A 22 year old male with hemophilia B was scheduled for the correction of a right subtrochanteric femur fracture. Plasma concentration of coagulation factor IX in this patient was 50% of the normal level and the partial thromboplastin time was 57 seconds on the first day of hospital administration. We started the intravenous administration of facnyne injection (factor IX) 11 days before the operation when his plasma concentration was 20%. His plasma concentration was 40% on the operation day. The operation and general anesthesia were accomplished safely without severe hemorrhage or major complication. He received facnyne injection continuously until the 5th postoperative day: 25-43% of his plasma concentrations of factor IX was maintained. He had no problem with postoperative care.
Administration, Intravenous ; Anesthesia, General ; Factor IX ; Femur ; Hemophilia A* ; Hemophilia B* ; Hemorrhage ; Hospital Administration ; Humans ; Male ; Partial Thromboplastin Time ; Plasma ; Postoperative Care ; Young Adult

BACKGROUND AND OBJECTIVES: Evaluation of right ventricular dysfunction in patients with pulmonary hypertension is useful for clinical management and it has prognostic implications. The purpose of this study was to evaluate the impact of pulmonary hypertension on the regional strain of the right ventricle and to assess the correlation between pulmonary arterial (PA) pressure and right ventricular (RV) strain. SUBJECTS AND METHODS: A total of fiftyone patients with chronic obstructive lung disease were classified into two groups on the basis of the presence of normal PA pressure (group I, PA pressure<35 mmHg, n=22) or high PA pressure (group II, PA pressure(35 mmHg, n=29), as estimated by the peak tricuspid regurgitation velocity on Doppler echocardiography. The left ventricular (LV) ejection fraction and RV fractional area change were assessed by conventional echocardiography, and the strain values were obtained from the RV, the LV free wall and the septum. RESULTS: The baseline characteristics were similar in both groups except for the peak PA pressure (group I: 30.2+/-3.9 mmHg, group II: 44.4+/-7.5 mmHg, p<0.00001). Group II had statistically reduced basal RV strain (-%) (20.3+/-7.1) compared to group I (24.1+/-6.7, p=0.033). The basal RV strain correlated with the PA pressure (r2=0.269, p=0.004). CONCLUSION: RV strain could determine regional RV dysfunction in patients with pulmonary hypertension.
Echocardiography ; Echocardiography, Doppler ; Heart Ventricles ; Humans ; Hypertension, Pulmonary* ; Pulmonary Disease, Chronic Obstructive ; Tricuspid Valve Insufficiency ; Ventricular Dysfunction, Right

BACKGROUND: Laparoscopic cholecystectomy and gynecologic pelviscopy need to induce pneumoperitoneum to allow visualization of the operative field, but the former requires a head-up position whereas the latter needs a Lithotomy-Trendelenburg position. The authors observed hemodynamic changes using an esophageal doppler monitor in both cases. METHODS: Eight females planned for laparoscopic cholecystectomy were assigned to Group 1 and 10 females for gynecologic pelviscopy were assigned to Group 2. Thiopental (5 mg/kg) and vecuronium (0.1 mg/kg) were used to induce general anesthesia. 50% O2-N2O and 1.5 vol.% isoflurane were used to maintain anesthesia. Mechanical ventilation was used with a tidal volume of 10 ml/kg and a respiratory rate of 12 breaths per minute. Mean arterial pressure, heart rate, end-tidal CO2 and peak airway pressure were measured and cardiac output, corrected flow time, and peak velocity were monitored using an esophageal doppler monitor in each group after inducing anesthesia, CO2 inflation, position change, and CO2 deflation. RESULTS: Mean arterial pressure increased in each group while changing position. No significant changes in the heart rate were observed in each group. End-tidal CO2 increased in each group after changing position, and remained elevated even with position reversal and deflation. Peak airway pressure was elevated in each group after CO2 inflation and increased more so with changing posture in group 2 (post inflation: 18.5 +/- 1.4 cmH2O, after position change: 21.4 +/- 2.0 cmH2O). Cardiac output and cardiac index were reduced after the induction of pneumoperitoneum in each group, and reduced more on changing posture in group 2 (CO: 5.9 +/- 2.0 L/min vs. 4.4 +/- 1.5 L/min, CI: 3.7 +/- 1.4 L/min/m2 vs. 2.7 +/- 1.1 L/min/m2). Stroke volume also reduced after changing posture in each group. Corrected flow time was not changed, but peak velocity decreased after CO2 inflation in each group (group 1: 97.4 +/- 30.0 cm/s vs. 78.9 +/- 27.3 cm/s, group 2: 111.9 +/- 14.1 cm/s vs. 88.3 +/- 12.6 cm/s). CONCLUSIONS: The Lithotomy-Trendelenburg position can augment the hemodynamic changes resulting from pneumoperitoneum. Therefore, additional caution is required in patients with cardiovascular disease who are undergoing gynecologic pelviscopy.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Cardiac Output ; Cardiovascular Diseases ; Cholecystectomy, Laparoscopic* ; Female ; Heart Rate ; Hemodynamics* ; Humans ; Inflation, Economic ; Isoflurane ; Pneumoperitoneum ; Posture ; Respiration, Artificial ; Respiratory Rate ; Stroke Volume ; Thiopental ; Tidal Volume ; Vecuronium Bromide

