We present a case of acquired tracheoesophageal fistula (TEF) which was found during induction of general anesthesia for clipping of aneurysm. The patient had been intubated with endotracheal tube for 10 days and then done tracheotomy for 45 days. Thereafter, TEF was confirmed by MRI and treated with fistula repair and tracheal fenestration. Acquired TEF can occur under the condition of prolonged tracheal intubation with high cuff pressure (>30 mmHg) and can also result from intratracheal neoplasm, mediastinitis, and other tracheal or esophageal damages. If unrecognized during anesthetic induction, TEF can cause gastric dilatation and rupture, pulmonary aspiration and respiratory failure. So early diagnosis and proper management is very important whenever TEF is suspected during anesthetic induction.
Anesthesia, General ; Aneurysm ; Early Diagnosis ; Fistula ; Gastric Dilatation ; Humans ; Intubation ; Magnetic Resonance Imaging ; Mediastinitis ; Respiratory Insufficiency ; Rupture ; Tracheoesophageal Fistula* ; Tracheotomy

To assess the effectiveness of Magnetic Resonance Imaging (MRI) with endorectal surface coil in the ataging of carcinoma of the uterine cervix with emphasis on parametrial involvement. Thirty women with clinically and radiographically proven carcinoma of the uterine cervix were initially included for this study, but thirteen patients were excluded since the stages of tumors wore beyond stage IIa. CT and MR findings of the remaining seventeen patients were performed at Cheil General Hospital and compared a1ong with clinical findings with the special emphasis on the parametrial involvement by the tumor. Staging was assessed by CT and MRI, and the results were compared with the pathologic staging. Radiea1 abdominal hysterectomy with the pelvic and paraaortic lymphnode dissection was done to all sewenteen patients. The staging made primarily by CT and MRI was either stsge 1 or Ila, but MR images with endorectal surface coil was superior to CT in the visualization of depth of tumor infiltration, especially parametrial involvement. The determination of the depth of the tumor made by MR images showed statistically significant correlation with histologic evaluation(R =0.768, p<0.01). The accuracy rate for the evaluation of the parametrial invo1vement was 82.3% far CT and 94.1% for MRI with endorectal surface coil. The overall accuracy rate for tumor staging was 70.5% for clinical, 58.8% for CT and 82.3% for MR evaluation. The accurecy rate in evaluation of the pelvic and paraaortic lymphnode was 88.2% for CT, but the evaluation done by MRl was not adequate due to small FOV(field of view). In assessment of The steging of careinoma of the uterine cervlx, MR images with endorectal surface coil was superior to CT, especially in the evaluation of the parametrial involvement.
Cervix Uteri* ; Female ; Hospitals, General ; Humans ; Hysterectomy ; Magnetic Resonance Imaging* ; Neoplasm Staging

Lymphomatoid papulosis (LyP), first described by Macaulay in 1968, is a paradoxical skin disease characterized by a generally clinical benign course, in contrast to malignant histological features. LyP is rarely seen in children. We herein report a case of LyP in a 10-year-old boy who had a 4-week history of multiple, scattered erythematous papules, crusted papules or ulcerated papules on the trunk, arms and thighs. Histopathologically, there was a superficial and midderma1 perivascular and interstitia1 infiltrate composed primarily of lymphocytes, which were admixed with large, atypical, mononuclear cells with pleomorphic nucleus. These atypical cells expressed CD30 (Ki-1) antigen. This is the first reported case in Korea of LyP present in a child.
Arm ; Child* ; Humans ; Korea ; Lymphocytes ; Lymphomatoid Papulosis* ; Male* ; Skin Diseases ; Thigh ; Ulcer

No abstract available.

No abstract available.

No abstract available.

BACKGROUND: It is known that left ventricular(LV) wall motion is not uniform even in normal heart, and the restoring forces make phase differences between LV wall motion and mitral flow velocity during rapid filling period. METHOD: To investigate the regional nonuniformity and restoring forces in 46 patients with hypertension(HT)(group:normal wall thickiness.n=12,II:LVH with fractional shortening(FS)>25%. n=22. III:FS<25%.n=12). We measured the time intervals from A2 to peak thinning rate point of LV posterior wall(A2-(-)dpw/dt).to mitral flow starting point (IRT).and to peak mitral flow velocity(A2-E) by M-mode and Doppler echocardiography. RESULTS: The noniformity((-)dpW/dt-dL/dt)and phase differance((-)dpw/dt-E) were increased in HT(control:HT.22+/-7.8 vs. 49+/-5.2msec, 63+/-4.5 vs, 86+/-6.2msec, p<0.05 respectively).In group comparison, nonuniformity increased in group II and III(group I: group II, III, 35+/-5.1 vs. 50+/-7.1,70+/-14msec, p<0.05 respectively). but phase difference increased only in group II(groupII: group I, III, 93+/-6.0 vs. 75+/-5.2, 80+/-20msec, p<0.05, respectively). CONCLUSION: We interpreted these data that in HT with hypertrophy or not, the nonuniformity of LV wall motion working on the restoring forces which can be expressed as phase difference between LV wall motion and mitral flow. But in HT with hypertensive heart failure group, no significant changes of phase difference and it's suggest that other mechanism could be also working on early diastolic filling.
Echocardiography* ; Echocardiography, Doppler ; Heart ; Heart Failure ; Humans ; Hypertension* ; Hypertrophy

