BACKGROUND: The apnea test is an essential component in the clinical determination of brain death, however it may incur a significant risk of complications such as hypotension, hypoxia and even cardiac arrest. We analyzed the risk factors associated with a failed apnea test during brain death assessment in order to predict and avoid these adverse events. METHODS: Medical records on apnea tests performed for brain-dead donors at our institution between January 2009 and January 2016 were retrospectively reviewed. Age, gender, etiology of brain death, use of catecholamines and results of arterial blood gas analysis (ABGA), systolic/diastolic blood pressure (SBP/DBP), mean arterial pressure and central venous pressure prior to apnea test initiation were collected as variables. A-a gradient and P(aO2)/F(iO2) were calculated for more precise assessment of the respiratory system. In total, 267 cases were divided into two groups based on those who completed the apnea test and those who failed the test. RESULTS: 13 cases failed the apnea test. Among them, seven cases failed due to severe hypotension (SBP < 60 mmHg) and the others failed due to refractory hypoxia. In terms of hemodynamic state, SBP was significantly higher in the completed test group than the failed group (126.5 ± 23.9 vs. 103 ± 15.2, respectively; p = 0.001). In ABGA, the completed test group showed significantly higher P(aO2)/F(iO2) (313.6 ± 229.8 vs. 141.5 ± 131.0, respectively; p = 0.008) and a lower A-a gradient (278.2 ± 209.5 vs. 506.2 ± 173.1, respectively; p = 0.000). In multivariable analysis, low SBP (p = 0.003) and high A-a gradient (p = 0.044) were independent risk factors associated with a failed apnea test. CONCLUSIONS: Although the unexpected adverse events during the apnea test for brain death determination do not occur frequently, they can be fatal. If a brain-dead patient has low SBP and a high A-a gradient, clinicians should pay more attention and prepare for potential complications prior to the apnea test.
Anoxia ; Apnea* ; Arterial Pressure ; Blood Gas Analysis ; Blood Pressure ; Brain Death* ; Brain* ; Catecholamines ; Causality ; Central Venous Pressure ; Heart Arrest ; Hemodynamics* ; Humans ; Hypotension ; Medical Records ; Respiratory System ; Retrospective Studies ; Risk Factors ; Tissue Donors

BACKGROUND: Myocardial ischemia in human hypertension and in various animal models of hypertension may be due to abnormal maximal coronary vasodilator reserve and disturbaces of coronary vasomotion. The vascular reactivity defects in hypertension have been associated with the defective endothelium and sympathetic neural activation. However, such abnormalities in hypertension need to be elucidated. In the present study the effectsof cardiac ischemia reperfusion on coronary circulation, intramyocytic adenylates and purine nucleosides were examined in Langendorff-perfused Sprague Dawley rat (SD) and spontaneously hypertensive rat (SHR) hearts. Coronary venous and cardiac lactate and cardiac pyruvate were also measured. It should be noted that in the regulation of coronary flow the intrinsic flow autoregulation is highly variable due to coexisting metabolic flow control, and that natural coronary flow and cardiomyocytic energy state are normally reciprocally related in perfused heart. METHODS: For the Langendorff heart perfusion, bicarbonate perfusion buffer (pH 7.40+/-0.02,37degrees C) was equilibrated with 95% O2 : 5% CO2 and contained 5mM glucose (+5U/1 insulin) and 2mM pyruvate as energy-yielding substrates. Global hypoperfusion ischemia was induced by lowering coronary perfusion pressure of 100 to 40 cmH2O, followed by 20 min reperfusion. RESULTS: During the ischemia and reperfusion, metabolic acidosis and enhanced venous lactate output in SHR were observed with increases in coronary vascular resistance and myocardial oxygen consumption.In addition, coronary reactive hyperemia during reperfusion was depressed. Although ischemia-induced increase in combined adenosine plus inosine were abolished during prolonged reperfusion, SD still exhibited coronary vasodilation. The depressed reactive hyperemia in SHR was associated with decreases in cardiac adenosine triphosphate (ATP) pool and creatine phosphate/inorganic phosphate (CrP/Pi) ratio and an increase in cardiac lactate/pyruvate ratio. CONCLUSION: This abnormal vascular reactivity during ischemia and reperfusion in SHR may be in part due to an alteration in the cardiac energy state and hence to a mismatch between myocardial metabolic demand and supply.
Acidosis ; Adenosine ; Adenosine Triphosphate ; Animals ; Coronary Circulation ; Creatine ; Endothelium ; Glucose ; Heart* ; Homeostasis ; Humans ; Hyperemia ; Hypertension ; Inosine ; Ischemia ; Lactic Acid ; Models, Animal ; Myocardial Ischemia ; Oxygen ; Perfusion* ; Purine Nucleosides ; Pyruvic Acid ; Rats ; Rats, Inbred SHR* ; Reperfusion ; Vascular Resistance ; Vasodilation

