A number of drug administered during anesthesia can provoke pathologic response by immunologic or nonimmunologic mechanisms. Known drugs involved in hypersensitivity reactions are muscle relaxants, local anesthetics, narcotics, barbiturates, contrast media, protamine and antibiotics. Clinical manifestations of anaphylaxis are diverse, but during anesthesia, cardiovascular collapse is predominate. We experienced a case of anaphylactoid reaction with erythema on upper thoracic region, severe hypotension, tachycardia and ventricular fibrillation. After defibrillation, the patient was recovered. During follow-up, we knew that this patient was exposed aprotinin repeatedly, and suspect the possibility of anaphylactoid reaction due to aprotinin.
Anaphylaxis ; Anesthesia ; Anesthetics, Local ; Anti-Bacterial Agents ; Aprotinin ; Barbiturates ; Contrast Media ; Erythema ; Follow-Up Studies ; Heart Arrest* ; Humans ; Hypersensitivity ; Hypotension ; Narcotics ; Tachycardia ; Ventricular Fibrillation

Reexpansion pulmonary edema(RPE) is a complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion or atelectasis, and generally believed to occur ipsilaterally when a chronically collapsed lung is rapidly reexpanded by evacuation of large amount of air or fluid. Clinical manifestations of RPE are dyspnea, tachypnea, cyanosis, frothy blood-tinged sputum, wet rale, and expiratory wheezing. Hypotension and decrease in organ perfusion can occur. We experienced intraoperative tension pneumothorax probably due to positive pressure ventilation or pleural injury during central venous catheterization through internal jugular vein. And bilateral RPE combined with acute renal failure occurs after spontaneous decompression of tension pneumothorax with chest tube insertion, even with brief duration of lung collapse.
Acute Kidney Injury ; Catheterization, Central Venous ; Central Venous Catheters ; Chest Tubes ; Cyanosis ; Decompression* ; Dyspnea ; Edema ; Hypotension ; Jugular Veins ; Lung ; Perfusion ; Pleural Effusion ; Pneumothorax* ; Positive-Pressure Respiration ; Pulmonary Atelectasis ; Pulmonary Edema* ; Respiratory Sounds ; Sputum ; Tachypnea

OBJECTIVES: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS. METHODS: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age=41.50+/-13.16 yrs, AHI <5, n=20), Group 2 : mild OSAS (mean age=43.67+/-12.11 yrs, AHI 5-15, n=30), Group 3 : moderate OSAS (mean age 44.93+/-12.38 yrs, AHI 16-30, n=30), Group 4 : severe OSAS (mean age=45.87+/-12.44 yrs, AHI >30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test. RESULTS: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were 991.1+/-27.1 and 875.8+/-22.0 ms (p=0.016), standard deviation of NN interval (SDNN) was 85.4+/-6.6 and 112.8+/-5.4 ms (p=0.022), SDNN index was 57.5+/-5.2 and 87.6+/-4.2 (p<0.001), total power was 11,893.5+/-1,359.9 and 18,097.0+/-1,107.2 ms2 (p=0.008), very low frequency (VLF) was 7,534.8+/-1,120.1 and 11,883.8+/-912.0 ms2 (p=0.035), low frequency (LF) was 2,724.2+/-327.8 and 4,351.6+/-266.9 ms2 (p=0.003). CONCLUSIONS: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group.
Acceleration ; Anoxia ; Arousal ; Autonomic Nervous System ; Cardiovascular System ; Heart ; Heart Rate ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Sympathetic Nervous System

Purpose: This study was aimed to investigate the changes in pediatric injury-related visits at an emergency department (ED) during coronavirus disease 2019 pandemic. Methods: We retrospectively compared injury-related visits to an ED in Korea by children aged 15 years or younger during February 2020-December 2021 (pandemic period), and the visits during February 2018-December 2019. Clinical characteristics, injury mechanisms, diagnostic codes, and ED outcomes were noted. We performed 2 sub-analyses of the pandemic period: biannual changes in the visits, and monthly trends of proportions of concussion and superficial injury as diagnostic codes using linear regression. Results: Despite a 51.2% reduction in injury-related visits during the pandemic, the proportion of the visits increased (25.2% vs. 40.0%; P < 0.001). Overall, increases were noted in proportions of use of emergency medical services and high acuity (P < 0.001). Among the diagnostic codes, brain injuries, fracture and dislocation, and laceration increased while superficial injuries, burn, intoxication, and foreign body ingestion decreased (P < 0.001). As the pandemic prolonged, injury-to-ED time shortened and ED length of stay lengthened while the abovementioned trends remained unchanged. Linear regression showed that the proportions of concussion and superficial injury respectively increased and decreased by 0.01% per month (P < 0.001). Conclusion The changes in pediatric injury-related visits at the ED during the coronavirus disease 2019 pandemic may serve as a basis for distributing emergency medicine resources in future infectious disease outbreaks.