BACKGROUND: Hemoglobin dilution occurs after acute blood loss, by shifting extravascular blood components into the intravascular space, providing the theoretical possible to calculate amount of blood loss by comparing this difference.Assessing blood loss during the operative procedure is crucial to provide appropriate treatment, however there are few objective standards by which to make this assessment.In this study, we used the hemoglobin dilution method to predict blood loss following an operative procedure. METHODS: During the year 2007, 96 patients who had undergone lumbar spinal fusion surgery were enrolled in this study.On a retrospective basis, we investigated the weight, height, intraoperative blood loss, hemoglobin change, and the amount of transfused erythrocytes by reviewing anesthetic notes from the surgery. On the basis of these data, we calculated estimated blood loss by using Nadler's formula. RESULTS: The majority of study participants were female and average age was 60.1 yrs.We observed 2.3 g/dl decrement of postoperative hemoglobin, and estimated blood volume was 3,599 ml. Estimated blood loss was 853.7 ml, and observed blood loss was 1,070 ml, thus creating 217.1 ml difference.Analysis showed a moderate degree of correlation between observed and estimated values and a correlation coefficient of 0.49. We obtained regression equations of y = 0.828x + 363.5. CONCLUSIONS: Estimated blood loss was underestimated compared to observed values, by 20%, and this discrepancy is was attributed to ethnic differences. To predict a precise estimated blood loss, attempts to make a modified formula targeted to the Korean population are required.
Blood Volume ; Erythrocytes ; Female ; Hemodilution ; Hemoglobins ; Hemorrhage ; Humans ; Retrospective Studies ; Spinal Fusion ; Surgical Procedures, Operative

Percutaneous endoscopic gastrostomy (PEG) has become a widely used and safe method for long-term enteral feeding in patients who are unable to tolerate oral feeding. Although a number of complications can occur following PEG placement, most of these complications are not life threatening. Serious complications occur rarely after this procedure and they include peritonitis, visceral perforation, major gastrointestinal bleeding, and necrotizing fasciitis. An esophageal perforation following PEG placement is very rare and predisposing factors include Zenker's or epiphrenic esophageal diverticuli, esophageal strictures, and mass lesions. We recently experienced a case of distal esophageal perforation following a PEG tube change. The predisposing esophageal perforation factor in this case was uncertain, and we successfully treated the patient with surgical intervention.
Constriction, Pathologic ; Enteral Nutrition ; Esophageal Perforation ; Fasciitis, Necrotizing ; Gastrostomy ; Hemorrhage ; Humans ; Peritonitis

