No abstract available.

No abstract available.
Down Syndrome* ; Humans ; Mothers*

The major purpose for the use of autotransfusion is to prevent the transmission of blood borne infectious agents, such as human immunodeficiency virus and non-A & non-B hepatitis virus. To evaluate the efficacy and quality of autolgous shed blood for autotransfusion, eighty patients who had total knee arthroplasty from Dec. 1992 to Mar. 1994, were included in one of two groups: Group I, who received the autotransfusion, or Group II, who did not. Each group included 20 patients of unilateral TKR and 20 patients of bilateral TKR. The Orth-evac system(Deknatel, USA) was used to salvage drained blood in the first six hours after the operation. All of the patients were evaluated for the postoperative blood loss, transfusion requirements, hemoglobin, hematocrit, platelet count, blood pressure and body temperatures. l. In bilateral TKR, the reinfusion of shed blood reduced the requirements for homologous blood by 41.4%(1.2 pints in group I versus 2.9 pints in group II). In unilateral TKR, it was decreased to 36.4%(0.4 pint in group I vs 1.1 pint in group II). 2. In bilateral TKR, the requirements for homologous transfusion was decreased from 95% of patients in control group to 55% in group I .In unilateral TKR, it was decreased from 60% to 20%. 3. There were four patients who had high fever above 39℃ after autotransfusion. 4. At the immediate postoperative period there were two patients who had hypovolemic shock in group I patients who had bilateral TKR. 5. There was no clotting abnormality, no transfusion reaction and no thromboembolic disease in group I patients. In conclusion, the reinfusion of autologous shed blood after TKR is an acceptable alternative to the homologous transfusion without untoward effect.
Arthroplasty, Replacement, Knee ; Blood Transfusion, Autologous ; Body Temperature ; Fever ; Hematocrit ; Hepatitis Viruses ; HIV ; Humans ; Knee ; Platelet Count ; Postoperative Hemorrhage ; Postoperative Period ; Shock ; Transfusion Reaction

Thyrotoxic periodic paralysis (TPP) is a rare manifestation of hyperthyroidism characterized by muscle weakness and hypokalemia. All ethnicities can be affected, but TPP typically presents in men of Asian descent. The most common cause of TPP in thyrotoxicosis is Graves' disease. However, TPP can occur with any form of thyrotoxicosis. Up to our knowledge, very few cases ever reported the relationship between TPP and painless thyroiditis. We herein report a 25-yr-old Korean man who suffered from flaccid paralysis of the lower extremities and numbness of hands. The patient was subsequently diagnosed as having TPP associated with transient thyrotoxicosis due to painless thyroiditis. The paralytic attack did not recur after improving the thyroid function. Therefore, it is necessary that early diagnosis of TPP due to transient thyrotoxicosis is made to administer definite treatment and prevent recurrent paralysis.
Administration, Oral ; Adult ; Anti-Arrhythmia Agents/therapeutic use ; Humans ; Hypokalemic Periodic Paralysis/*diagnosis/drug therapy/etiology ; Male ; Organotechnetium Compounds/chemistry/diagnostic use ; Potassium Chloride/therapeutic use ; Propranolol/therapeutic use ; Radiopharmaceuticals/diagnostic use ; Thyroiditis/*complications/radiography/ultrasonography ; Thyrotoxicosis/*diagnosis/etiology

