Cyanosis in children is most often caused by pulmonary disease, or cyanotic heart disease but is rarely caused by hematological problems such as methemoglobinemia and sulfhemoglobinemia. Abnormal hemoglobins with a reduced oxygen affinity are an exceptionally uncommon cause of cyanosis in children. Hemoglobin-M (Hb-M) is rapidly auto-oxidized into the met-form resulting in the loss of its O2-binding ability. This hemoglobinopathy is inherited in an autosomal dominant pattern and is characterized by marked cyanosis. Hb-M affects the anesthetic management because of the anomalous absorption spectrum of Hb-M in standard pulse oximetry. Sufficient O2 delivery should be maintained by keeping a high FiO2 and intermittently checking the O2 delivery state using arterial blood gas analysis. We reported our experience of the anesthetic management of a patient with hemoglobin M.
Absorption ; Blood Gas Analysis ; Child ; Cyanosis ; Heart Diseases ; Hemoglobin M ; Hemoglobinopathies ; Hemoglobins, Abnormal ; Humans ; Lung Diseases ; Methemoglobin ; Methemoglobinemia ; Oximetry ; Oxygen ; Sulfhemoglobinemia

No abstract available.
Emergencies* ; Humans

BACKGROUND: Because of the common etiologic factor, such as smoking, lung cancer and chronic obstructive Pulmonary disease are often present in the same patient. The preoperative prediction of remaining pulmonary function after the resectional surgery is very important to prevent serious complication and postoperative respiratory failure. 99mTc-MAA perfusion scan has been used for the prediction of postoperative pulmonary function, but it may be inaccurate in case of large V/Q mismatching. We compared 99mTc-DTPA radioaerosol inhalation scan with 99mTc-MAA perfusion scan in predicting postoperative lung function. METHOD: Preoperative inhalation scan and/or perfusion scan were performed and pulmonary function test were performed preoperatively and 2 month after operation. We predicted the postoperative pulmonary functions using the following equations. Postpneumonectomy FEV1=Preop FEV1x% of total function of lung to remain RESULTS: 1) The inhalation scan showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.94, 0.91, 0.87 respectively). 2) The perfusion scan also showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.86, 0.72, 0.97 respectively). 3) Among three parameters, FEV1 showed the best correlations in the prediction by lung scans. 4) Comparison between inhalation scan and perfusion scan in predicting pulmonary function did not show any significant differneces except FVC. CONCLUSION: The inhalation scan and perfusion scan are very useful in the prediction of postoperative lung function and don't make a difference in the prediction of pulmonary function although the former showed a better correlation in FVC.
Humans ; Inhalation* ; Lung ; Lung Neoplasms ; Perfusion* ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Respiratory Insufficiency ; Smoke ; Smoking

BACKGROUND: Patient controlled analgesia (PCA) has become an important means for treating postoperative pain. However, postoperative nausea and vomiting (PONV) are a major problem for patient using PCA system. This study was designed to evaluate the efficacy of two prophylactic antiemetic regimens on PONV during PCA after lobectomy. METHODS: Sixty five patients, who underwent lobectomy and received a mixture of 0.18% ropivacaine at 0.5 microgram/kg/hr of fentanyl (2,000 microgram) via thoracic epidural catheter. The study design was a prospective, randomized, double-blinded, placebo-controlled study. Group C was saline control group. In Group A or B, Nasea(R) (ramosetron) or Zofran(R) (ondansetron) was administered as an intravenous bolus at completion of operation. We assessed the frequency and severity of PONV at 6, 24, 48 hours after anesthesia. Postoperative pain was assessed 6 hr after the operation and everyday for 6 days on visual analog scale (VAS). Postoperative side effects and patient satisfaction for epidural analgesia were assessed by 4 grades. RESULTS: PONV occurred in 20%, 20%, and 35% of patients in Group A, B, and C at 6 hr after anesthesia, and 12%, 30%, and 30% at 24 hr after anesthesia. There were no significantly statistical differences among three groups. The VAS scores during coughing were higher than those of resting state without intergroup difference. There were no serious clinical adverse events caused by the study drug and epidurally administered drugs in any study groups. CONCLUSIONS: This study found that ramosetron and ondansetron for preventing PONV during epidural PCA after lobectomy was not different from placebo control.
Analgesia, Epidural* ; Analgesia, Patient-Controlled ; Anesthesia ; Catheters ; Cough ; Fentanyl ; Humans ; Ondansetron ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Postoperative Nausea and Vomiting ; Prospective Studies ; Thoracotomy* ; Visual Analog Scale

