We experienced a case of open heart surgery for correction of ventricular septal defect and patent ductus arteriosus in five years old boy with hemophilia A. Factor VIII activity in this patient was 0.7% of normal activity. He received 2,000 unit of factor VIII intravenously for loading dose and has been infused 6 unit/kg/hour for 12 hours before the operation. And his factor VIII activity was 68% in the morning of the operation day. During the operation, he received 6 unit/kg/hour of factor VIII. After intracardiac anomaly was repaired and protamine was injected, we administrated 1000 unit of factor VIII. At that time, his factor VIII was 57%. After operation was done, he received 6 unit/kg/hour of factor VIII during stay in ICU and postoperative 14 days. His factor VIII activity was maintained at 36~104% during stay in hospital. So we report a successful case of perioperative management for the open heart surgery in patient with hemophilia A.
Ductus Arteriosus, Patent ; Factor VIII ; Heart Septal Defects, Ventricular ; Heart* ; Hemophilia A* ; Humans ; Male ; Thoracic Surgery*

We experienced a case of open heart surgery for correction of ventricular septal defect and patent ductus arteriosus in five years old boy with hemophilia A. Factor VIII activity in this patient was 0.7% of normal activity. He received 2,000 unit of factor VIII intravenously for loading dose and has been infused 6 unit/kg/hour for 12 hours before the operation. And his factor VIII activity was 68% in the morning of the operation day. During the operation, he received 6 unit/kg/hour of factor VIII. After intracardiac anomaly was repaired and protamine was injected, we administrated 1000 unit of factor VIII. At that time, his factor VIII was 57%. After operation was done, he received 6 unit/kg/hour of factor VIII during stay in ICU and postoperative 14 days. His factor VIII activity was maintained at 36~104% during stay in hospital. So we report a successful case of perioperative management for the open heart surgery in patient with hemophilia A.
Ductus Arteriosus, Patent ; Factor VIII ; Heart Septal Defects, Ventricular ; Heart* ; Hemophilia A* ; Humans ; Male ; Thoracic Surgery*

BACKGROUND: Cryptococcus neoformans is an increasingly important pathogen in the immunosuppressed hosts. The aim of this study was to determine any change of the clinical features and to evaluate the laboratory diagnosis in cryptococcosis patients. METHODS: The clinical features of cryptococcsis patients who were diagnosed in Severance Hospital during the 1983~1995 were reviewed retrospectively and various diagnostic laboratory tests, especially latex cryptococcal antigen test were evaluated. RESULTS: The number of crytococcosis patients increased over the years. Twenty-six patients had various underlying diseases including two AIDS patients. Of the 43 patients, 41(95%) had CNS infections, while the patients with non-CNS infections were 10(23%). Latex antigen test, culture, India ink preparation, and Gram stain were positive in 100%, 87 %, 60% and 51%, respectively. Positivity of latex antigen test, India ink preparation, and culture persisted in average 69 days, 26 days, and 12 days, respectively in recovered patients. CONCLUSION: The number of cryptococcosis patients is an increasing trend in the Severance Hospital probably due to the increase of immunocompromised patients, and latex antigen test is a highly sensitive and reliable screening test for the laboratory diagnosis.
Clinical Laboratory Techniques ; Cryptococcosis* ; Cryptococcus neoformans ; Diagnostic Tests, Routine* ; Humans ; Immunocompromised Host ; India ; Ink ; Latex ; Mass Screening ; Meningitis ; Retrospective Studies

We introduce a new silicone implanting method to correct facial depression caused by trauma or congenital anomaly. It resulted in good facial aesthetics in patients with facial depression. From August 1997 to January 1999, 5 patient (3 males and 2 females), in ages from 19 to 34 years, underwent silicone implantation for facial depression using our method. Three males were injured by traffic accident and had facial depression with or without bone defect. Two females had congenital forhead depression and requested aesthetic contouring. An impression of the face was taken with alginate backed with quick setting plaster. When set, a further stone plaster model was taken from the alginate-plaster, which was removed after fixation. Wax was then carved into the patient's stone model to fill the depression. Another stone cover was taken to cover this was-stone model. Then wax was melted away and medical implant grade room temperature vulcanized silicone adhesive was squeezed into the empty space. After cured, this precisely-shaped silicone imlant was inserted into the patient. We did not experience major complicaion such as infection, implant extrusion during 4 to 18 months' follow-up periods. All patients were satisfied with the results. The clinical result of this technique would be useful for accurate and excellent aesthetic implantation.
Accidents, Traffic ; Adhesives ; Depression* ; Esthetics ; Female ; Follow-Up Studies ; Humans ; Male ; Silicones*

