BACKGROUND: Patients receiving an elective total knee replacement (TKR) are frequently older and immobilized. The related decline in respiratory function and structural changes may place these patients at an increased risk of perioperative pulmonary complications. METHODS: This study reviewed the data of 239 consecutive procedures performed by a single surgeon. The data examined included the patient's characteristics (age, gender, height, weight and body mass index [BMI]); concurrent pulmonary comorbidity (presence vs. absence); anesthetic techniques (general vs. spinal); types of operation (unilateral vs. bilateral); duration of operation (< 4 vs. > or = 4 hr); duration of tourniquet inflation (< 2 vs. > or = 2 hr); number of perioperative transfusions (< or = 4 vs. > or = 5 units); and American society of anesthesiologists (ASA) physical status. Pulmonary complications were grouped together as a single outcome. A Chi-square test and multiple logistic regression analysis were used to identify the risk factors. A P value < 0.05 was considered significant. RESULTS: Pneumonia, pulmonary edema, pulmonary congestion, atelectasis and pulmonary embolism were the pulmonary complications (n = 28; 11.7%) examined. Age, gender, BMI, pulmonary comorbidity, type and duration of surgery, duration of tourniquet inflation, anesthetic technique and ASA physical status were not associated with pulmonary complications. Only the number of packed cells transfused (> or = 5 units) was found to be associated with the pulmonary complications (odds ratio 5.21; P = 0.015). In particular, transfusions were related to pneumonia, pulmonary edema, pulmonary congestion and pulmonary embolism (P < 0.01). However, atelectasis was not related to any of the potential risk factors including the anesthetic technique. CONCLUSIONS: Transfusion requirements may be an important risk factor of the early postoperative pulmonary complications in patients receiving a TKR.
Arthroplasty, Replacement, Knee* ; Body Mass Index ; Comorbidity ; Estrogens, Conjugated (USP) ; Humans ; Inflation, Economic ; Logistic Models ; Pneumonia ; Pulmonary Atelectasis ; Pulmonary Edema ; Pulmonary Embolism ; Risk Factors* ; Tourniquets

PURPOSE: To determine the value of thin-section CT in the diagnosis of nasal bone fractures. MATERIALS AND METHODS: We evaluated the thin-section CT scans of 40 patients with nasal bone fracture. CT scans were obtained with both axial and coronal planes, 1.5mm collimation with 2mm interval, and 9.6cm field-of-view. The axial scan plane was kept parallel to the orbitomeatal line from the nasion to the lower limit of the nose and the coronal plane was kept perpendicular to the axial plane. The data were reconstructed with bone algorithm. Nasal bone fracture was classified into 1 of 3 types on thin section CT:(I) simple fracture;(ll) simple fracture with displacement;(III) comminuted fracture. Associated facial bone injuries were also evaluated Simple radiographs of nasal bone were reviewed for comparison. RESULTS: Six patients had simple fracture, 10 patients had simple fracture with displacement, and 24 patients had comminuted fracture. Twenty-six patients had associated facial bone injuries which included fracture of nasal septum (n=15), fracture of frontal process of maxilla (n=9), fracture of ethmoid (n=6), widening of nasofrontal suture (n=5), and fracture of nasolacrimal duct (n=2). In 15 of 40 patients, CT could identify nasal bone fractures not detected on simple radiographs. CONCLUSION: Thin-section CT is a valuable aid in the evaluation of nasal bone fracture for accurate identification, nature, and combined facial injury.
Diagnosis ; Facial Bones ; Facial Injuries ; Fractures, Comminuted ; Humans ; Maxilla ; Nasal Bone* ; Nasal Septum ; Nasolacrimal Duct ; Nose ; Sutures ; Tomography, X-Ray Computed

BACKGROUND: To test whether smokers have exaggerated hemodynamic responses to induction and intubation, we investigated the changes in blood pressure (BP) and heart rate (HR) on induction and intubation in smokers and nonsmokers. METHODS: Healthy male patients (25 smokers and 25 nonsmokers, aged 20 to 29 yrs) for elective surgery were studied. Anesthesia was induced with thiopental 3 mg/kg, fentanyl 1.5 microgram/kg, vecuronium 0.1 mg/kg and maintained with enflurane 1 % in N2O and O2 for the period of observation. After three minutes, orotracheal intubation was performed. Noninvasive BP and HR were recorded one minute before induction (baseline), immediately before intubation, and then every minute until five minutes after intubation. RESULTS: Systolic BP of smokers decreased significantly immediately before intubation, and at 4 and 5 min after intubation as compared to that of nonsmokers (Mean +/- SEM, 120.8 +/- 3.0 vs. 109.9 +/- 2.8, 116.7 +/- 2.4 vs. 108.9 +/- 2.3, and 114.8 +/- 2.2 vs. 106.7 +/- 2.3 mmHg, respectively, P < 0.05). Diastolic BP of smokers decreased only immediately before intubation compared with that of nonsmokers (Mean +/- SEM, nonsmoker 64.6 +/- 2.4 vs. smoker 58.6 +/- 1.8 mmHg, P < 0.05). However, there was no significant difference of HR between smokers and nonsmokers during the observational period. CONCLUSIONS: Hemodynamic response is different in smokers compared with nonsmokers. Our results indicate that smoking affects the hemodynamic response to induction and intubation.
Anesthesia ; Blood Pressure ; Enflurane ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Male ; Smoke ; Smoking ; Thiopental ; Vecuronium Bromide

