It would seem logical that a left to right shunt may be localized to that chamber in which an increase in oxygen content beyond the normal variation is first seen, while this is generally true, there are certain limitations to such direct diagnostic interpretation. The interpretation of an observed difference in oxygen content is influenced by the result of extremely poor mixing or of a change in respiratory, circulatory or metabolic steady states. This is one of the major challenges to proper interpretation. The purpose of this study was to analyze the blood oxygen content in various chambers of the right side of the heart in patients without shunt and to study the difference in oxygen content between the various chambers. The right heart catheterization was performed in 19 cardiac patients without shunt in Cardiac Laboratory in Hospital. 1. The blood oxygen content was 12.36+/-2.23 volume per cent (mean+/-standard error) in superior vena vava, 12.59+/-2.23 volume per cent in inferior vena cava, 12.59+/-2.23 volume per cent in mid-right atrium, 12.92+/-1.90 volume per cent in mid-right ventricle and 12.26+/-2.13 volume per cent in main pulmonary artery. 2. The mean difference of oxygen content was 0.16 volume per cent between superior vena cava and right atrium, 0.08 volume per cent between right atrium and right ventricle, and 0.06 volume per cent between right ventricle and main pulmonary artery.

No abstract available.
Child* ; Humans ; Lung*

No abstract available.
Anemia, Hypoplastic, Congenital*

The hyperosinophilic syndrome (HES) commonly involves liver and spleen but only a few literature has reported the imaging features. In this article, we present the imaging features of the liver and spleen in HES patients together with clinical and laboratory features. This study included 5 HES patients with hepatic involvement. Extensive laboratory tests including multiple hematologic, serologic, parasitologic, and immunologic examinations were performed. Imaging studies included CT, ultrasound (US) of upper abdomen and hepatosplenic scintigraphy. All patients were periodically examined by laboratory and imaging studies for 4 to 24 months. The common clinical presentations were weakness, mild fever, and dry cough. All patients revealed leukocytosis with eosinophilia of 40 to 80% and benign eosnophilic hyperplasia of the bone marrow. The percutaneous biopsy of the hepatic focal lesions performed in 2 patients showed numerous benign eosinophilic infiltrates and one of them revealed combined centrilobular necrosis of hepatocytes. All cases revealed hepatomegaly with multiple focal lesions on at least one of CT, US, or scintigraphy. These findings completely disappeared in 2 To 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphy. These findings completelydisappeared in 2 to 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphic studies showed hepatic multifocal lesions with hepatomegaly. Differential diagnoses of these findings should include metastatic disease, lymphoma, leukemia. candidiasis or other opportunistic infections.
Abdomen ; Biopsy ; Bone Marrow ; Candidiasis ; Cough ; Diagnosis, Differential ; Eosinophilia ; Eosinophils ; Fever ; Hepatocytes ; Hepatomegaly ; Histamine Antagonists ; Humans ; Hypereosinophilic Syndrome* ; Hyperplasia ; Leukemia ; Leukocytosis ; Liver ; Lymphoma ; Necrosis ; Opportunistic Infections ; Radionuclide Imaging ; Spleen ; Ultrasonography

