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

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

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*

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*

OBJECTIVES: To estimate false-negative rate of cervical smears using Autopap 300 QC system in rescreening modality. METHODS: From September 1997 to December 1997, Total 26,983 cervical smears were obtained and 18,592 cervical smears were rescreened by Autopap 300 QC system with 10% review rate. The 274 cases of total 26,983 cervieal smears were confirmed histologically by colposcopic biopsy, cone biopsy and hysterectomy. The 274 cases of cervical smears, which obtained prior to pathologic diagnosis made, were evaluated based on cyto-histologic correlation and then the false negative rate were estimated. The cervical smears were reviewed, researching for the cause of false negative. RESULTS: (1) Histologic diagnosis of 274 cases include 65 cases of Low SIL, 173 cases of High SIL, 29 cases of SCC, 2 cases of adenocarcinoma in situ, and 5 cases of invasive adenocarcinoma. (2) The false negative rate were 3% (9/274). Those were 6.2%(4/65) of LSIL, 2.3% (4/173) Of HSIL, none of SCC and AIS, and 20%(5/1) of invasive adenocarcinoma. (3) The false negative cases were reviewed. The 6 cases were sampling enor and 3 cases were screening error. CONCLUSION: Using AutoPap 300 QC system in rescreening modality, The false negative rate of cervical smears were decreased, compared with our previous study.
Adenocarcinoma ; Biopsy ; Diagnosis ; Hysterectomy ; Mass Screening ; Vaginal Smears