BACKGROUND: Total intravenous anesthesia (TIVA) is one of the anesthetic techniques that needs no inhalational agent but only an intravenous agent for induction and maintenance of anesthesia. Among drugs used in TIVA, propofol is the most popular agent. Rapid emergence and antiemetic characteristics of propofol are well known advantages but a dose dependent cardiovascular depressant effect is one of the disadvantages of this drug. Otherwise, ketamine, a dissociative agent, has been restricted in its use because of bad dreams, delirium and delayed emergence even though it has profound analgesic characteristics. However, ketamine has a stimulatory effect on the cardiovascular system, so it can raise blood pressure and pulse rate and in the case of TIVA, these properties can be advantageous when used with propofol. This study was aimed to decide whether TIVA using propofol and ketamine would have more stable vital signs during anesthesia and more rapid and smoother emergence in comparison with inhalational anesthesia using isoflurane. METHODS: Thirty two patients scheduled for elective general anesthesia were randomly allocated into two groups; I (inhalational anesthesia using isoflurane) group and PK (TIVA using propofol and ketamine) group. I group was controlled with isoflurane 1 - 1.5 vol% and the PK group was controlled with propofol 3 - 12 mg/kg/hr and ketamine 0.5 - 1.0 mg/kg/hr. Arriving at the recovery room, a single observer recorded the time to spontaneous movement, responses to painful pinch and verbal command, and orientation to age, name, place, date and time. At 5, 10, and 30 minutes after anesthesia, a PARS (postanesthesia recovery score), count-down test, and VAS (visual analogue scale) were checked. Postoperative events were checked in the recovery room and 24 hours lator. RESULTS: There was no significant difference in demographic data or characteristics of operation. Compared with the I group, the PK group had significantly rapid orientation responses on place, date and time. Restoration in the count-down test was more rapid in the PK group after 10 minutes in the recovery room. The VAS was lower in the PK group after 30 minutes in the recovery room. CONCLUSIONS: TIVA using propofol and ketamine has a more rapid emergence than inhalational anesthesia using isoflurane and better postoperative analgesic effect without respiratory depression.
Anesthesia* ; Anesthesia, General ; Anesthesia, Intravenous* ; Anesthetics, Intravenous ; Blood Pressure ; Cardiovascular System ; Delirium ; Dreams ; Heart Rate ; Humans ; Isoflurane* ; Ketamine* ; Propofol* ; Recovery Room ; Respiratory Insufficiency ; Vital Signs

Perimembranous ventricular septal defects(PMVSDs) are the most common type of ventricular septal defects(VSDs) and consist morphologically of deficiency of the membranous septum and variable portions of the adjacent muscular septum. Repair of VSD has begun via a right ventriculotomy. Even with this exposure, however, it mght lead to ventricular dysfunction. Transatrial exposure of VSDs is known to a versatile approach to PMVSDs and even malalignment defects can be repaired by this METHOD: Although transatrial exposure can be improved by taking down the atrioventricular valve at the annulus, surgeons have been hesitant to do so because of concern for valvular competence. Therefore, this study was undertaken to clarity the effects of transannular approach of tricuspid valve (TATV) at operation of PMVSD. During last 5 years, twenty eight cases from 96 patients of PMVSD were closed by TATV and follow up study was done from 3 months to 33 months and results were obtained as follows. 1. Age at operation was from 4 months to 38 years and most patients(17, 62%) were above 5 years. 2. Preoperative pulmonary-systemic flow ratio(Qp/Qs) was ranged from 1 to 2.8 and 22 patients(79%) were less than 2. 3. Peak systolic pulmonary artery pressure was below 30mmHg in 8, 30-50mmHg in 17, above 50mmHg in 3 patients and 25 patients(89%) were less than 50mmHg. 4. Preoperative tricuspid regurgitation(TR) is none in 12, trivial in 6, mild in 3, moderate in 5, severe in 2 patients but postoperative TR was none in 18, trivial in 6, mild in 4 patients, so TR in most patients had decreased or not. 5. Indications for operation were based on the presence of a significant shunt. However, in patients with small shunts, indications for operation were included additional factors, tricuspid valve pouch, RVOT obstruction(right ventricular outflow tract obstruction), subacute bacterial endocarditis and associated anomalies. 6. There were no hospital deaths and residual shunts in postoperative echocardiography. Therefore, TATV is especially a good method in PMVSD where patients have trcuspid valve pouch. And it is a safe and effective technique that improves exposure for PMVSD repair and does not adversely affect tricuspid valvular competence.
Echocardiography ; Endocarditis, Subacute Bacterial ; Follow-Up Studies ; Humans ; Mental Competency ; Pulmonary Artery ; Tricuspid Valve ; Ventricular Dysfunction

