Succinylcholine-induced prolonged neuromuscular blockade may occur in patients with either a low level of plasma cholinesterase activity or genotypically abnormal form of that enzyme. We experienced a case of succinylcholine-induced prolonged apnea due to a low level of plasma cholinesterase activity. A 31-year-old woman, full term primigravida, underwent cesarean section for breech presentation under general anesthesia. Familial and past medical history were nonspecific and preoperative physical and laboratory findings were within normal range. After operation, delayed apnea was detected and lasted for about one hour. We performed controlled and assisted ventilation for two and half hours. Plasma cholinesterase activity measured 30.00 IU/L (colorimetric method, normal value: 1130~1960 IU/L) at the first postoperative day. She was discharged on 7th postoperative day without any sequelae. From follow-up study after six months, it measured 1.02 U/ml (EIA, normal value: 7~9 U/ml).
Adult ; Anesthesia, General ; Apnea* ; Breech Presentation ; Cesarean Section* ; Cholinesterases* ; Female ; Follow-Up Studies ; Humans ; Neuromuscular Blockade ; Plasma* ; Pregnancy ; Reference Values ; Ventilation

PURPOSE: We evaluated the accuracy of death certificates for persons who registered in the Central Cancer Registry in 1993 and died from 1993 to 1995. MATERIALS AND METHODS: The study consisted of 27,058 cases which were classified into five groups. according to the possibility of accuracy of the underlying causes of death. We compared the distribution of five groups according to several demographic factors. Also we calculated the detection rate and the confirmation rate for a selected 23,858 persons reported to die of a cancer. RESULTS: Among the 27,058 deaths, only 64.4% was included in the group which had reported the same cancer site with registry as underlying cause of death. The accuracy decreased with increasing age and was worse for women and rural residence. And physicians certification was an important factor to improve the accuracy. Cancers of stomach, lung, esophagus and breast were included into the high accuracy group, cancers of the colon, rectum and gallbladder and extrahepatic biliary tract into the low accuracy group. Cancers of the colon, pancreas, liver and lung were overreported, varied from 1.2 to 1.4 times, and cervical cancer was severely underreported, about 0.5 times. CONCLUSION: These results suggest that the caution in the use and interpretation of cancer certificate data would be required.
Biliary Tract ; Breast ; Cause of Death* ; Certification ; Colon ; Death Certificates* ; Demography ; Diagnosis* ; Esophagus ; Female ; Gallbladder ; Humans ; Korea* ; Liver ; Lung ; Pancreas ; Rectum ; Stomach ; Uterine Cervical Neoplasms

We present a case report of primary middle ear lipoma diagnosed in right ear of a 25-month-old girl with right otitis media. We identified injection and retraction at right ear drum. Impedance tympanometry of right ear was type B and temporal bone CT was suggestive of a congenital cholesteatoma. During the tympanoplasty, a mass of tissue obstructing the eustachian tube orifice was noted in the middle ear. We have treated a case of a lipoma that originated from the middle ear; only 5 such cases have been reported worldwide.
Acoustic Impedance Tests ; Cholesteatoma ; Ear ; Ear, Middle ; Electric Impedance ; Eustachian Tube ; Lipoma ; Otitis Media ; Preschool Child ; Temporal Bone ; Tympanoplasty

BACKGROUND: The aim of this study was to compare the difference in hemodynamic change and in sensory or motor block between hyperbaric tetracaine and bupivacaine in spinal anesthesia. METHODS: The sixty-three patients, belonged to ASA class 1 and 2, were divided into tetracaine group and bupivacaine group. The patients were administered 0.5% hyperbaric tetracaine(Pantocaine ) in tetracaine group and 0.5% hyperbaric bupivacaine(Marcaine ) in bupivacaine group, intrathecally. After intrathecal injection of the agents, we measured the change of sensory block level according to pinprick test, the motor block by the modified Bromage score until fixations was achieved, and the blood pressure and heart rate. RESULTS: The two groups did not differ significantly with loss of sensory level and onset time. Bupivacaine group was revealed a slower fixations of motor block than tetracaine group(p<0.05). Changes of systolic blood pressure and mean arterial blood pressure of bupivacaine group were less than tetracaine group(p<0.05) in 2~25 minutes and 6~15 minutes, respectively. Diastolic blood pressure and heart rate were not different statistically in two groups. CONCLUSION: Spinal anesthesia with hyperbaric bupivacaine was revealed less changes of systolic blood pressure and mean arterial blood pressure than hyperbaric tetracaine, although fixation of motor block was delayed onset. Therefore, we thought that spinal anesthesia with hyperbaric bupivacaine may be used more safe than hyperbaric tetracaine in hemodynamical troublesome case.
Anesthesia, Spinal* ; Arterial Pressure ; Blood Pressure ; Bupivacaine* ; Heart Rate ; Hemodynamics ; Humans ; Injections, Spinal ; Tetracaine*

