BACKGROUND: Mixed venous oxygen saturation (SO2) monitoring turned out to be invaluable in following up systemic cardiovascular status. But balloon-tipped flow-directed thermodilution catheter (Swan-Ganz catheter) insertion carries additional inherent risks other than those of central venous catheterization, and it costs much more expense than simple venous catheter. There has been a lot of papers which argue that central venous catheterization may substitute for the Swan-Ganz catheterization. In addition, it may be very difficult or impossible to insert the Swan-Ganz catheter in pediatric patients. This study was performed to determine whether Swan-Ganz catheterization might be replaced by the central venous catheterization in regards to SO2. METHODS: In 17 pediatric open heart surgery (OHS) patients, from the central venous catheter, the tip of which had been located in the center of right atrium (RA) and pulmonary artery, blood samples were drawn for gas analysis simultaneously, which was done immediately after emergence from cardiopulmonary bypass. RESULTS: There were no significant differences between RA blood and mixed venous blood gas analyses except oxygen saturation. The oxygen saturations of both were linearly correlated with each other. The relation was SO2=17 0.8 SRAO2 (R=0.77, p<0.05) CONCLUSIONS: It may be concluded that RA blood may be used for blood gas analysis in place of mixed venous blood immediately after pediatric open heart surgery.
Blood Gas Analysis ; Cardiopulmonary Bypass* ; Catheterization, Central Venous ; Catheterization, Swan-Ganz ; Catheters ; Central Venous Catheters ; Heart Atria ; Heart* ; Humans ; Oxygen* ; Pulmonary Artery ; Thermodilution ; Thoracic Surgery*

BACKGROUND: We studied the effects of intraperitoneal CO2 insufflation and/or the reversed Trendelenburg position on airway pressure and compliance of the total respiratory system. METHODS: We selected and randomly allocated eighty adults to a control group C or laparoscopy group L. Without premedication, propofol and vecuronium were injected for anesthesia. In the supine position we checked peak and plateau airway pressures, and calculated the dynamic and static compliance of the total respiratory system. We only used 10o reverse Trendelenburg position in group C, and used both 10o reverse Trendelenburg position and abdominal CO2 insufflation in group L. Afterwards, we checked airway pressure and compliance and compared them between groups. RESULTS: In group C, there was no change in airway pressure and compliance. But in group L, peak airway pressure (13.9 +/- 2.4 vs 21.0 +/- 3.3 cmH2O) and plateau airway pressure (11.7 +/- 2.1 vs 18.9 +/- 3.2 cmH2O) were increased and dynamic compliance (47.7 +/- 9.1 vs 30.6 +/- 5.9 ml/cmH2O) and static compliance (58.4 +/- 12.4 vs 13.1 +/- 7.3 ml/cmH2O) of the total respiratory system were decreased. CONCLUSION: In a laparoscopic cholecystectomy, intraabdominal insufflation of CO2 raises airway pressure and reduces compliance of the total respiratory system. Reverse Trendelenburg position itself does not affect airway pressure and compliance.
Adult ; Anesthesia ; Cholecystectomy, Laparoscopic ; Compliance* ; Head-Down Tilt* ; Humans ; Insufflation* ; Laparoscopy ; Premedication ; Propofol ; Respiratory System ; Supine Position ; Vecuronium Bromide

BACKGROUND: Fanconi's anemia (FA) is an autosomal recessive disease characterized by aplastic anemia, pre-malignancy, congenital malformations and chromosome breakage syndromes. As up to 30% of patients have no detectable congenital anomalies, the modern diagnosis of FA rests on chromosomal breakage of patient's cells induced by chemical clastogens such as diepoxybutane (DEB) or mitomycin-C (MMC). METHODS: We have done chromosome breakage test to differentiate FA from 11 aplastic anemia, three Diamond-Blackfan syndrome, three myelodysplastic syndrome, one acute leukemia with congenital anomaly and three siblings of FA. The peripheral blood lymphocytes from each individual were co-cultured in phytohemagglutinin-containing medium by the three methods, i.e., DEB treated, MMC treated and un-treated. RESULTS: Five cases were found to have increased chromosomal breakages to DEB and MMC, confirming diagnosis of FA. Other 21 cases showed no increased chromosomal breakages. No overlap was found between FA group and others (P<0.01). In one FA, there was no increased spontaneous breakage, but increased breakage to DEB and MMC. Of five FA, one case showed no congenital anomalies. CONCLUSIONS: Chromosme breakage test was shown to be simple, reliable and useful in ascertaining the diagnosis of FA.
Anemia, Aplastic ; Chromosome Breakage* ; Diagnosis* ; Fanconi Anemia* ; Humans ; Leukemia ; Lymphocytes ; Mitomycin ; Mutagens ; Myelodysplastic Syndromes ; Siblings

