• Biomedical Science Letters
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• v.19 no.3
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• pp.254-260
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• 2013

The purpose of this study was to survey the effects of Karvonen exercise prescription in coronary artery disease patients reaching age-predicted maximal heart rates with the exercise stress test on hemodynamic responses and cardiorespiratory fitness. The subject group was comprised of acute coronary syndrome (ACS) patients, who were divided into the maximal heart rate (MHR) group that included those who completed the test with their heart rates reaching the number of 220-age and the maximal dyspnea (MD) group that included those who could not continue the test due to respiratory difficulty and were asked to stop the test. Both groups had the exercise stress test before and after the experiment. In the exercise stress test before the experiment, the exercise prescription intensity of Karvonen was set at the target heart rates of 50~85% with a six-week exercise monitoring arrangement. As a result, there were no interactive effects in rest heart rate (RHR) according to time and group, but interactive effects were observed in maximal heart rate (MHR) (P=0.000). Both rest systolic blood pressure (RSBP) and rest diastolic blood pressure (RDBP) had no interactive effects according to time and group. Maximal systolic blood pressure (MSBP) showed significant interactive effects according to time and group (P=0.017). Maximal diastolic blood pressure (MDBP) showed no interactive effects according to time and group, while maximal rate pressure product (MRPP) showed significant interactive effects according to time and group (P=0.003). Maximal time (MT) had no interactive effects according to time and group. $VO_{2max}$ and maximal metabolic equivalent (MMET) showed significant interactive effects according to time and group (P=0.000, P=0.002, respectively), whereas maximal respiratory exchange ratio (MRER) and maximal rating of perceived exertion (MRPE) showed no interactive effects according to time and group. The exercise test that was discontinued as the subjects reached the predicted maximal heart rates considering age did not reach the maximal exercise intensity and accordingly showed low exercise effects when applied to Karvonen exercise prescription intensity. That is, the test should keep going by monitoring cardiac events, MRER and MRPE until the heart rates exceed the predicted MHR by up to 10~12 even after the subject reaches the predicted MHR considering age in the exercise stress test.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.4
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• pp.221-227
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• 2015

Background: Endotracheal intubation induces clinically adverse cardiovascular changes. Various pharmacological strategies for controlling these responses have been suggested with opioids being widely administered. In this study, the optimal effect-site concentration (Ce) of remifentanil for minimizing hemodynamic responses to fiberoptic nasotracheal intubation was evaluated. Methods: Thirty patients, aged 18-63 years, scheduled for elective surgery were included. Anesthesia was induced with a propofol and remifentanil infusion via target-controlled infusion (TCI). Remifentanil infusion was initiated at 3.0 ng/mL, and the response of each patient determined the Ce of remifentanil for the next patient by the Dixon up-and-down method at an interval of 0.5 ng/mL. Rocuronium was administered after propofol and remifentanil reached their preset Ce; 90 seconds later fiberoptic nasotracheal intubation was initiated. Non-invasive blood pressure and heart rate (HR) were measured at pre-induction, the time Ce was reached, immediately before and after intubation, and at 1 and 3 minutes after intubation. The up-and-down criteria comprised a 20% change in mean blood pressure and HR between just prior to intubation and 1 minute after intubation. Results: The median effective effect-site concentration ($EC_{50}$) of remifentanil was $3.11{\pm}0.38ng/mL$ by the Dixon's up-and-down method. From the probit analysis, the $EC_{50}$ of remifentanil was 3.43 ng/mL (95% confidence interval, 2.90-4.06 ng/mL). In PAVA, the EC50 and EC95 of remifentanil were 3.57 ng/mL (95% CI, 2.95-3.89) and 4.35 ng/mL (95% CI, 3.93-4.45). No remifentanil-related complications were observed. Conclusions: The $EC_{50}$ of remifentanil for minimizing the cardiovascular changes and side effects associated with fiberoptic nasotracheal intubation was 3.11-3.43 ng/mL during propofol TCI anesthesia with a Ce of 4 ug/mL.

