BACKGROUND: Increasing coronary perfusion pressure with phenylephrine is important treatment strategies for right ventricular dysfunction caused by pulmonary hypertension. We compared the effects of phenylephrine on systemic and pulmonary hemondynamics in patients with and without pulmonary hypertension. METHODS: Twenty patients undergoing a valvular replacement were divided into two groups according to pulmonary artery pressure (PAP): control group (mean PAP < 25 mmHg, n = 9) or pulmonary hypertension group (mean PAP > 25 mmHg, n = 11). When systolic blood pressure decreased below 100 mmHg after the induction of anesthesia, phenylephrine was infused to raise systolic blood pressure up to 30% and 50% over baseline. Hemodynamic variables were measured at each time. RESULTS: Phenylephrine failed to raise systolic blood pressure up to 50% above baseline in more than half of the patients with pulmonary hypertension in contrast to successful increases in all patients without pulmonary hypertension. However, the ratio of PAP to systolic blood pressure was significantly reduced in patients whose systolic blood pressure was successfully increased up to 50% over baseline in the pulmonary hypertension group whereas the PAP concomitantly increased as systolic blood pressure was increased in the control group. CONCLUSIONS: Phenylephrine couldn't increase systolic blood pressure in some patients with pulmonary hypertension unlike in control group and it seemed to occur more often in patients with greater the ratio of PAP to systolic blood pressure. The baseline systemic vascular resistance index was high and cardiacoutput was low in the pulmonary hypertension group and these conditions seemed to restrict the effect of phenylephrine.
Anesthesia ; Blood Pressure ; Hemodynamics* ; Humans ; Hypertension, Pulmonary* ; Perfusion ; Phenylephrine* ; Pulmonary Artery ; Vascular Resistance ; Ventricular Dysfunction, Right

Primary thyroid lymphoma (PTL) is a relatively rare disease, accounting for less than 0.5~5% of all thyroid malignancies. We encountered two cases of a primary thyroid lymphoma with Hashimoto's thyroiditis; one in a 63-year-old man and the other in a 79-year-old woman. The first case was a mucosa-associated lymphoid tissue lymphoma, and the other was a diffuse large B-cell lymphoma. Both patients underwent surgery and radiotherapy after being diagnosed using fine-needle aspiration cytology (FNAC). Both patients recovered well with no recurrence throughout the study period. The role of the surgeon in the treatment and diagnosis of thyroid lymphoma has been reduced due to the development of FNAC and combination therapy with chemotherapy and radiotherapy. On the other hand, surgery can be an effective treatment option for PTL confined to the thyroid, for achieving a definitive diagnosis, and in the treatment of patients with an airway obstruction.
Aged ; Airway Obstruction ; Biopsy, Fine-Needle ; Diagnosis ; Drug Therapy* ; Female ; Hand ; Humans ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Middle Aged ; Radiotherapy ; Rare Diseases ; Recurrence ; Thyroid Gland* ; Thyroidectomy ; Thyroiditis

No abstract available.
Multicystic Dysplastic Kidney* ; Ultrasonography, Prenatal*

BACKGROUND: Asthmatic patients frequently suffer cold-weather-associated respiratory symptoms. The sensitivity, specificity, accuracy and diagnostic value of isocapnic hyperventilation of cold air(IHCA) using a multistep method was investigated in patients suspected to have asthma. METHOD: One hundred and 29 adult patients who had an IHCA performed between july 1999 and December 2000, had an methacholine bronchoprovocation test because of a clinical suspicion of asthma. RESULTS: According to strict criteria, 50 were defined as asthmatics and 79 as symptomatic nonashmatics. There were no differences in age, sex and smoking state between the asthmatic and symptomatic nonasthmatic groups. There was a significant decrease in the percentage reduction in the forced expiratory volume in 1 second(FEV1) after the IHCA between the asthmatics(-10.0±6.8%) and the symptomatic nonasthmatics(-2.3±2.5%). The factors associated with a reactivity to IHCA were FEV1/FVC, FEF25-75/FVC and FEV1(% of predicted). The accuracy was highest using a 7% fall in FEV1; the sensitivity was 76% and the specificity 96%. CONCLUSION: IHCA is a specific, although not a sensitive, test for diagnosing asthma in adult patients. Furthermore, the diagnostic cut-off value of the different methods of IHCA need to be determined.
Adult* ; Asthma* ; Forced Expiratory Volume ; Humans ; Hyperventilation* ; Methacholine Chloride ; Sensitivity and Specificity ; Smoke ; Smoking