PURPOSE: We investigated the incidence and risk factors of contralateral inguinal hernia or hydrocele in men dwelling in community with initially unilateral disease. MATERIALS AND METHODS: A total of 2,700 men aged 20 years dwelling in the community were randomly selected at a 10.0% sampling fraction after a sampling process by census district and 2,080 of these men agreed to participate in the study. All volunteers underwent a standard evaluation, including a detailed medical history and physical examination. They completed a self-administered questionnaire providing detailed information on any previous history. To evaluate risk factors for contralateral occurrence of inguinal hernia or hydrocele, we compared 3 possible variables (initial side, type and history of repair) between total patients with and those without contralateral inguinal hernia or hydrocele. For patients who underwent repair, 4 variables were compared (initial side, type, ipsilateral recurrence and age at repair) between the 2 groups. RESULTS: Of the participants, 48 men (2.3%) were observed to either have inguinal hernia or hydrocele on physical examination (n=14) or had a history of inguinal hernia or hydrocele repair (n=34). Six (12.5%) patients experienced contralateral inguinal hernia or hydrocele. Contralateral diseases occurred in 2 of 28 (7.1%) patients with initial right inguinal hernia or hydrocele, and 4 of 20 (20.0%) patients with initial left inguinal hernia or hydrocele. There were no significant differences between the 2 groups in any of the variables. CONCLUSIONS: We did not identify subgroups at sufficiently increased risk to warrant contralateral exploration. Our findings suggest that routine contralateral exploration cannot be justified in these patients since the incidence of contralateral clinical inguinal hernia or hydrocele is low.
Censuses ; Epidemiologic Studies* ; Hernia, Inguinal* ; Humans ; Incidence ; Male ; Physical Examination ; Surveys and Questionnaires ; Recurrence ; Risk Factors ; Testis ; Volunteers

A 3-month-old female presented with anuria and abdominal distention for 1 day. The patient was twin and was delivered at 30 week-term with low birth weight. Emergent ultrasonography revealed both hydronephrosis and hyperechogenic mass within the both renal pelves. Urinoma around left kidney was also found. Computed tomography showed high density material filled dilated pelvises. Urinoma measured 3x4cm in the left prerenal space and urinary ascites in the right abdomen were found. Candida albicans was cultured from catheter drained urine. We started the care with percutaneous nephrostomy with amphotericin B irrigation, coupled with systemic antifungal therapy. And this management had a major role in the successful outcome.
Abdomen ; Amphotericin B ; Anuria* ; Ascites* ; Bezoars* ; Candida albicans ; Catheters ; Female ; Humans ; Hydronephrosis ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature* ; Kidney ; Nephrostomy, Percutaneous ; Pelvis ; Twins ; Ultrasonography ; Urinoma

OBJECTIVE: To determine which factors affect the rehabilitation duration in patients with congenital muscular torticollis (CMT) and to predict the duration of rehabilitation and prognosis. METHODS: One hundred and eighteen patients (79 males and 39 females) who were diagnosed with CMT and received physical therapy were enrolled in this study. We retrospectively reviewed the information in terms of sex, gestational age, birth weight, methods of delivery, fetal presentation, age at diagnosis, the affected sternocleidomastoid (SCM) muscle site, SCM muscle thickness, ratio of muscle thickness on the affected side to that on the unaffected side (called the 'abnormal/normal [A/N] ratio'), and range of motion for cervical rotation and side bending. RESULTS: The SCM muscle thickness and A/N ratio had a positive linear relationship with the rehabilitation duration. Patients who were in the breech position needed longer rehabilitation. The birth weight and age at diagnosis were negatively correlated with the rehabilitation duration. However, the cervical range of motion, mass site, sex, gestational age, and methods of delivery were not correlated with the rehabilitation duration. CONCLUSION: Patients with a thicker SCM, lower birth weight, and history of breech delivery had a longer rehabilitation duration.
Birth Weight ; Diagnosis ; Female ; Gestational Age ; Humans ; Labor Presentation ; Male ; Pregnancy ; Prognosis ; Range of Motion, Articular ; Rehabilitation* ; Retrospective Studies ; Torticollis*

