Adequate radiographic demonstration of renal injury following blunt abdominal trauma is an important guide totherapy. The diagnostic evaluation of renal injuries usually begins with excretory urography, but not providedetailed information about the extent of injury. The need for a more accurate noninvasive modality led us toinvestigate the use of CT. We evaluated with CT and excretory urography 30 selected patients suspected of havingmajor renal injury. Of these patients 11 were also underwent arteriography for assessment of renal arterialinjuries. In this paper, we wish to analyze the result of the above modalites, particulary angiography and CT. Thebrief results were as follow. 1. Among 30 patients, 21 cases were male and 9 cases were female. About one third ofthese occured between the age of 20-29. 2. All cases were nonpenetrating blunt traumas. 3. Renal injuries werecategorized into 3 groups. Category I is minor renal injuries(14 cases), II is major renal injuries(1 cases), andIII is catastrophic renal injuries(3 cases). 4. IVP is the most common inital diagnostic modality and good forscreening of patients, but lack of specificity. In our study the specificity is about 33%. 5. CT is more accuratein detecting hematoma, parenchymal laceration, fracture and extravasation of urine, but agiography is moreconfirmative in diagnosis of vascular injuries. 6. Conservative management was done in 19 cases; 13 cases ofcategory I and 6 cases of II. Operation was performed in 11 cases: 1 case of category, I, 7 cases of II and 3cases of III. 7. Associated injuries were noted in 17 cases(57%).
Angiography ; Diagnosis ; Female ; Hematoma ; Humans ; Lacerations ; Male ; Sensitivity and Specificity ; Urography ; Vascular System Injuries

Postherpetic neuralgia (PHN) is a sequela of acute herpes zoster infection and is defined as pain persisting more than 1 month. The patients with PHN suffer from a persistent neuropathic pain. There are many treatments for PHN but some people occasionally do not respond to the conventional therapies. Neurodestruction using neurolytic agents are beneficial to patients with severe intractable pain because of it's prolonged pain-relief and simplicity, inexpensiveness. We report a case that we managed successfully a patient with intractable thoracic PHN using intrathecal alcohol neurolysis.
Herpes Zoster ; Humans ; Neuralgia ; Neuralgia, Postherpetic* ; Pain, Intractable

In maxillofacial surgery endotracheal tube provides patent airway and prevents patient from aspirating the blood. But serious complications such as tube obstruction or injury have been reported. In this case, endotracheal tube injury by surgical saw during Lefort I osteotomy occurred. We could not exchange the defective tube for a good one using laryngoscope or fiberoptic bronchoscope due to edema and blood in nostril and oral cavity. We didn't have any tube exchanger available too. Therefore, to provide patent and safe airway, we packed gauze around the lacerated part of tube, provided positive end expiratory pressure ventilation and increased oxygen flow. After anesthesia, the damaged tube was safely removed and there were no respiratory complications.
Anesthesia ; Bronchoscopes ; Edema ; Humans ; Laryngoscopes ; Mouth ; Osteotomy* ; Oxygen ; Positive-Pressure Respiration ; Surgery, Oral ; Ventilation

Hiccup is caused by synchronous contractions of the diaphragmatic and intercostal muscles followed by the closure of the glottis. Intractable hiccup is defined as hiccup bouts lasting more than 48 hours or recurring despite various treatments. Recently we have experienced a case of postoperative intractable hiccup. We failed to stop intractable hiccup by pharmacological treatment, but succeeded by unilateral phrenic nerve block.
Glottis ; Hiccup* ; Humans ; Intercostal Muscles ; Nerve Block ; Phrenic Nerve*

