The temperature-corrected values of blood gas analysis were compared to uncorrected values in 40 cases of open heart surgery under moderate hypothermic cardiopulmonary bypass. The results were as follows. 1. The corrected value of pH was significantly higher than uncorrected value, and it's relationship was ΔpH=-0.015 ΔTemp+0.005 (r=0.81, P<0.01). 2. The corrected value of PCO₂ was lower than uncorrected value, and it's relationship was ΔPCO₂=1.11 ΔTemp+1.81 (r=0.50, P<0.01). 3. The corrected value of PO₂ was lower than uncorrected value, and it's relationship was ΔPO₂=5.21 ΔTemp-1.45 (r=0.32, P<0.01). But there was no clinical significance. 4. The corrected values of HCO₃-, base excess, CO₂ content and oxygen saturation were similar with uncorrected values. In summary, the values of pH and PCO₂ were significantly changed by temperature-correction. Because of the neutral point of water (pH=pOH) rise as temperature falls and it change in parallel with the changes in blood pH, a corrected pH of 7.4, PaCO₂ of 40 mmHg during deep hypothermia would reflect a profound respiratory acidosis. Therefore, the use of the uncorrected value at 37℃ is more preferable and valid means of assessing acid-base management regardless of actual patient temperature.
Accidental Falls ; Acidosis, Respiratory ; Blood Gas Analysis* ; Cardiopulmonary Bypass* ; Humans ; Hydrogen-Ion Concentration ; Hypothermia ; Oxygen ; Thoracic Surgery ; Water

Plain 0.5% bupivacaine and hyperbaric 0.5% tetracaine were compared for spinal anesthesia in 40 patients undergoing operation of lower extremities. Lumbar puncture was performed with a 22 gauge spinal needle with the patient in the lateral recumbent position. The third lumbar interspace was chosen for the puncture, when a free flow of clear CSF was obtained, the local anesthetic solution (2.5 ml of 0.5% bupivacaine or 2.0 ml of hyperbaric 0.5% tetracaine) was injected at a rate of 0.1ml/sec without barbotage. After injection of anesthetics, clinical features were observed and compared between the two groups. The results were as follows: 1. The two groups were well matched for age, sex, height and weight. 2. In both groups, sensory block to T₁₂ dermatome was obtained within 4 minutes, mean maximal level of analgesia was T₆₋₇, and the mean time for maximal level was around 20 minutes. 3. The onset times of motor block were similar in both groups and complete motor block was obtained in all cases within 20 minutes. 4. The duration of analgesia above the T₁₂ dermatome was 3 hours, postoperative analgesia was 7 hours. These value were significantly prolonged than those of the tetracaine group (p<0.05). 5. The changes in systolic pressure in the bupivacaine group were significantly less than those of the tetracaine group (p<0.05). 6. The complications after spinal anesthesia were headache, numbness, urinary retention and backpain, and were no significant difference in both groups. From the obtained results, we concluded that plain 0.5% bupivacaine was a relatively satisfactory agent for spinal anesthesia for operation of lower extremities. The time of onset, height of block and the complications of postoperative period were similar in both groups. The advantages of plain 0.5% bupivacaine were less hypotension and long duration of analgesia.
Analgesia ; Anesthesia, Spinal* ; Anesthetics ; Blood Pressure ; Bupivacaine* ; Headache ; Humans ; Hypesthesia ; Hypotension ; Lower Extremity* ; Needles ; Postoperative Period ; Punctures ; Spinal Puncture ; Tetracaine* ; Urinary Retention

