Twenty patients with congenital aortic stenosis excluding valvular stenosis were studied beween April 1980 and April 1984 at Seoul National University Hospital. The clinical and radiologic findings with the emphasis on the cineangiographies were analyzed separately according to the type of aortic stenosis as subaortic and supravalvular aortic stenosis. The summaries of the analysis are as follows: 1. Among the 20 cases, 12 cases were subaorticstenosis and 8 cases were supravalvular stenosis. 2. The anatomic types of subaoritc stenosis were the discrete membranous type (8 cases), the fibromuscular type (2 cases) and the tunnel type (2 cases). 3. The obstruction of subaoritic types was usually severe, and the median left ventricular to aortic systolic pressure gradient was 60mmHg, and associated cardiac defects were found in 10 cases (84%), an incidence greater than that reported in mostother large series. 4. The anatomic types of 8 cases of supravalvular aortic stenosis were mainly focal type (7cases ) and 1 case of diffuse hypoplastic type. 5. The median left ventricular to aortic systolic pressure gradient of supravalvular stenosis was 75mmHg, and associated anomalies were seen in 6 cases(75%) with 3 cases of suspected mental retardation and facial abnormalities without definite hypercalcemia. 6. For accurate diagnosis of congenital aortic stenosis, retrograde left ventricular angiograms obtainend in axial pojections are of crucial importance in demonstration of anatomic types of stenosis and associated anomalies. And supravalvular aortic injection is sometimes helpful to outline the anatomy of the valve and to evaluate the degree of aortic regurgitation.
Aortic Stenosis, Supravalvular ; Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Blood Pressure ; Cineangiography ; Constriction, Pathologic ; Diagnosis ; Humans ; Hypercalcemia ; Incidence ; Intellectual Disability ; Seoul

OBJECTIVE: To evaluate the basophil histamine releasability in response to IgE- and non- IgE-mediated stimuli in children with atopic asthma. Met: Basophil histamine releasability was measured in Dermatophagoides farinae (D. farinae)-sensitive atopic asthmatics, D.farinae-sensitive healthy atopics, non-atopic asthmatics, and healthy non-atopics. Basophils were stimulated with D.farinae, goat antihuman IgE antibody, formyl-Met-Leu-Phe(fMLP), and Calcium ionophore A23187. Histamine was measured by automated fluorometric technique. RESULTS: Sponianeous histamine release was higher in atopic asthmatics compared to healthy non-atopics. Histamine release by D.farinae and by anti-IgE antibody was higher in atopic asthmatics compared to the other groups. There was no difference in histamine release by fMLP among all groups. Histamine release by Calcium ionophore was higher in healthy atopics and non-atopic asthmatics compared to healthy non-atopics. The atopics showed correlation between histamine release by D.farinae, by anti-IgE antibody and total serum IgE levels. CONCLUSIONS: Spontaneous and IgE-mediated histamine release were related to the presence of both atopy and asthma, whereas non-IgE mediated histamine release was different depending on the stimuli.
Asthma* ; Basophils* ; Calcimycin ; Calcium ; Child* ; Dermatophagoides farinae ; Goats ; Histamine Release ; Histamine* ; Humans ; Immunoglobulin E

BACKGROUND: The implementation of intraoperative normovolemic hemodilution is a strategy used in an attempt to diminish the need for or obviate allogeneic transfusion and to avert the potential complications. The goal of this study was to evaluate the safety and efficacy of moderate intraoperative normovolemic hemodilution. METHODS: Fifteen patients scheduled for posterolateral spinal fusion underwent intraoperative normovolemic hemodilution with 10% pentastarch to a target hematocrit level of 25% (hemodilution group). All units of blood procured by hemodilution and additional allogeneic blood was transfused in the perioperative period to maintain the hematocrit level of>25%. We investigated the effect of hemodilution on whole blood coagulation as measured by the thromboelastography and, evaluated its efficacy of decreasing the need for allogeneic blood transfusion as compared to the nonhemodilution group, retrospectively. RESULTS: Hemodilution with pentastarch caused a decrease in response and coagulation time (p<0.01) but did not influence on the alpha angle and maximum amplitude on thromboelstogram. Amount of transfusion of allogeneic blood was 4.1 1.7 units for the hemodilution group and 5.0 1.5 units for the nonhemodilution group. Net red blood cell volume ""saved"" from hemodilution was about 120 ml. CONCLUSION: Moderate intraoperative normovolemic hemodilution with pentastarch does not affect the coagulability of whole blood. But its efficacy of decreasing the need for allogeneic blood transfusion is minimal.
Blood Coagulation ; Blood Transfusion ; Erythrocytes ; Hematocrit ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Perioperative Period ; Retrospective Studies ; Spinal Fusion* ; Thrombelastography

