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Retrograde Autologous Priming: Is It Really Effective in Reducing Red Blood Cell Transfusions during Extracorporeal Circulation? (역행성 자가혈액 충전법: 체외순환 중 동종적혈구 수혈량을 줄일 수 있는가?)

  • Lim, Cheong;Son, Kuk-Hui;Park, Kay-Hyun;Jheon, Sang-Hoon;Sung, Sook-Whan
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.473-479
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    • 2009
  • Background: Retrograde autologous priming (RAP) is known to be useful in decreasing the need of transfusions in cardiac surgery because it prevents excessive hemodilution due to the crystalloid priming of cardiopulmonary bypass circuit. However, there are also negative side effects in terms of blood conservation. We analyzed the intraoperative blood-conserving effect of RAP and also investigated the efficacy of autotransfusion and ultrafiltration as a supplemental method for RAP. Material and Method: From January 2005 to December 2007, 117 patients who underwent isolated coronary artery bypass operations using cardiopulmonary bypass (CPB) were enrolled. Mean age was 63.9$\pm$9.1 years (range 36$\sim$83 years) and 34 patients were female. There were 62 patients in the RAP group and 55 patients in he control group. Intraoperative autotransfusion was performed via the arterial line. RAP was done just before initiating CPB using retrograde drainage of the crystalloid priming solution. Both conventional (CUF) and modified (MUF) ultrafiltrations were done during and after CPB, respectively. The transfusion threshold was less than 20% in hematocrit. Result: Autotransfusions were done in 79 patients (67.5%) and the average amount was 142.5$\pm$65.4 mL (range 30$\sim$320 mL). Homologous red blood cell (RBC) transfusion was done in 47 patients (40.2%) and mean amount of transfused RBC was 404.3$\pm$222.6 mL. Risk factors for transfusions were body surface area (OR 0.01, 95% CI 0.00 $\sim$ 0.63, p=0.030) and cardiopulmonary bypass time (OR 1.04, 95% CI 1.01 $\sim$ 1.08, p=0.019). RAP was not effective in terms of the rate of transfusion (34.5% vs 45.2%, p=0.24). However, the amount of transfused RBC was significantly decreased (526.3$\pm$242.3ml vs 321.4$\pm$166.3 mL, p=0.001). Autotransfusion and ultrafiltration revealed additive and cumulative effects decreasing transfusion amount (one; 600.0$\pm$231.0 mL, two; 533.3$\pm$264.6 mL, three; 346.7$\pm$176.7 mL, four; 300.0$\pm$146.1 mL, p=0.002). Conclusion: Even though RAP did not appear to be effective in terms of the number of patients receiving intraoperative RBC transfusions, it could conserve blood in terms of the amount transfused and with the additive effects of autotransfusion and ultrafiltration. If we want to maximize the blood conserving effect of RAP, more aggressive control will be necessary - such as high threshold of transfusion trigger or strict regulation of crystalloid infusion, and so forth.

Deep Neck Abscesses in Korean Children (소아 심부 경부 농양에 대한 임상적 고찰)

