Traumatic hemoperitoneum can still induce high mortality and morbidity rates, despite current method of intensive management. This study was performed to identify the independent prognostic factors in patients with traumatic hemoperitoneum. Two hundred thirty-six patients who underwent emergency operations because of traumatic hemoperitoneum at the Department of Surgery, Dong Kang General Hospital, Ulsan, from January 1986 to June 1994, were entered into this retrospective study. One hundred eighty-six patients were male, and fifty were female. The median age of the patients was 34 years (2 to 77 years). The modes of trauma were 131 motor-vehicle accidents, 43 fall down injuries, 30 stab injuries, 23 assaults, and 9 others . The common sites of injury were lthe iver and the spleen, followed by the mesentery, the stomach, the small bowels, the large bowels, the pancreas, the kidney, the diaphragm, and the retroperitoneum in order of frequency. Prognostic variables were identified from the perioperative parameters by using a univariate analysis(student t- test, chi-square test), and independent prognostic factors were determined by a multivariate stepwise logistic regression analysis, using the SPSS Win. Ver.5.0 PC package program. Statistical significance was present for p < 0.05. The overall postoperative morbidity and mortality rates were 34.3% and 19%, respectively. By using univariate analysis, the amount of bleeding, transfusion, and the immediate post-operative blood pressure were identified as significant prognostic factors for morbidity. Also age over 50, accompanying brain injury, time interval (less than 3 hrs), the systolic blood pressure on arrival (less than 100 mmHg), trauma score (less than 10), grade of liver injury (greater than IV), great vascular injury, total amount of resuscitative fluid (more than 4,000cc), the total amount of transfusion (more than 10 units), and the immediate postoperative systolic blood pressure (less than 100 mmHg) were identified as significant factors for mortality. Multivariate analysis demonstrated the following important independent prognostic factors : the total amount of transfusion for morbidity and mortality, and the post-operative blood pressure and trauma score for mortality. Our results suggest that early massive resuscitation, early operation to minimize the total amount of blood loss, and intensive immediate postoperative care to maintain blood pressure, are of utmost importance in multiple trauma patients with hemoperitoneum.
Blood Pressure ; Brain Injuries ; Diaphragm ; Emergencies ; Female ; Hemoperitoneum* ; Hemorrhage ; Hospitals, General ; Humans ; Kidney ; Liver ; Logistic Models ; Male ; Mesentery ; Mortality ; Multiple Trauma ; Multivariate Analysis ; Pancreas ; Postoperative Care ; Resuscitation ; Retrospective Studies ; Spleen ; Stomach ; Ulsan ; Vascular System Injuries

Eisenmenger's syndrome consists of high pulmonary vascular resistance with reversed or bidirectional shunt at aortopulmonary, ventricular, or atrial level. Noncardiac surgery for a patient with this syndrome is challenging because both the perioperative morbidity and mortality are high. We describe the anesthetic management of a 66-year-old female patient with Eisenmenger's syndrome secondary to the tetralogy of Fallot (TOF), who was operated on for the fractured neck of her left femur. Anesthesia was induced with etomidate and sufentanil and was maintained with propofol and sufentanil without any inhalational anesthetics (total intravenous anesthesia). To maintain the systemic vascular resistance, we administered norepinephrine throughout the surgery and the postoperative care. The patient was discharged 20 days after the operation without any complications.
Aged ; Anesthesia ; Anesthetics ; Eisenmenger Complex ; Etomidate ; Female ; Femur ; Humans ; Neck ; Norepinephrine ; Postoperative Care ; Propofol ; Sufentanil ; Tetralogy of Fallot ; Vascular Resistance

Diabetes insipidus caused by impaired production or reduced responses to vasopressin, can occasionally be seen postoperatively in neurosurgical patients, but rarely occurs during anesthesia and surgery. An 8-year old female patient with suprasellar germinoma was scheduled for tumor resection. Anesthesia was induced smoothly and maintained mainly with sevoflurane. Several hours after anesthesia and surgery, urine output was increased with increased serum sodium concentration, indicating the occurrence of diabetes insipidus. To prevent sodium increase and replace fluid loss, 2.5% dextrose half saline was used. Though sodium concentration did not increase further, the concomitant increase of glucose complicated anesthetic management. After the completion of anesthesia and surgery, serum sodium increased further but then gradually returned to normal with conservative management. The patient was discharged without any complications.
Anesthesia ; Brain ; Child ; Diabetes Insipidus ; Female ; Germinoma ; Glucose ; Humans ; Hypernatremia ; Methyl Ethers ; Sodium ; Vasopressins

