The Intensive Care Unit(ICU) of Severance Hospital was opened on October 18, 1968 with 7 beds and expanded to 19 beds on February 2, 1981. Statistical analysis of ICU patients has already been reported twice: 1. from 1970 to 1977 with 3, 072 cases and 2. from 197S to 1981 with 4,348 cases The following is a clinical analysis of l,458 ventilator cases which comprise6 33.5% of the ICU patients from March 1975 to February 1982. Until 1979 pressure and volume cycled ventilators were use6 at an equal ratio; however, since 1980, volume-cycled ventilators such as the Bennett MA I and MA g and the Bourns LS 104-150 were mainly used. The ventilator cases from the Department of Internal Medicine and Cardiac Surgery rem-ained almost constant at a 30: 30 ratio from 1975 to 1977 However since 1978, the cardiac surgery ventilator cases increased to over 50% of the total. The number of ventilator cases below the ten yearold age group was 396 cases, about 27% of the total. They have increased year by year. Among 587 ventilator cases in 1981, the Bennett MA I and II were used, in 225 and 203 cases respectively. In the under 1 year old age group, 36 cases(43, 9%) were Put on with the Bourns LS 104- 150 and 30 cases(36.6%) on the Drager Babylog I respectively. 487(90.7%) cases were supp-orted with controlled mechanical ventilation(CMV) mode and 135(25%) with the positive end expiratory pressure (PEEP). Of 537 cases, 441(85%) was disconnected from the ventilator within 3 days. Death according to duration of ventilator support was 47(18. 8%), 38(23. 8%) and 14(36.9%) in 1, 2 and 10 days respecitively. But, for the period of 10-19 days, the number of deaths was 4(36.4%) and for 2p or more days 1 case(25%). Reosons for ventilator support were postcardiac operation (301cases, 56%) followed by CNS(central nervous system), IRDS(idiopathic respiratory distress syndrome), and lap- arotomy cases in that order. All ventilator cases with neuromascular disease survived bat none with DEC(Disseminated microvascular cosgulopathy) did. From the above results it can be concluded that ventilator support cases are increasing and the attendant mortality rate is decreasing year by year.
Humans ; Intensive Care Units* ; Critical Care* ; Internal Medicine ; Mortality ; Positive-Pressure Respiration ; Thoracic Surgery ; Ventilators, Mechanical*

