Clinically, the Rh blood group system is important since Rh antibodies are readily induced by transfusion or pregnancy in individuals negative for the antigert and may cause hemolytic reactions or hemolytic disease of the newborn. Since the D antigert is strongly immunogenic, donors and patients are routinely typed for D status and patients are generally given D compatible blood. But under several circumstances such as spontaneous agglutination of red blood cells coated with immunoglobulin, antisera with additives may cause false positive results in test using high-protein reagents. And facton in the patient' s own serum may also affect the test, since unwashed red blood cells suspended in their own serum or plasma are frequently tested. Therefore, manufacturers and American Association of Blood Banks(AABB) recommend that the Rh(D) control test with Rh(D) control reagent which contains the same additive present in high-protein anti-D except for the anti-D. This study was undertaken to evaluate the usefss of the Rh(D) control test in Korea where Rh(D) negative population is small. Red blood cells from 1115 in-patients and 468 out-patients at Korea University Medical Center were employed in Rh(D) typing and Rh(D) control test in parellel. 1580 cases are Rh(D) positive and 3 cases were Rh(D) negative. No agglutination was observed with Rh(D) control test. Though AABB and manufacturers recommended that the Rh(D) control test should be done in parellel with Rh(D) typing test, the authers concluded that there were no need to run the Rh(D) control test in Korea.
Academic Medical Centers ; Agglutination ; Antibodies ; Erythrocytes ; Humans ; Immune Sera ; Immunoglobulins ; Indicators and Reagents ; Infant, Newborn ; Korea ; Outpatients ; Plasma ; Pregnancy ; Tissue Donors

Degenerative arthritis of the knee joint is one of the main causes of disability in middle-aged persons. This paper is planned by the necessity of objective information upon changes of tibio-femoral angle according to weight bearing in patients with degenerative arthritis of the knee joint. The authors studied the tibio-femoral angle in 29 cases of degenerative arthritis of the knee ranging fmm 5th to 6th decades of age, and compared with 27 cases of the control group, in the Dept. of Orthopedic Surgery, S.N.U.H. fmm Mar. 1983 to May 1984. The following observations were obtained: 1. In patients with degenerative arthritis of the knee, changes of the tibio-femoral angle according to weight bearing were +2.2±1.94 in 5th decade, +2.3±2.02 in 6th decade. 2. Compared to control group, the degenerative arthritis group showed a significant varization with weight bearing. 3. It was seemed that the weight bearing radiography is essential in diagnosis and treatment of degenerative arthritis of the knee joint.
Diagnosis ; Humans ; Knee ; Knee Joint ; Orthopedics ; Osteoarthritis ; Radiography ; Weight-Bearing

BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

To know the prevalence of the diabetes mellitus and associated diseases, we analyzed the date of the 3,088 subjects who were examined with the Computed Automated Medi-Screening Test System which consisted of 65 parameters including blood glucose determination fasting and one hour after 100 g of oral glucose load. We grouped the subjects by the modified criteria of National Diabetic Data Group. Followings are the results of the various analysis: 1. The prevalence of diabetes mellitus and impaired glucose tolerance in 2.27% and 18.26% respectively. 2. The prevalence of diabetes mellitus is 2.63% in male and 1.66% in female. There is no statistically significant difference between male and female. 3. There in tendency of increasing prevalence of diabetes mellitus as the age increases. From second to eighth decade, the prevalence of diabetes mellitus increases as 0.0, 0.45, 0.67, 2.28, 3.47, 5.36, 10.00% respectively. 4. There is no statistically significant difference of prevalence of obesity between normal and diabetes: that is, 18.03%, 22.86% respectively (P≥0.1). 5. There is no statistically significant difference of prevalence of impaired glucose tolerance and diabetes between non-obese and obses group (P≥0.1). 6. There is statistically significant increases of frequency of proteinuria, azotemia, hypertension as the glucose tolerance decreases (P≤0.05).
Azotemia ; Blood Glucose ; Diabetes Mellitus* ; Fasting ; Female ; Glucose ; Humans ; Hypertension ; Male ; Obesity ; Prevalence* ; Proteinuria

