Peterson's hernia is an internal hernia that can occur after Roux-en-Y anastomosis. It often accompanies small bowel volvulus and is prone to strangulation. Reconstruction of intestinal continuity after massive small bowel resection in a patient who undergoes near total gastrectomy and Roux-en-Y anastomosis can be difficult. A 74-year-old man who had undergone a near total gastrectomy and Roux-en-Y gastrojejunostomy for stomach cancer presented with abdominal pain. The preoperative computed tomography showed strangulated small bowel volvulus. During the emergent laparotomy, we found a strangulated Peterson's hernia with small bowel volvulus. After resection of the necrotized intestine, we made a new Roux-en-Y anastomosis connecting the remnant stomach and the jejunum with a transverse colon segment. We were safely able to connect the remnant stomach and the jejunum by making a new Roux-en-Y anastomosis utilizing a transverse colon segment as a new Roux-limb by two stage operation.
Abdominal Pain ; Aged ; Anastomosis, Roux-en-Y ; Colon, Transverse* ; Extremities* ; Gastrectomy ; Gastric Bypass ; Gastric Stump ; Hernia* ; Humans ; Intestinal Volvulus* ; Intestines ; Jejunum ; Laparotomy ; Stomach Neoplasms

Background & Objective: EGB 761 is a standardized natural extract used to treat impaired cerebral perfusion and nutrition (cerebrovascular insufficiency) in Korea. Although several animal studies have been conducted, few studies have investigated the clinical effects of EGB 761 in acute stroke. This study assessed the clinical benefit of intravenous EGB 761 in patients with acute ischemic stroke. Methods: This retrospective study examined a prospectively collected stroke database. We evaluated 232 patients with acute ischemic stroke within 48 hours of symptom onset. All patients were treated with antiplatelet or anticoagulation agents. We compared baseline characteristics between the EGB 761-treated and non-treated groups. The functional outcome measure was the modified Rankin Scale (mRS) score 90 days after stroke onset. Results: Of the 232 patients, 170 received EGB 761 during the first 3 days after arrival in the emergency department. We found no significant differences in baseline characteristics between the groups, with the exception of atrial fibrillation (p=0.032). After adjusting for baseline factors, intravenous administration of EGB 761 was associated with an improved 90-day functional outcome (mRS ≤2) compared with the control group (odds ratio, 2.56; p<0.05). Conclusions: Our results showed a clinical benefit of intravenous EGB 761 in patients with acute ischemic stroke
Stroke

PURPOSE: This study was conducted to examine the effects of simulation-based education regarding care in a cardio-pulmonary emergency care as related to knowledge, clinical performance ability, and problem solving process in new nurses. METHODS: An equivalent control group pre-post test experimental design was used. Fifty new nurses were recruited, 26 nurses for the experimental group and 24 nurses for the control group. The simulation-based cardio-pulmonary emergency care education included lecture, skill training, team-based practice, and debriefing, and it was implemented with the experimental group for a week in May, 2009. Data were analyzed using frequency, ratio, chi-square, Fisher's exact probability and t-test with the SPSS program. RESULTS: The experimental group who had the simulation-based education showed significantly higher know-ledge (t=5.76, p<.001) and clinical performance ability (t=5.86, p<.001) for cardio-pulmonary emergency care compared with the control group who had traditional education but problem solving process was not included (t=1.11, p=.138). CONCLUSION: The results indicate that a simulation-based education is an effective teaching method to improve knowledge and clinical performance ability in new nurses learning cardio-pulmonary emergency care. Further study is needed to identify the effect of a simulation-based team discussion on cognitive outcome of clinical nurses such as problem solving skills.
Adult ; Cardiopulmonary Resuscitation/*nursing ; *Clinical Competence ; *Competency-Based Education ; Educational Measurement ; Emergency Medical Services ; Female ; Humans ; Male ; *Problem Solving ; Program Evaluation ; Questionnaires ; Young Adult

