The insertion of nasogastric tubes in comatose, obtunded or anesthetized patients is often difficult, frustrating and time-consuming. A large variety of methods inserting nasogastric tubes in those uncooperative patients have been reported. As a new effective method, we used Savary-Gilliard Wire Guide(R), which is designed for introducing Savary-Gilliard Dilator(R) into a strictured esophagus, for inserting a nasogastric tube in a comatose patient who was intubated with a ballooned tracheostomy tube. The insertion was successful in the first attempt and no complication occurred.
Coma* ; Esophagus ; Humans ; Tracheostomy

BACKGROUND: Patients undergoing a cesarean section under general anesthesia are at risk of intraoperative awareness due to the use of low concentration of volatile anesthetics used. This study investigated the effect of different methods for administering isoflurane on the anesthetic adequacy using bispectral index (BIS) in the early period of cesarean section. METHODS: Eighty-two parturients undergoing a cesarean section were randomly assigned to receive 1 vol% isoflurane (Group EQ), 1.5 vol% isoflurane for the first 5 minutes and 1 vol% for the next 5 minutes (Group CO), 0.6 vol% end-tidal isoflurane immediately after intubation (Group ET). Thiopental 4 mg/kg was used to induce anesthesia. The bispectral index value, systolic and diastolic arterial pressure, heart rate and end-tidal concentration of isoflurane were recorded every minute for 10 minutes after intubation. RESULTS: There were no significant differences in the systolic and diastolic pressure, and heart rate between the groups. The BIS values from 1 to 8 minutes after intubation were significantly lower in the ET group than in the EQ group. BIS values from 4 to 8 minutes after intubation were significantly lower in the CO group than in the EQ group. CONCLUSIONS: The administration of volatile anesthetics using the end-tidal concentration after thiopental induction shows the best anesthetic efficacy in the early period of cesarean section. This method may further reduce the level of intraoperative awareness.
Anesthesia ; Anesthesia, General ; Anesthetics ; Arterial Pressure ; Blood Pressure ; Cesarean Section* ; Female ; Heart Rate ; Humans ; Intraoperative Awareness ; Intubation ; Isoflurane* ; Nebulizers and Vaporizers* ; Pregnancy ; Thiopental

Acute idiopathic scrotal edema (AISE) is a self-limiting condition that is characterized by acute scrotal swelling and erythema. AISE is a very rare cause of acute scrotum, especially in neonates. We report a case of AISE in a 26-day-old infant who was admitted to the outpatient clinic with swelling and erythema of the penis and scrotum for a week. His vital signs were stable, and laboratory findings were non-specific. A diagnosis of AISE was made using scrotal ultrasonography with color Doppler. His symptoms resolved within four days after the onset of supportive treatment, and he was discharged from the hospital. In neonates with an acute scrotum, AISE should be considered to prevent unnecessary surgical exploration.
Ambulatory Care Facilities ; Diagnosis ; Edema ; Erythema ; Humans ; Infant ; Infant, Newborn ; Male ; Penis ; Scrotum ; Ultrasonography ; Urologic Diseases ; Vital Signs

PURPOSE: To assess the usefulness of the Hounsfield number, measured by a non-contrast enhanced pelvic CT, after a uterine artery embolization as an index of the successful outcome of a uterine fibroid embolization (UFE). MATERIALS AND METHODS: The study subjects included 15 women (age range: 28-49 years, mean age: 36.4 years) diagnosed with symptomatic uterine myomas and seen from March 2003 to August 2005. A non-contrast enhanced pelvic CT scan was performed six hours after a uterine artery embolization. The global and maximal CT numbers were measured for each myoma. In addition, a pelvic MRI was performed to measure the volume of each myoma prior to and 6 months after the UFE. The relationship between fibroid volume reduction and the global CT number were prospectively analysed. RESULTS: The mean global CT number was 91.25 HU in Group I and 40.8 HU in Group II. Further, the mean fibroid volume reduction rate was 73% in Group I and 10% in Group II (p < 0.05). CONCLUSION: The global CT number measured by a non-contrast enhanced pelvic CT is a useful predictive factor of a successful uterine fibroid embolization.
Embolization, Therapeutic ; Female ; Humans ; Leiomyoma ; Myoma ; Prospective Studies ; Radiology, Interventional ; Tomography, X-Ray Computed ; Uterine Artery Embolization ; Uterine Neoplasms

