No abstract available.

BACKGROUND: The end-tidal carbon dioxide (ETCO2) is defined as a partial pressure of carbon dioxide at the end of an exhaled breath. And it has been found to correlate with cardiac output during cardiopulmonary resuscitation (CPR) in animal model. The purpose of this study is to determine that the assessment of ETCO2 could provide a highly sensitive predictor of return of spontaneous circulation (ROSC) during CPR. METHODS: Prospective, observational study was performed from Oct 1996 to Mar 1997 at the Severance hospital. All patients were endotracheally intubated and connected immediately to mainstream capnography sensor. We measured ETCO2 with Escort II model 20100 monitor(Medical Data Electronics, Inc, USA). It works on the principle of nondispersed infrared absorption with radiometric single beam optics. RESULTS: This study included 70 patients (52 were men) with a mean age of 54+/-15 years. ROSC was obtained in 43 patients. The initial ETCO2 averaged 15.5 +/-8.2 mmHg in survivors and 6.5+/-5.3 mmHg in nonsurvivors (p<0.01), and during the first 20 minutes of CPR, the maximal ETCO2 averaged 29.7+/-10.3 mmHg in survivors and 10.2+/-8.9 mmHg in nonsurvivors (p<0.01). ETCO2 was not significantly different in relation to initial rhythm, survival time after ROSC and possible cause of arrest. There is no cutoff value of ETCO2 satisfying greater than 90% of both sensitivity and specificity in predict ROSC. When maximal ETCO2 was less than 12 mmHg, we observed sensivity of 100% in predicting ROSC. CONCLUSION: Our results demonstrate that ETCO2 measurement represents a valuable, noninvasive, and clinical tool for monitoring patients during CPR.
Absorption ; Capnography ; Carbon Dioxide* ; Carbon* ; Cardiac Output ; Cardiopulmonary Resuscitation* ; Humans ; Models, Animal ; Observational Study ; Partial Pressure ; Prospective Studies ; Sensitivity and Specificity ; Survivors

Heart transplantation is an accepted procedure for treatment of end-staged cardiac failure. A return to near-normal quality on life can be expected in many patients with a nonrejecting cardiac allograft, and many of these patients will return to the operating room for noncardiac surgical procedures. Anesthesiologists should be alert to recognizing problems caused by the presence of infection in immunosuppressed patients, modes of presentation of rejection phenomena and how transplanted organs, notably significantly denervated ones, may behave and respond under the pathophysiologic circumstance that arise during surgery, resuscitation and intensive care. The use of regional techniques require adequate preloading to avoid exaggerated hypotension and aseptic technique to avoid infection. Hypobaric spinal anesthesia has some benefit. It does not depress cardiovascular and respiratory system and keep adequate venous return by trendelenberg position. We report herein a case of successfully undergone total hip replacement in a patient who had previously undergone orthotopic heart transplantation under hypobaric spinal anesthesia.
Allografts ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip ; Heart Failure ; Heart Transplantation ; Heart* ; Humans ; Hypotension ; Critical Care ; Operating Rooms ; Respiratory System ; Resuscitation

We evaluated clinical results and complications of LASIK using Technolas 217 C-LASIKTM excimer laser. This study included 102 patients(203 eyes) who had LASIK from March 1998 to February 1999 and followed up for at least 6months. Preoperative mean spherical equivalent was -3.99+/-1.198(SD), -7.928+/1.138(SD)and -11.92+/-1.060(SD)in each group I, II, III.The results at postoperative 6months were as following: 1. Mean spherical equivalent was -0 .44+/-0.410(SD), -0.34+/-0.500(SD), -0.37+/-0.430(SD)in each group I, II, III. 2. The 70 eyes(65%), 48 eyes(61%), 10 eyes(60%)in each group I, II, III were within+/-0.5D. 3. Mean uncorrected visual acuitywas 1.00+/-0.130(SD), 0.96+/-0.140(SD), 0.86+/-0.150(SD)in each group I, II, III. 4. Loss of best spectacle corrected visual acuity of two or more lines was 6 eyes(3%). Intraoperative complications was thin flap(5 eyes, 2.5%), flap tear(1 eyes, 0.5%)and postoperative complications was night glare and halo(58 eyes, 28.8%), punctate epithelial keratopathy(35 eyes, 12.3%)and interface foreign body(23 eyes, 11.3%). Above results suggests that myopic keratomileusis using Technolas 217 C-LASIKTM is a safe, effective way to correct myopia.
Glare ; Intraoperative Complications ; Keratomileusis, Laser In Situ* ; Lasers, Excimer ; Myopia ; Postoperative Complications ; Visual Acuity

