BACKGROUND: Almost all of the blood loss occurring postoperatively in total knee arthroplasty (TKA) is due to the use of an intraoperative tourniquet in all cases. So we tried having blood transfusions done, not by anesthesiologists intraoperatively but by orthopedic surgeons postoperatively. The purpose of this study is to analyze postoperative blood loss and transfusion practice in TKAs. METHODS: We analyzed retrospectively the medical records of 64 TKAs in 40 patients between March, 1997 and February, 1999. RESULTS: Six male and fifty-eight female patients were enrolled. Their mean preoperative, immediate postoperative, and post-transfusion hematocrit were 37.1+/- 3.4, 34.4+/- 3.3, and 34.4+/-3.9, respectively. The preoperative and post-transfusion hematocrit were measured in all cases, but immediate postoperative hematocrit was measured in only 21 cases, and the hematocrit of 17 among the 21 cases was over 32 percent. Drainage amount, for the 1st postoperative day were 843 328 ml, and the total drainage amount was 993+/-362 ml. The blood transfusion amount was 2.6+/-0.9 units. There were no statistically significant differences in preoperative hematocrit, immediate postoperative hematocrit, postoperative drainage amount and postoperative transfusion amount between the general and regional anesthetic group; Preoperative hematocrit did not statistically affect the postoperative transfusion amount, but the postoperative drainage amount was statistically associated with an increased postoperative transfusion amount. CONCLUSIONS: Based on these results, it was concluded that postoperative blood transfusion in TKA was to be done on the basis of clinical impressions of orthopedic surgeons in which postoperative drainage amount was the most important consideration. Therefore, postoperative transfusion should be based on appropriate transfusion guidelines and a careful clinical examination of the patient.
Arthroplasty* ; Blood Transfusion* ; Drainage ; Female ; Hematocrit ; Humans ; Knee* ; Male ; Medical Records ; Orthopedics ; Postoperative Hemorrhage ; Retrospective Studies ; Tourniquets

OBJECTIVE: The purpose of this study was to evaluate the relationship between uterine size and surgical outcomes in women undergoing total vaginal hysterectomy. METHODS: We reviewed the medical records of the 170 patients who underwent total vaginal hysterectomy from February 2001 to November 2003. These patients were stratified into two groups; Group I, patients with uterine weight of between 300 gm to 1000 gm; Group II, patients with uterine weight of <300 gm. The two groups were compared for ages, parity, uterine weight, previous abdominal operations, concurrent surgical procedures, postoperative discharge day, bleeding amount, perioperative hemoglobin concentration change and operative time. RESULTS: 1. There were no significant difference between the two groups with respect to postoperative discharge day, concurrent surgical procedures, bleeding amount and perioperative hemoglobin concentration change. 2. The rate of surgical complications were similar in the two groups (Group I 12.5%; Group II 13.1%) (P=.660). 3. Operative time for vaginal hysterectomy was slightly longer for women in Group I than Group II (Group I 78.4 +/- 27.1 minutes; Group II 62.9 +/- 22.7 minutes) (P=.176), but the difference between the two groups in operative time was not statistically significant. CONCLUSION: The vaginal hysterectomy is as safe and effective for the woman with enlarged uterus (300-1000 gm) as for the woman with uterine weight of <300 gm. Uterine enlargement (uterine weight > 300 gm) is not an absolute contraindication to vaginal hysterectomy.
Female ; Hemorrhage ; Humans ; Hysterectomy, Vaginal* ; Medical Records ; Operative Time ; Parity ; Postoperative Care ; Uterus

BACKGROUND: Intravenous patient-controlled analgesia (IV-PCA) is widely used because it is a simple, safe, and effective method for postoperative pain control. Controversies exist over the use of a continuous basal infusion in IV-PCA regarding its effectiveness. We evaluated the analgesic efficacy and side effects of PCA with basal infusion after gynecologic surgery and compared these results with PCA alone. METHOD: Eighty women undergoing elective gynecologic surgery under general anesthesia were studied. These patients were randomly assigned to receive either PCA alone (group 1) or PCA with basal infusion (group 2). Analgesic consumption, visual analogue scale (VAS) pain score, and side effects were assessed at postoperative 6 hours and 24 hours. RESULTS: In group 1, the amounts of analgesic used during the postoperative 6 hours and 24 hours were 15 +/- 5 and 30 +/- 13 ml, the median VAS pain score at postoperative 6 hours and 24 hours were 50 and 35 respectively. In group 2, the amounts of analgesic used during the postoperative 6 hours and 24 hours were 19 +/- 7 and 43 +/- 1 ml, the median VAS pain score at postoperative 6 hours and 24 hours were 50 and 38 respectively. The analgesic consumption during the postoperative 6 hours and 24 hours was significantly higher in group 2 than in group 1. There was no significant difference in median VAS pain score between the groups. There were no significant differences in incidence of side effects between groups. CONCLUSIONS: The use of a PCA with basal infusion appears to offer no clinical advantage over PCA alone.
Analgesia, Patient-Controlled* ; Anesthesia, General ; Female ; Gynecologic Surgical Procedures* ; Humans ; Incidence ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis*

