No abstract available.
Hip

The mechanism of forward blood flow during closed chest cardiac massage remains controversial. Two theories have been suggested: the cardiac pump theory and the thoracic pump theory. Case report is presented to illustrate the use of transesophageal echocardiography during cardiopulmonary resuscitation. The findings included right and left ventricular compression, closure of the mitral valve during compression, opening of the mitral valve during the release phase, and atrioventricular regurgitation during compression, indicating a positive ventricular-to-atrial pressure gradient. These findings suggest that direct cardiac compression was the predominant mechanism of forward blood flow during cardiopulmonary resuscitation in this patient. Transesophageal echocardiography offers a new approach for study of the flows and cardiac morphologic features during chest compressions in humans. An understanding of the actual mechanisms involved is necessary if improved cardiopulmonary resuscitative techniques are to be rationally developed for enhancing the outcome of resuscitation.
Cardiopulmonary Resuscitation ; Echocardiography* ; Echocardiography, Transesophageal ; Heart Massage* ; Humans ; Mitral Valve ; Resuscitation ; Thorax*

Pulmonary artery rupture with a flow-directed balloon tipped pulmonary artery catheter (Swan-Ganz catheter)is a rare complication with high mortality. This report concerns a case of this complication with hemothorax leading to fatal exsanguination. Emphasis is placed on the safety guidelines to prevent this. Also, possible causes and managements are presented. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained hemodynamic or respiratory changes.
Arteries* ; Catheters* ; Exsanguination ; Hemodynamics ; Hemoptysis ; Hemothorax ; Humans ; Mortality ; Pulmonary Artery ; Rupture*

Pulmonary artery rupture with a flow-directed balloon tipped pulmonary artery catheter (Swan-Ganz catheter)is a rare complication with high mortality. This report concerns a case of this complication with hemothorax leading to fatal exsanguination. Emphasis is placed on the safety guidelines to prevent this. Also, possible causes and managements are presented. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained hemodynamic or respiratory changes.
Arteries* ; Catheters* ; Exsanguination ; Hemodynamics ; Hemoptysis ; Hemothorax ; Humans ; Mortality ; Pulmonary Artery ; Rupture*

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

The bone mineral densities of 60 middle school boys were measured with dual photon absorptiometry to define the influence of Taekwon-Do. They were divided into Taekwon-Do and control group, each comprising 30 boys. The bone mineral densities of the head, trunk, pelvis, both upper and lower extremities, and body total were measured. The results were as follows. 1. The BMD of head was 1.668 ± 0.153 in Taekwon-Do and 1.554 ± 0.153 0.167 in control. It was significantly increased in aekwon-Do(p <0.05). 2. The BMD of trunk was 0.378 ± 0.153 0.044 in Taekwon-Do and 0.353 ± 0.153 0.053 in control. There was no significant difference(p >0.05). 3. The BMD of pelvis was 1.648 ± 0.153 0.112 in Taekwon-Do and 1.444 ± 0.153 0.215 in control. It was significantly increased in Taekwon-Do(p <0.005). 4. The BMD of right and left legs were 1.597 ± 0.153 0.118 and 1.579 ± 0.153 0.125 in Taekwon-Do and 1.425 ± 0.153 0.115 and 1.421 ± 0.153 0.113 in control group respectively. They were significantly increased in Taekwon-Do(p <0.005). 5. The BMD of right and left arms were 1.184 ± 0.153 0.090 and 1.178 ± 0.153 0.115 in Taekwon-Do and 1.056 ± 0.153 0.095 and 1.066 ± 0.153 0.097 in control group respectively. They were significantly increased in Taekwon-Do(p.<0.005). 6. The total body BMD was 0.932 ± 0.153 0.068 in Taekwon-Do and 0.846 ± 0.065 in control. It is significantly increased in Taekwon-Do(p<0.005). In conclusion, Taekwon-Do increases the total bone mineral density and the mineral densities of the head, pelvis and extremities but not that of trunk. It is thought that continued practice of Taekwon-Do throughout adult life might prevent the senile osteoporosis
Absorptiometry, Photon ; Adult ; Arm ; Bone Density ; Extremities ; Head ; Humans ; Leg ; Lower Extremity ; Miners ; Osteoporosis ; Pelvis

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

End-tidal (PETCO2) and arterial CO2, tensions (PaCO2) were measured in 66 anesthetized infants and children. 35 patients were under 7 year-old (group 1) and 31 patients were over 7 year-old (group 2). In both groups, differences between PETCO2, and PaCO2, were evaluated, and correlations between PETCO2, and PaCO2, were carried out. The children in group 1 had a PaCO2, (mean+/-S.D.) of 29.2+/-4.1mmHg and a PCO2, (mean+/-S,D.) of 29.2+4.1mmHg. The range of the PaCO2, and PETCO2 difference (P alpha-ETCO2) was from -1.0 to 1.2 mmHg. The children in group 2 had a PaCO2 (mean+/-S.D.) of 29.3+/-3.0 mmHg and a PETCO2 (mean+/-S.D.) of 29.3+/-4.0mmHg. The range of the P alpha-ETCO2 was from 1.9 to 2.5mmHg. The significant direct correlations between PaCO2 and PETCO2 in both groups (r=0.96,0.84, respec-tively) were defined. The difference between groups wasnt statistically significant. It is concluded that in normal infants and children during anesthesia, noninvasive measurement of PET CO2 can be used as a reliable estimate of PaCO2 and that PETCO2did not differ significantly from PaCO2.
Anesthesia ; Child* ; Humans ; Infant*

BACKGROUND: Hemodynamic instability is one of the main concerns for anesthesiologists during orthotopic liver transplantation (OLTX). The most troublesome event would be an increase of central venous pressure associated with sudden right ventricular (RV) filling without any change in heart contractility. An acute increase in RV outflow pressure depresses RV contractility and eventually causes overt RV failure. To avoid such disaster, it would be wise to evaluate right heart pressure/volume relationship and assess contractility when anticipating acute increase of pressure in right heart chamber. METHODS: RV function was assessed in 15 patients undergoing OLTX. RV function was monitored using an ejection fraction catheter and a monitor. Complete hemodynamic profile was obtained on regular intervals. Statistical analysis was performed using ANOVA for repeated measures. Correlation between variables were determined by simple regression analysis and ANCOVA. RESULTS: RV end-diastolic volume was in the range of supranormal values. No correlation was observed between right atrial pressure and RV end-diastolic volume index (RVEDVI). There was a significant correlation between stroke index and RVEDVI. RV ejection fraction and E-single were relatively constant throughout the procedure. There was weak negative correlation between E-signle and RVEDVI. CONCLUSION: RV function appeared to be well preserved during OLTX. However, RV contractility tends to decrease in response to RVEDV increase because RVEDV of endstage liver disease might increase to their maximal value. Right heart filling pressure was less reliable clinical indicator of RV preload.
Atrial Pressure ; Catheters ; Central Venous Pressure ; Disasters ; Heart ; Hemodynamics ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Myocardial Contraction ; Stroke

No abstract available.
Mitral Valve*