Gastric cancer is the second most common cause of cancer-related death in the world. A growing body of evidence indicates that inflammation is closely associated with the initiation, progression, and metastasis of many tumors, including those of gastric cancer. In addition, approximately 60% of the world's population is colonized by Helicobacter pylori, which accounts for more than 50% of gastric cancers. While the role of inflammation in intestinal and colonic cancers is relatively well defined, its role in stomach neoplasia is still unclear because of the limited access of pathogens to the acidic environment and the technical difficulties isolating and characterizing immune cells in the stomach, especially in animal models. In this review, we will provide recent updates addressing how inflammation is involved in gastric malignancies, and what immune characteristics regulate the pathogenesis of stomach cancer. Also, we will discuss potential therapeutics that target the immune system for the efficient treatment of gastric cancer.
Adaptive Immunity/*immunology ; B-Lymphocytes/immunology ; Cytokines/immunology ; Gastritis/immunology ; Helicobacter Infections/immunology ; Helicobacter pylori/immunology ; Humans ; Immunity, Innate/*immunology ; Immunotherapy/methods ; Receptors, Cytokine/immunology ; Stomach Neoplasms/diagnosis/*immunology/therapy ; T-Lymphocytes/immunology ; Tumor Microenvironment/*immunology

The purpose of this retrospective study was to evaluate the morphology of the intercondylar notch of the knee in 72 anterior cruciate ligament (ACL) intact group and 30 acute and chronic ACL tear group by plain radiographs and MRI, and to find the predisposing factors of ACL tear. The ACL tear group was divided into acute and chronic ACL tear group. In plain lateral radio-graphs, beta angle, angle between extension line from anterior cortical line of distal femur and from Blumensaat s line, was measured. In magnetic resonance imaging, the width of intercondylar notch (NB), the widest width of both femoral condyle (NW), intercondylar notch width from lower one third point of notch basal line (NB1), intercondylar notch width from upper one third point of notch basal line (NB2), depth of intercondylar notch from notch basal line (ND), and intercondylar angle which made from both end point of notch basal line and apex of intercondylar notch (alpha) were measured. Three groups were compared with each other by statistical analysis. Stastistically, the acute ACL tear group had narrow upper portion of intercondylar notch than chronic ACL tear group and more acute angle of roof of the intercondylar notch than intact ACL group. So in notchplasty, the upper one-third of intercondylar notch should be carefully widened. And after fixation of femoral interference screw, arthroscopic observation should be done whether reconstruced graft touchs the roof of the intercondylar notch during the extension of the knee.
Anterior Cruciate Ligament ; Causality ; Femur ; Knee ; Magnetic Resonance Imaging* ; Retrospective Studies ; Transplants

Nutcracker syndrome consists in the compression of the left renal vein by an aortomesenteric clamp. This results in left renal venous hypertension leading to the development of collateral veins with intrarenal and perirenal varicosities which can cause hematuria. The main presenting symptom is hematuria with or without left flank pain. It responds successfully to surgical treatment. We report a case of anesthesia for a nutcracker syndrome patient.
Anesthesia ; Flank Pain ; Hematuria ; Humans ; Hypertension ; Renal Veins ; Veins