PURPOSE: Though acute pyogenic infections of musculoskeletal system are infrequent in children, delayed diagnosis or inadequate management may cause serious chronic sequelae. We analysed 40 cases of children who were affected by acute septic osteomyelitis and/or septic arthritis to find etiologic agents and to establish proper initial antimicrobial therapy. METHODS: Medical records of 40 cases of microbiologically confirmed acute pyogenic osteomyelitis and/or septic arthritis diagnosed at the Seoul National University Children's Hospital from January 1985 to September 1998 were reviewed. RESULTS: There were 12 cases of acute osteomyelitis, 28 of acute septic arthritis, and 4 of concurrent cases of two diseases. Of 12 cases of acute pyogenic osteomyelitis, there were 7 boys and 5 girls whose average age was 75.4 months. Calcaneus was infected in 4 cases and it was the most common site. Ten cases (83.3%) of them were attributable to Staphylococcus aureus, 1 to Streptococcus viridans and 1 to Pseudomonas aeruginosa. Among the 28 cases of acute septic arthritis, male to female ratio was 16 : 12. The hip joint was the most frequent site involved in 13 cases (46.3%), followed by the ankle joint, which was involved in 6 cases (21.4%). The majority of the children were infected by S. aureus (20 cases, 71.4%). Two cases were infected by S. viridans or Salmonella (group D) species, and 1 by Haemophilus influenzae. CONCLUSION: S. aureus was the most common pathogen of acute pyogenic osteoarthritis, and H. influenzae was an infrequent cause of septic arthritis. Regarding initial empirical anibiotic therapy, anti-staphylococcal agent should be included.
Ankle Joint ; Arthritis ; Arthritis, Infectious ; Calcaneus ; Child* ; Delayed Diagnosis ; Female ; Haemophilus influenzae ; Hip Joint ; Humans ; Influenza, Human ; Male ; Medical Records ; Musculoskeletal System ; Osteoarthritis* ; Osteomyelitis ; Pseudomonas aeruginosa ; Salmonella ; Seoul ; Staphylococcus aureus ; Viridans Streptococci

BACKGROUND: Childhood obesity is becoming more prevalent, associated with a variety of adverse consequences which leads to adulthood obesity. Although diagnosis is usually made by body mass index, there is neither a cutoff point for the percentage body fat nor abdominal circumference. The aim of this study was to identify each cutoff point for both measures. METHODS: The measurement of height, weight, abdominal circumference and percentage body fat was performed through manual assessment and bioelectrical impedance analysis for 4,242 subjects aged 11 in Gunpo City, South Korea. The cutoff point for body fat percentage and abdominal circumference is set to maximize the sum of sensitivity and specificity for detecting obesity and overweight using the Receiver Operating Characteristics (ROC) curve. RESULTS: The mean percentage body fat was 13.6+/-6.9% for boys and 19.4+/-5.3% for girls. The mean abdominal circumference of boys was 68.0+/-9.1 cm, and that of girls was 64.3+/-7.7 cm. The cutoff point of percentage body fat for obesity was 21.8% in boys and 24.5% in girls. The prevalence of obesity was 15.2%, 16.7% for males and females, respectively. The abdominal circumference cutoff for obesity was 76.9 cm in boys and 70.7cm in girls. Based on that, the prevalence of obesity was 19.7% for boys and 20.0% for girls, which was higher than what was identified by body mass index, as in the case of body fat percentage. CONCLUSION: The cutoffs of body fat percentage and abdominal circumference in one city of Gyeonggi Province were lower than those suggested in the previous studies.
Adipose Tissue ; Aged ; Body Mass Index ; Electric Impedance ; Female ; Humans ; Male ; Obesity ; Overweight ; Prevalence ; Republic of Korea ; ROC Curve ; Sensitivity and Specificity

The association of malignancy with glomerulonephritis is well known. The most frequent observed renal lesions associated with malignancy are the membranous glomerulonephritis on carcinoma and minimal change nephrotic syndrome on Hodgkin's disease. Recently, IgA nephropathy associated with liver disease, connective tissue disease, gastrointestinal disease, dermatologic disease, hematologic disease and malignancy were reported. But the relationship between malignancy and IgA nephropathy is not clearly resolved. Here we report a case of IgA nephropathy associated with early gastirc cancer. Successful treatment of early gastric cancer didn't completely resolve the IgA nephropathy but led to a significant reduction of hematuria and loss of proteinuria. Therefore we suggest that a certain association between IgA nephropathy and early gastric cancer can be made by studying the course of the disease.
Connective Tissue Diseases ; Gastrointestinal Diseases ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Glomerulonephritis, Membranous ; Hematologic Diseases ; Hematuria ; Hodgkin Disease ; Immunoglobulin A* ; Liver Diseases ; Nephrosis, Lipoid ; Proteinuria ; Stomach Neoplasms*

