No abstract available.
Gaucher Disease*

BACKGROUND: Central nervous system dysfunction continues to be a major cause of morbidity after aorta and cardiac surgery under cardiopulmonary bypass (CPB). Pupillary reflexes are important component of the neurologic examination. The purpose of this study was to evaluate how the pupil reacts during hypothermic CPB under fentanyl anesthesia and its relation with postoperative neurologic deficits. METHODS: Fourteen patients undergoing ascending aortic dissection or aneurysm repair surgery under profound hypothermic CPB and circulatory arrest were enrolled. Pupil size and light reflex were evaluated at varying stages of CPB and temperatures. Temperatures were measured at different sites of perfusate, nasopharynx and rectum. Postoperatively neurologic assessments were performed to compare with the pupillary signs. RESULTS: Anesthetic induction with fentanyl decreased pupil size to pinpoint. Pupil dilated progressively under hypothermic CPB reaching fully dilated size at profound hypothermia. Rewarming returned the pupil to original size. Nasopharyngeal temperature correlated well with pupil size during cooling and rewarming. Light reflex was absent at any stage or temperature after anesthetic induction. Seven patients showed insignificant anisocoria and two died of other causes than neurologic deficit. One patient who was not in the anisocoria group exhibited delirium. CONCLUSIONS: Profound hypothermic CPB under fentanyl anesthesia dilates the pupil to a maximum size without light reflex overwhelming narcotic effect. Fully dilated pupil does not denote neurologic damage.
Anesthesia* ; Aneurysm ; Anisocoria ; Aorta ; Cardiopulmonary Bypass* ; Central Nervous System ; Delirium ; Fentanyl* ; Humans ; Hypothermia ; Narcotics ; Nasopharynx ; Neurologic Examination ; Neurologic Manifestations ; Pupil* ; Rectum ; Reflex ; Reflex, Pupillary ; Rewarming ; Thoracic Surgery

BACKGROUND: We examined the ability of thiopental known to have protective effect on brain to prevent brain damage resulting from cerebral ischemia due to global imbalance in cerebral metabolic rate for oxygen and cerebral blood flow during rewarming period in cardiopulmonary bypass. METHODS: Jugular venous oxygen saturation(SjO2) was used as a reflection of cerebral oxygen balance. Thiopental 20 mg/kg(thiopental 10 mg/kg bolus and 10 mg/kg continuous infusion) was received during rewarming from hypothermic cardiopulmonary bypass of 27~30.5degrees C to 36degrees C and SjO2 compared with control group. RESULTS: In 8 patients of the 25 control group(32%) and 7 patients of the 24 thiopental group(29.2%), SjO2 were < or =50% with no difference between groups. Artery-jugular vein oxygen content differences (C(a-j)O2) and O2 extraction ratios increased significantly in SjO2 < or =50% patients suggesting increased oxygen consumption. Awake time prolonged significantly with thiopental. CONCLUSIONS: Thiopental(20 mg/kg) administration during rewarming in cardiopulmonary bypass for cerebral protection is not recommended.
Anesthetics ; Brain ; Brain Ischemia ; Cardiopulmonary Bypass* ; Heart ; Humans ; Oxygen Consumption ; Oxygen* ; Rewarming* ; Thiopental* ; Veins

No abstract available.
Cloning, Molecular* ; DNA* ; Helicobacter pylori* ; Helicobacter* ; Sequence Analysis, DNA* ; Urease*

Postoperative bleeding is a common complication in cardiac surgery using cardiopulmonary by- pass(CPB) and thrombocytopenia and platelet dysfunction, as well as inadequate surgical hemostasis are cited as a cause. To evaluate the effect of routine use of platelet to prevent postoperative bleeding, auther compared the patients with and without platelet administration of 1 unit/10kg. Routine coagulation tests(RCT) and Thromboelastographs were compared to evaluate the effects of CPB and platelet administration. Also postoperative bleeding amounts were compared. PT and aPTT of RCT were prolonged and fibrinogen was decreased after CPB with no effect with platelet administration. Platelet count was decreased after CPB and recovered in number reaching the pre-CPB level with platelet. R, K, and a of TEG parameters showed no differences after CBP even with platelet. MA, the index of platelet function, remained in the normal range and became hypercoagulable with platelet administration. There was no difference in bleeding amounts between two groups. According to the results, routine administration of platelet after CPB in cardiac surgery is not recommended.
Blood Platelets* ; Cardiopulmonary Bypass* ; Fibrinogen ; Hemorrhage ; Hemostasis, Surgical ; Humans ; Platelet Count ; Platelet Transfusion ; Reference Values ; Thoracic Surgery* ; Thrombocytopenia

