: total emergency department staying time, T2: duration of visit-radiologic evaluation time, T3: duration of visit-consult to department of admission, T4: duration of consultation-issue of hospital admissions time, T5: duration of visit-issue of hospital admissions time, T6: duration of issue of hospital admission-emergency department discharge time) and the total time patients spent in the ED was compared and analyzed for periods; before and after the application of Six Sigma. RESULTS: After the application of Six Sigma, the numerical values in four of the six categories were significantly reduced; T2, T3, T4, and T5. However, the average of the total time patients spent in the ED did not show any remarkable change because the T6 increased highly. The level of Six Sigma increased 0.17sigma. CONCLUSION: The application of Six Sigma for major trauma patients in the ED resulted in a significant improvement in the error rate for the total time patients spent in the ED. The Six Sigma activity has shown great potential. Therefore, the project is expected to bring better results in every stage of treatment if the levels of the hospital facilities are improved.

Value of a Diagnostic RSS (rapid streptococcal screening) Test for Patients with Sore Throat in the Emergency Department

PURPOSE: This paper compares a RSS (Rapid Streptococcal Screening) detection test with a throat culture. The RSS detection kit is an easier and faster way to identify the infection of Group A beta-hemolytic streptococcus (GABHS), the most common causal agent of acute bacterial pharyngitis. We also examine the clinical symptoms that are associated with bacterial pharyngitis. METHODS: A throat culture and a RSS detection test were performed simultaneously to all 239 patients who were suspected of having acute pharyngitis, and visited the emergency department between September 1st, 2002, and June 30th, 2003. Then the values of the RSS detection test were analyzed comparatively on a chi square test. The correlation between Centor criteria clinical features and bacterial pharyngitis was examined through a logic regression test. RESULTS: Comparative analysis of the results of a throat culture and RSS detection test showed a test sensitivity of 83.6%, specificity was 97.2%, and the kappa coefficient was 0.83 (95% C.I: 0.75~0.91). This suggests that the RSS detection test is valuable statistically. CONCLUSION: The RSS detection test is more accurate than the diagnosis of bacterial pharyngitis based on clinical features. Assuming that all patients with acute pharyngitis take antibiotics, an RSS detection test reduce of unnecessary antibiotics use.

A Study of Anal Manometric Finding after Low Anterior Resection of Rectal Cancer

PURPOSE: Low anterior resection, irrespective of anastomotic technique, may be associated with frequent bowel movement and other bowel management difficulties. The aim of this study was to access the anorectal function after low anterior resection of the rectal cancer. METHODS: We studied 28 patients who had mid and low rectal cancer (average 8.3 cm above the anal verge) had undergone low anterior resection using stapling suture devices (average level of anastomosis was 3.8 cm above anal verge) and anal manometry was undertaken 95 times preoperatively (N=28) and 3 month (N=26), 6 months (N=22) and 12 months (N=19) postoperatively from 1992 to 1995 in Korea University Guro Hospital. RESULTS: Maximum resting pressure was reduced after resection (from 64.7 mmHg to 42.7 mmHg, change ?22 mmHg) but gradually increased and returned to preoperative level at 12 months postoperatively. Minimum perceived volume was decreased after operation (from 40.3 ml to 25 ml change of ?15.3 ml) and this change persist at 12 months postoperatively. Rectoanal inhibitory reflex was present in all patient before surgery but disappeared in most of the patient after operation. Reflex returned to normal in 4 of 22 patients at 6 months later and in 7 of 19 patients at 12 months after operation. Maximum squeezing pressure and maximum tolerable volume were not decreased after operation. CONCLUSIONS: Anorectal function (maximum resting pressure, minimum perceived volume and rectoanal inhibitory reflex) was reduced immediately after low anterior resection of rectal cancer. But this functional changes returning to normal at 6 months and most of the patients had good function at 12 months after operation.

Clinical Analysis of Retinal Detachment Following Extracapsular Cataract Extraction

The authors reviewed retrospectively preoperative ocular clinical characteristics, operative methods, postoperative anatomical results and visual rehabilitation for the 24 eyes, retinal detachments following extracapsular cataract extraction (ECCE). The most, common preoperative visual symptom was decreased vision, 19 eyes (79%) and the significant preoperative ocular findings were vitreous opacity 14 eyes (58%) and posterior capsular rupture 14 eyes (58%). The horseshoe tear 11 eyes (46%), atrophic hole 9 eyes (38%) were more comnnonly encountered, and the retinal breaks were principally located in the superotemporal quadrant in 18 eyes (75%), the superonasal quadrant. in 12 eyes (42%). Also, macular detachment 19 eyes (79%) was found most frequently with retinal detachment eyes. The overall anatomic success rate of surgical treatment of retinal detachment after ECCE was 21 eyes (88%). Especially, the visual acuity improved two line or more in II eyes (85%) with posterior chamber intraocular lens (PC-IOL) implantation group. We suggest that the early detection of retinal detachment. after ECCE with complications and proper operations are important to inaprove the postoperative anatomic success rate and the postoperative visual prognosis.

