No abstract available.
Snake Bites* ; Snakes*

BACKGROUND: Saline replacement is a difficult and time-consuming procedure employed to measure hemoglobin (Hb) levels when lipaemia interferes with the accurate determination of Hb content. As an alternative method, we tested the reliability of cellular Hb (cHb) measurement. METHODS: Forty-eight lipemic blood samples were analysed with the LH780 (or DxH 800; Beckman Coulter Inc., USA) and ADVIA 2120i (Siemens Healthcare Diagnostics, USA) instruments. We compared the Hb measurements obtained following saline replacement (srHb) with the cHb measurement and with the value of one-third of the hematocrit (1/3Hct). RESULTS: The bias estimate outcomes of cHb with srHb were found to be acceptable at all medical decision points. The average difference between the value of 1/3Hct and initial Hb, srHb, and cHb were 19.7%±3.3%, 2.3%±1.6%, and -0.1%±1.1%, respectively. CONCLUSIONS: cHb measurements may be a feasible alternative to srHb, when lipemia interferes with accurate Hb determinations.
Bias (Epidemiology) ; Delivery of Health Care ; Hematocrit ; Hyperlipidemias* ; Methods

Hemophilia A is a severe bleeding disorder resulting from the lack of functional blood coagulation factor VIII. Accordingly, operations on patients with hemophilia A, except in a few cases, are performed with the administration of factor VIII. However, in those hemophilia A patients administered factor VIII inhibitor, factor VIII replacement therapy is ineffective. The treatment of hemophilic patients with factor VIII inhibitor is undertaken to utilize the hemostatic capacity of the activated forms of FVII, FIX and FX contained within prothrombin complex concentrates, which are purposely manufactured to contain Factor Eight Inhibitor Bypassing Activity (FEIBA) during surgery. Further, in the last few years, a new product, recombinant activated FVII (FVIIa, Novo-VII), which is thought to ensure hemostasis by binding, directly or in complex with tissue factor, to negatively charged phospholipids on the surface of activated platelets, has been licensed. Recently, we experienced a GB stone, with acute cholecystitis, in a fifty year old hemophilia A man treated with factor VIII inhibitor. Under medication with FEIBA and Novo-VII, a laparoscopic cholecystectomy was performed. Here, this case is reported, with a review of the literature.
Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Factor VIII* ; Hemophilia A ; Hemorrhage ; Hemostasis ; Humans ; Phospholipids ; Prothrombin ; Thromboplastin

This study was conducted to evaluate the accuracy of the official death registry in rural area. The base data used for the study was 379 deaths registered during the period of 1993 and 1994 in 4 rural townships of Chonnam Province. The interview survey for cause-of-death was performed on the next of kin and/or neighbor. Additional medical informations were collected from hospitals and medical insurance associations for the purpose of verification. The underlying cause-of-death of 278 cases presumed by the survey was compared to the cause on official death registry. There was a prominent disagreement of cause-of-death between the survey data and the registry data(agreement rate: 38.9~44.6%%, according to disease classification method). These results may be caused by extremely low rates of physicians' certification, which were mostly confined to the poisoning and injury. Symptoms, signs, and ill defined conditions on death registry could be classified into circulatory disease(32.3%), neoplasm(21.2%), digestive disease(7.l%), injury and poisoning(7.l%) and so on. These results suggest that careful attention and verification be required on utilization of death registry data in rural area.
Cause of Death ; Certification ; Classification ; Insurance ; Jeollanam-do ; Poisoning

PURPOSE: Percutaneous cholecystostomy (PC) using a pig-tail catheter is indicated for high risk acute cholecystitis. However, this procedure is time consuming, expensive and requires radiological equipment. This study compared PC using a pig-tail catheter with central venous catheterization set. METHODS: From January 1992 to June 2003, 44 patients underwent PC without a malignancy or a combined hepato- biliary-pancreatic disease were selected. A retrospective study was performed on the time interval to procedure, cost, complications and therapeutic results of the central venous catheter group (A, 15) and the pig-tail catheter group (B, 29) RESULTS: The time interval was 1.8 days in group A, 3.52 in group B (p=0.002). The cost was 188,684 won in group A, 327,814 won in group B. There were 4 complications in group A (2 leakage, 1 dislodgment, 1 malfunction) while 5 in group B (2 dislodgement, 1 sepsis, 2 malfunction). Although PC, 2 in group A and 5 in group B were discharged hopelessly or died due to the progression of the underlying disease. Twenty-two patients underwent a delayed cholecystectomy with 7 patients in group A (3 laparoscopy, 4 open) and 15 in group B (6 laparoscopy, 8 open, 1 conversion to open). The complication rate was slightly high in group A but there were no statistical significance, no clinical problems and no difference in the mortality rate and surgical method. CONCLUSION: In high risk acute cholecystitis, PC using central venous catheter is easy, economic, effective and performed at early stage in the emergency room by medical doctors or surgeons.
Catheterization, Central Venous* ; Catheters* ; Central Venous Catheters* ; Cholecystectomy ; Cholecystitis, Acute ; Cholecystostomy* ; Emergency Service, Hospital ; Humans ; Laparoscopy ; Mortality ; Retrospective Studies ; Sepsis