Endoscopic metal stent insertion has been widely performed to palliatively treat gastrointestinal (GI) tract obstruction in patients with cancer. The use of metal stents for benign strictures of the GI tract is increasing due to the low risk of major complications other than stent migration. The incidence of acute pancreatitis after placing a GI tract metal stent is rare. Herein, we report a case of acute pancreatitis caused by a covered metal stent that was initially inserted for a benign stricture of a gastroduodenal anastomosis that developed after the operation, then distally migrated, bent into a U-shape, and impacted into the second portion of the duodenum in a 56-year-old female who underwent a Billroth-I gastrectomy due to gastric cancer.
Constriction, Pathologic ; Duodenum ; Female ; Gastrectomy ; Gastric Outlet Obstruction ; Gastrointestinal Tract ; Humans ; Incidence ; Middle Aged ; Pancreatitis ; Stents ; Stomach Neoplasms

Molluscum contagiosum is caused by a DNA virus from the poxvirus family. With the advent of new populations of immunocompromised individuals-especially those infected with HIV-molluscum contagiosum has emerged as an important cause of morbidity and disfigurement. Molluscum contagiosum in AIDS, although not life-threatening, is often a marker of late-stage disease and may lead to atypical clinical features and a progressive course that is recalcitrant to treatment. We report two cases of AIDS-related molluscum contagiosum in a 45 year-old male and a 30 year-old male. They were diagnosed as HIV-positive 3 years ago and 1 year ago, respectively. Physical examination revealed asymptomatic numerous skin-colored papules, nodules and tumorous masses on the face and neck. The histopathological finding showed characteristic features of molluscum contagiosum. We think that this is the first report of severe AIDS-related molluscum contagiosum in Korean literature.
Adult ; DNA Viruses ; Humans ; Male ; Middle Aged ; Molluscum Contagiosum* ; Neck ; Physical Examination

OBJECTIVES: To evaluate the efficacy of GnRH antagonist cetrorelix in women undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) and to determine changes in serum hormone concentrations during cetrorelix administration. METHODS: We performed a clinical trial on 30 patients undergoing COH with highly purified follicular stimulating hormone (HP-FSH) and gonadotropin releasing hormone antagonist (GnRHant), cetrorelix. FSH was administrated from day 2 or 3 of cycle with fixed dose and adjusted according to individual response. 0.25 mg of cetrorelix was injected daily subcutaneously from stimulation day 5 until the day of hCG administration. Daily ultrasound monitoring was performed for growing follicles and serum levels of luteinizing hormone (LH), estradiol (E2) and progesterone were measured daily during cetrorelix administration. Up to 4 embryos were transferred. RESULTS: Mean age of enrolled patients was 32.0+/-3.4 years (mean +/-S.D.). All of 30 patients underwent oocyte pick-up, and embryo transfer was done in 28 patients. The total and mean numbers of received oocytes were 196 and 6.5+/-4.7, the number of fertilized eggs was 111, and the fertilization rate was 56.6%. Total duration of FSH administration was 9.2+/-2.2 days and mean of 24.3+/-7.7 ampules of HP-FSH was administered. Total duration of cetrorelix administration was 5.7+/-1.9 days. Serum LH and progesterone levels were maintained in the range of 1.4~2.9 mIU/mL and 0.3~0.6 ng/ mL, which respectively reflected effective prevention of premature LH surge. Clinical pregnancies were achieved in 9 patients, and overall clinical pregnancy rate was 30.0% per oocyte retrieval, and 32.1% per embryo transfer. CONCLUSION: GnRH antagonist is safe and convenient for COH for IVF-ET and effective with optimal pregnancy rate.
Embryo Transfer ; Embryonic Structures ; Estradiol ; Female ; Fertilization ; Fertilization in Vitro ; Gonadotropin-Releasing Hormone* ; Humans ; Luteinizing Hormone ; Oocyte Retrieval ; Oocytes ; Ovulation Induction* ; Pregnancy ; Pregnancy Rate ; Progesterone ; Sperm Injections, Intracytoplasmic ; Ultrasonography ; Zygote

