No abstract available.

Introduction: Thromboelastography (TEG) provides an overall assessment of the platelet-coagulation protein cascade interaction. The information generated from the TEG is rapidly obtained and made useful to guide replacement therapy. The purpose of this study was to evaluate the efficacy of the TEG as its guided blood replacement therapy and pharmacological therapy during liver transplantation. METHODS: This study was carried out in 13 consecutive patients who were subjected to TEG-guided replacement therapy during liver transplantation. A prepared mixture of blood products used for continuous replacement therapy was a fluid composed of red blood cells(2 units), fresh frozen plasma (2 units), and normal saline(500 ml). The pharmacological therapy was performed by comparing TEG of untreated blood and blood treated with antifibrinolytic and heparin neutralizing agent. Based on the findings of TEG, platelet concentrates were given. The TEG samples were obtained at various intervals. Additional TEG tracing was obtained as needed to see the effect of therapeutic intervention. RESULTS: In all patients the reaction time was kept in an acceptable range in the preanhepatic stage by administration of the mixture of blood products. Heparin-induced anticoagulation was observed in 3 cases in the anhepatic stage and in 11 cases upon reperfusion. Fibrinolysis was seen in all but one patients: 8% in the preanhepatic stage, 41% in the anhepatic stage, 69% at reperfusion, and 2% in the postanhepatic stage. Early and aggressive treatment with epsilon-aminocaproic acid effectively inhibited fibrinolysis without complications. Ten patients needed platelet transfusion in the postanhepatic stage with significant improvement in the TEG. CONCLUSIONS: The results of this study suggest that TEG monitoring and TEG-guided replacement and pharmacological therapy are clinically effective in maintaining blood coagulability.
Aminocaproic Acid ; Blood Platelets ; Fibrinolysis ; Heparin ; Humans ; Liver Transplantation* ; Liver* ; Plasma ; Platelet Transfusion ; Reaction Time ; Reperfusion ; Thrombelastography ; Transplantation

INTRODUCTIONThe objective of this study was to examine the clinical outcome of single-level lumbar artificial disc replacement (ADR) compared to that of transforaminal lumbar interbody fusion (TLIF) for the treatment of symptomatic degenerative disc disease (DDD) in an Asian population.

METHODSThis was a retrospective review of 74 patients who had surgery performed for discogenic lower backs that involved only the L4/5 and L5/S1 levels. All the patients had lumbar DDD without radiculopathy or spondylolithesis, and concordant pain with discogram at the pathological level. The patients were divided into two groups--those who underwent ADR and those who underwent TLIF.

RESULTSA trend suggesting that the ADR group had better perioperative outcomes (less blood loss, shorter operating time, shorter hospital stay and shorter time to ambulation) than the TLIF group was observed. However, a trend indicating that surgical-approach-related complications occurred more frequently in the ADR group than the TLIF group was also observed. The rate of revision surgery was comparable between the two groups.

CONCLUSIONOur findings suggest that for the treatment of discogenic lower back pain, lumbar ADR has better perioperative outcomes and a similar revision rate when compared with TLIF. However, the use of ADR was associated with a higher incidence of surgical-approach-related complications. More studies with bigger cohort sizes and longer follow-up periods are needed to determine the long-term efficacy and safety of ADR in lumbar DDD.

Adult ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; surgery ; Lumbar Vertebrae ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Retrospective Studies ; Singapore ; epidemiology ; Spinal Fusion ; methods ; Total Disc Replacement ; methods ; Treatment Outcome

