Objective : Direct revascularization surgery is regarded as the most effective method of treatment of adults with moyamoya disease. These patients, however, have a higher risk of perioperative ischemic complications than do patients with atherosclerotic stroke, and are at risk for ischemic complications in the hemisphere contralateral to the one operated on. We investigated the incidence and risk factors for ischemic stroke in the contralateral hemisphere after surgical treatment of adults with moyamoya disease. Methods : We retrospectively reviewed the medical records and results of neuroimaging studies on 79 hemispheres of 73 consecutive patients with adult moyamoya disease ($mean{\pm}SD$ age, $37.96{\pm}11.27$ years; range, 18-62 years) who underwent direct bypass surgery over 6 years. Results : Ischemic complications occurred in 4 of 79 (5.1%) contralateral hemispheres, one with Suzuki stage 3 and three with Suzuki stage 4. Three patients showed posterior cerebral artery (PCA) involvement by moyamoya vessels. Advanced stage of moyamoya disease (Suzuki stages 4/5/6; $p$=0.001), PCA involvement ($p$=0.001) and postoperative hypotension (mean arterial blood pressure <80% of preoperative mean arterial blood pressure) on the first ($p$<0.0001) and second ($p$=0.003) days after surgery were significantly correlated with postoperative contralateral ischemic complications. Conclusion : In patients with advanced moyamoya disease and involvement of the PCA, intentional hypotension can result in ischemic stroke in the hemisphere contralateral to the one operated on. Careful control of perioperative blood pressure is crucial for good surgical results.
More and more non-injured operations are being implemented these days, thanks to the development of medical technology. Still, however, most operations leave direct scars on patient' bodies, as well as accompanying pain. The massage as an independent nursing intervention can stimulate the circulation of the blood of tissue and muscle and increase the relationship between a patient and a nurse. The purpose of this study is to investigate the effect of foot massage on pain in post abdominal operative patients. The nonequivalent control group, pre-post test design is used for this study. From July 7, 2000 to February 20, 2001, the 40 patients who were operated under general anesthesia in a university hospital in Seoul were studied. They were divided into two groups ; 20 patients were part of the experimental group, and the others, in the control group. In order to evaluate the effect of foot massage, severity of pain was checked with the VAS (Visual Analog Scale) and also each patients' vital signs were measured with pulse rate, systolic blood pressure and diastolic blood pressure. The collected datas were processed by SAS version 6.12 program and analyzed by the Chi-square, Fisher's exact test, t-test and repeated measures ANOVA. The results of this study were as follows. 1. The severity of pain decreased significantly in the experimental group as compared to the control group following foot massage (t=-3.317, p= .002). 2. Measured vital signs in the experimental group had more reduction of that than in the control group following foot massage. - The pulse rate in the experimental group was lower than that in the control group following foot massage (F=7.73, p=.008). - The systolic blood pressure in the experimental group was lower than that in the control group following foot massage (F=25.75, p=.000). - The diastolic blood pressure in the experimental group was lower than that in the control group following foot massage (F=15.27, p=.000). In conclusion, foot massage is an effective dependent nursing intervention for pain control of post abdominal operative patients.
This study was undertaken to search for a new antihypertensive or hypotensive agents in natural crude products in Korea. Betula schmidtii Regel, a tree belonging to the Betulaceae family, is cultivated for the most part of our country, and their cortecies or tree milk has been used as folk remedy, which exerted good antiinflammatory effect on rheumatic fever, arthritis or rheumatism. The rats were treated with several extracts from Betula schmidtii Regel, that is, extracts of water, methanol from inner cortecies, extracts of ether, methanol, hexane, chloroform or butanol from outer and total cortecies. In this experiment, we measured the blood pressure and heart rate in anesthetized rats, and atropine, diphenhydramine, phentolamine, propranolol, epinephrine, hexamethonium and hydralazine were pretreated prior to Betula extracts to clarify the mechanism of the hypotensive action. The results of the experiment were as follows; 1. BOIE(Betula outer cortex water-insoluble extract) and BICE(Betula inner cortex chloroform extract) elevated the blood pressure and heart rate. 2. BIME(Betula inner cortex methanol extract), BIBE(Betula inner cortex butanol extract) and BIWE (Betula inner cortex water extract) significantly lowered the blood pressure and heart rate. 3. With the pretreatment of hydralazine, the hypotensive effect of Betula schmidtii Regel was significantly blocked. From the above results, it is suggested that the hypotensive effect of Betula schmidtii Regel is due to the direct vasodilation of blood vessel.
