Blood transfusions in open heart surgery become increasingly dangerous in recent years because of hepatitis and the AIDS virus. For this reason, blood saving methods must be considered when assessing the quality of cardiac surgery. To evaluate different blood saving methods, seventy two patients undergoing open heart surgery were divided into 3 groups. Aprotinin group(group I, n=35) and aprotinin with acute normovolemic hemodilution group (group II, n=15) were compared with prospective control group (group III, n=22). We administered the serine protease inhibitor aprotinin in high dosage(loading dose of 4mg/kg and maintaing dose of 1mg/kg/hr) to group I, and II patients. Acute normovolemic hemodiluation(ANH) was done before heparinization in group II. One to three units of blood could be withdrawn with a desired hematocrit of 30%. After an extracorporeal circulation (ECC), autologous transfusion was undertaken. Hematocrit, platelet count, and partial thromboplastin time(PTT) were measured immediately after induction, during bypass and at the intensive care unit. Amount of blood loss was measured in 12 and 24 hours after arrival at an intensive care unit. Amount of homologous transfusion was counted in postbypass period and 12 hours after arrival at an intensive care unit. Hematocrit was elevated in group II(p<0.05) after ECC Platelet counts were elevated and partial thromboplastin time was prolonged in group II in postbypass period and 12 hours after arrival at an intensive care unit compared with group I and III. Postoperative blood loss was 560.4+/-272.5cc in group I, and 282.0+/-98.6cc in group II, 819.3+/-428,0cc in group III. The use of homologus transfusion(packed red cells and fresh frozen plasma) in group I could be reduced by 49 & 66% and group II by 73 & 84% compared with group III. In conclusion our study suggests that administration of high-dose aprotinin is effective in reducing intraoperative and postoperative bleeding and therefore reduces transfusion requirement. In addition, combination of ANH and aprotinin can further reduce homologous blood usage.
Aprotinin* ; Blood Transfusion ; Extracorporeal Circulation ; Heart* ; Hematocrit ; Hemodilution* ; Hemorrhage ; Heparin ; Hepatitis ; HIV ; Humans ; Intensive Care Units ; Partial Thromboplastin Time ; Platelet Count ; Postoperative Hemorrhage ; Prospective Studies ; Serine Proteases ; Thoracic Surgery* ; Thromboplastin

This study was designed to evaluate the possibility of esmolol to attenuate the cardiovascular reflex due to the induction of general anesthesia, tracheal intubation and/or surgical stimulations during open heart surgery. Esmolol was infused continuously to each patient by 150 ug/kg/min from 2 minutes prior to the completion of the induction of anesthesia and then by 75 ug/kg/min throughout the skin-incision. In patients undergoing coronary bypass grafts, esmolol group of 5 individuals did not show any significant change in hemodynamics in contrast to the control group of 5 individuals, which showed singificant decreases in systolic and mean arterial pressure(p<0.05). The plasma concentrations of the catecholamines in the esmolol group were not significantly different from those in control. In patients undergoing valve replacement, esmolol group did not show any significant difference in hemodynamics from control. The plasma concentrations of the catecholamines in the esmolol group were not changed by the anesthetic and surgical procedures in contrast to the control group, which showed 3 times increase (p<0.05) in norepinephrine level and 8 times increase (p<0.05) in epinephrine level. The results of these experiments demonstrate that esmolol can suppress the hemodynamic refiex and catecholamine-release due to the stimulations of anesthetic and surgical procedures under the general anesthesia by a high concentration of fentanyl, and that esmolol can be administered safely to attenuate the hazardous sympathetic reflexes.
Anesthesia ; Anesthesia, General ; Catecholamines ; Epinephrine ; Fentanyl ; Heart* ; Hemodynamics* ; Humans ; Intubation ; Norepinephrine ; Plasma ; Reflex ; Thoracic Surgery ; Transplants

Carbon monoxide gas is found in the atmosphere whenever society has become industrialized. In addition to the fact that Korea has become industrialized, bituminous coal is used to heat homes here, in heating systems that, if not very carefully maintained, leak this gas, resulting in a number of deaths and near deaths each winter. It has only rarely been reported by investigators that genetic damage may be done transplacentally to a human fetus by a pregnant woman's being poisoned by CO. We explored this by evaluating the damage done to the mouse fetus through an in vivo experiment, using micronucleus and sister chromatid exchange (SCE) tests. Mice were mated and pregnant ones divided into a group that received acute exposures on 3 different days, a group that received chronic exposure, and a control group. In the meantime in the control group the incidence of both micronuclei and SCE was less on the maternal side, in both the acute and chronic exposure groups, whereas the incidences of both micronuclei and SCE were more on the maternal side. However, the incidence on the fetal side was not far behind. Increasing, the dosage of carbon monoxide with gestational age increased the incidence of both micronuclei and SCE in the mother and fetus alike.
Animal ; Carbon Monoxide/toxicity* ; Cell Nucleus/drug effects* ; Female ; Fetus/drug effects* ; Maternal-Fetal Exchange ; Mice ; Mice, Inbred ICR ; Mutagens* ; Pregnancy ; Sister Chromatid Exchange/drug effects*

