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

Chronic fatigue of the respiratory muscles has contributed to the decreased ventilatory capacity and reduced excercise tolerance of individuals with COPD, especially in kyphoscoliosis. Nasal mask BiPAP has been shown to be useful for the patient with nocturnal muscle fatigue and COPD. A 35-year-old man with severe kyphoscoliosis was admitted to ICU due to acute respiratory failure. He had been diagnosed of COPD and had been intubated with mechanical ventilatory support for 7 times. This time he was intubated with ventilatory support, too, in ICU and readmitted to the ICU for severe hypoxemia and hypercarbia from general ward. Thereafter he refused the intubation. Nasal mask BiPAP ventilatory support system was applied and IPAP, EPAP level being adjusted to the 12, 4 cmH2O under monitoring vital signs and arterial blood gas analysis. His condition was improved and discharged home with support of nasal mask BiPAP system after 33 day-stay in the ICU.
Adult ; Anoxia ; Blood Gas Analysis ; Fatigue ; Humans ; Intubation ; Masks* ; Muscle Fatigue ; Patients' Rooms ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Insufficiency ; Respiratory Muscles ; Vital Signs

No Abstract Available.
Hepatitis B e Antigens* ; Hepatitis B Surface Antigens*

BACKGROUND: The synthetic narcotic sufentanil has been used in clinical practice for anesthetic induction and maintenance. But there is little information concerning its direct effects on heart. The purpose of this study is to evaluate the direct effects of sufentanil on contracture of ventricular myocardium. METHODS: Isometric contraction of isolated right ventricular papillary muscle of rabbit was measured under 0.2 Hz electrical stimulation in Krebs solution. Peak developed force(F), maximum rate of rise of developed force(+dF/dt(max)), maximum rate of fall of developed force(-dF/dt(max)) were analyzed. RESULTS: There were no statistically significant differences in frequency of isometric contraction from the 100% baseline value in time-matched control group. Sufentanil, in concentration of 0.01-0.1 mM, increased F, and -dF/dt(max) was decreased especially in concentration of 0.1 mM but not +dF/dt(max) Fo +dF/dt(max) and -dF/dt(max) were statistically different from time-matched control group in concentration of 0.1 mM. CONCLUSIONS: We conclude that sufentanil has mild contracture effect on ventricular muscle of rabbit directly.
Analgesics ; Contracture ; Electric Stimulation ; Heart ; Isometric Contraction ; Myocardium ; Papillary Muscles ; Rabbits* ; Sufentanil*

Objectives: This study surveyed the quality of psychotherapy training and psychotherapy competencies during residency in Korea. Methods: A questionnaire developed by The Committee of Residency Training of the Korean Neuropsychiatric Association was completed by fourth-year residents of Korean psychiatry (n=120). The questionnaire examined their demographic characteristics, their experience of clinical psychotherapy training, their degree of satisfaction in the quality of psychotherapy training, and self-rated competence regarding the six types of psychotherapies, including supportive psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, psychoanalytic psychotherapy, group psychotherapy, and family psychotherapy. Results: The degree of satisfaction of the residents with the psychotherapy training was diverse among the types of psychotherapy and contents of training. Across all types of psychotherapies, the satisfaction levels of the quantity and quality of supervision education were low, except for psychoanalytic psychotherapy. Overall, more than 70% of residents were not satisfied with the theoretical education, clinical practice, and supervision education in three types of psychotherapies, including interpersonal psychotherapy, group psychotherapy, and family psychotherapy. A positive correlation was found between the degree of satisfaction with the quality of training experience and self-rated competence of psychotherapy. Specifically, the self-rated competence of psychotherapy was more highly correlated with the experience of clinical cases and supervision than theoretical education Conclusion This study showed the quantitative and qualitative status of psychotherapy training in Korean psychiatry residency programs, and the satisfaction level of psychotherapy education was low except for psychoanalytic psychotherapy. There is a strong need for the improvement of psychotherapy training programs in Korea.

Objectives: This study surveyed the quality of psychotherapy training and psychotherapy competencies during residency in Korea. Methods: A questionnaire developed by The Committee of Residency Training of the Korean Neuropsychiatric Association was completed by fourth-year residents of Korean psychiatry (n=120). The questionnaire examined their demographic characteristics, their experience of clinical psychotherapy training, their degree of satisfaction in the quality of psychotherapy training, and self-rated competence regarding the six types of psychotherapies, including supportive psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, psychoanalytic psychotherapy, group psychotherapy, and family psychotherapy. Results: The degree of satisfaction of the residents with the psychotherapy training was diverse among the types of psychotherapy and contents of training. Across all types of psychotherapies, the satisfaction levels of the quantity and quality of supervision education were low, except for psychoanalytic psychotherapy. Overall, more than 70% of residents were not satisfied with the theoretical education, clinical practice, and supervision education in three types of psychotherapies, including interpersonal psychotherapy, group psychotherapy, and family psychotherapy. A positive correlation was found between the degree of satisfaction with the quality of training experience and self-rated competence of psychotherapy. Specifically, the self-rated competence of psychotherapy was more highly correlated with the experience of clinical cases and supervision than theoretical education Conclusion This study showed the quantitative and qualitative status of psychotherapy training in Korean psychiatry residency programs, and the satisfaction level of psychotherapy education was low except for psychoanalytic psychotherapy. There is a strong need for the improvement of psychotherapy training programs in Korea.

