There are many hemodynamic and physiologic changes during liver transplantation much more than other surgical interventions. The oxygen delivery and oxygen consumption are af- fected by depressed hemodynamic and metabolic status during the operation. At the lower levels of oxygen present in venous blood, a linear relationship exists between saturation and tension. The use of fiberoptic oximetry system in conventional pulmonary artery flotation catheters has made the bedside application of this relationship of practical value in the continuous assessment of mixed venous oxygen saturation. This study was performed to determine changes in SvO2 and other variables of oxygen kinetics during canine OLT and study the correlation between SvO2 and cardiac output, SvO2 and oxygen consumption and oxygen utilization ratio. The continuous rnixed venous oxygen saturation and cardiac output by SO2/CO computer were monitored and the oxygen delivery, oxygen consumption and oxygen utilization ratio were calculated by arterial and venous blood gas analysis and modified Fick's equation during orthotopic liver transplantation in 20 dogs. The results were as follow as ; 1. There was no significant difference in tissue oxygen extraction between preoperative control and anhepatic phase, while cardiac output were decreased during anhepatic phase. 2. By utilizing centrifugal pump(venovenous bypass) oxygen delivery and oxygen utilization ratio were well maintained even though suppressed the change of oxygen delivery and oxygen consumption during anhepatic phase. 3. There was a significant decrease in SvO2 immediately after declamping the suprahepatic vena cava, whereas the oxygen utilization rate and oxygen consumption following reperfusion were significantly increased than just prior to reperfusion of transplanted liver. 4. A Statistically significant correlation was found between SvO2 and cardiac output, oxygen consumption in all surgical stages except reperfusion(CO;r=0.478, p<0.001, VO2,r=-0. 272, p=0.004), but their correlations were relatively poor. However, there was highly significant correlation among SvO2 and oxygen utilization ratio in all surgical stages(O2UR; r=- 0.834, P<0.001). In conclusion, continuous monitoring mixed venous oxygen via a fiberoptic pulmonary catheter could be used as the index for evaluation of hemodynamics and oxygen kinetics during canine OLT, but further research should be performed to determine whether these measurements indicate viability of the grafted liver.
Animals ; Blood Gas Analysis ; Cardiac Output ; Catheters ; Dogs ; Hemodynamics ; Kinetics ; Liver Transplantation* ; Liver* ; Oximetry ; Oxygen Consumption ; Oxygen* ; Pulmonary Artery ; Reperfusion ; Transplants

BACKGROUND: Transfusion-transmitted virus (TTV) and TTV-like mini virus (TLMV) are small DNA virus with single-stranded, closed circular, antisense genome infecting man. TTV and TLMV are trans-missible by transfusion. However there had been a few study about TTV prevalence and no study about prevalence in blood donors in Korea. There has been no study about the TTV and TLMV infection in blood products in Korea. The aim of this study was to gain the prevalence of two viruses in blood products. METHODS: A total of 150 plasma samples from blood products (each 50 units of Red blood cell, whole blood, and platelet concentrate) were tested. The samples are obtained from the segments of the blood products. TTV DNA was detected using polymerase chain reaction (PCR) with two sets of primers (A set and B set) and TLMV DNA was detected using nested PCR with primer set C. RESULTS: TTV DNA was detected in 85.3% (128/150) of blood products. TLMV DNA was detected in 41.3% (62/150) of blood products. Either TTV or TLMV was detected in a total of 140 blood products (92.3%) and both TTV and TLMV were detected in 50 products (33.3%). CONCLUSIONS: The blood products are frequently infected with TTV and (or) TLMV in Korea and they can be transmissible by blood products with high probability.
Blood Donors ; Blood Platelets ; DNA ; DNA Viruses ; Erythrocytes ; Genome ; Humans ; Korea ; Plasma ; Polymerase Chain Reaction ; Prevalence ; Torque teno virus*

Introduction: Thromboelastography (TEG) provides an overall assessment of the platelet-coagulation protein cascade interaction. The information generated from the TEG is rapidly obtained and made useful to guide replacement therapy. The purpose of this study was to evaluate the efficacy of the TEG as its guided blood replacement therapy and pharmacological therapy during liver transplantation. METHODS: This study was carried out in 13 consecutive patients who were subjected to TEG-guided replacement therapy during liver transplantation. A prepared mixture of blood products used for continuous replacement therapy was a fluid composed of red blood cells(2 units), fresh frozen plasma (2 units), and normal saline(500 ml). The pharmacological therapy was performed by comparing TEG of untreated blood and blood treated with antifibrinolytic and heparin neutralizing agent. Based on the findings of TEG, platelet concentrates were given. The TEG samples were obtained at various intervals. Additional TEG tracing was obtained as needed to see the effect of therapeutic intervention. RESULTS: In all patients the reaction time was kept in an acceptable range in the preanhepatic stage by administration of the mixture of blood products. Heparin-induced anticoagulation was observed in 3 cases in the anhepatic stage and in 11 cases upon reperfusion. Fibrinolysis was seen in all but one patients: 8% in the preanhepatic stage, 41% in the anhepatic stage, 69% at reperfusion, and 2% in the postanhepatic stage. Early and aggressive treatment with epsilon-aminocaproic acid effectively inhibited fibrinolysis without complications. Ten patients needed platelet transfusion in the postanhepatic stage with significant improvement in the TEG. CONCLUSIONS: The results of this study suggest that TEG monitoring and TEG-guided replacement and pharmacological therapy are clinically effective in maintaining blood coagulability.
Aminocaproic Acid ; Blood Platelets ; Fibrinolysis ; Heparin ; Humans ; Liver Transplantation* ; Liver* ; Plasma ; Platelet Transfusion ; Reaction Time ; Reperfusion ; Thrombelastography ; Transplantation

