Effective Bolus Dose of Sufentanil to Attenuate Cardiovascular Responses in Laryngoscopic Double-Lumen Endobronchial Intubation.

BACKGROUND: Sufentanil is a potent opioid analgesic frequently used in clinical anesthesia. Double-lumen endobronchial intubation induces profound cardiovascular responses in comparison with ordinary endotracheal intubation because of the larger tube diameter and direct irritation of the carina. OBJECTIVES: The purpose of this study was to determine the effective bolus dose of sufentanil to attenuate hemodynamic changes in response to laryngoscopic double-lumen endobronchial intubation. PATIENTS AND METHODS: We randomly assigned 72 patients aged 18 - 65 years and with an American Society of Anesthesiologists physical status of 1 or 2 to one of four sufentanil dose groups: NS, S0.1, S0.2, or S0.3. The respective doses for the groups were as follows: normal saline, 0.1 mcg/kg of sufentanil, 0.2 mcg/kg of sufentanil, and 0.3 mcg/kg of sufentanil. Blood pressure and heart rate were recorded during the pre-anesthesia period at baseline, pre-intubation, immediate post-intubation, and every minute during 5 minutes after intubation. RESULTS: Baseline mean arterial pressures in the NS, S0.1, S0.2, and S0.3 groups were 89.8 ± 12.1, 89.2 ± 10.9, 88.8 ± 13.6, and 90.7 ± 11.1, respectively. At immediate post-intubation, the mean arterial pressures in the NS, S0.1, S0.2, and S0.3 groups were 129.7 ± 14.7, 120.7 ± 14.2, 120.8 ± 17.2, and 96.7 ± 10.4, respectively. At immediate post-intubation, the mean arterial pressure in the NS, S0.1, and S0.2 groups significantly increased from baseline (P < 0.001), but the S0.3 group showed no difference. In the time point comparison at immediate post- intubation, the S0.3 group had a significantly lower mean arterial pressure than did the NS, S0.1, and S0.2 groups (P < 0.001). CONCLUSIONS: We found that 0.3 mcg/kg of sufentanil attenuates cardiovascular responses to double-lumen endobronchial intubation without adverse effects.

Chorioamniotic membrane separation caused by the seromucinous collection from a placental chorioangioma.

Placental chorioangioma is a benign non-trophoblastic tumor of the placenta that can have various adverse effects on the mother and fetus depending on its size. Chorioamniotic membrane separation is rare condition of detachment between the amniotic membrane and chorionic membrane. Chorioamniotic membrane separation after the second trimester of pregnancy is usually occurs after invasive procedures or may occur spontaneously; it is mostly associated with fetal abnormalities. Here, we report a case of chorioamniotic membrane separation that might be occurred caused by the seromucinous secretion from a placental chorioangioma.

A symptomatic lumbosacral perineural cyst -A case report-.

Lumbosacral perineural cysts are formed by the arachnoid membrane of the nerve root at the lumbosacral level. Most of these cysts are asymptomatic and are found incidentally during computed tomography (CT) or magnetic resonance imaging (MRI) for other causes of chronic lower back pain. This type of cyst requires a differential diagnosis to distinguish it from other causes of radiating pain and neurological symptoms. In the present case, a symptomatic lumbosacral perineural cyst was found, and pain relief was achieved by non-surgical treatment. A lumbosacral perineural cyst was identified from a differential diagnosis of a lumbar disc disorder that presented as radiating pain and neurological symptoms.

Relationship between clinical phenotypes and cognitive impairment in Parkinson's disease (PD).

Most patients with idiopathic PD (IPD) show variable degrees of cognitive decline. The purpose of this study was to evaluate the relationship between the predominant motor symptom at the time of disease onset and the level of cognitive function in patients with IPD. A total of 159 patients with IPD were enrolled in this study. The patients' initial motor symptoms were classified into three types: tremor-dominant (TD), bradykinesia and rigidity-dominant (BRD), gait and postural instability-dominant (GPD). Disease severity was rated according to the Hoehn-Yahr classification (H&Y stage). Overall cognitive status was evaluated using the Korean versions of the Mini-Mental State Examination (K-MMSE) and the Modified Mini-Mental State (3MS) tests. The GPD group showed the lowest scores of the K-MMSE/3MS, and the patients with TD showed the best performance in the cognitive analysis (p<0.05). The patients who were older at disease onset showed worse cognitive performance than those the patients who were younger at disease onset (p<0.05). There was no difference in cognitive status according to H&Y stages. The accurate classification of initial motor symptoms and the detailed history, including the exact onset age of IPD, may allow us to predict cognitive decline in IPD.

Characteristics of clock drawing test (CDT) errors by the dementia type: quantitative and qualitative analyses.

