BACKGROUND: Multi-vessel off-pump coronary bypass surgery (OPCAB) imposes cumulative myocardial ischemia/reperfusion injury, which may be attenuated by continuous infusion of nitrate. However, nitrate infusion and consequent decrease in preload may be hazardous during heart displacement which causes restrictive filling of the ventricles. Therefore, we evaluated the effect of nitrate infusion on myocardial protection and hemodynamics in patients undergoing OPCAB, in a prospective, randomized and controlled trial. METHODS: Fifty patients with stable angina and left ventricular ejection fraction >40% undergoing elective, isolated, multivessel OPCAB were enrolled. Patients were randomized equally to either continuous infusion of isosorbide dinitrate 0.5microg/kg/min or same amount of normal saline during the surgery. Operative data including hemodynamic variables, intraoperative ST segment changes and postoperative cardiac enzyme release (creatine kinase-MB, troponin T) were compared. RESULTS: Patients characteristic and operative data including ST segment changes and use of vasopressors were similar between the groups except the total amount of infused crystalloid during the surgery which was significantly higher in the nitrate group. Postoperative variables including cardiac enzyme release were also similar between the groups. CONCLUSIONS: Prophylactic continuous infusion of nitrate during OPCAB exerted no additional benefit in terms of myocardial protection. It also, was not associated with accentuated decrease in cardiac output during heart displacement, and the decrease in preload seems to have been nullified by modest increase in fluid therapy.
Angina, Stable ; Cardiac Output ; Displacement (Psychology) ; Fluid Therapy ; Heart ; Hemodynamics ; Humans ; Isosorbide ; Isosorbide Dinitrate ; Isotonic Solutions ; Myocardial Ischemia ; Prospective Studies ; Stroke Volume ; Troponin

Percutaneous cardiopulmonary support (PCPS) provides hemodynamic and pulmonary support simultaneously and is increasingly used in medical practice. However, the presence of extracorporeal circulation and the use of heparin means it is not free of side effects, and use of PCPS for longer than 96 h is associated with poor prognosis. Therefore, along with the decision of when to apply or discontinue PCPS, an integrated team approach between the surgeon and the anesthesiologist to prevent and/ or manage PCPS-related complications is of paramount importance when the patient's physical status mandates prolonged use of PCPS. We hereby report 2 cases addressing successful management of postoperative cardiogenic shock, refractory to pharmacologic support, with early and prolonged application of PCPS in patients who underwent surgical anterior ventricular endocardial restoration and coronary artery bypass surgery.
Coronary Artery Bypass ; Extracorporeal Circulation ; Hemodynamics ; Heparin ; Humans ; Prognosis ; Shock, Cardiogenic ; Thoracic Surgery

Percutaneous cardiopulmonary support (PCPS) provides hemodynamic and pulmonary support simultaneously and is increasingly used in medical practice. However, the presence of extracorporeal circulation and the use of heparin means it is not free of side effects, and use of PCPS for longer than 96 h is associated with poor prognosis. Therefore, along with the decision of when to apply or discontinue PCPS, an integrated team approach between the surgeon and the anesthesiologist to prevent and/ or manage PCPS-related complications is of paramount importance when the patient's physical status mandates prolonged use of PCPS. We hereby report 2 cases addressing successful management of postoperative cardiogenic shock, refractory to pharmacologic support, with early and prolonged application of PCPS in patients who underwent surgical anterior ventricular endocardial restoration and coronary artery bypass surgery.
Coronary Artery Bypass ; Extracorporeal Circulation ; Hemodynamics ; Heparin ; Humans ; Prognosis ; Shock, Cardiogenic ; Thoracic Surgery

