BACKGROUND: The high incidence of deep vein thrombosis (DVT) of lower extremities and a subsequent pulmonary embolism (PE) makes it the most common cause of death following total hip replacement surgery. Therefore, the authors measured the perioperative changes in the blood coagulation activity with a thromboelastography (TEG) in the patients treated with fluid and packed red cells (PRC). METHODS: Hemodilution was estimated with a measurement of hemoglobin (Hb), hematocrit (Hct), and platelet count. The changes in the coagulation factor activities were measured with TEG. Samples were obtained before skin incision (step 1); at the period that Hb and Hct ranged from about 10 g/dl to 30% (step 2); in the postanesthetic care unit (step 3); and on the postoperative first and third day (step 4, 5). RESULTS: Although Hct and Hb decreased to 9.4% statistically at step 2 only, platelet counts were significantly decreased in step 2 (10.6%), 3 (34.5%), 4 (32.5%), and 5 (33.6%) compared with step 1 (P < 0.05). At step 2, there were no significant changes in TEG parameters except r time, which decreased (21.5%) (P < 0.05). At step 3, r time, alpha angle, and maximum amplitude (MA) decreased, and k time and lysis 60 increased (P < 0.05). CONCLUSIONS: In spite of consumption and dilution of coagulation factors after massive fluids and PRC therapy during total hip replacement surgery, the increased activities of procoagulants and decreased fibrinolytic activities predisposed the body to initiate and maintain the thrombus.
Arthroplasty, Replacement, Hip* ; Blood Coagulation ; Blood Coagulation Factors ; Cause of Death ; Hematocrit ; Hemodilution ; Humans ; Incidence ; Lower Extremity ; Platelet Count ; Pulmonary Embolism ; Skin ; Thrombelastography ; Thrombosis ; Venous Thrombosis

Uterine artery embolization for the treatment of uterine leiomyomas is gaining acceptance as an effective alternative to surgical treatment in preserving uterus and reducing symptoms. Vaginal expulsion of leiomyomas after UAE is uncommon, and has been regarded as a side effect of the procedure, as well as a natural phenomenon of treatment response. A-28-year-old unmarried woman who has been suffered from menorrhagia underwent UAE. MRI revealed the remnant leiomyomas were reduced in size and volume and also symptoms of leiomyomas were much improved. After 6 month, We've made sure about non-visualization of leiomyoma on follow-up pelvic dynamic MRI. We report this rare case of vaginal expusion of intramural leoimyoma with a brief literature.
Female ; Follow-Up Studies ; Humans ; Leiomyoma* ; Magnetic Resonance Imaging ; Menorrhagia ; Single Person ; Uterine Artery Embolization* ; Uterine Artery* ; Uterus

No abstract available.
Animals ; Dogs* ; Membranes* ; Periodontitis*

PURPOSE: There have been several studies addressing the correlation between central venous pressure (CVP) and ultrasonographic findings of the inferior vena cava (IVC). We performed the present study to discover the degree of correlation between CVP and the area of IVC as measured with ultrasound, and to determine which portion of the IVC shows the best correlation with CVP. METHODS: The present study was prospectively performed in emergency medical center of Chonnam National University Hospital from March 1 to October 31, 2006. Two intrahepatic portions and one extrahepatic portion of the IVC were evaluated. RESULTS: All tested areas of the IVC, and the collapsibility indices measured at each location, showed a substantial correlation with CVP. However, in multiple logistic regression analysis performed to identify the location best correlated with CVP, the area of the IVC just below the hepatic vein-IVC junction proved to be the only location to correlate with CVP with statistic significance. CONCLUSION: Measurement of IVC area using ultrasound can yield important information about a patient's volume status, especially in patients for whom central venous catheter insertion is contraindicated. We suggest that the portion of the IVC just below the hepatic vein-IVC junction is the optimal locatin for area measurement to estimate CVP.
Central Venous Catheters ; Central Venous Pressure* ; Emergencies ; Humans ; Jeollanam-do ; Logistic Models ; Prospective Studies ; Ultrasonography* ; Vena Cava, Inferior*