BACKGROUND: This study was performed to evaluate the therapeutic effects of sympathetic block in management of reflex sympathetic dystrophy (RSD); renamed complex regional pain syndrome (CRPS) Type I, according to the duration of RSD, and to evaluate predictable factors responding to sympathetic block in patients suffering from RSD. METHODS: Prospectively designed this study was divided thirty patients with upper extremity RSD into three groups according to the duration of RSD; Group I (< or = 3 months), Group II (4 to 6 months) and Group III (>or = 7 months). All patients were received repeated stellate ganglion blocks (SGB) with 12 ml of 0.2% bupivacaine by paratracheal approach. We compared the therapeutic effects of SGB between the groups and the clinical signs on initial examination to receive the first SGB at pain clinic. RESULTS: Response rates to SGB were 84.6% in Group I, 62.5% in Group II and 44.4% in Group III. The early treatment less than 6 months was better prognosis (p<0.05). Presence of edema (p<0.001), temperature differences between both hands (hot>cold>no difference, p<0.001), and allodynia (p<0.05) were favorable prognostic factors responding to sympathetic block. Especially, warm skin and edema in RSD were near-perfect predictors of sympathetic blocks. CONCLUSIONS: We conclude that SGB is effective in management of upper extremity RSD, and the duration and the clinical signs of RSD are important to the prognosis and responsibility to sympathetic block. If patients suffering from RSD visit pain clinic before 6 months, and they have edematous warm hands with allodynia, majority of them will be improved from their pain after sympathetic block.
Bupivacaine ; Edema ; Hand ; Humans ; Hyperalgesia ; Pain Clinics ; Prognosis ; Prospective Studies ; Reflex Sympathetic Dystrophy* ; Reflex* ; Skin ; Stellate Ganglion* ; Upper Extremity*

This study was carried out to observe the ultrastructure of tongue mast cells in frog, Bombina orientalis. In the light microscopy, mast cells were round, oval, spindle-like and irregular shape and occasionally had one or more tail-like long cytoplasmic processes. Mast cells had many red granules stained with toluidine blue in the cytoplasm. In the electron microscopy, mast cells had membrane-bounded granules and poorly developed organelles. The granules were composed of two parts, low and dense electron density. In high magnification the dense part in the middle region of granule had honey comb-like crystalline structure.
Anura* ; Crystallins ; Cytoplasm ; Honey ; Mast Cells* ; Microscopy ; Microscopy, Electron ; Organelles ; Tolonium Chloride ; Tongue*

BACKGROUND: In previous our retrospective study, we concluded that administered fluid volume, duration of operation, operative procedures and anesthetic techniques were the major factors of postoperative urinary retention. However, the administered fluid volume, age, types and duration of the operation confined to hemorrhoidectomy was questioned as a precipitating factor. The high retention rate in spinal anesthesia is also questioned. METHODS: We investigated these possible precipitating factors of urinary retention in healthy patients (n=154) undergoing hemorrhoidectomy. The patients were randomly divided into three different anesthetic techniques: caudal (2% lidocaine 300 mg with 1 : 200,000 epinephrine), spinal (0.5% tetracaine 5 mg with epinephrine 0.1 mg or 5% lidocaine 40 mg) and general (enflurane, N2O, vecuronium). Urinary retentin was searched according to above factors following surgery. RESULTS: The overall urinary retention rate was 46.1%. The retention rate in patients with spinal anesthesia was higher than that in those with other anesthetic techniques (p<0.05). There was no significant difference between patients with lidocaine and tetracaine spinal anesthesia in urinary retention rate. The administered fluid volume in patients with urinary retention was significantly higher than that of patients without retention (p<0.05). Age, duration and types of hemorrhoidectomy did not significantly affect urinary retention rate. CONCLUSIONS: Restriction of fluid administration and avoidance of spinal anesthesia are necessary in reducing postoperative urinary retention following hemorrhoidectomy.
Anesthesia, Spinal ; Epinephrine ; Hemorrhoidectomy* ; Humans ; Lidocaine ; Precipitating Factors ; Retrospective Studies ; Surgical Procedures, Operative ; Tetracaine ; Urinary Retention*