We wanted to define the characteristics of errors on the clock drawing test (CDT) and we also wanted to determine their value for making the early diagnosis of dementia, so the performance of patients with three types of dementia on the four CDT was evaluated. The patients with subcortical vascular dementia (VaD) and patients with Parkinson's disease with dementia (PDD) had more stimulus bound responses. Patients with Alzheimer disease (AD) made significantly more conceptual deficit (CD) errors. The CD correlated with the severity of dementia and it could be detected in the early and mild stage of dementia. Qualitative and quantitative analyses of the errors on the CDT might be useful for making the early differential diagnosis of dementia types.

Relation between the clock drawing test (CDT) and structural changes of brain in dementia.

The CDT is a useful screening instrument for assessing cognition. The aim of this study is to identify which structural change of the brain is related with the CDT performance. Eighty-four patients with memory impairment were enrolled. The Korean versions of the mini-mental state examination (K-MMSE) and the modified mini-mental state (3MS) test, and the Seoul Neuropsychological Screening Battery (SNSB) were given to every subject. Four CDT scoring methods were used. The cerebral white matter hyperintensity (WMH), cortical atrophy (CA), ventricular enlargement (VE), and medial temporal lobe atrophy (MTA) were rated by two neurologists who were kept "blind" to the clinical information. The cognitive and executive functions were significantly correlated with the CDT performance. The degree of WMH and MTA showed an inverse relation with the CDT performance. The periventricular WMH (PVH) contributed more to impairment of CDT, than that of the deep WMH (DWMH). This study suggests that a combination of executive dysfunction via the frontal-subcortical disruption due to the PVH and memory impairment due to the MTA might be responsible for further worsening on the CDT.

Relationship between brachial-ankle pulse wave velocity and cognitive function in an elderly community-dwelling population with metabolic syndrome.

Arterial stiffness (AS) and metabolic syndrome (MS) may correlate with poor cognitive function in elderly people. However, few studies have evaluated this relationship in a healthy, community-dwelling elderly population. Our aim was to evaluate a relationship between the AS measured by pulse wave velocity (PWV) and cognitive function and to know whether the relationship is influenced by the presence of MS. Our study population was community-dwelling healthy people in Geumsan province, Republic of Korea. A total of 370 participants without a history of cerebrovascular disease were evaluated with the Korean version of the mini-mental state examination (K-MMSE) and have measured the brachial-ankle PWV (baPWV). Correlation between baPWV and cognitive status and effect of MS were measured. Negative correlation between PWV and cognitive function was found in the older subjects (> or = 60 years of age) with MS (r=-0.38; p<0.05). In the receiver operating characteristic (ROC) curve, the cut-off score was 1800.8 cm/s with 67% sensitivity and 78% specificity. Aging (older than 60 years) and the presence of MS may affect synergistically cognitive decline in the elderly population. The baPWV can be a useful predictor for cognitive decline in elderly healthy community-dwelling population with MS.

Characterization of the optical properties of silver nanoparticle films.

To understand the collective properties of nanoparticles, it is necessary to control the particle size, spacing and ordering. Here we describe the chemical synthesis of well-controlled silver nanoparticles, the wet coat preparation and the optical properties of its film. The light incidence angle and polarization dependency of the resonant spectra show distinctive surface plasmon resonance extinction peaks for isolated particles and the coupled modes of neighbouring particles. Furthermore, we discuss the thermal treatment and dielectric surrounding effects on the optical properties of silver nanoparticle film.

Pulse pressure correlates with leukoaraiosis in Alzheimer disease.

The relation between pulse pressure (PP) and Alzheimer disease (AD) remains unclear. We performed this study to investigate the relation between PP and AD and the impact of PP to impair cognitive performance on this relationship. It is a cross-sectional study from the Neurology Memory Clinic of Chungnam National University Hospital and five senior welfare centers in the city of Taejon, Korea. A cohort of 75 patients with AD and 117 control subjects were enrolled for the study. PP was significantly higher whereas mean arterial pressure (MAP) was lower in patients with AD than those of control subjects. Elevated serum total cholesterol (TC) level was significantly associated with both PP and MAP in control subjects as well as patients with AD. We found a significant relationship between PP and cerebral white matter changes (WMCs) in AD. PP changes correlate with leukoaraiosis in AD.

Localized character of 4f electrons in CeRhx (x=2,3) and CeNix (x=2,5).

We have measured Ce 4f spectral weights of extremely alpha-like Ce transition metal intermetallic compounds CeRhx (x=2,3) and CeNix (x=2,5) by using the bulk-sensitive resonant photoemission technique at the Ce M5(3d(5/2)-->4f) edge. High energy resolution and longer escape depth of photoemitted electron at this photon energy enabled us to distinguish the sharp Kondo resonance tails at the Fermi level, which can be well described by the Gunnarsson-Schönhammer calculation based on the Anderson impurity Hamiltonian. On the other hand, the itinerant 4f band description shows big discrepancies, which implies that Ce 4f electrons retain localized characters even in extremely alpha-like compounds.