Postoperative hemorrhage after eardiopulmonary bypass(CPB) is one of the major causes of morbidity and mortality. Approximately 3% of patients have undergone surgical reexploration after open heart surgery. Coagulopathies after CPB are due to multiple hemostatic defects caused by hemodilution of procoagulants, firbrinogen, platelet, drugs and mechanical destruction by CPB machine. Thromboelastography(TEG) is the measures of viscoelastic properties of blood coagulation by providing information on the interaction of all the coagulation precursors and gives more clinically useful information on coagulation than that available from routine coagulation tests (RCT) or activated coagulation time(ACT). TEG is simple to use and can be performed within 30 minutes of blood sampling. Thirty-five patients of open heart surgery(12 were cyanotic and 23 were noncyanotic patients) were studied for the coagulation with TEG, ACT and RCT before and after CPB. Reaction time(R time), Coagulation time(R+K time), Maximum amplitude(MA), A60(Amplitude 60 min after MA), A60/MA index(Whole blood clot lysis index) and alpha angle were mea- sured in TEG, and at the same time RCT and ACT were also measured. Statistical analysis were performed by Student-t test for, significance, and 6 of TEG and 5 of RCT measurements were evaluated by multiple regression analytic methods(stepwise methods) for the correlation. The results were as follows: 1) TEG measurements before CPB were R time; 9.5+/-2.0min., R+K time; 14.6+/-2.7 min., MA; 52.4+/-3.6mm., A60; 45.1+/-4.5mm, Alpha; 46.2+/-5.50 and after CPB R time, 12.3+/-3.6min., R+K time, 24.3+/-16.4min., MA; 41.7+/-5.8min, A60; 36.4+/-4.4mm, Alpha, 32.0+/-8.90, respectively. There were significant differences between the measurements before and after CPB(P<0.005). 2) Before and after CPB, There was no significant difference between cyanotic and noncyanotic group in TEG 3) There was no fibrinolysis after CPB on TEG 4) There was significant correlation at the level of 95% significance after CPB following as; (1) R time vs aPTT and fivrinogen (2) R+K time vs PT, platelet and fibrinogen (3) MA vs platelet and PT (4) A60 vs platelet and fibrinogen (5) Alpha angle vs PT, aPTT, fibrinogen and Platelet 5) As the result of Multiple Regression Analytic Methods, R+K time, MA and Alpha angles after CPB could predict aPTT of RCT at the level of 99.5% signficance, In summary, thromboelastography is simple and easy to use in operating room for the diagnosis of coagulopathies compared with RCT.
Blood Coagulation ; Blood Platelets ; Cardiopulmonary Bypass* ; Diagnosis ; Fibrinogen ; Fibrinolysis ; Heart ; Hemodilution ; Hemostasis* ; Humans ; Mortality ; Operating Rooms ; Postoperative Hemorrhage ; Thoracic Surgery ; Thrombelastography*

Postoperative hemorrhage after eardiopulmonary bypass(CPB) is one of the major causes of morbidity and mortality. Approximately 3% of patients have undergone surgical reexploration after open heart surgery. Coagulopathies after CPB are due to multiple hemostatic defects caused by hemodilution of procoagulants, firbrinogen, platelet, drugs and mechanical destruction by CPB machine. Thromboelastography(TEG) is the measures of viscoelastic properties of blood coagulation by providing information on the interaction of all the coagulation precursors and gives more clinically useful information on coagulation than that available from routine coagulation tests (RCT) or activated coagulation time(ACT). TEG is simple to use and can be performed within 30 minutes of blood sampling. Thirty-five patients of open heart surgery(12 were cyanotic and 23 were noncyanotic patients) were studied for the coagulation with TEG, ACT and RCT before and after CPB. Reaction time(R time), Coagulation time(R+K time), Maximum amplitude(MA), A60(Amplitude 60 min after MA), A60/MA index(Whole blood clot lysis index) and alpha angle were mea- sured in TEG, and at the same time RCT and ACT were also measured. Statistical analysis were performed by Student-t test for, significance, and 6 of TEG and 5 of RCT measurements were evaluated by multiple regression analytic methods(stepwise methods) for the correlation. The results were as follows: 1) TEG measurements before CPB were R time; 9.5+/-2.0min., R+K time; 14.6+/-2.7 min., MA; 52.4+/-3.6mm., A60; 45.1+/-4.5mm, Alpha; 46.2+/-5.50 and after CPB R time, 12.3+/-3.6min., R+K time, 24.3+/-16.4min., MA; 41.7+/-5.8min, A60; 36.4+/-4.4mm, Alpha, 32.0+/-8.90, respectively. There were significant differences between the measurements before and after CPB(P<0.005). 2) Before and after CPB, There was no significant difference between cyanotic and noncyanotic group in TEG 3) There was no fibrinolysis after CPB on TEG 4) There was significant correlation at the level of 95% significance after CPB following as; (1) R time vs aPTT and fivrinogen (2) R+K time vs PT, platelet and fibrinogen (3) MA vs platelet and PT (4) A60 vs platelet and fibrinogen (5) Alpha angle vs PT, aPTT, fibrinogen and Platelet 5) As the result of Multiple Regression Analytic Methods, R+K time, MA and Alpha angles after CPB could predict aPTT of RCT at the level of 99.5% signficance, In summary, thromboelastography is simple and easy to use in operating room for the diagnosis of coagulopathies compared with RCT.
Blood Coagulation ; Blood Platelets ; Cardiopulmonary Bypass* ; Diagnosis ; Fibrinogen ; Fibrinolysis ; Heart ; Hemodilution ; Hemostasis* ; Humans ; Mortality ; Operating Rooms ; Postoperative Hemorrhage ; Thoracic Surgery ; Thrombelastography*