• The Journal of Pediatrics of Korean Medicine
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• v.14 no.2
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• pp.1-32
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• 2000

It has long been known that SOAT is effective for sudden palpitation occurring unexpectedly in Oriental Medicine. However, effect of SOAT on the isolated heart has not been studied yet. The purpose of this study is to investigate the effect of SOAT on hemodynamics and ECG of isolated rat hearts induced by electrical stimulation using Langendorff perfusion apparatus for nonworking heart. SOAT extract was manufactured by water-alcohol precipitated method. Sprague-Dawley rats weighting $120{\sim}150g$ were used for the experiments, Subject animals were divided into four groups, which are consisted of 1) control(Group orally administered by normal saline 1ml for 14days), 2) sample A(Group orally administered by SOAT extract 1ml for 14days), 3) sample C(Group injected by SOAT extract 0.5ml after stimulation, 4) sample C(Group injected by SOAT extract 1ml after stimulation. To evluate the effects of SOAT on hemodynamics and ECG of isolated rat heart induced by stimulation, heart rate, left ventricular pressure, systolic power, diastolic power, coronary artery perfusion volume and ECG were measured using Langendorff apparatus in both stimulation mode(5 volts, 450 beats/min) and arrythmic mode(5 volts, 420 beats/min including 60 beats/min) The results obtained are as follows : 1. After receiving stressful electrical stimuli, isolated heart showed the heart rate, left ventricular pressure, systolic power, diastolic power, coronary artery perfusion volume were all decreased temporarily, but perfusion continued longer recovery to the control state appeared. However, the coronary artery perfusion volume diminished continuously. 2. The heart rates did not change significantly with both stimulation mode and arrhythmic mode, among experimental groups. 3. The left ventricular pressure showed with both stimulation mode and arrhythmic mode, the significant changes(p<0.05) especially in the injection sample group. In case of stimulation mode, low concentration injection group(0.5ml) was more significantly increased rather than high concentration group(1ml) and in case of arrhythmic mode, high density group(1ml) was so increased than the other(0.5ml). 4. For the systolic power and diastolic power, no significant changes were noticed in the stimulation mode, but in the arrhythmic mode of injection sample groups, significant change(p<0.05) was noticed in both systolic power and diastolic power. Specially the high concentration group(1ml) showed more significant increase than the low concentration group. 5. For the coronary artery perfusion volume, no significant change difference among sample groups was observed in both the stimulation mode and the arrhythmic mode. 6. For the ECG recordings, arrhythmia was induced by electrical stimulus of arrythmia mode and after the stimulus was removed, irregular wave appeared temporarily, but as perpusion continued, recovery to the control state was abtained like the stimulation mode. According to the above results, SOAT significantly changed the hemodynamic data from the electrically stressed, isolated hearts of connected Langendorff perfusion apparatus and we propose SOAT has the direct effects on the muscular function of heart.

• Journal of Chest Surgery
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• v.22 no.2
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• pp.220-224
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• 1989

In candidates for aortic valve replacement [AVR]it is our primary intention to implant the largest possible vale prosthesis of at least 23 mm in diameter in patients with severe valvular aortic stenosis. However, in many patients there is an additional subvalvular asymmetric septal hypertrophy which in some cases may cause an postextrasystolic increase of the LV-aortic gradient. Another component of the aortic stenosis syndrome is a narrow valvular ring, or a combination of both. After complete removal of the diseased valve and decalcification the narrow aortic ring [< 23 mm] can be widened firstly by transaortic subvalvular septal myectomy- [TSM] thus unfolding the left ventricular outflow tract[LVOT]and secondly by extending the oblique aortic incision into the aortic valve ring or further down into the anterior leaflet of the mitral valve. The sub-and supra-valvular defect will be closed by patch enlargement of the aortic root [PEAR] using autologous pericardium. These techniques allow a considerable enlargement of the valvular ring of about 4 to 10 mm in circumference. In a retrospective study using a computerized program, 847 patients with AVR [1980-1984]were reviewed to evaluate the intraoperative hemodynamic results mainly concerning relief of the transvalvular gradient. In 626 patients AVR was performed, 151 patients had double valve replacement [AVR+MVR], and 70 patients had AVR plus additional surgical procedures. Concentrating on the AVR-group [n=626] there were 103 patients with TSM, 24 patients with PEAR and 20 patients with TSM+PEAR which demonstrated that in a total, of 147 patients of this groups [23.5%] an additional procedure was necessary. The Statistical evaluation of the intraoperative pressure measurements before and after AVR in relation to the size of the implanted prostheses indicated the lowest preoperative mean gradient in patients with AVR alone, the highest in patients who afforded TSM plus PEAR. However, after AVR the mean gradients in all three groups were very low [mean 5 to 10 mmHg]. These data indicate that in patients with a narrow aortic ring and additional considerable ASH, TSM and PEAR are suitable techniques to enlarge the aortic root to enable the implantation of an adequate aortic valve prosthesis. Long-term controls have shown that autologous pericardium is a qualified graft material for the ascending aorta.

