PURPOSE: Preservation of adequate vascular access is of vital importance for patients undergoing chronic dialysis in renal failure. The aim of this study is to evaluate the successful access rate and risk factors of arteriovenous fistula (AVF) in the arm for dialysis at a single center. MATERIALS AND METHODS: Patients undergoing vascular access operation between January 2006 and December 2011 were retrospectively identified. RESULTS: A total of 362 vascular access operations were performed. There were 338 autologous AVFs (93.4%) and 24 prosthetic grafts (6.6%). Men comprised 58.3% of all subjects. Mean age was 59.5+/-14.7 years. There were 187 diabetes mellitus patients (51.7%). There was a mean duration of 70.3+/-21.1 days between access creation to first cannulation. Overall successful access rate for dialysis was 95.9%. Of 338 autologous AVFs, 326 patients had patent AVFs for dialysis (96.4% surgical success rate), while 21 of 24 prosthetic grafts were patent (87.5% surgical success rate). A total of 141 patients (38.9%) came to surgery with preoperative central venous catheters (CVC) of which 130 (35.9%) AVFs had a patent fistula in the arm. The only risk factor related to successful access rate of AVF was preoperative CVC placement (P=0.012). CONCLUSION: Successful vascular access rate was 95.9%. The only risk factor related to patent access of AVF was preoperative CVC placement. At least 6 months prior to expected dialysis, AVF surgery is recommended, which may overcome the challenge of co-morbid conditions from having a preoperative CVC.
Arm* ; Arteriovenous Fistula ; Catheterization ; Central Venous Catheters ; Diabetes Mellitus ; Dialysis* ; Fistula ; Humans ; Male ; Renal Insufficiency ; Retrospective Studies ; Risk Factors* ; Transplants

No abstract available.
Knee* ; Passive Cutaneous Anaphylaxis*

No abstract available.
Animals ; Atrophy* ; Electric Stimulation* ; Muscle, Skeletal* ; Rats* ; Sciatic Nerve*

PURPOSE: Breast cancer is increasing in Korea. and it has become the second most common cancer in females. This study reviewed the history of surgery and clinical analysis with follow up result on 2,677 cases of breast cancer operated at the Gospel Hospital during the 50-year period 1951 to 2000 was performed. METHODS: We reviewed breast cancer cases by operative record datas and previous reports of our hospital during the 50-year period. RESULTS: Minimal age was 14 years old and Maximal age was 90 years old in all cases. The total count of operation was 2,677 cases during the 50-year period (1951~2000). In 1951, the hospital was opened. In 1953, 52-year old female was operated by mammary amputation. In 1958, 47-year old female was operated by radical mastectomy. In 1976, 50-year old female was operated by modified radical mastectomy. Since 1996, radical mastectomy has not been operated any more. Radical mastectomy was performed in 234 cases (8.7%), modified radical mastectomy in 2,164 cases (81.0%), simple mastectomy in 79 cases (3.0%), partial mastectomy with axillary dissection in 90 cases (3.4%), wide excision in 110 cases (4.0%) Overall 5 year survival rate was 41.5% (1970~1982), 79.0% (1983~1993), 82.3% (1994~2000). CONCLUSION: This study shows the fact that the incidence of breast cancer is increasing and the minimal age is getting younger and the maximal age is getting older. The treatment for breast cancer is changing according to the period. also it will be developing.
Adolescent ; Aged, 80 and over ; Amputation ; Breast Neoplasms* ; Breast* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mastectomy, Simple ; Middle Aged ; Survival Rate

