We developed the Tele-PACS of radiology, which uses the communication network as asymmetric satellite data communication system. The asymmetric satellite data communication system uses receive-only satellite links for data delivery and PSTN(Public Switched Telephone Network) modem or N-ISDN(Narrow-band Integrate Services Digital Network) for communication. The satellite communication linking we implemented showed the very high-speed performance compared to the terrestrial linking such as 28.8 kbps modem linking or 56Kbps linking. The satellite linking was 5-10 times faster than the terrestrial linking on the average. We developed the down-link system of satellite and the medical collaborative tools and the Web-based Image-viewer. We concluded that 1) Satellite networking is currently the cheapest and fastest solution for internet access. 2) Web-based Image-Viewer enables small size hospitals in rural area to connect to the central PACS easily and to retrieve the image data reliably. 3) The suggested teleradiology system using satellite networking could be adequate to the fast telemedicine and telecare for rural hospitals especially located in geographically isolated areas such as islands.
Hospitals, Rural ; Internet ; Islands ; Modems ; Satellite Communications ; Telemedicine ; Telephone ; Teleradiology

We developed the Tele-PACS of radiology, which uses the communication network as asymmetric satellite data communication system. The asymmetric satellite data communication system uses receive-only satellite links for data delivery and PSTN(Public Switched Telephone Network) modem or N-ISDN(Narrow-band Integrate Services Digital Network) for communication. The satellite communication linking we implemented showed the very high-speed performance compared to the terrestrial linking such as 28.8 kbps modem linking or 56Kbps linking. The satellite linking was 5-10 times faster than the terrestrial linking on the average. We developed the down-link system of satellite and the medical collaborative tools and the Web-based Image-viewer. We concluded that 1) Satellite networking is currently the cheapest and fastest solution for internet access. 2) Web-based Image-Viewer enables small size hospitals in rural area to connect to the central PACS easily and to retrieve the image data reliably. 3) The suggested teleradiology system using satellite networking could be adequate to the fast telemedicine and telecare for rural hospitals especially located in geographically isolated areas such as islands.
Hospitals, Rural ; Internet ; Islands ; Modems ; Satellite Communications ; Telemedicine ; Telephone ; Teleradiology

BACKGROUND: Nitric oxide (NO) is a simple molecule with a complex involvement in a wide variety of biologic functions. However, whether NO protects or aggravates brain injury is still controversial. This study was conducted to determine the effect of nitric oxide on the formation of brain edema resulting from a focal cryogenic injury in rats. METHODS: Thirty nine Sprague-Dawley rats (200~250 gm) were allowed food and water ad libitum. Anesthesia was induced in a specially designed plastic box with 5% halothane in oxygen. In experiment I (24 rats), animals were divided randomly into eight group (3 rats in each group) according to the decapitation time in control, 15, 30, 45, 60, 90, 120, and 180 min. Cryogenic injury was made by pouring liquid nitrogen to exposed temporo-parietal area through metal funnel for 60 seconds. After cryogenic injury, brain was quickly removed and cerebral hemispheres were seperated. Separated cerebral hemispheres were dried in a drying oven for 7 days at 60 degrees C. Cerebral water content was assessed by dry-weight method. In experiment II (15 rats), one subgroup (n=8) was control group, normal saline 0.5 ml was injected intraperitoneally 30 minutes before injury. the other (n=7) was experimental group, and a competitive nitiric oxide synthase inhibitor, N-nitro-L-arginine methyl ester (L-NAME), was given intraperitoneally 30 minutes before injury in a dose of 20 mg/kg. Body temperature was monitored during whole experiment. Ninety minutes after injury, brain was quickly removed and cerebral hemispheres were seperated. The cerebral water content of separated cerebral hemisphere was assessed by dry-weight method. RESULTS: In time courses of cryogenic brain edema of experiment I, the amount of brain edema was increased till 90 minutes after cryogenic brain injury and then decreased. In L-NAME group of ex-periment II, the amount of cerebral edema was not changed significantly (p<0.05). But, there was a tendency of decrease in brain edema formation in L-NAME group than control group. CONCLUSION: It was not proved that nitric oxide had a major role in the edema formation aftercryogenic brain injury, but it still seems that nitric oxide has at least partly involved in the pathogenesis of cerebral edema resulting from traumatic brain injury.
Anesthesia ; Animals ; Body Temperature ; Brain Edema ; Brain Injuries* ; Brain* ; Cerebrum ; Decapitation ; Edema* ; Halothane ; NG-Nitroarginine Methyl Ester ; Nitric Oxide* ; Nitrogen ; Oxygen ; Plastics ; Rats* ; Rats, Sprague-Dawley

