BACKGROUND: For a rapid transfusion, pressure is sometimes applied to packed red blood cells during the operation. However, there are neither standard guidelines nor reported data regarding adequate change interval of transfusion kits. The aim of this study is to present relevant data by simulating a surgical situation. METHODS: Each unit of packed red blood cells was mixed with 50 mL of normal saline. Pressure (250 mmHg) was applied to the mixed red blood cells. Each filtration time was measured without change of the transfusion kit. The weight of the mixed red blood cells was measured before and after administration. The passed blood was examined microscopically for detection of possible microaggregation. Eight transfusion sets were tested with 70 packed red blood cells. RESULTS: International guidelines have recommended replacement of the transfusion set if flow rate decreased to less than 100 mL/min. The flow rate of five transfusion sets was recorded as less than 100 mL/min. The flow rate of the third packed red blood cells decreased to less than 100 mL/min. No microaggregate was detected. CONCLUSION: Therefore, we recommended replacement of the blood filter after filtering two units of packed red blood cells with pressure under operation room circumstances.
Erythrocyte Transfusion ; Erythrocytes ; Filtration

BACKGROUND: Procedures in medical papers should be described in sufficient detail to allow other researchers to reproduce the results. The apparatus including anesthesia machine should be given, too. Anesthesia machine has dramatically improved as bioengineering has developed. There are several ventilator settings in modern anesthesia machines. However, it seems that only a few ventilator settings are described even though modern ventilators are used in research. The purpose of this study is to investigate that how many ventilator parameters were described in the papers of the Korean Journal of Anesthesiology from 2001 to 2006. METHODS: All of papers with human general anesthesia were reviewed except case reports, and papers regarding only induction or intubation procedures. Recruited articles were grouped into papers with strongly related to respiratory parameters (STP), and into ones with slightly related to them based on the research topics. The description of following categories was counted in each paper; the type of anesthesia machine, tidal volume, respiratory rate, inspiratory:expiratory ratio, mode of ventilation, pressure set in pressure targeted ventilation, positive end expiratory pressure, inspiratory pause, and inspiratory rising rate. RESULTS: The description rate of each parameters in STP were 36% in the type of anesthesia machine, 66% in tidal volume, 54% in respiratory rate, and 24% in inspiratory:expiratory ratio. The other settings were seldomly mentioned. CONCLUSIONS: Description on the ventilator parameters was sometimes missed. We should describe adequate ventilator settings to reproduce the results because the modern anesthesia machine has additional ventilator options.
Anesthesia* ; Anesthesia, General ; Anesthesiology ; Bioengineering ; Humans ; Intubation ; Positive-Pressure Respiration ; Respiration, Artificial ; Respiratory Rate ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical*

BACKGROUND: Empirical use of fresh frozen plasma (FFP) in perioperative blood transfusion leads to high wastage of FFP. However, coordination of many related clinical departments is difficult. Therefore, quality improvement (QI) activities for establishment of appropriate use of FFP are needed. METHODS: Departments of surgery (all surgery departments except ophthalmology) and the departments of anesthesiology, clinical pathology, and nurses met each month from March, 2011 to October, 2011. Each department investigated the number of FFP usages, wastage, and coagulation tests. Primary measured variables and objectives were decrease of 50% of FFP wastage rate compared with the previous year and 50% increase of coagulation testing before using FFP. Secondary measured variables were total amount of FFP usage and report time for coagulation tests. RESULTS: After the QI activities (March, 2011~October, 2011), FFP wastage decreased, from 71.5 units during the second half of 2010 to 37.8 units during the second half of 2011 (-47.1%). Rate of coagulation testing before using FFP more than doubled during the second half of 2011 (57%) compared with the second half of 2010 (25%). The rate of less than 30 minutes report time for coagulation testing increased from 60% to 75%. FFP transfusion per 1,000 surgical cases decreased to from 190 units to 118 units. CONCLUSION: Rate of FFP wastage and transfusion decreased and rate of performance of the blood coagulation test was enhanced through education and training on transfusion and QI activities.
Anesthesiology ; Blood Coagulation Tests ; Blood Transfusion ; Pathology, Clinical ; Plasma ; Qi ; Quality Improvement

BACKGROUND: The gene for chromodomain helicase/ATPase DNA binding protein 1-like (CHD1L) was recently identified as a target oncogene within the 1q21 amplicon, which occurs in 46% to 86% of primary hepatocellular carcinoma (HCC) cases. However, the prognostic significance of CHD1L in HCC remains uncertain. In this study, we investigated the roles of CHD1L in the prognosis of HCC. METHODS: We investigated the expressions of CHD1L in tumor tissue microarrays of 281 primary HCC patients who underwent surgical resection using immunohistochemistry. Prognostic factors of HCC were examined by univariate and multivariate analyses. The median follow-up period was 75.6 months. RESULTS: CHD1L expression was observed in 48 of the 281 HCCs (17.1%). CHD1L expression was associated with a younger age (p=0.033), higher Edmondson grade (p=0.019), microvascular invasion (p<0.001), major portal vein invasion (p=0.037), higher American Joint Committee on Cancer T stage (p=0.001), lower albumin level (p=0.047), and higher alpha-fetoprotein level (p=0.002). Multivariate analyses revealed that CHD1L expression (p=0.027), Edmondson grade III (p=0.034), and higher Barcelona Clinic Liver Cancer stage (p<0.001) were independent predictors of shorter disease-free survival. CONCLUSIONS: CHD1L expression might be a prognostic marker of shorter disease-free survival in HCC patients after surgical resection.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Disease-Free Survival ; DNA-Binding Proteins ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Joints ; Liver Neoplasms ; Multivariate Analysis ; Oncogenes ; Portal Vein ; Prognosis