The hyperosinophilic syndrome (HES) commonly involves liver and spleen but only a few literature has reported the imaging features. In this article, we present the imaging features of the liver and spleen in HES patients together with clinical and laboratory features. This study included 5 HES patients with hepatic involvement. Extensive laboratory tests including multiple hematologic, serologic, parasitologic, and immunologic examinations were performed. Imaging studies included CT, ultrasound (US) of upper abdomen and hepatosplenic scintigraphy. All patients were periodically examined by laboratory and imaging studies for 4 to 24 months. The common clinical presentations were weakness, mild fever, and dry cough. All patients revealed leukocytosis with eosinophilia of 40 to 80% and benign eosnophilic hyperplasia of the bone marrow. The percutaneous biopsy of the hepatic focal lesions performed in 2 patients showed numerous benign eosinophilic infiltrates and one of them revealed combined centrilobular necrosis of hepatocytes. All cases revealed hepatomegaly with multiple focal lesions on at least one of CT, US, or scintigraphy. These findings completely disappeared in 2 To 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphy. These findings completelydisappeared in 2 to 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphic studies showed hepatic multifocal lesions with hepatomegaly. Differential diagnoses of these findings should include metastatic disease, lymphoma, leukemia. candidiasis or other opportunistic infections.
Abdomen ; Biopsy ; Bone Marrow ; Candidiasis ; Cough ; Diagnosis, Differential ; Eosinophilia ; Eosinophils ; Fever ; Hepatocytes ; Hepatomegaly ; Histamine Antagonists ; Humans ; Hypereosinophilic Syndrome* ; Hyperplasia ; Leukemia ; Leukocytosis ; Liver ; Lymphoma ; Necrosis ; Opportunistic Infections ; Radionuclide Imaging ; Spleen ; Ultrasonography

INTRODUCTION: Critical thinking involves identifying problem(s), assessing resources, and generating possible solutions and allows clinical nurses to decide which solution is the most reasonable under the given circumstances, taking into consideration the "what ifs" and how they will affect the end result. This research was conducted to further understanding and identification of subjective factors in critical thinking in clinical nurses. METHODS: The research design was a Q-Methodological Approach. Q-population was formulated from a non-structured questionnaire and interviews from 17 experienced clinical nurses. Thirty selected Q-statements were sorted by 30 experienced clinical nurses. RESULTS: Four factors for critical thinking were identified: (1) Deductive reasoning based on causal relation, (2) Construction of an effective model based on patients' responses, (3) Formulating categories based on priorities for effective interventions, and (4) Judging validity of the situational significance on clinical performances. CONCLUSION: Critical thinking is an attitude and reasoning process. From this study, the frame of reference for clinical nurses in formulating critical thinking within the context of clinical settings is identified and indicates the way nurses utilize thinking skills when they care for patients and areas that need further exploration as nurses and faculty develop education systems to advance clinical performance competency.
Humans ; Surveys and Questionnaires ; Research Design ; Thinking

To identify osteoporosis and examine the relationship between health behavior and the self-efficacy of middle-aged women, a descriptive survey was conducted. The subjects were 465 healthy female residents of Kyunggido, Korea, who underwent ultrasound measurement and a health examination at the Kangmeung-Ci Health Center between July and August 2000. They were 40 to 60 years old, with a mean age of 46.7 years. The subjects completed a self- reported questionnaire that consisted of seven items concerning health behavior and twelve items concerning self-efficacy related to osteoporosis. Bone density was evaluated from ultrasound measurements of the right heel. All the data were analyzed using the program SAS-PC. The study found that the mean T score related to bone density was -1.30, and ranged from -3.52 to 3.06. Based on the T score, 74.8% of the subjects were normal, 12.9% had osteopenia, and 12.3% had osteoporosis. The mean osteoporosis self-efficacy score was 41.17 and ranged from 12 to 60. Osteoporosis self-efficacy differed significantly with health behavior related to health supplementary food (t=5.63, p=.018), exercise (t=6.65, p=.010), alcohol drinking(t=10.80, p=.001), and smoking (t=10.23, p=.001). A community-based health promotion program should be developed to prevent osteoporosis in middle-aged women.
Bone Density* ; Bone Diseases, Metabolic ; Female ; Gyeonggi-do ; Health Behavior ; Health Promotion ; Heel ; Humans ; Korea ; Middle Aged ; Osteoporosis ; Surveys and Questionnaires ; Smoke ; Smoking ; Ultrasonography

