No abstract available.
Cytomegalovirus Infections* ; Cytomegalovirus* ; HIV Infections* ; HIV* ; Humans

An anaysis is performed on 424 open heart patients having postoperative respiratory care in respiratory intensive care unit of Seoul National University Hospital in 1986. The analysis was done according to disease prevalence, sex, age, pump time, duration of mechanical ventilation and mortality rate. 1) The most prevalent disease was mitral valvular disease. 2) The mean age of total patients was 35.6 and oldest age group was patients who recieved CABG, and the youngest were with ventricular septal defect combined with other disease. 3) The mean pump time was 110.6 minutes and it was longer in the patients with acquired heart disease than the patients with congenital heart disease. 4) The mean duration of mechanical ventilation was 61.5 hours and it was longer in the patients with the acquired heart disease than with the congenital heart disease. 5) The overall mortality rate was 1.18% and it was higher in the patients with congenital heart disease than with the acquired heart disease. The most prevalent cause of death was low cardiac output syndrome. 6) The length of mechanical ventilation time was not related with pump time.
Cardiac Output, Low ; Cause of Death ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Intensive Care Units ; Mortality ; Prevalence ; Respiration, Artificial ; Seoul

BACKGROUND: Although blood is very important therapeutic agent in bleeding patients, it may transmit disease, cause an adverse reaction in the recipients, raise the cost of patient care. Since the misuse and inappropriate use of blood is common, we are to review the transfusion practice in our hospital and to reduce unnecessary blood transfusion. METHODS: During a 10-month period from June 1994 through March 1995, 347 patients received blood transfusion during the operation. Among them, we reviewed retrospectively the charts of 211 patients available. We analyzed the transfusion pattern of 47 patients whose postoperative hematocrit exceeded 32 percent to determine the magnitude and cause of unnecessary blood transfusion. RESULTS: The patients of postoperative hematocrit over 32 percent were 119 patients out of 211 patients(56.4%). The main cause of overtransfusion was no reevaluation of the patients hematocrit after the prior unit was given. CONCLUSIONS: Guidelines for transfusing patients must be constructed based on acceptable intraoperative hematocrits. Unnecessary transfusion can be decreased when the transfusion done according to the guidelines, insisting on each reevaluation of the hematocrit prior to the administration of unit of blood.
Blood Transfusion ; Hematocrit ; Hemorrhage ; Humans ; Patient Care ; Retrospective Studies

BACKGROUND: Most of nonrebreathing circuits were used for pediatrics, not for adults and the high flow of fresh gas and specially designed valve or lever should be needed. The current study was designed to compare between one corrugated tube(universal FTMcircuit) and two corrugated tube in patients with oral and maxillofacial surgery under general anesthesia. METHODS: Twenty adults undergoing oral and maxillofacial surgery were anesthetized with enflurane- N2O-fentanyl after radial arterial cannulation. Under the condition with stable vital signs, ventilator was setted with tidal volume 10ml/kg, respiratory rate 11 breaths/min using two separate limbs(expiratory and inspiratory limbs) and one corrugated tube of anesthesia machine. Mean arterial pressure, heart rate, saturated pulse oxygen, end tidal carbon dioxide, peak inspiratory oxygen, arterial blood gas analysis were measured at 15, 30min during the use of each circuit. RESULTS: There were no differences of mean arterial pressure, heart rate, end tidal carbon dioxide, saturated pulse oxygen. peak inspiratory presssure and arterial blood gas analysis between 2 circuits during mechanical ventilation. CONCLUSIONS: Universal FTMcircuit of single limb could substituted for the two corrugated tube, especially in patients with oral and maxiolofacial surgery.
Adult ; Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Blood Gas Analysis* ; Carbon Dioxide ; Catheterization ; Extremities ; Heart Rate ; Hemodynamics* ; Humans ; Oxygen ; Pediatrics ; Respiration, Artificial ; Respiratory Rate ; Surgery, Oral* ; Tidal Volume ; Ventilators, Mechanical ; Vital Signs

BACKGROUND: Rocuronium(ORG 9426) is a new steroid nondepolarizing neuromuscular blocking drug with fast onset and intermittent duration of action. Its effects on vital signs are controversial. We studied onset, clinical duration, recovery index of rocuronium and its effects on blood pressures and heart rates. METHODS: We selected thirty healthy children who would receive inguinal herniorrhaphy and allocated them to 2 groups(control and rocuronium group). Without premedication or with oral medication of PocralTM (20 mg/kg), they administrated propofol(2.5 mg/kg) intravenous for loss of consciousness and we maintained anesthetic states with 20 mg/kg/hr of propofol. After 2 minutes, we checked BP(SBP/ DBP/MBP) and HR at every minutes and checked TOF, T1 height compare to control, T4 to T1 at every twenty seconds. We injected intravenously rocuronium(0.8 mg/kg, 2ED95) to rocuronium group and nothing to control group. We determined intubation time(from injection to 90% depression of maximal block), onset time(to maximal depression or T1=0), clinical duration(to T1=25%) and recovery index(from T1=25% to T1=75%). RESULTS: In children, intubation time was 93.8sec, onset time was 146.2sec, clinical duration was 34.6min, recovery index was 15.4min. SBP, DBP, MBP and HR were not changed independent of injection of rocuronium. CONCLUSION: Rocuronium is a muscle relaxant with rapid onset and intermittent clinical duration in children. It does not affect BP and HR.
Anesthesia* ; Anesthetics ; Blood Pressure* ; Child* ; Depression ; Heart Rate* ; Heart* ; Herniorrhaphy ; Humans ; Intubation ; Neuromuscular Blockade ; Premedication ; Propofol* ; Unconsciousness ; Vital Signs