BACKGROUND: It is controversial whether the delay of surgery for acute appendicitis by physician results in higher morbidity. Our present study explores this problem of physician delay on the postoperative outcome of patients with acute appendicitis. MATERIAL AND METHODS: Among 432 patients admitted for the presumptive diagnosis of acute appendicitis between Jan., 1995 and Dec., 1997, 358 patients with pathologically proven acute appendicits were analyzed. Physician delay from the hospital admission to the surgery was evaluated in relation to the stage of the disease at operation and postoperative outcome. RESULTS: Postoperative complications occurred signifficantly higher in advanced appendicitis group, than in simple appendicitis group. Postoperative oral consumption started significantly later and hospital days are significantly prolonged in those group. Both patient and physician delays significantly affect the stage of the disease. The finding that physician delay correlated with the stage, however, was denied by multivariate analysis. CONCLUSION: On the contrary to the patient delay, physician delay does not affect the stage of the acute appendicitis nor lead to increased incidence of postoperative complication. Physician delay to clarify the diagnosis is a reasonable strategy and it does not affect the outcome adversely.
Appendicitis* ; Diagnosis ; Humans ; Incidence ; Multivariate Analysis ; Postoperative Complications

BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.
Anesthesia, Epidural* ; Bupivacaine ; Humans ; Injections, Epidural ; Lower Extremity* ; Needles

Spinal fusion has performed for instability and anatomical reconstruction since 1985 by Barthe. Bone grafts and synthetic materials has been used for spinal fusion, but they have several limitations and complications. Recently a new synthetic polymer B.O.P.(Biocompatible Osteoconductive Polymer) was developed and it overcome the limitations of other materials. The B.O.P. showed no foreign body reaction and gave scaffolding for the osteoconduction and osteointegration. Authors operated 35 cases of spinal fusion with B.O.P. and the results and literature reviews were discussed.
Bone Regeneration ; Bone Substitutes ; Foreign-Body Reaction ; Polymers ; Spinal Fusion* ; Transplants

Anterior interbody fusion has used for instability and anatomical reconstruction in various cervical diseases since 1958 by cloward. Bone grafts such as autograft, allograft, xenograft and synthetic materials were utilized in fusion as a graft material. But conventional fusion materials have problems including postoperative morbidity, transmission of diseases, foreign body reaction, collapse, prolongation of operation time. A new synthetic material, Biocompatible Osteoconductive Polymer(B.O.P) is developed and it was useful for cervical anterior interbody fusion as a substitute for other fusion materials.
Allografts ; Autografts ; Foreign-Body Reaction ; Heterografts ; Transplants

This review-article is aimed at shedding a light upon the nature of age-associated changes in the human skeletal system. When the anatomical, physiological and biochemical consequences of bone aging are considered together with the hardening, drying and the diminished repair capabilities of the elderly, it can be seen that fractures assume greater importance as a clinical problem in the geriatric population. Older people start out with a deficit of cortical bone, making them more fracture prone and once fractures occur, the necessary treatments (immobilization, use of casts, etc.) accelerate the rate of bone loss. In addition, aged individuals stand a higher risk for complications of the hospital and enforced bed rest that may ensue. The problems resulting from bone loss in the elderly may be partially alleviated by providing adequate health service support which should include consideration of the following points : 1. Age, sex and general health status ; 2. Habits and inclinations towards physical activities ; 3. Nutritional and endocrine background ; 4. Presence of any specific bone diseases, including osteoporosis, osteoarthritis, osteomalacia and ankylosis ; 5. Psychosocial adaptability and other behavioral elements.
Aged ; Aging ; Ankylosis ; Bed Rest ; Biology* ; Bone Diseases ; Health Services ; Humans* ; Motor Activity ; Osteoarthritis ; Osteomalacia ; Osteoporosis

Malignant melanoma is an uncommon tumor in Korea. To the best of our knowledge, we could not find malignant melanoma with multiple myeloma in Korean literature. A 57-year-old male patient had a 4×5 cm sized, irregular bordered, dark brownish plaque on the left sole, which has extended gradually since about 1 year ago and showed an occasional bleeding tendency. Laboratory examinations revealed a low hemoglobin level, rouleaux formation on peripheral blood, monoclonal gammopathy of IgG-kappa type and Bence-Jones proteinuria. Bone marrow aspiration findings showed markedly increased immature plasma cells suggesting multiple myeloma. Histopathologic findings of the skin biopsy from the left sole revealed proliferation of atypical melanocytes. We performed a surgical excision with a skin graft for malignant melanoma and chemotherapy (melphalan, vincristine and prednisolone) for multiple myeloma.
Biopsy ; Bone Marrow ; Drug Therapy ; Hemorrhage ; Humans ; Korea ; Male ; Melanocytes ; Melanoma* ; Middle Aged ; Multiple Myeloma* ; Paraproteinemias ; Plasma Cells ; Proteinuria ; Skin ; Transplants ; Vincristine