Surgical stress causes changes in the composition of white blood cells (WBCs). Ketorolac is believed to have analgesic effects and to reduce the stress response and may therefore improve postoperative outcomes. The aim of this study was to assess the effect of preoperative ketorolac on the WBC subsets in patients who had laparoscopic surgery for endometriosis. Fifty patients who had laparoscopic surgery for endometriosis were randomly assigned to one of two groups: the ketorolac group (n = 25) received ketorolac 0.5 mg/kg before the induction of anesthesia, and the control group (n = 25) received saline. White cell count, differential, and pathology studies were done immediately after surgery, on postoperative day 1, and on postoperative day 3. We compared the baseline values within and between the two groups. We also assessed postoperative pain and side effects. The time that elapsed before the first patient request for analgesia, total meperidine dose and VAS (Visual Analog Scale) for postoperative pain were significantly lower in the ketorolac group than in the control group. Compared to the pre- surgical values, there was an increase in total WBC count and percentage of neutrophils, but a decrease in percentages of lymphocytes, monocytes, eosinophils, basophils, and leucocytes. Total WBC count, neutrophils, monocytes, eosinophils and leucocytes showed significant differences between the two groups. The incidences of postoperative side effects, such as nausea, dizziness, headache, and shoulder pain were not different between the groups. Preoperative ketorolac reduced postoperative pain and influenced the WBC response in laparoscopic surgery for endometriosis.
Pain, Postoperative/*prevention & control ; Leukocytes/*drug effects ; Leukocyte Count ; *Laparoscopy ; Ketorolac/*therapeutic use ; Humans ; Female ; Endometriosis/diagnosis/*surgery ; Analgesics/*therapeutic use ; Adult

PURPOSE: The purpose of this study was to describe the clinical characteristics of neonatal urinary tract infection (UTI) caused by Klebsiella pneumoniae and non- Klebsiella pneumoniae UTI. METHODS: We compared clinical characteristics of 84 neonatal patients with UTI caused by Klebsiella pneumoniae who were hospitalized at the Department of Pediatricsat Han Dong University, Sunlin Hospital during the period between May, 1994 and August, 1998. The cases were divided into two groups depending upon causative organisms' Klebsiella pneumoniae UTI vs non-Klebsiella pneumoniae UTI, and the clinical characteristics of these groups were compared. RESULTS: Escherichia coli was the most common bacterial pathogen causing neonatal UTI, followed by Klebsiella pneumoniae. There was no significant difference in the sex distribution of Klebsiella pneumoniae UTI, but non-Klebsiella pneumoniae UTI showed male predominence. There were no significant differences in the incidences of hematologic, urologic, radiologic findings and perinatal complications in between these 2 groups. CONCLUSION: Klebsiella pneumoniae is the second most common pathogen causing neonatal UTI. There were no specific differences in the laboratory, symptomatologic, and radiologic findings in these two groups.
Escherichia coli ; Humans ; Incidence ; Klebsiella pneumoniae* ; Klebsiella* ; Male ; Pneumonia ; Sex Distribution ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND: We observed fentanyl known as centrally-acting antitussive agents provoke a cough response in some patients at induction of anesthesia. This may be of clinical importance. METHOD: 121 patients (ASA class I) were assigned randomly to 4 groups. Each group was given different doses of fentanyll Group 1 (n=30); 0.5ug/kg, Group 2 (n=30); 1ug/kg, Group 3 (n=33); 2ug/kg, Group 4 (n=28); 4 g/kgl, within 1 second through a peripheral venous cannula before induction of anesthesia. All patients were observed carefully in order to detect a cough response and any side effects. RESULT: The incidences of FCR (Fentanyl Cough Response) were 0% in Group 1, 10.0% in Group 2, 30.3% in Group 3, and 39.3% in Group 4. The ED50 of FCR was 4.25ug/kg. The mean onset-time from the end of fentanyl administration to the beginning of coughing was 12.5 seconds. FCR was decreased with aging, but not affected by weight, height, or smoking. Other serious side effects were not accompanied. CONCLUSION: Fentanyl can evoke the pulmonary chemoreflex dose-dependently and the ED50 was 4.25 g/kg.
Aging ; Anesthesia ; Antitussive Agents ; Catheters* ; Cough* ; Fentanyl* ; Humans ; Incidence ; Reflex* ; Smoke ; Smoking

PURPOSE: The purpose of the study is to investigate the correlation between burden, health status and well-being in spouse caregivers of patients with stroke. METHOD: The subjects of this study were 160 spouse caregivers registered at general hospital in Seoul and Seongnam. The data were collected from July 2th to October 30th, 2003. The Suh & Oh's burden scale, Yang's health status scale and Park's well-being scale were employed to measure burden, health status and wellbeing respectively. Collected data were analyzed using SPSS 12 version to obtain summary statistics for the descriptive analysis, Pearson Correlation, and Stepwise Multiple Regression. RESULTS: 1. The mean score of the degree of burden, health status and well-being were 3.52, 5.92 and 3.64 points. 2. The burden of the subjects were significantly negative correlated with psycho- logical health status(r=-.482. p<.01) and wellbeing(r=-.455, p<.01). 3. With the result of stepwise multiple regression, psychological health status and wellbeing were the main variables which could explain burden by 27.1%. CONCLUSION: The findings of this study will provide practical guidelines for developing emotional nursing interventions for the spouses taking care of CVA patients who would experience a heavy burden and distress.
Caregivers* ; Gyeonggi-do ; Hospitals, General ; Humans ; Logic ; Nursing ; Seoul ; Spouses* ; Stroke*

