The anorectal anomaly is not rarely seen in the neonatal period. But, If it is not accompanied with a fairly large fistula, it presents an urgent problem, so should be managed with perianal anoplasty or colostomy. Neonatal peritonitis is very grave and is caused by various conditions listed in Table 1. In Korea, no case of neonatal peritonitis caused by anorectal has yet been reported in the literature. With brief review of the literature, we present a case of neonatal peritonitis which appeared 36 hours after birth by perforation of the colon due to anorectal stenosis.
Colon ; Colostomy ; Constriction, Pathologic* ; Fistula ; Korea ; Parturition ; Peritonitis*

Background: The importance of establishing a regional stroke safety net for the treatment of acute stroke is increasingly emphasized. In this study, we analyzed effectiveness of transferring the suspected acute ischemic stroke (AIS) patients through the 1899-0215 hotline system from 119 ambulances and nearby hospitals. Methods: From July 2015 to July 2022, we analyzed data from 632 suspected acute stroke patients through the hotline. Furthermore, we investigated the proportion of patients in the target population who were eligible for reperfusion therapy and compared cases transferred by 119 emergency services (EMS) with those transferred from nearby hospitals. Results: Six hundred thirty-two suspected acute stroke patients were transferred to our stroke center through the 1899-0215 hotline system. The accuracy of diagnosing acute stroke among transferred patients is 81.0% for 119 EMS and 80.5% for cases transferred from nearby hospitals. Of the 200 patients transferred from hospitals, they were transferred from 47 nearby hospitals with an average transfer distance of 38.2 km and an average transfer time of 65 minutes. Among 291 patients diagnosed with AIS, The onset-to-door time was significantly shorter (p<0.01) for patients transferred by 119 EMS. The proportion of patients who received reperfusion therapy was significantly higher (p<0.01) for those transferred by 119 EMS. Conclusions The hotline service will become a useful tool for establishing a regional stroke network in the Busan area, and its effectiveness will be particularly useful for 119 EMS. Measures are needed in the Busan metropolitan region to ensure the speediness of transferring acute stroke patients between hospitals.

We present a case of 44-year-old male with spontaneous right vertebral arteriovenous fistula associated with neurofibromatosis type 1. The symptom of this patient was myeloradiculopathy of which was due to compressed cervical spinal cord by enlarged epidural vein. Complete occlusion of the fistula using coils resulted in relief of the patient symptom and complete disappearance of enlarged epidural vein on follow-up MR image one month later.
Adult ; Arteriovenous Fistula* ; Embolization, Therapeutic* ; Fistula ; Follow-Up Studies ; Humans ; Male ; Neurofibromatoses* ; Neurofibromatosis 1* ; Spinal Cord ; Veins

The Bcl-2 interacting death suppressor (Bis) protein is known to be involved in a variety of pathophysiological conditions. We recently generated bis-deficient mice, which exhibited early lethality with typical nutritional deprivation status. To further investigate the molecular basis for the malnutrition phenotype of bis deficient mice, we explored Bis expression in the digestive system of normal mice. Western blot analysis and quantitative real time reverse transcription polymerase chain reaction analysis indicated that Bis expression is highest in the esophagus, followed by the stomach, colon, jejunum and ileum. Immunohistochemical data indicated that Bis expression is restricted to the stratified squamous epitheliums in the esophagus and forestomach, and was not notable in the columnar epitheliums in the stomach, small intestine and colon. In addition, strong Bis immunoreactivity was detected in the striated muscles surrounding the esophagus and smooth muscles at a lesser intensity throughout the gastrointestinal (GI) tract. Ganglionated plexuses, located in submucous layers, as well as intermuscular layers, were specifically immunoreactive for Bis. Immunofluorescence studies revealed that Bis is co-localized in glial fibrillary acidic protein-expressing enteric glial cells. Immunostaining with neuron specific esterase antibodies indicate that Bis is also present in the cell bodies of ganglions in the enteric nervous system (ENS). Our findings indicate that Bis plays a role in regulating GI functions, such as motility and absorption, through modulating signal transmission between the ENS and smooth muscles or the intestinal epitheliums.
Absorption ; Animals ; Antibodies ; Blotting, Western ; Colon ; Digestive System ; Enteric Nervous System ; Epithelium ; Esophagus ; Fluorescent Antibody Technique ; Ganglion Cysts ; Ileum ; Immunohistochemistry ; Intestinal Mucosa ; Intestine, Small ; Jejunum ; Malnutrition ; Mice ; Muscle, Smooth ; Muscle, Striated ; Neuroglia ; Neurons ; Phenotype ; Polymerase Chain Reaction ; Reverse Transcription ; Stomach

Cockcroft and Gault's formula is frequently used to estimate creatinine (Ccr) in clinical practice. To determine the accuracy of such estimation in Korean patients, we measured simultaneously, serum creatinine and 24-hour urinary creatinine excretion in 696 Korean patients (male:350, female:346). Measured Ccr was significantly different from estimated Ccr in several age groups and the decrease of creatinine excretion with age is less than Cockcroft and Gault's estimation. We assumed that this difference can be due to difference of the body habitus and difference of urinary creatinine excretion per body weight between different races. So we divided the sample population into two groups and derived the new formula in one group with regression analysis between age and 24 hour urinary creatinine excretion per body weight for estimation of Ccr as Cockcroft and Gault derived their formula and applied it to another group to compare the new formula with Cockcroft and Gault's formula in Korean patients. The new formula was Ccr (mL/min)=[ (260-age)x weight (kg)]/[160 x serumCr (mg/dL)] for male and Ccr (mL/min)-[ (236-age) x weight (kg)]/[180 x serum Cr (mg/dL)] for female. Predictive accuracy of the new formula was significantly better than the Cockcroft and Gault's formula in the other sample population and also in subgroup of the patients with azotemia.
Azotemia ; Body Weight ; Continental Population Groups ; Creatinine* ; Female ; Glomerular Filtration Rate ; Humans ; Male

