Background: The effective dose of Tranexamic Acid (TA) is unclear in reducing blood loss after cardiac surgery. In Vietnam, the doses of TA 10mg/kg for starting anaesthesia, 5mg/kg for transfusion into extracorporeal circulation solution, then using a maintained dose of 1mg/kg/gi\u1edd reduces blood loss and transfusion, but there is no statistical significant. Objectives: To evaluate blood loss and need for transfusion after cardiac surgery in patients receiving TA 20 mg/kg at induction + 10 mg/kg in extracorporeal circulation solution and 2 mg/kg/1h for maintenance; To evaluate coagulation profile after TA. Subject and methods: A double blind randomly controlled trial is conducted in 80 surgical cardiac patients equally divided into TA and control groups: Results: In the TA group, the post - operative blood loss is 393.50 \xb1 136.64 ml, Hematocrit (Hct) 35.31 \xb1 3.38 % with less individuals and smaller amount of blood and/or frozen fresh platelets needed than in control (p<0.001). Conclusions: An above dose of TA reduces approximately a half of blood loss and elevates Hct postoperatively, with significant lower requirements of transfusion than the control and higher amount of platelets, reduced D-dimers (p<0.05) and unchanged Fibrinogen, PT, INR and aPTT (p >0.05).
open heart surgery ; tranexamic acid ; blood loss

OBJECTIVE: To evaluate the effect of uterine weight on short-term outcome of total laparoscopic hysterectomy (TLH) for benign gynecological conditions. METHODS: A retrospective medical records review of 265 cases of patients with TLH was performed. Patients included in this study underwent TLH as benign uterine disorders at Kangnam Sacred Heart Hostpital, Hallym University from January 2008 through June 2009. These patients were stratified into three groups; Group 1 patients with uterus weighing less than 180 g (n=60), Group2 patients with uterus weighing 180 g to 350 g (n=141), Group 3 patients with uterus weighing more than 350 g (n=64). The groups were compared as regard postoperative stay, operative time, estimated blood loss, hemoglobin change, conversion to open surgery, and postoperative complications. RESULTS: There was no significant difference in age, gravidity, body mass index, previous pelvic surgery and past medical history. The overall complication rates were not significantly different. But operative time prolonged as uterine weight increased. CONCLUSION: The TLH can be performed successfully in case of enlarged uterus. Therefore the enlarged uterus is not an absolute contraindication for TLH.
Body Mass Index ; Conversion to Open Surgery ; Gravidity ; Heart ; Hemoglobins ; Humans ; Hysterectomy ; Medical Records ; Operative Time ; Retrospective Studies ; Uterus

BACKGROUND AND OBJECTIVES: Although the standard management of an abdominal aortic aneurysm (AAA) is surgery, endovascular stent-graft treatment is more attractive for patients with significant co-morbid conditions. We evaluated the immediate and mid-term outcomes for the endovascular treatment of AAA. SUBJECTS AND METHODS: Between November 1996 and August 2004, 59 patients with an AAA (53 males, mean age 68.0+/-9.6 years, 3 cases with ruptured AAA) underwent an endovascular stent-graft repair at our institute. All patients were evaluated by an angiography, taken just after the completion of the procedure and at followed up with computed tomography (CT) at 1, 3, 6 and 12 months, and yearly thereafter. RESULTS: Technical success was achieved in 54 of the 59 patients (91.5%). The periprocedural mortality rate was 3.4% (2 of the 59 patients). A primary endoleak was found in 12 patients (20.3%)(type I; 9 patients, type II; 2 patients, type III; 1 patient), 2 of which required subsequent surgical conversion. Spontaneous resolution of an endoleak was seen in 4 patients (33.3%). The average follow-up period of 57 patients was 27.5 months (range from 72 days to 2581 days). In 8 patients (14.0%), a newly developed secondary endoleak was documented. A total 14 patients (23.7%) died during the follow-up period (rupture; 3, operation-related sepsis; 3, unrelated causes; 3, cardiac arrest; 1, unknown causes; 4). The cumulative survival rates at 30 days and at 1 and 2 years were found to be 93.0, and 85.7 and 76.3%, respectively, using Kaplan-Meier methods. Secondary intervention was required in 12 patients (21.8%), and surgical conversion in 4 (6.8%), with 2 (3.4%) requiring conversion to open surgery immediately after the intervention. In those with technical success, without endoleaks and graft failure, the survival rate during follow-up was higher (97.1%; rate with the exception of unrelated cause of death) than that of all the patients. CONCLUSION: The immediate and mid-term results suggest that the endovascular treatment of an AAA is technically feasible and effective. There was higher mortality and morbidity in primary and newly developed endoleak cases; therefore, proper selection of cases, according to the anatomical and clinical criteria, is essential, with meticulous regular follow-ups being critical for the optimal endovascular treatment of an AAA.
Angiography ; Aortic Aneurysm, Abdominal* ; Conversion to Open Surgery ; Endoleak ; Follow-Up Studies ; Heart Arrest ; Humans ; Male ; Mortality ; Sepsis ; Survival Rate ; Transplants ; Treatment Outcome

