OBJECTIVES: Over the last 30 years, despite the increasing sophistication in medical care, the mortality of acute renal failure(ARF) has remained virtually unchanged at 40-50%, but the reasons remain unknown. This study intend to identify prognostic risk factors influencing survival and predict the mortality in ARF patients. METHODS: We retrospectively analyzed 152 patients with ARF who required renal replacement therapy, or whose serum creatinine level above 5 mg/dl, from Jan. 1988 to May. 1995. Multiple factors which may influence mortality were evaluated by univariate and multivariate analysis. RESULTS: 1) Of the 152 patients, 97 were male and 55 were female. The mean age was 47 years and the overall mortality was 36.8%. 2) Based on the univariate analysis, age>60 years, cause of ARF, APACHE II score, number of failing organs, peak serum creatinine level, PaO2, coma, hypotension, ARDS, GI bleeding, ventilatory support, need for antiarrhythmics, DIC, cardiovascular failure, pulmonary failure, neurological failure, and gastrointestinal failure were all significant factors discriminating between survivors and nonsurvivors(p<0.05) 3) By multivariate analysis, hypotension, coma, ventilatory support, and age over 60 years were significant independent predictors influencing survival in ARF patients and logistic equation and logit score were as follows : z=-2.04+1.32(age over 60)+2.18(hypotension)+2.88 (ventilatory support) + 3.28(coma) P=ez/(1+ ez) 4) In ROC(receiver-operating characteristic)curve, when the cutoff point was 0.2, maximum sensitivity was 75% and maximum specificity was 82%. CONCLUSION: In ARF, prognostic risk factors for mortality were age over 60 years, hypotension, assisted ventilation and coma. The logit score by multiple analysis is a reliable predictor of mortality in ARF patients, however the further studies are required to confirm these results.
Acute Kidney Injury* ; APACHE ; Coma ; Creatinine ; Dacarbazine ; Female ; Hemorrhage ; Humans ; Hypotension ; Male ; Mortality* ; Multivariate Analysis ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors* ; Sensitivity and Specificity ; Survivors ; Ventilation

PURPOSE: To analyse the risk factors for recurrence of hemangiomas in extremities after surgical treatment and to compare with those of trunk. MATERIALS AND METHODS: 120 cases of hemangioma with surgical treatments from June 1998 to September 2009 were analysed. 53 cases with surgical treatment on trunk in the same period were set to be the control group. We analyze several factors: age, location, site, size, histologic types and correlation between recurrence and each risk factor using logistic regression analysis. RESULTS: Recurrence rate was 11.7% in extremities and 9.4% in trunk. There were no correlation between recurrence and age, site, size, histologic type. But, there was stastically significant correlation between recurrence rate and location, especially hand, forearm, feet in extremities and head and neck in trunk. CONCLUSION: Recurrence after surgical treatment of hemangioma is highly prevalent in anatomical location such as, hand, foot and forearm those are difficult to achieve complete resection because of close to neurovascular structures. Careful observation should be needed owing to incomplete resection can occurs recurrence.
Extremities ; Foot ; Forearm ; Hand ; Head ; Hemangioma ; Logistic Models ; Neck ; Recurrence ; Risk Factors

Anti-E and anti-c is one of the clinical significant irregular antibodies developing a delayed hemolytic transfusion reaction and hemolytic disease of the newborn. Since anti-c occurs frequently with anti-E in immunized people whosoe cells are E-and c-, it has been recommended to select blood of the patient's own R1 phenotype for transfusion, even when the presence of anti-c cannot be demonstrated in his/her serum. To determine the utility of this approach, we reviewed the blood bank laboratory records of patients identified anti-E and anti-c in his/her serum in Severance hospital over a 12 year period (1985-1996). During the 12-year period of study, 53 patients were identified with anti-E and/or anti-c; 30(56.6%) patients had anti-E alone, 6(11.3%) had anti-c, and 17(32.1%) had both. Thirty eight of forty two patients whose Rh-hr phenotypes were tested were R1R1. Of these 38 R1R1 patients, 16 patients (42.1%) presented with anti-c concomitant with anti-E. Ouru study showed that the incidence of antni-c in R1R1 patients with anti-E is similar to that of studies reported in Caucasian groups. We highly suggest the transfusion protocol of prophylactic use of c negative blood for R1R1 patients with anti-E. Furthermore, because anti-c may be present in concentrations too low to be detected, the enzyme technique is recommended in parallel with standard serologic methods for the identification of irregular antibodies.
Antibodies ; Blood Banks ; Blood Group Incompatibility ; Humans ; Incidence ; Infant, Newborn ; Phenotype

