BACKGROUND: The multifactorial hypothesis is proposed as a working hypothesis which encompass both the genetic and environmental factors known to participate in the etiology of congenital heart anomalies. So, at the moment, it is believed that avoidance of suspected environmental factors in early pregenancy is most certain preventive measure of congenital heart anomalies. This study has been undertaken in order to find the possible environmental risk factors for congenital heart anomalies in Korea. METHOD: A total of 320 mothers of infants with congenital heart anomalies diagnosed at Seoul National University Hospital were included in this study as case group. And 413 mothers of healthy infants, who visited well baby clinic at the hospital during the same period of 2 years from 1987, comprised the control group. Data related to environmental risk factors including drug use during the first trimester of pregnancy, any other confounders were collected by direct interview using questionmaires. RESULT: There were positive associations for lower educational level of mother, indoor smoking habit of father, number of pregnancy, and of experience of previous abortion of mother, and multiple(or twin) birth. Relative risk estimates for the first trimester exposure to anti-emetics and herb medicine were 2.1(p<0.006) and 1.4(p<0.044), respectively. Data showed a positive association between anti-inflammatory drug exposure and congenital anomalies of pulmonary valve(OR=22.7, p<0.01), and between anti-histamine exposure and coarctation of aorata(OR=12.7, p<0.017). CONCLUSION: Environmental factors such as smoking habit of father, certain drugs used in early pregnancy, plays a role in the etiology of congenital heart anomlaies. Further studies, designed to focus on specific drug and to differentiate the effect of the suspected drug and to differentiate the effect of the suspected drug form that of the underlying conditions prompting its use, should be called upon.
Abortion, Induced ; Antiemetics ; Case-Control Studies* ; Fathers ; Female ; Heart* ; Humans ; Infant ; Korea* ; Mothers ; Parturition ; Pregnancy ; Pregnancy Trimester, First ; Risk Factors ; Seoul ; Smoke ; Smoking

No abstract available.
Gait*

BACKGROUND: The use of uncrossmatched group O, Rh-negative RBCs has enabled immediate transfusion of patients who need critical care in life-threatening situations. We examined our 1-year experience with uncrossmatched group O, Rh-negative RBC transfusion in a tertiary care university hospital. METHODS: Uncrossmatched group O, Rh-negative RBCs were available for immediate transfusion upon request without performing any of the following pretransfusion tests: ABO and RhD typing, irregular antibody screening, crossmatching test. The characteristics of the transfused patients were studied retrospectively. RESULTS: Twenty-five patients received 56 units of uncrossmatched group O, Rh-negative RBCs from November 2005 to October 2006. An average of 2.24 units was issued to each patient, with no more than 4 units per patient being given; subsequent transfusion was done with type-specific, crossmatched blood. The average turnaround time for the release of uncrossmatched group O, Rh-negative RBCs was 1.8 minutes (mean+/-standard deviation: 1.8+/-1.96, range: 0~7 minutes). Seventeen patients died (68%), which included 16 patients who had received cardiopulmonary resuscitation. CONCLUSION: Patients admitted for traffic accident, falling down injury, gastrointestinal bleeding and aortic dissection received 72% of the emergency group O, Rh-negative RBCs, with a 72.2% mortality rate, which indicates the dire condition of these patients. The majority of RBCs for transfusion were available within 5 minutes upon request. Though group O, Rh-negative RBCs are recommended in emergency situations in which the blood group of the patient is unknown, the use of group O, Rh-positive RBCs may be an alternative blood supply, when considering the short supply of Rh-negative RBCs.
Accidents, Traffic ; Cardiopulmonary Resuscitation ; Critical Care ; Emergencies* ; Hemorrhage ; Humans ; Mass Screening ; Mortality ; Retrospective Studies ; Tertiary Healthcare

We report a case of unsuspected difficult intubation in an adult due to anatomical abnormalities caused by a thermal burn injury on the right anterior pillar of the pharynx. After induction of anesthesia, vocal cords and epiglottis were not seen and the right half of the pharyngeal cavity was obstructed by a narrowed palatoglossal arch on the laryngoscopic view. Endotracheal intubation trials failed by oral and nasal routes. The laryngeal mask airway could not be passed into the narrowed oropharynx. We awaked the patient and took the patient's past history precisely and an otolaryngologic evaluation was taken. We found that at the age of six, the patient experienced a thermal burn injury on the right anterior pillar of the pharynx by heated iron and anatomical deformities by scar contracture formed thereafter. The next day a partial palatoglossal resection was done in sitting position under local anesthesia and then endotracheal intubation by direct laryngoscopy could be completed successfully.
Adult ; Anesthesia ; Anesthesia, Local ; Burns ; Cicatrix ; Congenital Abnormalities ; Contracture ; Epiglottis ; Hot Temperature ; Humans ; Intubation ; Intubation, Intratracheal* ; Iron ; Laryngeal Masks ; Laryngoscopy ; Oropharynx ; Pharynx ; Vocal Cords