BACKGROUND: Controlled hypotension is used to reduce bleeding and improve surgical conditions during surgery. Remifentanil is an ultrashort-acting opioid with potent analgesic effect and is useful for rapid emergence. This study was performed to investigate the clinical usefulness of remifentanil for induced hypotension during orthognathic surgery. METHODS: Fifty adult patients scheduled for orthognathic two jaw surgery were randomly allocated to nitroglycerin (group N) and remifentanil group (group R). After induction of anesthesia, group N (n = 25) was infused with nitroglycerin to induce hypotension, and group R (n = 25) was infused with remifentanil. Mean arterial pressure (MAP) and heart rate (HR) were measured before, 5, 10, 20, and 30 min after drug administration. Surgical field rating and blood loss were measured after surgery. RESULTS: Heart rates at 10, 20, 30 minutes after continuous infusion of drug were lower in group R than in group N (P < 0.05). The time for the MAP to return to the baseline after discontinuation of drug infusion was shorter in group R than in group N (P < 0.05). There were no significant differences in the surgical field rating and blood loss between the groups. CONCLUSIONS: Remifentanil enabled controlled hypotension and provided good surgical conditions for orthognathic surgery with no need for additional use of a hypotensive agent.
Adult ; Anesthesia ; Arterial Pressure ; Heart Rate ; Hemorrhage ; Humans ; Hypotension ; Hypotension, Controlled* ; Jaw* ; Nitroglycerin ; Orthognathic Surgery*

1,25-Dihydroxyvitamin D3(1,25(OH)2D3) and interferon-gamma(IFN-gamma) are capable of regulating cells in immune system and are representative differentiation inducer/activator of monocyte/macrophage lineage cells. They may affect the proinflammatory and immune effector functions of monocyte/macrophage activated with immunostimulants such as bacterial endotoxin. The expression of HLA-D, costimulatory adhesion molecules such as ICAM-1(CD54) and Mac-1(CD11b), and secretion of IL-1betawere used to evaluate the influence of 1,25(OH)2D3 and IFN-gammaon human promyelocytic cell line THP-1 cells. IFN-gammamarkedly induces the expression of ICAM-1 and HLA-D, and 1,25(OH)2D3 induces the expression of Mac-1 to a lesser extent. LPS alone markedly induces the expression of ICAM-1 molecule without any increase of HLA-D expression. LPS-induced ICAM-1 expression is synergistically increased by IFN-gammapriming, but fail to increase Mac-1 and HLA-D expression. IFN-gamma, 1,25(OH)2D3, and LPS separately do not induce the secretion of IL-1betaby THP-1, however, IL-1betasecretion is synergistically increased when THP-1 is exposed to the combination of IFN-gammaand LPS. LPS-induced IL-1betaproduction by IFN-gamma-primed cell is much higher when THP-1 have been previously exposed to 1,25(OH)2D3. In conclusion, these results show that expression of MHC class II and costimulatory adhesion molecules, and production of IL-1betaby cells of monocyte/macrophage lineage is highly regulated and monocyte /macrophage differentiation is required for optimal proinflammatory and immune reaction in response to exposure of bacterial endotoxin.
Humans

We present our surgical experiences with functioning neuroendocrine neoplasms of the pancreas to define its natural history, and to suggest its proper management. From June 1990 to June 2005, patients with diagnosis of functioning neuroendocrine (islet cell) neoplasms of the pancreas were retrospectively reviewed. Fourteen patients (5 men and 9 women) with a median age of 49 years (range, 12 - 68 years) were identified. Twelve patients (86%) had insulinoma, two (14%) had gastrinoma. One (7%) with pancreatic insulinoma was multiple endocrine neoplasia type 1. Intraoperative ultrasound scan (sensitivity, 83%) was the most powerful modality for tumor localization. Fifteen neoplasms with median tumor size 1 cm (range 0-3 cm) were resected. Four insulinomas (26.7%) were located in the head of the pancreas and 5 (36%), in the tail. Another 5 (36%) insulinomas and 1 (7%) gastrinoma were located around the neck area near the SMV or PV. Eleven patients (79%) underwent enucleation, and 2 patients (14%), distal pancreatectomy with splenectomy. 100% of patients with functioning neuroendocrine neoplasms of the pancreas have survived. The overall disease free 10-year survival was found to be about 81%. Exact localization of tumor by intraoperative ultrasound and surgical removal are promising for good prognosis.
Retrospective Studies ; Prognosis ; Postoperative Complications ; Pancreatic Neoplasms/*surgery/ultrasonography ; Neoplasm Metastasis ; Middle Aged ; Male ; Insulinoma/*surgery/ultrasonography ; Humans ; Gastrinoma/surgery/ultrasonography ; Female ; Child ; Aged ; Adult ; Adolescent