BACKGROUND: Activated charcoal has been widely used as an adsorbent for the management of drug intoxicated patients in the emergency department(ED). Although there are several commercial ready-mixed charcoal suspension preparations in the market, we are using custom-made suspension from hospital grade bulk charcoal powder. We designed this study to compare the adsorptive capacity of the Actidose Aqua(R), which is a commercial charcoal product, Fuller's earth, and custom-made activated charcoal used in our ED. METHODS: First, we performed modified USP methylene blue adsorption test which is a standard adsorption test for activated charcoal. Then, the drug adsorption test for phenobarbital, acetaminophen, salicylate, and aminophylline was done. Graded amount of three adsorptives were added to the stock solutions of each drugs. The adsorption test were performed as follows: The vials containing drugs and adsorptives were shaken for 30 minutes to ensure adsorption equilibrium, then the suspension was filtered through in-line filter. The filtrates were analyzed by ultraviolet spectroscopy to determine the residual drug concentrations. Finally we examined and compared the surface area and the structure of activated charcoal and Fuller's earth using scanning electron microscopy. RESULTS: In methylene blue adsorption test, the adsorption rate was 60.1% in Actidose Aqua(R) and 59.0% in custom-made charcoal, and 70.2% in Fuller's earth. For the phenobarbital, acetaminophen, and sallcylate, the adsorption rate of Actidose Aqua(R) and custom-made charcoal was greater than 90% with the ratio o adsorptives to drugs over 10:1. For aminophylline, two charcoal products showed excellent adsorption in 5:1 ratio. But Fuller's earth showed poor adsorption in all rages. CONCLUSION: Custom-made activated charcoal showed a comparable adsorption capacity to Actidose Aqua(R). Fuller's earth showed a poor performance to be used as a substitute for activated charcoal in acute drug poisoning otherwise paraquat.
Acetaminophen ; Adsorption ; Aminophylline ; Charcoal* ; Emergencies ; Humans ; Methylene Blue ; Microscopy, Electron, Scanning ; Paraquat ; Phenobarbital ; Poisoning ; Rage ; Spectrum Analysis

PURPOSE: This study was undertaken to describe the clinicopathologic characteristics and evaluate the appropriate management of appendiceal tumors. METHODS: During 5 years between Sep. 2000 and Sep. 2005, 28 appendiceal tumors were identified in a retrospective review of 3,744 cases of appendectomy or right hemicolectomy pathology. RESULTS: Carcinoids were found incidentally as appendicitis. Mucinous cystadenomas were common in women older than 50 aged; half of the cases presented with appendicitis and the other half presented with non-specific abdominal symptoms such as palpable mass, intestinal obstruction and intussusception. Carcinomas were common in the older patients (mean age: 62.8 years) and this presented as periappendiceal abscess. Right hemicolectomy was undertaken when there was evidence of tumor spread beyond the resection margin, and carcinoma and tumors were located in the appendiceal base. Recurrence and metastasis were identified only in the carcinoma cases. CONCLUSION: Most appendiceal tumors presented with appendicitis and periappendiceal abscess. One stage curative resection was possible in more than 76% of the patients, and the prepoperative diagnosis rate was less than 35%. The preoperative diagnosis did not have much impact on the clinical course, and the postoperative pathology was important in determining the additional treatment. Close follow-up is needed for the early detection of recurrence, and all the carcinomas that were advanced as serosal involvement, peritoneal seeding and liver metastasis.
Abscess ; Appendectomy* ; Appendicitis ; Appendix ; Carcinoid Tumor ; Cystadenoma, Mucinous ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Intestinal Obstruction ; Intussusception ; Liver ; Neoplasm Metastasis ; Pathology ; Recurrence ; Retrospective Studies

Appendiceal mucocele is a cystic dilatation of the appendiceal lumen with mucus, which may be caused by either benign or malignant diseases. In this report, five cases of appendiceal mucocele are reported, three of which had a preoperative diagnosis of mucocele, whereas the others were found incidentally during the operation under the diagnosis of intussusception and periappendiceal abscess. All five patients underwent surgical resections, including one ileocecal resection and four right hemicolectomies. Histopathology revealed a mucinous cystadenoma in four cases, and a mucinous cystadenocarcinoma in one. There was no disease-related death during 18 months of follow-up.
Abscess ; Appendix ; Cystadenocarcinoma, Mucinous ; Cystadenoma, Mucinous ; Diagnosis ; Dilatation ; Follow-Up Studies ; Humans ; Intussusception ; Mucocele* ; Mucus