BACKGOUND: All medical research requires approval of the institutional review board ( IRB ) and informed consent from the research participants in advance. But there are reports of low rates of IRB approval in major anesthesia journals. The purpose of the study is to investigate IRB approval and informed consent rates of Korean anesthetic field researches and provide suggestion. METHODS: We reviewed 11 years data from Korean journal of anesthesiology and obtained the number and percentage of IRB approved papers, informed consents and verbal consents. RESULTS: The total number and percentage of IRB approved papers has increased to 60% and so as cases with informed consents over the past 11 years. But the ratio is still under 25%. The ratio of informed consent against verbal consent is also increasing. CONCLUSIONS: The number of IRB approved and informed consented papers have increased. But the proportion is still not satisfying or low. Changes in understandings of the clinical researchers with education of research ethics and systemic establishment are needed.
Anesthesia ; Anesthesiology ; Education ; Ethics Committees, Research* ; Ethics, Research ; Informed Consent*

BACKGROUND/AIMS: The prognosis after surgical resection of hepatocellular carcinoma (HCC) remains poor because of a high rate of recurrence. Thus, it is crucial to identify patients with a high risk of recurrence after curative hepatectomy and to develop more effective and targeted treatment strategies to improve disease outcomes. In this study, we investigated the roles of metadherin (MTDH) in the prognosis of HCC. METHODS: We investigated MTDH expression using immunohistochemistry in tumor tissue microarrays of 288 primary HCC patients who underwent curative surgical resection. RESULTS: High MTDH expression was observed in 138 of the 288 HCC cases (47.9%). High MTDH expression was associated with a younger age (p<0.001), higher Edmondson grade (p<0.001), microvascular invasion (p<0.001), higher American Joint Committee on Cancer T stage (p=0.001), and higher alpha-fetoprotein level (p=0.003). Multivariate analyses revealed that high MTDH expression (p=0.014), higher Barcelona-Clinic Liver Cancer (BCLC) stage (p<0.001), and Edmondson grade III (p=0.042) were independent predictors of shorter disease-free survival (DFS). Higher BCLC stage (p<0.001) and Edmondson grade III (p=0.047) were also independent predictors of shorter disease-specific survival. CONCLUSIONS: High MTDH expression may be a prognostic predictor of shorter DFS in HCC patients after curative hepatectomy.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Disease-Free Survival ; Hepatectomy ; Humans ; Immunohistochemistry ; Joints ; Liver Neoplasms ; Multivariate Analysis ; Prognosis ; Recurrence

BACKGROUND: Surgical patients should be provided adequate information on operation. The information on mortality is extremely important among them. The purposes of this study are to investigate the recent mortality associated with anesthesia and surgery, and to get a logistic regression model of mortality based on patient information. METHODS: We collected all of the anesthetic cases except local anesthesia during 5 years (between 2000 and 2004) in a hospital. All deaths within 7 days after anesthesia were retrieved. These data were analyzed in terms of age, gender, department in charge, time point after anesthesia, elective or emergency surgery, type of anesthesia, operation name, and diagnosis. The combined effects of the variables on the mortality were evaluated with logistic regression. The causes of death were also analyzed. RESULTS: There were 155 deaths among 74,458 patients under anesthesia. Age less than 1 year old or greater than 80 years old, male gender, department of thoracic surgery, emergency operation, cardiovascular surgery, and diseases for transplantation had higher mortality than their counterparts. Regression model was followed with assignment of '1' for the above mentioned categories. Other categories were designated by '0'. Log[p (death)/{1-p (death)}] = -9.15+1.03xage+0.66xsex+0.79xdepartment+2.77xemergency+2.52 xdiagnosis+0.89xoperation The leading cause of death was sepsis (21.9%). CONCLUSIONS: The average of mortality within 7 days after anesthesia was 21 per 10,000 anesthetic cases (0.21%). Estimated mortality based on logistic regression ranged from 0.01% to 10.25% depending on patient information.
Aged, 80 and over ; Anesthesia* ; Anesthesia, Local ; Cause of Death ; Diagnosis ; Emergencies ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Mortality* ; Sepsis ; Thoracic Surgery

