Pre-eclampain or eclampain is a cause of maternal morbidity and mortality. It is characterized by the triad of maternal hypertension, proteinuria and generlized edema. The etiology of pre-eclampain or eclampsia is thought to be a decreased placental perfusion which results in an increased production of renin, angiotensin, aldosteron, thrombolplastin and a decreased production of prostaglandin. Anesthesiologists have to perform anesthesia technic for high-risk toxemia of pregnancy, and make proper choices of anesthesia method and drugs. Advantages of general anesthesia for Cesarian-section in cases of eclampsia include rapid induction, less hypotension, control of ventilation and fetal oxygenation. Disadvantages include myocardial depression from the anesthetic drugs, hypertension during light anesthesia, the interacion between manesium sulfate and muscle relaxante which might lead to prolonges respiratory paralysis and neonatal depression associated with the general anesthesia. The author used general anesthesis for the Cesarian-section in two severe toxemic patients who had pulmonary edema and bloody sputum because of congestive heartfailure. One patient had cardiac arrest upon arrival at the emergency room and after cardiopulmonary resuscitation the cesarian-section was performed. The mother had complets recovery, but the baby expired in twenty-ninehours. The Mother and twin babies in the other case had complete recovery.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Angiotensins ; Cardiopulmonary Resuscitation ; Depression ; Eclampsia ; Edema ; Emergency Service, Hospital ; Estrogens, Conjugated (USP) ; Female ; Heart Arrest ; Humans ; Hypertension ; Hypotension ; Mortality ; Mothers ; Oxygen ; Perfusion ; Pre-Eclampsia ; Pregnancy* ; Proteinuria ; Pulmonary Edema ; Renin ; Respiratory Paralysis ; Sputum ; Twins ; Ventilation

PURPOSE: Usually papillary microcarcinoma (PMC) grows very slowly with a good prognosis, although it frequently metastasizes to regional lymph nodes and shows multiple tumor formation in the thyroid. Therefore, how to treat papillary microcarcinoma has been controversial. Recently several studies reported that some ultrasonographic features may potentially reflect the biological aggressiveness of a lesion. We investigated which ultrasonographic findings can reflect aggressive characteristics and whether US can helpful in selecting the appropriate surgical treatment of PMC. METHODS: We retrospectively reviewed the preoperative ultrasonographic findings and pathologic risk factors of 68 patients who had undergone surgical treatment for PMC at the Wallace Memorial Baptist Hospital from January 2004 to December 2005. RESULTS: The incidences of multifocality, extrathyroidal extension, and lymph node metastasis of PMC were 42.6%, 48.5% and 20.6%, respectively. The Mean sizes of PMC were no significant differences according to age, multifocality, extrathyroidal extension, lymph node metastasis, stage and AMES risk group, and tumor size more than 5 mm was not linked to pathologic prognostic factors. Cases demonstrating multiple nodules in the unilateral or bilateral lobes, as well as those with fine strong calcifications in the tumor on US, were directly linked to multifocality on pathologic finding. US is insensitive technique for detecting lymph node metastasis and it's sensitivity was only 14.3%, but it's positive predictive value and specificity were high (100%). CONCLUSION: The date suggested that complete surgery with appropriate nodal dissection should be performed in patients with PMC which their US demonstrating multiple nodules in the unilateral or bilateral lobes, fine strong calcifications echoes in tumor and US-detected node metastasis.
Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Protestantism ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Thyroid Gland* ; Ultrasonography*

No abstract available.
Typhlitis*

No abstract available.
Aged ; Carcinoma, Renal Cell/*diagnosis/surgery ; Coronary Angiography ; Creatine Kinase, MB Form/analysis/*metabolism ; Echocardiography ; Electrophoresis ; Enzyme-Linked Immunosorbent Assay ; False Positive Reactions ; Humans ; Kidney Neoplasms/*diagnosis/surgery ; Male ; Nephrectomy