BACKGROUND AND OBJECTIVES: Elevated hs-CRP (high sensitivity C-reactive protein) is well known as a biomarker reflecting the inflammatory process that might evoke the potential for microembolization of an atheromatous plaque, and imparts a poor prognosis in patients with coronary artery disease. We designed this study to evaluate whether the preprocedural hs-CRP level was associated with procedure-related myocardial injury following coronary stenting. SUBJECTS AND METHODS: We obtained the plasma hs-CRP level from angina patient, who underwent coronary stenting, within 24 hours prior to the procedure, and divided the patients into either the normal CRP (hs-CRP <3 mg/L) or elevated CRP groups (hs-CRP > or =3 mg/L). We defined the reduction of TMP (TIMI myocardial perfusion) grade as at least one decrease in the TMP grade following coronary stenting compared with the pre-procedural TMP. We also evaluate the procedure-related myocardial damage by measuring CK-MB leakage after stenting. RESULTS: We enrolled 279 lesions in 226 patients, who were divided into two groups: the normal CRP group (n=137, 1.28+/-0.71 mg/L) and the elevated CRP group (n=89, 6.89+/-4.23 mg/L). A reduction in the TMP grade was significantly more prevalent in the elevated CRP (20 lesions, 17.4%) compared to the normal CRP group (6 lesions, 3.7%, p=0.001). An elevated CRP level was related to an increased CK-MB leakage following stenting (elevated CRP group; 23 patients, 25.8%, normal CRP group; 21 patients, 15.3%, p=0.041). In a multivariable analysis, the only significant predictor of a reduction in the TMP grade following stenting was an elevated CRP level. CONCLUSION: Systemically detectable inflammatory activity, served by the plasma hs-CRP level, is associated with procedure-related microvascular injury, as assessed by a reduction in the TMP grade and CK-MB elevation following coronary stenting.
C-Reactive Protein ; Coronary Artery Disease ; Humans ; Microcirculation ; Plasma ; Prognosis ; Stents* ; Thymidine Monophosphate

Procedural sedation and analgesia (below PSA), which is used for induction of appropriate sedation and elimination of pain during many procedures, is particularly essential for children. Many other countries have pediatric PSA guidelines. PSA guidelines are also needed in Korea. We have developed pediatric PSA guidelines for Korea by reference review of pediatric PSA for standard and safe PSA practice in Korea. Pharmacologic and non-pharmacologic methods could be used for performance of ideal pediatric PSA. Pre sedation phase included assessment of patients, with accompanying personnel who have adequate knowledge and experience, and informed consent. For sedation phase, the route of medication should be determined, along with monitoring of patients and evaluation of the depth of sedation. This phase also included writing all of the PSA process, adverse events, and intervention. Considering the pain of the procedures, the time of procedures, necessity for immobilization, and characteristics of PSA medication, we decided on the PSA method. Procedures were categorized into three types according to the level of pain, anxiety, and immobilization. The first type was radiologic imaging, which requires immobilization. The second type of procedure involves a high level of anxiety and a low level of pain, such as simple suturing and lumbar puncture. The third type of procedure involves a high level of anxiety and a high level of pain, such as reduction of fracture and dislocation. After performance of the procedure, patients must be observed and monitored at a location where oxygen and airway management can be applied until they reach full recovery. Discharge information should be provided to competent parents. The main characteristics of Korean guidelines for pediatric PSA were as follows: 1. We emphasized assessment and monitoring of patients during and after PSA. 2. We suggested selection of medication by categorization of procedures according to the level of pain and anxiety. 3. We suggest that PSA be performed by two healthcare personnel; one should have adequate knowledge and experience in performance of PSA. More equipment, locations, and specialized personnel are needed for conduct of safe pediatric PSA practice in Korea.
Airway Management ; Analgesia ; Anxiety ; Child ; Conscious Sedation ; Delivery of Health Care ; Dislocations ; Humans ; Immobilization ; Informed Consent ; Korea ; Oxygen ; Parents ; Pediatrics ; Spinal Puncture ; Writing