A 6-year-old boy was scheduled for thoracic magnetic resonance imaging under deep sedation with midazolam 1.8 mg and propofol 100 µg/kg/min via intravenous injection. He showed emergence delirium in the post-anesthesia care unit. The staff attempted to calm him by administering flumazenil as an antidote for midazolam, propofol for further sedation, and meperidine. However, this was not successful. A psychiatrist recommended the use of antipsychotics. Administration of risperidone led to immediate resolution of the boy's symptoms and relaxed him. The use of antipsychotic drugs is not common for anesthesiologists, but should be considered for treating uncontrolled emergence delirium after anesthesia.
Anesthesia ; Antipsychotic Agents ; Child* ; Deep Sedation ; Delirium* ; Emergencies* ; Flumazenil ; Humans ; Injections, Intravenous ; Magnetic Resonance Imaging ; Male ; Meperidine ; Midazolam ; Propofol ; Psychiatry ; Risperidone*

PURPOSE: The association between liver enzymes and death from external causes has not been examined. We investigated the association between serum aminotransferase levels and external-cause mortality in a large prospective cohort study. MATERIALS AND METHODS: A total of 142322 subjects of 35-59 years of age who completed baseline examinations in 1990 and 1992 were enrolled. Mortalities were identified using death certificates. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were categorized into quintiles. Sub-distribution hazards ratios and 95% confidence intervals (CIs) were estimated using a competing risks regression model in which deaths from other causes were treated as competing risks. RESULTS: Of 8808 deaths, 1111 (12.6%) were due to external causes. Injury accounted for 256 deaths, and suicide accounted for 255. After adjusting for covariates, elevated ALT and AST were significantly associated with an increased risk of all external-cause mortalities, as well as suicide and injury. Sub-distribution hazards ratios (95% CIs) of the highest versus the lowest quintiles of serum ALT and AST were, respectively, 1.57 (1.26-1.95) and 1.45 (1.20-1.76) for all external causes, 2.73 (1.68-4.46) and 1.75 (1.15-2.66) for suicide, and 1.79 (1.10-2.90) and 1.85 (1.21-2.82) for injury. The risk of external-cause mortality was also significantly higher in the fourth quintile of ALT (21.6-27.5 IU/L) than in its first quintile. CONCLUSION: Elevated aminotransferase levels, even within the normal range, were significantly associated with increased risk of all external-cause mortalities, including suicide, and injury.
Adult ; Alanine Transaminase/*blood/metabolism ; Aspartate Aminotransferases/*blood/metabolism ; Female ; Humans ; Male ; Middle Aged ; *Mortality ; *Population Surveillance ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea/epidemiology ; Risk

We reviewed one case of AHA in 14 year old female child which followed a chronic course. The patient showed hypergammaglobulinemia with elevated IgM, positive direct coomb's test and positive cold aggutinin test. The patient improved with steroid therapy, and over the past six months has showen a fair course. We have presented a review of the literature briefly and given our report.
Adolescent ; Anemia, Hemolytic, Autoimmune* ; Child ; Coombs Test ; Female ; Humans ; Hypergammaglobulinemia ; Immunoglobulin M

Acute encephalopathies can be defined as an acute central nervous system (CNS) insult, due to an underlying pathology. The clinical symptoms almost always include an acute state of confusion and cognitive impairment. Toxic encephalopathies can occur acutely or chronically depending on the toxic drugs and other substances as well as the individual metabolism of the drug. The organs acutely affected include the heart, lung and kidneys. However, the brain, spinal cord and sympathetic nerves can be affected chronically. If the toxic substance passes through the bloodbrain barrier into the hypothalamus and the posterior pituitary gland, the result can be diabetes insipidus. If the substance affects the anterior pituitary gland, the result can include hormone dysfunction, impaired immune function and altered cognition or personality. We report a patient that developed acute toxic encephalopathy after the prescribed dose of oxycodone was exceeded.
Brain ; Central Nervous System ; Cognition ; Diabetes Insipidus ; Heart ; Humans ; Hypothalamus ; Kidney ; Lung ; Neurotoxicity Syndromes ; Oxycodone ; Pituitary Gland, Anterior ; Pituitary Gland, Posterior ; Spinal Cord

Abdominal cocoon is a rare disease of the peritoneum and almost invariably presents as an acute or subacute intestinal obstruction with or without a mass. The etiology of this disease is largely unknown and abdominal cocoon of unknown etiology has been limited to the tropical and subtropical zones and primarily affects young adolescent females. In the temperate zone, only one case has been reported from the United Kingdom, but the patient was also born in Pakistan. No case of abdominal cocoon purely developed in the temperate zone has been reported. Recently, we experienced a case of abdominal cocoon in a 34-year-old female patient(Korean) who had never been abroad. The diagnosis was made postoperatively by reviewing the literature. We herein report this rare condition developed in an unusual geographical location with a brief review of the literature.
Adolescent ; Adult ; Case Report ; Female ; Human ; Intestinal Obstruction/*etiology ; Male ; Peritoneal Diseases/complications/*etiology