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BACKGROUND: In anemic patients, it has been usually traditional practice to correct the anemic state with preoperative blood transfusion. But now, there is an increasing tendency of refusing blood transfusion due to the transfusional complications, especially AIDS etc. The purpose of this study is to survey the effects of anesthesia in anemic patients with normal cardiopulmonary function compared to non-anemics. METHOD: 40 patients with uterine myoma were divided into two groups, an experimental group of 20 patients with hemoglobin concentration of 8~10 gm% and a control group of 20 patients with hemoglobin concentration higher than 10 gm%, and their blood pressure, pulse rate and arterial oxygen saturation were monitored and compared. RESULTS: There were no significant differences between two groups in blood pressure, pulse rate and arterial oxygen saturation. CONCLUSION: Preoperative blood transfusion, in patients with moderate anemia, does not seem to be a mandatory practice.
Anemia ; Anesthesia ; Blood Pressure ; Blood Transfusion* ; Heart Rate ; Humans ; Leiomyoma* ; Oxygen

PURPOSE: The aim of this study was to develop a baptist electronic Nutritional Screening Program (B-eNSP) that could be easily used to identify patients with nutrition at risk or malnutrition on their admission to hospital using an integrated medical information system and to evaluate validity, reliability and efficiency of B-eNSP. METHODS: From June 1 2009 to June 21 2009, we enrolled 496 patients for prospective research. We analyzed age, sex, weight, height, weight loss in the last 3 months, serum albumin, alteration of dietary intake, gastrointestinal symptom, functional capacity, diagnosis and its relationship to nutritional requirements, physical examination and Subjective Global Assessment (SGA). B-eNSP included body mass index (BMI), weight loss in the last 3 months, serum albumin. Each component was scored. Sensitivity and specificity were calculated to evaluate the validity of the B-eNSP. The receiver operating characteristic (ROC) curve was drawn by using B-eNSP to choose a cut-off value that maximizes sensitivity and specificity and Yoden Index. Comparison with SGA and the reliability of the B-eNSP was done using kappa statistics. RESULTS: The maximum Yoden Index was 0.866 and the cut-off value of the ROC curve was 2. A B-eNSP score higher than 2 was defined as nutrition at risk or malnutrition. Reliability of the B-eNSP was in accordance with SGA by kappa 0.845. CONCLUSION: The B-eNSP can be used efficiently to identify patients with nutrition at risk or malnutrition by simply using an integrated medical information system.
Body Mass Index ; Electronics ; Electrons ; Humans ; Information Systems ; Malnutrition ; Mass Screening ; Nutritional Requirements ; Physical Examination ; Prospective Studies ; Protestantism ; ROC Curve ; Sensitivity and Specificity ; Serum Albumin ; Weight Loss

A retrospective review was performed in 33 knees of 30 patients who had undergone arthroscopic debridement for degenerative osteoarthritis of the knee. The mean age of the patients at operation was 55 years and the mean follow-up after operation was 15 months. We divided the knec:s into 2 groups; meniscectomy group (23 knees) and non-meniscectomy group (10 knees). The preoperative radiographic findings were divided into 3 groups according to the classification systern by Lotke et al. The postoperative results were evaluated using the nine-point scale by Baumgaertner et al. Our study was conducted to: 1) assess the overall efficacy of arthroscopic debridement, 2) compare the results between the. Meniscectomy group and nonmeniscectomy group, and 3) identify the relationship between the preoperative radiographic findings and out- come at the final follow-up time. Overall excellent or good results were ac.hieved in 22 knees (67%) and the preoperative radiographic findings correlated with the outcome at the final follow-up time. But the results in the meniscectomy and non-meniscectomy poups showed no significant differences statistically. We believe that arthroscopic debridement is an effective option of treatments for mild I:o moderate degenerative arthritis of the knee after failure of conservative measures.
Classification ; Debridement* ; Follow-Up Studies ; Humans ; Knee* ; Osteoarthritis* ; Retrospective Studies

BACKGROUND: Previous studies have shown that morphine in intravenous PCA provides effective pain control in the postoperative patient, but many patients received morphine have complained side effects. Many studies have suggested that meperidine is less common than morphine in side effects, especially nausea and vomiting. We studied morphine and meperidine in intravenous PCA to compare analgesic effects and side effects in both drugs. METHODS: 100 ASA class I patients undergoing cesarean section were chosen and randomly divided into two groups. Group I (n=50) received morphine (initial 0.1 mg/kg, maintenance 12.5~62 microgram/kg/hr) and group II (n=50) received meperidine (initial 1 mg/kg, maintenance 0.15~0.75 mg/kg/hr). We compared the analgesia and side effects of group I to those of group II for 2 days. We used Basal-Bolus Infusor R (15 minutes lock-out interval, 0.5 ml/hr, 0.5 ml/one push module, Baxter Healthcare Corporation, USA)) for intravenous PCA. RESULTS: There were no significant differences in effects of analgesia between both groups. Nausea was more in group I. There were no significant differences in patient's comfort between both groups. CONCLUSIONS: We concluded that meperidine is more useful than morphine in PCA intravenously for post-operative analgesia after cesarean section because there were no significant differences in analgesic effects between both groups but nausea was less in group received meperidine.
Analgesia ; Cesarean Section* ; Delivery of Health Care ; Female ; Humans ; Infusion Pumps ; Meperidine* ; Morphine* ; Nausea ; Passive Cutaneous Anaphylaxis* ; Pregnancy ; Vomiting