No abstract available.
Osteotomy*

BACKGROUND: Electroconvulsive therapy (ECT) can produce dangerous complications, such as arrhythmias, transient hypertension, and increases in intraocular pressure. This study was designed to whether propofol, in comparision with thiopental, would attenuate these hypertensive responses and increases in intraocular pressure. METHODS: Twenty patients were studied during courses of ECT administrations, each patient receiving propofol or thiopental on different occasions. The induction dose was 1.6 mg/kg of propofol and 3 mg/kg of thiopental sodium. Mean arterial pressure, heart rate, cardiac rhythm and intraocular pressure were checked before induction (control), after administration of succinylcholine, immediately, 5 min, and 10 min after ECT administration. Recovery time was also compared between two groups. RESULTS: Mean arterial pressure was lower following propofol than thiopental (p<0.05) immediately after ECT. Heart rate was lower following propofol than thiopental (p<0.05) immediately, 5 min, and 10 min after ECT. Cardiac rhythm abnormalities were infrequent and not serious. Intraocular pressure was lower following propofol than thiopental (p<0.05) immediately, 5 min, and 10 min after ECT. Recovery time of propofol (6.5+/-0.8 min) was shorter than thiopental (7.5+/-0.9 min). CONCLUSIONS: Propofol for ECT induction would seem to be an ideal drug, as it attenuates hypertensive responses and increases in intraocular pressure.
Anesthesia ; Anesthetics ; Arrhythmias, Cardiac ; Arterial Pressure ; Electroconvulsive Therapy* ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intraocular Pressure* ; Propofol* ; Succinylcholine ; Thiopental*

Preeclampsia is defined as the development of hypertension with proteinuria, edema induced by pregnancy after 20th week of gestation. Eclampsia implies the occurrence of convulsions unrelated to any coexisting neurologic disease in a preeclamptic. The leading cause of maternal death in preeclampsia-eclampsia is intracranial hemorrhage. Other causes of morbidity include congestive heart failure with pulmonary edema, pulmonary aspiration of gastric contents, disseminated intravascular coagulation, acute renal failure, and septic shock. We experienced a case of death from intracranial hemorrhage in eclamptic patient undergoing cesarean section.
Acute Kidney Injury ; Cesarean Section* ; Disseminated Intravascular Coagulation ; Eclampsia ; Edema ; Female ; Heart Failure ; Humans ; Hypertension ; Intracranial Hemorrhages* ; Maternal Death ; Pre-Eclampsia ; Pregnancy ; Proteinuria ; Pulmonary Edema ; Seizures ; Shock, Septic

This clinical trial was undertaken on 32 infants and chhildren who had G-I symptoms caused by a few diseases, such as meningitis, parenteral infection and intestinal infection. Out of 32 patients, six had vomiting only, caused by meingitis and habitual vomiting, eighteen had vomiting and diarrhea both which caused by parenteral infection and rest of them (8) had diarrhea only, caused by intestinal infection. Polybutine syrup, which 5.0 ml contain 24 mg of trimebutine, was given to these patients as follows; 2.5 ml twice a day at 6 months of age, 5.0 ml twice a day at 6 months to one year and 10 ml three times a day at 1-5 years of age. In ten of 24 patients, who had vomiting only (6), vomiting and diarrhea (18), the symptoms were improved within 48 hours, and rest of them (10) was also shown the improvement of their symptoms within 5 days after medication. In comparison of polybutine treated group and not treated group, the effectiveness of polybutine treatment for the symptoms was statistically meaningful.
Diarrhea ; Humans ; Infant ; Meningitis ; Trimebutine ; Vomiting