  • Lee, Dae Hyoung;Kim, Sun Mi;Lee, Jung Hyun;Kim, Jong Hyun;Hur, Jae Kyun;Kang, Jin Han
    • Pediatric Infection and Vaccine
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    • v.11 no.1
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    • pp.81-89
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    • 2004
  • Purpose : Retropharyngeal and parapharyngeal abscesses are often distinguishable from other head and neck abscesses on clinical grounds, but these infections can combine and the presentations are similar to one another. Because of the advances of antibiotic therapy, the frequency of the diseases decreased considerably, but recently the incidence of neck abscesses has increased. We sought to describe the clinical presentation of patients with deep neck abscess, and implications on management. Methods : For 10 year periods, 94 cases of charts were reviewed retrospectively, who were diagnosed as neck abscesses aged below 16 years old(between January 1993 to August 2003) in 4 hospitals. Deep neck abscesses were diagnosed by surgical pus drainage, neck CT (homogenous, hypodense area with ring enhancement) and neck sono findings. Results : The annual incidence of deep neck abscess has been increased since 2000. The median age of the patients was 4 years(range, 26 days~15 years); 63% of the patients were younger than 5 years. Abscesses in the submandibular space(34%) were most common, followed by peritonsillar space(29.7%), retropharyngeal space(11.7%), combined(10.8%), parotid space(7.4%) and parapharyngeal space(6.4%). Fever(73.4%), sore throat(37.2%), decreased oral intake(34%) and neck pain(27.7%) were the most common symptoms. In 6 children(6.4%), there was refusal to move neck, in 6(6.4%) headache, and in 4(4.3%) torticollis. Respiratory distress was observed in only 1 patient(2.1%) and stridor in 1 other(2.1%). The most common physical examinations were neck swelling/mass(67%), pharyngitis(46.8%), tonsillitis(36.2 %), and cervical lymphadenopathy(28.7%). Neck stiffness was observed in 4 patients(4.3%). Total 35 organisms were isolated in 33 patients. The most common organisms cultured by patients' blood or pus were S. aureus(34%) and S. pyogenes(28.6%). Most organisms were gram positive, and had sensitivities in vancomycin(96.4%), cefotaxime(88.9%), cephalothin (86.4%), trimethoprime-sulfamethoxazole(83.3%), and clindamycin(77.8%). 77 patients(81.9%) underwent surgery plus antibiotics; 17 patients(18.1%) were treated with antibiotics only. There is no significant differences between two groups. In duration of admission, fever after admission, and antibiotic treatment. Conclusion : The incidence of deep neck abscess has increased recently and the major symptoms have been changed. The incidence of respiratory distress or stridor is decreasing, while the incidence of abnormal head and neck symptoms and signs like headache, neck stiffness, refusal to move neck, or torticollis are increasing. Gram positive organisms are predominant, S. aureus is the most common followed by S. pyogenes. 1st generation cephalosporin has high sensitivity on gram positive organisms. Treatment with surgery plus antibiotics dose not significantly decrease total duration of antibiotic treatment or admission compared to treatment with antibiotics alone.

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A Study on the Conservation State and Plans for Stone Cultural Properties in the Unjusa Temple, Korea (운주사 석조문화재의 보존상태와 보존방안에 대한 연구)