BACKGROUND: Improved diagnostic and therapeutic strategies for infective for infective endocarditis such as proposed diagnostic criteria, Duke criteria and echocardiography resulted to increased life-spans of patients. METHODS: Retrospective analysis of medical records including medical history, laboratory data such as echocardiographic data and blood culture, and clinical outcomes was done for 106 patients with clinical diagnosis of infective endocarditis at Seoul National University Hospital from January 1990 to May 2000. Then we analysed differences of clinical features between elderly patients aged > or =60-years and the adult patients aged <60-years with infective endocarditis. RESULTS: The elderly patients >or=60-year are cases of 14%(15/106) and the mean ages are 67+/-8 years in elderly patient, 38+/-12 years in the adults patients respectively. Valvular heart disease was the most common predisposing heart disease with 9 cases(40%) followed by prosthetic valve endocarditis 2 cases (13%) in elderly patients, and there was no significant difference of frequencies with adult patients (valvular heart diseases, 33%; prosthetic valvular heart diseases, 25%). Although culture positive rates were not different with two groups: 47%(7/15) in elderly patients and 45%(41/91) in adult patients, the most common pathogen was staphylococcal species in elderly patients(27%, 4/15) but streptococcus species, in the adult patients(25%, 26/106, p<0.05). The frequencies of embolic complication were not different between two groups(20%, 3/15 vs 22%, 20/91: Elderly vs adult, respectively), but congestive heart failure was more developed in elderly patients, 33%(5/15) than in adult patients, 10%(9/91, p<0.05). Surgical intervention was more required in the elderly(47%, 7/15) than in adult patients(22%, 20/91, p<0.05). Out of 106 patients, 11 died and the overall mortality was 10.4%(11/106). In-hospital death was more common in the elderly than in adult patients: 4 cases(27%) vs 8%(7/91), p<0.05. Determinants of in-hospital death were patients with 60 years of age and older, Staphylococcus aureus endocarditis, and the presence of congestive heart failure(p<0.05) in univariate analysis. CONCLUSION: Infective endocarditis in elderly patients(age> or =60) had more poor outcomes than adult patients(age<60) such as the development of congestive heart failure, the need of surgical intervention, and the high mortality rate.
Adult ; Aged* ; Diagnosis ; Echocardiography ; Endocarditis* ; Estrogens, Conjugated (USP) ; Heart ; Heart Diseases ; Heart Failure ; Heart Valve Diseases ; Humans ; Medical Records ; Mortality ; Retrospective Studies ; Seoul ; Staphylococcus aureus ; Streptococcus

No abstract available.
Intellectual Disability ; Rubinstein-Taybi Syndrome*

The incidence of tracheal stenosis is increased because of the longterm respiratory care with endotracheal intubation and tracheostomy. Present therapeutic modalities for the relief of an tracheal or bronchial stenosis include laser resection, radiotherapy, cryotherapy, bougienation, stent insertion, dilatation with balloon catheter and finally reconstruction surgery. However, reconstruction surgery have some problems in ventilation during anesthetic management. Small sized tube insertion through lesion, high frequency jet ventilation, cardiopulmonary bypass are served to resolve ventilatory problem. We experienced a case of severe tracheal stenosis due to tracheostomy. The stenotic lesion was 2.5 cm above the carina, 3 mm in diameter and length of the stenotic segment was 1 cm. We used bougienation with endotracheal tube replace obturator for the ventilation before the reconstruction surgery and the patient was successfully managed without complications.
Airway Management* ; Cardiopulmonary Bypass ; Catheters ; Constriction, Pathologic ; Cryotherapy ; Dilatation ; High-Frequency Jet Ventilation ; Humans ; Incidence ; Intubation, Intratracheal ; Radiotherapy ; Stents ; Trachea ; Tracheal Stenosis* ; Tracheostomy ; Ventilation

No abstract available.
Addison Disease*

Most loci associated with type 2 diabetes mellitus (T2DM) discovered to date are within noncoding regions of unknown functional significance. By contrast, exonic regions have advantages for biological interpretation.