No abstract available.
Cafe-au-Lait Spots ; Nevus*

No abstract available.
Coronary Circulation* ; Heart* ; Rats, Inbred SHR*

PURPOSE: The purpose of the study was to explore factors influencing turnover intention of new graduate nurses according to length of services. METHODS: From May to July, 2017, a survey was conducted among 220 nurses working in four hospitals. Inclusion criteria were new graduate nurses who had careers of less than 16 months. Data were collected on organizational socialization, support in work place, job stress, and turnover intention. RESULTS: Satisfaction with current work department, job satisfaction, organizational commitment, and job stress were significant factors influencing turnover intention of new nurses with less than six months experience. However, in case of nurses with seven to 15 months experience, only organizational commitment influenced turnover intention. CONCLUSIONS: These findings indicate that the factors influencing turnover intention are different according to the length of time the new graduate nurses have worked. To reduce the turnover intention of new nurses, it is necessary to differentiate human resource management approaches according to length of employment. The study results could be useful evidence for developing strategies to reduce turnover in new nurses.
Employment ; Humans ; Intention ; Job Satisfaction ; Personnel Turnover ; Socialization ; Workplace

Chromomycosis is a chronic cutaneous fungal infection characterized by the presence of dark brown parasitic forms of fungi in biopsied tissues. It is usually resulted from the entry of the causative organism through a minor trauma, and therefore, most lesions are found on the exposed part of the body, such as limbs or face, and occurrence on the nasolacrimal duct is extremely rare. We report a case of chromomycosis of the right nasolacrimal duct, which was presented with clinical symptoms of nasolacrimal duct obstruction. The patient was a 40 year-old male who had had minor injuries on his left eye twice by paper and branches of the tree two months prior to epiphora in right eye. On dacryocystorhinostomy, right nasolacrimal duct was obstructed by pinkish brown mucoid ball. Microscopically, the mucoid ball revealed eosinophilic, amorphous, necrotic materials admixed with brown pigmented fungi. The organism showed characteristic dark brown, round, thick-walled, often septated, sclerotic bodies and brown pigmented long bead-like hyphae. The adjacent mucosa shows marked chronic nonspecific inflammation with fibrosis.
Male ; Humans

A case of primary amelanotic melanoma of the vagina diagnosed in scraping smear is described. A 64-year-old woman complained of vaginal bleeding with a 2.5x2cm sized, fungating mass on the right lateral vaginal wall near the introitus for 2 months. Scraping smears from the mass showed scattered individual tumor cells with single, bi- or multi-nucleated eccentric nuclei having prominent macronucleoli and occasional intranuclear inclusions. The cytoplasm was plump and cyanophilic with a indistinct rim. No melanin pigment was identified. Characteristic cytologic features of this case were very helpful to exclude more common squamous cell carcinoma in the vagina, which was strongly suggested in biopsy specimen.
Biopsy ; Carcinoma, Squamous Cell ; Child* ; Cytoplasm ; Female ; Humans ; Intranuclear Inclusion Bodies ; Mediastinum ; Melanins ; Melanoma, Amelanotic ; Middle Aged ; Proteinuria* ; Thyroid Gland ; Uterine Hemorrhage ; Vagina