Nine athletes and ten nonathletes were selected randomly to study the changes of cardiac function during exercise by impedance cardiography. The speed of the treadmill was maintained at 3.4 mph, and its grade was increased by 1% (Balke protocol). The exercise was continued until the target heart rate (THR), 85% of maximum oxygen uptake (VO2max). The measured parameters for pre- and post-exercise were stroke volume (SV), heart rate (HR), and cardiac output (CO). Average stroke volume of athletes at pre-exercise, 71.1 ml, was higher than that of nonathletes, 64.6 ml, and stroke volume of the former at post-exercise, 97.0 ml, was also higher than that of the latter, 85.2 ml. Therefore, despite the lower heart rate, cardiac outputs of athletes at pre- and post-exercise, 4.98 and 16.3 L/min, were higher than those of nonathletes, 4.87 and 14.2 L/min. For the second phase of the study, cardiac outputs of three subjects were measured during the continuous treadmill exercise with newly developed electrodes and shoes for minimizing motion artifact. Though there were several studies measuring cardiac output during continuous bicycle exercise, this is thought to be the first study in the world measuring cardiac output during continuous treadmill exercise without aid of ensemble averaging.
Adult ; *Cardiac Output ; *Cardiography, Impedance ; *Exertion ; Heart Rate ; Human ; Sports Medicine ; Stroke Volume ; Support, Non-U.S. Gov't

Pasteurella dagmatis is an oxidase and catalase positive, facultative anaerobic, gram-negative coccobacillus classified as a member of the family Pasteurellaceae. Pasteurella species are commonly colonizing the oropharynx of healthy domestic and wild animals including cats and dogs. These are usually pathogenic to domestic animals, but rarely to human beings. Pasteurella infection of human causes pneumonia, empyema, meningitis, peritonitis, bone and joint infection and septicemia. Recently, we experienced a case of dog-bite wounds from which Pasteurella dagmatis was isolated in a 39-year-old woman. To our knowledge, this is the first report of Pasteurella dagmatis isolated from dog-bite wounds in Korea.
Adult ; Animals ; Animals, Domestic ; Animals, Wild ; Catalase ; Cats ; Colon ; Dogs ; Empyema ; Female ; Humans ; Joints ; Korea ; Meningitis ; Oropharynx ; Oxidoreductases ; Pasteurella Infections ; Pasteurella* ; Pasteurellaceae ; Peritonitis ; Pneumonia ; Sepsis ; Wounds and Injuries*

BACKGROUND: Rocuronium(ORG 9426) is a new steroid nondepolarizing neuromuscular blocking drug with fast onset and intermittent duration of action. Its effects on vital signs are controversial. We studied onset, clinical duration, recovery index of rocuronium and its effects on blood pressures and heart rates. METHODS: We selected thirty healthy children who would receive inguinal herniorrhaphy and allocated them to 2 groups(control and rocuronium group). Without premedication or with oral medication of PocralTM (20 mg/kg), they administrated propofol(2.5 mg/kg) intravenous for loss of consciousness and we maintained anesthetic states with 20 mg/kg/hr of propofol. After 2 minutes, we checked BP(SBP/ DBP/MBP) and HR at every minutes and checked TOF, T1 height compare to control, T4 to T1 at every twenty seconds. We injected intravenously rocuronium(0.8 mg/kg, 2ED95) to rocuronium group and nothing to control group. We determined intubation time(from injection to 90% depression of maximal block), onset time(to maximal depression or T1=0), clinical duration(to T1=25%) and recovery index(from T1=25% to T1=75%). RESULTS: In children, intubation time was 93.8sec, onset time was 146.2sec, clinical duration was 34.6min, recovery index was 15.4min. SBP, DBP, MBP and HR were not changed independent of injection of rocuronium. CONCLUSION: Rocuronium is a muscle relaxant with rapid onset and intermittent clinical duration in children. It does not affect BP and HR.
Anesthesia* ; Anesthetics ; Blood Pressure* ; Child* ; Depression ; Heart Rate* ; Heart* ; Herniorrhaphy ; Humans ; Intubation ; Neuromuscular Blockade ; Premedication ; Propofol* ; Unconsciousness ; Vital Signs

