No abstract available.
Breast Neoplasms* ; Breast* ; Neoplasm Metastasis*

This study was designed to determine if topical cardiac hypothermia is a necessary adjunct to intraoperative myocardial protection. In this study, 105 patients ranging in age from 22 to 74 years were included. Myocardial temperature was measured at the ventricular septum. All patients received cold blood cardioplegia without topical cooling. In most of the patients(90%) the myocardial temperature was dropped to 10-15degrees C without topical cooling. In Group A, myocardial temperature was dropped rapidly to 10-15degrees C with, 1,000ml or less cardioplegic solution. In Group B, the amount of cardioplegic solution required for lowering myocardial temperature to 10-15degrees C was 1,000-2,000ml. In Group C, myocardial temperature was not dropped below 18degrees C or cardioplegic solution over 2,000ml was required for lowering myocardial temperatur. Eight patients(8/61, 8%) in group A, 12 patients(12/35, 34%) in group B and 8 patients(8/9. 89%) in group C had Complete obstructive lesions in at least one of major branches of coronary artery(p=0.001). Myocardial perfusion score was different among the groups(8.27+/-2.27 in group A, 9.98+/-2.21 in group B, 10.30+/-2.49 in group C, p<0.002). These data suggest that routine topical hypothermia may be unnecessary if myocardial temperature of less than 15degrees C could be attained with cold blood cardioplegia, especially in case of myocardial perfusion score below 10.
Cardioplegic Solutions* ; Heart Arrest, Induced ; Humans ; Hypothermia ; Perfusion ; Ventricular Septum

OBJECTIVES: To examine the current status of hospital information systems (HIS), analyze the effects of Electronic Medical Records (EMR) and Clinical Decision Support Systems (CDSS) have upon hospital performance, and examine how management issues change over time according to various growth stages. METHODS: Data taken from the 2010 survey on the HIS status and management issues for 44 tertiary hospitals and 2009 survey on hospital performance appraisal were used. A chi-square test was used to analyze the association between the EMR and CDSS characteristics. A t-test was used to analyze the effects of EMR and CDSS on hospital performance. RESULTS: Hospital size and top management support were significantly associated with the adoption of EMR. Unlike the EMR results, however, only the standardization characteristic was significantly associated with CDSS adoption. Both EMR and CDSS were associated with the improvement of hospital performance. The EMR adoption rates and outsourcing consistently increased as the growth stage increased. The CDSS, Knowledge Management System, standardization, and user training adoption rates for Stage 3 hospitals were higher than those found for Stage 2 hospitals. CONCLUSIONS: Both EMR and CDSS influenced the improvement of hospital performance. As hospitals advanced to Stage 3, i.e. have more experience with information systems, they adopted EMRs and realized the importance of each management issue.
Adoption ; Decision Support Systems, Clinical ; Electronic Health Records ; Electronics ; Electrons ; Health Facility Size ; Hospital Information Systems ; Information Management ; Information Systems ; Knowledge Management ; Korea ; Outsourced Services ; Tertiary Care Centers

BACKGROUND: We evaluated volumetric differences of syringe brand compatibilities, and investigated the impact of false brand settings on target-controlled infusion (TCI) and their methods of correction. METHODS: Gravimetric measurement of 10 ml bolus infusions was performed using BD Plastipak (BDP) and Terumo compatible syringes, while setting to 7 different kinds of brand compatibilities (BDP, Sherwood Monoject, BD Perfusion, Braun Perfusor, Braun Omnifix, Fresenius Injectomat, and Terumo). To investigate the performance of TCI using BDP with a false setting to Terumo (BDPTERUMO) and Terumo to BDP (TERUMOBDP), 24 TCI targeting 4.0 microg/ml of effect-site concentration (Ceff) of propofol were performed. Subsequently, another 24 TCI were evaluated for simple corrections of false settings at 30 min. We also investigated 24 TCI using active corrections (fill-up for BDPTERUMO, evacuation for TERUMOBDP) based on the pharmacokinetics of propofol. The Ceff at 30 min of TCI and time to normalize to +/- 5% of target concentration (T+/-5%target) were compared. RESULTS: The Ceff of BDPTERUMO showed negative bias and 17.2% inaccuracy, and the Ceff of TERUMOBDP showed positive bias and 19.5% inaccuracy. The Ceff at 30 min showed no difference between the methods of correction in BDPTERUMO or TERUMOBDP. The T+/-5%target in both the active corrections was significantly shorter than that of each simple corrections (P < 0.001). CONCLUSIONS: False brand setting of syringe proportionally maintained different predicted concentrations as much as the volumetric differences of syringe brand. Based on the results, it is proposed that correction methods based on pharmacokinetics could effectively normalize the differences, without giving up the wrong TCI.
Androsterone ; Bias (Epidemiology) ; Perfusion ; Propofol ; Syringes

