Blood utilization review has recently been used to minimize inappropriate transfusion, reduce post transfusion infections and improve the quality of transfusion practices. Ajou University Hospital is a 906 bed tertiary care teaching institution. Since March, 1995, the concurrent review of blood transfusion requests using institutional blood transfusion criteria has been initiated. To evaluate the effectiveness of the transfusion review, the units of blood components transfused per patient(total number of units of blood components transfused/total number of patients discharged) and inappropriate transfusion ratio of blood components(total number of units of blood components inappropriately transfused/total number of units of blood components transfused) were compared during the concurrent review for 9 months and pre-concurrent review for 9 months, respectively. The possible savings of blood components realized by the review were also extrapolated. The results were as follows : 1. The unit transfused per patient for pre-review and during review were 0.675 (9,080/ 13,422) and 0.654(12,123/18,546) for packed RBC(PRBC); 0.417 (5,602/ 13,422) and 0.296 (5,444/18,546) for fresh frozen plasma(FFP); 0.372(5,007/13,422) and 0.424(7,868/18,546) for platelet con-centrates(PC), respectively. 2. The inappropriate transfusion ratio of blood components for pre-review and during review were 0.039 and 0.009 for PRBC; 0.321 and 0.064 for FFP; 0.143 and 0.008 for PC, respectively. These differences were statistically significant(p=0.000). 3. The PRBC and FFP anticipated to have been saved by this review was 519 units and 2,992 units annually, respectively. 4. However, 2,621 units of PC were used additionaly during this review due to increased number of oncology patients and better hemostatic therapy practiced during the same period. In conclusion, the concurrent review of transfusion requests was very effective tool to educate residents in clinical departments the transfusion medicine and improve utilization of blood and its components.
Blood Platelets ; Blood Transfusion* ; Concurrent Review* ; Humans ; Income ; Tertiary Healthcare ; Transfusion Medicine ; Utilization Review

The refractive state of 321 children (160 boys and 161 girls) of a rural primary school were examined under the cycloplegic condition with 5% homatropine. The results obtained as folIow; 1. Among 321 children, the refractive errors was revealed in 28.0% and emmetropia was revealed in 72.0%. 2. As to the distribution of refractive errors, hyperopic eyes were 39.5% and myopic eyes were 60.6%. 3. The refractive errors were observed more frequently in girls (15.4%) than those of boys (12.5%). 4. There was a tendency that hyperopic refractive error was gradually decreased from 8 years of age as the age increased. However, myopic refractive error was incerased gradually from 8 years of age. 5. At the age of 11 highest incidence of the refractive errors was observed (22.8%). 6. The degree of most of refractive errors(98.4%) were revealed less than 3 diopters. 7. As to the type of astigmatism, with the rule was 51.4% and against rule was 42.9%.
Astigmatism ; Child* ; Emmetropia ; Female ; Humans ; Incidence ; Refractive Errors

BACKGROUND: The HLA-DR and DQ genes are known to show in strong linkage disequilibrium. Authors investigated the allele frequencies of HLA-DQB1 genes and HLA-DQB1-DRB1 haplotypic associations in Koreans. METHODS: HLA-DRB1 and DQB1 typing were performed in 120 unrelated Koreans consisting of normal tissue donors and patients with hematologic diseases using polymerase chain reaction-reverse dot blot hybridization method with INNO-LiPA HLA-DRB and DQB kits (INNOGENETICS, Zwijndrecht, Belgium). Haplotypic associations between DRB1 and DQB1 alleles were calculated according to the formula from Mattiuz et al. RESULTS:1. Allele frequencies of the five most common DQB1 alleles were DQB1* 0301, 14.4%; 0303, 11.0%; 0302, 9.6%; 0601, 9.2%; 0401, 8.7%. 2. Haplotype frequencies (%) of the ten most common DQB1*-DRB1* haplotypes were 0303-0901, 9.17%; 0401-0405, 8.71%; 0602-1501/03/04, 7.35%; 0501-0101, 7.35%; 0601-0803, 5.98%; 0609-1302, 5.10%; 0503-1405, 4.69%; 0302-0406, 4.26%; 0301-1101/10/12 or 1104, 4.26%; 02-0701, 4.23%. They consisted 61.1% of total haplotypes in this study. CONCLUSIONS: The results of this study may be useful as basic data of Koreans for anthropology, accurate interpretaion of DRB1 and DQB1 typing and quality control of genotyping.
Alleles* ; Anthropology ; Gene Frequency* ; Haplotypes ; Hematologic Diseases ; HLA-DR Antigens ; HLA-DRB1 Chains ; Humans ; Linkage Disequilibrium ; Quality Control ; Tissue Donors