  • Sa-Duk, Kim;Chan-Hee, Lee;Seok-Won, Choi;Eun-Jeong, Shin
    • Korean Journal of Heritage: History & Science
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    • v.37
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    • pp.285-307
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    • 2004
  • Synthesize and examine petrological characteristic and geochemical characteristic by weathering formation of rock and progress of weathering laying stress on stone cultural properties of Unjusa temple of Chonnam Hwasun county site in this research. Examine closely weathering element that influence mechanical, chemical, mineralogical and physical weathering of rocks that accomplish stone cultural properties and these do quantification, wish to utilize by a basic knowledge for conservation scientific research of stone cultural properties by these result. Enforced component analysis of rock and mineralogical survey about 18 samples (pyroclastic tuff; 7, ash tuff; 4, granite ; 4, granitic gneiss; 3) all to search petrological characteristic and geochemical characteristic by weathering of Unjusa temple precinct stone cultural properties and recorded deterioration degree about each stone cultural properties observing naked eye. Major rock that constitution Unjusa temple one great geological features has strike of N30-40W and dip of 10-20NE being pyroclastic tuff. This pyroclastic tuff is ranging very extensively laying center on Unjusa temple and stone cultural properties of precinct is modeled by this pyroclastic tuff. Stone cultural propertieses of present Unjusa temple precinct are accomplishing structural imbalance with serious crack, and because weathering of rock with serious biological pollution is gone fairly, rubble break away and weathering and deterioration phenomenon such as fall off of a particle of mineral are appearing extremely. Also, a piece of iron and cement mortar of stone cultural properties everywhere are forming precipitate of reddish brown and light gray being oxidized. About these stone cultural properties, most stone cultural propertieses show SD(severe damage) to MD(moderate damage) as result that record Deterioration degree. X-ray diffraction analysis result samples of each rock are consisted of mineral of quartz, orthoclase,plagioclase, calcite, magnetite etc. Quartz and feldspar alterated extremely in a microscopic analysis, and biotite that show crystalline form of anhedral shows state that become chloritization that is secondary weathering mineral being weathered. Also, see that show iron precipitate of reddish brown to crack zone of tuff everywhere preview rock that weathering is gone deep. Tuffs that accomplish stone cultural properties of study area is illustrated to field of Subalkaline and Peraluminous, $SiO_2$(wt.%) extent of samples pyroclastic tuff 70.08-73.69, ash tuff extent of 70.26-78.42 show. In calculate Chemical Index of Alteration(CIA) and Weathering Potential Index(WPI) about major elements extent of CIA pyroclastic tuff 55.05-60.75, ash tuff 52.10-58.70, granite 49.49-51.06 granitic gneiss shows value of 53.25-67.14 and these have high value gneiss and tuffs. WPI previews that is see as thing which is illustrated being approximated in 0 lines and 0 lines low samples of tuffs and gneiss is receiving esaily weathering process as appear in CIA. As clay mineral of smectite, zeolite that is secondary weathering produce of rock as result that pick powdering of rock and clothing material of stone cultural properties observed by scanning electron micrographs (SEM). And roots of lichen and spore of hyphae that is weathering element are observed together. This rock deep organism being coating to add mechanical weathering process of stone cultural properties do, and is assumed that change the clay mineral is gone fairly in stone cultural properties with these. As the weathering of rocks is under a serious condition, the damage by the natural environment such as rain, wind, trees and the ground is accelerated. As a counter-measure, the first necessary thing is to build the ground environment about protecting water invasion by making the drainage and checking the surrounding environment. The second thing are building hardening and extirpation process that strengthens the rock, dealing biologically by reducing lichens, and sticking crevice part restoration using synthetic resin. Moreover, it is assumed to be desirable to build the protection facility that can block wind, sunlight, and rain which are the cause of the weathering, and that goes well with the surrounding environment.

Study on the Technological System of the Cooperative Cultivation of Paddy Rice in Korea (수도집단재배의 기술체계에 관한 연구)