BACKGROUND: Rhinovirus has long been considered as the most important cause of uncomplicated upper respiratory infection and a trigger of asthma exacerbation, and was recently been widely appreciated for it's association with lower respiratory tract illness. METHODS: One hundred and sixty-six children with lower respiratory tract infections were enrolled. They had been hospitalized at the Seoul National University Children's Hospital from August 1997 to March 2000. All the children had been previously healthy and under 5 years of age. Rhinovirus was detected in nasal aspirates by semi-nested reverse transcription polymerase chain reaction and confirmed by digestion pattern of the amplicon with a restriction enzyme. Presence of other respiratory pathogens was also analysed. RESULTS: Of the 166 children, rhinoviruses were detected in 8 children (4.8%). Majority of rhinovirus was detected in the patients who had been hospitalized in the late fall and winter, and all the infected children recovered completely. Other respiratory pathogens identified were; mycoplasma in 7 (4.2%), respiratory syncytial virus in 15 (9.0%), parainfluenza virus in 8 (4.8%), adenovirus in 4 (2.4%) and influenza virus in 3 (1.8%). CONCLUSION: Rhinovirus may be a significant cause of acute lower respiratory infections in healthy children. Further investigation on the diagnosis and clinical characteristics of rhinoviral infection is warranted.
Adenoviridae ; Asthma ; Child* ; Diagnosis ; Digestion ; Humans ; Mycoplasma ; Orthomyxoviridae ; Paramyxoviridae Infections ; Polymerase Chain Reaction* ; Respiratory Syncytial Viruses ; Respiratory System* ; Respiratory Tract Infections* ; Reverse Transcription* ; Rhinovirus* ; Seoul

BACKGROUND: Rhinovirus has long been considered as the most important cause of uncomplicated upper respiratory infection and a trigger of asthma exacerbation, and was recently been widely appreciated for it's association with lower respiratory tract illness. METHODS: One hundred and sixty-six children with lower respiratory tract infections were enrolled. They had been hospitalized at the Seoul National University Children's Hospital from August 1997 to March 2000. All the children had been previously healthy and under 5 years of age. Rhinovirus was detected in nasal aspirates by semi-nested reverse transcription polymerase chain reaction and confirmed by digestion pattern of the amplicon with a restriction enzyme. Presence of other respiratory pathogens was also analysed. RESULTS: Of the 166 children, rhinoviruses were detected in 8 children (4.8%). Majority of rhinovirus was detected in the patients who had been hospitalized in the late fall and winter, and all the infected children recovered completely. Other respiratory pathogens identified were; mycoplasma in 7 (4.2%), respiratory syncytial virus in 15 (9.0%), parainfluenza virus in 8 (4.8%), adenovirus in 4 (2.4%) and influenza virus in 3 (1.8%). CONCLUSION: Rhinovirus may be a significant cause of acute lower respiratory infections in healthy children. Further investigation on the diagnosis and clinical characteristics of rhinoviral infection is warranted.
Adenoviridae ; Asthma ; Child* ; Diagnosis ; Digestion ; Humans ; Mycoplasma ; Orthomyxoviridae ; Paramyxoviridae Infections ; Polymerase Chain Reaction* ; Respiratory Syncytial Viruses ; Respiratory System* ; Respiratory Tract Infections* ; Reverse Transcription* ; Rhinovirus* ; Seoul

PURPOSE: The present research was done to examine the fundamental significance and structure of conflict experience of nurses in hospital nursing organizations.METHODS: This qualitative research was conducted by analyzing data collected through in-depth interviews based on Colaizzi's (1978) method of analysis, one of the phenomenological methods of analysis.RESULTS: Statements from the 12 study participants demonstrate two key topics “accumulation of conflicts” and “manifestation of new conflicts” as well as seven sub-topics including “being forced to comply”, “Lack of respect and consideration”, “unsatisfactory conflict management by the leaders”, “continuous and overwhelming vicious cycle”, “prevalence of self-defensive egotism”, “difficult to accept differences”, and “incapable of responding to the structural changes of nursing workforce”.CONCLUSION: Resolving the dysfunctional conflicts in hospital nursing organizations requires not only improvement in the organizational culture of individuals and nursing organizations, but also legal and institutional measures in addition to new attempts to integrate education and research findings from relevant fields of studies.
Education ; Methods ; Nursing ; Organizational Culture ; Qualitative Research