No abstract available.
Seroepidemiologic Studies*

BACKGROUND: As single donor platelets (SDP) has been increasingly used, the quality of SDP, especially apheresis-induced platelet activation, has become a major issue. This study evaluated the activation of SDP platelets prepared with three different cell separators that are currently being used at the Korean Red Cross. METHODS: CD62p, CD63 and CD42 were measured in 35 units of SDP prepared with Amicus (Baxter, Deerfield, IL, USA), MCS+ (Haemonetics, Braintree, MA, USA), or Trima (Gambro BCT, Lakewood, USA) using flow cytometry. RESULTS: Expression of CD62p gradually increased with storage time, but no difference in expression was noted between cell separators. Expression of CD63 also increased with storage time and platelets prepared with the Amicus displayed significantly higher CD63 expression 72 and 120 hours after collection compared to those prepared with MCS+ and Trima. Expression of CD42b tended to decrease with storage time, but this was only significant for Amicus 120 hours after collection. No difference in CD42b expression was noted between cell separators. CONCLUSIONS: Platelet activation increased with storage time, and platelet activation was more pronounced in the platelets prepared with the Amicus. However, because in vitro results of platelet activation does not necessarily reflect in vivo platelet function and survival, additional studies are needed to clarify clinical effectiveness of activated platelets.
Blood Platelets* ; Flow Cytometry ; Humans ; Platelet Activation* ; Plateletpheresis* ; Red Cross ; Tissue Donors

OBJECTIVE: The contents of microbial information are complicated because of being hierarchical, duplicated as well as their changes are continuous and various. Much of time and cost are required for maintaining, expanding the information after representing them into a relational database. The relational database is not adequate to make the information sharable via Internet. In addition, user's meta-knowledge is insufficient to use the information via Internet and users may not be able to cope with the continuous changes of microbial information through the static web interface. Therefor, this study is conducted to develop an active microbial web database for resolving those problems. METHODS: To solve these problems, object-oriented database, which was able to represent the complicated contents and knowledge, was used, and intelligent agents were implemented to cope with the continuous evolution of microbial information. Also, they were incorporated into user interface to assist users in an interactive environment, who want to use information via Internet. RESULTS: The implemented system have shown advantages of solving difficulties arising from hierarchical and duplicated microbial data. It showed the possibility to share and manage the complex microbial data via Internet. It helped the system to be implemented as the active database, information stored in the object-oriented database. CONCLUSION: This study indicates that a similar approach may lead to develop an expert system based on the web and active database, which is able to be evolved, and to develop intelligent interface, using the agent.
Expert Systems ; Internet

For the purpose of prenatal diagnosis of CAH, genetic linkage analysis by HLA genotyping with lymphocytes and cultured amniotic cells were performed in a family at risk in which two consecutive children had been affected with SW CAH. In addition, the response of serum 17-OHP to intravenous ACTH was determined in obligate carrier parents, and 17-OHP concentration of amniotic fluid was also measured at 16 weeks of gestation. As might be expected, the baseline levels of 17-OHP in obligate parents were significantly higher than that of normal control. Although the post stimulation response of 17-OHP to ACTH in the mother (I-2) was significantly higher than that of normal control, the post stimulation levels of 17-OHP were in normal range in the father (I-1). The 17-OHP level (5.7 ng/ml) in the amniotic fluid showed intermediate value compared to Pang's report (normal less than 30 ng/ml, CAH greater than 12.0 ng/ml) suggesting heterozygote of the fetus. Genetic linkage analysis by HLA genotyping with cultured amniotic cells revealed heterozygote in their fetus (II-3) who has received one chromosome No,6 containing HLA haplotype A24, B40, Cw3 (normal allele for 21-OH) from the father and the other chromosome No,6 containing HLA haplotype A2, Bw62, Cw4 (mutant allele for 21-OH D) from the mother. In conclusion, attempts to detect heterozygote for 21-OH deficiency by ACTH stimulation test were partially successful and prenatal diagnosis of CAH by the hormone studies in ammiotic fluid requires reliable values in normal, heterozygotes and patients group, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
*Adrenal Hyperplasia, Congenital/*diagnosis/enzymology/genetics ; Adult ; Amniocentesis ; Cells, Cultured ; Female ; Fetal Diseases/*diagnosis/enzymology ; HLA Antigens/analysis ; Heterozygote Detection ; Humans ; Pedigree ; Pregnancy ; *Prenatal Diagnosis ; Steroid Hydroxylases