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

PURPOSE: Delirium in the elderly is common in the postoperative period but there are only few reports on detailed studies of this condition. Number of urologic patients with postoperative delirium was increas ed in our hospital for recent 24 months. The clinical characteristics of patients with postoperative delirium was analyzed retrospectively. MATERIALS AND METHODS: We selected the patients with postoperative delirium from 1010 patients who had undergone urological surgery under general or spinal anesthesia in the period from Jan. 1997 to Dec. 1999. Diagnosis of postoperative delirium was established with Diagnostic and Statistical Manual of Mental Disorders(DAM-III-R) by psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric disorder, relationship with anesthesia, drugs, and surgical procedures, concomittant medical conditions, and complications were retrospectively reviewed. RESULTS: Postoperative delirium was observed in 13 patients (1.3%). All patients were male and mean age was 70.4 years (46-86 years). Surgical procedures included TURP(8 patients), cystectomy (3 patients), nephroureterectomy (1 patient), and bladder rupture repair (1 patient). Delirium became apparent between one day and two days after the operation (mean 32.2 hours) and lasted for up to 7 days (mean 53 hours). Several factors such as older age (>65 years), male patient, longterm medication, past history of CVA, memory impairment, hearing difficulty, traumatic brain contusion, and obsessive personality were thought to be risk factors of postoperative delirium. Treatment with Haloperidol(R) intramuscular injection (2.5-5mg, every 30 minutes, 2-4 times until symptom resolution was achieved) with or without Ativan(R) intravenous injection (2mg) were effective. Complete symptom recovery was seen in 92.3% (12/13) of patients. One patient (7.7%) with previous history of dementia had persistent memory disturbance and disorientation during follow-up periods. CONCLUSIONS: Generally, postoperative delirium is an acute transient confusional state without considerable sequeles. Treatment is sedation and prevention of inadvertent accident associated with confusional state. Urologic surgeon must be attentive to the development of this illness especially when high risk factors were present.
Aged ; Anesthesia ; Anesthesia, Spinal ; Brain Injuries ; Cystectomy ; Delirium* ; Dementia ; Diagnosis ; Follow-Up Studies ; Hearing ; Humans ; Injections, Intramuscular ; Injections, Intravenous ; Male ; Memory ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Rupture ; Urinary Bladder

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

PURPOSE: To compare the outcomes of indocyanine green (ICG) and triamcinolone (TA) assisted internal limiting membrane (ILM) peeling during idiopathic macular hole surgery. METHODS: Fifty-four eyes of 54 patients with idiopathic macular hole underwent pars plana vitrectomy including peeling of the posterior cortical hyaloid and peeling of the internal limiting membrane. For enhanced visualization of ILM, ICG was used in 25 eyes and TA in the remaining 29 eyes. Postoperative visual acuity was measured and OCT was performed. RESULTS: Anatomical closure was achieved in 25 eyes (100%) in ICG group and 28 eyes (97%) in TA group, Best corrected visual acuity improvement by > or =2 lines was in 15 eyes (60%) in ICG group and 18 eyes (62%) in TA group. Postoperative visual improvement rates by > or =20/50 were 10 eyes (40%) in ICG group and 9 eyes (31%) in TA group. CONCLUSIONS: Peeling of the internal limiting membrane using triamcinolone and indocyanine green was safe and effective for anatomic and functional success in idiopathic macular hole surgery. Further studies of the toxicity of TA, ICG and the result of internal limiting membrane peeling is needed.
Humans ; Indocyanine Green* ; Membranes ; Retinal Perforations* ; Triamcinolone* ; Visual Acuity ; Vitrectomy

PURPOSE: To determine the diagnostic performance of contrast-enhanced multidetector CT (MDCT) and the Alvarado score for acute appendicitis. MATERIALS AND METHODS: MDCT and determination of the Alvarado score were prospectively performed in 282 patients with 146 pathologically proven cases of acute appendicitis and 136 pathologically proven or clinically diagnosed cases of non-acute appendicitis. To compare the diagnostic performance of MDCT and the Alvarado score, the patients were subdivided according to age and sex, and receiver operating characteristics (ROC) analysis and Spearman rank correlation were performed. RESULTS: ROC analysis revealed that the optimal cut off value of the CT appendicitis grades was 2 in all patients, resulting in a sensitivity of 96.6% and a specificity of 94.9%. The optimal cut off values of the Alvarado score was different according to age and sex, resulting in a sensitivity of 85.6% and a specificity of 48.5%. There was a significant correlation between the CT appendicitis grades and the surgical-pathological grades (r=0.496, p<.0001). However, no significant correlation was observed between the Alvarado score and the surgical-pathological grades. CONCLUSION: Contrast-enhanced MDCT has a higher diagnostic accuracy and significant correlation with pathological findings than those of the Alvarado score in patients with acute appendicitis.
Acute Disease ; Appendicitis* ; Humans ; Prospective Studies* ; ROC Curve ; Sensitivity and Specificity

