No abstract available.
Bacteriology* ; Biliary Tract*

PURPOSE: Incorrect positioning of umbilical artery catheter (UAC) results in an increased incidence of complications and erroneous pressure measurements. We radiologically localized major aortic branches and calculated the length of catheter from umbilicus to celiac artery, renal artery and aortic bifurcation for optimal positioning of UAC. To determine the neonatal body measurement that best predicts optimal UAC lengths, we studied three commonly used parameters-birth weight (BW), total body length (TBL) and shoulder-umbilicus length (SUL). METHODS: Fifty one high type of UAC were routinely identified by sonographic scanning from the epigastrium in longitudinal projection and 42 low type of UAC from the flank in coronal projection. The distances from the catheter tip to the celiac artery, the renal artery and to the aortic bifurcation were measured by electronic calipers and were compared with the length of the catheter from umbilicus to the tip on the chest anteroposterior radiograph. RESULTS: The celiac arteries originated from T10-T12, renal arteries Ll-L2, and aortic bifurcations L3-L5. There was positive correlation between BW, TBL or SUL and the length of catheter to the celiac artery (r2=0.476, 0.749 or 0.753), to the renal artery (r2= 0.785, 0.847 or 0.720), and to the aortic bifurcation (r2=0.714, 0.809 or 0.747). CONCLUSION: Although any one of the three parameters can be used clinically, we prefer the TBL and SUL parameters for its reliability and usefulness in emergency settings. The use of a new distribution plot of origins of major branches and regression equations for calculation of the lengths may help deciding the optimal position of UAC.
Catheters* ; Celiac Artery ; Emergencies ; Humans ; Incidence ; Infant, Newborn* ; Renal Artery ; Thorax ; Ultrasonography* ; Umbilical Arteries* ; Umbilicus

OBJECTIVE: Stenotrophomonas maltophilia has been emerging as an important nosocomial pathogen in recent years in patients with impaired host- defense mechanism or who has been exposed to large amount of inocula. This organism is usually resistant to multiple (commonly used) antimicrobial agents, particularly to those of the beta-lactam class. To evaluate the clinical feature of Stenotrophomonas maltophilia infection and in vitro anti- microbial susceptibility, we performed a retrospective study. METHODS: We analyzed the result of in vitro antimicrobial susceptibility test for 200 isolates of S. maltophilia and the annual isolation rate during the period between January 1990 and December 1994 in our institution, and performed a retrospective study for the available records of 165 cases among them. The data were obtained with only the first isolation of the organism for each patients. RESULTS: Total of 165 initial isolates, the isolates were from wounds in 50(30.3%), urine in 47(28.5%), the respiratory tract in 37(22.4%), blood in 9(5.5%), bile in 6(3.6%), and miscellaneous sources in 16(9.7%). The 84.2% of isolates were hospital-acquired isolate and 58.3% of these patients had received antecedent antibiotic therapy: polymicrobial growth was demonstrated in 61.9% of the cases. In vitro antimicrobial susceptibiiity test, ofloxacin was active against the isolates in 89.2%, moxalactam in 85.9%, ciprofloxacin in 83.9%, TMP-SMX(trimethoprim-sulfamethoxazole) in 64.2%, As expected, S. maltophilia isolates were, in general, not susceptible to cephalosporins, penicillins. The annual isolation rate at Kyung Hee University hospital was not increased significantly from 1990 to 1994, 19.53 per 10,000 patients dismissals in 1990, 13.56 in 1994. The major underlying diseases of patients were malignancy(17.6%), cerebrovascular disorder(17%), diabetic mellitus(13.3%). Mortality rate is 10.3%. CONCLUSION: S. maltophilia has been emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad-spectrum antimicrobial therapy. And this organism is resistant to multiple antimicrobial agents, particularly to those of the beta-lactam class. When antimicrobial treatment is necessary, the clinician should be guided by results of in vitro susceptibility testing because of the notable in vitro resistance of S. maltophilia to commonly used antibiotics. And when S. maltophilia has been recovered from a patient, wound and contact isolation is warranted.
Anti-Bacterial Agents ; Anti-Infective Agents ; Bile ; Cephalosporins ; Ciprofloxacin ; Humans ; Immunocompromised Host ; Mortality ; Moxalactam ; Ofloxacin ; Penicillins ; Respiratory System ; Retrospective Studies ; Stenotrophomonas maltophilia ; Stenotrophomonas* ; Wounds and Injuries

