After the description of the necessity of denitrogenation in rebreathing anesthesia circuits some decades ago, many methods were recommended for techniques of ventilation with oxygen before induction of anesthesia for the purpose of maintaining arterial oxygenation during laryngoscopy and tracheal intubation . In this point of view, we compared PaO2, MAP, PaCO2, pH of non-preoxgenation group(oxygen was given after succinylcholine was injected) with those of preoxygenation group(owygen was given after thiopental sodium was injected). The cases were selected randomly who blongs to ASA class l or ll(without cardiopulmonary abnormalities) and ages betweens 27 years and 66 years old. Before induction of general anesthesia, we cannulated radial artery after Allen's test and sampled arterial blood before anesthesia, after thiopenthal and succinylcholine were injected respectively, when tracheal intubation was done in the two groups and measured PaO2, PaCO2, MAP, pH respectively. PaCO2, MAP, pH changes in the two groups were not significant and of no clinical significanses. PaO2 after tracheal intubation showed marked increase in preoxygenation group compared to non-preoxygenation group but mean PaO2 was maintained within normal range in non-preoxygenation group with the apnetic period of tracheal intubation. WE found that non-preoxygenated patients also had normal range of PaO2 during the whole process of induction of anesthesis. But I think preoxygenation technique of any method can reserve more time and will do more effectively, especially when times consuming events of difficult intubation of any reason occurs.
Aged ; Anesthesia ; Anesthesia, Closed-Circuit ; Anesthesia, General* ; Humans ; Hydrogen-Ion Concentration ; Intubation ; Laryngoscopy ; Oxygen ; Radial Artery ; Reference Values ; Succinylcholine ; Thiopental ; Ventilation

OBJECTIVE: To measure the performance of a hospital enterprise resource planning (ERP) system and suggest various system improvements. METHODS: A survey based on a 5-point Likert scale questionnaire and an exclusive interview was administered to 102 employees with a one-year experience of using an ERP system at one university hospital. In order to analyze the factors affecting the ERP system performance, multiple regression analysis and Chi-square test were conducted. RESULTS: All three examined variables-system quality, information quality and integration of hospital information resources-affected the ERP system performance positively. However, the system quality variable had the lowest mean score indicating that the ERP system was difficult to understand for many users. User characteristics were not significantly associated with information quality satisfaction. CONCLUSION: On the basis of the study results, we recommended some suggestions to improve the ERP system performance. In order to reduce users' dissatisfaction with the new system, hospitals should publicize the needs of the ERP system for the employees, design more effective training programs, and provide more decision-supporting information for managers.
Education ; Surveys and Questionnaires

Animals ; Enflurane* ; Halothane* ; Isoflurane* ; Rats* ; Relaxation* ; Vasodilator Agents*

OBJECTIVES: This research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems. METHODS: We focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively. RESULTS: Using queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%. CONCLUSIONS: It is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process.
Delivery of Health Care ; Electronic Health Records ; Hospitals, Public ; Humans ; Outpatients

43 cases of pen heart surgery anesthesia done at Kyungpook National University hospital from Jun 1983 to August 1984, were measured for the concentrations of serum Na, K, Cl and CO2 before, during and after bypass. Also these values were analysed according to disease such as A(V)SD, TOF and M(S)I groups. The results were as follows. The mean values for serum sodium level before, during and after bypass were observed to be 124.41+/-8.62, 127.56+/-8.63, and 130.73+/-29.04mEq/G. These values revealed a tendency to elevation and the value after bypass was significantly increased comparied with the value before bypass(p<0.01). The mean values for serum potassium levels of all the cases before, during and after bypass were observed to be 3.84+/-1.01, 4.38+/-1.48, and 3.59+/-0.95mEq/G. The value after bypass was significantly decreased compared with the value during bypass(p<0.001). The mean values for serum chloride level of all the cases before, during and after bypass were observed to be 98.26+/-6.87, 97.10+/-6.59 and 98.35+/-7.94mEq/G and these values showed no significant change. The mean values for serum carbon dioxide levels of all the cases before, during and after bypass were observed to be 20.78+/-3.70, 22.33+/-4.53 and 24.87+/-3.72 mEq/G and these values continuously increased. The value after bypass was significantly increased. The value after bypass was significantly increased compared with the value before bypass. In the changes of serum electrolytes before, during and after bypass according to disease, the serum potassium level after bypass of the A(V)SD group and during bypass of TOF group showed a significant change(p<0.05). The changed values in the serum electrolytes before and during bypass became within normal range after bypass.
Anesthesia* ; Carbon Dioxide ; Electrolytes ; Gyeongsangbuk-do ; Heart* ; Potassium ; Reference Values ; Sodium ; Thoracic Surgery*

