Cardiac rupture following blunt thoracic trauma is rarely encountered, since it commonly causes death at the scene. With advances in critical care, blunt cardiac rupture has been successfully treated with well-organized team approach including an emergency physician, anesthesiologist, and cardiac surgeon. We encountered a patient with blunt cardiac rupture of the junction of the superior vena cava and right atrium that extended 7 cm to the right ventricular junction. The patient was successfully resuscitated after a closed thoracostomy and pericardiocentesis with fluid loading. Cardiac injury was repaired via mid-sternotomy without cardiopulmonary bypass. The patient recovered without complications and was discharged on the 7th day after surgery.
Cardiopulmonary Bypass ; Critical Care ; Emergencies ; Heart Atria* ; Heart Injuries ; Heart Rupture* ; Humans ; Pericardiocentesis ; Thoracostomy ; Vena Cava, Superior*

Juvenile xanthogranuloma is characterized by one, or oftener many, yellow, re3dish yellow, or, brown 4-to-20 mm papules or nodules on the face, scalp, trunk, and mostly, extensor surfaces. It may involve internal organ besides the skin such as eye, gastrointestinal and genitourinary tracts. anthogranuloma in adult is usually solitary and dose not involve organs other than skin, and generally dose ncit resolve without treatment. Histopathologically, characteristic Touton giant cells usually appear numerously. We report a case of juvenile xanthogranulorna which occured on scalp of 49 year-old male showing typical clinical and histopathological findings.
Adult* ; Giant Cells ; Humans ; Male ; Middle Aged ; Scalp* ; Skin ; Xanthogranuloma, Juvenile

Purpose: Internuclear ophthalmoplegia (INO) is an eye movement disorder caused by a lesion of the medial longitudinal fasciculus. It typically manifests bilaterally and is commonly caused by multiple sclerosis. We report a case of pediatric unilateral INO, which is rare in the pediatric population.Case summary: A 14-year-old female, with a history of traumatic head injury 9 days previously, presented with diplopia, nausea and vomiting for the past 5 days. Her ophthalmic examination revealed severely impaired adduction of the right eye and abduction nystagmus in the left eye. Orbital computed tomography showed no evidence of orbital wall fracture or muscle impingement. However, an magnetic resonance imaging of her brain demonstrated an infarct in the right paramedian midbrain, leading to a diagnosis of unilateral INO. Diplopia and impaired adduction of the right eye resolved completely 7 weeks after the trauma. Conclusions Demyelinating diseases, such as multiple sclerosis, account for most of the pediatric INO cases. Although most of these cases are bilateral, this reports highlights a pediatric case of unilateral INO following head injury, which is an uncommon occurrence in this age group.

The simultaneous occurrence of primary glomerulonephritis in identical twins has been rarely reported previously. It has suggested that genetic factors may play an important role in the pathogenesis of primary glomerulonephritis. We describe a pair of 17-year-old identical twin brothers with asymptomatic proteinuria, one with histologically proven minimal change disease and the other with focal segmental glomerulosclerosis. HLA typing in twin brothers revealed an identical phenotype consisting of A25, A33, B44, B54, Cwl, Cw7, DR7 and DRB1. To our knowledge, this is the first case of glomerulonephritis in identical twins in Korea.
Adolescent ; Glomerulonephritis ; Glomerulosclerosis, Focal Segmental* ; Histocompatibility Testing ; Humans ; Korea ; Nephrosis, Lipoid* ; Phenotype ; Proteinuria ; Siblings* ; Twins, Monozygotic*

BACKGROUND: Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. METHODS: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. RESULTS: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax (n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complication free probability is significantly higher in group 1 (p = 0.040). CONCLUSIONS: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.
Catheterization ; Catheters ; Follow-Up Studies ; Humans ; Incidence ; Jugular Veins ; Medical Records ; Motor Activity ; Pneumothorax ; Retrospective Studies ; Subclavian Vein ; Vascular Access Devices ; Vena Cava, Superior ; Venous Thrombosis

We found an error in this article. The author's affiliation.

Surgical treatment of congenital scoliosis is often frustrating due to its severity and rigidity. Many surgical methods were provided for these complex deformities and some instruments were used to achieve better correction. However, no surgical treatment was satisfactory to correct the deformities. Recently, pedicle screw fixation, enabling a powerful grip of individual vertebral segment, is becoming a promising method to enhance correction of these tenacious deformities. This study was to compare the correction, loss of correction and complications of the various surgical methods employed for congenital scoliosis in Seoul National University Hospital and to verify the advantages of pedicle screw fixation. Ninety-two congenital scoliosis subjected to surgery and followed up for more than 2 years(range 2-9 years) were analysed. Surgical methods were; anterior uninstrumented fusion, 5; posterior fusion, 50(14 without instrument, 15 with hooks, 21 with screws); combined anterior and posterior fusion, 37(7 without instrument, 11 with posterior hooks, 10 with posterior screws, 9 with anterior VDS and posterior screws). Mean preoperative magnitude of index curve was 58° with no significant difference between the groups except for the anterior VDS and posterior screw group which had a mean magnitude of 93°. Mean flexibility of index curve was 18.7% with no significant difference between groups. The correction of index curves were; anterior uninstrumented fusion, 23%; posterior uninstrumented fusion, 28%; posterior hook, 31%; posterior screw, 46%; combined anterior and posterior uninstrumented, 37%; anterior fusion and posterior hook, 30%; anterior fusion and posterior screw, 47%; anterior VDS and posterior screw, 48%. The correction of pedicle screws were significantly better(p < 0.01) with significantly smaller loss of correction(p < 0.01). Nonunion occurred in 4, 1 in posterior uninstrumented fusion, 2 in posterior hooks and 1 in posterior pedicle screws with concomitant instrument failures. However, there were no neurologic or visceral complications related to screw placement. Pedicle screw fixation offers an enhances correction of congenital scoliosis with low complication rate, and when combined with an anterior procedure, enables control of the most severe and rigid curves.
Congenital Abnormalities ; Hand Strength ; Methods ; Pedicle Screws ; Pliability ; Scoliosis ; Seoul

