Jehovah's Witness patients who require an operation represent a challenge to the physician because of the patients' refusal to accept a blood transfusion. We report 5 years experience with a consecutive series of 12 Jehovah's Witness patients in the Obstetric & Gynecological department who underwent operation. In 12 cases, death ensued in one patient who underwent subtotal hysterectomy for ectopic pregnancy. The cause of death was severe anemia & complicated respiratory problems. We discussed the problem of elective & emergency operations on Jehovah's Witness patients. Anesthesiologists must understand legal aspects, as well as and ethical, if they are to conduct their practice as an art as well as science.
Anemia ; Blood Transfusion* ; Cause of Death ; Disulfiram* ; Emergencies ; Female ; Humans ; Hysterectomy ; Jurisprudence ; Pregnancy ; Pregnancy, Ectopic

It is a well known fact that the major craniofacial operation is a complicated procedure. In this procedure, the operative period is extremely long and blood loss is large, extremely difficult to estimate and continuous into the early postoperative period. The air was should be protected intraoperatively and postoperatively due to frequent airway obstruction. We had experienced of an anesthetic management for correction of hypertelorism. Anesthetic management of this case should focus on reduction intracranial pressure and volume. WE had performed neurolept anesthesia with controlled hyperventilation. The careful monitoring and frequent measuring of blood gas analysis, hematocrit, hourly urine output, electrolytes, body temperature, CVP, ECG, and acid-base balance status are recommended. We report a case of anesthetic management for a patient.
Acid-Base Equilibrium ; Airway Obstruction ; Anesthesia ; Blood Gas Analysis ; Body Temperature ; Electrocardiography ; Electrolytes ; Hematocrit ; Humans ; Hypertelorism* ; Hyperventilation ; Intracranial Pressure ; Postoperative Period

We have experienced the anesthetic management of bilateral adrenalectomy in a 17 years old male, who was diagnosed as Cushing's syndrome. Anesthetic problems in Cushing`s Syndrome are hypertension, tachrcardia, hyperglycemia, hypokalemia and acute adrenal insufficiency. Therefore anesthetic management of this disease should focus on the through understanding of pathophysiology and adequate control of preoperative condition. Careful monitoring of the patient and frequent measurement of electrolytes and acid base balance status during the operation are also needed. We report the case of anesthetic experience of Cushing`s Syndrome and review anesthetic choice and management for better outcome of the patient.
Acid-Base Equilibrium ; Adolescent ; Adrenal Insufficiency ; Adrenalectomy ; Cushing Syndrome ; Electrolytes ; Humans ; Hyperglycemia ; Hypertension ; Hypokalemia ; Male

OBJECTIVES: Many psychiatrists ignore the behavioral and attitudinal aspects of religious beliefs of patients with schizophrenia. Therefore, how the Christian belief affects the treatment of schizophrenia was investigated. METHODS: The subjects of the study were 13 schizophrenic outpatients with protestant belief having partial or full insight. GAF score of each of the patients was above 41. RESULTS: A. Positive effects; 1) Taking the patient's belief seriously without prejudice was helpful to therapeutic relation. 2) Faith fulfilled it's function of silencing the anxiety of the patients. 3) The factors which make schizophrenic patients develop self-identity and self-concept in their religious lives were as follows; social identity as a Christian, religious identity as a child of God, experiences of safe dyadic relationship with God, feelings of being always accepted by God, and experiences of being accepted safely by the church. 4) Faith experiences and spiritual enlightenment itself had a therapeutic impact on the patients as a guiding principle of their lives and blueprints for their actions. 5) Experiences of a safe dyadic relationship with God, feelings of being accepted by God, faith experiences, and spiritual enlightenment provided peculiar religious experiences which can not be found in everyday life. And these peculiar religious experiences seemed to have healing power. B. Negative effects; 1) The clergymen and the members of the church put the patients and their families into the confusion by compelling or recommending religious treatment methods like prayer retreats. 2) They interfered with patients getting insights by interpreting their symptoms religiously. 3) There was a risk of cognitive defect of grasping faith literally. 4) There was a tendency to direct punishment and blame inwards, on to the self with guilty feelings. CONCLUSIONS: Christian belief exerted many influences both good and bad, on the treatment of the schizophrenic outpatients. We suggest that psychiatrists should consider the influence of the patient's faith upon the treatment.
Anxiety ; Child ; Hand Strength ; Humans ; Outpatients* ; Prejudice ; Protestantism ; Psychiatry ; Punishment ; Religion ; Schizophrenia ; Social Identification