PURPOSE: The purpose of present study is to analyze the incidence and the predisposing factors for postoperative complications that diabetes mellitus (DM) patients suffer after undergoing total hip arthroplasty. MATERIALS AND METHODS: Among the 379 patients who underwent primary cementless total hip arthroplasty from September 1998 to February 2007, fifty-nine patients (62 hips) who had DM were selected and the other 320 patients (378 hips) without DM were set as a control group to perform comparative analysis. The mean follow up period was 36 months (range, 12-117 months) and the mean age of patients was 55.5 years (range, 16-79 years). The preoperative and annual postoperative Harris Hip Score (HHS) and the postoperative complications were checked. We analyzed the factors that were associated with the incidence of postoperative complications in DM patients. RESULTS: The DM group had a higher incidence of urinary tract infection and a longer admission period than did non-DM group (p=0.001 and p=0.002). The HHS was 52 and 53 (p=0.185), respectively, for the DM patients and the non-DM patients preoperatively, and it was 93 and 95 (p=0.467), respectively, at the last follow up. The predisposing factors for postoperative complications in DM patients are a high hemoglobin A1c (HbA1c) level and comorbidities. CONCLUSION: Total hip arthroplasty in DM patients is associated with a higher incidence of postoperative complications and a prolonged admission period. A high HbA1c level and comorbidities are considered to have significant associations with these complications.
Arthroplasty ; Comorbidity ; Diabetes Mellitus ; Follow-Up Studies ; Hemoglobins ; Hip ; Humans ; Incidence ; Postoperative Complications ; Urinary Tract Infections

PURPOSE: The objective of our study was to compare preoperative "Monitor Templating" with postoperative results for total hip replacement and to investigate the accuracy of "Monitor Templating" that was carried out by monitoring with picture archiving communication system (PACS). MATERIALS AND METHODS: Forty five patients underwent primary cementless total hip replacements. For setting parameters, we located the 10cm rod placed in the medial thigh on anteroposterior view of both hips and in the anterior thigh on Lowenstein lateral view. We measured implant sizes and the predictive value of corrective change in leg length and horizontal offset, by using radiographs magnified 120% of the anteroposterior views of both hips and Lowenstein lateral view of PACS on 27 inch monitor. We examined the correlation between preoperative monitor templating and the actual implant size, postoperative leg length and horizontal offset difference. RESULTS: The preoperative monitor templating showed a high rate of coincidence with the actual implant size, the postoperative leg length, and the horizontal offset difference. The averages in accurate prediction were 98% in the acetabular cup, 98% in the femoral stem, 97% in the postoperative actual difference of leg length, and 97% in the horizontal offset. With regard to leg length discrepancy, the sick limb was on average 4.7 mm shorter and 0.5 mm longer postoperatively than the contralateral limb. The average ratio of horizontal offset of the sick limb to the contralateral limb was 94.6% preoperatively and increased to 97.8% postoperatively. CONCLUSION: Preoperative "Monitor Templating" using PACS images on 26 inch monitor is an easy and effective method for predicting implant size, correcting leg length discrepancy and restoring horizontal offset.
Arthroplasty, Replacement, Hip ; Extremities ; Hip ; Humans ; Leg ; Organothiophosphorus Compounds ; Thigh

PURPOSE: To demonstrate the capability of anterior segment optical coherence tomography (OCT), to evaluate central corneal thickness (CCT) and to compare the results with those by Orbscan II and standard ultrasound (US) pachymetry. METHODS: One examiner measured the CCT of 44 normal eyes of 22 subjects using anterior OCT, Orbscan II, and US pachymetry. Non-contact measurements by anterior segment OCT and Orbscan II were performed first, followed by contact measurements using US pachymetry. Three consecutive measurements were taken with each method and the mean values and correlations were analyzed. RESULTS: The mean value of the CCT was 531.45+/-32.90 micrometer with anterior OCT, 537.11+/-32.21 micrometer with Orbscan II, and 548.18+/-34.17 micrometer with US pachymetry. There was no statistically significant difference among the values obtained by the 3 instruments (P>0.05). CCT measurements by anterior segment OCT were highly correlated with Orbscan II and US pachymetry (P<0.001) measurements. CONCLUSION: CCT measurements by anterior segment OCT are highly correlated with Orbscan II or US pachymetry measurements. Using non-contact anterior segment OCT, a closer examination of the anterior segment including the cornea is possible. The measurement of the CCT using anterior segment OCT is applicable because result values are similar to measurements by Orbscan II or US pachymetry.
Cornea ; Tomography, Optical Coherence* ; Ultrasonography

Dextran 40, a polysaccharide with molecular weight of 40,000, has been used clinically for expansion of plasma volume, improvement of microcirculation in low flow states and thromboprophylaxis especially in major operation such as vascular and hip surgery. However severe anaphylactoid reaction to dextran 40 can occur rarely. We experienced a case of cardisc arrest due to a severe reaction of dextran 40 in a patient who underwent aortofemoral bypass surgery. The patient was resuscitated immediately and followed up carefully.
Dextrans* ; Heart Arrest ; Hip ; Humans ; Microcirculation ; Molecular Weight ; Plasma Volume