BACKGROUND: Alterations in blood cell count are well recognized features of bacteremia. The study objective was to determine the hematologic changes predictive of bacteremia. METHODS: We retrospectively studied febrile adult patients with neutrophilia and included patients were either bacteriologically proven cases or those who had clinically suspected bacterial infections. Hematologic findings derived from basic hematologic tests were compared between patients with and those without bacteremia. RESULTS: Of the 624 patients, 143 (22.9%) had significant bacteremia. The following items were significantly different between patients with and those without bacteremia by univariate analysis: absolute neutrophil count, neutrophil differential, absolute lymphocyte count, lymphocyte differential, platelet count and band-associated parameters such as absolute band neutrophil count (ABC). Multivariate analysis revealed platelet count, lymphocyte differential and ABC as independent predictors (P<0.0001, each). Platelet count, the most potent predictor of bacteremia, showed area under the curve (AUC) of 0.685. Analysis according to the primary diagnosis indicated that the most potent predictors of bacteremia in patients with respiratory tract, urinary tract and hepatobiliary system infections were platelet count (P=0.002, AUC=0.697), ABC (P=0.002, AUC=0.681) and neutrophil differential (P=0.0001, AUC=0.822), respectively. CONCLUSIONS: Simple variables obtained from basic hematologic tests were associated with bacteremia even in febrile patients with neutrophilia. In particular, very high neutrophil differential was highly predictive of bacteremia in patients with hepatobiliary system infections and its clinical usefulness needs to be elucidated in a prospective study.
Adult ; Bacteremia ; Bacterial Infections ; Blood Cell Count ; Hematologic Tests ; Humans ; Lymphocyte Count ; Lymphocytes ; Multivariate Analysis ; Neutrophils ; Platelet Count ; Respiratory System ; Retrospective Studies ; Urinary Tract

OBJECTIVES: The purpose of this study was to investigate whether elderly and young adults differ in their recognition of facial expressions of emotion. METHODS: A total of 120 (elderly group 53, young group 67) subjects participated in this study. Korean facial expressions of emotion including happiness, sadness, fear, anger, disgust, surprise and neutral were used as stimuli for facial affect recognition test. Computerized facial affect recognition test that consists of facial affect discrimination test and facial affect intensity test was performed. RESULTS: For facial affect discrimination test, there was a significant difference between two groups (F=3.986, p<.01) after controlling the effect of education. Elderly participants showed significantly less correct recognition rate with sadness, anger and disgust (p<.05). For facial affect intensity test, there was no significant difference between the groups in recognition of emotional intensity. Chi-square test or t-test was done according to the clinical variables. Multivariate analysis of covariance was done to test group differences of correct recognition rate and emotional intensity. CONCLUSION: This is the first report of differential decrease of facial affect recognition in elderly using Korean facial expressions. This study suggests that the decrement of facial affect recognition maye be a part of normal aging process.
Aged* ; Aging ; Anger ; Discrimination (Psychology) ; Education ; Facial Expression ; Happiness ; Humans ; Multivariate Analysis ; Young Adult

Macrodactyly of the toe is a rare congenital anomaly characterized by the overgrowth of a digit/digits in the foot and is one of the most difficult conditions to treat. Since the condition alters functionality and appearance, the treatment goal is to restore function and cosmetically enhance the appearance. Various surgical techniques are used for toe macrodactyly, including amputation, debulking, and epiphysiodesis. Herein, we present a case of a six-year-old patient with a second toe macrodactyly who was successfully treated with a twostage operation over a seven-year period. We initially performed an ostectomy of the middle phalanx with a fusion of the proximal and distal phalanges and then performed a soft tissue debulking procedure.

The prevalence of colon cancer is increasing in Korea and the principal strategy of its management is early detection and surgical resection. For the early detection of colon cancer, endoscopic evaluation is important and the ability to find out early stage small lesion is needed for the endoscopist. To find out encloscopic features of early colon cancer, we reviewed 17 cases of early colon cancer who have admitted to Seoul National University Hospital from January 1982 to December 1993. 1)59% of the lesions were located in rectum and the size ranged from 0.7cm to 9cm, all of the 17 cases showed polypoid mass contour and the surface of them had erosion, hyperemia, ulceration and easy touch bleeding tendency. 2) Colon cancer was diagnosed by endoscopic gross findings in 41% and endoscopic biopsy could confirm colon cancer in 70%. However, barium enema could diagnose only 41% of early colon cancer. 3) Five cases were operated under the diagnosis of colonic adenoma which were large(>3 cm) villous type or contained severe dysplasia 4) Submucosal tumor infiltration was found in 10 cases and 65% had associated adenoma 5) Lymph node involvement was none and there was no recurrence in 47 month follow up period after various surgical treatments.
Adenoma ; Barium ; Biopsy ; Colon* ; Colonic Neoplasms* ; Diagnosis ; Endoscopy ; Enema ; Follow-Up Studies ; Hemorrhage ; Hyperemia ; Korea ; Lymph Nodes ; Prevalence ; Rectum ; Recurrence ; Seoul ; Ulcer

OBJECTIVE: The objective of this study was to identify patterns of brain activation elicited by erotic visual stimuli in patients treated with either Selective Serotonin Reuptake Inhibitors (SSRIs) or mirtazipine. METHODS: Nine middle-aged men with major depressive disorder treated with an SSRI and ten middle-aged men with major depressive disorder treated with mirtazapine completed the trial. Ten subjects with no psychiatric illness were included as a control group. We conducted functional brain magnetic resonance imaging (fMRI) while a film alternatively played erotic and non-erotic contents for 14 minutes and 9 seconds. RESULTS: The control group showed activation in the occipitotemporal area, anterior cingulate gyrus, insula, orbitofrontal cortex, and caudate nucleus. For subjects treated with SSRIs, the intensity of activity in these regions was much lower compared to the control group. Intensity of activation in the group treated with mirtazapine was less than the control group but grea-ter than those treated with SSRIs. Using subtraction analysis, the SSRI group showed significantly lower activation than the mirtazapine group in the anterior cingulate gyrus and the caudate nucleus. CONCLUSION: Our study suggests that the different rates of sexual side effects between the patients in the SSRI-treated group and the mirtazapine-treated group may be due to different effects on brain activation.
Brain ; Caudate Nucleus ; Depressive Disorder, Major ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Male ; Mianserin ; Serotonin Uptake Inhibitors