BACKGROUND/AIMS: Telemedicine is a useful tool for remote education to overcome limitations of location. We have shared medical knowledge by the use of a real-time, high quality digital video transfer system (DVTS). The study aim was to evaluate the use of the DVTS by viewer questionnaire. METHODS: After an endoscopic live demonstration using DVTS and satellite broadcasting system (SBS), questions were provided for the degree of satisfaction about image and sound of the presentation. A questionnaire was composed of 11 questions concerning factors such as a comparison of image quality between the two systems. The preference between DVTS with SBS was analyzed. RESULTS: For image quality, SBS was more preferable than DVTS (65.6% versus 16.7%). However, 16.7% found no difference between the use of DVTS and SBS. For the time delay between the image and sound, 62.5% preferred SBS and 11.5% preferred DVTS. The satisfaction for combining DVTS with SBS were 68% as good and 22% as very good. CONCLUSIONS: We have demonstrated the feasibility of telemedicine by the demonstration of a satisfactory teleconference, although DVTS was utilized as an assistant tool. DVTS should prove to be a promising tool as a useful and economic means to provide remote medicine.
Education, Medical ; Telecommunications ; Telemedicine ; Surveys and Questionnaires

OBJECTIVES: The purpose of this study was to examine personality traits associated with suicidal symptoms (with history of suicide attempt or suicidal idea) in depressed patients. METHODS: A sample 186 patients diagnosed with major depressive disorder was divided into two groups : suicidal group (with history of suicide attempt or suicidal idea, n=70) and non-suicidal group (without history of suicide attempt or suicidal idea, n=116). NEO Personality Assessment System were used to evaluate personality trait. RESULTS: Neuroticism was high in suicidal group (p=0.041). In multivariate logistic regression, Neuroticism was also a significant influence on suicidal symptoms (Odds Ratio=1.04, 95% Confidence Interval 1.01–1.07, p=0.0145). CONCLUSIONS High Neuroticism is a useful information to identify individuals at high risk of suicide in depressive patients.

Objectives: ：This study was designed to investigate the correlation between defense mechanism and posttraumatic stress disorder in burn patients. Methods: ：We recruit 40 burn patients and we evaluate sociodemographic characteristics, characteristics related to burn, korean version of Impact of Event Scale-Revised (IES-R), Korean Version of Center for epidemiologic studies depression scale (CES-D) and Ewha Defense Mechanisms Test (EDMT). Multiple regression analysis was performed to evaluate the correlation between EDMT score and IES-R score. Results: ：Factor 2 of EDMT which consists of Ego-expansion subjects was significantly correlate with IER-S score. In factor 2, Controlling (β=-0.299, p<0.05), Sublimation (β=-0.276, p<0.05) is significantly correlate with IER-S score. Conclusions ：Some subjects of defense mechanism was significantly correlate with IES-R score. it might behelpful to understand defense mechanism for the posttraumatic stress disorder in burn patients.

NK/T-cell lymphoma, which often shows an angiocentric growth pattern, is a distinct clinicopathologic entity highly associated with Epstein-Barr virus. The disease is characterized by a destruction of the upper respiratory tract, particularly the nasal cavity, palate and paranasal sinuses. Interestingly, NK/T-cell lymphoma is closely linked to a variety of complications, such as hemophagocytic syndrome, second primary cancer, sepsis and bleeding. Here we report a case of a 50-year-old man diagnosed initially as NK/T-cell lymphoma of the oropharynx and who developed a second primary carcinoma of the hard palate during combination chemotherapy and radiation therapy.
Carcinoma, Squamous Cell/*pathology/therapy ; Case Report ; Combined Modality Therapy ; Fatal Outcome ; Human ; Killer Cells, Natural ; Lymphoma, T-Cell/*pathology/therapy ; Male ; Middle Age ; Neoplasms, Second Primary/*pathology/therapy ; Oropharyngeal Neoplasms/*pathology/therapy ; Palatal Neoplasms/*pathology/therapy

BACKGROUND: Laryngoscopic tracheal intubation causes acute hemodynamic changes such as hypertension and tachycardia. Adjuvant opioids during induction have been used to attenuate such responses. The aim of this study was to determine the optimal dose of bolus remifentanil, a newly developed ultra short acting opioid, to suppress cardiovascular responses immediately after laryngoscopic endotracheal intubation in patients anesthetized with N2O-O2-sevoflurane. METHODS: Sixty ASA I or II patients who requiring endotracheal intubation were randomly allocated to one of the four groups; C, R0.5, R1, and R2. Each group received normal saline, 0.5, 1, or 2microgram/kg of remifentanil respectively. Predetermined drugs for each group were administered over 30 seconds after induction of anesthesia with thiopental, rocuronium and 2 vol% of sevoflurane with 50% nitrous oxide. Laryngoscopic endotracheal intubation was carried out 60 seconds after the study drug administration. Mean arterial pressure (MAP) and heart rate (HR) were recorded at pre-anesthesia (PA), pre-intubation (PI) and during 5 minutes after intubation (IT-1 to IT-5). Statistical analysis was done for comparison of time and dose dependent changes among the groups. RESULTS: Baseline values were similar among the groups. IT-1 values did not change compared to PI values in R1 and R2. However, MAP and HR in R2 were significantly lower than PA values during post-intubation period. CONCLUSIONS: Bolus injection of 1microgram/kg of remifentanil blocks MAP and HR elevation after laryngoscopic endotracheal intubation without adverse effects in patients under N2O-O2-sevoflurane anesthesia.
Analgesics, Opioid ; Anesthesia ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal* ; Nitrous Oxide ; Tachycardia ; Thiopental