Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.
Acute Lung Injury ; Anesthesia* ; Anesthesia, General ; Anoxia ; Blood Gas Analysis ; Extracorporeal Membrane Oxygenation* ; Female ; Gastrointestinal Tract ; Humans ; Incidence ; Intubation, Intratracheal ; Laparoscopy ; Middle Aged ; Mortality ; Pneumonia, Aspiration ; Respiration, Artificial ; Stomach Neoplasms

BACKGROUND: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. METHODS: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. RESULTS: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. CONCLUSIONS: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.
Acromion ; California ; Clavicle* ; Humans ; Osteolysis ; Periprosthetic Fractures ; Shoulder ; Skin

PURPOSE: To evaluate the degree of Group B streptococcal colonization in Korean pregnant women of gestational age 35-37 weeks. METHODS: From May 1, 2002 to April 30, 2003, the medical records of 53 pregnant(gestational age from 35 to 37 weeks) women who visited the department of Ob & Gyn, Pusan National Hospital for antenatal care, were reviewed. By use of CDC recommendations, specimens were obtained from lower vagina, cervix and rectum, and inoculated on Lim Broth(selective media, Becton Dikinson Co., Cokeysville, MD, USA) to isolate group B streptococci. RESULTS: The prevalence of group B streptococci in pregnant women was 3.44%(2/58). Two specimens were obtained from cervicovagina; there were no GBS infection signs in their neonate. CONCLUSION: This study reported a 3.44% prevalence rate. GBS colonization in pregnant women (gestational age 35-37weeks) was lower than other countries. By use of CDC recommendation, we reported that our results were meaning. To resolve the reason for low the GBS infection of Korean pregnant women, further studies will be needed.
Busan ; Centers for Disease Control and Prevention (U.S.) ; Cervix Uteri ; Colon ; Culture Media ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Medical Records ; Pregnancy ; Pregnant Women* ; Prevalence ; Rectum ; Streptococcal Infections* ; Streptococcus agalactiae ; Vagina

PURPOSE: Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory infections in infants and young children. Early detection allows quarantining of infected inpatients to prevent nosocomial transmission and to choose a treatment. To achieve rapid reporting, to facilitate prompt antiviral therapy, and to avoid unnecessary use of antibiotics, an easy, rapid diagnostic method for RSV is needed. We evaluated a lateral flow immunochromatography (RSV Respi-Strip test) and EIA (Enzyme immuno assay) compared to RT-PCR. METHODS: From April 2007 to March 2008, 112 consecutive respiratory specimens (nasopharyngeal aspirates, throat swabs, tracheal aspirates, sputum) from patients who were suffering from the clinical signs and symptoms of respiratory tract infection were enrolled in Busan. A total of 112 patients were tested with RSV Respi-Strip (Corio-BioConcept, Belgium), EIA, and RT-PCR at the same time. RESULTS: Of the 112 specimens tested, the number of children who showed positive results at RT-PCR and Respi-Strip were 45 and 42, respectively. The Respi-Strip rapid antigen test had a sensitivity of 88% and a specificity of 94%. The positive and negative predictive values were 90% and 92%, respectively. The agreement was 83%. CONCLUSION: In our study, the rapid antigen test had as much sensitivity as any method for detection of RSV. The test has many advantages such as easy performance, simple interpretation, and rapid results. If the rapid antigen test is widely applied in the clinical setting, the may be useful for diagnostic and epidemiological studies of RSV infection.
Anti-Bacterial Agents ; Child ; Humans ; Immunochromatography ; Infant ; Inpatients ; Pharynx ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Sensitivity and Specificity ; Stress, Psychological

PURPOSE: Polyarteritis nodosa is a necrotizing vasculitis affecting medium and small sized arteries throughout the vascular system, including ocular tissues. We report a case of orbital polyarteritis nodosa complicated with retinal vasculitis and exophthalmos. METHODS: A 51-year-old woman complained of swelling and hard mass in periorbital region for 3 months. The left eye was anophthalmos after enucleation secondary to corneal infection. The patient has treated marginal ulcer of the cornea and keratomalacia. Posterior synechia and motility disturbance of lateral rectus muscle were also revealed. Fundus examination showed focal retinal hemorrhage, macular hard exudate, and soft exudate, which may mean retinal vasculitis. Both eyes gradually developed exophthalmos. Orbital CT scan revealed homogenous infiltration in the orbit, ethmoid bone, and nasal cavity and perforation of the nasal septum. The pathologic examination for the biopsy specimen from the orbital tissue demonstrated a nongranulomatous vasculitis, diagnosing the polyarteritis nodosa. RESULTS: The authors present ocular manifestations, including marginal corneal ulcer, keratomalacia, dysfunction of the extraocular muscles, posterior synechia, retinal hemorrhage, soft exudate, hard exdate in the macula, and exophthalmos, in this patient with the polyarteritis nodosa.
Anophthalmos ; Arteries ; Biopsy ; Cornea ; Corneal Ulcer ; Ethmoid Bone ; Exophthalmos* ; Exudates and Transudates ; Female ; Humans ; Middle Aged ; Muscles ; Nasal Cavity ; Nasal Septum ; Orbit* ; Peptic Ulcer ; Polyarteritis Nodosa* ; Retinal Hemorrhage ; Retinal Vasculitis* ; Retinaldehyde* ; Tomography, X-Ray Computed ; Vasculitis

No abstract available.
Humans ; Sexual Behavior* ; Uterine Cervical Neoplasms*

PURPOSE: Cerebral edema in meningitis is a potentially complication. Hypertonic saline of various concentrations are frequently used to treat cerebral edemas in meningitis. We analyzed the safety and efficacy of osmotic therapy in cerebral edema by comparison of various hypertonic saline concentrations and mannitol. METHODS: The medical records of 42 patients, who were followed up in the Department of Pediatrics, Busan Medical Center, from Jan. 2002 to Oct. 2005, were analyzed retrospectively. We measured intracranial pressure, mean flow velocity, and various laboratory parameters. RESULTS: In cerebral edema developed in meningitis, intracranial pressure and symptoms were improved in treatment of hypertonic saline and mannitol. Serial bolus infusion of 3 percent hypertonic saline resulted in the best outcome. There was not a statistically considerable difference on the mean values of the intracranial pressure gap. On transcranial doppler, mean flow velocity was increased and pulsatilty index was decreased. Laboratory findings (osmolarity, Na, Cl, pH, lactic acid, Ca) were diffenent during the treatment period as opposed to K, Hb, bicarbonate, base excess. There was not a specific form of hypertonic saline used in meningitis treatment with cerebral edema. CONCLUSION: The therapy for cerebral edema in meningitis remains largely empirical. Serial bolus infusion of 3 percent hypertonic saline is better than other hypertonic salines. Various concentrations and different infusion methods of hypertonic saline statistically does not influence the result of treatment. More research aimed at improving cerebral edema treatment is needed to identify new, effective forms of treatment.
Brain Edema* ; Busan ; Humans ; Hydrogen-Ion Concentration ; Intracranial Pressure ; Lactic Acid ; Mannitol ; Medical Records ; Meningitis* ; Pediatrics ; Retrospective Studies

No abstract available.
Cyclosporine* ; Scleroderma, Localized*

No abstract available.
Cyclosporine* ; Scleroderma, Localized*

No abstract available.
Disabled Persons* ; Female ; Humans ; Menarche*