BACKGROUND: There have been recent reports on the effects of the addition of intrathecal midazolam to bupivacaine on spinal anesthesia. Therefore, the effects of the addition of intrathecal midazolam to bupivacaine on spinal anesthesia and peri-operative sedation were investigated. METHODS: Thirty one ASA class 1 and 2 patients, scheduled for transurethral resection of the bladder or prostate (TURB or TURP), were randomly divided into two groups. Group B (n = 15) received bupivacaine 12 mg, and normal saline 0.6 ml, whereas group BM (n = 16) received bupivacaine 12 mg, midazolam 2 mg, and normal saline 0.2 ml. The blood pressure (BP), heart rate (HR), arterial oxygen saturation (SaO2), bispectral index (BIS) and Observer's Assessment of Alertness/Sedation Scale (OAA/S scale) scores were recorded every 5 minutes, both before and during the spinal anesthesia. The sensory blockade was measured using a pin-prick test, and motor blockade evaluated using the Bromage motor scale. In addition, the side effects, including pruritus, nausea, vomiting, and headache, and so on, were observed for a period of 24 hours. RESULTS: There were no differences in the motor and sensory block and recovery between the two groups. However, a difference was found in the time to first recognition of pain and the BIS scores between the two groups. CONCLUSIONS: Intrathecal midazolam did not, itself, affect the spinal anesthesia, but was found to have a statistically prolonged postoperative analgesic and more sedative effects.
Anesthesia, Spinal* ; Blood Pressure ; Bupivacaine* ; Headache ; Heart Rate ; Humans ; Hypnotics and Sedatives ; Midazolam* ; Nausea ; Oxygen ; Prostate ; Pruritus ; Urinary Bladder ; Vomiting

BACKGROUND: Pulmonary venous flow velocity pattern (PVFVP) is widely used to assess LV diastolic function. It is known that the parameters of PVFVP have a significant correlation with the ratio of peak early diastolic filling velocity (E) to peak filling velocity at atrial contraciton (A) measured in the transmitral flow. However, the correlations between parameters of superior vena caval flow (SVCF) and transtricuspid E/A ratio have not been reported. Therefore the present investigation was performed to elucidate these correlations. METHODS: Fifty patients (26 men, mean age 63.1+/-11.1 years), who did not have significant tricuspid valvular disease and restrictive filling pattern on tricuspid and superior vena caval doppler, were included in this study. SVCF was recorded with the transducer positioned at subxiphoid area and the sample volume placed 2 cm within the superior vena cava. Blood flow across the tricuspid valve was obtained from standard four chamber view or modified parasternal four chamber view with the sample volume placed on leaflet tips. Recording was made during midexpiratory apnea. The following doppler parameters were measured: transtricuspid E and A velocity, E/A ratio: systolic (S) and diastolic (D) peak velocities and time velocity integrals (TVI), S/D velocity ratio, S/D TVI ratio, atrial reversal peak velocity (ArV) and TVI (ArTVI) in SVCF. RESULTS: 1) In SVCF, S velocity (63.7+/-11.8 cm/s vs 73.4+/-13.6 cm/sec, p<0.05), S TVI (17.4+/-3.6 cm vs 21.1+/-6.2 cm, p<0.05), ArV (30.0+/-6.9 cm/s vs 37.2+/-7.3 cm/s, p<0.005), and ArTVI (2.7+/-0.8 cm vs 3.3+/-0.8 cm, p<0.01) were significantly decreased in group E/A>1. And D TVI (7.1+/-3.0 cm vs 5.2+/-3.1 cm, p<0.05) and D/S TVI ratio (0.41+/-0.13 vs 0.26+/-0.14, p<0.05) were significantly increased in group E/A>1. 2) As E/A ratio increased, diastolic TVI (r=0.315, p<0.05) and D/S TVI ratio (r=0.448, p<0.001) increased, and ArTVI (r=-0.376, p<0.01) and ArV (r=-0.416, p<0.01) decreased. 3) As E peak velocity increased, SVCF D peak velocity increased (r=0.305, p<0.05). CONCLUSIONS: Tricusupid E/A ratio has positive correlations with D TVI and D/S TVI ratio, and negative correlations with ArTVI and ArV. But there were no correlations in S velocity, D velocity, and S/D velocity ratio as the relation of mitral E/A ratio with PVFVP.
Apnea ; Humans ; Male ; Transducers ; Tricuspid Valve ; Vena Cava, Superior