BACKGROUND: A regional wall motion nonuniformity and a phase difference between LV posterior wall motion and transmitral flow are present during normal rapid filling period and are thought to be an evidence for involvement of ventricular restoring forces. To assess the role of nonuniformity on diastolic funtional impairment of asymmetric septal hypertrophy(ASH), the time relations between left ventricular regional wall motions and filling velocity were studied. METHOD: We measured the time intervals from A2 to peak rate of LV posterior wall(short axis) thinning(A2-(-)dpw/dt), peak rate of medial mitral annulus (long axis dimension) lengthening(A2-dL/dt) and peak mitral flow(A2-E) by M-mode and Doppler echocardiography. Result: In ASH patients, A2-(-)dpw/dt(106+/-6msec, mean SE) and the regional wall motion nonuniformity((-)dpw/dt-dL/dt, 89+/-11msec, mean SE) were increased significantly when compared with normal control values(88+/-4, 28+/-5msec, mean SE, p<0.01,respectively).In normal controls, peak mitral flow velocity lagged peak rate of regional wall motion, so the phase differences were present((-)dpw/dt-E :71+/-8msec, dL/dt-E:44+/-6msec). In ASH patients, (-)dpw/dt-E was present(90+/-16msec) but dL/dt-E was not present or reversed(-21+/-18 msec). So these chacteristic phase differences were disturbed. CONCLUSION: These data suggested that the relaxation nonuniformity of regional wall motion in ASH may act as an energy dissipating factor of restoring forces during rapid filling period.
Axis, Cervical Vertebra ; Cardiomyopathy, Hypertrophic* ; Echocardiography* ; Echocardiography, Doppler ; Humans ; Relaxation

The deformity of hallux valgus is associated with three hasic prohlems: a prominent rnedial eminence, contracted soft-tissue structures on the lateral side of the great toe, and an altered intermetatarsal angle between the first and second metatarsal. We retrospectively have reviewed the results for thirty-one patients(47 feet) in whom a hallux vaigus deformity had heen conected with the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and proximal crescentic osteotomy of the first metatarsal. The patients were followed for an average of twenty months(range, twelve to twenty-eight months). There were nine cases with mild defoimity, twenty-nine cases with moderate deformity, nine cases with severe deformity. The preoperative hallux valgus angle averaged 38.1 degrees, and the immediate postoperative angle averaged 6.7 degrees. The preoperative intermetatarsal angle averaged 17.1 degrees, and the immediate postoperative angle, 7.6 degrees. At the latest follow-up, the hallux valgus angle averaged 19.3 degrees, the intermetatarsal angle averaged 9.9 degrees. We found that the more the deformity, the lesser the congruency. 74.5% of the patients were satisfied with the result of the procedure. They stated that, eiven the same circumstances, they would have the operation again. The most common complication was recurrence of the nallux valgus, which occurred in nine feet(five patients). The other complications included pain under a fibular sesamoid in one foot, severe hypoesthesia on the medial aspect ot the big toe in one foot, and superficial wound infection in one foot.
Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hallux Valgus* ; Hallux* ; Humans ; Hypesthesia ; Metatarsal Bones* ; Osteotomy* ; Recurrence ; Retrospective Studies ; Toes ; Wound Infection

This study investigated the degree of knowledge achievement and self-confidence in aseptic technique as a part of the fundamental nursing practice classes. The subjects were 220 nursing students in a junior college in Chonnam and an applied Quasi -experimental research methodology was used thirty of them comprised an experimental group to examine learning according to the teaching method. Wata were collected over 80 days, from April to June 1988, analyzed using descriptive statistics, percentages, means, t-test, one way ANOVA Pearson's correlation coefficient and stepwise multiple regression with the SAS program. The conclusions are as follows. 1. The mean score of the degree of knowledge achievement of aseptic technique of the 220 students was 0.68(possible score 1.0) before the lecture but was 0.88 after lecture(p=.000). 2. The mean score for aseptic technique of the 220 students was 3.41(possible score 5.0) before practice but was 4.27 after practice(p=.000). 3. The correlation of self-confidence before and after practice was relatively low(r=.25, p=.000). 4. The mean score of the degree of knows edge achievement of aseptic technique in the experimental group(selected 30 students) was 0.72 before the lecture but was 0.90 after the lecture. 5. The mean score of self-confidence on aseptic technique in the experimental group(selected 30 students) was 3.18 before practice but was 4.32 after practice (p=.000). 6. The mean score of learning according to the type of teaching to aseptic technique for the experimental group(selected 30 students) was 23.2(possible score 34) after lecture and presentation, was 27.3 after learning through video tape, was 31.7 after presentation through practice, was 33.7 after first practical training, and was 34 after secondary practical training. As a result of this study, learning methods in the education of fundamental nursing skill effective for knowledge achievement and competence in practicing skill.
Education ; Humans ; Jeollanam-do ; Learning* ; Mental Competency ; Nursing* ; Research Design ; Students, Nursing* ; Teaching*