No abstract available.
Gastrointestinal Tract* ; Radionuclide Imaging*

MRSA strains cause serious nosocomial infections. The rate of MRSA among Staphylococcus aureus isolated in Korea is about 70 - 80%. The treatment for MRSA infection is vancomycin. But vancomycin has several side effects and its therapeutic rate is 60 - 75%. Therefore the disinfectants play an important role in preventing and treating MRSA infection. In this study, 44 MRSA isolates were obtained from Wonkwang University Hospital, and examined for the efficacy of disinfectants commonly used in hospital. The tested disinfectants were chlorohexidine (Hibitan(R)), H2O2, tego, Gentian Violet, potadine, chlorohexidine gluconate (Microshield(R)), boric acid, alcohol, zepanon, acetic acid, and combinations of these disinfectants. MRSA studied were killed after exposure to chlorohexidine gluconate (Microshield (R)), alcohol, zepanon, alcohol+potadine, and alcohol+Gentian Violet within 30 seconds. But, tego, boric acid, and Gentian Violet+acetic acid could not kill MRSA after 30 minutes. Agar dilution minimal inhibitory concentration test was done with cephalothin, ciprofloxacin, clindamycin, erythromycin, fusidic acid, gentamicin, mupirocin, oxacillin, penicillin G, rifampin, tetracycline, and vancomycin. We found that bactericidal activity of vancomycin, fusidic acid, and mupirocin were good. In conclusion, this study provided useful information: 75% alcohol is the best disinfectant for wound dressing, 4% chlorohexidine gluconate(Microshield(R)) is useful for hand washing, and zepanon is useful for ward cleansing. Vancomycin-resistant Staphylococcus aureus was not found in our study.
Acetic Acid ; Agar ; Anti-Bacterial Agents* ; Bandages ; Cephalothin ; Ciprofloxacin ; Clindamycin ; Cross Infection ; Disinfectants* ; Erythromycin ; Fusidic Acid ; Gentamicins ; Gentian Violet ; Gentiana ; Hand Disinfection ; Korea ; Methicillin-Resistant Staphylococcus aureus* ; Mupirocin ; Oxacillin ; Penicillin G ; Rifampin ; Staphylococcus aureus ; Tetracycline ; Vancomycin ; Viola ; Wounds and Injuries

BACKGROUND: Rheumatoid arthritis(RA) is a systemic disease not infrequently involing the heart. It has been known that pericardial effusion, most commonly observed cardiac abnormality in patients with RA, and other cardiac manifestations such as conduction disturbances, valve thickenings, and enlargement of left atrium or aorta are associated with RA. We have determined the nature and extent of cardiac manifestations of RA in comparison with those of control group by echocardiographic examination. METHOD: 27 patients with RA(4 males and 23 females, mean age=47 +/-13 years) and 22 control subjects(3 males and 19 females, mean age+43 +/- 11 years) were randomly selected. Standard two-dimensional, M-mode and doppler echocardiographic examination were done on each group of subjects. RESULTS: 1) Pericardial effusions were more commonly detectd in patients with RA than control group(55.6% vs 22.7%, p<0.01). There were no significant differences in the amount of pericardial effusion according to the duration and the stage of RA. 2) Thickness of each cardiac valve was thicker in patients with RA than control group. But, there were no statistical significance between them. 3) The left ventricular mass index(LVMI) and the diameter of aorta showed a trend to increase in patients with RA(109.5 +/-28.0 g/m(2) vs 94.2 +/-24.6 g/m(2), p=0.054). 4) The diameter of left atrium was more lager in patients with RA(35.1 +/- 4.0mm vs 31.6 +/- 4.5mm, p=o.005). 5) The E/A ratio of mitral valve was statistically significantly lower in patients with RA(RA:control=1.2 +/- 0.5 : 1.7 +/- 0.4, p=0.01). CONCLUSION: The asymptomatic patients with RA more frequently show cardiac abnormalities such as pericardial effusion, valve thickening, decrease of E/A ratio than control group. So two-dimensional echocardiography is necessary for early, noninvasive and accurate evaluation of asymptomatic cardiac abnormalities in patients with RA.
Aorta ; Arthritis, Rheumatoid ; Echocardiography ; Female ; Heart ; Heart Atria ; Heart Valves ; Humans ; Male ; Mitral Valve ; Pericardial Effusion