The train transportation has a lot of advantages-energy efficiency is high, it is eco-friendly, safety is better than normal roads and it is possible for people to arrive on time. In these days, the valuation of ride comfort, which is only limited to road transportation, is newly recognized in order to having competitiveness from other transportation. Especially, in the development of the Korean high-speed railroad business, the ride comfort enhancement of train is very important problem to be solved. Currently, there are international standards of ride comfort such as UIC13, ISO2631. In Korea case, although it has own standard like KS R9216, it mainly depends on the physical parameter such as vibration and noise. So recently, in the valuation of ride comfort, the movements of living parameter technique introduction are increasing on the base of Japan and many developed countries of Europe techniques. Presently, the method of train ride comfort is mainly based of vibration, that is, mechanical parameter adding selection of variable acceleration and noise. This paper would like to show biological parameter; heart rate and blood pressure variation. This method is more direct, based on human body response, than mechanical parameter method. In this experiment, the variability of heart rate and blood pressure of passengers according to tilting angle change of Train, the Korean tilting train, we are supposed to know that the extent of tilting on the simulation has influence on variability of heart rate and blood pressure, which are living parameter of heart's blood.
In order to investigate the dietary intakes and physical characteristics in college women smokers, interviews using questionnaires were done on 33 smokers and 42 nonsmokers residing in seoul area. General living habits, dietary habits, food consumption frequency and nutrient intake by quick estimation were investigated through direct interviews with subjects. Subjects height, weight and blood pressure were measured, and body fat percentage were statistically analyzed using Bio-electrical Impedence Fatness Analyzer(GIF-891). All data were statistically analyzed by SAS PC package program ; percentage or mean and standard error were examined for each item, and the significant difference was evaluated by chi-square test or Student's t-test at $\alpha$=0.05. In the analysis of taste and food preference, smokers consumed larger amount of alcohol and coffee than nonsmokers ; they also disliked sweet taste. The results of food consumption frequency data also showed that smokers consumed less fish, milk and fruits but consumed more instant foods than nonsmokers. As a result of anthropometric measurements, height, age, and 패요 fat percentage showed no difference, but there was a significant difference in weight, BMI, systolic blood pressure, and diastolic blood pressure. Energy intake in nonsmokers was 1640 ㎉/day(CHO : Pro : Fat=66.0 : 14.7 : 19.3), in smokers. Intakes of calcium, iron, vitamin C, vitamin A, vitamin B1, vitamin B2, and niacin in smokers were not significantly different from those of nonsmokers.
Objective: To determine the efficacy and reliability of measuring direct current microcurrent applied through the skin to determine injury in the underlying tissues. Design: Case control study. Methods: First, microcurrent was measured as decreased blood flow induced hypoxia in healthy subjects. Next, reliability was assessed by measuring over ten days with set variations in pressure and distance between the electrodes. Finally, measurements over sprained ankle were compared to measurements over comparable uninjured areas on the same injured subject. Results: For the blood flow test phase, microcurrent significantly decreased an average of 17% after 5 minutes (p<0.05), remained decreased for 30 seconds, and returned to non-occlusive levels after 2 minutes of normal circulation. The results indicate that the microcurrent decrease was not due to blood flow, and most likely from hypoxic cellular damage. For the reliability phase, the coefficients of variation averaged 10.3% for the shoulder, 14.8% for the low back, and 29.1% for the knee. Changing distance 2.5 cm between the electrodes resulted in insignificant changes. Changes in pressure had some significant effect after an increase in force of 2.6 N, affirming the need for consistent pressure for measurement. For the injury test phase, a significant 69% decrease occurred comparing injured areas to the same area on the uninjured side, and a significant 74% occurred comparing injured and non-injured areas on the same limb. Conclusions: Microcurrent through the skin shows promise as an objective method of assessing a soft tissue injury by detecting damage likely due to hypoxia.