PURPOSE: Infective endocarditis (IE) is a serious complication in children with structural heart disease. We reviewed 35 cases of IE to identify the recent changes in the pattern of preexisting heart diseases, the spectrum of causative organisms and prognosis. METHODS: The clinical records of children diagnosed as IE at the Seoul National University Children's Hospital from January 1987 through December 1997, were reviewed retrospectively. Duke criteria was used for diagnosis. Cases were categorized into primary group(PG) IE in an unoperated heart and post operative group(POG), and the latter further into early POG(within 2 months after operation) and late POG. RESULTS: There were 35 cases of IE developed in 34 patients; 18 cases in the PG, 6 cases in the early POG, and 11 cases in the late POG. Male to female ratio was 16 : 19. Mean age of POG, especially early POG was less than that of PG (early POG : late POG : PG=1.65 years : 6.5 years : 8.34 years, P=0.0267). Preexisting heart diseases were identified in 30 cases; rheumatic heart disease 1 case and congenital heart disease (CHD) 29 cases. Causative organisms were identified in 80%; viridans streptococci, 10 cases (33.3%); pneumococci, 2 cases; Group-D streptococci, 3 cases; staphylococci, 8 cases; Gram (-) organisms, 5 cases and Candida albicans, 2 cases. Vegetation was detected in 88.9% of PG and 64.7% of POG. The most common indication for surgery was uncontrolled infection, which were required in 9 cases. The overall mortality rate was 12.1%. Mortality in POG was higher than that of PG (23.5% versus 0%, P=0.033). CONCLUSION: The discrepancy of mean age among patient groups and the high proportion of patients belonging to POG, were consistent with the increase in the number of newly risky population that survived after cardiac surgery. A more aggressive consideration for operative management may improve the treatment results.
Candida albicans ; Child* ; Diagnosis ; Endocarditis* ; Female ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Male ; Mortality ; Prognosis ; Retrospective Studies ; Rheumatic Heart Disease ; Seoul ; Thoracic Surgery ; Viridans Streptococci

Lymphangioleiomyomatosis, a rare disease in women of childbearing age, is the result of benign nodular hypertrophy of the smooth muscle of the lypmhatics and other tissues of the abdomen and thorax. We report a 36-years-old woman with pulmonary and retroperitoneal lymphangioleiomyomatosis who responded with hormone treatment. She developed vaginal pruritis and a pelvic ultraound was done given her significant past medical history. Ultrasound examination demonstrated a large mass in the right side of her pelvis. Therefore she was admitted to St. Michael's Hospital in Toronto for laparoscopy. Result of cytology was to be consistent with the diagnosis of retroperitoneal lymphangioleiomyomatosis. High resolution CT sacn of the thorax demonstrated multiple small cystic lesions, without associated nodularity compatible with a diagnosis of pulmonary lymphangioleiomyomatosis. She has been taking Provera tablets l00mg po tid since Dec. 15, 1993. We have given her a prescription for Depo provera 500mg IM monthly since she came back to Korea, and made arrangements for regular follow up monthly. We performed chest X-ray, CT of chest(high resolution), abdomen and pelvis, pulmonary function tests and arterial blood gas analysis. Chest X-ray and CT findings showed no significant change since July. 20, 1993.
Abdomen ; Blood Gas Analysis ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hypertrophy ; Korea ; Laparoscopy ; Lymphangioleiomyomatosis* ; Medroxyprogesterone Acetate ; Muscle, Smooth ; Pelvis ; Prescriptions ; Pruritus ; Rare Diseases ; Respiratory Function Tests ; Tablets ; Thorax ; Ultrasonography

OBJECTIVE: To assess the feasibility and clinical efficacy of laparoscopic myomectomy (LM). METHODS: We analyzed retrospectively the data for 110 LM preformed at Kangbuk Samsung Hospital between July 2003 and July 2006. We reviewed their clinical charts and the operative and anesthetic records, and analyzed data on the patients' age, parity, previous operative history, preoperative indication, the diameter of the largest myoma, operating time, number of the removed myoma, hospital stay, change of the hemoglobin concentration from preoperative to postoperative day 1, concomitant procedures, histopathological reports, and complications. RESULTS: The mean age of the patients was 35.7+/-5.8 years, the mean parity was 0.8+/-0.9, and 26 (23%) patients had a previous operative history. The most common operative indication was a palpable abdominal mass (46 patients, 41.9%), followed by chronic pelvic pain (32 patients, 29.0%), abnormal uterine bleeding (24 patients, 21.8%), urinary frequency (7 patients, 6.4%), and infertility (1 patient, 0.9%). The mean operating time was 82.9+/-30.8 minutes, and the mean diameter of the largest myoma was 7.1+/-2.3 cm. The heaviest of the removed myoma weighed 795 gm. The mean change of the hemoglobin concentration was 2.2+/-1.1 g/dL, and the mean hospital stay was 3.5+/-1.4 days. Postoperatively, transfusions were done 10% (11 cases) of patients, and 2 cases of paralytic ileus and a case of subcutaneous emphysema were noted. Conversion rate to laparotomy was 0.9% (1 case). CONCLUSION: LM for various sized myomas can be performed successfully and effectively by decreasing laparoconversion, if the surgical team and the laparoscopic surgeon are experienced and enhanced equipment is available.
Female ; Humans ; Infertility ; Intestinal Pseudo-Obstruction ; Laparotomy ; Length of Stay ; Myoma* ; Parity ; Pelvic Pain ; Retrospective Studies ; Subcutaneous Emphysema ; Uterine Hemorrhage