Background/Aims: Adequate bowel preparation is important for successful colonoscopy. We aimed to evaluate the clinical feasibility and effectiveness of abdominal vibration stimulation in bowel preparation before therapeutic colonoscopy. Methods: A single center, prospective, randomized, investigator-blinded study was performed between January 2016 and December 2016. Patients for therapeutic colonoscopy were prospectively enrolled and assigned to either the vibrator group or walking group. Patients who refused to participate in this study as part of the experimental group consented to register in the control group instead. During the preparation period, patients assigned to the walking group walked ≥3,000 steps, whereas those assigned to the vibrator group received abdominal vibrator stimulation and restricted walking. All patients received the same colon cleansing regimen: 4-L split-dose polyethylene glycol (PEG) solution. Results: Three hundred patients who received PEG solution for therapeutic colonoscopy were finally enrolled in this study (n=100 per group). Bowel cleansing with abdominal vibration stimulation showed almost similar results to that with walking exercise (Boston Bowel Preparation Scale score for the entire colon: vibrator vs walking vs control, 7.38±1.55 vs 7.39±1.55 vs 6.17±1.15, p<0.001). There were no significant differences between the vibrator group and walking group regarding instances of diarrhea after taking PEG, time to first diarrhea after taking PEG, total procedure time, and patient satisfaction. Conclusions This study indicates that, compared with conventional walking exercise, abdominal vibration stimulation achieved similar rates of bowel cleansing adequacy and colonoscopy success without compromising safety or patient satisfaction.

PURPOSE: Helicobacter pylori (H. pylori) infection has been known to be vital in the pathogenesis of duodenal ulcer disease in children as well as in adults. But the relationship between H. pylori infection and the histopathologic findings of the duodenum has not been explained obviously in children yet. So the aim of this study is to determine whether duodenitis and/or gastric metaplasia in the duodenum increases the risk of duodenal ulcer disease in children infected by H. pylori. METHODS: From October 2001 to April 2004 gastric and duodenal biopsies were performed in 177 children who visited Department of Pediatrics, Gil Hospital, Gachon Medical School. Biopsy sections were stained with hematoxylin and eosin and also with Giemsa for identification of H. pylori. The grades of duodenitis and gastric metaplasia were classified from 0 to 3 and from 0 to 4, respectively. RESULTS: The incidence of H. pylori infection was 54% in total patients. Amongst 163 children with duodenitis there was a lack of correlation between H. pylori infection and the grade of duodenitis. Amongst 11 patients with duodenal ucler, only 4 children were infected by H. pylori. And amongst 5 patients with gastric metaplasia, H. pylori and duodenal ulcer were detected in 2 and 3 children, respectively. The occurrence of duodenal ulcer and gastric metaplasia were increased significantly in proportion to the grade of duodenitis (p<0.0001 and p=0.0365, respectively). CONCLUSION: As opposed to the results of previously reported articles, there were lacks of correlation between H. pylori infection and duodenitis, duodenal ulcer, and gastric metaplasia. So further study hould be done to clarify the effect of H. pylori on the duodenal histopathology in children infected by H. pylori.
Adult ; Biopsy ; Child* ; Duodenal Ulcer* ; Duodenitis* ; Duodenum ; Eosine Yellowish-(YS) ; Helicobacter pylori* ; Helicobacter* ; Hematoxylin ; Humans ; Incidence ; Metaplasia* ; Pediatrics ; Prospective Studies* ; Schools, Medical