Dextran 40, a polysaccharide with molecular weight of 40,000, has been used clinically for expansion of plasma volume, improvement of microcirculation in low flow states and thromboprophylaxis especially in major operation such as vascular and hip surgery. However severe anaphylactoid reaction to dextran 40 can occur rarely. We experienced a case of cardisc arrest due to a severe reaction of dextran 40 in a patient who underwent aortofemoral bypass surgery. The patient was resuscitated immediately and followed up carefully.
Dextrans* ; Heart Arrest ; Hip ; Humans ; Microcirculation ; Molecular Weight ; Plasma Volume

BACKGROUND: Streptococcus viridans group (SVG) is the normal flora of the upper respiratory tract, skin and genitourinary tract, and is the major causative agent isolated in 30-40% of bacterial endocarditis patients. However, SVG has not been properly identified to the species level for lack of diagnostic system which enables the accurate identification of SVG. Poyart et al. have recently described the identification of SVG to the species level by DNA sequencing of superoxide dismutase gene (sodAint). Using this method, we report here the identification of SVG isolated from the patients in Seoul National University Hospital within recent 2 years. METHODS: According to the method by Poyart et al., a set of two oligonucleotides, D1 (5 '-CCI TAY ICI TAY GAY GCI YTI GAR CC-3 ') and D2 (5 '-ARR TAR TAI GCR TGY TCC CAI ACR TC-3 ') were used as PCR primers, and PCR products of 480-bp size were obtained. The PCR products purified by MicroSpin S-400 HR Column were sequenced using ABI-PRISM 3700 Sequence Analyzer. D1 and D2 were used as sequencing primers. The clinical isolates were respectively identified as the species showing the greatest sequence homology which was demonstrated by the BLAST program provided by NCBI(USA). RESULTS: Clinical strains isolated from 26 patients who had shown two or more positive blood cultures were analyzed by DNA sequencing of superoxide dismutase gene, which showed 6 strains of S. salivarius, five S. oralis, four S. sanguis, three S. pasteuri, three S. equisimilis, two S. gordonii, one S. constellatus, one S. luteciae, and one S. mitis. S. salivarius and S. sanguis were clearly discriminated, while S. equisimilis and S. pyogenes were not. Species identification results by conventional method seldom corresponded to those by DNA sequencing. Among 7 patients suspected to have bacterial endocarditis, S. sanguis were isolated in 4 patients, and S. gordonii, S. oralis, S. pasteuri in one, respectively. Among 17 patients with liver cirrhosis or cancer, S. salivarius were isolated in 6 patients, and S. oralis in four. CONCLUSIONS: In this study, we could identify the species of SVG isolated from the patients with bacteremia; S. sanguis were frequently isolated from patients with bacterial endocarditis, while S. salivarius from ones with malignancy. These results imply that a different group of underlying diseases could show correspondingly different group of SVG species which cause bacteremia, and we suggest that further pathophysiological study on the correlations between underlying disease and the species of SVG be performed.
Bacteremia ; Endocarditis, Bacterial ; Homosexuality, Male ; Humans ; Liver Cirrhosis ; Male ; Oligonucleotides ; Polymerase Chain Reaction ; Respiratory System ; Seoul ; Sequence Analysis ; Sequence Analysis, DNA ; Sequence Homology ; Skin ; Streptococcus* ; Superoxide Dismutase ; Viridans Streptococci*

BACKGOUND: Transfusion of red blood cells is a life saving measure in the management of a variety of surgical conditions. A guideline for blood transfusion during elective surgical procedure is necessary to reduce the risks of transfusion-associated complications, excessive blood bank workload, excessive blood request and overtransfusion, and the cost. From this, a program of quality assessment was adopted to improve blood transfusion practice and to establish the guideline for blood transfusion in elective surgery at Pusan National University Hospital. METHODS: Fifty-six patients undergoing elective surgery was divided 2 groups. Transfusion (T) group was 18 persons. Non-transfusion (NT) group was 38 persons. The preoperative, pre-transfusion, postoperative, and post-transfusion hemoglobin (Hb), hematocrit, mean arterial blood pressure (MAP), heart rate (HR), average amount of transfused red blood cell units, allowable blood loss, and the amount of infused crystalloids and colloids was estimated for 9 months in Pusan National University Hospital. RESULTS: There were no significant differences in Hb between T & NT group. Hb decreased significantly until postoperative 3rd day in NT group. Platelet count decreased in NT group on postop. 3rd day. There were no significant differences in MAP & HR. One-ninth of T group was overestimated blood loss & 18.4% of NT group was underestimated blood loss. One-third of transfusion patient were overtransfused & 36.2% of transfused RBC was unnecessary. Nearly 90% of patient was transfused packed RBC with FFP concurrently. CONCLUSIONS: To minimize overtransfusion, transfusion based on intraoperative hematocrit is necessary. If possible, single use of packed RBC is recommended when the blood loss is below allowable blood loss. In massive bleeding above allowable blood loss, combined administration of FFP and packed RBC or transfusion of whole blood will be better.
Arterial Pressure ; Blood Banks ; Blood Transfusion* ; Busan ; Colloids ; Erythrocytes ; Heart Rate ; Hematocrit ; Hemorrhage ; Humans ; Operating Rooms* ; Platelet Count ; Surgical Procedures, Elective