PURPOSE: This study aimed to examine levels of stress and professionalism of nurses who provided nursing care during the 2015 Middle East respiratory syndrome outbreak based on their experience, to investigate the nurses' intention to respond to possible future outbreaks in relation to their experience during the outbreak, and to determine the relationship between the outbreak experience and nursing intention considering stress and professionalism. METHODS: A self-administered questionnairewas designed based on modifications of related questionnaires, and used to assess levels of stress, professionalism, and nursing intention according to participants' experiences during the outbreak. Multiple regression analysiswas used to examine the relationship between the outbreak nursing experience and nursing intention considering stress and nursing professionalism. RESULTS: The overall stress, professionalism, and nursing intention scores for the firsthand experience group were 33.72, 103.00, and 16.92, respectively, whereas those of the secondhand experience group were 32.25, 98.99, and 15.60, respectively. There were significant differences in professionalism and nursing intention scores between the groups (p = .001 and p < .001, respectively). The regression analysis revealed that the regression estimate between stress and nursing intention was B(SE) = −0.08(0.02), beta = −0.21, p < .001 and the regression estimate between professionalism in nursing and nursing intention was B(SE) = 0.05(0.01), beta = 0.23, p < .001. CONCLUSIONS: Prior outbreak nursing experience was importantly associated with intention to provide care for patients with a newly emerging infectious disease in the future considering stress and professionalism. Gathering information about nurses' experience of epidemics and regular assessment of job stress and professionalism are required.
Communicable Diseases* ; Communicable Diseases, Emerging ; Coronavirus ; Coronavirus Infections ; Disease Outbreaks ; Emergencies* ; Hospitals, Public* ; Humans ; Intention* ; Korea* ; Nursing Care ; Nursing* ; Professionalism* ; Stress, Psychological

BACKGROUND: The current study examined the acute systemic toxicity of QX-314 that there have been few research results for this so far. In order to be useful as a drug, it must be shown to have minimal toxicities. Hence, we compared the CNS and cardiac toxicities of QX-314 to the conventional local anesthetic lidocaine. METHODS: Acute toxicity was evaluated by determining the individual intravenous CD50 and LD50 of QX-314 and lidocaine. There were four doses for each LD50 determination and 8 animals per dose level. Animals were observed for several hours immediately following drug administration and recorded overt effects and fatalities. Both lidocaine and QX-314 were dissolved in saline. Lidocaine and QX-314 were diluted to 1, 2, 4, 6 and 0.5, 1, 2, 4%, respectively with saline and injected at the same volume to minimized cardiovascular effect. RESULTS: The intravenous CD50 and LD50 were 12.7 and 14.1 mg/kg for QX-314 and 15.7 and 28.8 mg/kg for lidocaine. Electrocardiograms showed intraventricular block (widened QRS complex) at high doses of lidocaine compared to AV block (loss of QRS complex) at high concentrations of QX-314. There are no evidence that CNS toxicity led mouse to death. CONCLUSIONS: QX-314 is about 1.5 times as toxic as lidocaine. Although QX-314 may still be useful clinically as a long-lasting local anesthetic, its safety relative to other available local anesthetics must be considered.
Anesthetics, Local ; Animals ; Atrioventricular Block ; Electrocardiography ; Lethal Dose 50 ; Lidocaine ; Mice ; Quaternary Ammonium Compounds

Differential diagnosis of posterior neck and occipital pain is difficult based on symptoms and physical examination only. We report a case of patient who complained of pain in the posterior neck and occiput, with the initial diagnosis of myofascial pain syndrome, but who did not improve with conventional treatments. Magnetic resonance imaging revealed a cervical intraspinal tumor, and the patient developed subsequent motor weakness and sensory changes. Comprehensive diagnostic approaches are strongly recommended when the patient manifests symptoms unresponsive to treatment.
Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Myofascial Pain Syndromes ; Neck ; Neck Pain ; Physical Examination

Lymphangiomas are malformations of the lymphatic system accounting for approximately 5% of all benign tumors in infants and children. Abdominal lymphangiomas are rare, and can arise from either the retroperitoneum, gastrointestinal tract, or the mesentery of the abdominal viscera. Lymphangioma involving the whole mesentery is particularly rare. Most lymphangiomas are detected during infancy or childhood, but intraabdominal lymphangiomas such as mesentery are not found until adulthood. We report here on a patient with uncommon lymphangioma involving the whole mesentery who presented with fever and abdominal pain. This patient is unusual because he was confirmed through core needle biopsy which showed variable sized lymphatic spaces representing a immunoreactive for D2-40 antibody with involvement of the whole mesentery. No cases of mesenteric lymphangioma confirmed preoperatively have been previously reported in Korea.
Abdominal Pain ; Biopsy, Large-Core Needle* ; Child ; Fever ; Gastrointestinal Tract ; Humans ; Infant ; Korea ; Lymphangioma* ; Lymphatic System ; Mesentery* ; Viscera

