An accurate and relatively simple method for estimating the amount of acute blood loss is essential in the hemorrhagic shock patients. Conventional physiologic parameters, blood pressure, pulse rate and CVP, could not serve for evaluation of the adequate oxygen transport in the tissue. Pulmonary artery catheter is a best tool for evaluating the cardiopulmonary function and the oxygen transport system, and mixed venous oxygen saturation(SvO2) monitoring have made a great advances for early detection of cardiovascular dysfunction and the changes in peripheral tissue oxygenation. But pulmonary artery catheterization is complicated procedure in emergency setting. Although the central venous oxygen saturation(ScvO2) cannot completely replace the SvO2 value, it has a close relation with SvO2 change in variable clinical situations. We testify the usefulness of ScvO2 monitoring in 24 patients of the hemorrhagic shock. Initial resuscitation was performed with ATLS standard and continuous ScvO2 was monitored. Systolic blood pressure and pulse rate were recorded for one hour from initial resuscitation in each 15 minutes. Nineteen patient was traumatic hemorrhagic shock and five was non traumatic. Twelve of 19 patients was blunt trauma, and remains were stab in injury mechanism. Mortality rate was 29.2%. Initial ScvO2 of nonsurvivor was 43.6%, and 51.3% in survivor groups(p>0.05). In the group of stab wound and non-traumatic hemorrhage, the ScvO2 was gradually increase by time. But ScvO2 in survivors of blunt trauma was increased first 30 minutes and decrease afterthen. Continuous monitoring of ScvO2 may by partly useful in resuscitation for hemorrhagic shock. It is more valuable in the blunt trauma than in the penetrating injury or non-traumatic hemorrhage.
Blood Pressure ; Catheterization, Swan-Ganz ; Catheters ; Emergencies ; Heart Rate ; Hemorrhage ; Humans ; Mortality ; Oxygen* ; Pulmonary Artery ; Resuscitation ; Shock, Hemorrhagic* ; Survivors ; Wounds, Stab

Transrectal Ultrasonography (TRUS) easily provides an accurate assessment of the seminal tract. In Magnetic Resonance Imaging(MRI) of the seminal tract, the anatomic relationships are more clearly seen and the multiplanar imaging is available, so a more definitive diagnosis can be achieved. Although TRUS and MRI have been studied extensively, the findings of TRUS have not been compared with those of MRI. We studied 29 patients who were assessed with TRUS and MRI simultaneously due to disease of the seminal tract. The findings of cystic disease were coincident between TRUS and MRI. But the small size Mullerian duct cysts were not found in TRUS but were found in MRI. Hemorrhage of the ejaculatory duct and seminal vesicle, thickened ampulla portion of vas deferens were found only in MRI. Ejaculatory duct and seminal vesicle calcification were not easily found in TRUS due to their small size. The findings of seminal vesicle atrophy, dilatation and prostatic calcification between TRUS and MRI were discrepant. In conclusion, MRI is more helpful than TRUS in the diagnosis of small Mullerian duct cyst, small ejaculatory duct calculi, small seminal vesicle calculi, hemorrhage of ejaculatory duct and seminal vesicle and thickened ampulla portion of vas eferens.
Atrophy ; Calculi ; Diagnosis* ; Dilatation ; Ejaculatory Ducts ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Male ; Seminal Vesicles ; Ultrasonography* ; Vas Deferens