PURPOSE: Atrial natriuretic peptide(ANP) is a hormone with strong vasodilating, diu-retic and natriuretic properties. The aim of this study was to clarify the interrelationship of ANP secretion and hemodynamic changes of patent ductus arteriosus(PDA) in healthy preterm and fullterm infants without clinical evidence of PDA. METHODS: Thirteen preterm infants and six full term infants who did not develop clinical evidence of PDA were studied at 6 hr, 12 hr, 24 hr, 3rd day and 4th day after birth, until their PDAs closed spontaneously. Plasma ANP concentrations and the hemodynamic changes of PDA were rneasured. RESULTS: The ANP concentrations of all infants increased from 34.1+/-10.9 pg/ml at 6 hr to 120.5+/-18.8 pg/ml at 12 hr, and declined thereafter gradually to 74.2+/-12.7 pg/ml at 4th day. The ANP concentrations, LA/Ao ratio and LAV decreased after ductal closure. The pulmonary flow velocity(PFV) of PDA correlated with ANP concentration in preterm infants(r=0.23, P<0.05). LA/Ao ratio correlated with ANP contration in all infants (r=0.28, P<0.05), especially in preterm infants(r=0.46, P<0.01 during 12 hr and 4th day after birth. LAV correlated with the ANP concentrations in preterm infants during 12 hr and 4th day after birth(r=0.34, P<0.05). CONCLUSION: The changes of ANP concentrations are probably due to the changes of the left-to-right shunt of PDA with left atrial stretch. Reduction of the ANP concentrations may serve as an indicator of spontaneous closure of PDA. Therefore ANP measurement may be useful in deciding the need and the timing of medical and surgical managernent of newbom infants without clinical evidence of PDA.
Atrial Natriuretic Factor ; Ductus Arteriosus, Patent* ; Hemodynamics* ; Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Infant, Premature ; Parturition ; Plasma*

OBJECTIVES: The hippocampal atrophy has been known to be an important biological marker for the early diagnosis of mild cognitive impairment (MCI). The aims of this study are to disclose the differerence in the interuncal distance (IUD) between MCI, dementia of the Alzheimer's type (DAT) and healthy aged controls, and to identify the affecting factors. METHODS: In transaxial plane, the IUDs at the level of the suprasellar cistern on the T1-weighted images on the brain MRI were measured in patients with MCI (N=30), those with DAT (N=34), and healthy aged controls (N=20). Furthermore, demographic data about age, sex, educational level as well as cerebrovascular factors were obtained by structured interviews and medical records, and the severity of cognitive disorders were assessed using the Mini-Mental Status Examination (MMSE), the Clinical Dementia Rating (CDR) and the Global Deterioration Scale (GDS). RESULTS: 1) The mean (+/-S.D.) IUD of DAT group (26.52+/-3.37 mm) was significantly different from that of healthy aged controls (24.35+/-2.91 mm)(p=0.044). However, there were no significant differences between IUD of MCI group (25.60+/-2.66 mm) and that of DAT group (p=0.483) as well as that of healthy aged controls and that of MCI group (p=0.363). 2) Variables such as age, sex, educational level, cerebrovascular risk factors and severity of cognitive disorder were not related to the IUD. CONCLUSIONS: The measurement of IUD on the brain MRI did not seem to be a helpful biological marker for the early detection of MCI in clinical practice.
Atrophy ; Biomarkers ; Brain ; Dementia ; Early Diagnosis ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Mild Cognitive Impairment* ; Risk Factors