The author investigated serum immunoglobulin (IgG, IgA, and IgM) and complements (C3) of cord blood in 74 cases of normal fullterm infants and 50 cases of premature infants. Serum immunogloblin and complement levels were measured by the single radial immunodiffusion method. The following results were obtained; 1) The mean seru IgG levels of cord blood in 74 cases of the normal full term infants was 1407.3+/-230.5mg/dl. 2) The mean serum IgG levels of cord blood in 50 cases of the premature infants was 675.2+/-329.4mg/dl. In comparison of serum IgG levels between the premature infants and the normal full term infants, serum IgG levels in the premature infants was significantly lower than that level of the normal infants (P< 0.05). 3) The serum IgA levels were measured in 28 (37.8%) of 74 cases of the normal full term infants and in 6 912%) of 50 cases of the premature infants. The serum IgA levels measured ranged from 0.4mg/dl to 3.7mg/dl in the normal full term infants and ranged from 0.4mg/dl to 2.4mg/dl in the prematre infants. 4) The mean serum IgM levels of cord blood in 74 cases of the normal full term infants was 4.05+/-3.53mg/dl and that in 50 cases of the premature infants was 2.20+/-2.15mg/dl. 5) The mean serum C3 levels of cord blood in 74 cases of normal full term infants was 49.7+/-18.1mg/dl and those of the premature infants was 30.9+/-10.5mg/dl. In comparison of serum C3 levels between the premature infants and the normal full term infants, the mean levels of serum C3 in the premature infants was significantly lower A statistically significant increase of IgG and C3 levels of cord blood in newborn infants were observed in accordance with the increase of the gestational age. It has been suggested that decreased IgG levels among premature infants may provide a rationale for prophylactic gamma globulin administration.
Complement System Proteins* ; Fetal Blood ; gamma-Globulins ; Gestational Age ; Humans ; Immunodiffusion ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins* ; Infant ; Infant, Newborn* ; Infant, Premature

This study was conducted to analyze the relations among nutritional knowledge, nutritional attitude eating practice and total nutritional diagnosis and also to find the influencing factors of them. The survey was done during the period from April 1990 to June 1990 and the target population were Ewha Woman's University students (freshmen and senior) of whom 1,354 peoples were surveyed. The summarized results are as follows ; 1. For the learning environment, the percentage of completion on nutritional knowledge course was 28.6% and among them the department of foods and nutrition had the highest score(100.0%) and the next was dept. of medicine(53.4%). 2. To find the relation which the nutritional knowledge, nutritional attitude, eating practice and the total nutritional diagnosis influence on one another, the multiple correlation analysis was done. The attitude the practice were highly correlated with total nutritional diagnosis, but the correlation between nutritional knowledge and total nutritional diagnosis was not significant. The correlation between the practice and nutritional knowledge which were positively and significantly correlated with attitude respectively was positive but not significant. 3. The difference which were analyzed by department, grade and completion on knowledge course on the nutritional knowledge, attitude, eating practice were significant (p<0.01) by ANOVA. 4. The significant variables on nutritional diagnosis are the eating practice points, the grade, the knowledge course, the breakfast and the attitude (r2=10.3%) by multiple regression analysis. This study has the limitation that it did not consider the environmental factors of dietary life such as dietary culture, family environment, cultural habit. Therefore important points of these dietary studies are to extend to the practical nutritional education and dietary improvement for the national health not restricted to the local area or local population.
Attitude ; Breakfast ; Diagnosis ; Eating* ; Education ; Female ; Health Services Needs and Demand ; Humans ; Learning

The angiotensin I converting enzyme inhibitor (Captopril) has recently been studied extensively in various experimental models of radiation injury and has proven its protective effects in various organs, such as the lungs, gastrointestinal tract, and kidneys. Twenty-three Sprague-Dawley rats were divided into experimental and control group. The experimental group was divided into two large groups: the first one received a single dose of 18 Gy irradiation from an electron beam on the local field of the kidney region only, and the second group received captopril per oral continuously after the same doses of irradiation. The second experimental group was divided into four subgroups by captopril doses: 62.5 mg/l, 125 mg/l, 250 mg/l, and 500 mg/l, respectively. On light and electron microscopy, the kidneys of the irradiated rats with no captopril treatment showed diffuse glomerular contraction, congestion with occlusion and focal necrosis of the endothelial, and mesangial cells. The tubules showed ballooning degeneration, desquamation, and diffuse coagulation necrosis. Captopril treated rats, especially those given a high dose (more than 250 gm/l), revealed a marked reduction of the tubular and glomerular injuries. There was a statistically significant difference in the degree of renal injury among the experimental groups (p<0.05). The result of this study suggests that an administration of high dose captopril might prevent radiation-induced renal injury, especially in the early post-irradiation period.
Animals ; Captopril* ; Estrogens, Conjugated (USP) ; Gastrointestinal Tract ; Kidney ; Lung ; Mesangial Cells ; Microscopy, Electron ; Models, Theoretical ; Necrosis ; Peptidyl-Dipeptidase A ; Radiation Injuries ; Rats* ; Rats, Sprague-Dawley