5-hydroxytryptamine (5-HT) containing pathways exert a inhibitory or facilitate effect on copulation. The administration of gamma aminobutyric acid (GABA) receptor agonists to the central nervous system in rats inhibits male copulatory behavior, whereas the administration of antagonists facilitates corpulatory behavior. GABA may influence the erection through dopaminergic pathway. But few about the effect of GABA on serotoninergic neuron are known. Raphe nuclei give rise to the major serotonergic innervation to the hippocampal formation and the GABAergic interneurons are located at the hippocampal formation also. This study was performed to investigate the influence of GABA, inhibitory interneuron, on the 5-HT release from rat hippocampal slices to understand the connection of the serotonergic neurons to GABAergic interneurons. The hippocampus was obtained from the male rat brain and sliced to a 400 Im thickness. After 30 minutes preincubation in the normal buffer, the slices were incubated for 20 minutes in a buffer containing 0.1 microM [3H]5-HT for uptake, and washed. After administration of GABA, the release of [3H] 5-HT into the buffer was measured and the radioactivities in each buffer and the tissue were counted using liquid scintillation counter and the results were expressed as a percentage of the total activity. Spontaneous release of [3H] 5-HT from the rat hippocampal slices decreased rapidly during the first 40 minutes of incubation. Through the rapid release of [3H] 5-HT, a steady state of [3H] 5-HT release was obtained from the 50 minutes of incubation. The value of released [3H] 5-HT after 50 minutes was expressed as percent of the value at 50 minutes. After administration of GABA (10(-4)M), the values (mean +/- SE) of released (3H)5-HT were 97.3 +/- 3.8% at 60 minutes and 91.2 +/- 3.4% at 70 minutes. The values of control group were 96.6 +/- 1.9% at 60 minutes and 89.6 +/- 2.3% at 70 minutes. There were no changes in the release of (3H)5-HT after administration of GABA. These results suggest that there are few connections between GABA and serotoninergic neurons and GABA does not influence the release of 5-HT in rat hippocampus.
Animals ; Brain ; Central Nervous System ; Copulation ; gamma-Aminobutyric Acid* ; Hippocampus ; Humans ; Interneurons ; Male ; Radioactivity ; Raphe Nuclei ; Rats ; Scintillation Counting ; Serotonergic Neurons ; Serotonin*

PURPOSE: The authors evaluated the 2-year clinical results of intravitreal bevacizumab injection in retinal vein occlusion (RVO). METHODS: Thirty-two eyes of 32 patients treated with an intravitreal bevacizumab injection of 1.25 mg (0.05 ml) for RVO (branch RVO: 22 eyes, central RVO: 10 eyes), repeated 3 times at a 6-week interval and were available for a follow-up period of at least 2 years were retrospectively reviewed. Best-corrected visual acuity (BCVA) before treatment and 6, 12, and 24 months after 3 serial injections, was recorded. The optical coherence tomography (OCT) results were analyzed to identify prognostic factors for recurrent macular edema that needed reinjection. RESULTS: Two years after the treatment, mean BCVA was significantly improved (p = 0.000). Out of 32 eyes, 16 (branch RVO: 8 eyes; central RVO: 8 eyes) needed reinjection because of recurrent macular edema. In central RVO, a significantly high reinjection rate was shown in serous retinal detachment (SRD) compared with cystoid macular edema (CME) as identified in OCT findings (p = 0.049). Additionally, in branch RVO, a high reinjection rate was shown in SRD, although statistically not significant (p = 0.375). CONCLUSIONS: In patients with RVO, a significant visual improvement was maintained for at least 2 years after intravitreal bevacizumab injection. Based on OCT results, SRD showed a high reinjection rate compared with CME in CRVO.
Antibodies, Monoclonal, Humanized ; Eye ; Follow-Up Studies ; Humans ; Macular Edema ; Retinal Detachment ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; Bevacizumab

BACKGROUND: In patients with chronic obstructive pulmonary disease(COPD), several factors have been associated with a poor prognosis. These include old age, low FEV, low diffusing capacity, high alveolar-arterial oxygen pressure difference, and finally cor pulmonale. This study was done to investigate in the ECG signs suggesting cor pulmonale were independent prognostic factors in patients with COPD. METHOD: We analyzed ECG, pulmonary function data and arterial blood gas values in 61 patients who were admitted through the emergency department with an acute exacerbation of COPD. The ECG signs reflecting cor pulmonale were right atrial overloading(RAO), right bundle branch block, right ventricular hypertrophy and low-voltage QRS. The 61 patients were divided into 2 groups, group I with no ECG signs(n=36) and group II with one or more ECG signs(n=25) suggesting cor pulmonale. RESULTS: Poor prognostic factors by univariate analysis were low FEV1, FEV1 % pred., VC% pred., DLco, DLco % pred., PaO2 and SaO2 high PaCO2 presence of ECG signs reflecting cor pulmonale, presence of mental status change, use of mechanical ventilator, and long tern use of glucocorticoid. A multivariate analysis indicated that age(risk ratio=1.13, 95% confidence interval 1.05~1.23), Dlco % pred. (risk ratio=0.97, 95% confidence interval 0.94~0.99), PaO2 (risk ratio=0.95, 95% confidence interval 0.90~0.99) and RAO(risk ratio=5.27, 95% confidence interval 1.40~19.85) were independent prognostic factors of survival. There was a significant difference in survival between the patients with and without RAO(p=0.038). The survival rates at 1, 2, and 5 years were 94.5%. 81.4%, and 50.0% in patients without RAO and 82.4%, 70.6%, and 27.5% in patients with RAO, respectively. CONCLUSION: These results suggest that the presence of ECG signs reflecting cor pulmonale is a predictor of survival and that RAO of these ECG signs is a significant independent predictor of survival in patients with COPD.
Animals ; Bundle-Branch Block ; Charadriiformes ; Electrocardiography* ; Emergency Service, Hospital ; Humans ; Hypertrophy, Right Ventricular ; Multivariate Analysis ; Oxygen ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Pulmonary Heart Disease* ; Survival Rate ; Ventilators, Mechanical