Background: It has been reported that steroid and lidocaine reduce inflammatory responses to endotoxin. The aim of this study is to compare the effects of lidocaine with those of steroid on inflammatory responses to Escherichia coli endotoxemia in the rabbit lung. Methods: Twenty four animals were randomly assigned to one of four groups. Group I (endotoxemic group; control, n=6): They were received E. coli endotoxin (500 microg/kg) intravenously through the ear vein and followed by saline infusion at 20 ml/kg/hr for 4 hours. Group II (steroid treated group, n=6): They were treated with steroid (30 mg/kg) intravenously just after endotoxin injection and then saline was given at 20 ml/kg/hr for 4 hours. Group III (lidocaine treated group, n=6): They were received same as the endotoxemic group and lidocaine (3 mg/kg IV bolus, then continuous infusion at the rate of 2 mg/kg/hr) was administered with saline at 20 ml/kg/hr for 4 hours. Group IV (steroid & lidocaine treated group, n=6): They were received same as the endotoxemic group and after endotoxin infusion, steroid (30 mg/kg) and lidocaine (3 mg/kg IV bolus, then continuous infusion at the rate of 2 mg/kg/hr) was administered intravenously with saline. Numbers of neutrophils and monocytes in the samples of peripheral blood and lung tissue were counted and compared to evaluate the anti-inflammatory effect of drugs. Results: The group II, III, and IV showed significant attenuation of inflammatory responses compared to group I in the rabbit lung(P<0.05). But there were no significant differences among group II, III, and IV. There was no additive effect between steroid and lidocaine. Conclusion: These results suggest that lidocaine could be used as an alternative drug to steroid for its anti-inflammatory effects and cost-effectiveness.
Animals ; Ear ; Endotoxemia* ; Escherichia coli ; Lidocaine* ; Lung* ; Monocytes ; Neutrophils ; Veins

BACKGROUND: Many drugs are commonly administered according to total body weight or age basis. However, drugs are primarily distributed to the lean body mass. This study was undertaken to find out the best determinant for drug requirements during induction in elderly. METHODS: Forty-five ASA 1 to 3 male and female patients older than 65 years scheduled for elective surgery were divided into 3 groups and received thiopental sodium 62.5 mg/min (group T, n = 15), propofol 25 mg/min (group P, n = 15), or etomidate 5 mg/min (group E, n = 15) respectively. Kendall's tau test for correlations was used to describe the relationship between drug requirements for induction and total body weight, lean body mass determined by Weisburg's modification of Gubner's formula, ideal body weight calculated by Devine's method, and body surface area. RESULTS: Loss of consciousness was obtained with a thiopental sodium dose of 128.4 +/- 29.3 mg, propofol 59.8 +/- 13.6 mg, and etomidate 9.8 +/- 1.4 mg. Kendall's tau correlation test showed that requirements of drugs were related to lean body mass (group T, r = 0.490*, group P, r = 0.433*, group E, r = 0.493*, global P < 0.05) and ideal body weight (group P, r = 0.426*, group E, r = 0.434*, p < 0.05), but not to total body weight or body surface area. CONCLUSIONS: Our results indicate that drug requirements for induction of anesthesia correlate better with lean body mass and ideal body weight than with total body weight or body surface area in elderly patients.
Aged* ; Anesthesia ; Body Surface Area ; Body Weight ; Etomidate* ; Female ; Humans ; Ideal Body Weight ; Male ; Propofol* ; Thiopental* ; Unconsciousness

No abstract available.
Lupus Erythematosus, Systemic* ; Polyarteritis Nodosa*

BACKGROUND: Acute myocardial infarction is one of major cardiovascular disease that increases according to the changes of diet and life style. Early diagnosis and treatment of acute myocardial infarction is critical for better prognosis and for reducing mortality. But early diagnosis of acute myocardial infarction is limited by several factors. Recently it was reported that measurements of several serum cardiac enzymes were useful for early diagnosis of acute mocardial infarction. This study was performed to investigate which method of serum creatine kinase measurement is the faster and accurate and whether serum creatine kinase is an early noninvasive predictor of coronary artery patency following thrombolysis in patients with acute myocardial infarction by means of analysis of serial changes in serum creatine kinase. METHODS: This study included 32 patients who had acute myocardial infarction. Serum CK-MB was measured by electrophoretic method and enzymatic immuoasssay method. and compared with EKG and total CK activity which measured by photoabsorbance method. Also we studied whether CK time-activity could be predictor for reperfusion. RESULTS: Immunoassay method accurately measures the serum CK-MB and correlates well with that of electrophoretic method in patients with acute mocardial infarction. Immunoassay method is more sensitive than EKG and has the similar sensitivity to electrophoretic method in diagnosis of acute myoardial infarction. Reperfusion of an occluded coronary artery results in early elevation of serum creatine kinase and CK-MB reflected by earlier appearance time, peak, and onset of clearance. CONCLUSION: Because immunoassay measurement of serum creatine kinase is faster than electrophoresis and requires less technical expertise, it is possible to make diagnosis in patients with acute myocardial infarction in a more timely and cost effective manner and creatine kinase is good predictor of recanalization of an occluded coronary artery after intravenous thrombolytic therapy.
Cardiovascular Diseases ; Coronary Vessels ; Creatine Kinase* ; Creatine* ; Diagnosis ; Diet ; Early Diagnosis* ; Electrocardiography ; Electrophoresis ; Humans ; Immunoassay ; Infarction ; Life Style ; Mortality ; Myocardial Infarction* ; Professional Competence ; Prognosis ; Reperfusion* ; Thrombolytic Therapy

