No abstract available.
Groin* ; Vulvar Neoplasms*

As the mitral valve disease becomes long-standing, the patient may develop pulmonary hypertension. It was reported that after surgical correction, the elevated pulmonary vascular resistance(PVR) would fall quickly in association with the fall in left atrial pressure(LAP). This study was performed to evaluate the changes in mean pulmonary artery pressure(PAP) and PVR immediately after mitral valve replacement(MVR). Fifty six patients undergoing mitral valve replacement(MVR) were divided into two groups on the basis of the presence or absence of significant pulmonary hypertension, defined as a resting mean pulmonary arterial pressure greater than 30mmHg. After induction of anesthesia, PAP, PVR, cardiac output(CO) were measured and compared with values in postbypass period. PAP and PVR were significantly decreased(PAP from 39.64+/-1.88 to 29.18+/-1.65 mmHg, P 0.001, PVR from 6.16+/-1.14 to 3.53+/-0.62 units, P<0.05) in Group II(PAP> or = 30mmHg, n=23), whereas not changed in Group I(PAP30 mmHg, n=33)(P<0.05). Persistance of an elevated PVR may cause right ventricular failure and low-output syndrome, so that an attempt to reduce the PVR is needed postoperatiavely. This study demonstrated that the PAP and PVR fall significantly after MVR especially in patients with severe pulmonary hypertension.
Anesthesia ; Arterial Pressure* ; Humans ; Hypertension, Pulmonary ; Mitral Valve* ; Pulmonary Artery ; Vascular Resistance*

Introduction: Oxygen delivery to tissue is of major clinical interest in patients with cyanotic congenital heart disease (CHD). The use of pulse oximeter to monitor arterial oxygen saturation (SaO2) is considered accurate and reliable in the range of 90% to 100%. However with desaturation, the accuracy remains controversial below 90%. The aim of this study was to evaluate the accuracy of pulse oximetry in severe hypoxemia. METHOD: In 110 children with cyanotic CHD, pulse oximeter (N-200, Nellcor, USA) readings were compared with the direct measurement of SaO2 by blood gas analyser (Profile10, Stat, USA). All measurements were carried out after induction of anesthesia and devided into 4 groups according to saturation measured by pulse oximeter (SpO2). SpO2 in group I was higher than 90% (n=90), in group II between 80% and 89% (n=75), in group III between 70% and 79% (n=41), in group IV lower than 69% (n=18). Statistical analysis of paired SpO2 and SaO2 values was performed using correlation analysis and paired t-test. The other comparisons were perfomed with ANOVA. p<0.05 was considered statistically significant. RESULTS: Correlation coefficient of group I was 0.89 (p<0.01), group II was 0.67 (p<0.01), group III was 0.63 (p<0.01) and group IV was 0.41. The study demonstrate that SpO2 seems to have good correlation with SaO2 when SpO2 is higher than 70%. This results are contrary to other studies which show that SpO2 is not reliable when SpO2 is below 90%. However, the correlation value r seems to decrease with desaturation. CONCLUSION: The use of pulse oximeter in severe hypoxemic children with CHD is efficient in monitoring oxygenation, even though there is decrease in accuracy of the SpO2.
Anesthesia ; Anoxia ; Child* ; Heart Defects, Congenital* ; Humans ; Oximetry* ; Oxygen ; Reading

This paper reports our experiences in laparoscopically assisted surgical staging (LASS) to manage the patients with early-stage endometrial cancer. From March 1996 to March 1999, we performed LASS in 6 patients with clincal stage I adenocarcinoma of the endometrium. We performed laparoscopic-assisted vaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy (BSO) and intraoperative frozen-section (IFS) diagnosis. The depth of myometrial invasion, tumor differentiation, histologic types, cervical invasion, and adnexal involvement were determined by IFS diagnosis. Laparoscopic pelvic and/or para-aortic lymphadenectomies were performed based on the grade of the tumor and depth of myometrial invasion. One patient was discovered to have tumor metastases in pelvic peritoneum and uterosacral ligaments, and underwent only para-aortic lymphadenectomy for determining field of radiation therapy. 2 out of 5 patients only underwent LAVH with BSO and peroitoneal washing cytology. Three other patients underwent LAVH with BSO, peritoneal washing cytology and pelvic lymphadenectomy because they were identified by IFS diagnosis as intermediate risk group for nodal metastasis. The mean age of the patients was 46.4 years. Total length of the operation time ranged from 100 minutes to 305 minutes and the mean was 187.5 minutes. The mean hemoglobin decrement after the surgery was 0.9 gm/dl. No one recieved blood transfusion. The average number of pelvic and para-aortic lymph nodes removed were 16.7 and 18, respectively. After the surgery, the patients passed gas after an average of 2.0 days and urinated urine after an average of 3.8 days. No one had complication after LASS. Based on our experiences, LASS might be an alternative to the traditional surgical approach in patients with early-stage endometrial carcinoma.
Adenocarcinoma ; Blood Transfusion ; Diagnosis ; Endometrial Neoplasms* ; Endometrium ; Female ; Humans ; Hysterectomy, Vaginal ; Ligaments ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Peritoneum

