Duodenal diverticula are common disease entities occurring in up to 25% of the healthy population. Duodenal diverticular perforation is a rare but fatal complication. Although the main treatment for duodenal diverticular perforation is surgery, conservative treatment can be an option for selected patients. We present a case of a 71-year-old woman with a perforated duodenal diverticulum successfully managed with conservative treatment with antibiotics and percutaneous drainage of abscesses.
Abscess ; Aged ; Anti-Bacterial Agents ; Diverticulum* ; Drainage ; Duodenum ; Female ; Humans

PURPOSE: In the present study, the surgical outcome and postoperative exodrift pattern between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession (ULR) in intermittent exotropia of 20 prism diopters (PDs) were compared. METHODS: In this retrospective study, 5.0 mm BLR or 8.5 mm ULR was performed on 82 patients for the treatment of intermittent exotropia of 20 PDs with a follow-up period of 2 years. The main outcome measures were postoperative 1-week, 1-month, 6-month, 1-year and 2-year exodeviation angles with their patterns and success rates. A surgical success was considered an alignment within 10 PDs and sensory success was defined at 100 seconds of arc. RESULTS: The mean deviation angles at postoperative 1 week were 4.7 ± 5.1 PD esodeviation in the BLR group (44 patients) and 1.2 ± 4.2 PD esodeviation in the ULR group (38 patients). The BLR group was significantly more overcorrected than the ULR group (p = 0.001), but postoperative exodrift occurred in the BLR group at 1 week, 1 month, 6 months, 1 year, and 2 years. In the ULR group, the postoperative exodrift occurred at 1 week, 1 month, and 6 months which was followed by stabilized alignment. Surgical success rate at the postoperative 2-year follow-up was 75.0% in the BLR group and 81.6% in ULR group (p = 0.717). CONCLUSIONS: ULR showed less overcorrection and early exodrift up to only 6 months, resulting in stabilization of the alignment afterwards; surgical success rate at the final 2-year follow-up was similar to BLR.
Esotropia ; Exotropia* ; Follow-Up Studies ; Humans ; Outcome Assessment (Health Care) ; Retrospective Studies

PURPOSE: To identify predictive factors for recovery time in patients with orbital fracture with diplopia through analysis of preoperative and postoperative computed tomography (CT) images and postoperative recovery time. METHODS: We retrospectively analyzed CT findings-preoperative: fracture size, type of fracture, fracture site, extraocular muscle (EOM) swelling, EOM and soft tissue injury, and the amount of soft tissue herniation; post-operative: degree of enophthalmos, and diplopia recovery period in 379 patients who underwent surgical treatment for orbital fracture between March 2006 and December 2015. RESULTS: The average postoperative follow-up period was 556.2 ± 59.5 days, and the mean duration of recovery was 23.9 ± 42.5 (range, 3–186) days. The recovery time of diplopia was significantly increased with the following preoperative CT findings: fracture size (small and medium < large) (p = 0.049), type of fracture (linear < hinge < comminuted, trap-door) (p < 0.01), fracture site (inferior < medial and both) (p < 0.01), EOM and soft tissue injury (prolapse and torsion, muscle entrapment, kinked muscle) (p < 0.01), and the amount of soft tissue herniation (small and medium < large) (p < 0.001). The mechanism of injury, sex, age, and the degree of enophthalmos were not related to the length of the diplopia recovery period. CONCLUSIONS: The length of diplopia recovery could be predicted by CT findings.
Diplopia ; Enophthalmos ; Follow-Up Studies ; Humans ; Orbit ; Orbital Fractures ; Retrospective Studies ; Soft Tissue Injuries