BACKGROUND: In order to improve the quality of life of dying patients so that they may die with dignity, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care. However, their is no adequate medical service at present. We studied terminal cancer patients'behavior patterns of health care utilization, the problems of caring for the patient, and medical services that bereaved families suggested for terminal cancer patients and their families. METHODS: From 271 patients'families who participated in our hospice program from March 1991 to February 1996, 108 bereaved families whom we able to had been contact were interviewed by three student nurses with a structured questionnaire. RESULTS: The terminal cancer patients received their medical care through admission to hospital(45.4%), outpatient clinic(22.2%), emergency room(16.7%), and oriental medicine(12.0%). But during their terminal phase of the illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alternative medicine care such as intake of mushroom and elm tree. 26 bereaved families(24.1%) pointed out the indifference of the medical team as a problem receiving proper hospital care, and 22 bereaved families(20.4%) emphasized emotional strain of their helplessness with the patient's suffering as a problem of caring for the patient at home. Over 90% of bereaved families from their experience suggested needs of continuous care, hospice care, home care, and 24hr telephone service. CONCLUSIONS: There were inappropriate behavior patterns of health care utilization which resulted in large proportion of terminal cancer patients received alternative medicine never receiving proper medical care. Therefore, there is a need to develop the continuous and comprehensive care for terminal cancer patients and their family, such as hospice.)
Agaricales ; Complementary Therapies ; Delivery of Health Care* ; Emergencies ; Home Care Services ; Hospice Care ; Hospices ; Humans ; Medicine, East Asian Traditional ; Outpatients ; Quality of Life ; Telephone ; Ulmus ; Surveys and Questionnaires

PURPOSE: We evaluated the contralateral patent processus vaginalis(CPPV) by transinguinal laparoscopy in boys with unilateral inguinal hernia, to determine its incidence and the association with various clinical parameters. We also investigated the factors responsible for the development of a metachronous inguinal hernia. MATERIALS AND METHODS: One hundred sixty seven boys with unilateral inguinal hernia were analyzed. The morphology of the ring was classified into four patterns(type 1, 2a, 2b, and 3). We analyzed the morphology of the internal ring and the variables related to a CPPV by age, laterality and the size of the ipsilateral and/or bilateral hernia sac. RESULTS: The incidence of a CPPV was 33.9%. The positive predictive value was 94.9%(56/59). There was no statistical difference in the incidence of a CPPV by laterality. The incidence of a CPPV was significantly higher in the group with a larger size(>or=1cm) compared to the smaller abnormalities(<1cm). The incidence of the type 3 pattern was higher than the type 2b pattern in the group with larger abnormalities. With increasing age, type 1 and 2a patterns increased in frequency, but type 2b decreased and the type 3 pattern was stable. The size of the contralateral hernia sac was significantly larger with the type 3 pattern than the type 2b. CONCLUSIONS: The results of our study showed that the size of the hernia sac and patient age were related to the presence of a CPPV. A type 3 pattern was associated with a more primitive morphology, a wider hernia sac and no change in the incidence with advancing age. Therefore, the findings of this study suggest that a metachronous inguinal hernia develops more commonly in patients with a type 3 pattern internal ring.
Diagnosis ; Hernia* ; Hernia, Inguinal* ; Humans ; Incidence ; Laparoscopy* ; Risk Factors*