We experienced a case of unilateral vocal cord paralysis following tracheal extubation. The patient was a 60-year-old man undergoing subtotal gastrectomy. He had no laryngeal symptoms prior to operation and the trachea was intubated with a cuffed endotracheal tube. The surgical procedure lasted 6 hours and was uneventful. Three days later after operation, he began to complain of hoarseness and mild aspiration symptom. On endoscopic examination, left vocal cord paralysis was found. Fifteen weeks later the voice and left vocal cord function return to normal without specific management. In this case, we suggested that possible causes of unilateral vocal cord paralysis are compression of recurrent laryngeal nerve by overexpanded endotracheal cuff, laryngeal trauma during difficult intubation, stretching of the nerve as a result of traction on distant organ, decreased elasticity of trachea and surrounding tissues in the older age group and long operating time.
Airway Extubation* ; Elasticity ; Gastrectomy ; Hoarseness ; Humans ; Intubation ; Middle Aged ; Recurrent Laryngeal Nerve ; Trachea ; Traction ; Vocal Cord Paralysis* ; Vocal Cords ; Voice

BACKGROUND: Through the control of tuberculosis at 22 public health centers under the National Tuberculosis Control Program, this study is purposed to examine the situation of the tuberculous patients and the characteristics of the therapeutic regimens. METHODS: The data was obtained from 8091 medical records of pulmonary tuberculous patients who were registered for treatment at public health center in Seoul during the year of 1993. It was comparatively analysed by the general characteristics(gender, age, chest X-ray findings, sputum results, treatment results, side effects, combined diseases and accompanied extra-pulmonary tuberculosis) according to various regimens of the tuberculosis. RESULTS: The male patients were 5144, the female were 2947. 34.1% of patients were between 21 and 30years of age. Short course regimen was 97.1% and long course regimen was 2.9%. According to chest X-ray findings minimal 53.5%, moderately advanced 41.2%, far advanced 5.3%. Sputum AFB negative was 52.2% and positive was 47.8%. Therapeutic efficiency was high in short course regimen. Among the side effects, dermatologic problems was high and at the regimen of EHRZ side effects were developed highly. Combined diseases were liver diseases(5.2%), DM(4.2%). Accompanied extrapulmonary tuberculosis were pleurisy(5.4% ), superficial lymphadenitis(0.4% ). CONCLUSIONS: There was great effects in the treatment of tuberculosis with short course regimen in the National Tuberculosis Control Program. But only 38% among the expected patients were treated in this country. So the greater efforts were needed to find and treat more patients effectively.
Female ; Humans ; Liver ; Male ; Medical Records ; Public Health* ; Seoul* ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

Here we report an autopsy case of diabetic ketoacidosis (DKA) with severe hypertriglyceridemia (12,900 mg/dl). A 29-year-old woman with a history of type 1 diabetes was found dead at a motel. There was no injury on external inspection, but a lump of cheese-like material was noted in the heart at autopsy and peripheral blood plasma had a creamy appearance. After postmortem biochemical analysis, we made a diagnosis of DKA with severe hypertriglyceridemia and concluded that these unusual autopsy findings were caused by DKA and postmortem change. Uncontrolled diabetes often causes DKA and hypertriglyceridemia. To the best of our knowledge, this is the first report in Korea of DKA with severe hypertriglyceridemia diagnosed by autopsy.
Adult ; Autopsy* ; Diabetic Ketoacidosis* ; Diagnosis ; Female ; Heart* ; Humans ; Hypertriglyceridemia* ; Korea ; Plasma ; Postmortem Changes

PURPOSE: As cardiomyopathy is more prevalent and currently the leading cause of death in Duchenne muscular dystrophy (DMD), early detection of myocardial involvement is important. The purpose of this study was to analyze myocardial strain in DMD children, for the possibility of early detection of myocardial dysfunction. MATERIALS AND METHODS: We reviewed medical records of DMD patients who were >10 years of age (15.6±1.6 years, 12.5-18 years), from March 2013 to June 2014. Data of 24 DMD children who underwent echocardiography with three-layer specific myocardial strain were compared with 24 controls (age: 9.3±4.0 years, 5.5-17 years). RESULTS: Epicardial longitudinal strain was lower in DMD (DMD: -9.3±3.8%; control: -12.3±4.3%; p=0.012). Radial strain (DMD: 24.1±11.1%; control: 37.3±25.9%; p=0.027) and strain rate (SR) (DMD: 1.68±0.91; control: 2.42±0.84; p=0.006) on parasternal short axis view were lower in DMD. Circumferential strains in the endocardium (DMD: -17.5±4.7%; control: -24.2±5.3%; p<0.001), myocardium (DMD: -12.7±3.8%; control: -18.0±4.0%; p<0.001), and epicardium (DMD: -8.4±4.0%; control: -12.2±5.0%; p=0.006) were significantly decreased in DMD. Circumferential SRs were lower in the endocardial (DMD: -1.46±0.38; control: -1.78±0.27; p=0.002) and myocardial layers (DMD: 1.02±0.27; control: -1.28±0.22; p=0.001). CONCLUSION: In DMD patients, deteriorations in myocardial circumferential strain might be an indicator for predicting cardiomyopathy.
Adolescent ; Cardiomyopathies/*diagnostic imaging/*etiology ; Case-Control Studies ; Child ; Child, Preschool ; Early Diagnosis ; *Echocardiography ; Female ; Humans ; Male ; Muscular Dystrophy, Duchenne/*complications/*diagnostic imaging ; Predictive Value of Tests