To estimate the cancer mortality rates among Koreans, a mortality survey was carried out in the province of Kyongsangnam-do. The study population are the beneficiaries of Korea Medical Insurance Corporation (KMIC), Kydngsangnam-do area, among which the 3,867 deaths occurred from January, 1989 to December, 1990, were reviewed to confirm the cancer deaths. These were based upon the death certificates and medical utilization records before dying which were available through the computerized databases on medical care utility of KMIC. The survey was conducted along three steps. At first, the death certificates were examined, as a second step medical utilization records were reviewed, and finally direct contacts to the family members of the deceased were done. As a result, 990 deaths were found due to cancer. Using them, age and sex specific cancer(all sites and several sites) mortality rates were estimated. Overall cancer mortality rate in the area was estimated 138.7 per 100,000 person-years in males, and 65.7 in females, respectively. And the orders of site-specific cancer mortality rates were the cancers of stomach, liver, lung, esophagus, and cancers of the hematopoietic system among males, In females, followed by gastric cancer, cancers of lung and liver are the 2nd and 3rd in rank, respectively and cancers of breast and uterine cervix are the 4th and the 5th in rank.
Breast ; Cervix Uteri ; Death Certificates ; Esophagus ; Female ; Gyeongsangnam-do* ; Hematopoietic System ; Humans ; Insurance ; Korea ; Liver ; Lung ; Male ; Mortality* ; Stomach ; Stomach Neoplasms

The technique of radial artery cannulation and its complications are well documented, but serious complications are rare. This is a report of one case of amputation of wrist due to finger necrosis developed from the radial artery cannulation in patient who had craniectomy surgery. This 52-year-old 79 kg male underwent subdural hematoma removal surgery. Right radial artery cannulation was carried out percutaneously using 22 gauge Teflon extracath needle after modified Allen's test appeared to be positive. It was intermittently flushed by heparinized solution. His arterial blood pressure was maintained 100/70-110/80 mmHg and 5 units of banked whole blood and 1 unit of fresh frozen plasma were transfused during 8-hours operation. Cannula was removed on the 9th hour after operation because that was obstructed. On the 12th hour after removal of cannula, his right hand noted to be cool and cyanotic. So, warm towel and hot bag applied continuously on the right hand and the right stellate ganglion block was carried out every day for 4 times. However, on the 10th day after removal of cannula, necrotic change of all fingers of the right hand became worse and skin of fingers were shrunken. Therefore, disarticulation of the right wrist carried out on the 71th day of his hospitalization.
Amputation* ; Arterial Pressure ; Catheterization* ; Catheters ; Disarticulation ; Extremities* ; Fingers ; Hand ; Hematoma, Subdural ; Heparin ; Hospitalization ; Humans ; Male ; Middle Aged ; Necrosis ; Needles ; Plasma ; Polytetrafluoroethylene ; Radial Artery* ; Skin ; Stellate Ganglion ; Wrist