Primary peritoneal leiomyoma is histologically benign and rare non-neoplastic proliferation of smooth muscle that occurs in the peritoneal wall during the reprodutive years of women. A 51-year old patient had a solid tumor of 18cm diameter in the peritoneal wall, which was pathologically confirmed as a benign leiomyoma primarily originated from the retroperitoneal wall. Laparotomy revealed a solid tumor in the peritoneal wall, about 18cm, and histologically diagnosed as a leiomyoma. We report a case of primary peritoneal leiomyoma with a brief review of literatures.
Female ; Humans ; Laparotomy ; Leiomyoma* ; Middle Aged ; Muscle, Smooth

Anti-M is detected at room temperature and is often found in the sera of people who have never been exposed to human red cells. In a few cases, anti-M can be detected at 37 degrees C or at the antiglobulin phase, and these antibodies can cause hemolytic diseases in newborn or hemolytic transfusion reactions. Some examples of anti-M demonstrate stronger agglutination at low pH (pH 6.5), and when they react with the red blood cells of the MM type (dosage effect). An unexpected antibody test was carried out for the routine screening of donated blood and two cases that reacted to all panel cells at 5 degrees C were found, which indicated anti-M. We repeated the unexpected antibody identification test at pH 6.5 and confirmed the presence of anti-M. The reduction of the test system pH is a useful and simple method for detecting some cases of anti-M.
Agglutination ; Antibodies ; Blood Group Incompatibility ; Erythrocytes ; Humans ; Hydrogen-Ion Concentration* ; Infant, Newborn ; Mass Screening

Authors found a case of anti-Wr(a) with anti-E antibody in 67 years old female patient. Anti-Wr(a) in Korea was reported for the first time in 2005. Anti-Wr(a) has been associated with hemolytic transfusion reaction (HTR) and hemolytic disease of the newborn (HDN). It is necessary to study the incidence of Wr(a) antigen and anti-Wr(a) in Korea.
Aged ; Blood Group Incompatibility ; Female ; Humans ; Incidence ; Infant, Newborn ; Korea

Current anatomy education in Korea has been dependent upon foreign textbooks and atlas. Various models and medical devices from overseas were imported and commonly used in Korea, Now, we need to provide our own literatures and graphic data based on Korean population for student education. It is necessary to design, produce and supply medical education, operative tools and treatment supportive devices customized to Korean human body and constitution. Accordingly, this is the time to assemble and deliver medical data to Korean population. In this study, we primarily focused on building musculoskeletal system of Korea population and set our goal as utilizing its graphic data for medical education in Korea. It is first study preparing theoretical foundations of Korean skeletal graphic system based on Korean body shape by comparison with other ethnic groups and foreign graphical models. Simultaneously, we conducted practical construction of the skeletal atlas by employing Korean standard measures. Parameters from the measurement for various types of bones were calculated, and the results were compared with data from foreign atlas and pictures. Individual drawings of bones from skull, upper extremity was made by using parameters we calculated, thus the atlas of Korean skeleton was constructed from artistic anatomical point of view. As a result, there were significant differences between Korean skeletons and the medical drawings from the oversea edition. Because many foreign drawings used data from Caucasians only and there were numerous exaggerated and false dimensions without actual measurement. In conclusion, the result of the study is expected to provide fundamental data for building anatomical atlas about Korean human body structure.
Constitution and Bylaws ; Education ; Education, Medical ; Ethnic Groups ; Foundations ; Human Body ; Humans ; Korea ; Musculoskeletal System ; Skeleton* ; Skull ; Upper Extremity*