We present our surgical experiences with functioning neuroendocrine neoplasms of the pancreas to define its natural history, and to suggest its proper management. From June 1990 to June 2005, patients with diagnosis of functioning neuroendocrine (islet cell) neoplasms of the pancreas were retrospectively reviewed. Fourteen patients (5 men and 9 women) with a median age of 49 years (range, 12 - 68 years) were identified. Twelve patients (86%) had insulinoma, two (14%) had gastrinoma. One (7%) with pancreatic insulinoma was multiple endocrine neoplasia type 1. Intraoperative ultrasound scan (sensitivity, 83%) was the most powerful modality for tumor localization. Fifteen neoplasms with median tumor size 1 cm (range 0-3 cm) were resected. Four insulinomas (26.7%) were located in the head of the pancreas and 5 (36%), in the tail. Another 5 (36%) insulinomas and 1 (7%) gastrinoma were located around the neck area near the SMV or PV. Eleven patients (79%) underwent enucleation, and 2 patients (14%), distal pancreatectomy with splenectomy. 100% of patients with functioning neuroendocrine neoplasms of the pancreas have survived. The overall disease free 10-year survival was found to be about 81%. Exact localization of tumor by intraoperative ultrasound and surgical removal are promising for good prognosis.
Retrospective Studies ; Prognosis ; Postoperative Complications ; Pancreatic Neoplasms/*surgery/ultrasonography ; Neoplasm Metastasis ; Middle Aged ; Male ; Insulinoma/*surgery/ultrasonography ; Humans ; Gastrinoma/surgery/ultrasonography ; Female ; Child ; Aged ; Adult ; Adolescent

Retroperitoneal Hematoma is a rare intraabdominal bleeding occurring in patients with low- molecular weight heparin anti-coagulant therapy. We report a case of dalteparin sodium-associated retroperitoneal hematoma in a 70-year-old man with diabetic nephropathy with review of this condition in the literature. He had been suffered from type 2 diabetes mellitus and hypertension for 15 years. In July 2002, he was admitted to our hospital because of unstble angina and left pleural effusion. He was treated with dalteparin sodium and aspirin for unstable angina. On the second hospital day, he was refered to division of nephrology for diabetic nephropathy. Laboratory data on admission included white blood cell count of 4,500/mm3, hemoglobin 9.6 g/dL, platelet count 294,000/mm3, BUN 58.1 mg/dL, serum creatinine 4.1 mg/dL, blood glucose 178 mg/dL, hemoglobin A1c 5.9%, PT 13.9 sec (INR: 1.09), and aPTT 50 sec. On days 6 through 8, he had lower back pain, lower extremity pain and neuropathy, anemia and hypotension. Abdominal ultrasound showed 6 x 6 cm-sized well marginated mixed echogenic lesion in psoas muscle and fluid collection in retroperitoneal cavity. Magnetic resonance imaging (MRI) showed increased signal intensity and thickening of the right psoas muscle including 4.7 x 2.3 x 2.1 cm-sized cytic lesion and 6.2X5.3X3.7 cm-sized cystic lesion on the lateral portion of right psoas muscle in T2-weighted images. Percutaneous drainage of cystic lesion was performed by right lateral approach. Hemodialysis was begun without heparinization. Abdominal CT showed 5.5X5 cm-sized high attenuated lesion in right psoas muscle and 5X3 cm, 3X2 cm, 4.5 x 2.5 cm, 4 x 2.5 cm-sized heterogenous, slightly high attenuated lesions in the right lower abdomen and cul-de-sac in the scans with no enhancement. He was treated by conservative therapy. He recovered gradually. Patients with kidney diseases receiving low molecular weight heparin (dalteparin, enoxaparin, etc.) should be closely monitored to prevent serious bleeding complications. The possibility of retroperitoneal hematoma should be considered, whenever symptoms including lower back pain, inguinal pain, leg pain, anemia, or hypotension occured during the lower molecular weight heparin anticoagulant therapy. To our knowledge, this is the first reported case of retroperitoneal hematoma in a patient during dalteparin sodium (Fragmin(R)) anticoagulant therapy.
Abdomen ; Aged ; Anemia ; Angina, Unstable ; Aspirin ; Blood Glucose ; Creatinine ; Dalteparin* ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies* ; Drainage ; Enoxaparin ; Hematoma* ; Hemorrhage ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension ; Hypotension ; Kidney Diseases ; Leg ; Leukocyte Count ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Imaging ; Molecular Weight ; Nephrology ; Platelet Count ; Pleural Effusion ; Psoas Muscles ; Renal Dialysis ; Tomography, X-Ray Computed ; Ultrasonography