The effects of the Evodiae fructus on the cardiovascular function were assessed in spontaneously hypertensive rats, and isolated preparation of spontaneously hypertensive rats aortic strip. In spontaneously hypertensive rats, intraperitoneal administration of methanol crude extract of Evodiae Fructus (0.5mg/kg) lowered aterial blood pressure which lasted for at least 4 hours. The hypotensive effect of Evodiae Fructus was more stronger with ${\alpha}-adrenoreceptor$ inhibitor(Phentholamine) and it was not affected by ${\beta}-adrenoreceptor$ inhibitor(Propranolol). The hypotensive effect of Evodiae Fructus was abolished by NAME. It is suggested that the hypotensive effect of Evodiae Fructus may be concern with endothelium-derived relaxing factor and it may be mediated through NO synthesis. Evodiae Fructus showed a vasorelaxing effect on denude aortic strip. It is suggested that Evodiae Fructus has a direct relaxing effect on vascular smooth muscle cells. Judging from above results, it was proved that hypotensive effect of Evodiae Fructus. The mechanism of hypotensive action may be concern with endothelium-derived relaxing factor and direct relaxing effect on vascular smooth muscle cells. Therefore, it is suggested that Evodiae Fructus is applicable to hypertension.
Atrial septal defect is one of the most frequently encountered congenital heart disease. Up to December 31, 1976, 1682 cardiac patients received cardiac catheterization in the cardiac department of Yonsei university medical college. Out of the 1682 cardiac patients 723 cases had congenital heart disease and only 116 cases had congetial atrial septal defect. This amounted to 16.04% of all those with congenital heart disease. 58 cases of congenital atrial septal defect operated in the chest surgery department were presented. Of these 58 cases of atrial septal defect, 27 cases were male and 31 cases were female. Their ages ranged from 5 years to 54 years. The systolic pressure of the main pulmonary artery of 40 out of the 58 cases of atrial septal defect was below 40% of that of the systemic blood pressure: in 6 cases, the range of the systolic pressure of the main pulmonary artery was 50-90mmHg; in 12 cases, the range of the systolic pressure of the main pulmonary artery was 40-50mmHg. Average age of these was 30. 1 years. This study tends to show that Korean patients with atrial septal defect even though younger have a slight higher systolic pressure of the main pulmonary artery than Western patients have. The pulmonary blood is 1.5-2.5 times of systemic blood flow in 52 cases out of 58 cases of atrial septal defect.In only one of the 58 cases of atrial septal defect, the Rp was found to be as high as 45% of Rs. All other cases were below this level.51 cases had ostium secundum defect, 4 out of these cases had ostium secundum defect combined with mitral incompetence and 6 out of them had double ostium secundum defect. The remaining 7 cases had ostium primum defect. Their atrial defects were repaired under direct vision utilizing extracorporeal circulation, by hemodilution technic combined with moderate hypothermia. 44 cases [2nd atrial septal defect] were repaired by direct sutures while 14 cases, including the 7 cases ostium primum defects needed patches [1 pericardium and 13 teflon patch]. In 4 cases there were single defects while showed two defects. However the associated septal defect was so small that it could be closed by direct sutures. The size of the defect ranged between 6.0cm2and 10.0cm2 in 19 cases[33.7%]: the smallest being 0. 5cm2 and the largest 24cm2. The surgical mortality was 2 cases [3.4%]. These one case with ostium primum defect, could not be resuscitated on operation table. The cause of death in this case was myocardial failure and MI. The other, a case of ostium primum defect had a second operation on the first operative day due to massive bleeding from LV vent-line insertion site.The patient died on 26th post-operative day due to sepsis.
