BACKGROUND: Pelviscopic techniques have rapidly increased in therapeutic procedures as well as diagnostic procedures because of the many benefits associated with much smaller incisions than traditional open techniques. But the deliberate pneumoperitoneum with carbon dioxide during pelviscopic surgery may cause some problems-hypercarbia, pneumomentum, subcutaneous or mediastinal emphysema, pneumothorax, hypoxemia, hypotension, cardiovascular collapse and cardiac dysrhythmia. METHOD: We observed the changes of blood pressure (systolic, mean, diastolic), pulse rate, PaCO2, PaO2, peak inspiratory airway pressure and expired tidal volume at 10 minute after induction of general anesthesia (control value), 30 minutes and 60 minutes after insufflation of CO2 and Trendelenburg position. RESULTS: The blood pressure, PaCO2 and peak inspiratory airway pressure were increased significantly than control values (p<0.05). The changes of pulse rate and expired tidal volume were not statistically significant in comparison to control values. The PaO2 was decreased significantly (p<0.05). CONCLUSION: To minimize the risk of CO2 retension and unstability of cardiovascular system during pelviscopy under the Trendelenburg position, we must monitor the vital signs and the arterial blood gas status continuously and carefully.
Anesthesia, General* ; Anoxia ; Arrhythmias, Cardiac ; Blood Pressure ; Carbon Dioxide ; Cardiovascular System ; Head-Down Tilt* ; Heart Rate ; Hypotension ; Insufflation* ; Mediastinal Emphysema ; Pneumoperitoneum ; Pneumothorax ; Tidal Volume ; Vital Signs

In Korea medical record administrators/technicians are coding diagnoses and procedures of discharged patients based on their medical records mostly using International Classification of Diseases, 9th revision(ICD-9) and International Classification of Procedures(ICPM) by WHO. This study examined consistency of coding in 63 hospitals in the year of 1992. The statistical data showed great inconsistency in coding patterns among many hospitals. The main reasons of inconsistency were coders errors, ill-defined diagnoses/procedures, no unified route to make new code numbers for the new or ambiguous diagnoses/procedures, inconsistency of selection of using optional(additional) codes, and inconsistency of reference records on coding. Near half of the hospitals do not recheck the accuracy of coding after completion of medical records by physicians. Most of the coders review operation record, admission and discharge record, discharge summary, progress notes, pathology report, and consultation record as references on coding, but 14 hospitals do not review the whole record when they code diagnoses and procedures. Twenty-three hospitals discuss with physicians when they have questions in assigning code numbers. Further study should be done continuously for valid and reliable statistics of diseases and operations and for establishing a systematic unified channel for the new and ambiguous cases.
Classification ; Clinical Coding* ; Diagnosis ; Humans ; International Classification of Diseases* ; Korea ; Medical Records ; Pathology

PURPOSE: Urinary tract infection(UTI) in children may be cause of end stage renal failure and hypertension. So, early detection of renal scar, vesicoureteral reflux(VUR) and anomaly, and proper management are important. We carried this study to observe the significance of 24 hours urine beta2-microglobulin(beta2-MG) for predicting renal injury and correlation of beta2-MG with the grade of VUR. METHODS: We evaluated 52 patients with UTI who were admitted to the department of Pediatrics, Sung-Ae General Hospital from April 1994 to December 1994. All patients were evaluated with 99mTc-2,3-dimercaptosuccinic acid (DMSA) renal scan, voiding cystourethrogram(VCUG) and 24 hours urine beta2-MG. We divided them into 3 groups, group A; renal scarring in DMSA scan and no reflux in VCUG(14 patients), group B; renal scarring and reflux (10 patients), and group C; no renal scarring and reflux (24 patients). RESULTS: 1) Among 52 patients, 31 patients(59.6%) were less than 1 year of age and 21 patients(40.4%) were older than 1 year. The sex ratio of male to female was 1.6:1. 2) Among 24 patients with renal scarring, 15 patients(63%) were less than 1 year of age, and vesicoureteral reflux was observed in 10 patients (41.6%). 3) Vesicoureteral reflux was seen in 14 patients (26.9%): one with grade I, four with grade II, six with grade III, one with grade IV, and two with grade V. 4) The values of 24 hours urine beta2-MG in group A and B were 3.94+/-6.13mg /g Cr and 3.72+/-5.38mg/g Cr respectively, while 0.85+/-0.63mg/g Cr in group C, showing significant difference between group A and group C(p<0.05). However, there was no significant difference between group A and B(p>0.05). The grade of vesicoureteral reflux was also significantly correlated with the level of 24 hours urine beta2-MG. 5) 24 hours urine beta2-MG was significantly decreased with improvement of renal scarring after successful treatment of urinary tract infection. CONCLUSIONS: Measurement of 24 hours urine beta2-MG can be used as a sensitive marker of the severity of UTI and also useful for the evaluation of successful treatment and prognosis of patients with urinary tract infection.
beta 2-Microglobulin ; Child ; Cicatrix ; Female ; Hospitals, General ; Humans ; Hypertension ; Male ; Pediatrics ; Prognosis ; Renal Insufficiency ; Sex Ratio ; Succimer ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