PURPOSE: We designed this study to find out the risk factors affecting the patency rate after creation of arteriovenous fistula (AVF) for maintenance hemodialysis. METHODS: From March 1997 to April 1999, a total of 206 AVF creation operations [126 of radiocephalic fistula (RCF), 59 of brachiocephalic fistula (BCF), and 21 of grafted fistula] in 165 patients were undertaken by single surgeon under the same surgical technique and principles. In 128 cases (62.1%), operation was performed for the first time and in 42 cases (20.4%), the trial was second time. However in remaining 36 cases (17.5%), the operation was three or more than three times. RESULTS: After a mean follow-up of 9 months, 27 patient death and 53 fistula failure were identified. The overall patency rate at 1- and 2-year were 72.6% and 61.1%. The success patency rate, excluding the early failure cases, at 1-and 2-year were 78.4% and 65.9%. In multivariate analysis, the presence of 2 or more than 2 times failed AVF episodes was the significant risk factor forecasting the poor fistula patency (p<0.05, odd ratio=2.72). Although the odd ratio in patients with grafted fistula or in diabetic patients was 1.39 or 1.48 in multivariate analysis, these factors did not reach the statistical significance in multivariate analysis (P>0.05). In univariate analysis, the 1- and 2 year patency rate of more than third AVF trial group were 53.2% and 25.3%, which showed significant poor patency rate comparing with the ones of first or second AVF trial group (76.73% in 1- and 67.9% in 2-year) (p=0.0197). CONCLUSION: In conclusion, repeated trial of AVF creation (= or >3) in itself was the most powerful significant risk factor affecting the patency rate after AVF creation. The successful first or second trial is very important to expect a long-term patency. Well designed surgery under delicate surgical technique in early referred patient should promise the long-term patency even in patients with diabetes or patients requiring grafted fistula.
Arteriovenous Fistula* ; Fistula ; Follow-Up Studies ; Forecasting ; Humans ; Multivariate Analysis ; Renal Dialysis* ; Risk Factors* ; Transplants

Background: Various types of miniplates have been developed and used for the reduction of facial bone fractures. We introduced Yang’s Keyhole (YK) plate, and reported on its short-term stability. The purpose of this study was to evaluate the long-term stability of the YK plate, as a follow-up study, by examining the patients who had used the YK plate among the patients with the reduction of mandible fractures and who visited for plate removal. Methods: We reviewed the medical records of 16 patients who underwent mandibular fracture fixation using a YK plate (group I) and 17 patients who underwent mandibular fracture fixation using a conventional plate (group II). Assessment was then made on malunion, occlusal stability, discomfort during the application, and clinical symptoms. Results: From January 2015 to December 2017, a total of 36 patients underwent mandibular fracture surgery using a YK plate. A total of 16 patients received plate removal. Among them, 15 were male and 1 female. The average age was 26 years. The applied surgical sites were the 12 on mandibular angle, 4 on mandibular symphysis, and 2 on subcondyle. The application period of YK plate was an average of 335 days. During the same period, 45 people underwent surgery on the conventional plate. A total of 17 patients received plate removal. Among them, 15 were male and 2 females. The average age was 36 years. The applied surgical sites were the 8 on mandibular angle, 4 on mandibular symphysis, and 2 on subcondyle. The application period of the conventional plate was an average of 349 days. No malocclusion occurred at the time of removal, and occlusion was stable. No patient complained of joint disease or discomfort. Conclusion The YK plate system, in which the screw was first inserted and the plate was applied, for clinical convenience did not cause any particular problem and no significant difference from the conventional plate.

PURPOSE: Atrial natriuretic peptide(ANP) is a hormone with diuretic and natriuretic properties that is released by the atrial stretch and plays an important role in sodium and volume homeostasis. We studied plasma ANP concentration and the influence of ANP on sodium balance after birth in low birth weight neonates on the basis of 34 wks gestational age when the nephrogenesis was completed. METHODS: Twenty low birth weight neonates without congenital heart disease, respiratory insufficiency, renal disease or sepsis born between June 1997 and December 1997 at Korea University Guro Hospital were enrolled in this study. Blood sampling for ANP was done at 6 hr, 12 hr, 24 hr, 3 days, 4 days and 10 days after birth. FENa was calculated by blood and urine electrolyte and creatinine. We analyzed the correlation of plasma ANP concentration and fractional Na excretion rate(FENa). RESULTS: Plasma ANP concentration of low birth weight neonates less than 34 wks was 63.67+/-12.94pg/ml at 6 hr after birth and peaked at 24 hr(110.67+/-6.34pg/ml). Thereafter, it gradually decreased and reached 42.43+/-21.89pg/ml at 10 days(P<0.05). Plasma ANP concentration of low birth weight neonates more than 34 wks was 25.50+/-8.22pg/ml at 6 hr after birth and peaked at 12hours(152.67+/-39.93pg/ml). Thereafter, it gradually decreased and reached 42.78+/-17.67pg/ml at 10 days(P<0.001). And plasma ANP concentration did not correlate significantly with FENa in low birth weight neonates less than 34 wks(r=0.02, P=0.09), but there was good correlation between plasma ANP and FENa in low birth weight neonates more than 34 wks(r=0.6, P<0.001). CONCLUSION: From the above results, it is concluded that ANP influences renal Na excretion after 34-week gestational age when the development of distal tubule, containing ANP receptors, is rapid and contributes to body fluid and Na homeostasis.
Atrial Natriuretic Factor ; Body Fluids ; Creatinine ; Gestational Age ; Heart Defects, Congenital ; Homeostasis ; Humans ; Infant, Low Birth Weight* ; Infant, Newborn ; Infant, Newborn* ; Korea ; Parturition* ; Plasma* ; Receptors, Atrial Natriuretic Factor ; Respiratory Insufficiency ; Sepsis ; Sodium