Technological advances in video camera, high resolution monitors and optical systems have produced considerable process in endoscopic surgery. Recently we have experienced transthoracic endoscopic sympathectomy(TES) for the treatment of Buerger's disease of both hands in a 47 years old male healthy patient. For the TES, one lung ventilation is necessary to provide adequate surgical access, so this patient had general anesthesia with a disposable left sided Robertshaw double lumen endobronchial tube. The patient was monitored for arterial pressure, herat rate, ECG, pulse oximetry, end-tidal carbon dioxide concentration, peak inspired airway pressure and arterial blood gas analysis. Potenial intraoperative problems wese hypoxemia during one-lung anesthesia, hypotension and hypercarbia occurred by insufflation of carbon dioxide into the chest cavity. Our patient also developed moderate hypoxemia which was corrected by application of high frequency jet ventilation with low driving pressure during right sided operation, and increased significantly arterial carbon dioxide tension about 8-12 mmHg during one lung ansthesia. We reviewed our experience and discussed the anesthetic technique and perioperative problems encounterd in the patient undergoing transthoracic endoscopic sympathectomy for Buerger's disease.
Anesthesia* ; Anesthesia, General ; Anoxia ; Arterial Pressure ; Blood Gas Analysis ; Carbon Dioxide ; Electrocardiography ; Hand ; High-Frequency Jet Ventilation ; Humans ; Hypotension ; Insufflation ; Lung ; Male ; Middle Aged ; One-Lung Ventilation ; Optical Devices ; Oximetry ; Sympathectomy* ; Thorax ; Thromboangiitis Obliterans

A 39 years old, ASA PS I. healthy female patient was scheduled for surgical resection of a paraganglioma surrounding right carotid artery bifurcation area. Anesthesia was induced with thiopental and sucinylcholine and maintained with 0.75-1.25 Vo1% halothane in 50% nitrous oxide in oxygen. Reconstructive carotid artery surgery with intraluminal shunt was performed due to laceration of carotid artery bifurcation area during wide dissection of tumor mass. Duration of the carotid artery clamp and release was 35 minutes and any significant changes in vital signs and EEG were not found. Soon after the patient was recovered from anesthesia. She was delivered to recovery room and then she was transferred to intensive care unit. She was discharged from hospital without any neurologic sequelae on the 13th postoperative day.
Adult ; Anesthesia ; Carotid Arteries ; Electroencephalography* ; Female ; Halothane ; Humans ; Intensive Care Units ; Lacerations ; Nitrous Oxide ; Oxygen ; Paraganglioma ; Recovery Room ; Thiopental ; Vital Signs

BACKGROUND: Propafenone is a new class Ic antiarrhythmic compound.This study was performed to evaluate the clinical efficacy and safety of propafenone by double-blind, placebo-controlled, randomized cross-over comparison of propafenone and disopyramide in patients with stable ventricular ectopy. METHODS: All patients were included in the study if they had an average of at least 30 PVC/hr on a 24-hour Holter recordings. During the 1st 7 days, two placebo tablets(identical in apperance to the propafenone and the disopyramide tablets) were administrated in a double-blind manner(run-in period). Then 1st treatment period lasting 1 week with one verum and the other placebo, wish-out period of 3 day,2nd treatment period lasting 1 week with cross-over drugs were followed. RESULTS: Twenty patients were enrolled. During the run-in period, VPCs were reduced to 18%, compared to the baseline data before the administration of placebo.During the treatment period,propafenone 600mg/day reduced VPCs by 43% and disopyramide 400mg/day reduced VPCs by -10% Propafenone was effective(80% or greater reduction of VPCs) in 7 of 20 patients. Disopyramide was not effective in all patients. Propafenone and disopyramide produced no significant change of paired VPCs and VT events. Propafenone had no effect on heart rate. It increased the PR interval(7.9%;p<0.01) and QRS interval(5.2%;p<0.01). The drug did not change QTc interval(-1.1%) significantly. There were no cardiovascular side effects. Propafenone produced nausea in one patient. Disopyramide produced dysuria in 2 patients. CONCLUSIONS: Propafenone was more effective in controlling VPC than disopyramide, and there was no major limiting side effects.
Cross-Over Studies* ; Disopyramide* ; Dysuria ; Heart Rate ; Humans ; Nausea ; Propafenone* ; Ventricular Premature Complexes*