Intravenous administration of high dose of fentanyl is gaining wide popularity as the sole anesthetic agent for patients undergoing cardiac surgery because of its favorable characteristics such as, simplicity, stable hemodynamics and supression or modification of stress response to surgery. But some investigators reported the necessity of supplementary anesthetic agent in addition to fentanyl to maintain hemodynamic stability during the surgical procedure. Therefore, we measured the heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), and rate pressure product(RPP) at induction, tracheal intubation, skin incision, and sternotomy time to evaluate the cardiovascular responses to surgical procedure under fentanyl-O2 anesthesia on 12 patients with acquired valvular heart disease. The patients were anesthetized with a loading dose (30ug/kg fentanyl for induction and 1.5ug/ kg/min until sternotomy) followed by continuous infusion of fentanyl (0.3pg/kg/min until the end of cardiopulmonary bypass.) The patients required total doses of 108+/-4.6ug/kg fentanyl for the entire operation. These measurements were compared with control data (before induction). The results were as followings: 1) During induction (infusion of fentanyl 30ug/kg), HR, SBF, DBP, MAP, and RPP revealed no significant change compared with control data. 2) During intubation and skin incision, HR, SBP, DBP, MAP, and RPP slightly increased but were not statistically significant (p>0.05) 3) During sternotomy, SBP increased from 119.8+/-16.36 torr to 136.5+/-15.22 torr, DBP increased from 79.1+/-12.76 torr to 95.4+/-10.87 torr, MAP increased from 99.4+/-13.96 torr to 115.5+/-12.70 torr, and RPP increased from 10929+/-2206 torr.beats/min to 13889+/-2865 torr. beats/min (p<0.05). HR increased from 90.7+/-8.71 beats/min to 100.2+/-13.79 beats/min, but was not statistically significant(p> 0.05). 4) One of the patients had recall of the sternotomy and spreading of the chest with the sternal retractor. These data demonstrate that anesthetic doses of fentanyl and O produce minimal change in cardiovascular dynamics during the surgical procedures except sternotomy time. Our findings suggest that fentanyl-O2 anesthesia may be an attractive anesthetic technique in patients with valvular heart disease undergoing valve replacement operations but, will be needed considerations about infusion method, dosage of fentanyl and use of supplementary anesthetic agent according to patients conditions.
Administration, Intravenous ; Anesthesia* ; Anesthetics ; Fentanyl* ; Heart ; Heart Valve Diseases ; Hemodynamics ; Humans ; Intubation ; Methods ; Research Personnel ; Skin ; Sternotomy ; Thoracic Surgery ; Thorax

No abstract available.
Pulmonary Disease, Chronic Obstructive* ; Rehabilitation*

OBJECTIVE: The objective of this research is to survey the requirements of Oriental Medical Informatics, and to suggest a direction that Oriental Medical Informatics development may take. METHODS: Consumers and medical experts were randomly selected, and 14 uestions for consumers and 17 questions for medical experts were sent to respondents by mail and e-mail. RESULTS: Both consumers and medical experts were greatly concerned with the systemized dissemination of Oriental Medical Information, but they were not satisfied with it because of the perceived low quality of the information. Medical experts responded that they need standards and statistical evidences for Oriental Medicine. Consumers demanded good-quality information about diseases and health management. CONCLUSION: To carry out Oriental Medical Informatics, it is necessary to conduct a joint research between the sectors of Oriental Medicine and Information Technology, followed by the development of a standard information infrastructure. Oriental Medicine must also have standards in terms of medical data content, data format, and data communication, to ensure the reliability of the disseminated information on Oriental Medicine.
Surveys and Questionnaires ; Electronic Mail ; Joints ; Medical Informatics ; Medicine, East Asian Traditional* ; Postal Service

First branchial cleft anomalies constitute less than one percent of all branchial arch anomalies. First branchial clefi anomalies are classified into 2 digerent types with different embryologic, anatomical and histologic features by Work (1972)1. Among 2 types, type II anomaly is less common than type I and there has been no report of type II anomaly in the Korean literatures. We experienced a 5-year-old female who had a inflammed cystic mass over neck which was extended into parotid area After elevation of parotidectomy skin incision and superficial parotid gland, the cystic mass was observed to be extended upward into the parotid gland, medial to the facial nerve and ended at the external auditory canal. Microscopic examination shows that cyst wall is lined with squamous epithelium and contains some mesodermal tissue such as pilosebaceous gland and muscle. In conclusion, we can present this case as the first branchial cleft anomaly type II.
Branchial Region* ; Child, Preschool ; Ear Canal ; Epithelium ; Facial Nerve ; Female ; Humans ; Mesoderm ; Neck ; Parotid Gland ; Skin