PURPOSE: To report a case of non-arteritic anterior ischemic optic neuropathy (NAION) in a patient on hemodialysis. CASE SUMMARY: A 59-year-old female undergoing intravenous hemodialysis developed sudden blurred vision for 2 days. Chronic hypotension and anemia may have been persisted for approximately 6 months before the onset of symptoms. Her corrected visual acuity in both eyes was 0.7 and visual field test showed superior arcuate defect in the left eye. Fundus photography showed inferonasal optic disc swelling and fluorescein angiography revealed hyperfluorescence of the disc in the late phase which was probably attributable to NAION. After 3 weeks, corrected visual acuity was 0.7 in the left eye and fundoscopic finding of the left eye was improved. CONCLUSIONS: Hemodialysis can cause a hypotensive event and anemia which may be associated with NAION. Avoiding acute hypotension and anemia should be advised to prevent development of NAION in dialysis patients.
Anemia ; Dialysis ; Female ; Fluorescein Angiography ; Humans ; Hypotension ; Middle Aged ; Optic Neuropathy, Ischemic* ; Photography ; Renal Dialysis* ; Visual Acuity ; Visual Field Tests

PURPOSE: The clinical significance of preoperative serum levels of CEA and CA19-9, levels of CEA and CA19-9 in peritoneal washing fluid and free cancer cells in peritoneal washing fluid in gastric cancer patients were evaluated in this study. MATERIALS AND METHODS: Serum and peritoneal levels of CEA and CA19-9 and peritoneal washing cytology in 115 patients with gastric cancer were analyzed with respect to the prognostic factors using univariate and multivariate analysis. RESULTS: Positive rate of serum CEA and CA19-9 was 16.5%, 13.0%. And that of peritoneal washing CEA, CA19-9 and cytology was 15.7%, 7.8% and 9.6%. A univariate analysis showed that tumor markets in serum and peritoneal washing fluid and peritoneal washing cytology had significant correlations with the progression of the tumors, and patients with positive serum or peritoneal tumor markers had poorer survival after operation than did the patients with negative tumor markers. But in a multivariate analysis showed that only peritoneal CA19-9 was an independent risk factor. And combination of these five markers provided rnore predictable prognostic informations in a multivariate analysis. CONCLUSION: Combination of serum or peritoneal levels of CEA, CA19-9 and washing cytology appeared to be a useful marker for managing gastric cancer patients.
Humans ; Multivariate Analysis ; Risk Factors ; Stomach Neoplasms ; Biomarkers, Tumor

BACKGROUND: Acute normovolemic hemodilution (ANH) is known as the easieat and most economical and the quality of autologous blood saved by it is the best of all methods of autotransfusion. To investigate the efficacy of ANH, we studied whether it could reduce the transfusion requirement in spinal surgery. METHODS: Forty patients were randomly divided into 2 groups. In the hemodilution group (n=20), 2 or 3 units of autologous blood were procured immediately before or after anesthetic induction while Ringer's lactate and pentastarch were infused to maintain normovolemia. All patients received deliberate hypotension induced by labetalol. Perioperative changes of hemoglobin, hematocrit and platelets, the transfusion requirement and the amount of postoperative drainage were compared between each group. RESULTS: Perioperative changes of hemoglobin, hematocrit and platelet showed no significant differences between each group. Less packed RBC were used in the hemodilution group (1.9 2.0 units) than in control group (5.9 6.8 units) (p<0.05). In the control group, 4 patients were transfused with fresh frozen plasma (mean 4.8 units), 3 patients with platelets (mean 13 units) and 1 patient with cryoprecipitate (10 units) while only one patient was transfused with 3 units of fresh frozen plasma in the hemodilution group. Postoperative drainage was significantly less in the hemodilution group (1,494 488 ml) than in the control group (2,476 1,730 ml). CONCLUSION: ANH seems to decrease the transfusion requirement in spinal surgery. Reduction of postoperative wound drainage appears to play an important role in that.
Blood Platelets ; Blood Transfusion, Autologous ; Drainage ; Hematocrit ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Hypotension ; Labetalol ; Lactic Acid ; Plasma ; Wounds and Injuries