Malignant hyperthermia is defined as a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia, skeletal muscle rigidity, tachycardia, respiratory and metabolic acidosis, cyanosis etx. There is no simple noninvasive test to identify the susceptible individuals. A history of hyperpyrexia and/or muscle rigidity during previous general or a family history of such a condition provides the anesthesiologist with valuable information. Avoidance of potent inhalational anesthetic agents and other triggering agenta, and the selective use of regional anesthesia with either a local anesthetic agent or neuroleptic anesthesia, are the usual acceptable guidelines in the anesthetic management of susceptible individuals. Dentrolene sodium has been shown to be effective in the prevention and treatment of malignant hyperthermia in malignant hyperthermia susceptible swine. We gave Dantrolene sodium orally as a part of the prophylaxia for malignant hyperthermia in a 34yearts-old woman who underwent an emergency bilateral salpingectomy and who had a family history of malignant hyperthermia. We report on this patient with a family history of hyperthermia and reviewed the literature concerning malignant hyperthermia.
Acidosis ; Anesthesia ; Anesthesia, Conduction ; Anesthetics ; Cyanosis ; Dantrolene ; Emergencies ; Female ; Fever ; Humans ; Malignant Hyperthermia* ; Muscle Rigidity ; Muscle, Skeletal ; Salpingectomy ; Sodium ; Swine ; Tachycardia

Pneumothorax was recognized as a potential hazard of mechanical ventilation shortly after the introduction of the technique of tracheal intubation in the 19th century. Because the gases used in anesthesia are delivered from cylinders and wall outlets at higher than atmoshperic pressure, the possibility of damage to the lung is ever present. Immediate, prompt and adequate management of bilateral tension Pneumothorax are essentil, otherwise the patient dies rapidly. We had a case of bilateral tension Pneumothorax in a 3 year-old boy who underwent a B-E amputation of a severely crushed hand. We report this case along with a review of the literature on Pneumothorax.
Amputation ; Anesthesia ; Anesthesia, General* ; Child, Preschool ; Gases ; Hand ; Humans ; Intubation ; Lung ; Male ; Pneumothorax* ; Respiration, Artificial

PURPOSE: Billroth I and II reconstructions are commonly performed after a distal subtotal gastrectomy. However, both may cause duodenogastric and duodenogastroesophageal reflux, which are conditions reported to have carcinogenic potential. This study investigated which reconstructive procedure would be most effective in prevent bile reflux into the gastric remnant after a distal gastrectomy. METHODS: A group of 43 patients who underwent a curative distal gastrectomy for gastric cancer were assigned to three groups prospectively according to the reconstructive procedure undertaken: 14, Billroth I (B-I); 14, Billroth II with Braun anastomosis (B-II with Braun); and 15 Billroth II (B-II). The bile reflux period (percent time) for the gastric remnant was measured using a Bilitec 2000 under standardized conditions. The endoscopic findings for reflux gastritis were classified into four grades. RESULTS: The mean standard error time of bile reflux in B-I, B-II with Braun and the B-II groups was 30.9+/-3.9%, 32.8+/-5.1% , and 60.9+/-7.0%, respectively. The B-II group showed significantly higher levels of the % time of bile reflux than the B-I or B-II with Braun groups (P<0.001). Regarding the endoscopic classification for reflux gastritis, the remnant stomach after B-II showed significantly more severe and extensive gastritis than that after the B-I and B-II with Braun procedures (P=0.003). There was also a positive correlation between the degree of % time of bile reflux and the extent of gastritis in the gastric remnant (P<0.001). CONCLUSION: After a distal subtotal gastrectomy, a B-II reconstruction is associated with a high reflux of duodenal content, whereas a Braun enteroenterostomy after a B-II reconstruction minimized the reflux at the levels of a B-I reconstruction.
Bile Reflux ; Classification ; Duodenogastric Reflux* ; Gastrectomy* ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Humans ; Prospective Studies ; Stomach Neoplasms

Interstitial lung disease (ILD) is often observed in connective tissue diseases (CTDs), frequently in rheumatoid arthritis, systemic sclerosis, primary Sjögren’s syndrome, and inflammatory myositis. Early detection of ILDs secondary to rheumatic diseases is important as timely initiation of proper management affects the prognosis. Among many imaging modalities, high-resuloution computed tomography (HRCT) serves the gold standard for finding early lung inflammatory and fibrotic changes as well as monitoring afterwards because of its superior spatial resolution. Additionally, lung ultrasound (LUS) and magnetic resonance imaging (MRI) are the rising free-radiation imaging tools that can get images of lungs of CTD-ILD. In this review article, we present the subtypes of ILD images found in each CTD acquired by HRCT as well as some images taken by LUS and MRI with comparative HRCT scans. It is expected that this discussion would be helpful in discussing recent advances in imaging modalities for CTDILD and raising critical points for diagnosis and tracing of the images from the perspective of rheumatologists.