BACKGROUND: Echocardiography has been routinely performed before liver transplantation to screen perioperative risks due to cardiovascular complications. However, only limited echocardiographic indices have been used and have become familiar with clinicians. Here we aimed to evaluate the relationship between preoperative echocardiography and circulatory manifestations during living donor liver transplantation (LDLT). METHODS: Perioperative data including preoperative echocardiographic indices and intraoperative circulatory manifestations from 159 LDLT recipients (> or =18 years) were retrospectively collected. Relationships between individual echocardiographic indices and intraoperative circulatory manifestations were assessed by Pearson or Spearman correlation test. Intraoperative circulatory manifestations showing potential correlation with echocardiographic indices (r > or = 0.2 or < or =-0.2) were additionally analyzed by unpaired t or chi-square test after their dichotomizations at clinically meaningful cutoffs. RESULTS: Strong correlations (r > or = 0.5 or < or =-0.5) were not found between echocardiographic indices and intraoperative circulatory manifestations, but intensive vasopressor coverage, urine output, sodium bicarbonate administration and last blood pH showed potential relations with at least one of preoperative echocardiographic indices. Early and late (atrial) ventricular filling velocity (E/A) ratios were lower in recipients with intensive vasopressor coverage, and left atrial diameter (LAD) were larger in recipients with last blood pH < 7.25. However, other parts of echocardiographic indices showed inconsistent relationships with formerly prevalent knowledge. CONCLUSIONS: Preoperative echocardiographic indices such as E/A ratio and LAD showed relationship with circulatory manifestations during LDLT. However, low correlation degrees and lack of evidence in reverse relationship with circulatory manifestations demands further studies focusing on such specific cardiac function.
Echocardiography ; Humans ; Hydrogen-Ion Concentration ; Liver ; Liver Transplantation ; Living Donors ; Retrospective Studies ; Sodium Bicarbonate

BACKGROUND: We evaluated the effect of low doses of rocuronium on tracheal intubating conditions and hemodynamic changes during induction of anesthesia with 8 vol% sevoflurane and remifentanil 1microg/kg. METHODS: Eighty four patients were randomized into one of three groups; Group I, II, III. Each group received normal saline, 0.3, 0.45 mg/kg of rocuronium respectively. Predetermined drugs for each group and remifentanil 1microg/kg were administered during induction of 8 vol% sevoflurane. After induction of 8 vol% sevoflurane, tracheal intubation was preformed. The tracheal intubation conditions and hemodynamic responses to tracheal intubation were assessed. RESULTS: Tracheal intubation was successful in all patients. The incidence of clinically acceptable intubating conditions was 79% in Group I, 100% in Group II, and 100% in Group III. There was no significant difference in intubating condition between Group II and Group III. The hemodynamic responses to tracheal intubation were blunted in all groups. CONCLUSIONS: After induction with 8 vol% sevoflurane and remifentanil 1microg/kg, low-dose rocuronium provides more satisfactory tracheal intubation conditions.
Anesthesia ; Hemodynamics ; Humans ; Incidence ; Intubation

BACKGROUND: An immediate examination of ocular movement is required during strabismus surgery. The aim of this study was to determine the effect of the level of sedation on the recovery of patients undergoing a target controlled propofol infusion with a bolus of fentanyl for strabismus surgery. METHODS: Twenty-one outpatients scheduled to undergo strabismus surgery were assigned randomly to one of two groups. In both groups, sedation was induced with a bolus of fentanyl 1microgram/kg intravenously followed by an infusion of propofol with a target concentration of 1.0microgram/ml. The target concentration was increased or decreased by 0.1 microgram/ml steps until the patient reached and maintained the observer's assessment of alertness/sedation (OAA/S) scale score of 3 (group A) or 4 (group B). The supplemental analgesics consisted of fentanyl 25-50microgram bolus injection. The target concentration of propofol, the total dose of fentanyl, delayed awakening, and recovery time were recorded. RESULTS: The mean target concentration of propofol (mean +/- SD) in group A (1.8 +/- 0.4microgram/ml) was significantly higher than that of group B (1.3 +/- 0.4microgram/ml) (P<0.05). There were no significant differences in the total dose of fentanyl, delayed awakening and recovery time between the two groups. There was an an increasing trend in the recovery time with the total dose per kilogram of body weight of fentanyl (Spearman's correlation coefficient, r = 0.384, P = 0.086). CONCLUSIONS: The levels of sedation did not affect the recovery time in patients during target propofol infusion with a bolus of fentanyl. However, the addition of fentanyl tended to prolong the recovery time.
Analgesics ; Body Weight ; Fentanyl* ; Humans ; Outpatients ; Propofol* ; Strabismus*