In this report, we describe ovarian mixed germ cell tumor in a patient with Turner syndrome. Right ovary was replaced by a 15 x 11 x 10cm teratomatous benign tissue and small area of mixed malignant germ cell tissue. The malignant germ cell portion was composed of embryonal carcinoma and loose reticular area of yolk sac tumor and syncytiotrophoblastic giant cells. Left ovary was streak gonad. This is the first reported case of mixed germ cell tumor with Turner syndrome in Korea.
Carcinoma, Embryonal ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Giant Cells ; Gonads ; Humans ; Korea ; Neoplasms, Germ Cell and Embryonal* ; Ovary ; Trophoblasts ; Turner Syndrome*

Protruding atheromas of the aorta have been identified as one of the sources of a systemic emboli and a major cause of stroke following cardiac surgery. We report a case of surgical modification in a 58-year-old man with an atheromatous aortic arch detected by an intraoperative transesophageal echocardiography (TEE) during coronary artery bypass grafting (CABG). After induction of anesthesia, protruding atheromatous plaques with a mobile element in the aortic arch were identified by a TEE that was not noticed by a preoperative angiography and transthoracic echocardiograpy. Based on the TEE finding, the surgical technique was modified to CABG combined with an aortic atherectomy under deep hypothermic circulatory arrest. The atheromatous areas correlated well with the TEE finding and the patient recovered from anesthesia and surgery without neurologic deficit. Therefore, an intraoperative TEE examination is considered as a safe and reliable technique to identify atherosclerotic disease of the thoracic aorta in patients undergoing CABG and to minimize unexpected neurologic complications after CABG.
Anesthesia ; Angiography ; Aorta ; Aorta, Thoracic* ; Atherectomy ; Circulatory Arrest, Deep Hypothermia Induced ; Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography, Transesophageal* ; Humans ; Middle Aged ; Neurologic Manifestations ; Plaque, Atherosclerotic ; Stroke ; Thoracic Surgery

BACKGROUND: Hypertension following coronary artery bypass graft surgery (CABG) occurs frequently. Pharmacologic therapy of postoperative hypertension has often been treated with sodium nitroprusside (SNP). Nicardipine which is a dihydropyridine calcium-channel blocker, has little or no direct negative effects on cardiac contractility. Thus, we have compared the effects on hemodynamics between nicardipine and SNP after a CABG. METHODS: After a CABG, when systolic blood pressure (SBP) was elevated above 140 mmHg, patients were randomized to receive either nicardipine (N-group, n = 26) or SNP (S-group, n = 21) at an initial rate of 2ng/kg/min until the SBP was lowered to 120 130 mmHg (target blood pressure, TBP) for 10 minutes. If the TBP was not achieved, the infusion rates of both drugs were increased by 1ng/kg/min every 10 minutes. If SBP was lowered below 100 mmHg, phenylephrine was infused. Hemodynamic measurements were obtained just before (T1) and at 10 min (T2), 60 min (T3) and 24 h (T4) after the infusin of nicardipine or SNP. Infusion time, total doses, creatine phosphokinase (CK)-MB, plasma catecholamine and the use of phenylephrine were compared between groups. RESULTS: The SBP and systemic vascular resistance were significantly decreased in both groups. The cardiac index and stroke volume index were significantly increased at T3 in both groups but they were significantly increased only in the N-group at T2. The infusion time and the total doses of both drugs were significantly less in the N-group than the S-group. There were no significant differences in CK-MB, plasma catecholamine and the use of phenylephrine between groups. CONCLUSIONS: It has been suggested that the infusion of nicardipine is as effective as the infusion of SNP for the control of postoperative hypertension and the increase of cardiac output after a CABG. However, immediately after the drug infusion, nicardipine was superior to SNP in maintaining left ventricular performance.
Blood Pressure ; Cardiac Output ; Coronary Artery Bypass* ; Coronary Vessels* ; Creatine Kinase ; Hemodynamics ; Humans ; Hypertension* ; Nicardipine* ; Nitroprusside* ; Phenylephrine ; Plasma ; Sodium* ; Stroke Volume ; Transplants ; Vascular Resistance