PURPOSE: The purpose of this study was to investigate current statistics relating to foreigners who visit a Korean emergency department (ED). METHODS: Subjects included in this study were 125,263 patients who visited one Korean ED from January 1, 2008 to December 31, 2010. We divided subjects into two groups, natives (Koreans) and foreigners (non-Koreans). We compared the two groups according to their age, sex, chief medical complaints, department to which they were referred, their final diagnosis, results of treatment applied, ED residence time, mortality rate, total billed cost of treatment, balance of any unpaid bills and method of visiting the ED. RESULTS: Of the total patients included in the study, 119,864 (95.7%) were natives and 5,399 (4.3%) were foreigners. In natives, the majority were 0 to 10 years old (35.1%), while foreigners were mostly 41 to 50 (22.8%) years old. The most common symptom in both natives and foreigners was fever. The most common diagnosis for foreigners was head, face, and neck injury (13.8%). The main referred departments for foreigners were internal medicine (20.1%), pediatric medicine (16.9%), and orthopedics (14.3%). The admission rate for foreigners (13.0%), was lower than that of natives (17.3%). The mortality rate for foreigners (0.5%) was higher than that of natives (0.3%). The ED residence time for foreigners was higher than that of natives. The total billed cost of treatment and balance of unpaid money by foreigners was higher than that of natives. For foreigners, the proportion of medical fees paid from personal accounts and industrial medical insurance were higher than those of natives. CONCLUSION: Medical insurance and policy for the management of foreigners who visit the ED must be improved.
Emergencies ; Emergency Medical Services ; Emigrants and Immigrants ; Fees and Charges ; Fees, Medical ; Fever ; Head ; Humans ; Insurance ; Internal Medicine ; Korea ; Neck Injuries ; Orthopedics ; Population Groups

BACKGROUND: Increased isolation of extended-spectrum beta-lactamase (ESBL)-producing Entero bacteriaceae resistant to third generation cephalosporins and aztreonam has been noted recently. This study was to determine the prevalence of resistance to these drugs and ESBL in Enterobacteriaceae and to evaluate the methods for de tection. METHODS: During the period of October, 1997 and March, 1998, a total of 731 clinical isolates of Enterobacteriaceae were collected from patients of the Kosin Medical Center, Pusan, Korea. Antimicrobial susceptibility test by disk diffusion method and double disk synergy test were performed. MICs of beta-lactams were determined by agar dilution method. And ESBL genotypes were determined by polymerase chain reaction. RESULTS: About 10% of Escherichia coli isolates and 20% of Klebsiella pneumoniae isolates were intermediate or resistant to the third generation cephalosporins or aztreonam. Sensitivities of cefotaxime, ceftazidime, ceftriaxone and cefpodoxime disks for the detection of ESBL- producing strains of E. coli and K. pneumoniae by NCCLS standards were 100%, respectively, but that of aztreonam disk was 97%. Positive predictive value of the ceftazidime disk was higher than those of other disks. Twenty strains of E. coli, 20 K pneumoniae, 19 Enterobacter spp., six Citrobacter freundii, and eight Serratia marcescens showed positive results in double disk synergy test. The transconjugant strain of K. pneumoniae K20482 had blaSHV, and remains of transconjugants of ESBL-producing K. pneumoniae, Enterobacter spp. and S. marcescens had blaTEM. CONCLUSIONS: In this study, many strains of Enterobacteriaceae isolated in Korea were resistant to third generation cephalosporins and aztreonam. Some of the strains of Enterobacter spp. and S. marcescens as well as E. coli and K. pneumoniae produced ESBL, and majority of these strains had blaTEM. In the detection of ESBL-producing strains of E. coli and K. pneumoniae by NCCLS standards, all of the antimicrobial agent disks tested were useful, but ceftazidime disk was most effective because of its highest positive predictive value.
Agar ; Aztreonam ; beta-Lactamases ; beta-Lactams ; Busan ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins ; Citrobacter freundii ; Diffusion ; Enterobacter ; Enterobacteriaceae* ; Escherichia coli ; Genotype ; Humans ; Klebsiella pneumoniae ; Korea ; Pneumonia ; Polymerase Chain Reaction ; Prevalence* ; Serratia marcescens