To establish predictors of prognosis and recurrence of hepatocellular carcinoma (HCC) after curative resection, retrospective analyses of clinical and pathologic factors were done in 85 hepatectomized patients of HCC. The median follow-up duration was 30.5(range: 3-134) months. Two postoperative mortalities and five palliative resections were excluded from analysis of recurrence. The overall 1, 3, 5 year survival rates in 85 patients were 78.6%, 63.6%, 45.6%. The 1, 3, 5 year survival rates in 78 curative resections were 81.8%, 70.2%, 50.3%. The 1, 2, 3 year survival rates of the palliative resections(5 cases) were 60%, 20%, 0%. The 1, 3, 5 year recurrence-free survival rates in the curative resections were 64.4%, 43.2%, 27.5%. Included prognostic variables were age, gender, viral hepatitis, cirrhosis, serum alpha-FP level, ICG-R15, diabetes, preoperativeTACE, tumor size, tumor capsulation, number of tumors, vascular invasion, tumor histologic grading, stage of the chronic hepatitis, and anatomic resection. The significant factors affecting recurrence were number of tumors and vascular invasion.
Carcinoma, Hepatocellular* ; Fibrosis ; Follow-Up Studies ; Hepatectomy ; Hepatitis ; Hepatitis, Chronic ; Humans ; Mortality ; Prognosis ; Recurrence* ; Retrospective Studies ; Survival Rate

Serum prostate specific antigen(PSA) as well as serum prostate acid phosphatase(PAP), the reference serum marker and digital rectal examination were measured to evaluate the clinical significance according to the diagnosis and stage of prostate cancer in 17 patients with prostate cancer & 40 patients with BPH proven pathologically, 21 normal control group free of prostate disorders from June. 1991 to June, 1992. As the mean PSA value (+/-S.D.) was 92.75 +/-16.30ng/ml for prostate cancer. 16.52 +/-2.85ng/ml for BPH and 1.51 +/-0.17 for normal control group and the mean PAP value( +/-S.D.) was 12.33 +/-3.73ng/ml, 1.48 +/-0.21ng/ml and 0.70 +/-0.1ng/ml each other, there- fore the mean PSA value in prostate cancer group revealed statistical significance(p <0.01). PSA was more sensitive and nearly same specific as PAP in diagnosis of prostate cancer(n=20ng/ml). The diagnostic accuracy of PSA was higher than PAP, positive predictive value was highest in PSA(n=20ng/ml) with abnormal digital rectal examination. The higher of the PSA, PAP value, the higher stage of prostate cancer and there was slight increase in PSA value as mush as increased grade of prostatic cancer. And serum PSA level was determined during the follow up after endocrine or combined chemotherapy and as the results 4 of 8 patients revealed normal PSA value and improvement of clinical symptoms within 2.8 months. We concluded that PSA was a simple and useful method for detection of prostate cancer and follow up after treatment, but by strict statistical criteria alone, PSA by itself didn`t qualify as an effective screening tool. Therefore if in PSA combined with digital rectal examination and transrectal ultrasonography and especially combined with PSAD and PSAV in case of 4-20ng/ml in serum PSA value it might be very useful in early diagnosis and therapeutic monitoring of prostate cancer.
Biomarkers ; Diagnosis* ; Digital Rectal Examination ; Drug Therapy ; Early Diagnosis ; Follow-Up Studies ; Humans ; Mass Screening ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; Ultrasonography

This study examined within- and between-person variation in nutrient intakes in order to estimate the degree of precision in dietary assessment among 37 males and 46 females whose mean age was 70.4 years old. To collect dietary data, each subject was interviewed 5 or 6 times using a 24-hour recall method during a 3 month period. Within-person variation ranged from 23.5% to 101.2%. Lower values of within-person variation were observed in energy, carbohydrated, protein and phosphorous while higher value was observed in vitamin A. Between person variations of nutrient intakes ranged 12.6-23.5% in most nutrients. With 1 day dietary data, observed nutrient intakes were estimated to within 6-25% of the group's usual9true) intakes and 52-198% of the individuals' usual intakes. The values of these maximum percentage deviations became smaller when the number of dietary recalls increased. The results of this study suggest that the Korean elderly subjects appear to have a slightly less diverse diet compared to young Korean women. Within persons, intakes of nutrients largely from animal sources were more variable for the Korean elderly than for their counterparts in Western countries. This study also implies that commonly used 1 day dietary study may be appropriate for assessing group means of nutrient intakes, but clearly not appropriate for assessing individual's nutrient intakes.
Aged* ; Animals ; Diet ; Female ; Humans ; Male ; Vitamin A