BACKGROUND: The purpose of this study was to evaluate the usefulness and safety of the anterosuperior deltoid splitting approach for fixation of displaced proximal humeral fractures by analyzing the surgical outcomes. METHODS: Twenty-three patients who could be followed-up for at least 8 months after the treatment of displaced proximal humeral fractures through the anterosuperior deltoid splitting approach were enrolled. We evaluated the reduction of the fractures and surgery-related complications at the last follow-up using X-ray results and clinical outcomes comprising the University of California at Los Angeles (UCLA) scoring system and the Korean Shoulder Society (KSS) score. RESULTS: At the last follow-up of patients treated using the anterosuperior deltoid splitting approach for internal fixation of proximal humeral fractures, we found 22 cases (95.6%) of bone union, a mean UCLA score of 28.3 (range, 15 to 34) and a mean KSS score of 82.1 (range, 67 to 95). Various surgery-related complications were noted; a case of varus malunion after fracture displacement, a case of nonunion, a case of delayed union, two cases of impingement, and a case of partial axillary nerve injury, which recovered completely through the follow-up. CONCLUSIONS: Plate fixation using the anterosuperior deltoid splitting approach could be another reliable option for treating displaced proximal humeral fractures.
California ; Follow-Up Studies ; Humans ; Humerus ; Shoulder ; Shoulder Fractures*

To measure the mutagenic activity of micro-organic pollutants in drinking water, mutagenic test was conducted using Salmnella typhimurium TA 98 strain on the water sample taken from three water supply station and six tap water in Seoul in July and November 1987. The results were as follows : 1. The average amounts of organic matters in raw, treated, and tap water sampled in July were 0.38mg/l, 0.28mg/l, and 0.45mg/l, respectively, and sampled in November were 0.34mg/l, 0.24mg/l, and 0.22mg/l, respectively. The amount of organic matters of tap water sampled in November did not increase while that of tap water sampled in July increased compare to those of raw or treated water. 2. The amount of organic matters is the highest in neutral fraction compare to acidic and basic fractions. 3. In the five out of six tap water and raw water of Paldang and Kuui station sampled in July, the mutagenic ratios were greater than two (both direct and indirect mutagenicity). 4. In the three out six tap water and raw and treated water of Kuui station sampled in November, the mutagenic ratios were greater than two. 5. While mutagenic were low in acidic and basic fraction, they were high in neutral fraction. The samples which had high mutagenic activity in the total amount also showed high mutagenic activity in neutral fraction. 6. While mutagenic activity was decreased after the treatment of water, it was increased in tap water as the distance from the water supply station increases.
Drinking Water* ; Drinking* ; Seoul* ; Water ; Water Supply

BACKGROUND: Intraoperative collection of bile and a bile culture are of use in predicting bacterial infection in the biliary system. The aim of this study was to identify chronological changes in the bacteriology of the bile in the age and sex distributions for biliary tract disease of the patients. METHODS: We retrospectively reviewed the clinical records of 722 patients who had been operated on for biliary tract disease at the Department of Surgery Ewha Womans University Hospital, from Jan. 1979 to July 1998 and on whom intraoperative bile culture had been performed. We divided the 722 patients into two group based on the time of their treatment, period A being 1979-1988 and period B being 1989-1998. The statistical analysis was done by using the Mantel-Haenszel Chi-Square test. RESULTS: The overall bile culture positive rate was 56% (404 cases), and the male-to-female ratio was 1:1.64. There was no significant statistical difference in the sex ratio between the two periods (period A: 1:1.78, period B: 1:1.55) (p>0.05). Overall, the most commonly isolated organism in the bile was Escherichia coli (137 cases, 30%). Comparing the two periods, we found that the Enterococcus species was an organism found increasingly in biliary tract infections (period A: 0%; period B: 17%) whereas infection by Escherichia coli was significantly decreased in the latter period (period A: 43%; period B: 28%) (p<0.05). The sixth decade (29.1%) was the most prevalent age overall. The age distribution for period A showed no statistical difference between the 5th (21.58%) and the 7th decades (21.94%), but there was significant difference between the 7th (29.95%) and the 5th decades (16.89%) in the age distribution for period B (p<0.05). CONCLUSIONS: According to the above results, we concluded that there were significant chronological changes in the bacteriology of the bile & in the age distributions between the two periods, but no such difference was observed between the sex distribution.
Age Distribution ; Bacterial Infections ; Bacteriology* ; Bile* ; Biliary Tract ; Biliary Tract Diseases ; Enterococcus ; Escherichia coli ; Female ; Humans ; Retrospective Studies ; Sex Distribution ; Sex Ratio

