Fluid resuscitation, hemostasis, and transfusion is essential in care of hemorrhagic shock. Although estimation of the residual blood volume is crucial, the standard measuring methods are impractical or unsafe. Vital signs, central venous or pulmonary artery pressures are inaccurate. We hypothesized that the residual blood volume for acute, non-ongoing hemorrhage was calculable using serial hematocrit measurements and the volume of isotonic solution infused. Blood volume is the sum of volumes of red blood cells and plasma. For acute, non-ongoing hemorrhage, red blood cell volume would not change. A certain portion of the isotonic fluid would increase plasma volume. Mathematically, we suggest that the residual blood volume after acute, non-ongoing hemorrhage might be calculated as 0·25N/[(Hct1/Hct2)-1], where Hct1 and Hct2 are the initial and subsequent hematocrits, respectively, and N is the volume of isotonic solution infused. In vivo validation and modification is needed before clinical application of this model.
Blood Volume ; Hematocrit ; Humans ; Isotonic Solutions/*therapeutic use ; *Models, Theoretical ; Shock, Hemorrhagic/*prevention & control/*therapy

Open carpal tunnel release has been the standard method of sumical treatment of carpal tunnel syndrome. Recently endoscopic carpal tunnel release has been introduced and is heing used by many authors. The advantages of this new technique are less postoperative pain, rapid restoration of power and rapid return-to-work. However many considerate authors, in spite of these advantages. insist that the inevitahle risk of neurovascular injury during the endoscopic procedure should not he underestimated. The purpose of our study is to compare the clinical results of endoscopic carpal tunnel release with those of open release. 20 open carpal tunnel releases in 16 patients and 15 endoscopic carpal tunnel reieases (single-portal technique) in 11 patients were performed hy the first author. Preoperative conditions of both groups are not different. Authors compared the clinical results between the two groups with some parameters. The overall clinical results were not different significantly hetween two groups. Rapid return-to-work(36 days in endoscopic group versus 60 days in open group) and less postoperative scar and pillar pain in endoscopic group were demonstrated. However, the major complication of one median nerve injury in endoscopic group seemed to overweigh these some benefits. We suggest that the standard operative technique for carpal tunnel syndrome should be open carpal tunnel release and more considerations should be takcn in choosing endoscopic method because of its inherent risk.
Carpal Tunnel Syndrome ; Cicatrix ; Humans ; Median Nerve ; Pain, Postoperative ; Return to Work

PACS (Picture Archiving and Communications System) is a computer-based image storage and retrieval system that can store, recall and display medical images rapidly on high resolution workstations. The image acquisition system consists of direct digital interface to computed radiography (CR) system. We reviewed X-rays of 84 patients who had both studies of Dual energy X-ray Absorptiometry (DXA) and AP, lateral views of lumbar vertebrae between January and December of 1995. We tried to verify the clinical implication of pixel values on PACS for DXA by comparing pixel values and bone mineral density (BMD) of the 2nd, 3rd and 4th lumbar vertebrae. They were all female between 44 and 72 years old, average age of 59. Bone mineral density (BMD), represented in DXA of a total of 252 vertebrae were mostly in the range of between 0.228 (22%) and 1.318 (121%). Pixel values of the AP and lateral views of the 2nd, 3rd and 4th vertebrae in the PACS workstation were closely correlated to bone mineral density (p=0.0001). The values of the DXA (bone mineral density and T score) get comparatively lower as the pixel values get smaller. In conclusion, the pixel value on PACS interfaced to CR could be utilized as an easy, speedy and economical tool for screening of osteoporosis.
Absorptiometry, Photon* ; Aged ; Bone Density ; Female ; Humans ; Lumbar Vertebrae ; Mass Screening ; Osteoporosis ; Radiography ; Spine