It is very rare for an exocervical adenocarcinoma to metastasize to the lung parenchyma and pleura. A 54-year-old woman was admitted with dyspnea and left pleural effusion on chest X-ray. She had a history of exocervical adenocarcinoma 3 years previously and was treated with hysterectomy, chemotherapy, and radiation therapy. Last year, she was diagnosed with a left vestibular schwannoma and underwent subtotal mass removal surgery. After admission, metastatic adenocarcinoma of the pleura was diagnosed by video-assisted thoracic surgery biopsy. We herein report the rare case of exocervical adenocarcinoma that presented as a metastatic lesion to the pleura 3 years after the initial diagnosis.
Adenocarcinoma ; Biopsy ; Dyspnea ; Female ; Humans ; Hysterectomy ; Lung ; Middle Aged ; Neoplasm Metastasis ; Neuroma, Acoustic ; Pleura ; Pleural Effusion ; Pleural Neoplasms ; Recurrence ; Thoracic Surgery, Video-Assisted ; Thorax

The aim of this study was to establish whether the pylorus-preserving pancreatico-duodenectomy (PPPD) is a safe, but radical, procedure in the treatment of malignant periampullary lesions, without increased morbidity and mortality rates, compared with the standard Whipple's procedure (PD). From 1993 to 1996, a PD (N = 25) or a PPPD(N = 15) was performed on 40 patients. Postoperative mortality rates were 2% after the PD and 0% after the PPPD. The mean operation time and blood loss in the PPPD group were 465 minutes and 840ml, respectively, and in the PD group were 444 minutes and 1080ml, respectively, both statistically insignificant. During follow-up, no differences were found in the postoperative complications, the recurrence of disease, and survival rates according to operation type, lymph node metastasis, or pancreas invasion. No differences were found the numbers of days of gastric drainage, liquid diet, and regular diet, but a delayed gastric emptying time was found in the PPPD group(40% of the patients after PPPD vs 12% after PD). Tumor-containing duodenal or gastric resection margins were not found in either group of patients. The hospital stay was the same for both groups (38 days after PPPD, 37 days after PD). The mean duration of follow-up was 23 months. Weight gain fter operation during follow-up was relatively more favorable after a PPPD. In conclusion, a PPPD is a safe, but radical, procedure and can be an alternative choice, without compromising curability. to a PD in the treatment periampullary cancer. No difference in either the morbidity or the mortality rates existed between the two procedures. Further investigation will be needed to understand the delayed gastric emptying time in the PPPD group, but during 3 months, of follow-up weight gain was better in the PPPD group.
Diet ; Drainage ; Follow-Up Studies ; Gastric Emptying ; Humans ; Length of Stay ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Pancreas ; Pancreaticoduodenectomy* ; Postoperative Complications ; Recurrence ; Survival Rate ; Weight Gain

PURPOSE: Although relatively rare, urachal remnants manifest as a large number of diverse disorders, which can lead to a high misdiagnosis rate. Because of the many clini-cal pre-sentations, there are no uniform guidelines for the evaluation and treatment of urachal remnants. We report our experi-ence with urachal anomalies in an attempt to establish an optimal diagnostic and treatment modality. METHODS: Fifteen patients (6 males and 9 females), who had undergone surgery for urachal anomalies from December 1988 to July 2004, were analyzed retrospectively. RESULTS: The patients' age ranged from 1 day to 71 years old. The 3 variants of urachal anomalies included a patent urachus in 1 patients (7%), urachal sinus in 5 (33%), and an urachal cyst in 9 (60%). The presenting complaint was a low abdominal mass in 6 patients, abdominal pain in 5, periumbilical discharge in 3, fever in 3, and periumbilical urination in 2. Four combined anomalies were observed in 4 patients. The diagnostic evaluation included fistulography in 3 cases, sonography in 12, and CT in 3. Excision was performed in 12 patients. CONCLUSION: Urachal anomalies most often present in infancy, and can be diagnosed and treated with certainty if a good physical examination and proper imaging studies are performed. Surgical excision is the treatment of choice for urachal anomalies.
Abdominal Pain ; Aged ; Diagnostic Errors ; Fever ; Humans ; Male ; Physical Examination ; Retrospective Studies ; Urachal Cyst ; Urachus ; Urination