BACKGROUND: Smoking, upper respiratory tract infection, genetic factors and hydrocarbons are known as risk factors of Goodpasture's syndrome. We studied a patient with Goodpasture's syndrome who had worked for 27 years in a foundry company. Based on a study on the work-relatedness of the syndrome, we describe and discuss our study results. CASE: A 46-year-old man, who had worked as a foundry worker for 27 years and had a 12 1/2 packyear history of smoking cigarettes, was admitted into a hospital on 15th February 2006 with coughing, chest pain and dyspnea. On admission, he had hematuria, proteinuria, severe restrictive pulmonary function disorder and rapid elevation of blood urea nitrogen/creatinine. Immunological examination showed ANA (+), ANCA (-) and Anti-GBM Ab (+). Kidney biopsy showed pauci-immune crescentic glomerulonephritis. Mild bleeding was revealed through bronchoscopy and no vasculitis and granuloma were present on at lung biopsy. Finally, we diagnosed the worker's illness as Goodpasture's syndrome and carried out hemodialysis and plasmapheresis. In the workplace survey, the exposure level of respirable crystalline silica exceeded the TLV-TWA (0.0106 mg/m3), which was calibrated for overtime. CONCLUSION: Based on both the clinical test and industrial hygiene examination, we concluded that the Goodpasture's syndrome in this case was caused by long-term silica exposure.
Anti-Glomerular Basement Membrane Disease ; Antibodies, Antineutrophil Cytoplasmic ; Autoantibodies ; Biopsy ; Bronchoscopy ; Chest Pain ; Cough ; Crystallins ; Dyspnea ; Glomerulonephritis ; Granuloma ; Hematuria ; Hemorrhage ; Humans ; Hydrocarbons ; Kidney ; Lung ; Middle Aged ; Occupational Health ; Plasmapheresis ; Proteinuria ; Renal Dialysis ; Respiratory Tract Infections ; Risk Factors ; Silicon Dioxide ; Smoke ; Smoking ; Threshold Limit Values ; Tobacco Products ; Urea ; Vasculitis

BACKGROUND: Smoking, upper respiratory tract infection, genetic factors and hydrocarbons are known as risk factors of Goodpasture's syndrome. We studied a patient with Goodpasture's syndrome who had worked for 27 years in a foundry company. Based on a study on the work-relatedness of the syndrome, we describe and discuss our study results. CASE: A 46-year-old man, who had worked as a foundry worker for 27 years and had a 12 1/2 packyear history of smoking cigarettes, was admitted into a hospital on 15th February 2006 with coughing, chest pain and dyspnea. On admission, he had hematuria, proteinuria, severe restrictive pulmonary function disorder and rapid elevation of blood urea nitrogen/creatinine. Immunological examination showed ANA (+), ANCA (-) and Anti-GBM Ab (+). Kidney biopsy showed pauci-immune crescentic glomerulonephritis. Mild bleeding was revealed through bronchoscopy and no vasculitis and granuloma were present on at lung biopsy. Finally, we diagnosed the worker's illness as Goodpasture's syndrome and carried out hemodialysis and plasmapheresis. In the workplace survey, the exposure level of respirable crystalline silica exceeded the TLV-TWA (0.0106 mg/m3), which was calibrated for overtime. CONCLUSION: Based on both the clinical test and industrial hygiene examination, we concluded that the Goodpasture's syndrome in this case was caused by long-term silica exposure.
Anti-Glomerular Basement Membrane Disease ; Antibodies, Antineutrophil Cytoplasmic ; Autoantibodies ; Biopsy ; Bronchoscopy ; Chest Pain ; Cough ; Crystallins ; Dyspnea ; Glomerulonephritis ; Granuloma ; Hematuria ; Hemorrhage ; Humans ; Hydrocarbons ; Kidney ; Lung ; Middle Aged ; Occupational Health ; Plasmapheresis ; Proteinuria ; Renal Dialysis ; Respiratory Tract Infections ; Risk Factors ; Silicon Dioxide ; Smoke ; Smoking ; Threshold Limit Values ; Tobacco Products ; Urea ; Vasculitis