There are ethnic differences in the timing of sexual maturation. However, averages of sexual maturity rating (SMR) for Korean adolescents were not available until recently. The purpose of this study was to determine averages for the SMR of adolescent girls and boys in Korea. The study population included 3,249 boys and 3,337 girls. The sample comprised 2,406 from the Seoul area, 2,441 from a medium-sized city and 1,739 from rural areas. Data were obtained through questionnaires and physical examinations for SMR given by pediatricians from 1991 to 1992. Sexual maturity was graded using the Tanner scales. This was a cross-sectional study. In boys, the first growth of the testes (SMR 2) was observed at a mean age 12.7 years (from 10.4 to 15.1 years of age for 95% of them). SMR 3 and SMR 4 of genitalia were 14.2+/-1.4, 15.4+/-1.3 years of age, respectively. Adult genitalia (SMR 5) was observed from 14 to 18.2 with a mean age of 16.1 years. SMR 2 of pubic hair was at a mean age of 13.2 years, and SMR 3,4, and 5 were 14.4+/-1.4, 15.6+/-1.2, 16.0+/-1.0 years of age, respectively. In girls, the mean age for breast budding (SMR 2) was 11.0 years with a range of 8.9 years to 13.1 years for 95% of them. SMR 3,4, and 5 for breast were 12.6+/-1.4, 14.2+/-1.5, 15.7+/-1.1 years of age, respectively. SMR 2,3,4, and 5 for pubic hair were 12.9+/-1.8, 14.5+/-1.5, 15.1+/-1.3, 16.0+/-1.0 years of age, respectively. Tanner stages for breast and pubic hair in girls, and genitalia and pubic in boys did not agree well within one ordinal rank. Average length of time from SMR 2 to 5 was 3.3 years for boys and 5.0 years for girls. Mean age of menarche was 12.8 years (from 10.8 to 14.8 years of age for 95% of them). Mean of menarcheal age was significantly different, geographically (12.6 years Seoul, 12.9 medium-sized city, and 12.9 rural area) (P<.0001). Menarche occurred 1.7% on breast SMR 2, 41.5% on SMR 3, 85.9% on SMR 4, 99.3% on SMR 5. In conclusion, this findings might be interpreted as providing averages of SMR for Korean girls and boys in adolescence.
Adolescent* ; Adult ; Breast ; Cross-Sectional Studies ; Female* ; Genitalia ; Hair ; Humans ; Korea* ; Menarche ; Physical Examination ; Surveys and Questionnaires ; Seoul ; Sexual Maturation ; Testis ; Weights and Measures

Before beginning the extracorporeal circulation, perfusionists should supply oxygen into the oxygenator and establish blood flow through the blood line of the heart-lung machine. But these manipulation can induce severe hypocarbic state of priming solutions due to wash out of CO2 gas in the solution. This study was carried out to examine the relationship of blood gas changes between hypocarbic priming solutions and body circulation in 15 patients undergoing open heart surgery with extracorporeal circulation. PaCO₂, pH, buffer base and PaO2 were measured from priming solutions before and 15 minutes after the extracorporeal circulation. The results were as follows; 1) Before the extracorporeal circulation, mean PaCO₂ level was 12.1±7.8 mmHg in the priming solution. However, 15 minutes after extracorporeal circulation, the PaCO₂ level was maintained at 35.7±5.7 mmHg. 2) pH in the priming solution was variable from 6.93 to 7.99 (mean 7.45±0.29), but after 15 minutes it was ranged from 7.28 to 7.42 (mean 7.35±0.05). 3) Mean buffer base level in the priming solution was 7.9±3.5 mmol/l. but after 15 minutes, it was 19.6±1.2 mmol/l. 4) Mean PaO₂ level in the priming solution was 667.1±45.6 mmHg, but after 15 minutes, it was 280.7±131.7 mmHg.
Extracorporeal Circulation* ; Heart* ; Heart-Lung Machine ; Humans ; Hydrogen-Ion Concentration ; Oxygen ; Oxygenators ; Thoracic Surgery*

This study included 38 children patients of less than 4 years old and 18 kg body weight. After 8 hours of starvation, the children were divided into 2 groups: Group I received Hartmann's solution and Group II received Hartmann's dextrose solution. In both groups, the rates of infusion were 10 ml/kg/hr before and during operation and blood samples were collected just before and 1 hr after induction of anesthesia, respectively. The results were as follows; 1) In the Group I, blood glucose concentration just before induction was decreased than control values that was checked at ward, and 1 hr value after induction was significantly increased then control values. 2) In the Group II, blood glucose concentration was increased just before and 1hr after induction than control values significantly respectively. 3) In the blood glucose concentration 1 hr after induction, difference between Group I and Group II was not significant. 4) In children, duration of starvation about 8 hrs did not significant influence on blood glucose concentration although dextrose was not administered.
Anesthesia* ; Blood Glucose* ; Body Weight ; Child* ; Fluid Therapy* ; Glucose ; Humans ; Starvation*