• Journal of Chest Surgery
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• v.27 no.3
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• pp.177-186
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• 1994

Pentastarch is a hydroxyethyl starch similar to hetastarch, but lower average molecular weight and fewer hydroxyethyl groups which result in enhanced enzymatic hydrolysis and faster renal elimination.This report was performed to compare the clinical efficacy and safety of 10 % pentastarch[Pentaspan , group I] for plasma volume expansion after open heart surgery with that of 5% albumin[Plasmanate, group II]. There were no statistically significant differences between the group I [n=18] and group II [n:19] in the preoperative parameters [age, sex, body weight] and operative parameters[bypass time, aorta cross clamping time]. During the first 24 hours after arrival of the patient in the surgical intensive care unit, colloid solution [500--1000 ml] was infused to maintain left atrial pressure of more than 8 mmHg, or cardiac index of 2.0 L/min/M2 of more. In results, there were 3 complications of hypotension immediately after infusion of 5 % albumin solution and 2 among the 3 patients were excluded for the study. However there was no complication after infusion of 10 % pentastarch solution. Hemodynamic responses to infusion was similar for both groups, although in group I a greater increase in both left atrial pressure[mean 1.8 versus 0.7 mmHg, p< 0.05] and right atrial pressure [mean 2.2 versus 1.7 mmHg, p < 0.05] was observed during infusion of the first 500 ml. There were no significant differences in any of the measured respiratory parameters[PaO2, intrapulmonary shunt, and effective lung compliance]. Homodilution with colloid significantly reduced hemoglobin [mean 1.2 versus 0.8 gm/dl], and serum protein and albumin level[total protein;4.8$\pm$ 0.5 versus 5.2 $\pm$0.5 gm/dl, p < 0.05: albumin: 3.2 $\pm$0.4 versus 3.6 $\pm$0.6 gm/dl, p < 0.05] by 6:00 AM on 1 day postoperatively, however there were no significant differences on 7 day postoperatively. The mean serum colloid osmotic pressure and osmolarity was similar in both group.There were no abnormal findings of liver function and kidney function in all the patients. There were no significant between-group differences in bleeding time, platelets, prothrombin time, activated partial thromboplastin time and amount of chest tube output measured on 1st and 7th postoperative day. These findings demonstrated that 10% pentastarch is more effective and safe for plasma volume expension than 5 % albumin solution with no adverse effects on coagulation. Also 10 % pentastarch is less expensive than 5 % albumin and it would appeare to be a reasonable first choice for plasma volume expansion.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.57-62
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• 2010

Purpose: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. Methods: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. Results: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. Conclusion: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

• Journal of the Korean Society of Radiology
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• v.6 no.1
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• pp.19-26
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• 2012

It is very important for early diagnosis and therapy with ischamic cerebral infarction patients. This study was to know the ischemic penumbra lesion which compared CT-perfusion and diffusion weighted MRI(DWMRI) with acute cerebral infarction patients. 12 acute cerebral infarction patients had performed perfusion CT and performed DWMRI. Perfusion images including cerebral blood volume(CBV), cerebral blood flow(CBF), time to peak(TTP) and mean transit time(MTT) maps obtained the values with defect lesion and contralateral normal cerebral hemisphere and DWMRI was measured by signal intensity and compared of lesion size between each perfusion map. All perfusion CT maps showed the perfusion defect lesions in all patients. There were remarkable TTP and MTT delay in perfusion defect lesions. The lesions on CBF map was the most closely correlated with the lesions on DWMRI. The size of perfusion defect lesions on TTP and MTT map was larger than that of lesions on DWMRI, suggesting that MTT map can evaluate the ischemic penumbra. Perfusion CT maps make it possible to evaluate not only ischemic core and ischemic penumbra, but also hemodynamic status in the perfusion defect area. These results demonstrate that perfusion CT can be useful to the diagnosis and treatment in the patients with acute cerebral ischemic infarction.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1055-1061
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• 1997