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer. About 74% cases of basal cell cancer occur on the head and neck. Basal cell carcinoma on the face may have a higher degree of subclinical spread than tumors arising elsewhere. And incompletely excised BCCs become more aggressive when they recur. So the surgical removal and reconstruction of BCC located on the face are important to make perfect curing and cosmetic results. METHODS: A retrospective study was done with 128 patients (137 cancers) who were treated with BCC on the face since 1987 to 2011. General data of these cases such as the primary site of cancer, age and sex of the patients, operative methods, and recurrence rate were reviewed. RESULTS: The ratio of men to women was 1:1.4. And 86.9% of the patients with BCC were older than the age of 50 years with the mean age of 65.8 years. The distribution of facial basal cell carcinoma was on the nose, eyelids, cheek, and nasolabial fold. Surgical methods for treatment were local flap, full thickness skin graft, primary closure, and split thickness skin graft. Specifically, local flap consists of V-Y advancement flap, cheek advancement flap, limberg flap, forehead flap, nasolabial flap, rotation flap, transposition flap, bilobed flap, and island flap. Six cases recurred and all of them were treated with reoperation. CONCLUSION: The authors reviewed facial basal cell carcinoma cases in our hospital. This study might be helpful to choose appropriate operation method to manage BCC on face in Korea.
Carcinoma, Basal Cell* ; Cheek ; Eyelids ; Female ; Forehead ; Head ; Humans ; Korea ; Male ; Nasolabial Fold ; Neck ; Neoplasms, Basal Cell ; Nose ; Recurrence ; Retrospective Studies ; Skin ; Skin Neoplasms ; Transplants

Purpose: Several studies have evaluated the impact of sarcopenic obesity (SO) on postoperative complications, including postoperative pancreatic fistula (POPF), in patients undergoing pancreatoduodenectomy (PD). Previous studies have shown that SO increases POPF, but it remains unclear whether SO increases postoperative complications. In this study, we aimed to determine the relationship between SO and immediate postoperative complications. Methods: From January 2005 to December 2019, the medical records of patients who underwent PD for periampullary cancer were retrospectively reviewed. Skeletal muscle index (SMI) and visceral fat area (VFA) were calculated from preoperative computed tomography images. Patients with high VFA were classified as obese, while those with low SMI were classified as sarcopenic. Patients were divided into 4 groups: normal group, sarcopenia only group, obesity only group, and SO group. Postoperative outcomes were compared between groups, and factors affecting postoperative complications were analyzed by multivariate analysis. Results: Normal group (n = 176), sarcopenia only group (n = 130), obesity only group (n = 207), and SO group (n = 117) were analyzed retrospectively. SO group had significantly more frequent major complications compared to the normal group (P = 0.006), as well as a significantly more frequent clinically relevant POPF compared to the other groups (P = 0.002). In multivariate analysis, SO was an independent risk factor for major complications (P = 0.008) and clinically relevant POPF (P = 0.003). Conclusion SO is a factor associated with poor immediate postoperative outcomes after PD for periampullary cancer.