Electrosurgical Burn at the Site of EKG Electrode: A case report / 대한마취과학회지

In the operation room, members of the surgical team have the ultimate responsibility of safe guarding the patient from electrical devices. The electrosurgical unit is one instrument commonly used during surgical procedures. We have experienced accidental burning. Sixty-seven years-old patient received burn at the site of the ECG electrode which was caused by an electrocautery used in conjunction with electronic monitoring equipment. Although cutting and coagulation powers were very low, the normal size of the ECG electrodes led to the generation of a high current density. Prevention of interactions of this kind between properly functioning monitoring and surgical units requires good communication among all members of the operating room team and every electrical instruments should inspected, tested regularly.

Medical Treatment of Constipation

No abstract available.

Intra-articular Morphine, Bupivacaine-Morphine for Pain Relief after Arthroscopy Surgery of the Knee Joint / 대한마취과학회지

BACKGROUND: Evidence has accumulated that opioids can produce potent antinociceptive effects by interacting with opioid receptors in peripheral tissues. Bupivacaine is potent analgesic with early peak onset in the postoperative period. The combination of intra-articular bupivacaine and morphine has been suggested as an ideal analgesic after knee arthroscopy. METHODS: Thirty patients scheduled for knee arthroscopy under general anesthesia were allocated randomly to two groups. Group 1 received morphine 5 mg in normal saline 25 ml, group 2 received morphine 5 mg in 0.25% bupivacaine 25 ml intraarticularly, and all solutions contained 1:200,000 epinephrine. Tourniquet was inflated above knee joint for 10 minutes after injection in each of the patients. Postoperative pain was assessed using the visual analogue scale at 1, 2, 3, 4, 6, 12 and 24 hours after the intra-articular injection. The need for supplemental analgesic was recorded. RESULTS: Patients in the group 2 had lower pain scores than group 1 at first and second hour. There were no significant differences from 3 hours to 24 hours postoperative period. Supplemental analgesic requirements were significantly greater in group 1 than group 2 for the first 3 hours. CONCLUSIONS: It is concluded that, after knee arthroscopy, intra-articular morphine 5 mg in 0.25% bupivacaine 25 ml results in satisfactory analgesia with small amount of supplementary analgesic.

Problems of Application to McBride Disability Evaluation in Loss of Visual Effciency Patients

We had carried out a retrospective analysis which consisted of 61 consecutive cases on disability evaluated and estimation of loss of efficiency in this hospital for the last five years. Factors in disability evaluation were decreased visual acuity (27 patients, 44.2%), contracted visual field (5 patients, 8.1%) and disabled ocular motility (15 patients, 24.5%). Estimation errors in disability evaluation occurred in 9 (14.7%) in all cases. The average error rate was 10.2%. The causes were confusion of efficiency with loss of efficiency, conversion deficiency of 75% visual efficiency in pseudophakic eye and estimation errors in diplopia field test. Beforehead estimation cases in disability evaluation were 9 cases (4.7%). The case which needed request of calculation of medical fee after this were 19 cases (31.3%). The incidence of malingering were observed in 11 patients (18.0%) and the major factor of malingering was decreased visual acuity (8 patients, 72.7%). In conclusion, with the use of the estimation of loss of efficiency, we presented many problems such as estimation errors, beforehead estimation cases in disability evaluation, maligerings, request of calculation of medicalfee after this, and etc. Therefore, in accord with the actual condition, we request the establishment of standardization, methods, articles of estimation.

A Statistical Analysis of the Ocular Status of Matriculants

Ophthalmologic examinations were performed and analyses were done in regard to the visual acquity, refractive states, color deficiency, and ocular diseases in relation to each college department and year, on 11,930 applicants for entrance to Chonnam National University(first successful candidates; male:9247, female: 2683) from 1971 to 1978. The results were as follows: 1. The incidence of eyes with visual acquities below 1.0 was 45.3%, most of which were myopes. Myopic eyes were 44.0% of the total, of which 42.1% were male and 50.2% female. 2. The prevalence of myopes was highest in applicants to the College of Commerce (52.3%), next the College of Medicine (48.3%), and the least the College of Agriculture (34.1%). 3. On the whole the prevalance of myopic eyes showed a rising tendency every year; the highest in 1976, 51.9% both 50.5% in 1975 and 1978, and the lowest in 1971, 31.5%. 4. The prevalence of color deficiency was 3.9% (364 persons) in males and 0.2% (5 persons). in females. Of the male color deficients, 48.6% (177) had green blindness, 28.3% (103) red green weakness, 11.5% (42) red blindness, 11.3% (41) red green blindness, and 0.3% (1) total color blindness. 5. Of other ocular diseases, exophoria and exotropia were the most predominant.