BACKGROUND: Liver transplantation (orthotopic) is considered as an important therapy for the end stage liver diseases, but because of the coagulopathies of these patients, the massive bleeding during the operation has been a disturbing problem. So, the role of blood bank has increasingly been important for the appropriate blood products supply for the operation. METHODS: The authors reviewed retrospectively the hospital records of 9 patients who had taken orthotopic liver transplantations (OLT) at the Seoul Paik Hospital from March, 1992 to November, 1994. RESULTS AND CONCLUSION: The mean operation time and hospitalization duration was 14.1 hours and 35.3 days, respectively. Intraoperatively, the operations required a mean of 2.4 units of whole blood (WB), 29.4 of red cells (RBCs), 32.0 of fresh frozen plasma (FFP), 17.5 of platelet concentrates (PLTs), and 4.1 of cryoprecipitates (CRYOs). During the entire hospital stay, a mean of 9.3 units of WB, 56.1 of RBCs, 108.3 of FFP, 210.8 of PLTs, and 5.6 of CRYOs were transfused.
Blood Banks ; Blood Platelets ; Hemorrhage ; Hospital Records ; Hospitalization ; Humans ; Length of Stay ; Liver Diseases ; Liver Transplantation* ; Liver* ; Plasma ; Retrospective Studies ; Seoul

BACKGROUND: The hepatitis B surface antibody (anti - HBs) level has been used as an indicator for protective immunity after vaccination. Various kinds of assay systems including EIA (Enzyme Immunoas-say) and MEIA (Microparticle enzyme immunoassay) have been used for the quantification of that antibody. Although most anti - HBs assay systems have been standardized based on the WHO reference preparations, and results of the assay systems are in good agreement for most of the serums that were examined, some discrepancies in the cases have been observed among the various assay systems. In this study, four kinds of anti - HBs assay systems were compared for relative qualitative and quantitative results based on mIU/mL unit. METHODS: Serum samples from five hundred visitors to the Health Care Center, Seoul Paik Hospital were assayed by Cobas Core Anti-HBs Quant EIA II (Roche), Enzygost Anti-HBs II (DADE Behring), AxSYM AUSAB (Abbott) and Elecsys Anti-HBs (Roche). RESULTS: The concordance rates among the 4 assay kits were 92.8% (464/500) and 75.6% (378/500) was positive (anti - HBs > or =10 mIU/mL) and 17.2% (86/500) were negative. Among 36 samples (7.2%) showing discrepant results, 23 samples (4.6%) were negative by AxSym or Behring or both and positive by Elecsys or Cobas Core or both. Most of the discrepant samples showed low-level reactive results in the range of 10 to 100 IU/L for the other assay kits, which showed positive results. Quantitative agreements between 2 assay systems gave linear correlation coefficients ranging from CONCLUSIONS: The quantification of anti - HBs can show various results according to the kind of assay kit used. Samples showing relatively low reactive results in the range of 10 to 100 mIU/mL when tested by Elecsys or Cobas Core should be especially interpreted cautiously because those same samples might be negative when tested by Behring or AxSYM.
Delivery of Health Care ; Hepatitis B* ; Hepatitis* ; Immunoenzyme Techniques ; Seoul ; Vaccination

PURPOSE: The aim was to investigate the effect of implant thread designs on the stress dissipation of the implant. MATERIALS AND METHODS: The threads evaluated in this study included the V-shaped, buttress, reverse buttress, and square-shaped threads, which were of the same size (depth). Building four different implant/bone complexes each consisting of an implant with one of the 4 different threads on its cylindrical body (4.1 mm x 10 mm), a force of 100 N was applied onto the top of implant abutment at 30degrees with the implant axis. In order to simulate different osseointegration stages at the implant/bone interfaces, a nonlinear contact condition was used to simulate immature osseointegration and a bonding condition for mature osseointegration states. RESULTS: Stress distribution pattern around the implant differed depending on the osseointegration states. Stress levels as well as the differences in the stress between the analysis models (with different threads) were higher in the case of the immature osseointegration state. Both the stress levels and the differences between analysis models became lower at the completely osseointegrated state. Stress dissipation characteristics of the V-shape thread was in the middle of the four threads in both the immature and mature states of osseointegration. These results indicated that implant thread design may have biomechanical impact on the implant bed bone until the osseointegration process has been finished. CONCLUSION: The stress dissipation characteristics of V-shape thread was in the middle of the four threads in both the immature and mature states of osseointegration.
Axis, Cervical Vertebra ; Finite Element Analysis ; Osseointegration