BACKGROUND: The stress of operation inhibits bowel motility. The blockade of efferent sympathetic nerve is helpful to recovery of bowel motility. So we tried to examine that the extent of sympathetic blockade by alterations of bupivacaine infusion rate affected the recovery of bowel motility. METHODS: Group 1 (N = 25) received postoperative meperidine intramuscular injection on demand as a control group, group 2 (N = 25) received postoperative epidural 0.125% bupivacaine 100 ml plus morphine 10mg by infusion pump, 1 ml/hour, for 4days, group 3 (N = 25) received 0.125% bupivacaine 400 ml plus morphine 10mg by infusion pump, 4 ml/hour, for 4days. The Group 2 and 3 received additional morphine 2mg in 0.2% bupivacaine 10 ml epidurally as a single bolus when the peritoneum was closed. The time interval from termination of operation to the first passage of flatus was estimated. RESULTS: In group 1, bowel motility was regained at 92+/-23 hours, group 2 ; 90+/-19 hours and group 3 ; 91+/-19 hours. All values are not significantly different among the groups (p>0.05). CONCLUSIONS: The alteration of epidural bupivacaine and morphine infusion rate did not affect the recovery of postoperative bowel motility.
Anesthetics ; Bupivacaine* ; Flatulence ; Infusion Pumps ; Injections, Intramuscular ; Meperidine ; Morphine* ; Peritoneum

Cervical pregnancy is a rare and dangerous form of ectopic pregnancy in which the blastocyst implants within the cervical canal below the internal os of the uterine cervix. The characteristic clinical sign is a severe asymptomatic uterine bleeding in early pregnancy or during curettage. Most cervical pregnancies result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervical tissue. Because of uncontrolled profuse vaginal bleeding, total hysterectomy has been the mostly necessitated to control life-threatening bleeding. Transvaginal sonography allows early diagnosis, and conservative treatment (two-time treatment : first treatement with systemic or intraamnionic methotrexate, secondly with curettage or ligature of the uterine arteries) improves the patient's fertility. Successful treatment is defined as elimination of the cervical pregnancy with preservation of the uterus. We report two cases of cervical pregnancy managed, successfully with methotrexate, leucovorin and curettage.
Abortion, Spontaneous ; Blastocyst ; Blood Vessels ; Cervix Uteri ; Curettage ; Cytochrome P-450 CYP1A1 ; Early Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Leucovorin ; Ligation ; Methotrexate ; Pregnancy* ; Pregnancy, Ectopic ; Uterine Hemorrhage ; Uterus

BACKGROUND: In adults, tissue Doppler imaging (TDI) is a recommended component of routine echocardiography. However, TDI velocities are less accepted in pediatrics, due to their strong variability and age dependence in children. This study examines the distribution of myocardial tissue Doppler velocities in healthy children to assess the effect of age with cardiac growth on the various echocardiographic measurements. METHODS: Total 144 healthy children were enrolled in this study. They were recruited from the pediatric outpatient clinic for routine well-child visits. The statistical relationships between age and TDI values were analyzed. Also, the statistical relationships between body surface area (BSA) and TDI values, left ventricle end-diastolic dimension (LVEDD) and TDI values were analyzed. Also, we conducted multivariate analysis of cardiac growth parameters such as, age, BSA, LVEDD and TDI velocity data. RESULTS: All of the age, BSA, and LVEDD had positive correlations with deceleration time (DT), pressure half-time (PHT), peak early diastolic myocardial velocity, peak systolic myocardial velocity, and had negative correlations with peak late diastolic velocity (A) and the ratio of trans-mitral inflow velocity to early diastolic velocity of mitral annulus (E/E'). In the multivariate analysis, all of the age, BSA, and LVEDD had positive correlations with DT, PHT, and negative correlations with A and E/E'. CONCLUSION: The cardiac growth parameters related alterations of E/E' may suggest that diastolic myocardial velocities are cardiac growth dependent, and diastolic function has positive correlation with cardiac growth in pediatric group. This cardiac growth related myocardial functional variation would be important for assessment of cardiac involvement either in healthy and sick child.
Adult ; Ambulatory Care Facilities ; Body Surface Area ; Child* ; Deceleration ; Echocardiography ; Heart Ventricles ; Humans ; Multivariate Analysis ; Pediatrics

No abstract available.
Occupational Health*

The hospital standardized mortality ratio (HSMR) is a widely used generic measure for assessing quality of hospital care in many countries. However, the validity of HSMR as a quality indicator is still controversial. We critically reviewed characteristics of HSMR and suggested how to use HSMR as a quality indicator in the Korean setting. The association between HSMR and other quality measures of hospital care is inconclusive. In addition current HSMR model has shortcomings in risk adjustment because of the lack of clinical data, accuracy of disease coding, coding variation among hospitals, end-of-life care issues, and so on. Therefore, HSMR should be used as an indicator for improvement, not for judgement such as public reporting and pay-for-performance. More efforts will be needed to tackle practical and methodological weaknesses of HSMR in the Korean setting.
Clinical Coding ; Korea* ; Mortality* ; Quality of Health Care ; Risk Adjustment

A total of 131 Pasteurella (P.) multocida strains were isolated from the lungs of 1,064 pigs with respiratory clinical signs nationwide during 2009-2010 and 2013-2014. The strains of P. multocida comprised 77.1% serotype A and 22.9% serotype D. Analysis of a recent P. multocida outbreak in Korean pigs showed that the isolation rate of serotype D decreased annually. The incidence of antimicrobial resistance, as measured using minimal inhibitory concentration values, has decreased recently. Overall, further studies to characterize P. multocida isolated from pigs in Korea are needed to prevent P. multocida infection in the Korean swine industry.
Incidence ; Korea* ; Lung ; Pasteurella multocida* ; Pasteurella* ; Swine*