No abstract available.
Krukenberg Tumor*

The occurrence of the colonic obstruction secondary to colorectal carcinoma (CRC) has been reported in 7~30% of the CRC patients. It is generally believed that obstructive CRC is associated with a poor prognosis with respect to operative mortality and five-year survival. A series of 1064 cases of the CRC treated surgically at Asan Medical Center from June 1989 to December 1996 has been analyzed to compare clinicopathological findings between obstructive and non-obstructive CRC and to evaluate surgical treatment options in obstructive CRC. Complete obstruction was present in 49 cases (4.6%). There were no differences between obstructive and non-obstructive CRC in tumor location, size, Dukes' stage, and differentiation. In forty-nine obstructive CRC cases, primary resections were performed in 29 cases after peri-operative bowel decompression. In this group, right colon cancer was more prevalent than staged operation group (45% vs. 5%, P<0.05) and hospital stay was significantly short (16 days vs. 38 days, P<0.05). Postoperative complication rate was higher in staged operation group (65% vs. 28%, P=0.01). It may be due to stoma related wound complication. In obstructive left colon cancer, there was a significant difference in complication rate between primary resection and staged operation (P<0.05). Overall 5-year survival rate were 66% and 53% in non-obstructive and obstructive group, respectively. Survival rate according to the Dukes' B and C stages did not show statistical differences, either. Conclusively, primary resection is preferred to the obstructive CRC when supportive care, preoperative bowel decompression, and intraoperative colonic irrigation were performed adequately.
Chungcheongnam-do ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Decompression ; Humans ; Length of Stay ; Mortality ; Postoperative Complications ; Preoperative Care ; Prognosis ; Survival Rate ; Wounds and Injuries

Hereditary hemorrhagic telangiectasia(Osler-Rendu-Weber Syndrome) is characterized by telangiectasia of the skin and mucous membranes and intermittent bleeding from vascular abnormalities. About 20% of patients with this is syndrome have pulmonary arteriovenous fistulas. Pulmonary arteriovenous fistula is uncommon malformation which has an abnormal connection between the pulmonary capillary bed, in which venous blind in the pulmonary artery is shunted through the fistula into the pulmonary vein without exposure to alveolar oxygen and result in unoxygenated, desaturated systemic arterial blood, polycythemia, cyanosis and clubbing. Death often results from cerebral abscess and rupture of the malformation with massive hemorrhage. Therapeutic intervention is recommended for all symptomatic patients because of the risk of those serious complications. Treatment options include surgery and transcatheter obliteration with steel coils or detachable balloons. Therapeutic embolization has the advantages that multiple bilateral pulmonary arteriovenous fistulas can be occluded and also that the procedure can be repeated if necessary. Recently we experienced a case of the multiple bilateral pulmonary arteriovenous fistulas associated with telangiectatic change of hepatic artery and multiple angiodysplasia on the gastric mucosa in 41 years old female patient who had mild dyspnea of exertion(NYHA class II), clubbing finger, severe iron deficiency anemia. She was treated with embolization technique using steel coils and iron replacement. After the therapeutic embolization, significant improvement of dyspnea of exertion with disappearance of multiple pulmonary nodule on follow-up simple chest x-ray was noted. During the subsequent six months follow-up period, she bad the improvement of symptoms arid iron deficiency anemia.
Adult ; Anemia, Iron-Deficiency ; Angiodysplasia ; Arteriovenous Fistula* ; Brain Abscess ; Capillaries ; Cyanosis ; Dyspnea ; Embolization, Therapeutic* ; Female ; Fingers ; Fistula ; Follow-Up Studies ; Gastric Mucosa ; Hemorrhage ; Hepatic Artery ; Humans ; Iron ; Mucous Membrane ; Multiple Pulmonary Nodules ; Oxygen ; Polycythemia ; Pulmonary Artery ; Pulmonary Veins ; Rupture ; Skin ; Steel ; Telangiectasia, Hereditary Hemorrhagic ; Telangiectasis ; Thorax