BACKGROUND: Cholesterol plays an important role in the action of opioid analgesics, but its association with postoperative pain has not been clarified. Our study examined the association of pre- and postoperative total serum cholesterol (TSC), and change between the pre- and postoperative TSC levels with postoperative pain outcomes in patients with non-small cell lung cancer (NSCLC) who underwent video-assisted thoracoscopic surgery (VATS) lobectomy. METHODS: We retrospectively reviewed medical records of patients with NSCLC who underwent VATS lobectomy at the Seoul National University Bundang Hospital in South Korea. We sought to determine the association between preoperative TSC, TSC on postoperative day (POD) 0–1, and pre- and postoperative changes in TSC by comparing numeric rating scale (NRS) scores on POD 0, 1, and 2 and total morphine equivalent consumption on POD 0–2. Multivariate linear regression analyses were used, and P < 0.05 was considered statistically significant. RESULTS: A total of 1,720 patients with NSCLC who underwent VATS lobectomy were included in the analysis. The change in TSC, preoperative TSC, and postoperative TSC showed no associations with morphine equivalent consumption on POD 0–2 (P > 0.05). In addition, the changes in TSC, preoperative TSC, and postoperative TSC were not associated with postoperative NRS pain score on POD 0, 1, and 2 (P > 0.05). CONCLUSIONS Our results indicated that no significant association was observed between pre- and postoperative TSC level and postoperative pain outcome after VATS lobectomy of the lung.

BACKGROUND: Cholesterol plays an important role in the action of opioid analgesics, but its association with postoperative pain has not been clarified. Our study examined the association of pre- and postoperative total serum cholesterol (TSC), and change between the pre- and postoperative TSC levels with postoperative pain outcomes in patients with non-small cell lung cancer (NSCLC) who underwent video-assisted thoracoscopic surgery (VATS) lobectomy. METHODS: We retrospectively reviewed medical records of patients with NSCLC who underwent VATS lobectomy at the Seoul National University Bundang Hospital in South Korea. We sought to determine the association between preoperative TSC, TSC on postoperative day (POD) 0–1, and pre- and postoperative changes in TSC by comparing numeric rating scale (NRS) scores on POD 0, 1, and 2 and total morphine equivalent consumption on POD 0–2. Multivariate linear regression analyses were used, and P < 0.05 was considered statistically significant. RESULTS: A total of 1,720 patients with NSCLC who underwent VATS lobectomy were included in the analysis. The change in TSC, preoperative TSC, and postoperative TSC showed no associations with morphine equivalent consumption on POD 0–2 (P > 0.05). In addition, the changes in TSC, preoperative TSC, and postoperative TSC were not associated with postoperative NRS pain score on POD 0, 1, and 2 (P > 0.05). CONCLUSIONS: Our results indicated that no significant association was observed between pre- and postoperative TSC level and postoperative pain outcome after VATS lobectomy of the lung.
Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthesia ; Carcinoma, Non-Small-Cell Lung ; Cholesterol ; Humans ; Korea ; Linear Models ; Lung ; Medical Records ; Morphine ; Pain, Postoperative ; Retrospective Studies ; Seoul ; Thoracic Surgery ; Thoracic Surgery, Video-Assisted

Background: The aim of this study was to determine an intravenous dose of ketorolac providing augmentation of analgesia and lowering adverse events for patients using postoperative intravenous patient-controlled analgesia (IV-PCA) with morphine Methods: One hundred and ninety eight patients who underwent an elective gynecologic operation were allocated to one of seven groups (ketorolac 180 mg K6, ketorolac 150 mg + morphine 10 mg K5M1, ketorolac 120 mg + morphine 20 mg K4M2, ketorolac 90 mg + morphine 30 mg K3M3, ketorolac 60 mg + morphine 40 mg K2M4, ketorolac 30 mg + morphine 50 mg K1M5, morphine 60 mg M6). After a loading dose of 3 ml, the PCA was started at a setting of 1 ml per demand, with a 8 minute lockout interval and 5-h limit. Results: The total PCA volume was lower in the K3M3, K2M4 and M6 groups. Visual analogue scale pain scores were higher in the K6 and M6 groups. More additional analgesics were required in the K6, K5M1, K1M5 and M6 groups. More antiemetics were required in the M6 group, although the incidence of nausea/vomiting and pruritus was similar among the groups. The sedation scores were lower in the K6 group and higher in the M6 group, 6 h postoperatively; and higher in the M6 and K1M5 groups, 24 h postoperatively. Conclusions: The combination of morphine 30 mg and ketorolac 90 mg, or morphine 40 mg and ketorolac 60 mg in IV-PCA with a total volume of 60 ml, is more effective in analgesia and has less adverse events.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics ; Antiemetics ; Female ; Gynecologic Surgical Procedures* ; Humans ; Incidence ; Ketorolac* ; Morphine* ; Passive Cutaneous Anaphylaxis ; Pruritus