  • Min-Shin Cho
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.8 no.1
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    • pp.129-177
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    • 1970
  • For the purpose of establishing the systematized technical scheme of the cooperative rice cultivation which has most significant impact to improve rice productivity and the farm management, the author have studied the cultivation practices, and the variation of rice growth and yield between the cooperative rice cultivation and the individual rice cultivation at random selected 18 paddy fields. The author also have investigated through comparative method on the cultivation practices, management, organization and operation scheme of the two different rice cultivation methods at 460 paddy fields. The economic feasibility has been ana lysed and added in this report. The results obtained from this study are summarized as follows; 1. In the nursery, the average amount of fertilizer application, especially, phosphate and potassium, and the frequency of chemicals spray for the disease, insect and pest control at the cooperative rice cultivation are significantly higher than those of the individual rice cultivation. 2. The cultivation techniques of the cooperative rice farming after the transplanting can be characterized by a) the earlier transplanting of rice, b) the denser hills per unit area and the lesser number of seedlings per hill, c) the application of larger quantities of fertilizer including nitrogen, phosphate and potassium, d) more divided application of fertilizers, split doses of the nitrogen and potassium, e) the increased frequencies of the chemicals spray for the prevention of disease, insect and pest damages. 3. The rate of lodging in the cooperative rice cultivation was slightly higher than that of the individual rice cultivation, however, the losses of rice yield owing to the occurrence of rice stem borer and grass leaf roller in the cooperative rice cultivation were lower than that of the individual rice cultivation. 4. The culm length, panicle length, straw weight and grain-straw ratio are respectively higher at the cooperative rice cultivation, moreover, the higher variation of the above factors due to different localities of the paddy fields found at the individual rice cultivation. 5. The number of panicles, number of flowers per panicle and the weight of 1, 000 grains, those contributing components to the rice yield were significantly greater in the cooperative rice cultivation, however, not clear difference in the maturing rate was observed. The variation coefficient of the yield component in the cooperative cultivation showed lower than that or the individual rice cultivation. 6. The average yield of brown rice per 10 are in the cooperative rice cultivation obtained 459.0 kilograms while that of the individual rice cultivation brought 374.8 kilograms. The yield of brown rice in the cooperative rice cultivation increased 84.2 kilogram per 10 are over the individual rice cultivation. With lower variation coefficient of the brown rice yield in the cooperative rice cultivation, it can be said that uniformed higher yield could be obtained through the cooperative rice cultivation. 7. Highly significant positive correlations shown between the seeding date and the number of flowers per panicle, the chemical spray and the number of flowers per panicle, the transplanting date and the number of flowers per panicle, phosphate application and yield, potassium application and maturing rate, the split application of fertilizers and yield. Whilst the significant negative correlation was shown between the transplanting date and the maturing rate 8. The results of investigation from 480 paddy fields obtained through comparative method on the following items are identical in general with those obtained at 18 paddy fields: Application of fertilizers, chemical spray for the control of disease, insects and pests both in the nursery and the paddy field, transplanting date, transplanting density, split application of fertilizers and yield n the paddy fields. a) The number of rice varieties used in the cooperative rice cultivation were 13 varieties while the individual rice cultivation used 47 varieties. b) The cooperative rice cultivation has more successfully adopted improved cultivation techniques such as the practice of seed disinfection, adoption of recommended seeding amount, fall ploughing, application of red soil, introduction of power tillers, the rectangular-type transplanting, midsummer drainage and the periodical irrigation. 9. The following results were also obtained from the same investigation and they are: a) In the cooperative rice cultivation, the greater part of the important practices have been carried out through cooperative operation including seed disinfection, ploughing, application of red soil and compost, the control of disease, insects and pests, harvest, threshing and transportation of the products. b) The labor input to the nursery bed and water control in the cooperative rice cultivation was less than that of the individual rice cultivation while the higher rate of labor input was resulted in the red soil and compost application. 10. From the investigation on the organization and operation scheme of the cooperative rice cultivation, the following results were obtained: a) The size of cooperative rice cultivation farm was varied from. 3 ha to 7 ha and 5 ha farm. occupied 55.9 percent of the total farms. And a single cooperative farm was consisted of 10 to 20 plots of paddies. b) The educational back ground of the staff members involved in the cooperative rice cultivation was superior than that of the individual rice cultivation. c) All of the farmers who participated to the questionaires have responded that the cooperative rice cultivation could promise the increased rice yield mainly through the introduction of the improved method of fertilizer application and the effective control of diseases, insects and pests damages. And the majority of farmers were also in the opinion that preparation of the materials and labor input can be timely carried out and the labor requirement for the rice cultivation possibly be saved through the cooperative rice cultivation. d) The farmers who have expressed their wishes to continue and to make further development of the cooperative rice cultivation was 74.5 percent of total farmers participated to the questionaires. 11. From the analysis of economical feasibility on the two different methods of cultivation, the following results were obtained: a) The value of operation cost for the compost, chemical fertilizers, agricultural chemicals and labor input in the cooperative rice cultivation was respectively higher by 335 won, 199 won, 288 won and 303 won over the individual rice cultivation. However, the other production costs showed no distinct differences between the two cultivation methods. b) Although the total value of expenses for the fertilizers, agricultural chemicals, labor input and etc. in the cooperative rice cultivation were approximately doubled to the amount of the individual rice cultivation, the net income, substracted operation costs from the gross income, was obtained 24, 302 won in the cooperative rice cultivation and 20, 168 won was obtained from the individual rice cultivation. Thereby, it can be said that net income from the cooperative rice cultivation increased 4, 134 won over the individual rice cultivation. It was revealed in this study that the cooperative rice cultivation has not only contributed to increment of the farm income through higher yield but also showed as an effective means to introduce highly improved cultivation techniques to the farmers. It may also be concluded, therefore, the cooperative rice cultivation shall continuously renovate the rice production process of the farmers.

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