BACKGROUND/AIMS: Blood loss and blood transfusion are extremely important determinants of morbidity and mortality following hepatic resection. This is attributed to increased risks of coagulopathy, acute respiratory distress syndrome and multiorgan failure. The hypothesis is that a low pressure in the central veins would be accompanied by a low pressure in the hepatic veins and sinusoids, thereby decreasing blood loss during hepatic resection. This study evaluates the effectiveness of continuing low central venous pressure comparing with high central venous pressure during major hepatic resection. METHODS: 20 consecutive major hepatic resections between March 2000 and August 2000 were studied prospectively concerning central venous pressure which was analysed for 10 cases with a central venous pressure less than 10 mmHg, and greater than or equal to 10 mmHg. The central venous pressure was monitored continuously using a Narkomed Anaesthetic Component Monitoring System (Drager Inc., USA). RESULTS: Low central venous pressure allowed a smaller intraoperative blood loss (<10 mmHg: 1010+/-465.3 ml vs. > or =10 mmHg: 1770+/-916.5 ml, p<0.05), a smaller perioperative transfusion (<10 mmHg: 139+/-276.2 ml vs. > or =10 mmHg: 807+/-799.2 ml, p<0.05), a lower postoperative peak AST (<10 mmHg: 167.4+/-53.2 IU/L vs. > or =10 mmHg: 293.0+/-123.2 IU/L, p<0.05), a lower postoperative peak ALT (<10 mmHg: 96.1+/-55.3 IU/L vs. > or =10 mmHg: 193.2+/-103.5 IU/L, p<0.05), and a earlier resumption of a normal hepatic enzyme (<10 mmHg: 6.4+/-0.9 days vs. > or =10 mmHg: 8.7+/-1.6 days, p<0.05) in comparison to high central venous pressure. There was no postoperative mortality in both group. CONCLUSIONS: Maintaining a low central venous pressure throughout major hepatic resection reduced blood loss, blood transfusion requirements and enzyme recovery periods. Lowering the central venous pressure is a simple and effective way during hepatic resection.
Blood Transfusion ; Central Venous Pressure* ; Hepatic Veins ; Mortality ; Prospective Studies ; Respiratory Distress Syndrome, Adult ; Veins

PURPOSE: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. METHODS: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. RESULTS: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. CONCLUSION: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons.
Anti-Bacterial Agents ; Emergencies ; Emergency Medicine ; Humans ; Hypotension ; Logistic Models ; Prevalence ; Retrospective Studies ; Thoracostomy

Anaplastic carcinomas of the pancreas, also known as pleomorphic, sarcomatoid, or undifferentiated carcinomas, are in most cases variants of duct-derived carcinomas. However, their appearance is so distinctive and their behavior so aggressive that a distinction from the ordinary ductal adenocarcinoma is warranted. They comprise about 7% of all non-endocrine pancreatic malignancies. Most tumors are large and apparently more likely to involve the body or tail of the pancreas rather than the head. Most patients are above the age of 50 at the time of diagnosis, and there is a distinct male predilection. Here we report on a 50-year woman who diagnosed pathologically as a anaplastic carcinoma of the pancreas. The patient underwent Whipple's operation because of a distal common bile duct cancer 6 years ago. Distal pancreatectomy and splenectomy were performed. The patient was discharged with a good general condition.
Adenocarcinoma ; Carcinoma* ; Common Bile Duct* ; Diagnosis ; Female ; Head ; Humans ; Male ; Pancreas* ; Pancreatectomy ; Splenectomy

Purpose: : Job stress is a risk factor for depression. Many employees work in teams. However, few studies have examined the effect of team work and team climate on employees’ mental health in the workplace. We investigated the associations between team work and depression among Korean employees. Methods: : We conducted a secondary analysis of data from the 5th Korean Working Conditions Survey (KWCS), a cross-sectional national survey. The sample comprised 30,235 wage employees over the age of 15, including 14,555 men and 15,680 women. To measure team work, respondents were asked, “Do you work in a group or team that has common tasks and can plan its work?” Depressive mood was measured using the 5-item World Health Organization (WHO-5) Well-Being Index. The analysis was conducted by univariate and multiple logistic regression analyses to estimate the effect of team work on depressive mood. Results : Depressive mood was observed in 26.6% of team employees and 29.5% of those without a team (out of all wage employees), indicating a significant difference. After adjusting for demographic and workplace characteristics as potential confounding variables, as compared to non-team work, the odds ratios of depressive mood for team work were 0.96 (95% CI: 0.88–1.04) for men, which was not statistically significant, and 0.80 (95% CI: 0.73–0.87) for women, which was statistically significant. Conclusion : Our findings can be used to develop safety and health policies to improve the mental health of Korean employees. Reorganizing companies to support team work would also benefit the mental health of wage employees, especially female employees.

PURPOSE: The purpose of this study was to assess the safety and early outcomes of the Pipeline device for large/giant or fusiform aneurysms. MATERIALS AND METHODS: The Pipeline was implanted in a total of 45 patients (mean age, 58 years; M:F=10:35) with 47 large/giant or fusiform aneurysms. We retrospectively evaluated the characteristics of the treated aneurysms, the periprocedural events, morbidity and mortality, and the early outcomes after Pipeline implantation. RESULTS: The aneurysms were located in the internal carotid artery (ICA) cavernous segment (n=25), ICA intradural segment (n=11), vertebrobasilar trunk (n=8), and middle cerebral artery (n=3). Procedure-related events occurred in 18 cases, consisting of incomplete expansion (n=8), shortening-migration (n=5), transient occlusion of a jailed branch (n=3), and in-stent thrombosis (n=2). Treatment-related morbidity occurred in two patients, but without mortality. Both patients had modified Rankin scale (mRS) scores of 2, but had an improved mRS score of 0 at 1-month follow-up. Of the 19 patients presenting with mass effect, 16 improved but three showed no changes in their presenting symptoms. All patients had excellent outcomes (mRS, 0 or 1) during the follow-up period (median, 6 months; range, 2-30 months). Vascular imaging follow-up (n=31, 65.9%; median, 3 months, range, 1-25 months) showed complete or near occlusion of the aneurysm in 24 patients (77.4%) and decreased sac size in seven patients (22.6%). CONCLUSION: In this initial multicenter study in Korea, the Pipeline seemed to be safe and effective for large/giant or fusiform aneurysms. However, a learning period may be required to alleviate device-related events.
Aneurysm* ; Carotid Artery, Internal ; Follow-Up Studies ; Humans ; Korea* ; Learning ; Middle Cerebral Artery ; Mortality ; Retrospective Studies ; Thrombosis