OBJECTIVE: Cross-sectional survey was performed to evaluate prevalence of allergic rhinitis and its causative allergens in people in rural area of Cheju Isl~and. Subject and METHOD: A total of 1,236 people with 1,055 children and 181 adults in rural area of Cheju Island were enrolled in this study. In children, 544 were males and 511 were females, and their mean age was 12.3(ranging from 7 to 16) years. In adults, 78 were males and 103 were females, and their mean age was 50.1 (ratging from 18 to 87) years. Evaluations included a questionnaire survey, and skin prick test with extracts of Japanese cedar (Cryptomera japonica, J cedar) pollen and citrus red mite (Panonychus citri, CRM) as well as eleven common inhalant allergens. RESULTS: Prevalence of chronic nasal symptoms was 40.6% (429/1,055) in children, and 45.8 % (83/181) in adults. Prevalence of allergic rhinitis based on positive nasal symptoms on the questionnaire and positive skin response to one or more of the 13 inhalant allergens were 15.4 % (159/1.035) in children, and 19.3% (35/181) in adults. Of 1,035 children, skin-test response was positive in 37.6%, and common sensitizing allergens in order of decreasing frequency were Dermatophagoides pteronpssinus (DP) (26.6%), D. farinae (DF)(22.6%), CRM(14.2%), cockroach(11.3%) and J cedar(9.7%). Of 181 adults, skin-test response was positive in 25.9%, and t,he most common sensitizing allergen was CRM(16.5%), followed by cockroach(11.0%), DP(9. 9%), DF(9.4%), and J cedar(6.6%). Of 159 children with allergic rhinitis, the common sensitizing allergens in order of deereasing frequency were DP(79.2%), DF(67.3%), CRM(35.8%), J cedar(32.7%), and cockroach(27.0%). Of 35 adults with allergic rhinitis, the most common sensitizing allergen was CRM(68.6%), followed by DP(40%), DF(34.3%), cockroach(34.3%), and J cedar(28.9%). CONCLUSION: Allergic rhinitis is a very common disease with a prevalence of 15.4% in children and 19.3% in adults in rural area of Cheju island, and common sensitizing allergens include house dust mite, citrus red mite, cockroach, and Japanese cedar pollen.
Adult ; Allergens* ; Child ; Citrus ; Cockroaches ; Cross-Sectional Studies ; Cryptomeria ; Female ; Humans ; Jeju-do* ; Male ; Mites ; Pollen ; Prevalence* ; Pyroglyphidae ; Rhinitis* ; Skin ; Surveys and Questionnaires

BACKGROUND: Prevalence of bee venom allergy in Korea is unknown, OBJECTIVE: We performed a cross-sectional study to evaluate the prevalence of bee venom allergy and importance of risk factors, such as age, sex, and atopy, in the development of the allergic reaction in children and adults living in rural area of Cheju Island. Swbject and METHOD: The prevalence was investigated in subjects with 1,054 children and 370 adults (701 male, 723 female), aged 7-87 years, living in rural area of Cheju Island. A history particularly focused on the systemic reactions after the bee stings was taken in all subjects. Skin prick test,s to common inhalant allergens, including house dust mites, fungi, tree, grass, mugwort and ragweed pollen, cockroach, animal epithelium, Japanese cedar pollen, and citrus red mite were performed. RESULT: The prevalence of bee venom allergy was 5.8% (mild systemic reactions 5.0%, severe systemic reactions 0.8% ). The prevalence was higher in adults than in children (10.2% vs. 5.0%, g = 12.0, p<0.01). Among the children, the prevalerlce wB.S Signifcantly higher ill male than in female (8.6% vs. 1.3%, x=28.7, p<0.01), but no significant diffecence was noted between male and female in adults (10.0% vs. 10.3%, p>0.05). The prevalence of bee venom allergy was not significantly different between subjects with positive skin reaction and those with negative skin reaction to inhalant allergens (6.4% vs. 5.4% ), Conclasion'. The prevlence of bee venom allergy in inhabitants of rural area of Cheju Island is 5.8% (mild systemic,' 5.0%, severe systemic reaction. 0.8%), and bee venom allergy was more common in adults than in children, and in male children than in female children.
Adult* ; Allergens ; Ambrosia ; Animals ; Artemisia ; Bee Venoms* ; Bees* ; Bites and Stings ; Child* ; Citrus ; Cockroaches ; Cross-Sectional Studies ; Cryptomeria ; Epithelium ; Female ; Fungi ; Humans ; Hypersensitivity* ; Jeju-do* ; Korea ; Male ; Mites ; Poaceae ; Pollen ; Prevalence* ; Pyroglyphidae ; Risk Factors ; Skin