OBJECTIVES: This study aimed to investigate the differences in the facial emotion recognition and discrimination ability between children with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). METHODS: Fifty-three children aged 7 to 11 years participated in this study. Among them, 43 were diagnosed with ADHD and 10 with ASD. The parents of the participants completed the Korean version of the Child Behavior Checklist, ADHD Rating Scale and Conner's scale. The participants completed the Korean Wechsler Intelligence Scale for Children-fourth edition and Advanced Test of Attention (ATA), Penn Emotion Recognition Task and Penn Emotion Discrimination Task. The group differences in the facial emotion recognition and discrimination ability were analyzed by using analysis of covariance for the purpose of controlling the visual omission error index of ATA. RESULTS: The children with ADHD showed better recognition of happy and sad faces and less false positive neutral responses than those with ASD. Also, the children with ADHD recognized emotions better than those with ASD on female faces and in extreme facial expressions, but not on male faces or in mild facial expressions. We found no differences in the facial emotion discrimination between the children with ADHD and ASD. CONCLUSION: Our results suggest that children with ADHD recognize facial emotions better than children with ASD, but they still have deficits. Interventions which consider their different emotion recognition and discrimination abilities are needed.
Autism Spectrum Disorder ; Autistic Disorder* ; Checklist ; Child Behavior ; Child* ; Discrimination (Psychology)* ; Facial Expression ; Female ; Humans ; Intelligence ; Male ; Parents

OBJECTIVES: This study investigated the effect of social skills training (SST) on facial emotion recognition and discrimination in children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). METHODS: Twenty-three children aged 7 to 10 years participated in our SST. They included 15 children diagnosed with ADHD and 8 with ASD. The participants' parents completed the Korean version of the Child Behavior Checklist (K-CBCL), the ADHD Rating Scale, and Conner's Scale at baseline and post-treatment. The participants completed the Korean Wechsler Intelligence Scale for Children-IV (K-WISC-IV) and the Advanced Test of Attention at baseline and the Penn Emotion Recognition and Discrimination Task at baseline and post-treatment. RESULTS: No significant changes in facial emotion recognition and discrimination occurred in either group before and after SST. However, when controlling for the processing speed of K-WISC and the social subscale of K-CBCL, the ADHD group showed more improvement in total (p=0.049), female (p=0.039), sad (p=0.002), mild (p=0.015), female extreme (p=0.005), male mild (p=0.038), and Caucasian (p=0.004) facial expressions than did the ASD group. CONCLUSION: SST improved facial expression recognition for children with ADHD more effectively than it did for children with ASD, in whom additional training to help emotion recognition and discrimination is needed.
Autism Spectrum Disorder* ; Autistic Disorder* ; Checklist ; Child Behavior ; Child* ; Discrimination (Psychology) ; Facial Expression ; Facial Recognition ; Female ; Humans ; Intelligence ; Male ; Parents ; Social Skills*

We present a case of problematic tracheal intubation in an adult patient with an unrecognized tracheal bronchus. Immediately after tracheal intubation and position change to prone, bilateral breath sounds were almost absent, and there was a diminished tidal volume. In order to resolve the ventilatory difficulty, the wire-reinforced tube was replaced with a conventional tube, and proper positioning of the tube was completed under fiberoptic guidance. A tracheal bronchus (originating about 1.2 cm above the carina, and supplying the right upper lobe) was found on the postoperative chest CT. In the presence of tracheal bronchus, tracheal intubation may cause pulmonary complications. Anesthesiologists should keep in mind the anesthetic implications of tracheal bronchus, and must be familiar with the use of fiberoptic bronchoscopy for proper positioning of endotracheal tube.
Adult ; Bronchi ; Bronchoscopy ; Humans ; Intubation ; Intubation, Intratracheal ; Thorax ; Tidal Volume