The purpose of this study is to investigate the distribution and the direction of fibers in nasal polyps. The distribution of fibers is not well known about position and quantity. From June 1993 to April 1996, the authors obtained 232 nasal polyps from 191 patients. The polyps had been stained with H-E method. Authors observed the histopathologic type of polyps, and then the polyps have been stained with Weigert's method getting information about the fibers of polyps. In the polyps, the origin site of polyp showed dense collagen fibers of which direction resembled the movement of sand in hour-glass. In the submucosa, the direction of fibers is parallel to epithelium. Each gland or grouped glands in the polyps were circumscribed with collagen fibers. Our current study on the fibers and glands in nasal polyps is very fundamental, but we suggest that further investigation about the fibers and glands in polyps would enable to reveal pathogenesis of polyp investigated.
Collagen ; Epithelium ; Humans ; Nasal Polyps* ; Polyps ; Silicon Dioxide

PURPOSE: To assess the normal range of transverse and AP diameter of the trachea on simple chest radiographs and to determine whether or not there is any correlation between tracheal diameter and age, sex, height, or bodyweight. MATERIALS AND METHODS: Six hundred and ninety patients with no lesion on chest radiographs and noclinical evidence of respiratory disease were involved in this study. To obtein transverse and lateral diameters,the internal diameter of the tracheal air column was measured at a level 2 cm above the top of the aortic arch onboth posteroanterior and lateral radiographs. RESULTS: The normal ranges of AP and transverse diameters of thetrachea were 16 to 25mm, and 14 to 22mm in men, respectively and 12 to 20mm and 12 to 18mm in women. Statistically significant differences were observed between AP and transverse diameter in both in men and women, the former being consistently larger than the latter in both sexes. In men, significant correlations were observed between transverse diameter and patients' height, and between AP diameter and age as well as height. In women, significant differences were observed between AP diameter and patients' height, and transverse diameter and height as well asbody weight of patients. CONCLUSIONS: Normal tracheal diameter was larger in men than in women. and AP diameter was larger than transverse diameter. Patients' height showed persistent correlation with luminal diameter.
Aorta, Thoracic ; Female ; Humans ; Male ; Phenobarbital* ; Radiography, Thoracic* ; Reference Values ; Thorax* ; Trachea

BACKGROUND: This study was conducted in order to evaluate the propriety of expanded donor criteria in Korea and to identify the preoperative factors influencing allograft survival and function. METHODS: We studied 404 patients who received deceased renal transplants from five transplantation centers of 2, 3 territory from 2000 to 2010. Differences in 1-year graft function, delayed graft function (DGF) rate, and graft survival rate between the standard criteria donor (SCD) and expanded criteria donor (ECD) were compared retrospectively. The preoperative factors influencing graft function and graft survival were analysed. RESULTS: SCD showed significantly better 1-year graft function than ECD (P=0.011). No differences in 1-year acute rejection rate were observed between SCD (13.2%) and ECD (16.9%) (P=0.449). Significantly higher DGF rate was observed for ECD (25.4%) than for SCD (14.1%) (P=0.022). Graft type had no significant influence on 5-year graft survival (SCD 94.5% vs. ECD 93.7%) (P =0.835). Advanced donor age (P=0.001), donor hypertension history (P=0.047), high serum creatinine (P=0.002), and cerebral infarction as cause of death (P=0.004) had a negative influence on 1-year allograft function. Significantly low graft survival was observed for advanced donor age (P =0.002). CONCLUSIONS: Graft function, DGF rates of ECD were poorer than those of SCD. Graft survival rate of ECD was comparable to that of SCD kidney. Korean Network for Organ Sharing expanded criteria may underestimate the organ quality of deceased kidney and modification may be needed in order to expand the potential donor pool through nationwide study.
Cause of Death ; Cerebral Infarction ; Creatinine ; Delayed Graft Function ; Graft Survival ; Humans ; Hypertension ; Kidney ; Kidney Transplantation* ; Korea ; Retrospective Studies ; Survival Rate ; Tissue Donors* ; Transplantation, Homologous ; Transplants