BACKGROUND: BCL9 enhances beta-catenin-mediated transcriptional activity regardless of the mutational status of the Wnt signaling components and increases the cell proliferation, migration, invasion, and metastatic potential of tumor cells. The goal of this study was to elucidate the prognostic significance of BCL9 protein expression in hepatocellular carcinoma (HCC) patients. METHODS: We evaluated BCL9 protein expression by immunohistochemistry in tumor tissue from 288 primary HCC patients who underwent curative hepatectomy. The impact of BCL9 expression on the survival of the patients was analyzed. The median follow-up period was 97.1 months. RESULTS: Nuclear BCL9 protein expression was observed in 74 (25.7%) of the 288 HCCs. BCL9 expression was significantly associated with younger age (p=0.038), higher Edmondson grade (p=0.001), microvascular invasion (p=0.013), and intrahepatic metastasis (p=0.017). Based on univariate analyses, BCL9 expression showed an unfavorable influence on both disease-free survival (DFS, p=0.012) and disease-specific survival (DSS, p=0.032). Multivariate analyses revealed that higher Barcelona Clinic Liver Cancer stage was an independent predictor of both shorter DFS (p<0.001) and shorter DSS (p<0.001). BCL9 expression tended to be an independent predictor of shorter DFS (p=0.078). CONCLUSIONS: BCL9 protein expression might be a marker of shorter DFS in HCC patients after curative hepatectomy.
Carcinoma, Hepatocellular ; Cell Proliferation ; Disease-Free Survival ; Follow-Up Studies ; Hepatectomy ; Humans ; Immunohistochemistry ; Liver Neoplasms ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence

This study was performed to investigate the status of food restriction and the list of restricted foods in children with moderate to severe atopic dermatitis (AD), and to find out the effect of food restriction on the changes in nutrient intake and the severity of the disease. Sixty two patient children aged 12 months to 13 years presenting AD with a SCORing of Atopic Dermatitis (SCORAD) index between 20 and 50 were enrolled. The presence of food limitation, and list of restricted foods were surveyed through the caretakers and the patients were divided into 3 groups by the number of restricted food: non-restricted group, one to three restricted group, and more than three restricted group. Dietary intake was assessed for 3 months using a food frequency questionnaire (FFQ). Half of the subjects restricted foods. The restriction was higher in the order of soda, food additives, walnut, peanut, and other nuts as a single food item; and shellfish and crustacean group, processed foods, nuts, milk & dairy products, and meats as a food group. More than three restricted group ingested more fruits and less fish and meats, resulting in high consumption of vitamin C (p = 0.027). No significant difference in the ratio of nutrient intake by the number of restricted foods was observed in other nutrients. Significant improvement of AD symptom was observed in non-restricted group (p = 0.036) and one to three restricted group (p = 0.003). It is necessary to provide proper nutrition information and systematic and continuous nutrition management for balanced nutrient intake and disease improvement in children with AD.
Ascorbic Acid ; Child* ; Dairy Products ; Dermatitis, Atopic* ; Food Additives ; Fruit ; Humans ; Juglans ; Meat ; Milk ; Nuts ; Shellfish ; Surveys and Questionnaires

BACKGROUND: The chemical reaction of carbon dioxide absorbent and sevoflurane is known to produce compound A. However, carbon dioxide absorbents are not controlled by the Food and Drug Administration, but are treated as industrial products in some nations. Moreover, carbon dioxide absorbents differ in their capacities to produce compound A, because their chemical compositions differ. In this study, we compared the renal safety between carbon dioxide absorbent products in patients under sevoflurane anesthesia. METHODS: Eighty patients with no preexisting renal disease undergoing elective gynecologic surgery were randomly assigned to receive sevoflurane or isoflurane anesthesia with one of four carbon dioxide absorbent products (Sodasorblime(R), Sodalyme(R), Sodasorb(R), Spherasorb(R)) at the same fresh gas flow of 2 L/min. The renal safety was evaluated by changes of blood urea nitrogen (BUN), creatinine and urine N-acetyl-b-glucoseaminidase (NAG)-creatinine ratio at 24 hours and 72 hours after surgery from preoperative level. RESULTS: There was no significant difference in the renal safety indicators between carbon dioxide absorbents during sevoflurane anesthesia (P > 0.05). However, the BUN and urine NAG-creatinine ratios at 72 hours after surgery were higher in isoflurane anesthesia in some carbon dioxide absorbent groups (P = 0.03 and 0.04, respectively). CONCLUSIONS: We could not find significant differences of renal safety indicators with carbon dioxide absorbents. Although the adverse effect of carbon dioxide absorbents on renal function was not proved, consideration should be given to their contol by the regulation on their efficacy and safety because carbon dioxide absorbents can produce compound A.
Anesthesia ; Anesthetics ; Blood Urea Nitrogen ; Carbon ; Carbon Dioxide ; Creatinine ; Female ; Gynecologic Surgical Procedures ; Humans ; Inhalation ; Isoflurane ; Kidney ; Methyl Ethers ; Pilot Projects ; United States Food and Drug Administration