Trichobezoar usually occurs in patients who have trichotillomania combined with trichophagia. Bezoars can result in serious complications including gastric ulceration, bleeding, perforation and small bowel obstruction when undiagnosed. The three main venues of bezoar removal (chemical dissolution, endoscopic removal and surgical removal) are chosen mainly by the size and composition of the bezoar. Trichobezoars generally require endoscopic or surgical removal. An 8-year-old girl visited our emergency room with recurrent epigastric pain and vomiting. Gastroduodenoscopy showed a 2x10 cm trichobezoar causing pyloric obstruction. During endoscopic removal of trichobezoar, esophageal impaction occurred. The trichobezoar was pushed into the stomach and was removed through surgical gastrostomy under general anesthesia. We report this case as an instructive reference for the proper treatment of trichobezoar in children.
Anesthesia, General ; Bezoars ; Child ; Emergencies ; Gastrostomy ; Hemorrhage ; Humans ; Stomach ; Stomach Ulcer ; Trichotillomania ; Vomiting

No abstract available.
Diagnosis* ; Hemophilia A* ; Molecular Biology* ; Polymorphism, Restriction Fragment Length*

Endoscopic sinus surgery as a surgical technique for chronic sinusitis has become very popular. So, surgeons should be familiar with the structures and variation of the paranasal sinus to avoid the risks of endoscopic sinus surgery. Many investigations were performed to measure the sinus structure with CT and cadaver dissection. But, there were not to be performed precise measurements in paranasal sinus during operation. The authors measured the distance between anterior nares to intranasal structures such as uncinate process, bulla ethmoidalis, basal lamella, maxillary ostium, posterior wall of ethmoid sinus, anterior wall of sphenoid sinus and posterior wall of sphenoid sinus in 86 patients during endoscopic sinus surgery which were performed by one surgeon. The authors analyzed between measured distance in paranasal sinus and circumference and anteroposterior diameter of head using t-test. The results were as followed. 1) The distance from anterior nares to uncinate process was 45.3+/-2.8mm, to basal lamella 57.9+/-4.6mm, to maxillary ostium 48.3+/-4.7mm, to anterior wall of sphenoid sinus 69.9+/-3.6mm, and to posterior wall of sphenoid sinus 83.7+/-4.3mm. 2) There were no significant difference between sex, circumference and anteroposterior diameter of head.
Cadaver ; Endoscopes* ; Ethmoid Sinus ; Head ; Humans ; Nose* ; Paranasal Sinuses* ; Sinusitis ; Sphenoid Sinus

Otitis media with effusion(OME) is the most common cause of acquired hearing loss in children. Some children suffer from a chronic form of this disease known as chronic otitis media with effusion(COME), which is manifested by the retention of fluid and inflammatory products in the middle ear cleft and by the eustachian tube dysfunction. The etiology and pathogenesis of COME, however, have not been fully elucidated. Middle ear effusion(MEE) is a complex mixture of transudate, secretory products from glands of middle ear mucosa and products from inflammatory cells and infecting organisms. Recently, there has been a great interest in the pathogenetic roles of cytokines, a group of low molecular weight glycoproteins produced by macrophages, lymphocytes and other cells. Activities of cytokines include fever production, activation of osteoclasts, fibroblasts, phagocytes and cytotoxic cells, regulation of antibody formation and inhibition of growth of cartilage, bone and endothelial cells. In this study, we have utilized the reverse transcription polymerase chain reaction(RT-PCR) technique to determine accurately the existence of mRNAs for five cytokines in MEEs collected from 22 children with COME. Messenger RNAs for TNF-alpha, IL-1beta, IL-2 and IL-8 were detected in 68%, 86%, 59% and 95% of specimens, respectively, Interleukin-4 mRNA was absent in all the specimens. The persistent production of cytokines by the inflammatory cells in MEE of COME due to sustained presence of antigens or most-recent antigenic stimuli may play the central role in prolonged OME and responsible for the mucosal damage, bone erosion, fibrosis and resulting hearing loss seen in some cases of COME.
Antibody Formation ; Cartilage ; Child* ; Cytokines ; Ear, Middle ; Endothelial Cells ; Eustachian Tube ; Exudates and Transudates ; Fever ; Fibroblasts ; Fibrosis ; Glycoproteins ; Hearing Loss ; Humans ; Interleukin-2 ; Interleukin-4 ; Interleukin-8 ; Lymphocytes ; Macrophages ; Molecular Weight ; Mucous Membrane ; Osteoclasts ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; Phagocytes ; Reverse Transcription ; RNA, Messenger* ; Tumor Necrosis Factor-alpha