BACKGROUND: Abnormalities of the left ventricular (LV) diastolic dysfunction are common in patients with end-stage renal disease (ESRD). Recently, Doppler tissue imaging (DTI) has been introduced as a method to evaluate diastolic function or myocardial relaxation by measuring mitral annulus velocity during diastole. This study was undertaken to assess resting diastolic function and diastolic functional reserve during exercise in ESRD patients starting dialysis treatment. METHODS: Mitral inflow velocities by Doppler echocardiography and septal mitral annular velocities by DTI were measured at rest and during supine bicycle exercise in 22 new ESRD patients and 23 age- and sex-matched subjects with normal renal function as a control. RESULTS: LV end-diastolic and end-systolic dimensions, septal thickness, and left atrial volume index were significantly higher in patients with ESRD compared with those of controls (p<0.01). LV ejection fraction was significantly lower in ESRD group (p<0.05). There were no significant differences in mitral inflow velocities (E, E/A, DT) between the two groups except A velocity, which was significantly higher in ESRD group (p<0.01). However, early diastolic mitral annular velocity (E') at rest (5.3+/-1.3 cm/sec vs. 6.5+/-1.5 cm/sec, p=0.013) and augmentation of E' with exercise (deltaE') were significantly lower in ESRD group compared with controls (at 25W exercise, 1.3+/-1.6 cm/sec vs. 4.0+/-3.0 cm/sec, p=0.002; at 50W exercise, 3.3+/-2.3 cm/sec vs. 6.5+/-5.3 cm/sec, p=0.030). CONCLUSION: Unlike conventional mitral inflow parameters, longitudinal resting diastolic function and diastolic functional reserve during exercise assessed by DTI were significantly reduced in ESRD patients starting dialysis treatment.
Dialysis* ; Diastole ; Echocardiography, Doppler ; Humans ; Kidney Failure, Chronic* ; Relaxation

Endothelial dysfunction is thought to be a central pathogenic feature in preeclampsia on the basis of elevated adhesion molecules. The aim of the present study was to compare the levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1) and E-selectin (sE-selectin) in sera of normal and preeclamptic pregnancies. We studied the serum levels of sVCAM-1, sICAM-1 and sE-selectin in normal pregnant women (n=63), mild preeclampsia (n=33) and severe preeclampsia (n=82). Concentrations of soluble adhesion molecules were determined with enzyme-linked immunoassay (ELISA). Serum concentrations of sVCAM-1 were significantly higher in both mild (p=0.004) and severe preeclampsia (p=0.000) than normal pregnancy. There were also significant differences in sVCAM-1 levels between mild and severe preeclampsia (p=0.002). sICAM-1 levels of severe preeclampsia were statistically different from those of normal pregnancy (p=0.038). Levels of sE-selectin were elevated in both mild (p=0.011) and severe preeclampsia (p=0.000) compared to normal pregnancy, but no statistical difference between the mild and severe preeclampsia (p=0.345). These results suggest that all three soluble adhesion molecules are increased in severe preeclampsia, and sVCAM-1 among them may be useful in predicting the severity of preeclampsia.
Adult ; Biological Markers ; Cell Adhesion Molecules/*blood ; E-Selectin/blood ; Female ; Humans ; Intercellular Adhesion Molecule-1/blood ; Pre-Eclampsia/*blood ; Pregnancy ; Severity of Illness Index ; Solubility ; Vascular Cell Adhesion Molecule-1/blood