Return of facial nerve function is important in patients with facial nerve paralysis by trauma. Sometimes, delay in diagnosis of facial nerve paralysis make recovery of facial nerve function difficult. Traumatic facial palsy mostly occur after temporal bone fracture in unilateral. Temporal bone fracture after head trauma are divided into the three group; longitudinal fracture, transverse fracture and mixed fracture. The most common symptoms are hearing impairment, bloody otorrhea, loss of consciousness and facial nerve paralysis. The early care of temporal bone fracture involves facial nerve paralysis. And there has been many discussion and study in the treatment of the immediate or delayed facial palsy ; examply, surgical approach, time and methods. We have managed a patient with unilateral facial nerve paralysis after longitudinal temporal bone fracture in mastoid process and conservative facial nerve decompression was performed. We have obtained good result and report this case with review of literatures.
Craniocerebral Trauma ; Decompression* ; Diagnosis ; Facial Nerve* ; Facial Paralysis* ; Hearing Loss ; Humans ; Mastoid ; Paralysis ; Temporal Bone ; Unconsciousness

Proliferative vitreoretinopathy (PVR) is the main cause of failure in retinal reattachment surgery, Vitrectomy combined with pharmacologic therapy to inhibit proliferating and contracting epiretinal membranes appears to be a promismg approach in the management of PVR. We investigated the inhibitory effect of intravitreal 5-fluorouracil (5-FU) on experimental PVE induced by intravitreal injection of homologous dermal fibroblast in pigmented rabbits. At 6 weeks after intravitreal injection, Goup I (fibroblast only), Group II (early treatment with 1mg of 5-FU), and Group Ill (delayed treatment with 1mg of 5-FU) developed the retinal detachment in 85.7%, 33.3%, and 58.3% respectively. The rate of retinal detachment was lower in treatment groups than in non-treatment group, but there was a statistically significant difference only between non-treatment group (Group I) and early-treatment group (Group II) (p<0.05). In the group that only 5-FU was injected (Group IV), the retinas were preserved in normal clinically and pathologically. These results show that 5-FU may exert a significant anti proliferative effect on intraocular proliferative disorders including PVR especially if the drug is administered more earlier.
Epiretinal Membrane ; Fibroblasts ; Fluorouracil* ; Intravitreal Injections ; Rabbits ; Retina ; Retinal Detachment ; Retinaldehyde ; Vitrectomy ; Vitreoretinopathy, Proliferative*

After the first description of epikeratoplasty for the correction of aphakia, it has been widely used in high myopia and keratoconus for improvement of visual acuity. Seven epikeratoplasties were performed on five high myopia and two keratoconus patients showing intolerance to eye-glasses and contact lens, with the mean follow-up period of 9.7 months. In high myopia, mean spherical equivalent decreased from -15.90D to -2.05D postoperatively. In keratoconus, mean keratometric value decreased more than 4.94D postoperatively and the progression of disease stopped. All patients showed an imporvement in thei uncorrected visual acuity and best corrected visual acuity. In all cases, reepithelialization completed in 4-23 days (mean 14 days).
Aphakia ; Epikeratophakia* ; Follow-Up Studies ; Humans ; Keratoconus ; Myopia ; Visual Acuity

Arterial carbon dioxide partial pressure (PaCO2) and pH are basic indices of the adequacy of ventilation in anesthetized patients. Previous reports by us and by Frances et al indicate that peripheral venous Pco2 and pH approach values arterial blood during general anesthesia. The present study compares the arterial venous difference for Pco2 and pH during diethyl ether, methoxyflurane and halothane anesthesia in 20 cases each. After induction with thiopental, succinylcholine, the patient was intubated and maintained with N2O-O2 and one of above volatile agents. Venous blood was drawn from the back of the hand and an arterial sample was obtained from the radial artery of the other hand. The results were as follows: 1) The mean arteriovenous Pco2 differences in ether, methoxyflurane and halothane groups were -l. 25, -1. 425 and -0. 065 torr respectively. 2) The mean arterovenous pH differences in each group were 0. 031, 0, 017and 0. 014 respectively. We conclude from above results that the differences for the arteriovenous Pco2 and pH during halothane anesthesia were less than that of the ether or methoxyflurane groups.
Anesthesia* ; Anesthesia, General ; Carbon Dioxide ; Ether* ; Halothane* ; Hand ; Humans ; Hydrogen-Ion Concentration* ; Methoxyflurane* ; Partial Pressure ; Radial Artery ; Succinylcholine ; Thiopental ; Ventilation