No abstract available.
Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn

This study was performed to compare the effect of premedicant with triflupromazine, one of the phenothizine derivatives, and more common drugs such as morphine, hydroxyzine or atropine on flow rate and mean arterial pressure. A total of 54 cases who had open heart surgery for acquired or congenital heart diseases were divided into 3 groups depending on the main premedicants. Group l : 22 cases had triflupromazine, pethidine, hydroxyzine and atropine in divided doses. These cases were induced with a small amount of thiopental, morphine and succinylcholine and maintained with either nitrous oxide(50%), oxygen, gallamine and methoxyflurane in analgesic concentrations or with morphine fractionation. Group ll: 26 cases were given morphine, hydroxyzine and atropine as premedicants. Anesthesia was induced with thiopental, morphine and diazepam and maintained with morphine, nitrous oxide and oxygen. Group lll : 6 cases were premedicated with hydroxyzine and atropine only and maintained with halothane. After induction, surface cooling was begun using a blanket, combined with internal cooling during bypass. In group l and lll rectal temperature was maintained between 28 and 32 degrees C. in group ll, however, temperature was lower than other groups. After the main intracardiac procedures, rewarming was performed with combined surface and internal techniques. In most case a bypass time of longer than 1 hour was required with the longest times in group lll, 129.80+/-21.49 min. in duration. The longest anesthetic time was in the child group of group lll, 430+/-45.82min. in duration. Urine output during bypass in subgroup of methoxyflurane and morphine of group l was 8.95+/-0.33 and 12.15+/-0.36cc/kg/hr. In group ll the subgroup maintained with morphine in the adult and child and halothane, outputs were 11.63+/-0.14, 19.79+/-0.26 and 8.43+/-0.33 cc/kg/hr. respectively. In group lll maintained with halothane, output was 8.64+/-0.22mg/kg/hr. Mean arterial pressure(MAP) during bypass in most cases was maintained between 50 to 100 torr. In group l, the methoxyflurane subgroup, pressures were lower than in any other group, and higher flow rate was required than in any other group. Average MAP during cross clamp on the aorta of group l-methoxyflurane, group ll-morphine adult, group lll were 56.61+/-12.47, 78.79+/-17.33, and 74.06+/-19.09 mmHg respectively. MAP below 50 torr immediately after beginning bypass was more frequent in group ll(94.8%) than in other groups, and MAP above 100 torr after aorta clamping was observed more in group ll(65.2%) and in group lll(50%) than in group l(10.05%). Time to extubation was longer in group ll, the morphine subgroup, than in other groups 19.02+/-1.26 hours in the adult group and 20.05+/-2.69 hours in the child group. Post-op recovery in ICU averaged 4.17+/-0.65 days being longer in group l, the morphine subgroup, than in other groups. With this experience, we may conclude that group l with triflupromazine premedicants, as compared with the other groups, showed less esophageal and rectal temperature gradients during cooling and rewarming states, less acid base imbalance, better urine output, lower requirement of vasopressors or dilators to keep MAP with more flow rate in reasonable range during bypass and shorter time to extubation after surgery.
Acid-Base Imbalance ; Adult ; Anesthesia ; Aorta ; Arterial Pressure ; Atropine ; Cardiopulmonary Bypass* ; Child ; Constriction ; Diazepam ; Gallamine Triethiodide ; Halothane ; Heart Diseases ; Humans ; Hydroxyzine ; Meperidine ; Methoxyflurane ; Morphine ; Nitrous Oxide ; Oxygen ; Rewarming ; Succinylcholine ; Thiopental ; Thoracic Surgery ; Triflupromazine

This study was undertaken to evaluate the effect of flunitrazepam as a premedicant on the prevention undesirable side effects such as hypertension, tachycardia and emergence phenomena associated with ketamine anesthesia. Twenty surgical adult patients were given flunitrazepam(2 mg) and atropine intramusculary before anesthesia. Endotracheal anesthesia was induced by ketamine and alcuronium and maintained with 0.1% ketamine infusion, 02-N2O and alcuronium. The results were as follows. 1) Sedative effect of flunitrazepam as a premedication waa satisfactory in 90% of the patients. 2) Anesthesia was induced smoothly with ketamine(average 0.98mg/kg) and alcuronium (av. 0.33 mg/kg) for intubation. Total dose of ketamine averaged 0.014 mg/kg/min during anesthesia. and was less than that of the Lorazeam group. 3) The influence on blood pressure and pulse rate due to flunitrazepam were not significant but they were increased an average 18 and 16% immediatly after intubation. More than 20% increase from preoperative blood pressure and pulse rate during anesthesia waa noted in 4 and 6 cases respectively. 4) As emergence phenomena, diplopia with moderate delirium and visual hallucination was reported in 2 cases. However unpleasant dreams were not complained of and a long amnesic effect experienced in all cases. From the above results, it may be concluded that, premedication with flunitrazepam and endotracheal anesthesia with ketamine infusion, alcuronium, N20 and 02 can reduce the undesirable effects of ketamine and this is one of the suitable balanced anesthesia techniqes for long operation especially in old, critically ill patients.
Adult ; Male ; Female ; Humans

Arterial blood gas analysis has become an integral part of the clinical evaluation of the patient with known or suspected pulmonary disease. However, when the results of the measurements show arterial hypoxemia which is out of proportion to the clinical and X-ray evidence of lung disease, we may consider potential errors in measurement involving the blood gas analyzer or methods of blood sample storage. We experienced spurious hypoxemia in a patient with extreme leukocytosis (220.0 X 10(3)/mm3) secondary to leukemia. The degree of PaO2 decay was blunted by placing the blood on ice.
Anoxia ; Blood Gas Analysis ; Humans ; Ice ; Leukemia ; Leukocytosis* ; Lung Diseases ; Oxygen*