We compared all frozen section examination of ovarian tumors during a 5 year period in our institute with permanent section diagnosis from paraffin sections. In this period, 604 ovarian tumors had frozen section examination. Final histologic diagnosis was divided into benign, low malignant potential and malignant. Sensitivity of frozen section diagnosis for malignant was 80 %, low malignant potential 73,1%, and benign 99.8%. Predictive value for malignancy was 98.5%, for low malignant potential 76.6%, and for benign disease 96.2%. Diagnostic problems occurred in huge tumors and low malignat potential mucinous tumors. Analysis of the 32 false negative(miss or under diagnosis) revealed that a sampling error was involved almostly. The cases of discrepancy between frozen section diagnosis and permanent section diagnosis, were 26/34 in mucinous tumors and 33/34 in huge size of tumors(more than 10cm). Although surgeons and pathologist are aware of the limitations of frozen section diagnosis of ovarian tumors, peroperative histologic examination can be worthwhile and prevent under or over treatment of ovarian malignancies.
Diagnosis* ; Frozen Sections* ; Mucins ; Paraffin ; Selection Bias

The Bain circuit system was first used by bain and spoerel in 1972. It is a type of non-rebreathing system which is a variation of the Mapleson D or E system. Its total length, diameter of the inner tube and the outer tube are 1.8 m, 8 mm and 22 mm respectively. In this study the children and infants who weight 5~20 kg were selected, and during open heart surgery using bypass technique the respiration was controlled mechanically by using the bain circuit system with a fresh gas flow of 200 ml/kg/min. The minimum fresh fas flow was 2 L/min and the maximum fresh gas flow 3.5 L/min. The patients were divided into three groups according to body weight; group 1(5~10 kg of B.W.), group 2(10.1~15 kg of B.W.)and group 3(15.1~20 kg of B.W.). Each group was subdivided into the cyanotic heart disease group and the acyanotic. The results of our study showed that CO2 retention was not seen in either group. We observed that the Bain circuit system was very satisfactory and valuable in all groups during controlled ventilation, and this technique is also suitable for prolonged surgery(4~10 hrs) in infants and children.
Body Weight ; Child ; Heart Diseases ; Humans ; Infant ; Respiration ; Thoracic Surgery ; Ventilation

At present glucose solution is commonly used as the priming solution in cardiopulmonary bypass and an elevated blood glucose level is seen throughout and following bypass. The relationship between elevated blood glucose levels and plasma insulin response during cardiopulmonary bypass has not been clearly established. Plasma immunoreactive insulin and blood glucose levels were studied in 13 adult patients undergoing open heart surgery with cardiopulmonary bypass. The following results were obtained: 1) With body cooling, plasma insulin levels fell despite the oevelopment of hyperglycemis. On rewarming plasma insulin levels rose markedly and blood glucose levels remained high until the procedure was ended. 2) During cardiopulmonary bypass, serum sodium levels did not show any marked fluctuation, but serum potassium levels were low compared to control values.
Adult ; Blood Glucose ; Cardiopulmonary Bypass ; Glucose* ; Heart* ; Humans ; Insulin ; Plasma ; Potassium ; Rewarming ; Sodium ; Thoracic Surgery*

The cellular cardiac effects of protamine, the cationic polypeptide employed to reverse heparin anticoagulation, were examined in vitro to define its mechanisms of action. Isometric contractile force and action potential (AP) characteristics after rest (RS) and at frequencies up to 3 Hz were recorded in guinea pig ventricular papillary muscle. The actions of protamine (10-300 ug/ ml) were compared to those of heparin (10, 30 units/ml), and to heparin (10 units/ml) neutralized with equivalent (100 ug/ml) or excess (200 ug/ml) protamine. The effects of protamine were also examined using muscle rapid cooling contractures (RCCs to assess intracellular Ca(z+) stores). Protamine (100-300 ug/ml) depressed contractions by 35-65% at 3 Hz, whereas contractions were enhanced 150-500% at lower rates (RS-0.5 Hz), with a concommitant rise in resting force. Protamine caused a resting depolarization from -84 to -72 mV and depressed AP amplitude. In contrast, heparin minimally altered contractile or AP characteristics. In 26 mM K(+)-solution with 0.1 uM isoproterenol, 30-300 ug/ml protamine caused dose-dependent depression of late peaking force development and slow AP prolongation. After 15 minutes rest, when RCCs were not normally elicited, rest RCCs became prominent in 100-300 ug/ml protamine. Effects of heparin with 100 ug/ml excess protamine were similar to those of 100 ug/ml protamine alone. In conclusion the loss of normal force-frequency relation, partial depolarization, rise in resting tension, and appearance of rested state RCCs suggest that unbound protamine can lead to excess intracellular Ca(2+), mediated by an alteration in memebrane ionic conductances.
Action Potentials ; Animals ; Contracture ; Depression ; Electrophysiology ; Guinea Pigs ; Heparin ; Isoproterenol ; Papillary Muscles