PURPOSE: Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by a decreased aortomesenteric angle that causes a duodenal obstruction. It usually occurs after a period of weight loss, nausea or vomiting due to a partial obstruction of the third portion of the duodenum. If conservative management fails, then a laparotomy, with a duodenojejunostomy, is indicated. A minimally invasive laparoscopic approach to the retroperitoneum, or duodenal, operation has recently been introduced. Although the role of laparoscopy in the management of SMA syndrome is not clearly defined, a laparoscopic duodenojejunostomy may be an alternative approach for its surgical treatment. METHODS: We retrospectively reviewed and analysed our experience of 8 cases of SMA syndrome, and included another 45 cases that had previously been reported in the Korean literature since 1967. RESULTS: There was no gender predominance, but SMA syndrome was more common in younger patients. There were several diseases, or underlying conditions, associated with gastrointestinal, or other general conditions, in SMA syndrome. With respect to its surgical management, most cases in Korea were treated with a duodenojejunostomy. We recently experienced two cases of superior mesenteric artery syndrome, which were treated laparoscopically. The operation time and lenghth of hospital stay were acceptable, with no complications. CONCLUSION: SMA syndrome shows a greater predominance in young age, and is associated with many other diseases, or conditions, in Korea. A duodenojejunostomy is the best choice of operative procedure for the treatment of SMA syndrome. A laparoscopic duodenojejunostomy is also a feasible, alternative option in the treatment of SMA syndrome, providing the benefits of a definitive and minimally invasive surgical technique for a duodenal obstruction.
Arteries* ; Duodenal Obstruction ; Duodenum ; Humans ; Korea ; Laparoscopy ; Laparotomy ; Length of Stay ; Mesenteric Artery, Superior ; Mesentery* ; Nausea ; Retrospective Studies ; Superior Mesenteric Artery Syndrome ; Surgical Procedures, Operative ; Vomiting ; Weight Loss

BACKGROUND: Spontaneous pneumothorax have been managed with a variety of methods. The technique most frequently used is chest tube drainage. Small caliber catheters were first used in the management of pneumothorax complicating the percutaneous needle aspiration lung biopsy, and the try to treat spontaneous pneumothorax also has been reported. However, the value of small caliber catheters in spontaneous pneumothorax has not been fully evaluated. So, we tried to elucidate the efficacy of 8 French catheter in the management of spontaneous pneumothorax. METHOD: From January, 1990, to April, 1994, 44 patients with spontaneous pneumothorax treated at Chung-Ang university hospital were reviewed. The patients were sub-divide into 8 French catheter insertion group (n=21) and chest tube insertion group (n=23). We compared the presence of underlying lung disease, the extent of the collapse, the duration of indwelling catheter and complication between two groups. RESULTS: 1) The duration of indwelling showed no significant difference between 8 French catheter group and chest tube. But, complication after insertion as subcutaneous emphysema was developed in only chest tube group. (p<0.05) 2) In the primary spontaneous pneumothorax, all case of the pneumothorax of which size was less than 50% showed complete healing with 8 French catheter insertion. Whereas the success rate in patients with large pneumothorax (more than 50%) was tended to be dependent on the age. 3) In the patients with secondary spontaneous pneumothorax who were managed with 8 French catheter, the success rate was trended to be high if the underlying disease of pneumothorax was not COPD and if the patient was young. CONCLUSION: These results show that 8 French catheter insertion probably was effective in the pneumothorax less than 50%, the primary spontaneous pneumothorax, young age or secondary pneumothorax not associated with COPD.
Biopsy ; Catheters* ; Catheters, Indwelling ; Chest Tubes* ; Drainage ; Humans ; Lung ; Lung Diseases ; Needles ; Pneumothorax* ; Pulmonary Disease, Chronic Obstructive ; Subcutaneous Emphysema ; Thorax*