In spite of vigorous efforts to enhance appropriateness of blood usage in surgery, it is recognized that there are still not a few overuse and misuse of blood products in Korean hospitals. To assure appropriate use of blood, continuous monitoring and controlfling blood orders, particularly for surgical operations, should be implemented. The indicator of 'ratio of crossmatching to transfusion' (C/T ratio) has been focalized on in this regard. The authors investigated C/T ratio for eight hospitals, evenly distributed in their geographical location as well as size. Only elective surgeries operated from March 1 to May 31, 1995 were included for analysis. Standardized survey format was distributed, and retrospective reviews of medical records were performed by volunteer surveyors from each hospital after two sessions of pre- survey education. The results were as follows. Average C/T ratio, for all hospitals and all surgeries, was 1.76. Differences in C/T ratio by sex, months, clinical departments, blood components were not significant. However, the ratio showed increasing tendency with ages. The C/T ratio on the average was not higher, compared with the recommended guideline. However, due to study' s limitations ini standardization of survey method and verification of data, we could not conclude that current status of appropriateness of blood use is satisfactory. In addition, to pervasively use the C/T ratio as a quality indicator for blood use management, supplementary measures, such as standardization of data, should be adopted.
Surveys and Questionnaires ; Education ; Medical Records ; Quality Indicators, Health Care* ; Retrospective Studies ; Volunteers

BACKGROUND: In the most of emergency department, the diagnosis of appendicitis has been carried by clinical history, physical examination and plain X-ray. But the diagnostic accuracy by these methods was so low that unnecessary operation was common performed, and sometimes the operation was delayed till the physicians could confirm the acute appendicitis clinically. Although many kinds of diagnostic tools such as CT scan, laparoscope, and etc, we believe that ultrasonography(US) would be a quick and sensitive diagnostic method for the evaluation of acute appendicitis in the Emergency Department. METHODS: Forty-seven patients who were clinically suspected as acute appendicitis were evaluated with the grayscaled US by emergency physician. The probe of US was placed on maximal tender point of abdomen, and the appendix image was evaluated while probe was pressed deeply and gentry. When the blind loop was fecund at maximal tender point of abdomen, we evaluated the diameter of appendix, the presence of compressibility, peri-aspen-diceal fluid collection and other mass effect. As soon as the ultrasonographic evidences of the appendicitis were noticed, the operations were done and pathologic report were reviewed later. RESULTS: Among the forty-seven patients, forty patients were diagnosed as a appendicitis by US, and most common ultrasonic findings were as follows; 1) non-compressible blind loop larger than 5 mm in diameter, 2) wall thickening more than 3 mm, 3) peri-appendiceal fluid collection, 4) periappendiceal mass. Among remaining 7 patients in whom we could not get any positive findings of appendicitis, abdominal CT scan was carried in 2 cases who had direct and rebound tenderness on right lower abdomen, and CT scan showed the evidences of the appendicitis. The other 5 cases without rebound tenderness were observed far 2 hours, and abdominal pain was disappeared lately. Finally forty-two patients were operated and confirmed as acute appendicitis by pathologic reports; 24 were reported as suppurative appendicitis, and 12 cases of gangrenous appendicitis, 3 cases of perforated appendicitis, and 3 cases were peri-appendiceal abscess. The specificity of US in the diagnosis of acute appendicitis was 71.4%, and the sensitivity was 95.2%. CONCLUSIONS : In some patients suspected appendicitis, emergency physicians could diagnosis acute appendicitis accurately and rapidly by use of ultrasonography. Although the US was an actuate imaging modality to diagnosis acute appendicitis and evaluate its complications, we recommend a laparotomy or abdominal Cf scan in the patients with negative US findings in spite of presence of peritoneal irritation signs such as rebound tenderness and/or muscle guarding on right lower abdomen.
Abdomen ; Abdominal Pain ; Abscess ; Appendicitis* ; Appendix ; Diagnosis ; Early Diagnosis* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Laparoscopes ; Laparotomy ; Physical Examination ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Ultrasonics ; Ultrasonography*

No abstract available.
Animals ; Muscle, Smooth, Vascular* ; Nitric Oxide* ; Rats*

Mechanical complications of acute myocardial infarction which may lead to heart failure or shock include ruptute of left ventricular free wall, ventricular septum and papillary muscle. The clinical characteristics of these lesions vary conservative management alone has high mortality rate, for which reason surgical repair of these defects are essential. Structural defects including rupture of the left ventricular free wall, ventricular septum, and papillary muscle, accout for 5% to 20% of all deaths from acute myocardial infarction. Among these, ventricular septal defects occur in approximately 1% of all myocardial infarction, and account for up to 2% of deaths subsequent to myocardial infarction. Rupture of the ventricular septum following acute myocardial infarction(AMI) is associated with high mortality rate, as 54% of the patients succumb within two weeks, 87% within two months and 92.5% during the first year. We experienced two cases of postinfarct ventricular septal defects(VSD) which had been repaired within 1 week after AMI due to progressive deterioration of patients` conditions, and were to be reoperated because of repeated septal ruptures in postoperation period and development of cardiogenic shock.
Heart Failure ; Heart Septal Defects, Ventricular ; Humans ; Infarction* ; Mortality ; Myocardial Infarction ; Papillary Muscles ; Rupture ; Shock ; Shock, Cardiogenic ; Ventricular Septum