PURPOSE: The present study explores the expression rate of p53 mutation and the correlation between the expression of p53 protein and prognostic factors in medulloblastoma/ PNET (primitive neuroectodermal tumor). MATERIALS AND METHODS: We studied retrospectively 24 patients with medulloblastoma/ PNET, who were admitted in Dong-A University Hospital, Pusan National University Hospital and Inje University Pusan Paik Hospital from 1988 to 1995. Detection of p53 mutations was made by immunohistochemical staining of p53 protein on paraffin- embedded tissues. The correlation between the expression of p53 protein and prognostic factors was evaluated by the Spearman correlation analysis. RESULTS: p53 protein was expressed in 6 of 24 patients (25%). In 20 patients who could be evaluated for metastasis, 16 patients of M0, 1 patient of M1 and 3 patients of M2 were grouped by M stage, and the expression of p53 was detected in 1 of 16 M0 group (6.3%) and 3 of 3 M2 group (100%). p53 expression was significantly related to the M stage of medulloblastoma/PNET (r=0.73, p<0.001). The detection of p53 was not significantly associated with T stage, cellular differentiation and the relapse rate of medulloblastoma/ PNET. CONCLUSION: The immunohistochemical detection rate of p53 protein in medulloblastoma/ PNET was 25%. The expression of p53 protein was significantly related to the M stage, with higher expression rate in M2 group of medulloblsatoma/PNET.
Busan ; Humans ; Medulloblastoma ; Neoplasm Metastasis ; Neural Plate ; Neuroectodermal Tumors, Primitive ; Recurrence ; Retrospective Studies

Nineteen patients with previously untreated invasive squamous cell carcinoma of the uterine cervix were treated by irradiation alone at the Keimyung University Hospital from January, 1990 to July, 1991. The serial samplings of the tissue taken before and during radiation of the uterine cervix were studied by light and electron microscopic examination. Radiation-induced cellular changes, particularly nuclear degeneration was pronounced. The tumor invasion pattern remained unchanged but the number of mitosis and tumor cells decreased. The number of infiltrating inflammatory cells, multinucleated giant cells and karyolitic cells were increased with radiation. Fibrosis was also increased. Electron microscopically, the amount of tonofilament in the tissue samplings was increased in the postirradiated state, but the desmosomes were decreased in numbers. Fibroblasts began to appear after an irradiation dose of 2700cGy. After an irradiation dose of 3600cGy or more, tumor cells were nearly completely degenerated and displaced with mature fibrotic tissue. There was an increase of activated fibroblasts and collagen fibers but a decrease of inflammatory cells in the interstitial tissue. Swelling of the mitochondria and endoplasmic reticulum, loss of intercellular bridges and an increased number of secondary lysosomes were also found with radiation.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Collagen ; Desmosomes ; Endoplasmic Reticulum ; Female ; Fibroblasts ; Fibrosis ; Giant Cells ; Humans ; Intermediate Filaments ; Lysosomes ; Mitochondria ; Mitosis

Meigs' syndrome is defined as serous ascites and hydrothorax in association with a benign ovarian fibroma, thecoma, granulosa cell tumor; the ascites and hydrothorax must resolve fully after removal of the tumor. Pseudo-Meigs' syndrome refers to the same clinical features associated with other ovarian or gynaecological tumors. Although struma ovarii is associated with ascites in up to one third of cases it has only rarely been reported to cause Pseudo-Meigs' syndrome. We have experienced a case of Pseudo-Meigs' syndrome with an elevated CA 125 resulting from struma ovarii with a brief review of the concerned literatures.
Ascites ; Female ; Fibroma ; Granulosa Cell Tumor ; Hydrothorax ; Meigs Syndrome ; Struma Ovarii* ; Thecoma

No abstract available.
Calcium*