This study was designed to investigate the effect of preoperative collection of blaod and acute normovolemic hemodilution(ANH) on the requirement of homologous transfusion, perioperative blood loss and hematological parameters in patients undergoing open heart surgery. Ninety two adult patients for elective open heart surgery were randomly assigned to one of three groups. Group I, ANH group, had blood withdrawn to a hematocrit of 33%o after induction of anesthesia(n =54). In Group II preoperative collection of blood in accordance with hospital protocol and ANH were performed(n=16). Ciroup III was control group(n=22). Autologous blood was replaced post bypass. The patients whose hematocrit fell below 25% were transfused with homologous blood. The use of homologous transfusion was 2.2+/-0.4 units in group I, 0.1+/-0.1 units in group II and 4.1+/-0.8 units in group III. Requirement of homologous transfusion in group II was reduced compared with group II and III with statistical significance(P<0.05). There was statistical significance between group I and group III(P<0.05) in homologous transfusion. Postoperative blood loss was 760.7+/-74.6 ml in group I, 675.6+101.5 ml in group II and 819.3+/-91.3 rnl in group III. There was no statistical significance among 3 groups. There was no difference in hematocrit or platelet count, and total blood loss on immediately post surgery or on day 1. Our data show that preoperative collection of blood and ANH can reduce the amount of homologous transfusion.
Adult ; Heart* ; Hematocrit ; Hemodilution* ; Humans ; Platelet Count ; Postoperative Hemorrhage ; Thoracic Surgery*

The purposes of this study were to investigate the current status of contracted hospital food services and to find out the difference in accordance with the number of beds in hospitals. Thirty six hospitals having more than 100beds in Seoul, Inchon and Kyungkido were the subjects of this study. Data was collected through surveys. The survey was conducted during March and April in 2002. The Questionnaires were mailed to the 36 directors of dietetic departments of the hospitals and 36 managers of contracting patient food services. Statistical analysis was completed using SPSS Win(11.0) for descriptive analysis and t-test. The results of the study are summerized as follows; I. Hospital perspective : The range covered by contract food service was 63.3% and 36.7% in hospital food services, and medical nutrition services. The patient and employee food services were in 83.3%, and patient food services were in 6.7%. The methods selecting contractors are general, limited, selected and competitive biddings, and private contracts. The responsibility for supervision of contract food services was the dietetic department (51.7%) in most cases. Hospitals having personnel responsible for contracting affairs were in 75.9% of the cases and 24.1% did not have personnel. The biggest reason for contracting was facilitation of personnel management. The most important criteria on selecting food services contractors was the professionality of the contractor. II. Contractor's perspective : The cost per meal in the year 2001 was composed of 1,905 won for food cost, 1,081 won for labor cost, 222 won for expenses, 114 won for VAT, 14 won for rent and 146 won for miscellaneous or controllable expense, representing 109 won loss per meal. The profit-and-loss contract cost is higher than the fee-contract cost. The ratios of food cost, labor cost and expenses are higher and the ratios of miscellaneous or controllable expense, VAT, rent and profit are lower in hospitals with more than 400 beds compared with those less than 400 beds. However, no significant differences are present between these two groups of hospitals. The actual contract period was 2.2 years upon initial contract and 1.2 years upon renewal. The initial investment cost was 53 million won and the cost of renovation and repair was 8.5 million won. Significant differences were present between two groups of hospitals. The conditions of employment and number of personnel hired by contractors for contract patient food services were significantly different according to the number of beds.
Competitive Bidding ; Employment ; Food Service, Hospital* ; Food Services ; Gyeonggi-do ; Humans ; Incheon ; Investments ; Meals ; Organization and Administration ; Personnel Management ; Postal Service ; Surveys and Questionnaires ; Seoul