The laryngeal mask airway (LMA) has been used with increasing frequency for many purposes. It is one of its advantages that there is no need of muscle relaxants to insert the LMA. So it can be used to look into the movement of glottis during spontaneous respiration. We report a case using a fiberoptic bronchoscope via the laryngeal mask under the impression of cricopharyngeal incoordination. The patient was a 17-days-old and 3.36-kg infant. After injecting glycopyrrolate 0.05mg and propofol 10mg intravenously, a size-1 LMA was inserted. Fiberoptic bronchoscope was inserted through the LMA. We could see the movement of vocal cords normal. Also, no structural abnormality was seen in the larynx and trachea. After removal of the LMA, conventional suspension laryngoscopy was performed to examine the epiglottis and hypopharynx. We could successfully assess the movement and/or structure of vocal cord and trachea. Fiberoptic bronchoscopy via the laryngeal mask airway may be a safe and convinient method in infants.
Ataxia ; Bronchoscopes ; Bronchoscopy* ; Epiglottis ; Glottis ; Glycopyrrolate ; Humans ; Hypopharynx ; Infant ; Laryngeal Masks* ; Laryngoscopy ; Larynx ; Propofol ; Respiration ; Trachea ; Vocal Cords

BACKGROUND: There are many factors such as diffusion abnormality, V/Q mismatch, intrapulmonary shunt, alveolar hypoventilation and FIO2 in reducing arterial hypoxemia. Intrapulmonary shunting can be due to blood going from the right to the left side of the heart without respiring with alveolar gas(true shunt mechanism) or blood that respires but achieves a PaO2 less than the ideal (shunt effect mechanism). Understanding the portion of true shunt in patients with hypoxemia is very important indicator to analyze the effects of oxygen therapy. Several equations are used for calculation of physiologic shunt. The aim of this study was to calculate and compare shunts derived from four shunt equations; classic physiologic, estimated, modified clinical and simple equations. METHOD: After cardiovascular stability following open heart surgery, 40 patients were mechanically ventilated with an FIO2=1.0. Arterial and mixed blood gases were measured. We calculated and compared shunts by classic physiologic [S/T=(CcO2 CaO2)/(CcO2 CO2)], estimated [S/T=(CcO2 CaO2)/ (3.5 CcO2 CO2)], modified clinical [S/T= AaDO2 0.0031/(AaDO2 0.0031 CcO2 CaO2)], and simple equations [S/T=AaDO2/20]/ RESULTS: Shunts by classic physiologic, estimated, and modified clinical shunt equation were 26.9 8.5%, 25.1 7.1%, and 26.3 8.2%, respectively and did not differ one another significantly. Shunts by simple shunt equations was 18.8 6.2% and significantly lower than those by other 3 equations(P<0.05). CONCLUSIONS: It is reasonable to conclude that in post-open heart patients with stable cardiovascular function and mechanically ventilated with an FIO2=1.0, classic physiologic, estimated, and modified clinical shunt equations show a reliable reflection of the physiologic shunt. But simple equation (AaDO2/20) might be used as a simple estimate.
Anoxia ; Diffusion ; Gases ; Heart ; Humans ; Hypoventilation ; Oxygen ; Thoracic Surgery

Serum epinephrine and norepinephrine concentrations were measured in 7 patients during fentanyl-oxygen anesthesia, who were undergoing elective open heart surgery(single valvular replacement operations) in Seoul National University Hospital. Sampling times and corresponding total fentanyl doses were as follows; 1) after arterial cannulation 2) 5 minutes after intubation(50 ug/kg of B. Wt) 3) 5 minutes after sternotomy(65 ug/ka) 4) after aortic dissection(75 ug/kg) 5) 15 minutes after initiating bypass 6) 60 minutes after initiating bypass [20 ug/kg of fentanyl was added to the priming solution before initiation of Cardio-pulmonary bypass(CP bypass)]. High Performance Liquid Chromatography(HPLC) was used to analyze hormones. Epinephrine concentrations(pg/ml) corresponding to the sampling times were as follows (mean+/-SE); 1) 213+/-59 2) 199+/-62 3) 246+/-83 4) 173+/-35 5) 270+/-70 6) 269+/-70 Norepinephrine concentrations(pg/ml) were as follows(mean+/-SE); 1) 609+/-107 2) 500+/-73 3) 645+/-152 4) 470+/-82 5) 494+/-65 6) 955+/-311 There were no significant hormonal changes except the 6th norepinephrine value. There were no significant hemodynamic changes except blood pressure decrease at the beginning of CP bypass. It is concluded that high dose fentanyl-oxygen anesthesia was limitedly effective to block the stress of open heart surgery, general anesthesia and CP bypass.
Anesthesia* ; Anesthesia, General ; Blood Pressure ; Catheterization ; Epinephrine ; Fentanyl* ; Heart* ; Hemodynamics ; Humans ; Norepinephrine ; Oxygen* ; Seoul ; Thoracic Surgery*