No abstract available.
Cholera* ; Korea*

PURPOSE: Ventricular repolarization is assessed using the QT interval corrected by the heart rate (QTc) via an electrocardiogram (ECG). Prolonged QTc is associated with an increased risk of arrhythmias and cardiac mortality. As there have been few reports regarding the effects of hyperthyroidism on ventricular repolarization, we studied the association between serum free thyroxine (free T4 [fT4]) and thyroid stimulating hormone (TSH) levels and the QTc interval. METHODS: Thirty-eight patients with hyperthyroidism (<30 years old) were included, and we used their clinical records and available ECGs (between August 2003 and August 2011) to evaluate the association between their fT4 and TSH levels and their QTc interval. In addition, we studied the ECGs of 72 age-matched patients with no hyperthyroidism (control group) and compared their data with that from the patients group. RESULTS: The QTc duration in patients with hyperthyroidism was significantly prolonged compared to that in the control subjects (P<0.001). In addition, the number of hyperthyroid patients with abnormal prolonged QTc was significantly higher than that in the control group (P<0.001). Among the patients with hyperthyroidism, patients with prolonged QTc and borderline QTc had higher fT4 levels and there was positive correlation between their fT4 levels and their QTc interval (P<0.05). However, no correlation was observed between their TSH levels and their QTc interval. CONCLUSION: We report that hyperthyroidism is associated with QTc prolongation. The correlation between the fT4 levels and the QTc interval suggests that thyroid status is associated with QTc values and the risk of cardiac mortality.
Arrhythmias, Cardiac ; Electrocardiography ; Heart Rate ; Humans ; Hyperthyroidism* ; Long QT Syndrome ; Mortality ; Thyroid Gland* ; Thyrotropin ; Thyroxine

BACKGROUND: The Fogarty thromboembolectomy catheter technique was devised to extract distal arterial emboli and it represents a milestone for the treatment of patients with acute arterial occlusion since the 1960s. The major causes of arterial occlusion have changed from emboli of a heart origin to atherosclerosis over the past 30 years. Accordingly, questions have been raised about the effectiveness of simple Fogarty thromboembolectomy. MATERIAL AND METHOD: During the period from March 1990 through August 2008, 156 patients who requiring Fogarty thromboembolectomy were analyzed. The patients were divided into two groups: those with simple Fogarty thromboembolectomy (Group 1, 79 patients) and those with additional vascular bypass graft surgery (Group 2, 77 patients). The duration of symptoms, the cause of thrombi, admission via the emergency room, a history of acupuncture or misdiagnosis, combined diseases, the anatomic occlusion site and the cause of death were analyzed using T-tests, cross tab tests, Chi square tests and Kaplan-Meier tests, respectively. RESULT: The mean age was 64+/-10 years in the 2 groups. The duration of symptoms (pain) in Group 1 vs Group 2 was 12+/-4 days vs 71+/-14 days (p=0.001). 50 (63%) patients in Group 1 were admitted via the emergency room vs 18 (23%) patients in Group 2 (p=0.005). Misdiagnosis and the treatment for herniated intervertebral disc or acupuncture were given to 20 (25%) patients in Group 1 vs 30 (39%) patients in Group 2. Anticoagulation treatment before admission was performed in 22 (28%) patients in Group 1 vs 11 (14%) patients in Group 2. The causes of thrombi were heart disease in 24 (30%) patients in Group 1 vs 6 (8%) patients in Group 2 (p=0.001), atherosclerosis in 46 (58%) patients in Group 1 vs 67 (87%) patients in Group 2 (p=0.001) and trauma in 9 (11%) patients in Group 1 vs 6 (8%) patients in Group 2. The combined diseases were cerebrovascular accident, hypertension and diabetes mellitus in 22~37% of the total patients. The occlusion sites were mainly in the iliac and femoral arteries. Endarterectomy was performed in 7 (9%) patients in Group 1 vs 18 (23%) patients in Group 2 (p=0.012). Treatment was successful in 27 (34%) patients in Group 1 and in 40 (52%) patients in Group 2 (p=0.019). Reocclusion occurred in 37 (47%) patients in Group 1 vs 20 (26%) patients in Group 2 (p=0.000). Amputation was done in 4 (5%) patients in Group 1 vs 12 (16%) patients in Group 2 (p=0.012) and death occurred in 10 (13%) patients (Group 1) vs 3 (4%) patients (Group 2) (p=0.044). CONCLUSION: The recent past has shown a decline in the effectiveness of simple Fogarty thromboembolectomy with a changing pattern of acute arterial occlusion from a rheumatic heart origin to atherosclerosis. Additional bypass procedures play a role for the treatment of arterial occlusion instead of always performing simple Fogarty thromboembolectomy.
Acupuncture ; Amputation ; Atherosclerosis ; Catheters ; Cause of Death ; Diabetes Mellitus ; Diagnostic Errors ; Emergencies ; Endarterectomy ; Femoral Artery ; Heart ; Heart Diseases ; Humans ; Hypertension ; Intervertebral Disc ; Kaplan-Meier Estimate ; Peripheral Vascular Diseases ; Stroke ; Thromboembolism ; Transplants