Carotid artery angioplasty and stenting (CAS) has become increasingly accepted as an alternative therapy to carotid endarterectomy for treatment of carotid artery stenosis. Central retinal artery occlusion (CRAO) is one of the diseases presented due to carotid artery stenosis. But CRAO without cerebral ischemia after CAS is uncommon. An 80-year-old man was admitted to the hospital with the right centrum ovale ischemic stroke and right proximal carotid artery stenosis. We performed CAS with a distal protection device after pre-ballooning 3 times, without post-ballooning. Then, 12 hours after the CAS, the patient complained of blindness in the right eye and was diagnosed with CRAO. However, Diffusion weighted magnetic resonance imaging (DW-MRI) showed no significant findings in the brain. CRAO after CAS without intracranial infarction is a rare complication.
Aged ; Aged, 80 and over ; Angioplasty ; Arteries ; Blindness ; Brain ; Brain Ischemia ; Carotid Arteries ; Carotid Stenosis ; Diffusion ; Endarterectomy, Carotid ; Eye ; Humans ; Infarction ; Magnetic Resonance Imaging ; Retinal Artery ; Retinal Artery Occlusion ; Stents ; Stroke

We report an unusual case of a sigmoid colon perforation after ventriculoperitoneal shunt surgery. Distal catheters are known to cause perforation in the setting of colonoscopy. The exact pathogenesis of this complication is not clear, but it can cause serious complications. Hence, patients require prompt and aggressive management, including laparotomy with bowel wall repair, catheter removal, and antibiotic therapy.
Catheters ; Colon, Sigmoid ; Colonoscopy ; Humans ; Hydrocephalus ; Intestinal Perforation ; Laparotomy ; Ventriculoperitoneal Shunt

The cerebral arteriovenous malformation (AVM) recognized as a congenital lesion traditionally. AVM is an abnormal connection between cerebral artery and vein without capillary and neural structure. Nidus of AVM was located between arteriovenous direct connections. This case report presents newly developed de novo AVM after curative treatment of the initial AVM lesion. The 8-year-old boy was admitted with a small intracranial hemorrhage on medulla oblongata and intraventricular hemorrhage. Nidus of AVM was found on medulla oblongata by trans-femoral cerebral angiography (TFCA). Nidus’s embolization using Oynx (Medtronic, Minneapolis, MN, USA) was performed and complete occlusion was maintained for 4 years. Newly developed AVM was found on a 4-year follow-up TFCA. The de novo AVM is located opposite hemisphere from the initial AVM. New AVM was treated by radiosurgery, and the treatment result is being observed. The de novo AVM is a very rare condition. However, AVM may have a chance to develop in a new location and physicians may have attention to de novo AVM.

Acute subdural hematoma (ASDH) has been a major part of traumatic brain injury.Intracranial hypertension may be followed by ASDH and brain edema. Regardless of the complicated pathophysiology of ASDH, the extent of primary brain injury underlying the ASDH is the most important factor affecting outcome. Ongoing intracranial pressure (ICP) increasing lead to cerebral perfusion pressure (CPP) decrease and cerebral blood flow (CBF) decreasing occurred by CPP decrease. In additionally, disruption of cerebral autoregulation, vasospasm, decreasing of metabolic demand may lead to CBF decreasing. Various protocols for ICP lowering were introduced in neuro-trauma field. Usage of anti-epileptic drugs (AEDs) for ASDH patients have controversy. AEDs may reduce the risk of early seizure (<7 days), but, does not for late-onset epilepsy. Usage of anticoagulants/antiplatelets is increasing due to life-long medical disease conditions in aging populations. It makes a difficulty to decide the proper management. Tranexamic acid may use to reducing bleeding and reduce ASDH related death rate. Decompressive craniectomy for ASDH can reduce patient's death rate.However, it may be accompanied with surgical risks due to big operation and additional cranioplasty afterwards. If the craniotomy is a sufficient management for the ASDH, endoscopic surgery will be good alternative to a conventional larger craniotomy to evacuate the hematoma. The management plan for the ASDH should be individualized based on age, neurologic status, radiologic findings, and the patient's conditions.