Atrial septal defect is one of the most frequently encountered congenital heart disease. Up to December 31, 1976, 1682 cardiac patients received cardiac catheterization in the cardiac department of Yonsei university medical college. Out of the 1682 cardiac patients 723 cases had congenital heart disease and only 116 cases had congetial atrial septal defect. This amounted to 16.04% of all those with congenital heart disease. 58 cases of congenital atrial septal defect operated in the chest surgery department were presented. Of these 58 cases of atrial septal defect, 27 cases were male and 31 cases were female. Their ages ranged from 5 years to 54 years. The systolic pressure of the main pulmonary artery of 40 out of the 58 cases of atrial septal defect was below 40% of that of the systemic blood pressure: in 6 cases, the range of the systolic pressure of the main pulmonary artery was 50-90mmHg; in 12 cases, the range of the systolic pressure of the main pulmonary artery was 40-50mmHg. Average age of these was 30. 1 years. This study tends to show that Korean patients with atrial septal defect even though younger have a slight higher systolic pressure of the main pulmonary artery than Western patients have. The pulmonary blood is 1.5-2.5 times of systemic blood flow in 52 cases out of 58 cases of atrial septal defect.In only one of the 58 cases of atrial septal defect, the Rp was found to be as high as 45% of Rs. All other cases were below this level.51 cases had ostium secundum defect, 4 out of these cases had ostium secundum defect combined with mitral incompetence and 6 out of them had double ostium secundum defect. The remaining 7 cases had ostium primum defect. Their atrial defects were repaired under direct vision utilizing extracorporeal circulation, by hemodilution technic combined with moderate hypothermia. 44 cases [2nd atrial septal defect] were repaired by direct sutures while 14 cases, including the 7 cases ostium primum defects needed patches [1 pericardium and 13 teflon patch]. In 4 cases there were single defects while showed two defects. However the associated septal defect was so small that it could be closed by direct sutures. The size of the defect ranged between 6.0cm2and 10.0cm2 in 19 cases[33.7%]: the smallest being 0. 5cm2 and the largest 24cm2. The surgical mortality was 2 cases [3.4%]. These one case with ostium primum defect, could not be resuscitated on operation table. The cause of death in this case was myocardial failure and MI. The other, a case of ostium primum defect had a second operation on the first operative day due to massive bleeding from LV vent-line insertion site.The patient died on 26th post-operative day due to sepsis.
Kim, So-Young;Cho, In-Sook;Lee, Jae-Ho;Kim, Ji-Hyun;Lee, Eun-Jung;Park, Jong-Hyock;Lee, Jin-Seok;Kim, Yoon
Journal of Preventive Medicine and Public Health
/
v.40
no.6
/
pp.487-494
/
2007
Objectives : Little is known about the physician-related factors that are associated with the management of Hypertension. The purpose of this study was to determine the physician-related factors associated with blood pressure control in hypertensive patients. Methods : We surveyed 154 physicians at 117 public health (subhealth) centers in Gyeonggi-do, Forty-one physicians completed the survey (response rates : 26.6%) and 31 physicians were finally included as the study subjects. Using the information obtained from the self-reported survey, we measured the physician-related factors associated with hypertension control, including their perception of hypertension, prescription patterns (combination prescription rates, specific antihypertensives prescription rates among patients with diabetes mellitus), and sociodemographic factors. We then collected data on blood pressure and medication use in patients seen by these physicians from the health center#s information system. We compared the physicians# perceived hypertension control rates with the actual rates, and then evaluated the rate of high overestimation (overestimation by more than 25% of the median degree of hypertension control rate overestimation) among the physicians. The physicians# antihypertensive prescription patterns were also evaluated. Multiple logistic regression analysis was used to evaluate the independent association between hypertension control and physician-related factors. Results : The physicians tended to overestimate the proportion of their patients with controlled blood pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with high overestimation was 35.5% (11 physicians). The physicians with lower control rates were more likely to highly overestimate their patients# control rates. Physicians with below-median actual control rates tended to prescribe fewer combination treatments for patients with uncontrolled blood pressure and angiotensin-converting enzyme inhibitors or fewer angiotensin receptor blockers for patients with diabetes mellitus. The rate of high overestimation by physicians was 1.31 times higher in patients with uncontrolled blood pressure than in patients with other conditions (OR=1.31, 95% CI : 1.17-1.48). Conclusions : Physicians have a tendency to overestimate the rates of hypertension control in their patients. Because physicians have a direct role in treatment outcomes, physicians# overestimation about hypertension management contributes to inadequate blood pressure control. Thus, interventions for improving physician# awareness regarding the management of patients with hypertension are needed.
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