Aorto-gastric fistulas are relatively rare. Fistula formation between the aorta and the gartrointestinal tract is a serious condition that results in severe hemorrhage with a very high mortality rate. We present an unusual case of successful surgical treatment in Chonnam national university hospital ; of a patient with a aortogastric fistula into thoracoabdominal aortic aneurysm.
Aorta ; Aortic Aneurysm, Thoracic* ; Fistula* ; Hemorrhage ; Humans ; Jeollanam-do ; Mortality

In the era of coronary artery bypass grafting, the intraaortic balloon pump(IABP) is more widely used and its indication has been expanded. We performed retrospective clinical analysis on the patients who have received IABP pre and/or postoperatively during the course of CABG. From January 1981 to June 1995, total 322 patients have received CABG at the Seoul National University Hospital and among them 50 patients(15.5%) were supported by IABP during the course of the operation. The mean age at the time of the operation was 57.2 years(39-75 years) and the male to female ratio was 33:17. The preoperative diagnosis was unstable angina in 33(66%), stable angina in 7(14%) and postinfarct angina in 8 patients(16%). As for the indications of the IABP, there were 13 cases(26%) with left main disease, 13(26%) with class IV angina, 12(24%) with difficulty in CPB weaning, 6(12%) with postinfarct angina and 3(6%) with severe LV dysfunction. In the remaining 3 cases, one patient was operated on after PTCA failure in emergency basis, another was a patient with AMI, and the other was one who had postoperative low cardiac output syndrome. All IABPs were introduced via femoral artery and among them 45 cases(90%) percutaneously. The mean postoperative assist time was 22.3 hours(0.5-168 hours) and IABP could be removed within 48 hours in most of them(44/50). The operative mortality was 6.1%(3 cases) and postoperative morbidity was only one with lower extremity ischemia. The more general application of the IABP during the course of the CABG ,especially in patients with high preoperative risk factors or difficulty in CPB weaning is a good measure of protecting and recovering myocardial function with minimal risk.
Angina, Stable ; Angina, Unstable ; Cardiac Output, Low ; Coronary Artery Bypass* ; Coronary Vessels* ; Diagnosis ; Emergencies ; Female ; Femoral Artery ; Humans ; Intra-Aortic Balloon Pumping ; Ischemia ; Lower Extremity ; Male ; Mortality ; Retrospective Studies ; Risk Factors ; Seoul ; Weaning

BACKGROUND: Rhabdomyolysis is a relatively rare disease caused by various factors and is characterized by skeletal muscle damage. While crush injury is the most common cause in Korea as well as other countries, overexertion is an important common cause among young men in daily life. Although exercise-induced rhabdomyolysis is already well published among athletes or military persons, there have been few reports in workers. CASE REPORT: We observed a 28-year-old male worker who had elevated liver transaminases during a periodic workers' health checkup. Although he did not exhibit the typical pattern of toxic hepatitis, we had to exclude any possibility of dimethylacetamide-induced hepatitis (DIH) because he had worked in a spandex-producing factory, which already had a history of many DIH cases over several years. We performed careful history taking, several laboratory tests, liver ultrasonography and liver biopsy. We also investigated the results of biological monitoring and air concentrations of dimethylacetamide. The findings from these examinations supported the clinical diagnosis of exercise-induced rhabdomyolysis with hepatitis. CONCLUSION: This case demonstrates that exercise can induce rhabdomyolysis and hepatitis. This disease must be treated by prompt and appropriate management because it might develop more serious complications such as acute renal failure.
Acute Kidney Injury ; Adult ; Athletes ; Biopsy ; Diagnosis ; Drug-Induced Liver Injury ; Environmental Monitoring ; Hepatitis* ; Humans ; Korea ; Liver ; Male ; Military Personnel ; Muscle, Skeletal ; Rare Diseases ; Rhabdomyolysis* ; Transaminases ; Ultrasonography