PURPOSE: This study was to assess clinically the incidence of abutment screw loosening of posterior implant-supported fixed prosthesis and its affecting factors. MATERIALS AND METHODS: 391 implant-supported crowns restored from January 2013 to January 2016 were included in this study. All restorations were fabricated with either a single crowns or a splinted crown, and cemented with temporary cement. The incidence of abutment screw loosening is investigated and gender, restoration position, opposing teeth, restoration type, abutment connection type were assessed as possible factors affecting abutment screw loosening. RESULTS: During the observation period (2 – 5 years), abutment screw loosening was found in 29 restorations (7.4%). It took 3 to 48 months (means 19.5 months) to loose the screw, and three of these implants were fractured. Among the factors considered, there were statistically significant differences at abutment screw loosening rate between molar group (9.4%) and premolar group (2.6%) (P<.019). According to the type of opposing teeth, there were statistically significant differences between nature teeth (74.7%) and implant (25.0%), removable denture (3%) (P<.019). The other possible factors did not have a significant effect on loosening of the abutment. CONCLUSION: The incidence of abutment screw loosening in posterior restoration was 7.4%. Abutment screw loosening were more likely to occur in molars group than premolar group, and according to the opposing teeth, there were the greatest frequency in nature teeth than implant and removal denture. There was a statistically significant difference.
Bicuspid ; Crowns ; Dental Prosthesis, Implant-Supported ; Dentures ; Incidence* ; Molar ; Prostheses and Implants ; Splints ; Tooth

BACKGROUND AND OBJECTIVES: The patient presenting to the emergency department with the complaint of dizziness is one of the most common as well as most challenging problems confronting the emergency physician today. Dizziness is a vague symptom of disease ranging from serious to benign. The differential diagnosis and proper management of dizziness in a department of emergency medicine are the most important things. We undertook this study to evaluate the character and clinical analysis of the dizzy patients and to discuss the significance and necessity of primary care in a department of emergency medicine. MATERIALS AND METHOD: From September 1999 to October 2003, we sampled the 1,371 dizzy patients who visited the Emergency Department(ED). Of these patients, the 650 patients performed electronystagmography(ENG) and rotatory chair test were selected, except for the patients with loss of consciousness, known psychiatric disease or direct brain injury. RESULTS: The 650 patients were attributed to acute peripheral vestibulopathy in 88.5% (575 patients) of patients, benign paroxysmal positional vertigo in 9.5% (62 patients) of patients, central origin in 1.4% (9 patients) of patients, other organic origin in 0.6% (4 patients) of patients. In a retrospective analysis of patients with central origin, the symptoms estimated at central origin, for example, persistent headache, were found. CONCLUSION: The exact diagnosis and management for the dizzy patients in a department of emergency medicine require the primary physician's concern and understanding for dizziness.
Brain Injuries ; Diagnosis ; Diagnosis, Differential ; Dizziness ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Headache ; Humans ; Primary Health Care ; Retrospective Studies ; Unconsciousness ; Vertigo ; Vestibular Neuronitis

INTRODUCTION: The purpose of positioning is to allow the procedure to be performed as simply as possible and to achieve the best possible results free of complications. In a normal person, many investigators have researched the hemodynamic changes during positional adjustments. But the delicate qualitative hemodynamic changes in various positions has not been recorded very much. So we studied the qualitative hemodynamic changes in various positions with a noninvasive bioimpedance method. METHOD: Healthy adult males were studied (n=25). The protocol was that the position changed from supine to head-up, head-down, lithotomy, sitting, right-lateral, prone and Jackknife (J-K) position. Each position was sustained for three minutes. The mean arterial pressure (MAP), heart rates (HR), left cardiac work index (LCWI), systemic vascular resistance index (SVRI), cardiac index (CI), stroke index (SI) and end diastolic index (EDI) were measured with the bioimpedance method and an automated blood pressure device. Result: The contractility of heart expressed by LCWI, CI and SI decreased in head-down, sitting, right-lateral, prone and J-K positions. The preload expressed by EDI decreased in right-lateral and J-K positions. The afterload expressed by SVRI increased in sitting, prone and J-K positions, and decreased in right-lateral position. CONCLUSIONS: These results may be used as reference for anesthesiologist managing many patients of various physical status.
Adult* ; Arterial Pressure ; Blood Pressure ; Heart ; Heart Rate ; Hemodynamics* ; Humans ; Male ; Research Personnel ; Stroke ; Vascular Resistance