PURPOSE: The aim of this study was to assess the safety of TME with pelvic autonomic nerve preservation in male rectal cancer patients in terms of voiding and sexual function. METHODS: We performed uroflowmetry using Urodyn (Dantec, Denmark) and a standard questionnaire employing the IIEF (International Index of Erectile Function) and the IPSS (International Prostate Symptom Score) pre- and postoperatively in 68 male rectal cancer patients. RESULTS: There were significant differences of mean maximal flow rate and voided volume before and after surgery (18.9+/-5.7 vs 13.7+/-7.0, 240+/-91.9 vs 143+/-78, P<0.05, P<0.05), respectively. But, there was no difference of residual volume before and after surgery (4.4 2.6 vs 8.1 4.4, P>0.05). The total IPSS (International Prostate Symptom Score) was increased after surgery from 6.2+/-5.8 to 9.8+/-5.9 (P<0.05). There were no changes of score for one of each seven IPSS items in from 49 patients (73.5 percent) to 61 patients (89.7 percent). Five IIEF (International Index of Erectile Function) domain score (erectile function, intercourse satisfaction, orgasmic function, sexual desire and overall satisfaction) was statistically decreased after surgery (18.2+/-9.3 vs 13.5+/-9.0, 8.4+/-4.2 vs. 4.4+/-2.9, 5.8+/-2.9, vs. 4.4+/-2.9, 6.1+/-2.4 vs. 4.8+/-2.0, 6.1+/-2.2 vs. 4.5+/-2.3, P<0.05, respectively. Erection was possible in 55 patients (80.9 percent), but penetration ability was possible in 51 patients (75 percent). Complete inability for erection and intercourse was observed in 3 patients (5.5 percent). Retrograde ejaculation was noted in 9 patients (13.2 percent). IIEF domains such as sexual desire and overall satisfaction were markedly decreased in 39 patients (57.4 percent), 43 patients (63.2 percent), respectively. Multiple regression analysis of factors affecting postoperative sexual dysfunction showed that over 60 years (sexual desire: P=0.019), within 6 months (erectile function: P=0.04, intercourse satisfaction: P=0.011, orgasmic function: P=0.03), lower rectal cancer (erectile function: P=0.02, intercourse satisfaction: P=0.036, orgasmic function: P=0.027) were significant factors. CONCLUSIONS: TME with pelvic autonomic nerve preservation technique showed a safety and comparable data in preserving sexual and voiding function. The IPSS and IIEF questionnaire were useful and more investigative in assessing urinary and sexual function.
Autonomic Pathways* ; Ejaculation ; Humans ; Male* ; Orgasm ; Prostate ; Surveys and Questionnaires ; Rectal Neoplasms* ; Residual Volume

Carbon monoxide (CO) is a well-known chemical asphyxiant, which causes tissue hypoxia with prominent neurological injury. Therapeutic hypothermia (TH) has been shown to be an effective neuroprotective method in post-cardiac arrest patients. A 26-year-old man presented to the emergency department with severe CO poisoning. On arrival, the patient was comatose. His vital signs were blood pressure, 130/80 mm Hg; heart rate, 126/min; respiratory rate, 26/min; body temperature, 36degrees C; and O2 saturation, 94%. Initial carboxyhemoglobin was 45.2%. Because there was no available hyperbaric chamber in our local area, he was intubated and treated with TH. The target temperature was 33 +/- 1degrees C for 24 hours using an external cooling device. The patient was then allowed to reach normothermia by 0.15-0.25degrees C/hr. The patient was discharged after normal neurological exams on day 11 at the hospital. TH initiated after exposure to CO may be an effective prophylactic method for preventing neurological sequelae.
Anoxia ; Blood Pressure ; Body Temperature ; Carbon ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Carboxyhemoglobin ; Coma ; Emergencies ; Heart Rate ; Humans ; Hypothermia ; Hypothermia, Induced ; Respiratory Rate ; Vital Signs

OBJECTIVES: To prevent progression to fatal asthma it is essential to assess the severity of asthma and treat adequetely. But there was no objective index to evaluate the severity of airway inflammation in asthmatic patients, So we evaluated that serum ECP concentration is a objective parameter of airway inflammation in patients with acute severe asthmatic attack. METHODS: We measured the parameters of asthamtic severtity(clinical parameter, FEV1, arterial blood gas, peripheral blood eosinophil counts, and serum ECP levels) before and after antiasthmatic treatment in 9patients with acute severe asthmatic attack, And we compared serum ECP concentrations of severe asthmatic patients with those of control patients with mild to moderate severity. RESULTS: 1) The serum ECP levels in patients with acute asthmatic attacks compared to patients with mild to moderate, asthmatic severity were significantly increased. 2) The serum ECP levels and pheriperal blood eosinophil counts 2hours after antiasthmatic treatment were significantly lower than the value before treatment, but the total scores of clinical parameter, FEV1, and scores of arterial blood gases were not significantly different from the basal values, CONCLUSION: It is suggested that the serum ECP level is a objective parameter as a response to antiasthmatic treatment as well as a severity of airway inflammation in patients with acute asthmatic attack.
Asthma ; Eosinophil Cationic Protein* ; Eosinophils ; Gases ; Humans ; Inflammation