Occipital neuralgia is a form of headache that involves the posterior occiput in the greater or lesser occipital nerve distribution. Pain can be severe and persistent with conservative treatment. We present a case of intractable occipital neuralgia that conventional therapeutic modalities failed to ameliorate. We speculate that, in this case, the cause of headache could be the greater occipital nerve entrapment by the obliquus capitis inferior muscle. After steroid and local anesthetic injection into obliquus capitis inferior muscles under fluoroscopic and sonographic guidance, the visual analogue scale was decreased from 9-10/10 to 1-2/10 for 2-3 weeks. The patient eventually got both greater occipital neurectomy and partial resection of obliquus capitis inferior muscles due to the short term effect of the injection. The successful steroid and local anesthetic injection for this occipital neuralgia shows that the refractory headache was caused by entrapment of greater occipital nerves by obliquus capitis inferior muscles.
Fluoroscopy ; Headache ; Humans ; Muscles ; Nerve Compression Syndromes ; Neuralgia

BACKGROUND: The use of mouse bone marrow mesenchymal stem cells (mBMSCs) represents a promising strategy for performing preclinical studies in the field of cell-based regenerative medicine; however, mBMSCs obtained via conventional isolation methods have two drawbacks, i.e., (i) they are heterogeneous due to frequent macrophage contamination, and (ii) they require long-term culturing for expansion. METHODS: In the present study, we report a novel strategy to generate highly pure mBMSCs using liposomal clodronate.This approach is based on the properties of the two cell populations, i.e., BMSCs (to adhere to the plasticware in culture dishes) and macrophages (to phagocytose liposomes). RESULTS: Liposomal clodronate added during the first passage of whole bone marrow culture was selectively engulfed by macrophages in the heterogeneous cell population, resulting in their effective elimination without affecting the MSCs.This method allowed the generation of numerous high-purity Sca-1 ＋ CD44 ＋ F4/80 - mBMSCs ([ 95%) with just one passaging. Comparative studies with mBMSCs obtained using conventional methods revealed that the mBMSCs obtained in the present study had remarkably improved experimental utilities, as demonstrated by in vitro multilineage differentiation and in vivo ectopic bone formation assays. CONCLUSION Our newly developed method, which enables the isolation of mBMSCs using simple and convenient protocol, will aid preclinical studies based on the use of MSCs.

PURPOSE: Hepatolithiasis has been regarded as having a potential of to invoke cholangiocarcinogenesis. The aim of this study was to examine the expression of survivin in hepatolithiasis and cholangiocarcinoma, and to try to predict whether hepatolithiasis plays a role in the carcinogenesis of cholangiocarcinoma. We also investigated the expression of survivin according to subcellular sites (cytoplasmic and nuclear) in the cholangiocarcinoma specimens and to correlation this with the clinical outcome. METHODS: Thirty-four surgically resected hepatolithiasis specimens and ten stone-containing cholangiocarcinoma specimens were the focus of this study. Immunohistochemical staining was done to check the expression of survivin in the hepatolithiasis and cholangiocarcinoma specimens. We classified the survivin positive group according to the subcellular sites in the cholangiocarcinoma specimens. RESULTS: The expression rate of survivin was 5.9% in the hyperplasia specimens, 47.1% in the dysplasia specimens and 90% in the adenocarcinoma specimens (p < 0.01), respectively. The over expression of nuclear and cytoplasmic survivin was seen in 3 specimens and 6 specimens, respectively, among the survivin positive specimens (9 total specimens) of the cholangiocarcinoma specimens. The median survival time of the nuclear and cytoplasmic expression groups of patients was 1.5 months and 10 months, respectively. CONCLUSION: We conclude that the overexpression of survivin in hepatolithiasis could be associated with cholangiocarcinoma based on the sequentially increased survivin expression. We purpose that the nuclear survivin expression predicts aggressive clinical behavior of cholangiocarcninoma.
Adenocarcinoma ; Carcinogenesis ; Cholangiocarcinoma* ; Cytoplasm ; Humans ; Hyperplasia