PURPOSE: The purpose of the study is to investigate the correlation between burden, health status and well-being in spouse caregivers of patients with stroke. METHOD: The subjects of this study were 160 spouse caregivers registered at general hospital in Seoul and Seongnam. The data were collected from July 2th to October 30th, 2003. The Suh & Oh's burden scale, Yang's health status scale and Park's well-being scale were employed to measure burden, health status and wellbeing respectively. Collected data were analyzed using SPSS 12 version to obtain summary statistics for the descriptive analysis, Pearson Correlation, and Stepwise Multiple Regression. RESULTS: 1. The mean score of the degree of burden, health status and well-being were 3.52, 5.92 and 3.64 points. 2. The burden of the subjects were significantly negative correlated with psycho- logical health status(r=-.482. p<.01) and wellbeing(r=-.455, p<.01). 3. With the result of stepwise multiple regression, psychological health status and wellbeing were the main variables which could explain burden by 27.1%. CONCLUSION: The findings of this study will provide practical guidelines for developing emotional nursing interventions for the spouses taking care of CVA patients who would experience a heavy burden and distress.
Caregivers* ; Gyeonggi-do ; Hospitals, General ; Humans ; Logic ; Nursing ; Seoul ; Spouses* ; Stroke*

BACKGROUND: This prospective study of 40 patients who underwent diagnostic laparoscopy at outpaient surgery center was performed to assess the use of ketamine as a analgesic adjuvant during intravenous anesthesia with propofol compared with the combination of propofol-fentanyl. METHOD: Anesthesia was induced with propofol (2 mg/kg) and either fentanyl (1 microgram/kg) or ketamine (0.2 mg/kg). Anesthesia was maintained with propofol 200 microgramkg-1min-1 during the first 5 min, followed by 180 microgram/kg 1min 1 for 5 min and then 160 microgram/kg-1min-1 after 10 min. The patient's lungs were mask ventilated with 50% N2O-O2. Increments of propofol were given during anesthesia if analgesia was judged to be inadequate. RESULT: Stable arterial pressure and heart rate were seen in the patients of both groups, except for a temporary increase of heart rate after induction of anesthesia in ketamine group. There were no significant differences between ketamine and fentanyl groups in total dose of propofol, response time, recovery time or VAS at 30 min after operation. Patients who received propofol-ketamine demonstrated a longer discharge time than the patients received propofol-fentanyl. There were higher incidences of dizziness and 1 patient showed emergence delirium in patients given propofol-ketamine, other side effects were similar. CONCLUSION: We concluded that low-dose ketamine with propofol can replace propofol-fentanyl for intravenous outpatient anesthesia.
Analgesia ; Anesthesia ; Anesthesia, Intravenous* ; Arterial Pressure ; Delirium ; Dizziness ; Fentanyl* ; Heart Rate ; Humans ; Incidence ; Ketamine* ; Laparoscopy ; Lung ; Masks ; Outpatients ; Propofol* ; Prospective Studies ; Reaction Time

BACKGROUND: This prospective study of 40 patients who underwent diagnostic laparoscopy at outpaient surgery center was performed to assess the use of ketamine as a analgesic adjuvant during intravenous anesthesia with propofol compared with the combination of propofol-fentanyl. METHOD: Anesthesia was induced with propofol (2 mg/kg) and either fentanyl (1 microgram/kg) or ketamine (0.2 mg/kg). Anesthesia was maintained with propofol 200 microgramkg-1min-1 during the first 5 min, followed by 180 microgram/kg 1min 1 for 5 min and then 160 microgram/kg-1min-1 after 10 min. The patient's lungs were mask ventilated with 50% N2O-O2. Increments of propofol were given during anesthesia if analgesia was judged to be inadequate. RESULT: Stable arterial pressure and heart rate were seen in the patients of both groups, except for a temporary increase of heart rate after induction of anesthesia in ketamine group. There were no significant differences between ketamine and fentanyl groups in total dose of propofol, response time, recovery time or VAS at 30 min after operation. Patients who received propofol-ketamine demonstrated a longer discharge time than the patients received propofol-fentanyl. There were higher incidences of dizziness and 1 patient showed emergence delirium in patients given propofol-ketamine, other side effects were similar. CONCLUSION: We concluded that low-dose ketamine with propofol can replace propofol-fentanyl for intravenous outpatient anesthesia.
Analgesia ; Anesthesia ; Anesthesia, Intravenous* ; Arterial Pressure ; Delirium ; Dizziness ; Fentanyl* ; Heart Rate ; Humans ; Incidence ; Ketamine* ; Laparoscopy ; Lung ; Masks ; Outpatients ; Propofol* ; Prospective Studies ; Reaction Time