MATERIALS AND METHODS: Between 1984 to 1994, 136 patients underwent primary and isolated aortic valve replacement with 79 Carbomedics and 57 St. Jude prostheses. RESULTS: Age ranged from 16 to 67 year (mean : 44.5+/-12.7 years). Statistically significant differences in preoperative clinical characteristics between two groups were not found. There was one early death in the St. Jude group and none in the Carbomedics group. Early prosthetic valve-related complications including death were not significantly different between the two groups (p value= 0.572). One hundred thirty five early survivors were followed for a total of 354.2 patient-years (mean=31.5+/-16 months). In the CarboMedics group, actuarial survial rate at 5 years was 97.1+/-1.9%, and in the St. Jude group, it was 95.9+/-2.8%. In the CarboMedics group, actuarial free rate from all valve-related events at 5 years was 92.1+/-3.1%, and in St. Jude group, it was 89.8+/-5.0%. CONCLUSION: We conclude that early and late results after performing isolated aortic valve replacement with CarboMedics and St. Jude valve are not significantlly different.
Aortic Valve* ; Heart Valve Prosthesis ; Humans ; Prostheses and Implants* ; Survivors

BACKGROUND: We analyzed five hundred patients who underwent either isolated or concomitant coronary artery bypass grafting(CABG) between November 1981 and June 1997. MATERIAL AND METHOD: There were 330 males and 170 females with a mean age of 57.4+/-8.9 years. To evaluate the preoperative status, we performed electrocardiograghy, echocardiography, MIBI scan, Duplex sonogram, common blood test including CK and LDH and coronary angiography. RESULT: Preoperative clinical diagnoses were unstable angina in 282 (56.4%), stable angina in 141 (28.2%), postinfarction angina in 58 (11.6%), acute myocardial infarction in 8 (1.6%), variant angina in 7 (1.4%) and failed percutaneous transluminal coronary angioplasty in 4 (0.8%) patients. Preoperative angiographic diagnoses were three-vessel disease in 263 (52.6%), two-vessel disease in 93 (18.6%), one-vessel disease in 71 (14.2%), left main disease in 68 (13.6%), and others in 5 (1.0%) patients. Patients had various risk factors for coronary disease, and the frequency of the risk factors such as hypertension, diabetes and smoking showed increasing tendency year by year. We used saphenous vein grafts in 1143, internal thoracic artery grafts in 442, radial artery graft in 17, and gastroepiploic artery graft in 1 anastomosis. The mean number of grafts was 3.2+/-1.2 per patient. Concomitant operations were prosthetic valve replacement or valvuloplasty in 31, coronary endarterectomy and angioplasty in 27, left main coronary angioplasty in 13, carotid endarterectomy in 5, and neurologic problems, bleeding, and perioperative myocardial infarction. The mean follow-up period was 25+/-23 months and there were 5 cases of reoperation. CONCLUSION: We hope that the surgical results would improve with the accumulation of experience, application of new myocardial protection technique, and timely intervention of mechanical assisted devices.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Disease ; Coronary Vessels* ; Diagnosis ; Echocardiography ; Endarterectomy ; Endarterectomy, Carotid ; Female ; Follow-Up Studies ; Gastroepiploic Artery ; Hematologic Tests ; Hemorrhage ; Hope ; Humans ; Hypertension ; Male ; Mammary Arteries ; Myocardial Infarction ; Radial Artery ; Reoperation ; Risk Factors ; Saphenous Vein ; Smoke ; Smoking ; Transplants

BACKGROUND: Severe respiratory variations of systolic arterial and central venous pressure (CVP) may increase the risk of embolic event in orthopedic patient. As airway obstruction during sedation can cause this respiratory variation, we evaluated the degree of variations of systolic blood (SBP) and CVP during airway obstruction period. METHODS: Fifteen females who had obstructed airway during total knee replacement (TKR) were included for the study. After regional anesthesia were established, SBP and CVP variations were analyzed according to the three periods; baseline, obstruction, and airway, respectively. Calculated CVP variables were similar to SBP variables as below: DeltaSBP = Expmax (maximal value at expiration) - Inspnadir (minimal value at inspiration), %DeltaSBP = (DeltaSBP/ Exp(max)) x 100. The frequencies of pulsus paradoxus (PP) and negative inspiratory CVP (NIC) were also measured. RESULTS: At obstruction period, DeltaSBP was 21.7 mmHg and 93.3% of patient had PP. Also, DeltaCVP was 19.3 mmHg and 100% of patient showed NIC. %DeltaCVP (140%) was larger than %DeltaSBP (16%). And DeltaCVP was inversely correlated with baseline and obstruction SBP and %DeltaCVP was also inversely correlated with baseline CVP at obstruction period. CONCLUSIONS: During airway obstruction in sedated TKR patients, variations of CVP are larger than those of SBP. So we have to monitor CVP continuously as well as SBP so as not to increase the possible risk of respiratory of variation.
Airway Obstruction ; Anesthesia, Conduction ; Arthroplasty, Replacement, Knee ; Central Venous Pressure ; Female ; Humans ; Organothiophosphorus Compounds ; Orthopedics