BACKGROUND: Opioid based patient-controlled analgesia (PCA) effectively provides adequate pain control after spine surgery, often at the expense of high incidence of postoperative nausea and vomiting (PONV). This study was designed to compare the effect of ramosetron with ondansetron for preventing PONV in highly susceptible patients using PCA following spine surgery under general anesthesia. METHODS: Seventy female patients, aged 18 to 65, scheduled for elective lumbar spine surgery, were randomly allocated into either ondansetron group (Group O, n = 35) or ramosetron group (Group R, n = 35). In patients assigned to group O, ondansetron 4 mg was injected and 12 mg was added to the PCA regimen. In patients assigned to group R, ramosetron 0.3 mg was injected and 0.3mg was added to the PCA regimen. The PCA regimen consisted of fentanyl 25microgram/kg (total volume including saline: 100 ml) and was programmed to deliver 2 ml/hr as background infusion and 0.5 ml per demand with a 15 min lockout. The incidence and severity of PONV, pain score, total amount of administered rescue analgesic and rescue antiemetic were assessed following 48 hrs after surgery. RESULTS: The incidence of PONV showed no significant differences between groups during 48 hrs after surgery. There were no differences in the severity of nausea, pain score, total amount of administered rescue analgesic and rescue antiemetic between groups. CONCLUSIONS: Ramosetron prophylaxis for preventing PONV is as effective as ondansetron in highly susceptible patients using fentanyl based PCA following spine surgery under general anesthesia.
Aged ; Analgesia, Patient-Controlled ; Anesthesia, General ; Benzimidazoles ; Female ; Fentanyl ; Humans ; Incidence ; Nausea ; Ondansetron ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Spine

This study was designed to investigate the effect of preoperative collection of blaod and acute normovolemic hemodilution(ANH) on the requirement of homologous transfusion, perioperative blood loss and hematological parameters in patients undergoing open heart surgery. Ninety two adult patients for elective open heart surgery were randomly assigned to one of three groups. Group I, ANH group, had blood withdrawn to a hematocrit of 33%o after induction of anesthesia(n =54). In Group II preoperative collection of blood in accordance with hospital protocol and ANH were performed(n=16). Ciroup III was control group(n=22). Autologous blood was replaced post bypass. The patients whose hematocrit fell below 25% were transfused with homologous blood. The use of homologous transfusion was 2.2+/-0.4 units in group I, 0.1+/-0.1 units in group II and 4.1+/-0.8 units in group III. Requirement of homologous transfusion in group II was reduced compared with group II and III with statistical significance(P<0.05). There was statistical significance between group I and group III(P<0.05) in homologous transfusion. Postoperative blood loss was 760.7+/-74.6 ml in group I, 675.6+101.5 ml in group II and 819.3+/-91.3 rnl in group III. There was no statistical significance among 3 groups. There was no difference in hematocrit or platelet count, and total blood loss on immediately post surgery or on day 1. Our data show that preoperative collection of blood and ANH can reduce the amount of homologous transfusion.
Adult ; Heart* ; Hematocrit ; Hemodilution* ; Humans ; Platelet Count ; Postoperative Hemorrhage ; Thoracic Surgery*

PURPOSE: We report a case of intraocular Thelazia callipaeda infestation in a patient with panuveitis who had a successful recovery after pars plana vitrectomy. METHODS: A 73-year-old female patients complained of a floating sensation and gradually decreasing visual acuity in her right eye. On slit lamp examination, severe intraocular inflammatory reaction was observed. Fundus examination revealed severe vitreous haze with mobile linear structure. Three-port pars plana vitrectomy was performed and then the worm was removed. RESULTS: The worm was confirmed to be Thelazia callipaeda. At postoperative 2 months, the patient's visual acuity was 0.6 and intraocular pressure 14 mmHg. There was no evidence of intraocular inflammatory reaction. CONCLUSIONS: Thelazia callipaeda usually lie in the conjunctival sac or lacrimal apparatus, causing ocular surface disease, but intraocular infestation rarely occurs. If intraocular infestation does occur, early surgical removal should be performed.
Aged ; Female ; Humans ; Intraocular Pressure ; Lacrimal Apparatus ; Panuveitis ; Sensation ; Thelazioidea ; Visual Acuity ; Vitrectomy

Primary pulmonary hypertension is characterized by progressive increase in pulmonary vascular resistance leading to right ventricular (RV) failure and death.The desirable goal of primary pulmonary hypertension is preserving coronary perfusion of RV while decreasing pulmonary arterial pressure with selective pulmonary vasodilators.We report a case in which anesthetic management was successfully performed in a 67 years old man, who had experienced ventricular tachycardia at the previous anesthesia induction, with severe pulmonary hypertension and right ventricular dysfunction.
Anesthesia ; Arterial Pressure ; Humans ; Hypertension, Pulmonary ; Perfusion ; Tachycardia, Ventricular ; Vascular Resistance