OBJECTIVES: The purpose of this study was to clarify the buffering effects of christian belief on the interactional stress process of the white-collars. METHODS: The sample of this study was 545 white-collars working in the large enterprise. The questionnaire was composed of demographic data, job stress questionnaire, global assessment of recent stress, the ways of coping checklist, Beck depression inventory, stait-trait anxiety inventory, and shepherd Scale for defferentiate Christians from non Christians. Christianity was divided nito 'Christian way of thinking' and 'Christian way of living' for deep survey and analysis. RESULTS: In recognizing life stress and job stress, there was no difference between christians and non Christian atheist. But in coping stress, there was differecne between Christians and non Christians. 'Christian way of thinking' strengthened emotion focused coping, but didn't play a buffering role in reducing stress-induced depression and anxiety of the white-collars. But 'Christian way of living' increased challenge-appraisal and strenthened problem focused coping as a consequence. Also, Christian way of living had a influence on hoping thought and seeking social support. As a result, Christian belief reduced depression and anxiety. CONCLUSION: Christian belief a buffering effect on the interactional stress process of the white-collars of large enterprises.
Anxiety ; Checklist ; Christianity ; Depression ; Hope ; Surveys and Questionnaires ; Stress, Psychological

Granulocytic sarcoma(chloroma) is an uncommon and solid tumor composed of immature cells of the mycloid series usually seen during the course of myelogenous leukemia or myeloproliferative disorders. The common sites for the occurrence of granulocytic sarcoma are soft tissue, periosteum, bone, lymphoid tissue, skin, gastrointestinal tract and testis. But extradural presentation of the spine is very rare. We report two cases of extradural granulocytic sarcoma of the spine. Early recognition of the etiology of the paraplegia and the underlying systemic involvement with leukemia resulted in an excellent neurological and hematological outcome.
Gastrointestinal Tract ; Leukemia ; Leukemia, Myeloid ; Lymphoid Tissue ; Myeloproliferative Disorders ; Paraplegia ; Periosteum ; Sarcoma, Myeloid* ; Skin ; Spine* ; Testis

PURPOSE: We report the performance of natural orifice transluminal endoscopic surgery (NOTES) low anterior resection in animals using transanal total mesorectal excision (TME) with laparoscopic assistance and endoscopic inferior mesenteric artery (IMA) dissection. METHODS: Four pigs weighing 45 kg each, and one dog weighing 25 kg, underwent surgery via a transanal approach. The rectum was occluded transanally using a purse-string suture, approximately 3-4 cm from the anal verge. The rectal mucosa was incised circumferentially just distal to the purse-string. A SILS or GelPOINT port was inserted transanally. Transanal TME was assisted by laparoscopy and proceeded up to the peritoneal reflection. More proximal dissection, including IMA dissection, was performed along the retroperitoneal avascular plane by endoscopy alone and facilitated by CO2 insufflation. The IMA was clipped and divided endoscopically. The mobilized rectosigmoid were exteriorized transanally and transected. A colorectal anastomosis was performed using a circular stapler with a single stapling technique. RESULTS: Endoscopic dissection of the IMA was successful in all five animals. The mean operation time was 125 minutes (range, 90-170 minutes). There were no intraoperative complications or hemodynamic instability. The mean length of the resected specimen was 14.4 cm (range, 12-16 cm). CONCLUSION: A NOTES retroperitoneal approach to the IMA with CO2 insufflation and intact peritoneal covering overcame the difficulties of retraction and exposure of endoscopic dissection in animals.
Animals ; Dogs ; Endoscopy ; Hemodynamics ; Insufflation ; Intraoperative Complications ; Laparoscopy ; Mesenteric Artery, Inferior* ; Models, Animal* ; Mucous Membrane ; Natural Orifice Endoscopic Surgery* ; Rectum ; Sutures ; Swine