BACKGROUND: The need for using sunscreen is increasing today, but we know little about the effect of sunscreens on the skin of Korean people. OBJECTIVE: We tried to estimate and compare the SPF of 8% homomenthyl salicylate lotion, which was recommended as the control in SPF experiments by the FDA, USA, in Koreans according to different light sources. METHODS: After application of 8% homomenthyl salicylate lotion to the back, 33 men of the third decade were irradiated by xenon arc solar simulator or by fluorescent sunlamp, We estimated the SPF of them 24 hours later. RESULTS: The SPF of 8% homomenthyl salicylate lotion was 4.8+/-0.8 with the solar simulator, 2.7+/-0.6 with the fluorescent sunlamp. CONCLUSION: We confimed that the SPF of 8% homomenthyl salicylate lotion with xenon arc solar simulator can be used as a control value in Koreans, and found out that the SPF with the fluorescent sunlamp was significantly lower than that with the xenon arc lamp. So it should be taken into consideration that differences of SPF according to light sources exists in studying sunscreens.
Humans ; Male ; Skin ; Solar System* ; Sun Protection Factor* ; Sunscreening Agents ; Xenon

BACKGROUND: The need for using sunscreen is increasing today, but we know little about the effect of sunscreens on the skin of Korean people. OBJECTIVE: We tried to estimate and compare the SPF of 8% homomenthyl salicylate lotion, which was recommended as the control in SPF experiments by the FDA, USA, in Koreans according to different light sources. METHODS: After application of 8% homomenthyl salicylate lotion to the back, 33 men of the third decade were irradiated by xenon arc solar simulator or by fluorescent sunlamp, We estimated the SPF of them 24 hours later. RESULTS: The SPF of 8% homomenthyl salicylate lotion was 4.8+/-0.8 with the solar simulator, 2.7+/-0.6 with the fluorescent sunlamp. CONCLUSION: We confimed that the SPF of 8% homomenthyl salicylate lotion with xenon arc solar simulator can be used as a control value in Koreans, and found out that the SPF with the fluorescent sunlamp was significantly lower than that with the xenon arc lamp. So it should be taken into consideration that differences of SPF according to light sources exists in studying sunscreens.
Humans ; Male ; Skin ; Solar System* ; Sun Protection Factor* ; Sunscreening Agents ; Xenon

Analgesics ; Blood Pressure ; Conscious Sedation ; Dentistry ; Fentanyl ; Heart ; Heart Rate ; Humans ; Ketorolac ; Memory ; Midazolam ; Surveys and Questionnaires ; Reference Values ; Surgery, Oral ; Vital Signs

Background: Surgical ciliated cysts, also known as postoperative maxillary cysts or implantation cysts, occur mainly in the posterior maxilla after radical maxillary sinus surgery; they rarely develop in the mandible. They are thought to occur when the sinonasal epithelium is infiltrated by a surgical instrument during surgery or as a result of transplantation of bone or cartilage with respiratory epithelium attached.Case presentationWe report a case in which a surgical ciliated cyst developed in the anterior part of the mandible, presumably as a result of bimaxillary orthognathic surgery and genioplasty performed 24 years earlier. We then review the few similar cases reported in the literature. Conclusion Surgical ciliated cysts in the mandible are extremely rare, but they could occur after simultaneous surgery on the maxilla and mandible, even decades later. To prevent surgical ciliated cysts in the mandible, we recommend that the surgical instruments, especially the saw blade used during bimaxillary surgery, be new or cleaned and that previously placed plates and screws be removed at an appropriate time.

BACKGROUND: We predicted that the self-reporting questionnaire proposed by Fitzpatrick might not be appropriate for classifying the skin phototype in Korean people. OBJECTIVE: We classified the skin phototypes in Korean people by measuring the minimal erythema dose (MED) of UVB on the basis of MEDs of skin type proposed by Pathak and Fitzpatrick. METHODS: Two hundred and eighty-four male Korean medical students participated in this study. We irradiated UVB with Waldmann UV 800 and measured MEDs after 24 hours. RESULTS: The mean MED was 70.1+/-21.3 mJ/cm2. Most of the MEDs were 70, 60, 50 mJ/cm2 in the order of frequency. On the basis of the skin type proposed by Pathak and Fitzpatrick, the most frequent phototype was the skin type V(56.3%) by MED. 20.8% and 13.8% of the subjects corresponded to the skin types UV and III, respectively. 9.1% of the subjects fell into the UV sensitive group, skin type l and II. CONCLUSION: Using these results as groundwork, simple and precisely applicable classification of skin phototype in Korean people needs to be established.
Adult* ; Classification* ; Erythema* ; Humans ; Male ; Skin* ; Students, Medical ; Surveys and Questionnaires

Cantrell's pentalogy may be defined as a failure of fusion of the midline from the sternum to the umbilicus. Thus, this malady consists of multiple anomalies of the sternum, heart, pericardium, diaphragm and umbilicus or anterior abdominal wall. According to the degrees of each anomaly, various operations can be planned as a one-stage operation or as a multi-stage operation and then palliative or corrective operations. The authors experienced a case of Cantrell's pentalogy that consisted of a bifid sternum, ventricular septal defect, atrial septal defect, ventricular diverticulum, dextrocardia, pericardial defect, anterior diaphragmatic defect and diastasis recti; all of these problems were corrected by a one-stage operation.
Abdominal Wall ; Dextrocardia ; Diaphragm ; Diverticulum ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Pentalogy of Cantrell ; Pericardium ; Sternum ; Umbilicus