BACKGROUND: The aim of this study was to evaluate causes of unstable total knee arthroplasty and results of revision surgery. METHODS: We retrospectively reviewed 24 knees that underwent a revision arthroplasty for unstable total knee arthroplasty. The average follow-up period was 33.8 months. We classified the instability and analyzed the treatment results according to its cause. Stress radiographs, postoperative component position, and joint level were measured. Clinical outcomes were assessed using the Hospital for Special Surgery (HSS) score and range of motion. RESULTS: Causes of instability included coronal instability with posteromedial polyethylene wear and lateral laxity in 13 knees, coronal instability with posteromedial polyethylene wear in 6 knees and coronal and sagittal instability in 3 knees including post breakage in 1 knee, global instability in 1 knee and flexion instability in 1 knee. Mean preoperative/postoperative varus and valgus angles were 5.8degrees/3.2degrees (p = 0.713) and 22.5degrees/5.6degrees (p = 0.032). Mean postoperative alpha, beta, gamma, delta angle were 5.34degrees, 89.65degrees, 2.74degrees, 6.77degrees. Mean changes of joint levels were from 14.1 mm to 13.6 mm from fibular head (p = 0.82). The mean HSS score improved from 53.4 to 89.2 (p = 0.04). The average range of motion was changed from 123degrees to 122degrees (p = 0.82). CONCLUSIONS: Revision total knee arthroplasty with or without a more constrained prosthesis will be a definite solution for an unstable total knee arthroplasty. The solution according to cause is very important and seems to be helpful to avoid unnecessary over-constrained implant selection in revision surgery for total knee instability.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*adverse effects ; Female ; Humans ; Joint Instability/*etiology ; Knee Joint/*surgery ; Knee Prosthesis ; Male ; Middle Aged ; *Prosthesis Failure ; Reoperation ; Retrospective Studies

Isolated adrenal gland injuries have rarely been reported, but can be potentially devastating if unrecognized. Herein, we describe a case of an isolated adrenal gland injury following a motor vehicle accident. Under the diagnosis of an isolated adrenal injury without visceral organ injury by abdominopelvic CT, conservative management led to a favorable outcome.
Adrenal Glands ; Motor Vehicles

Hematocrit is an important determinant of oxygen delivery. Of particular interest, its target level is very wide for different kinds of shock: from 30% for hemorrhagic or septic shock to 56% for secondary polycythemia. This range is not only wide but also deviated to the higher level from the optimal value of 40%. In this letter, the authors determine the mathematical basis of the wide and deviated range of hematocrit starting from the Hagen-Poisseuille equation.
Hematocrit ; Hemoglobins ; Oxygen ; Polycythemia ; Shock ; Shock, Septic

OBJECTIVES: The direct causal relationship between the experience of sexual assault and development of psychiatric disorder remains uncertain. However, studies consistently show that those with history of this horrendous event report a wide range of symptoms, higher level of distress, and various social and psychological problems. This study investigated the prevalence and associated risk factors in a cohort sample of 340 Korean psychiatric patients. METHODS: Data from consecutive 340 new patients were gathered at a psychiatric department of a university affiliated hospital. Participants completed Life Events Scale, Symptom Checklist-90-R, State-Trait Anxiety Inventory, Beck Depression Inventory, and Dissociative Experiences Scale. RESULTS: History of sexual assault was reported by 11.5% of respondents (women 18.6%;men 2.1%). Bivariate analysis revealed that women (p<.001), divorced or widowed and never been married (p<.05), unemployed and students or housewives (p<.05), monthly income more than 2 million Won (p<.05) were associated significantly with experience of sexual assault. All the scores from the scales but Beck Depression Inventory were significantly higher for the sexually assaulted. Multiple logistic regression analysis revealed that women were 12 times more likely to be sexually assaulted (Odds ratio=12.24, 95% CI=3.51-42.64). Other risk factors included younger age and interaction of post-traumatic stress disorder (PTSD) and Global Severity Index. CONCLUSION: This study supported the risk factors of sexual assaults identified in western literature. Clinicians can be alert for any history of sexual assault when younger women with PTSD present higher level of symptomatology.
Anxiety ; Cohort Studies ; Surveys and Questionnaires ; Depression ; Divorce ; Female ; Humans ; Logistic Models ; Prevalence* ; Rape ; Risk Factors ; Stress Disorders, Post-Traumatic ; Weights and Measures ; Widowhood