Cortical dysplasia is a cause of intractable epilepsy and a candidate for surgical resection to control epileptic attacks. The neuronal cytomegaly and balloon cell change are the diagnostic hallmarks of cortical dysplasia. Little research has been performed about the normal-sized dysplastic neuron which has complex arborizing dendrites and lacks in its polarity. The aim of this study was to define the histopathologic characteristics of the neurons in cortical dysplasia. Twelve cases of cortical dysplasia who underwent partial lobectomy for intractable seizures were selected and immunohistochemical staining for NF-M/H, MAP2, tau, and ubiquitin was performed. The perikarya and dendrite of dysplastic neurons were more intensely labeled with antibodies for the high and medium molecular weight neurofilament proteins (NF-M/H) than normal neurons. Immunoreactivity with the MAP2 antibody expressed mainly within the somatodendritic regions was present in the dysplastic or normal neurons without any significant difference in intensity. The complex arborizing dendrites of dysplastic neurons were easily identified due to pronounced immunoreactivity within the somatodendritic regions. Immunoreactivity with the primary antibody against tau and ubiquitin was present in the normal-looking neurons as well as the dysplastic neurons. This study suggests that the dysplastic neurons in cortical dysplasia are accompanied by changes of cytoskeletal neurofilaments, and the immunohistochemical stains for NF-M/H, MAP2, tau, and ubiquigin are useful to detect them.
Antibodies ; Coloring Agents ; Dendrites ; Epilepsy ; Malformations of Cortical Development* ; Molecular Weight ; Neurofilament Proteins ; Neurons ; Seizures ; Ubiquitin

BACKGROUND: The purpose of the current study is to investigate anatomical relationships between the muscle overlying the distal transverse carpal ligament (TCL) and the thenar motor branch of the median nerve. METHODS: Of the 192 wrists that underwent open carpal tunnel release, a muscle belly overlying the TCL was observed on the distal margin of TCL in 25 wrists and ligament exposure could not be achieved without transection of it. We recorded surgical findings of these 25 wrists. The origin of the recurrent motor branch arising from the major median nerve was marked on the axial and coronal section diagrams of the wrist. RESULTS: The presence of muscle overlying the TCL was seen in 25 wrists (21 patients, 13%). The locations of origin were distributed not only on the radial side but anterior or ulnar side of the major median nerve. Abnormal branches originated from the unusual side in 14 cases (56% of those with a muscle overlying the TCL): central-anterior side in eight cases, ulnar-anterior side in five cases, and ulnar side in one case. These anomalous branches were frequently associated with the muscle belly overlying the TCL in our study regardless of the origin site. The branches were prone to cut if careless midline incision along the third web space was performed. Unusual origin and aberrant pathway of the recurrent thenar motor branch were associated with the presence of a muscle overlying the TCL. CONCLUSIONS: A thorough knowledge of the standard and variant anatomy of the muscle belly and recurrent motor branch in the carpal tunnel is fundamental to prevention of complications such as muscle wasting or atrophy by iatrogenic motor branch injury during carpal tunnel release.
Atrophy ; Carpal Tunnel Syndrome ; Humans ; Ligaments* ; Median Nerve* ; Muscles* ; Wrist

A 81-year-old man was referred for respiratory failure by emergency medical technicians. He admitted at intensive care unit for ventilator treatment. Several hours before admission, he took sildenafil 100 mg for erectile dysfunction without prescription. The episodes of hemoptysis occurred several hours later. Computed tomography revealed multifocal diffuse ground-glass attenuation in both lungs. And the more we performed bronchoalveolar lavage, the more the color of it was turned into red. We treated him with empirical antibiotics and tranexamic acid, and hemoptysis was stopped in one day after admission. But in the 5th admission day, he died from sepsis combined with pneumonia caused by Acinetobacter baumannii abruptly.
Acinetobacter baumannii ; Aged, 80 and over ; Anti-Bacterial Agents ; Bronchoalveolar Lavage* ; Emergency Medical Technicians ; Erectile Dysfunction* ; Hemoptysis* ; Hemorrhage* ; Humans ; Intensive Care Units ; Lung ; Male ; Pneumonia ; Prescriptions ; Respiratory Insufficiency ; Sepsis ; Tranexamic Acid ; Ventilators, Mechanical ; Sildenafil Citrate

Rheumatoid arthritis is a systemic inflammatory disorder inducing multiple joint destruction. The wrist joint is frequently involved in early stage and proper management can preserve the ability to maintain a daily living and to work. Advances in medical treatment modalities can halt most joint destruction, however, not in all instances of joint inflammation and deformities. Most patients want to improve their own functional disability, pain, aesthetic problems in addition to medication. We review the current concept of rheumatoid wrist surgery and discuss the surgical treatment strategies for optimizing outcomes for patients with rheumatoid wrist.
Arthritis, Rheumatoid* ; Congenital Abnormalities ; Humans ; Inflammation ; Joints ; Wrist Joint ; Wrist*

Adequate postoperative pain control is in highlight because it has been known that uncontrolled pain has adverse effects on postoperative cardiopulmonary, immunologic functions and in turn, possibly prolongs patient's recovery. One hundred and two patients who underwent spine surgery including laminectomy, fusion and fixation were given 10mg of morphine into operative field (exposed epidural area) just prior to wound closure for relief of postoperative pain. These patients were compaired with 51 patients who did not received epidural morphine. The median of the numerical rating scale of epidural morphine spray group (Group A) at 4, 12, 24 hours after operation revealed 2, 3, 5 respectively and no epidural morhine group (Grade B) revealed 4, 5 and 5. In conclusion, postoperative pain relief of group A is superior to that of group B.
Humans ; Laminectomy ; Morphine* ; Pain, Postoperative ; Spine* ; Wounds and Injuries