Ten patients with muscle-invading bladder carcinoma (clinical stage T2-TsB Nx Mo, T.C.C.) who were not candidates for cystectomy were treated with combined cisplatin and external-beam radiotherapy From Mar. 1990 through Feb. 1992. Results of the combined therapy had been compared with those of the radiation therapy alone. Using this combined therapy, 5(71.4%) of 7 patients achieved partial remission with a mean follow-up of 10.8 months. Three patients died of unrelated causes. Partial remission following radialion therapy alone was 6 (60%) of 10 patients. Patients with complete remission was none in the two groups. All patients in the combined therapy group were nauseated on the day treatment was given and 7 patients developed total atopecia. The malaise associated with cisplatin therapy tended to increase with the number of courses. All patients refused further treatment on this account (mean amount of cisplatin received: 3 courses). Combined cisplatin and radiotherapy may be applied to patients unsuited for radical cystectomy. Tolerance to cisplatin and radiotherapy was poor due to relatively severe toxicity, poor performance status with old age and underlying medical disease. Refinement of this protocol, careful selection of patients and longer follow-up will be necessary to determine the real benefit of this alternative modality.
Cisplatin* ; Cystectomy ; Drug Therapy ; Follow-Up Studies ; Humans ; Radiotherapy* ; Urinary Bladder*

In order to observe the changes in left ventricular function during coronary artery occlusion and reperfusion, left anterior descending (LAD) coronary arteries in the anesthetized dogs were occluded for 1 hour and then reperfused for 4 hours. Hemodynamic indexes of global systolic and diastolic function and regional wall thickness changes as a regional contractile index were measured during occlusion and reperfusion. The results were as follows; 1) Indexes of global systolic function (left ventricular peak systolic pressure, peak positive dP/dt) and global diastolic function (peak negative dP/dt, time constant, left ventricular end-diastolic pressure) showed deterioration in early occlusion period (10-30 minutes) but gradually improved even if coronary occlusion persisted. Reperfusion did not induce significant changes except that peak positive dP/dt transiently deteriorated 30 minutes after reperfusion and left ventricular end-diastolic pressure decreased 1.5-2 hours after reperfusion. 2) Indexed of regional function (i.e, end-diastolic thickness and % systolic thickening of anterior left ventricular wall) deteriorated by 10 minutes' occlusion which persisted during the entire occlusion period. Reperfusion induced no significant improvement in regional contractile function compared with occlusion 60 minutes' data, which suggested reperfusion for 4 hours after 1 hour's LAD occlusion may be insufficient for the ischemic region to recover its contractility. 3) Reperfusion arrhythmia (ventricular tachycardia) was noted in most (6/9) of the dogs, one of which deteriorated into ventricular fibrillation and the others spontaneously converted to normal sinus rhythm.
Animals ; Arrhythmias, Cardiac ; Blood Pressure ; Coronary Occlusion ; Coronary Vessels* ; Dogs ; Hemodynamics ; Reperfusion* ; Ventricular Fibrillation ; Ventricular Function, Left*

No abstract available.
Primary Health Care*

A patient who had akinetic mutism was mistaken for a psychologic disorder or true coma. We experienced a case of reversible akinetic mutism and paraplegia for 5 hours after general anesthesia in a 28-year-old female who underwent debridement of chemical burn-induced skin necrosis on the left leg.
Adult ; Akinetic Mutism* ; Anesthesia, General* ; Coma ; Debridement ; Female ; Humans ; Leg ; Necrosis ; Paraplegia ; Skin

A patient who had akinetic mutism was mistaken for a psychologic disorder or true coma. We experienced a case of reversible akinetic mutism and paraplegia for 5 hours after general anesthesia in a 28-year-old female who underwent debridement of chemical burn-induced skin necrosis on the left leg.
Adult ; Akinetic Mutism* ; Anesthesia, General* ; Coma ; Debridement ; Female ; Humans ; Leg ; Necrosis ; Paraplegia ; Skin

Peritonesl insufflation of CO2 to creste the pneumoperitoneum necessary far laparoscopy in- duces intraoperative cardiovascular and ventilatory changes that complicste anesthetic management of laparoscopy. We investigated cardiovascular and ventilstory changes during laparoscopic cholecystectomy under general anesthesia in 11 healthy patients. During operation, intraabdominal pressure was maintained automatically at 14 mmHg by a CO2 insufflator and controlled ventilation setting was adjusted at the values of PaCO2 about 30 mmHg before peritoneal insufflation, and this ventilatory setting was not changed throughout the operation. We measured peak inspiratory pressure(Ppi), mean arterial pressure(MAP), pulse rate(PR), arterial blood gas and end tidal carbon dioxide(PEtCO2) before and during peritoneal insufflation, snd after peritoneal exsufflation. Peritoneal insufflation of CO2 resulted in a significant increase of Ppi, MAP, PaCO2 and PEtCO2, a significant decrease of pH. And PaCO2 and pH were not restored until 15 minutes after CO2 exsufflation. PR and PaO2 were not changed significantly throughout the operation. Conclusively, during general anesthesia for laparoscopic choleeystectomy, hyperventilation was needed under the monitoring of PEtCO2 or PEt,CO2 and special care and monitoring was mendatory for the patients with impaired cardiopulmonary function and increased intracranial pressure.
Anesthesia, General* ; Carbon ; Cholecystectomy, Laparoscopic* ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation ; Insufflation ; Intracranial Pressure ; Laparoscopy ; Pneumoperitoneum ; Ventilation