BACKGROUND: Primary coronary stenting results in reduced rates of reinfarction, recurrent ischemia, stroke and in-hospital mortality and may allow earlier hospital discharge compared with primary angioplasty for acute myocardial infarction(AMI). This study evaluated the hypothesis that primary coronary stenting, with subsequent discharge within 4 days after admission, is safe and cost-effective in low risk patients for AMI, prospectively. METHODS: The study group consisted of low risk patients after susccessful primary stenting with conventional transfemoral intervention for AMI. Low risk status required be met all the following criteria : age< or =75 years, no persistent arrhythmias, no recurrent ischemia and no symptomatic heart failure signs during admission after successful reperfusion. The total 41 patients were randomized into 2 groups{early discharge group(ED, hospital stay < or =4 days), N=25//conventional discharge group(CD, hospital stay > or =5 days), N=16}. Their demographic and angiographic characteristics, the rate of major adverse cardiac events, ejection fraction during 3 months, and total medical costs were analyzed. RESULTS: The 25 patients(61%) were discharged on day 3 or 4. The peak level of CK-MB were not significantly lower in early discharge group than conventional discharge group(ED/CD;112.4+/-67.3/153.3+/-76.9 U/L, p=0.089). Comparing to conventional discharge group, in-hospital costs were significantly lower in patients of early dicharge group(ED/CD;7,109,118+/-1,068,861/8,766,336+/-1,688,707, p=0.001). Major adverse cardiac events were similar in both group(ED/CD;16/25%, p=0.329). CONCLUSION: Early identificaton of low risk patients after successful primary stenting by transfemoral intervention for AMI allowed safe omission of the intensive care phase and noninvasive testing, and early hospital discharge, resulting in substantial costs savings.
Angioplasty ; Arrhythmias, Cardiac ; Heart Failure ; Hospital Mortality ; Humans ; Income ; Critical Care ; Ischemia ; Length of Stay ; Myocardial Infarction* ; Prospective Studies ; Reperfusion ; Stents* ; Stroke

BACKGROUND AND OBJECTIVES: Arrhythmia is known to be a major cause of death in acute myocardial infarction (AMI). Reperfusion arrhythmias (RA) may also occur during angioplasty or thrombolysis. As yet, the clinical significances of RA and angiographic characteristics of the patients who develop RA during primary angioplasty and stenting are not clearly defined. METHODS: The study group consisted of 60 patients treated with primary angioplasty or stenting for AMI (angioplasty 13, stenting 47 patients). The patients were classified into 2 groups according to RA [RA (-) N=36/RA(+) N=24]: demographic and angiographic characteristics including time to reperfusion and incidence of pre-infarct angina were analyzed. RESULTS: The RA occurred in 40% of patients undergoing primary angioplasty or stenting (24/60 patients). The minor arrhythmias were more common after reperfusion (transient bradycardia 14, accelerated idioventricular rhythm 11, premature ventricular contraction 4 cases): major arrhythmias were uncommon (ventricular tachycardia/fibrillation 5, asystole 1 case). In the two groups, baseline clinical characteristics were similar except for pain to reperfusion time [RA (-): RA (+)=490.8+/-291.7: 252.9+/-109.2 minutes, P=0.001]. There was a trend toward a greater incidence of RA in the right coronary infarct-related artery [RA (-): RA (+)=16.7: 41.7%, P=NS]. The RA occurred in totally occluded artery (TIMI 0) with a giant thrombus and first ballooning in 19/24 patients (79.2%). The RA disappeared with conservative managements including pacemaker insertion and cardiopulmonary resuscitation and there were no differences in major adverse cardiac events in the two groups during follow-up. CONCLUSIONS: These findings suggest that the RA are frequent events during primary angioplasty but unrelated to clinical and angiographic characteristics except for reperfusion time and do not influence short-term prognosis in AMI.
Accelerated Idioventricular Rhythm ; Angioplasty* ; Arrhythmias, Cardiac* ; Arteries ; Bradycardia ; Cardiopulmonary Resuscitation ; Cause of Death ; Follow-Up Studies ; Heart Arrest ; Humans ; Incidence ; Myocardial Infarction* ; Prognosis ; Prospective Studies* ; Reperfusion* ; Stents ; Thrombosis ; Ventricular Premature Complexes

Apolipoprotein (apo) E deficient mouse can produce reproducible fixed stenotic primary atherosclerotic lesion, which reveals failure to remodel of vascular lumen, in the ascending aorta, external carotid, common carotid, iliac, femoral and popliteal arteries. To evaluate the effect of drugs in regarding to both prevention of primary atherosclerotic lesion and vascular remodeling, a systematic analysis of distribution of atherosclerotic lesions was undertaken in chow-fed, 9-momth-old apo E deficient mice, which was administrated drugs including asprin, methotrexate, probucol, sulodexide, diltiazem, cilazapril, trimetazidine, molsidomine, pentoxiphylline and Ginexin (R) for 7 month from 3 month-old. On gross and microscopic examination, formation of primary atheroscleotic lesions could be delated and/or prevented patially by effets of these drugs. On morphometric examination, failure to remodel forming vascular stenosis could not be seen, though relatively mild atherosclerotic lesion occured at vascular tree. These data suggest that the stenotic process in advanced atherosclerotic vessels can be delayed and/or prevented by several drugs including methotrexate, probucol, sulodexide, diltiazem, cilazapril, trimetazidine, molsidomine, pentoxiphylline and Ginexin (R) in vivo state.
Animals ; Aorta ; Apolipoproteins ; Apolipoproteins E* ; Atherosclerosis ; Cilazapril ; Constriction, Pathologic ; Diltiazem ; Humans ; Infant ; Methotrexate ; Mice ; Mice, Knockout* ; Molsidomine ; Popliteal Artery ; Primary Prevention ; Probucol ; Trimetazidine