No abstract available.
Ivermectin ; Larva Migrans

BACKGROUND: Endotoxin stimulates nitric oxide synthase (NOS) and the free radical nitric oxide (NO) is produced by NOS, which vasodilates the smooth muscle of pulmonary vessels. Otherwise, endotoxemia stimulates the release of cyclooxygenase (COX) products, which may modify hypoxic pulmonary vasoconstriction (HPV). We also observed the effect of nonselective NOS inhibition by NG-nitro-L-arginine methyl ester (L-NAME) on receptor-mediated acetylcholine (Ach)/bradykinin (BK) induced vasoconstriction and receptor independent HPV in E.coli lipopolysaccharide (LPS) induced septic isolated rat lungs. METHODS: Four hours before surgical instrumentation for lung isolation, we administered saline (1 ml) to the control group (n = 15), E.coli LPS (20 mg/kg) to the LPS group (n = 14) and LPS (30 mg/kg) the nitric oxide synthase inhibitor, L-NAME (15 mg/kg) to the LPS + L-NAME group (n = 14), intraperitoneally. In 43 isolated rat lungs perfused with physiologic salt-albumin- blood mixture, angiotensin II 0.2 microgram was injected into the perfusion circuit, to confirm pulmonary vascular reactivity in each isolated lung. HPV responses were induced by three hypoxic challenges for 5 minutes separated by 5 minutes of ventilation with a normoxic gas mixture. We observed the pulmonary arterial pressure at each challenge, ten minutes after the last HPV, 0.01, 0.1, 1.0 microgram of Ach and 1, 3, 10 microgram of BK were injected. PAP and static lung compliance were measured. RESULTS: The baseline pulmonary artery pressure in the LPS group higher than in the controls and HPV in the LPS group was changed compared to the controls but in the LPS + L-NAME it was higher than in the controls. The administration of Ach 0.1, 1.0 microgram and BK 3, 10 microgram causedpulmonary vasoconstriction and the vasoconstrictions of BK were dosage-dependent. Lung stiffness in the LPS and LPS + L-NAME groups were higher than those of the controls. CONCLUSIONS: Vascular constriction of pulmonary vessels and increased lung stiffness by Ach and BK might be the result of the endothelial injury. But pulmonary vasoconstriction and stiffness by Ach and BK were similar in the LPS and LPS + L-NAME groups, showing that factors other rather than excessive NO production might be involved in endothelial injury.
Acetylcholine ; Angiotensin II ; Animals ; Arterial Pressure ; Constriction ; Endotoxemia ; Lung Compliance ; Lung* ; Muscle, Smooth ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Perfusion ; Prostaglandin-Endoperoxide Synthases ; Pulmonary Artery ; Rats* ; Surgical Instruments ; Vasoconstriction* ; Ventilation

On the contrary to congenital anomalies of intestinal rotation in pediatric patients, those in adults are generally nonsymptomatic and of little consequence. Occasionally, however, an adult may have midgut nonrotation and complain of chronic or recurrent abdominal pain. Intestinal nonrotation can be divided into complete or partial failure of rotation and into abnormalities affecting the proximal segment, the distal segment or both. We report herein a 43-year old female patient with symptomatic partial, cecocolic nonrotation.
Abdominal Pain ; Adult* ; Female ; Humans

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

The operative technic for the correction of hydronephrosis due to obstruction at ureteropelvic junction has been discussed. There are two different types of technics in pyeloplasty ; 1st. nondismembered pyeloplasty molds and restructures the obstructed ureteropelvic junction without completely dismembering it and 2nd. dismembered pyeloplasty interrupts the continuity of the transport system of the obstructed ureteropelvic junction. Since Andereon-Hynes reported the technics which belongs to dismembered pyeloplasty for retrocaval ureter in 1949, many articles with satisfactory result have been published. We report Anderson-Hynes pyeloplasty for hydronephrosis secondary to obstruction of the ureteropelvic Junction in 7 cases. Advantages of Anderson-Hynes pyeloplasty are as follows. 1. Complete excision of the obstructive segment. 2. Reduction of the dead space. 3. Excision of a good part of the sick pelvis. 4. Activation of latent pacemaker P cells.
Fungi ; Hydronephrosis ; Pelvis ; Retrocaval Ureter