Spontaneous pneumothorax is a known, but relatively rare complication of pulmonary metastases of sarcoma. A 19-year-old man was presented with chest pain and dyspnea for three days and was diagnosed as left pneumothorax. After bleb resection, microscopic examination revealed metastatic osteosarcoma forming subpleural fistula and dystrophic calcification. Four years ago, he had had limb salvage operation and chemotherapy for osteosarcoma of left femur. After two and a half years he had a bleb resection for right pneumothorax without any evidence of metastasis. Six months later, he was found to have a 4x3cm sized lung mass in the right lower lobe. After lobectomy, he was diagnosed as pulmonary metastasis of osteosarcoma. Pneumothorax is the common complication of metastatic osteosarcoma to the lung and it may be presented before the pulmonary metastasis is clinically evident. It is important to recognize a pneumothorax of the patients with osteosarcoma as a possible sign of metastases.
Blister ; Chest Pain ; Drug Therapy ; Dyspnea ; Femur ; Fistula ; Humans ; Limb Salvage ; Lung ; Neoplasm Metastasis* ; Osteosarcoma* ; Pneumothorax* ; Sarcoma ; Young Adult

No abstract available.
Animals ; Embryonic Structures* ; Fertilization in Vitro* ; Fetal Blood* ; Humans* ; Mice* ; Quality Control* ; Sperm Motility* ; Spermatozoa*

BACKGROUND: More attention is given to oxidative hypothesis which causes atherosclerosis to be recognized as inflammatory response. The relationship between serum ferritin which catalyzes lipid peroxidation and high sensitivity C-reactive protein which reflects vascular inflammation was investigated among adults in a health promotion center. METHODS: The study group consisted of 297 men and women (men 86, women 211) who visited the health promotion center of a hospital in Seoul to have a health checkup from October 1, 2004 to April 1, 2005. These subjects answered the questionnares and were measured in the following; blood tests, brachial-ankle pulse wave velocity and several anthropometric measurements. Statistical analysis was performed on 111 subjects after exclusion of those subjects who were taking antihypertensive agents or antidiabetic agents, and who had acute inflammatory diseases, acute liver diseases, anemia, and who had a WBC > or =11,000x10(3)/mm3 or a serum ferritin > or =200 ug/L or a ABI (Ankle Brachial Index) <0.9. RESULTS: The average serum ferritin concentration of men against women was 132.57+/-43.12 ng/ml to 78.23+/-38.10 ng/ml which means that men have about 1.7 times as high concentration than women (P<0.001). Serum ferritin was significantly correlated with high sensitivity C-reactive protein (r=0.332). Even in multiple stepwise regression analysis, there was a independent relationship between serum ferritin and high sensitivity C-reactive protein (beta=0.138, P=0.010). When we analyzed with distinction of sex, this relationship in women was constant (beta=0.131, P=0.031), but serum ferritin in men just showed the trend of correlation with BMI (beta=9.510, P=0.059). CONCLUSION: There is a significant relationship between the increase of serum ferritin and high sensitivity C-reactive protein in healthy women; furthermore, studies in men need to be confirmed.
Acute Disease ; Adult ; Anemia ; Antihypertensive Agents ; Atherosclerosis ; C-Reactive Protein ; Female ; Ferritins ; Health Promotion ; Hematologic Tests ; Humans ; Hypoglycemic Agents ; Inflammation ; Lipid Peroxidation ; Liver Diseases ; Male ; Oxidative Stress ; Pulse Wave Analysis

To examine the relationship between birth characteristics and childhood cancer mortality, a retrospective cohort study of Korean children was conducted using data collected by the national birth register between 1995 and 2006, which were then individually linked to death data. A cohort of 6,479,406 children was followed from birth until their death or until December 31, 2006. Poisson regression analyses were used to calculate rate ratios of childhood cancer deaths according to birth characteristics. A total of 1,469 cancer deaths were noted and the childhood cancer mortality rate was found to be 3.43 per 100,000 person-years in Korea during the period of 1995-2006. The birth characteristics examined in this study (i.e. , birth weight, gestational age, multiple births, parental ages, and number of siblings) were generally found to be not significantly associated with childhood cancer mortality, and the associations did not vary meaningfully with gender nor with cancer sites. However, among children aged 5-11 yr, higher birth weight was associated with elevated childhood cancer mortality (rate ratio = 1.28, 95% confidence interval 1.04-1.58). Our results offer no overall associations between childhood cancer mortality and birth characteristics, but suggest that the association may be specific to age group.
Birth Weight ; Child ; Child, Preschool ; Cohort Studies ; Gestational Age ; Humans ; Multiple Birth Offspring ; Neoplasms/*mortality ; Parents ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Siblings ; Socioeconomic Factors