PURPOSE: Crohn's disease (CD) can involve any site of the gastrointestinal tract (GIT). However, the characteristics of upper GIT involvement in CD are unclear, especially in the Eastern pediatric population. This study aimed to estimate the prevalence of upper GIT involvement and identify the clinical features of Korean children with CD. METHODS: This was a retrospective multicenter cohort study that included 52 pediatric patients with CD who underwent esophagogastroduodenoscopy and biopsy. The clinical symptoms and endoscopic and histologic features of the upper GIT were identified according to the presence or absence of upper gastrointestinal symptoms. RESULTS: Among the 52 patients, upper GIT involvement was noted in 50.0% (26/52). The mean age at CD diagnosis was 14.1±2.1 years. Gastric ulcer was the most common lesion (19.2%) found on upper GIT endoscopy, followed by duodenal ulcers (15.4%). Chronic inflammation was the most common histopathologic feature (75.0%), followed by gastric erosion (17.3%). Granuloma was found in 9.6% of patients. Helicobacter pylori infection was identified in 5.8% of patients. Endoscopic and histologic findings were not significantly different, but the mean values of erythrocyte sedimentation rate (60.7±27.1 vs. 43.0±27.6 mm/h, p=0.037) and C-reactive protein (16.5±28.2 vs. 6.62±13.4 mg/dL, p=0.014) were significantly different between patients with and without upper gastrointestinal CD symptoms. CONCLUSION: Upper GIT involvement was relatively common in pediatric patients with CD irrespective of upper gastrointestinal symptoms, and H. pylori infection was relatively uncommon. The results of this study should aid the establishment of regional guidelines for upper GIT examination.
Biopsy ; Blood Sedimentation ; C-Reactive Protein ; Child ; Cohort Studies ; Crohn Disease* ; Diagnosis ; Duodenal Ulcer ; Endoscopy ; Endoscopy, Digestive System ; Gastrointestinal Tract ; Granuloma ; Helicobacter pylori ; Humans ; Inflammation ; Pediatrics ; Prevalence ; Retrospective Studies ; Stomach Ulcer ; Upper Gastrointestinal Tract*

PURPOSE: Crohn's disease (CD) can involve any site of the gastrointestinal tract (GIT). However, the characteristics of upper GIT involvement in CD are unclear, especially in the Eastern pediatric population. This study aimed to estimate the prevalence of upper GIT involvement and identify the clinical features of Korean children with CD. METHODS: This was a retrospective multicenter cohort study that included 52 pediatric patients with CD who underwent esophagogastroduodenoscopy and biopsy. The clinical symptoms and endoscopic and histologic features of the upper GIT were identified according to the presence or absence of upper gastrointestinal symptoms. RESULTS: Among the 52 patients, upper GIT involvement was noted in 50.0% (26/52). The mean age at CD diagnosis was 14.1±2.1 years. Gastric ulcer was the most common lesion (19.2%) found on upper GIT endoscopy, followed by duodenal ulcers (15.4%). Chronic inflammation was the most common histopathologic feature (75.0%), followed by gastric erosion (17.3%). Granuloma was found in 9.6% of patients. Helicobacter pylori infection was identified in 5.8% of patients. Endoscopic and histologic findings were not significantly different, but the mean values of erythrocyte sedimentation rate (60.7±27.1 vs. 43.0±27.6 mm/h, p=0.037) and C-reactive protein (16.5±28.2 vs. 6.62±13.4 mg/dL, p=0.014) were significantly different between patients with and without upper gastrointestinal CD symptoms. CONCLUSION: Upper GIT involvement was relatively common in pediatric patients with CD irrespective of upper gastrointestinal symptoms, and H. pylori infection was relatively uncommon. The results of this study should aid the establishment of regional guidelines for upper GIT examination.
Biopsy ; Blood Sedimentation ; C-Reactive Protein ; Child ; Cohort Studies ; Crohn Disease* ; Diagnosis ; Duodenal Ulcer ; Endoscopy ; Endoscopy, Digestive System ; Gastrointestinal Tract ; Granuloma ; Helicobacter pylori ; Humans ; Inflammation ; Pediatrics ; Prevalence ; Retrospective Studies ; Stomach Ulcer ; Upper Gastrointestinal Tract*