STUDY DESIGN: This is a mechanical study. OBJECTIVES: We wanted to investigate the mechanical properties of newly developed dual growing rods for obtaining approval for their clinical application. SUMMARY OF LITERATURE REVIEW: The current expandable spinal implant system appears effective for controlling progressive early onset scoliosis, and it allows for spinal growth and improving lung development. MATERIALS AND METHODS: We investigate the yield load and ultimate load during compression, tension and torsion of the growing rods and the conventional rods assembly using UHMWPE blocks, and the diameter of the rods was 6.0 mm and they expanded 5cm long. We also performed a fatigue test with growing rods, and the diameter of which was 6.0 mm and it expanded 2.5cm long. The guideline for the American Society for Testing Materials was followed during the entire mechanical test. With the growing rods and conventional rods, we tested for each mechanical property7 times with the new rods and blocks. RESULTS: The yield load of the growing rods and conventional rods were 845.2+/-18.2 (N) and 812.9+/-29.9 (N), respectively, and the ultimate load of the growing rods and conventional rods were 961.9+/-31.1 (N) and 914.9+/-25.6 (N), respectively, when compression force was applied. The yield load and ultimate load of the growing rods were statistically higher than those of the conventional rods (p<0.05). The ultimate load of the growing rods and conventional rods were 3281.7+/-41.5 (N) and 3678.5+/-447.9 (N), respectively when tension force was applied. The ultimate load was similar for both types of rods (p>0.05). The yield loads of the growing rods and conventional rods were 11.56+/-0.59 (Nm) and 12.46+/-0.71 (Nm), respectively, the ultimate loads of the growing rods and conventional rods were 16.97+/-0.94 (Nm) and 17.42+/-2.66 (Nm) during the torsion, respectively. The yield load and ultimate load of the growing rods were statistically lower than that of the conventional rods (p<0.05). CONCLUSIONS: The newly developed growing rods have a higher yield load and ultimate load under compression, a similar ultimate load under tension and a lower yield load and ultimate load under torsion. The differences of the yield load and ultimate load under torsion were minimal, and so the growing rods and conventional rods have similar mechanical properties.
Fatigue ; Lung ; Polyethylenes ; Scoliosis

Massive intraoperative pulmonary embolism (PE) is a fatal complication. However, the diagnosis of PE is difficult because clinical symptoms and signs are nonspecific, and specialized diagnostic facilities are not readily available in the operating room. We report a case of cardiac arrest due to a massive PE diagnosed by transthoracic and transesophageal Echocardiography during a nephrectomy in patient with renal cancer. This case demonstrates the great value of echocardiography in the diagnosis of an intraoperative massive pulmonary embolism.
Diagnosis ; Echocardiography ; Echocardiography, Transesophageal* ; Heart Arrest ; Humans ; Kidney Neoplasms* ; Nephrectomy* ; Operating Rooms ; Pulmonary Embolism*

BACKGROUND: Nitrous oxide inactivates cobalamin which is important in the folate-dependent synthesis of thymidylate. Also, methotrexate has the anti-cancer activity. The aim of this work was to determine the optimal pressure and exposure time of nitrous oxide that maximize the suppression of cancer growth, and the adequate level of methotrexate that maximize the anti-cancer activity of nitrous oxide. METHODS: Acute lymphoblastic leukemic cells and normal lymphocytes were cultured in hyperbaric chamber at 1, 2 and 3 atm of 74% nitrous oxide in 24, 48 and 72 hours at 0, 0.3, 0.5 and 0.7 micrometer of methotrexate, respectively. The results were expressed in the ratio of cell number in hyperbaric chamber to that in the incubator. RESULTS: Compared to control, the growth rates of cancer cells and lymphocytes were 0.767, 0.990 at 1 atm, 0.592, 0.880 at 2 atm and 0.718, 0.864 at 3 atm of nitrous oxide in 24 hours. The survival fraction of cancer cells and lymphocytes were 0.767, 0.894 in 24 hours, 0.800, 0.630 in 48 hours, and 0.571, 0.597 in 72 hours, at 1 atm of nitrous oxide. The growth rates of cancer cells and lymphocytes were 1.012, 0.745 at 0 micrometer, 0.912, 0.696 at 0.3 micrometer, 0.77, 0.647 at 0.5 micrometer and 1.133, 0.506 at 0.7 micrometer of methotrexate. CONCLUSIONS: The pressure increase of nitrous oxide significantly suppressed the growth of lymphocyte but not cancer cells. However, growth of cancer cells and lymphocytes were significantly reduced at high concentration of methotrexate and larger exposure time.
Cell Count ; Incubators ; Leukemia ; Lymphocytes ; Methotrexate* ; Nitrous Oxide* ; Vitamin B 12