PURPOSE: We present a new simple technique to remove subconjunctival cyst under the slit lamp microscope. CASE SUMMARY: A cotton swab was used to verify whether or not the cyst was freely movable under the conjunctiva. After topical anesthesia, we incised the conjunctiva near the cyst using a 30-gauge needle and extracted the cyst through the wound using forceps under the slit lamp microscope. Four cases of subconjunctival cyst were successfully removed with our new technique. During the average five month (2-10 month) follow-up period, there was no recurrence or procedure-related complications. CONCLUSIONS: Some subconjunctival cysts such as an epithelial inclusion cyst which is freely movable without attachment to surrounding tissues can be easily removed with a 30-gauge needle and forceps under the slit lamp microscope. This could be considered as the primary procedure instead of simple aspiration.
Anesthesia ; Conjunctiva ; Follow-Up Studies ; Needles ; Recurrence ; Surgical Instruments

No abstract available.
Prostate* ; Prostate-Specific Antigen*

BACKGROUND: The prognostic indicators of patients who received massive transfusion were studied to assist management of high risk patients. METHODS: Medical records and laboratory data of 184 adult patients who received massive transfusions during 1996-1998 were reviewed. The indicators studied were outcome of treatment, cause of transfusion, age, sex, vital signs at admission, number of units of blood components, results of platelet counts (Plt), hematocrit (Hct), prothrombin time (PT), activated thromboplastin time (aPTT) and arterial blood pH (pH) performed within 24 hours after transfusion. RESULTS: The percent and mean age of survivor were 60.3% and 44.8 years old and nonsurvivor were 39.7 and 49.7, respectively. The frequency and survival rate by causative disorders were as follows: trauma 33.2% and 56%; liver disease 23.9% and 57%, cancer 13.6% and 56%, cardiovascular disorders 7.5% and 78.6%. Nonsurvivors had lower systolic and diastolic pressures in liver disease and cancer, and lower body temperature in trauma patients than those of survivors. In trauma patients nonsurvivors had lower Plt counts and pH, and prolonged PT and aPTT results than those of survivors. In cancer patients nonsurvivors showed lower Hct and pH, but those of liver disease patients showed only lower Plt counts. The average unit of blood components transfused per patient in nonsurvivors were 27.3 of RBC, 13.4 of FFP, and 15.2 of platelet concentrate, respectively. The percent of patients who were transfused more than 20 units of RBC was 28% in survivors, but 55% in nonsurvivors. CONCLUSIONS: It is concluded that the patients transfused with more than 20 units of RBC showed low systolic and diastolic pressures, body temperature, Plt counts, Hct and arterial blood pH, and prolonged PT and aPTT results appeared to be poor prognostic indicator of massive transfusions.
Adult ; Blood Platelets ; Body Temperature ; Hematocrit ; Humans ; Hydrogen-Ion Concentration ; Liver Diseases ; Medical Records ; Platelet Count ; Prognosis* ; Prothrombin Time ; Survival Rate ; Survivors ; Thromboplastin ; Vital Signs

Legg-Calve-Perthes disease (LCP) has been reported to be associated with hypofibrinolysis and a deficiency in coagulation. The goal of this prospective study was to confirm or refute these findings and to establish a guide for a screening test. The coagulation systems of twenty-three patients with Legg-Calve-Perthes disease were evaluated by means of the tests which included prothrombin time, activated partial thromboplastin time, antithrombin-III (AT-III), protein C, protein S, lipoprotein(a), and anticardiolipin antibody (ACA). Study subjects were 21 males and 2 females. Mean age was 8.7 years. No abnormal results were found for Antithrombin-III and Protein S, but 2 patients had low Protein C level. Two of 23 patients had Lipoprotein(a) values greater than 30 mg/dl. Another two patients had positive finding for Anticardiolipin antibody. There were no statistical differences in all parameters between Catterall group stage in the patients with Legg-Calve-Perthes disease. We were unable to establish an association between thrombotic tendency and Legg-Calve-Perthes disease based on this prospective study. So, routine screening of patients with Legg-Calve-Perthes disease for abnormalities of antithrombotic factors would be not warranted.
Antibodies, Anticardiolipin ; Female ; Humans ; Legg-Calve-Perthes Disease* ; Lipoprotein(a) ; Male ; Mass Screening ; Partial Thromboplastin Time ; Prospective Studies ; Protein C ; Protein S ; Prothrombin Time