OBJECTIVE: This study is performed to assess whether detection of phosphorylated insulin like growth factor binding protein-1 (phIGFBP-1) in cervical secretions by a bed side test could be used to prediction preterm delivery in patient with regular uterine contraction. METHODS: In our prospective study, 42 women between 20.2 and 36.4 weeks gestation with regular, persistent contraction (2-3/min for 30 min). and 27 women between 22.0 and 37.0 weeks of gestation without symptoms of preterm labor were assessed for presence of cervical phIGFBP-1. Dacron swabs were applied to the cervix and assayed in 5min by using immunochromatography, actim partus test (Medix Biochemica). RESULTS: Of the 42 patients with regular uterine contractions, 22 had a positive actim partus test and 20 had a negative test. Among the 22 patients with positive test, 5 delivered preterm and other 17 patients delivered term (<37 weeks). Among the the 20 women with a negative test, 2 delivered preterm (NS). The mean concentration of phIGFBP-1 in 22 positive patients is 83.8+/-86.5 microgram/L and that in 20 negative patients is 2.1+/-5.0 microgram/L (P<0.0001) (Table 4). Sensitivity, specificity, false positive, false negative, positive predictive, and negative predictive values were 18.5, 59.6, 40.3, 28.6, 16.7, and 94.9%, respectively. CONCLUSION: The absence of cervical phIGFBP-1 is seems to be a valuable test in excluding preterm delivery in patients who have regular uterine contractions. The high negative predictive value in this study may enable physicians to prevent over treatment of patients with uterine contractions. Therefore, many unwanted side-effects and complications of potentially hazardous tocolytic therapy can be prevented.
Cervix Uteri ; Female ; Humans ; Immunochromatography ; Insulin ; Obstetric Labor, Premature ; Polyethylene Terephthalates ; Pregnancy ; Prospective Studies ; Sensitivity and Specificity ; Tocolysis ; Uterine Contraction

Antiviral activity against Influenza virus of 14 Lactobacillus species isolated from food was monitored. Lactobacillus species were isolated from traditional Korean fermented food. Each live Lactobacillus was administered into the nasal cavity of SPF 6-week-old BALB/c mice. After the Lactobacillus treatment, Influenza virus (A/NWS/33/H1N1) was inoculated to each mouse. Clinical signs and mortality was monitored for 21 days. Each Lactobacillus strain showed various level of antiviral activity against Influenza virus. As a result of this study, this mouse experiment model, including intranasal treatment of live Lactobacillus species, could be effective model in evaluating immunomodulatory response of probiotics against respiratory viruses.
Administration, Intranasal* ; Animals ; Influenza, Human ; Lactobacillus ; Mice* ; Models, Animal ; Mortality ; Nasal Cavity ; Orthomyxoviridae* ; Probiotics

OBJECTIVE: To compare the risk of congenital anomaly after exposure to suspected teratogens in early pregnancy with the known baseline risk to the geneneral population. METHODS: From September 1999 to August 2001, we counseled about the teratogenic risk of the fetus by relevant medical literatures after assessment of type, amount, and time of exposure for 302 pregnant women exposed to suspected teratogens such as drugs, radiation, alcohol, and cigarette smoking. We followed up on the pregnancy outcome with the rate of termination of pregnancy and incidence of congenital anomaly. RESULTS: Among a total of 302 cases, 253 pregnant women (83.8%) delivered, 15 (5%) were aborted spontaneously, 34 (11.3%) were terminated. 297 pregnant women (98.3%) were lastly exposed to drugs in mean 5.3 +/- 0.2 gestational weeks. Medicines taken were gastrointestinal drugs (23%), NSAIDs (18.3%), antibiotics (16.2%), antihistamines (10.8%) in the order of frequency. 74 pregnant women (24.5%) were exposed to radiation in mean 5.1 +/- 0.5 gestational weeks. The mean dose was 234.60 mrem. 113 pregnant women (37.3%) lastly drank alcohol in mean 4.5 +/- 0.4 gestational weeks and the mean amount was 1.55 oz. 36 pregnant women (11.9%) lastly smoked in mean 4.4 +/- 0.3 gestational weeks and the mean amount was 7.3 cigarettes/day. We found structural anomalies in 5 cases (Polydactylyl, Ileal agenesis, Both ear mass, Left ectopic kidney, Meningomyelocele) and 1 chromosomal abnormality case (Trisomy18). CONCLUSION: The rate of fetal structural anomaly was 2% in this study and is not more than baseline risk of general population. Therefore, evidence-based teratogenic risk counseling may prevent unnecessary pregnancy termination.
Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Chromosome Aberrations ; Counseling ; Ear ; Female ; Fetus ; Gastrointestinal Agents ; Histamine Antagonists ; Humans ; Incidence ; Kidney ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Pregnant Women ; Smoke ; Smoking ; Teratogens*