BACKGROUND: The goals of this study are to investigate the propensity to depression and anxiety in children, and also, to investigate its relationship to the family structure, their life events, and school achievement. We have attempted to aid the continuous and comprehensive management of children with depression and anxiety in a field of family practice. METHODS: A group of 797 boys and girls in 5th and 6th were selected grades a elementary school in their, In the area of ll-san and In-cheon city in August, 1997. Making use of the Kovacs' Children's Depression Inventory(CDI, 1977) and the Spielberger's State-Trait Anxiety Inventory for Children(STAIC, 1973), we investigated the propensity to depression and anxiety by self-rating. At the same time, the general characteristics(gender, age, resideuce, family structure), life events(death single parent, divorced family, death of a sibling, family discord between husband), and school achievement were investigated and assessed their relationship. RESULTS: The Children's Depression Inventory score was 11.69, the State Anxiety Inventory score was 31.51, and the Trait Anxiety Inventory score was 31.49. The CDI score were significantly higher in females, sixth year students, residents execpt for those living in an apartment or villa, and low school achievement group(P<0.01, P<0.05), There was no significance between CDI score and age, whether or not a dual-income family, death of a sib, hospitalization within 6 months, and family discord between husband and wife. The STAIC score was significantly higher for old age, female, sixth year students, and low school achieve menu group(P<0.01), and there was no significance between the STAIC score and residence, whether or not a dual-income family, death of a sibling, hospitalization within 6 months, and family discord between husband and wife. CONCLUSIONS: According to our results, there was a significant correlation between gender, school years, school achievement and a propensity to depression and anxiety. Therefore, family physician should be more involved in family intervention and anticipatory guidance upon medical examination and treatment, if he or she has a symptoms of anxiety and depression.
Anxiety* ; Child* ; Depression* ; Divorce ; Family Practice ; Female ; Hospitalization ; Humans ; Incheon ; Physicians, Family ; Siblings ; Single Parent ; Spouses

BACKGROUND: Myasthenia gravis is an autoimmune neuromuscular disorder that shows increased sensitivity to nondepolarizing muscle relaxants. Atracurium is eliminated by Hofmann elimination and ester hydrolysis. We studied the onset and duration of atracurium in patients with myasthenia gravis. METHODS: Ten patients undergoing thymectomy for myasthenia gravis and ten patients of ASA Class I-II without liver, kidney and neuromuscular disease for orthopedic surgical procedures were assigned. Anesthesia was induced with thiopental (4~5 mg/kg) and maintained with inhalation of N2O:O2 (1:1) and enflurane (1.0~2.0 vol%). Atracurium (0.5 mg/kg) was given as a muscle relaxant and then intubation was performed after twitch response was depressed more than 80%. Neuromuscular relaxation was assessed by TOF (T1) at the adductor pollicis with supramaximal stimulation of ulnar nerve at 2 Hz every 12 seconds. The onset and the duration of 5, 25, 50, 75% recovery time of T1 and the recovery index were recorded. RESULTS: Onset of block was shortened and recovery time of 5, 25, 50, 75% and recovery index were prolonged in patients with myasthenia gravis. Conlusions: In patients with myasthenia gravis, atracurium induced rapid onset time and prolonged recovery time of 5, 25, 50, 75% and recovery index.
Anesthesia ; Atracurium* ; Enflurane ; Humans ; Hydrolysis ; Inhalation ; Intubation ; Kidney ; Liver ; Myasthenia Gravis* ; Neuromuscular Diseases ; Orthopedic Procedures ; Relaxation ; Thiopental ; Thymectomy* ; Ulnar Nerve

Group B Streptococcus (GBS) commonly causes neonatal meningitis and sepsis. In infants with late-onset meningitis, fever, irritability or lethargy or both, poor feeding, and tachypnea are common initial signs. Major neurologic sequelae are observed in 29% of children, the most serious including global or profound mental retardation, spastic quadriplegia, cortical blindness, deafness, uncontrolled seizures, hydrocephalus, and hypothalamic dysfunction. We report a 14-day-old full-term female infant who presented with grunting and irritability to the emergency room and was diagnosed with GBS meningitis subsequently complicated with central diabetes insipidus and secondary hypopituitarism. Central diabetes insipidus should be ruled out in infants with complicated GBS meningitis.
Blindness, Cortical ; Child ; Deafness ; Diabetes Insipidus, Neurogenic ; Emergency Service, Hospital ; Female ; Fever ; Humans ; Hydrocephalus ; Hypopituitarism* ; Infant ; Infant, Newborn ; Intellectual Disability ; Lethargy ; Meningitis* ; Quadriplegia ; Seizures ; Sepsis ; Streptococcus ; Tachypnea