PURPOSE: We investigated the characteristics of the distribution of the serum prostate- specific antigen (PSA) and evaluated the factors influencing the serum PSA levels in healthy men under 50 years old. MATERIALS AND METHODS: A total of 5,701 healthy Korean men under 50 years old who visited the Health Promotion Center at our hospital for a routine health checkup were enrolled into a prospective study. All the men underwent a PSA determination using a Hybritech Tandem-R assay, anthropometric measurements, liver function tests, renal function tests, and other constituents. The risk factors associated with an increase in the serum PSA among these clinical parameters were investigated using univariate and multivariate logistic regression analyses. RESULTS: Almost no change was observed in the median and 95th percentiles serum PSA value in men under 50 years old. Univariate logistic regression analysis indicated that the hematocrit, sodium, potassium, osmolarity, albumin, and globulin levels were the risk factors associated with an increase in the serum PSA. In the multivariate model used, the hematocrit, potassium and albumin levels were found to be independent predictors of an increase in the serum PSA, whereas the sodium, and globulin levels, and the osmolarity had no statistical significance. CONCLUSIONS: Age does not appear to influence the serum PSA levels of healthy Korean men under 50 years old. The results also suggest that the chemical constituents in young adults may exert an influence on the serum PSA levels.
Health Promotion ; Hematocrit ; Humans ; Kidney ; Liver ; Liver Function Tests ; Logistic Models ; Male ; Middle Aged* ; Osmolar Concentration ; Potassium ; Prospective Studies ; Prostate-Specific Antigen* ; Risk Factors ; Sodium ; Young Adult

There are inconsistent findings on the effects of vitamin K on bone mineral density (BMD) and undercarboxylated osteocalcin (UcOC). The present intervention study evaluated the effect in subjects over 60-yr-old. The vitamin K group (vitamin K + vitamin D + calcium supplement; 15 mg of vitamin K2 [menatetrenone] three times daily, 400 IU of vitamin D once a day, and 315 mg of calcium twice daily) and the control group (vitamin D + calcium supplement) were randomly assigned. During the six months of treatment, seventy eight women participated (38 in the vitamin K group and 40 in the control group) and 45 women completed the study. The baseline characteristics of study participants did not differ between the vitamin K and the control groups. In a per protocol analysis after 6 months, L3 bone mineral density has increased statistically significantly in the vitamin K group compared to the control group (0.01 +/- 0.03 g/cm2 vs -0.008 +/- 0.04 g/cm2, P = 0.049). UcOC concentration was also significantly decreased in the vitamin K group (-1.6 +/- 1.6 ng/dL vs -0.4 +/- 1.1 ng/dL, P = 0.008). In conclusion, addition of vitamin K to vitamin D and calcium supplements in the postmenopausal Korean women increase the L3 BMD and reduce the UcOC concentration.
Aged ; Bone Density/*drug effects ; Calcium/*administration & dosage ; Dietary Supplements ; Female ; Humans ; Middle Aged ; Osteocalcin/*blood ; Postmenopause ; Republic of Korea ; Vitamin D/*administration & dosage ; Vitamin K/*administration & dosage

Granular cell tumors involving the esophagus are rare tumors. Since Abrikossoff first reported five cases of granular tumor of the tongue in 1926, fewer than 200 cases of esophageal granular cell tumors have been reported in the world. The granular cell tumors usually were seen in tongue, skin & breast. it has rarely been noted in the esophagus. The treatment of this tumor was not established well. Therefore, we report a case of granular cell tumor of the low esophagus, which was resected by polypectomy following 'O'-band ligation. This 56-year-old male patient was transferred to our hospital because of abnormal endoscopic finding on the esophagus at local clinic. There was esophageal polypoid lesion on the low esophagus. After polypectomy, the lesion was revealed as granular cell tumor in histopathologic examination.
Breast ; Endoscopes ; Esophagus ; Granular Cell Tumor* ; Humans ; Ligation* ; Male ; Middle Aged ; Skin ; Tongue