BACKGROUND: This study was aimed to elucidate the effect of ketamine anesthesia on circulatory response to hemorrhage in rats by power spectral analysis of heart rate and blood pressure variability. METHODS: Nineteen male Sprague-Dawley rats weighing 290~475 g were divided into ketamine (100 mg/kg, im)-anesthetized(K, n=10) and conscious(C, n=9) groups. Hemorrhage was induced with a withdrawal pump from the femoral artery at 3 ml/kg/min for 5 min. Arterial pressure was measured with a pressure transducer connected to the contralateral femoral artery for 5 min before, during and after hemorrhage. The blood pressure signal digitized at 500 Hz through a data acquisition system was analyzed with fast Fourier transform algorithm to yield power spectra of sytolic(SP) and diastolic(DP) blood pressure and instantaneous heart rate(HR). Powers of very low frequency(VLF, 0.02~0.26 Hz), low frequency (LF, 0.26~0.75 Hz) and high frequency(HF, 0.75~5.00 Hz) band were expressed as percent of total power. RESULTS: Before hemorrhage blood pressure was higher in K(152.4+/-3.7/99.9+/-4.9 mmHg) than in C(143.3+/-5.7/95.5+/-4.1 mmHg) rats, but was changed by hemorrhage in both groups. Before hemorrhage HR in K and C rats were 361.4+/-17.5 and 363.4+/-18.5 beats/min . HR were significantly increased to 403.2+/-20.3 and 396.2+/-18.9 beats/min during and after hemorrhage in K rats, and increased to 409.1+/-20.9 beats/min during hemorrhage in C rats. Before hemorrhage total powers of blood pressure and HR variability were higher in K than in C rats. During hemorrhage, total powers of blood pressure and heart rate variability tended to increase in both groups. Before hemorrhage, percent powers of systolic pressure variability of HF and VLF were higher in K than in C rats and LF was lower in K than in C rats. During hemorrhage, K group showed no significant changes but C group showed significant changes. Before hemorrhage, percent powers of diastolic pressure variability of VLF was higher in Kthan in C rats, and HF and LF were lower in K than in C rats. During and after hemorrhage, K group showed no significant changes, but C group showed significant decrease in LF and increase in VLF. Before hemorrhage, percent powers of heart rate variability of K rats showed higher HF and VLF, and lower LF than C rats. During and after hemorrhage HF and VLF of both groups showed no significant changes except significant increase in VLF after hemorrhage in C rats, but LF of both groups showed significant decrease. CONCLUSIONS: It was concluded that autonomic activity, especially cardiac sympathetic activity, was increased in response to hemorrhage in K rats. Ketamine anesthesia stimulated overall autonomic activity, especially sympathetic activity and vasomotor tone. In C rats hormonal factor contributed to blood pressure and heart rate variability during hemorrhage.
Anesthesia ; Animals ; Arterial Pressure ; Blood Pressure* ; Femoral Artery ; Fourier Analysis ; Heart Rate* ; Heart* ; Hemorrhage* ; Humans ; Ketamine ; Male ; Rats* ; Rats, Sprague-Dawley ; Transducers, Pressure