Purpose: Several studies have evaluated the impact of sarcopenic obesity (SO) on postoperative complications, including postoperative pancreatic fistula (POPF), in patients undergoing pancreatoduodenectomy (PD). Previous studies have shown that SO increases POPF, but it remains unclear whether SO increases postoperative complications. In this study, we aimed to determine the relationship between SO and immediate postoperative complications. Methods: From January 2005 to December 2019, the medical records of patients who underwent PD for periampullary cancer were retrospectively reviewed. Skeletal muscle index (SMI) and visceral fat area (VFA) were calculated from preoperative computed tomography images. Patients with high VFA were classified as obese, while those with low SMI were classified as sarcopenic. Patients were divided into 4 groups: normal group, sarcopenia only group, obesity only group, and SO group. Postoperative outcomes were compared between groups, and factors affecting postoperative complications were analyzed by multivariate analysis. Results: Normal group (n = 176), sarcopenia only group (n = 130), obesity only group (n = 207), and SO group (n = 117) were analyzed retrospectively. SO group had significantly more frequent major complications compared to the normal group (P = 0.006), as well as a significantly more frequent clinically relevant POPF compared to the other groups (P = 0.002). In multivariate analysis, SO was an independent risk factor for major complications (P = 0.008) and clinically relevant POPF (P = 0.003). Conclusion SO is a factor associated with poor immediate postoperative outcomes after PD for periampullary cancer.

Purpose: Several studies have evaluated the impact of sarcopenic obesity (SO) on postoperative complications, including postoperative pancreatic fistula (POPF), in patients undergoing pancreatoduodenectomy (PD). Previous studies have shown that SO increases POPF, but it remains unclear whether SO increases postoperative complications. In this study, we aimed to determine the relationship between SO and immediate postoperative complications. Methods: From January 2005 to December 2019, the medical records of patients who underwent PD for periampullary cancer were retrospectively reviewed. Skeletal muscle index (SMI) and visceral fat area (VFA) were calculated from preoperative computed tomography images. Patients with high VFA were classified as obese, while those with low SMI were classified as sarcopenic. Patients were divided into 4 groups: normal group, sarcopenia only group, obesity only group, and SO group. Postoperative outcomes were compared between groups, and factors affecting postoperative complications were analyzed by multivariate analysis. Results: Normal group (n = 176), sarcopenia only group (n = 130), obesity only group (n = 207), and SO group (n = 117) were analyzed retrospectively. SO group had significantly more frequent major complications compared to the normal group (P = 0.006), as well as a significantly more frequent clinically relevant POPF compared to the other groups (P = 0.002). In multivariate analysis, SO was an independent risk factor for major complications (P = 0.008) and clinically relevant POPF (P = 0.003). Conclusion SO is a factor associated with poor immediate postoperative outcomes after PD for periampullary cancer.

Purpose: Several studies have evaluated the impact of sarcopenic obesity (SO) on postoperative complications, including postoperative pancreatic fistula (POPF), in patients undergoing pancreatoduodenectomy (PD). Previous studies have shown that SO increases POPF, but it remains unclear whether SO increases postoperative complications. In this study, we aimed to determine the relationship between SO and immediate postoperative complications. Methods: From January 2005 to December 2019, the medical records of patients who underwent PD for periampullary cancer were retrospectively reviewed. Skeletal muscle index (SMI) and visceral fat area (VFA) were calculated from preoperative computed tomography images. Patients with high VFA were classified as obese, while those with low SMI were classified as sarcopenic. Patients were divided into 4 groups: normal group, sarcopenia only group, obesity only group, and SO group. Postoperative outcomes were compared between groups, and factors affecting postoperative complications were analyzed by multivariate analysis. Results: Normal group (n = 176), sarcopenia only group (n = 130), obesity only group (n = 207), and SO group (n = 117) were analyzed retrospectively. SO group had significantly more frequent major complications compared to the normal group (P = 0.006), as well as a significantly more frequent clinically relevant POPF compared to the other groups (P = 0.002). In multivariate analysis, SO was an independent risk factor for major complications (P = 0.008) and clinically relevant POPF (P = 0.003). Conclusion SO is a factor associated with poor immediate postoperative outcomes after PD for periampullary cancer.