BACKGROUND: The definition of evidence-based clinical practice guidelines (CPGs) is "statements that are systematically developed to assist in the doctors' and patients' decision-making in certain situations." This study aims to establish the concept of evidence-based CPGs and investigate the development status to seek measures to apply evidence-based methods to CPG development for dental sedation in Korea. METHODS: The study conducted systematic searching methods based on evidence-based CPGs. Articles published between 1995 to 2015 were searched on a Korean database and the international database PubMed. The search was based on keywords related to four subjects (dentistry, clinical practice, guideline, recommendation). Two authors independently reviewed the searched articles to determine their analysis inclusion and the convergence stages, and to arrive at a conclusion through discussion. RESULTS: A total of 65 Korean CPGs were included. There were 51 medical guidelines, of which seven were dental and seven were Oriental medicine. CONCLUSIONS: As a basic direction for the development of evidence-based CPGs, this work suggests the following: increased awareness; consensus on the need to supply evidence-based development methods; education, computerization, and systematic observation of evidence-based CPG development methods; continuous research development and distribution of CPGs; and creation of a database for Korean clinical dentistry practice outcomes.
Consensus ; Dentistry ; Education ; Korea ; Medicine, East Asian Traditional

BACKGROUND: Several methods have been used to evaluate the engraftment and to monitor residual disease after bone marrow transplantation (BMT). Among them, karyotyping have been useful in gauging engraftment following opposite sex BMT. More recently, fluorescence in situ hybridization (FISH) has also been applied to determine engraftment and residual status. In order to establish the utility of this method in clinical practice, we have evaluated the data from FISH and several methods. METHODS: We performed FISH using chromosome X alpha-satellite probe (Oncor , USA) on twenty eight peripheral blood and nine bone marrow nuclear cells from eleven patients who underwent sex mis-matched transplant and from a patient who had a loss of X chromosome. RESULTS: In nine patients with well engrafted BMT, signals of host cells showed less than 5% in all patients, evaluated 21-210 days post-transplant. Mixed chimerism was detected in six patients; transiently in early post-transplant period in four, in a patient with engraftment failure, and in a patient with relapse, respectively. CONCLUSION: FISH using X probe is a rapid, quantitative and sensitive 'interphase cytogenetic method' for the evaluation of engraftment and monitoring of residual disease following sex mis-matched BMT or BMT in a patient with a loss of X chromosome; It is especially useful in early post-transplant period when ony a few cells are available during severe cytopenia.
Bone Marrow Transplantation* ; Bone Marrow* ; Chimerism ; Cytogenetics ; Fluorescence* ; Humans ; In Situ Hybridization* ; Karyotyping ; Recurrence ; X Chromosome

No abstract available.
Catheters* ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Fetal Therapies* ; Lung*

BACKGROUND: Evidence-based clinical practice guidelines (CPGs) are defined as “statements that are scientifically reviewed about evidence and systematically developed to assist in the doctors' and patients' decision making in certain clinical situations.” This recommendation aims to promote good clinical practice for the provision of safe and effective practices of conscious sedation in dentistry. METHODS: The development of this clinical practice guideline was conducted by performing a systematic search of the literature for evidence-based CPGs. Existing guidelines, relevant systematic reviews, policy documents, legislation, or other recommendations were reviewed and appraised. To supplement this information, key questions were formulated by the Guideline Development Group and used as the basis for designing systematic literature search strategies to identify literature that may address these questions. Guideline documents were evaluated through a review of domestic and international databases for the development of a renewing of existing conscious sedation guidelines for dentistry. Clinical practice guidelines were critically appraised for their methodologies using Appraisal of guidelines for research and evaluation (AGREE) II. RESULTS: A total of 12 existing CPGs were included and 13 recommendations were made in a range of general, adult, and pediatric areas. CONCLUSION: The clinical practice guidelines for conscious sedation will be reviewed in 5 years' time for further updates to reflect significant changes in the field.
Adult ; Conscious Sedation* ; Decision Making ; Dentistry* ; Evidence-Based Medicine ; Humans