"The prenatal diagnosis of spine bifida include the combined use of maternal serum alpha-fetoprotein (MSAFP) screening and fetal sonography. Sonographically, spina bifida is characterized by direct signs of the visualization of the spinal defect, and indirect signs of the cranial markers : the lemon sign, the banana sign, and ventriculomegaly. These ultrasonographic signs are more accurate in defining the cranial malformations associated with spina bifida than evaluation of the spine. Recently, three cases of spina bifida which was diagnosed as ""splaying"" of the posterior ossification centers, meningomyelocele sac at the lumbosacral area, lemon sign, banana sign and ventriculomegaly by ultrasonography at 21+2 gestational weeks in a 32 years old nullipara, at 21+2 gestational weeks in a 26 years old nullipara, at 23+6 gestational weeks in a 26 years old multipara were experienced at our department. We present this cases with a brief review of literatures"
Adult ; alpha-Fetoproteins ; Humans ; Mass Screening ; Meningomyelocele ; Musa ; Prenatal Diagnosis ; Spinal Dysraphism* ; Spine ; Ultrasonography

BACKGROUND: Most febrile neutropenic patients are treated in an aggressive manner. However, identification of low-risk patients may enable clinicians to administer risk-based treatment. The object of this study is to certify the factors associated with increased risk at the time of visiting the emergency department. METHODS: This is a retrospective study. We reviewed the medical records of 101 febrile neutropenic patients who had visited the emergency department of Seoul National University Hospital from January 1998 to August 1999. We assumed 22 risk prediction factors that could be assessed at admission to the emergency department and 5 factors that could be assessed during treatment course. To find independent risk-prediction factors, we analyzed these factors respectively by using multiple regression analysis. RESULTS: Tachycardia(aOR=136.5), altered mentality(aOR=28.8), decreased renal function(aOR=20.1), and significant comorbidity(aOR=17.2) are the independent factors associated with higher mortality. Altered mentality(aOR=31.6) and decreased renal function(CCr<75ml/min, aOR=5.4) are those associated with a higher incidence of septic shock. Independent factors associated with persistent(more than 3 days) fever are the early(within 10 days) onset of fever after last chemotherapy(aOR=8.8) and the existence of new pulmonary infiltrates on a simple chest X-ray(aOR=4.3). CONCLUSION: The stability of vital signs, the change of mentality, the renal function, the existence of significant comorbidity, the existence of new pulmonary infiltrates, and the rate of neutropenia are clinically useful risk-predication factors in febrile neutropenia at the time of visiting the emergency department.
Comorbidity ; Emergency Service, Hospital ; Febrile Neutropenia ; Fever ; Humans ; Incidence ; Medical Records ; Mortality ; Neutropenia ; Retrospective Studies ; Seoul ; Shock, Septic ; Thorax ; Vital Signs

PURPOSE: Despite advances in the techniques and development of new devices, endovascular (EV) procedures are not the panacea for peripheral vascular diseases. This is partly because substantial cases are too complicated to manage with only EV procedures and partly because of the relatively large size of devices. We reviewed our experience of hybrid vascular procedures and report here on their outcomes. METHODS: Between August 2008 and March 2010, thirteen cases of hybrid vascular operation were performed. A retrospective review of electronic medical records was performed. The primary outcome measures were technical outcomes and patency rates. RESULTS: The mean follow-up duration was 17.7 months. Treatment indications were as follows: critical ischemia (n=6), claudication (n=3), abdominal aortic aneurysm with leg ischemia (n=3), and unstable aortic atheroma with recurrent embolism (n=1). All operations were performed under local anesthesia in an angiography suite. A single surgeon and a single interventional radiologist performed all the major procedures together. Technical and clinical success rates were 92.3%. All limbs were salvaged in patients with critical ischemia. The primary patency rate of the 13 cases was 83.3% at 1 year. There was no in-hospital mortality. CONCLUSION: hybrid vascular operation is useful for patients with a complex vascular condition. The role of hybrid vascular operation should be established with regards to not only the cost benefit but also the long-term outcomes.
Anesthesia, Local ; Angiography ; Aortic Aneurysm, Abdominal ; Chimera ; Cost-Benefit Analysis ; Electronic Health Records ; Embolism ; Extremities ; Follow-Up Studies ; Humans ; Ischemia ; Leg ; Outcome Assessment (Health Care) ; Peripheral Vascular Diseases ; Plaque, Atherosclerotic ; Retrospective Studies