BACKGROUND: The purpose of this study is to assess the risk of hemorrhage from coexisting unsecured, unruptured aneurysms during hypervolemic hypertensive therapy after treatment for ruptured aneurysms in patients with multiple intracranial aneurysms. METHODS: From 1995 to 2004, the authors treated 1052 patients of ruptured and unruptured aneurysms, in which 201 patients had multiple aneurysms. Of the 201 patients, 45 patients had unsecured, unruptured aneurysms after the initial treatment of ruptured aneurysms. We performed retrospective analysis for these 45 patients' data including the characteristics of unsecured, unruptured aneurysms at risk, hemodynamic parameters and duration of hypervolemic hypertensive therapy. RESULTS: The total number of aneurysms for the 45 patients was 103, where 53 aneurysms were secured at the acute period of post-subarachnoid hemorrhage. Twenty nine out of 45 patients with unsecured, unruptured aneurysms after treatment of ruptured aneurysms had been managed with hypervolemic hypertensive therapy for symptomatic cerebral vasospasm. These 29 patients harbored 30 aneurysms. In 29 patients with hypervolemic hypertensive therapy, the mean systolic blood pressure was 181.4+/-20.7 mm Hg, the mean central venous pressure 12.5+/-2.2 mm Hg, and the mean duration of hypervolemic hypertensive therapy was 10.2+/-5.1 days. There was no hemorrhage from the 50 unsecured, unruptured aneurysms in all 45 patients with or without hypervolemic hypertensive therapy. CONCLUSION: It is presumed that the advantage of hypervolemic hypertensive therapy in the patients with symptomatic vasospasm after surgery of ruptured aneurysms endorses its use, even in the presence of unsecured, unruptured aneurysms in patients with multiple aneurysms.
Aneurysm* ; Aneurysm, Ruptured ; Blood Pressure ; Central Venous Pressure ; Hemodynamics ; Hemorrhage ; Humans ; Hypertension ; Intracranial Aneurysm* ; Retrospective Studies ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial

OBJECTIVES: To investigate the prevalence of cognitive impairment and dementia in elderly people, aged 65 or above, residing in Busan Metropolitan City. METHODS: Total of 1, 101 old people, aged 65 or above, living in Busan as of December 31, 2001 were selected using stratified three-stage cluster sampling. Cognitive impairment was determined from the MMSE-K score, and dementia confirmed from five psychometric measures and the Barthel index. The crude prevalence, sex-age adjusted for the Korean population, were obtained. RESULTS: With the cut-off point for cognitive impairment was set at 24 points, or below, on the MMSE-K scale, the crude rate of cognitive impairment was 29.3% (15.7% for men and 37.5% for women), and the sex-age adjusted prevalence was 30.5% (17.5% for men and 37.0% for women). When the cut-off point for cognitive impairment was set at 20 points, or below, on the MMSE-K scale, the crude rate of cognitive impairments were 10.0% (4.1% for men and 13.5% for women), and 10.6% (4.7% for men and 13.1% for women), respectively. The crude dementia, and the sex-age adjusted rates were 7.4% (2.4% for men and 10.5% for women), and 8.0% (2.7% for men and 10.0% for women), respectively. CONCLUSIONS: The prevalence of dementia in this study was somewhat lower than that reported by other domestic and foreign studies. Our results related to the difference in time and space, diagnostic tools, response rates, and distribution of male and female subjects, etc.
Aged* ; Busan* ; Cognition Disorders* ; Dementia* ; Female ; Humans ; Male ; Prevalence* ; Psychometrics

Background and Objectives: The outcome benefits of β-blockers in chronic coronary artery disease (CAD) have not been fully assessed. We evaluated the prognostic impact of β-blockers on patients with chronic CAD after percutaneous coronary intervention (PCI). Methods: A total of 3,075 patients with chronic CAD were included from the Grand DrugEluting Stent registry. We analyzed β-blocker prescriptions, including doses and types, in each patient at 3-month intervals from discharge. After propensity score matching, 1,170 pairs of patients (β-blockers vs. no β-blockers) were derived. Primary outcome was defined as a composite endpoint of all-cause death and myocardial infarction (MI). We further analyzed the outcome benefits of different doses (low-, medium-, and high-dose) and types (conventional or vasodilating) of β-blockers. Results: During a median (interquartile range) follow-up of 3.1 (3.0–3.1) years, 134 (5.7%) patients experienced primary outcome. Overall, β-blockers demonstrated no significant benefit in primary outcome (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.63–1.24), all-cause death (HR, 0.87; 95% CI, 0.60–1.25), and MI (HR, 1.25; 95% CI, 0.49–3.15). In subgroup analysis, β-blockers were associated with a lower risk of all-cause death in patients with previous MI and/ or revascularization (HR, 0.38; 95% CI, 0.14–0.99) (p for interaction=0.045). No significant associations were found for the clinical outcomes with different doses and types of β-blockers. Conclusions Overall, β-blocker therapy was not associated with better clinical outcomes in patients with chronic CAD undergoing PCI. Limited mortality benefit of β-blockers may exist for patients with previous MI and/or revascularization.