PURPOSE:This study was a pilot study to develop structure, clinical performance and outcome measurement and criteria for increasing number of dialysis facilities and patients to provide quality of care. METHODS:The six components of developing quality indicators for hemodialysis were as follows: 1) Organizing expert panel members. 2) Selecting the area: to reflect stakeholders' opinion, structured interviews were done. And literature reviews were performed to investigate guidelines and quality measurements of foreign countries. 3) Selecting clinical performance indicators: From experts' opinions and literature review. 4) Developing candidate indicators. 5) Performing demonstration survey: Systemic sampling was performed and 43 facilities were participated in self-answered medical record survey. 6) Based on preliminary evaluation model, final indicators were selected from expert panel reviews. RESULTS:Eleven measures of structure, thirteen performance measures of process and nine monitoring measures of outcome were developed based on literature review and clinical practice guideline. As for criterion-related validity, those of process and outcome were most high and in case of face validity, those of structure and process were most high. The most valid quality indicators were the rate of internal medicine specialist, dialysis frequency per doctor, whether or not keeping emergency equipment, examination of water quality, hemodialysis adequacy (Kt/V), monitoring arterial venous graft for stenosis maintenance of iron storage, and administration of supplemental iron. CONCLUSION:By developing quality indicators of hemodialysis and performing demonstration evaluation, quality of care for hemodialysis patients is expected to be improved, so as to promote hemodialysis patients' health and improve on quality of life.
Constriction, Pathologic ; Delivery of Health Care ; Dialysis ; Emergencies ; Humans ; Internal Medicine ; Iron ; Medical Records ; Pilot Projects ; Quality Indicators, Health Care ; Quality of Health Care ; Quality of Life ; Renal Dialysis ; Specialization ; Transplants ; Water Quality

Williams syndrome is a rare genetic disorder with a frequency of one per 20,000-50,000 live births. It is caused by a deletion of one elastin allele located within chromosome subunit 7q11.23 (long arm). This syndrome is frequently accompanied by congenital heart disease, facial anomalies, and mental retardation and as a result, anesthetic management may be complicated by hemodynamic instability and difficult intubation. Also, as it was reported that this disease is associated with malignant hyperthermia, careful anesthetic selection is required. We experienced the anesthetic management of a 3-year-old girl with Williams syndrome who received dental treatment for severe dental caries under general anesthesia, and of a 4-year-old girl underwent aortoplasty for supravalvular aortic stenosis. Airway management and tracheal intubation was accomplished successfully in both patients. For anesthetic management, propofol, fentanyl and rocuronium, and fentanyl, isoflurane and vecuronium were used in the first and second patients, respectively. Surgeries were performed uneventfully in both cases, and the patients were discharged without complication.
Airway Management ; Alleles ; Anesthesia ; Anesthesia, General ; Aortic Stenosis, Supravalvular ; Child, Preschool ; Dental Caries ; Elastin ; Female ; Fentanyl ; Heart Defects, Congenital ; Hemodynamics ; Humans ; Intellectual Disability ; Intubation ; Isoflurane ; Live Birth ; Malignant Hyperthermia ; Propofol ; Vecuronium Bromide ; Williams Syndrome*

The present study was conducted to develop an effective method for establishment of porcine parthenogenetic embryonic stem cells (ppESCs) from parthenogenetically activated oocyte-derived blastocysts. The addition of 10% fetal bovine serum (FBS) to the medium on the 3rd day of oocyte culturing improved the development of blastocysts, attachment of inner cell masses (ICMs) onto feeder cells, and formation of primitive ppESC colonies. ICM attachment was further enhanced by basic fibroblast growth factor, stem cell factor, and leukemia inhibitory factor. From these attached ICMs, seven ppESC lines were established. ppESC pluripotency was verified by strong enzymatic alkaline phosphatase activity and the expression of pluripotent markers OCT3/4, Nanog, and SSEA4. Moreover, the ppESCs were induced to form an embryoid body and teratoma. Differentiation into three germ layers (ectoderm, mesoderm, and endoderm) was confirmed by the expression of specific markers for the layers and histological analysis. In conclusion, data from the present study suggested that our modified culture conditions using FBS and cytokines are highly useful for improving the generation of pluripotent ppESCs.
Animals ; Blastocyst/*cytology ; Cell Culture Techniques/*veterinary ; *Cell Differentiation ; Cytokines/metabolism ; Embryonic Stem Cells/*cytology ; Parthenogenesis ; Pluripotent Stem Cells/*cytology ; Swine/*physiology