BACKGROUND AND OBJECTIVES: Deep neck infection may still be lethal especially when life-threatening complications occur. The objective of this study is to clarify the therapeutic module for deep neck infection and analyze epidemiologic characteristics, clinical course, microorganisms and site of infections. SUBJECTS AND METHOD: We retrospectively reviewed the medical charts of 98 patients who were confirmed with deep neck infection and who received treatment at the Soonchunhyang University Hospital between 2000 and 2009. We analyzed the data for deep neck infection using the statistical tools like t-test and Spearman's coefficient of correlation. RESULTS: The parapharyngeal space was the most commonly involved space in deep neck infection. The most common pathogen was Streptococcus. The most common underlying disease was Diabetes mellitus. CONCLUSION: Statistical dada showed that there was no significant correlation between the hospitalization period and deep neck infection.
Diabetes Mellitus ; Hospitalization ; Humans ; Neck ; Retrospective Studies ; Streptococcus

OBJECTIVE: Hepatic dysfunction frequently occurs in patients with hematologic malignancies and aplastic anemia who receive intensive chemotherapy or bone marrow transplantation (BMT). The role of laparoscopic liver biopsy in patients with hematologic disorders is very important to determine the etiological factors and to make treatment decisions. The aim of the present study was to evaluate the possible causes of liver disease in patients with abnormal liver function tests. METHODS: Laparoscopy guided liver biopsy was performed in 38 subjects who were receiving intensive cytotoxic therapy with BMT or without BMT. Two to three pieces of liver tissues were obtained in each patients using Vim-Silverman needle with electrocoagulation on biopsy site. Platelet transfusions were given if platelet count was less than 50,000/mm3. 39 biopsies were obtained in 38 patients. RESULTS: At the time of liver biopsy, platelet count was 170,000+/-138000/mm3 (range: 42,000 - 798,000/mm3). No procedure-related complications were observed. Biopsy findings after BMT (n=16) revealed graft versus host disease (GVHD) (n=9), drug induced hepatitis (n=6), veno-occlusive disease (n=2), viral hepatitis (n=1), and nonspecific reactive hepatitis (n=1). 3 patients of GVHD associated with other liver diseases such as drug-induced hepatitis, veno-occlusive disease and chronic active hepatitis B. The authors compared histologic diagnosis with laparoscopic findings. Laparoscopic findings of the liver surface were classified by Shimada's code number system. 5 patients who were biopsed before BMT showed cholestasis and fatty changes and it was possible to be treated with allogenic BMT. Histologic diagnosis in patients without BMT (n=18) showed viral hepatitis (n=6), drug induced hepatitis (n=5), non-specific reactive hepatitis (n=1), and others (n=6). In 12 cases (31%) laparoscopic liver biopsy led to a change in medical management. CONCLUSION: Laparascopic liver biopsy has been proven to be an effective means of assessing the cause of liver dysfunction in patients with hematologic disorders. The diagnosis obtained at laparoscopic liver biopsy could be changed the therapeutic plan in 12 of 39 (31%) patients.
Anemia, Aplastic ; Biopsy* ; Bone Marrow Transplantation ; Cholestasis ; Diagnosis ; Drug Therapy ; Drug-Induced Liver Injury ; Electrocoagulation ; Graft vs Host Disease ; Hematologic Neoplasms ; Hepatitis ; Hepatitis, Chronic ; Humans ; Laparoscopy ; Liver Diseases ; Liver Function Tests ; Liver* ; Needles ; Platelet Count ; Platelet Transfusion

Postganglionic cholinergic dysautonomia is a rare disease characterized by impaired secretion of tears and saliva, generalized absence of sweating, lack of cardiac response to carotid massage and atony of the gastrointestinal tract and urinary bladder. Autonomic function tests show the preservation of sympathetic adrenergic functions in contrast to the generalized involvement of postganglionic parasympathetic and sympathetic cholinergic nerves. Recently, we experienced a patient with gut dysmotility in selective postganglionic cholinergic dysautonomia. She is now being treated with bethanechol and milk of magnesia and has experienced minimal symptom improvement.
Bethanechol ; Gastrointestinal Tract ; Humans ; Magnesium Oxide ; Massage ; Milk ; Primary Dysautonomias* ; Rare Diseases ; Saliva ; Sweat ; Sweating ; Tears ; Urinary Bladder