BACKGROUND: Today, the eradication of H. pylori represents a generally accepted and beneficial therapeutic strategy for treatment and prevention of peptic ulcer relapse. Major factors that have affected H. pylori eradication are eradication rate of regimen, compliance of patients and complications of drugs. Recently, the combination of omeprazole, amoxicillin and clarithromycin has been accepted as one of the most effective treatment for the eradication of H. pylori. The primary aim of this study was to evaluate the efficacy of this therapeutic modality in Korean patients. METHODS: Two hundred twenty three patients with peptic ulcer and H. pylori infection were taken two types of triple therapy. Group A were treated with omeprazole 20 mg bid, amoxicillin 500 mg tid, clarithromycin 500 mg tid daily for 14 days. Group B were treated with omeprazole 20 mg bid, amoxicillin 1g bid, clarithromycin 500 mg bid daily for 7 days. Endoscopy with H. pylori tests was repeated 4 weeks after the end of treatment and then biopsy specimens were taken in antrum and body. CLO test and Warthin Starry silver stain were conducted concordantly. RESULTS: The H. pylori eradication rate was 92.5% in group A, 90.4% in group B. There was no significant difference in eradication rate. More than 50% of ulcer size reduction was observed 90.5% in group A, 86.3% in group B. There was no significant difference in ulcer healing(p > 0.05). The incidence of all side effects in both group were as follows; 22.6% in group A, 19.1% in group B. But major side effect was found only group A, of whom the symptom was too serious for the treatment to continue. CONCLUSION: We concluded that the seven days regimen was more favorable, because the eradication rate was almost the same as the 14 days regimen. And drug compliance and cost effectiveness were better than 14 days treatment regimen.
Amoxicillin* ; Biopsy ; Clarithromycin* ; Compliance ; Cost-Benefit Analysis ; Endoscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence ; Omeprazole* ; Peptic Ulcer ; Recurrence ; Silver ; Ulcer

A 46-year-old female was admitted to Soon Chun Hyang University hospital with a complaint of intermittent epigastric pain. X-ray and endoscopic pictures showed diffase irregular shallow depression which is similar to the macroscopic pattern of the type IIc early gastric cancer. But endoseopic biopsy showed no malignant cell infiltration. Hndoaeopic biopsy plays an important role in excluding the possibility of carcinoma. But operation shoud be considered inspite of biopsy result because malignant lymphoma ean not be completely ruled out. Histopathologic diagnosis was pseudolymphoma of stomach.
Biopsy ; Depression ; Diagnosis ; Female ; Humans ; Lymphoma ; Middle Aged ; Pseudolymphoma* ; Stomach ; Stomach Neoplasms

BACKGROUND: The aim of this study was to evaluate the sensitivity of a clinicians' self-report method for the detection of nosocomial infections (NIs) in comparison with a total surveillance method in a neonatal intensive care unit (NICU). METHODS: Two surveillance methods were concurrently performed in the NICU of a university hospital during 5 months in 2003. Clinicians' self-report surveillance (CSRS) was based on the retrospective verification of monthly reports of positive bacteriologic results by NICU clinicians. Total surveillance (TS) was done prospectively by an infection control nurse based on chart review and laboratory data. RESULTS: One hundred fifty nine patients accounting to 2759 patient-days were included in the study. Twenty-seven NIs among 26 patients were identified by TS. The sensitivity of CSRS compared to TS was 14.8% (4 of 27 NIs). The specificity was 98.5% (131 of 133 non-NIs). Kappa measures of agreement were -0.309. CONCLUSIONS: Our results confirm that the retrospective review of charts and laboratory data by clinicians lacks sensitivity and agreement for the surveillance of nosocomial infections.
Cross Infection* ; Humans ; Infant, Newborn ; Infection Control ; Intensive Care, Neonatal* ; Prospective Studies ; Retrospective Studies ; Sensitivity and Specificity