PURPOSE: Laparoscopy is being used increasingly for the management of small bowel obstructions (SBOs), but only a few studies have examined the indications and utility of laparoscopic surgery in SBO. This study investigated the feasibility, effectiveness and safety of laparoscopic surgery in SBO, as well as the predictors of the success or failure of laparoscopic surgery. METHODS: From June 2006 to March 2010, 73 patients underwent surgery for SBO at the Department of Surgery, Kyung Hee University Medical Center. The patients treated by laparoscopy were compared with those treated by laparotomy in terms of the differences in operative time, postoperative hospital stay and return of bowel function, as evidenced by the toleration of a liquid diet, surgical site infection and recurrence rate. A Chi-square test, student's t-test and ANOVA test were performed to identify the predictors of success or failure of laparoscopic surgery, particularly the preoperative laboratory findings, vital signs, previous abdominal surgery, duration of illness, bowel diameter on abdomen plain film and location of the transition zone on computerized tomography. RESULTS: Of the 73 cases, 30 cases were in the laparoscopic group (41.1%) and 43 cases were in the laparotomy group (58.9%). The postoperative hospital stay was significantly shorter in the laparoscopic group than in the laparotomy group (8.1+/-5.8 vs. 15.2+/-14.9 days, p=0.04), and the period until the return of bowel function was significantly shorter in the laparoscopic group than laparotomy group (4.3+/-3.1 vs. 6.6+/-3.6 days, p=0.02). The surgical site infection rate tended to be lower in the laparoscopic group than in the laparotomy group (4.5% vs. 23.3%, p=0.07) and the mean surgery time tended to be shorter in the laparoscopic group than in the laparotomy group (76.3+/-28.1 vs. 96.3+/-55.9 minutes, p=0.06). There were no differences in the incidence of intraoperative bowel injury between the two groups (0/22 (0%) in the laparoscopic group vs. 2/43 (4.7%) in the laparotomy group, p=0.30), recurrence rate (0/22 (0%) vs. 3/43 (7.1%), p=0.34) and mortality rate (1/22 (4.5%) vs 0/43 (0%), p=0.30 respectively). The rate of conversion to open surgery was 26.7% (8/30). The causes of conversion to open surgery were severe bowel distension (2 cases), severe adhesion (2 cases), no visible cause of obstruction (1 case), iatrogenic bowel injury (1 case), bowel ischemia and perforation (1 case) and hemodynamic instability (1 case). There were no significant differences in the preoperative WBC count, CRP, pulse rate, number of past abdominal surgeries, duration of illness, bowel diameter on plain abdominal film and obstruction site between the successful group and conversion group, except for the significant differences in body temperature and marginal differences in the type of previous surgery. CONCLUSION: The laparoscopic approach has been shown to be safe and feasible in the management of SBO for selected patients. There were no pre-operative predictive factors for successful laparoscopy, except for factors such as afebrility and previous gynecological surgery. Nevertheless, larger, randomized prospective trials will be needed to determine the predictors of success or failure of laparoscopic surgery.
Abdomen ; Academic Medical Centers ; Body Temperature ; Conversion to Open Surgery ; Diet ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Ischemia ; Laparoscopy ; Laparotomy ; Length of Stay ; Operative Time ; Recurrence ; Vital Signs