In the field of the experimental lung transplantation, we analyzed the CT findings of acute rejection, infection in the left single allotransplanted lung of adult mongrel dogs, and the CT findings were compared with the histological findings obtained by the lung biopsy Twenty two adult mongrel dogs were divided into two groups(Donor and recipient group). Donor lungs were flushed with LPDG(low pota,ilium dextral glucose) solution(n=4) or modified Euro-collins solution(n=7) and preserved over 20 hours with $10^{\circ}C(1$ case preservation for 4hours). After left single lung transplantation, the chest X-ray and sequential computed tomogram were performed with concomitant hemodynamic study and arterial blood gas analysis on immediate postoperative period, postoperative 3rd day and postoperative 7th day. Two of eleven transplanted lungs had acute rejection which was represented as moderate infiltration at immediate or 1st postoperative d y but became extensive infiltration at postoperative 3rd day on CT. There were showed one case of bronchopleural fistula, six cases of pneumonia and two cases of pulmonary infarction. In one rejection cases, the opacity of transplanted lung was improved by injection of methylprednisolone 500mg daily during 3 days. We concluded that CT was a useful noninvasive evaluation parameter after lung transplantation and the serial CT scan enabled early detection of acute rejection.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.66-71
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• 1989

It has been standard practice in many institutions to use a combination of a light general anesthesia and an epidural block for lower abdominal and pelvic surgery. This combination of a balanced anesthesia can provide various benefits to the patient such as less bleeding in the surgical field, the use of a lower concentration of general anesthetics, less muscle relaxant, and post operative pain management. However, there are several problems associated with hemodynamics such as bradycardia and hypotension etc. In order to block the pain of the high surgical area with a lumbar epidural puncture postoperatively, a large volume of local anesthetic is required and consequently an extensive blockade of sympathetic, sensory and motor functions can occur causing motor weakness, numbness and postural hypotension. Therefore, the patient is unable to have early ambulation postoperatively. In this study, thoracic epidural catheterization was undertaken to locate the tip of the catheter exactly at the surgical level for upper abdominal surgery, and was followed by general anesthesia. Twenty-one patients scheduled for upper abdominal surgery were selected. Fifteen of them had hepatobiliary operations and the remaining 6 had gastrectomies. Thoracic epidural punctures were performed mostly at T9-T10 (57.1%) and T8-T9. Neuromuscular blocking agents were not used in half of the cases and the, mean doses of relaxant were $3.5{\pm}1.0mg$ in gastrectomies, and $2.7{\pm}0.9mg$ in cases of hepatobiliary operation. Epidural morphine was injected 1 hour before the end of the operation for postoperative pain control. Eight patients did not require additional analgesics and the mean dose of epidural morphine was $2.2{\pm}0.9mg$, and 13 cases were given 0.125% epidural bupivacaine when patients complained of pain. Their initial doses of epidural morphine were $1.9{\pm}0.4mg$ and the mean duration of bupivacaine was 6 hours 20 minutes${\pm}40$ minutes. In conclusion. thoracic epidural analgesia is valuable to reduce postoperative pain in patients with upper abdominal surgery, However, it is not easy to maintain this balanced anesthesia with high epidural analgesia-and light general anesthesia for upper abdominal surgery because of marked hemodynamic changes. Therefore, further practice will be required.

• Journal of the East Asian Society of Dietary Life
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• v.20 no.5
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• pp.735-742
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• 2010

Biogenic amines are synthesized by microbial decarboxylation for the putrefaction or fermentation of foods containing protein. Although biogenic amines such as histamine, tyramine, and putrescine are required for many physiological functions in humans and animals, consumption of high amounts of biogenic amines can cause toxicological effects, including serious gastrointestinal, cutaneous, hemodynamic, and neurological symptoms. In this study, a novel amperometric biosensor wasdeveloped to detect biogenic amines. The biosensor consisted of a working electrode, a reference electrode, a counter electrode, an enzyme reactor with immobilized diamine oxidase, an injector, a peristaltic pump and a potentiostat. A working electrode was fabricated with a glassy carbon electrode (GCE) by coating functionalized multi-walled carbon nanotubes (MWCNT-$NH_2$) and by electrodepositing Prussian blue (PB) to enhance electrical conductivity. A sensor system with PB/MWCNT-$NH_2$/GCE showed linearity in the range of $0.5 {\mu}M{\sim}100 {\mu}M$ hydrogen peroxide with a detection limit of $0.5 {\mu}M$. The responses for tyramine, 2-phenylethylamine, and tryptamine were 95%, 75%, and 70% compared to that of histamine, respectively. These results imply that the biosensor system can be applied to the quantitative measurement of biogenic amines.