PURPOSE: The aim of this study was to define the characteristics of female voiding difficulty, and evaluate the effects of the alpha-blocker, tamsulosin, on the symptoms in those patients. MATERIAL AND METHODS: 148 patients, who complained of voiding difficulty between March 2002 and September 2004, were retrospectively evaluated. 32 patients with anatomical and neuropathic causes were excluded, with the remaining 116 assigned to 4 groups from their urodynamic evaluations: group I, bladder outlet obstruction (BOO) only; group II, BOO plus an overactive bladder (OAB); group III, detrusor underactivity (DU) only; and group IV, DU plus an OAB. After 2 weeks of observation, tamsulosin, 0.2mg/d, was prescribed in all groups, with the patients re-evaluated after 3 months. RESULTS: 58 (50%), 23 (19.8%), 20 (17.3%) and 15 (12.9%) of the 116 study subjects were placed into groups I, II, III and IV, respectively. In group I, 45 (77.5%) had symptomatic improvement after taking tamsulosin for 3 months, and in group II improvement was observed in 73.9% (17/23) of patients. In groups III and IV; however, improvements were seen in only 25 (5/20) and 13.3% (2/15) of cases, respectively. Dizziness, postural hypotension and urinary incontinence occurred in some patients, but these disappeared after the medication was discontinued. CONCLUSIONS: 81 patients (69.8%) had a bladder outlet obstruction, without detrusor underactivity, and 62 (76.5%) of these exhibited a voiding improvement after taking tamsulosin for three months. However, in patients with detrusor underactivity, the response rate was very low (20%).
Adrenergic alpha-Antagonists ; Dizziness ; Female ; Humans ; Hypotension, Orthostatic ; Retrospective Studies ; Urinary Bladder Neck Obstruction ; Urinary Bladder, Overactive ; Urinary Incontinence ; Urination Disorders ; Urodynamics

Postoperative hypertension occurs often in hypertensive patients due to pain, hypercapnia, hypoxemia, or excessive intravascular fluid volume. In addition, tracheal extubation exacerbates hypertension and tachycardia, which leads to left ventricular failure, myocardial infarction, or cerebral hemorrhage. We experienced a case of recurrent intracerebral hemorrhage after extubation in the postanesthetic care unit. The patient was 50-year old female who underwent total abdominal hysterectomy. Three months ago, she suffered a hypertensive cerebral hemorrhage with conservative treatment. Anesthesia induction and intraoperative course were relatively uneventful. In the postanesthetic care unit, she had voluntary movement of all limbs to command and fully awake consciousness. Immediately after tracheal extubation, the blood pressure was increased sharply to 200/110 mmHg. After then, the patient's mental status was deteriorated and the motor weakness of left extremities was developed. Brain CT showed a hypertensive hemorrhage at the right putamen and emergency stereotaxic aspiration was performed. After rehabilitative treatment, the patient was discharged with alert mental status and moderate improvement of motor weakness.
Airway Extubation ; Anesthesia ; Anoxia ; Blood Pressure ; Brain ; Cerebral Hemorrhage* ; Consciousness ; Emergencies ; Extremities ; Female ; Hemorrhage ; Humans ; Hypercapnia ; Hypertension ; Hysterectomy ; Intracranial Hemorrhage, Hypertensive ; Middle Aged ; Myocardial Infarction ; Putamen ; Tachycardia

Purpose: Brachymetatarsia is a relatively rare disease that is characterized by one or more metatarsals shorter than the adjacent metatarsal bones by 5 mm or more. Corrective treatment is done, not only for cosmetic purposes but also to improve function. The aim of this study was to evaluate radiologic and clinical results after distraction osteogenesis using external fixators for the fourth brachymetatarsia. Materials and Methods: From January 2005 to September 2018, 45 patients (60 cases) with brachymetatarsia who underwent distraction osteogenesis using external fixators and who were followed up for at least 6 months were studied retrospectively. At the final follow-up, the application time of the external fixator was measured and the percentage of lengthening, healing index, complication, and the patient’s satisfaction were analyzed. The patient’s satisfaction was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scores, based on the level of stiffness, pain, function, and alignment. Results: The average gain in length and the percentage increase in the fourth metatarsals were 13.8 mm and 30.0%, and the mean followup period was 14.2 months after the removal of the external fixator. Bony union was obtained in the metatarsal bones in almost all the cases except for one case of non-union. According to the AOFAS score, 39 cases were rated excellent, and 6 cases were good at the final follow-up. The patients showed satisfactory cosmetic and functional results. Complications were pin site infections in 3 cases, all improved by oral antibiotic administration and dressing for about 2 weeks. Decreased sensation of the distal phalanx occurred in one case, and there was one case of non-union where we performed revision with an autogenous bone graft. In one case metatarsal joint subluxation occurred due to angular deformity, for which corrective osteotomy was performed. Conclusion Satisfactory results were obtained after distraction osteoplasty using external fixation for the treatment of the fourth brachymetatarsia.