PURPOSE: To evaluate dysphagia objectively and quantitatively, and ta clarify the effect of neck position and viscosity changes in patients with aspiration and laryngeal penetration. MATERIALS AND METHODS: We studied 35 patients with dysphagia and 21 normal controls using videofluoroscopy and scintigraphy. Videofluoroscopy was performed with barium with three different viscosity, and scintigraphy was done, with water, yogurt, and steamed egg mixed with Tc-99m tin colloid. 1f aspiration was found during videofluoroscopic examination, patients neck position was changed and study repeated. Videofluoroscopy was analyzed qualitatively. We calculated 7 quantitative parameters from scintigraphy. According to the videofluoroscopic findings, we divided patients into 3 subgroups; aspiration, laryngeal penetration, and no-aspiration group. RESULTS: The result of videofluoroscopy revealed that the most cornmon finding was the delay in triggering pharyngeal swallow. Pharyrigeal transit time (PTT) and pharyngeal swallowing efficiency(PSE) in patients with aspiration were significantly different from other groups. After neck position change, aspiration could be reduced in all of 7 patients, and laryngeal penetration reduced hy about 82%. PTT ancl PSE were also improved after position change. Aspiration and laryngeal penetration occurred more frequently in thin liquid swallowing than in thick liquid and solid swallowing. CONCLUSION: PTT and PSE were useful for the evaluation of dysphagia. Aspiration and laryngeal penetration could be reduced when appropriate position assumed, We could decrease the chance of aspiration by changing the patient diet consisIency. Scintigraphy might be useful tool to quantitate and follow up these changes.
Barium ; Colloids ; Deglutition ; Deglutition Disorders* ; Diet ; Evaluation Studies as Topic* ; Follow-Up Studies ; Humans ; Neck ; Ovum ; Radionuclide Imaging* ; Steam ; Tin ; Viscosity ; Water ; Yogurt

BACKGROUND: The aim of this study was to evaluate the influence of an improved method of endotracheal suction on nosocomial pneumonia (NP) and tracheal colonization by Pseudomonas aeruginosa and Acinetobacter baumannii in intensive care units (ICUs). METHODS: The study was carried out in both the medical and surgical ICUs of a tertiary-care university hospital; 2,347 patients were admitted in the ICUs from January 2003 to December 2004. The method of endotracheal suction to remove secretions was improved by using a sterile, individually packed catheter and sterile fluid filled in a small container for a single use instead of sterile catheters and fluid packed or filled in large containers for a multiple use. Then, we compared the incidence of NP, the colonization rates of P. aeruginosa and A. baumanni in the respiratory tract, and their carbapenem resistance before and after the intervention. RESULTS: The incidence of NP (1,000 patient-day rate) was decreased from 4.08 to 2.46 in the SICU and from 1.4 to 0.8 in the MICU after the intervention, but the differences were not significant. The colonization rate by A. baumannii was decreased significantly from 35.7% to 4.6% in the SICU (P<0.001) and from 12.7% to 7.6% in the MICU (P<0.001). The colonization rate by P. aeruginosa was decreased significantly from 17.7% to 7.4% in the SICU (P<0.001), but not in the MICU. There was also a marked decrease in carbapenem resistance, 21% to 8% in P. aeruginosa and 70% to 16% in A. baumannii. CONCLUSION: Endotracheal suction with a sterile catheter and sterile fluid is important in preventing respiratory infections and colonization by P. aeruginosa and A. baumannii in the ICU.
Acinetobacter baumannii* ; Acinetobacter* ; Catheters ; Colon* ; Drug Resistance, Bacterial ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Pneumonia* ; Pseudomonas aeruginosa* ; Pseudomonas* ; Respiratory System ; Respiratory Tract Infections ; Suction*

BACKGROUND: It has been reported that heart disease is the most common cause of sudden death in children. There have been relatively few studies concerning heart disease screening of school children in Korea. This study was to evaluate the usefulness of 12-lead ECG for mass screening of heart disease in elementary school children. METHODS: Mass screening of heart disease with 12-lead ECG was done in 17,343 first grade elementary school children(male 8,948, female 8,395) in Kwangju area during 4 months period since September 1992. Among 200 children(male 135, female 65) who showed abnormal electrocardiographic findings, 128 were referred to pediatric cardiologist for detection of heart diseases by thorough examinations including 24-hour ECG, echordiography, cardiac catherization and angiocardiography. RESULTS: 1) The incidence of 12-lead ECG abnormalities was 1.2%. Male outnumbered female in the incidence of abnormalities(0.8% vs 0.4%). 2) Incomplete right bundle branch block was the most frequent ECG abnormality with the incidence of 5.3 among 1,000, followed by right ventricular hypertrophy and premature ventricular contraction, both of them stand the next common abnormalities with the same incidence of 1.6 among 1,000. 3) Out of 39 cases undergoing echocardiography, seven were found to have structual heart abnormalities : 6 atrial defects and one ventricular septal defect. 4) All patients having structual defects but one with atrial septal defect underwent open heart surgery without problems. CONCLUSION: These results suggest that routine 12 lead ECG be one of the useful methods for mass screening of heart disease and imply that establishment of heart disease screening system is necessary for the health promotion of the school chidren with heart disease.
Angiocardiography ; Bundle-Branch Block ; Child* ; Death, Sudden ; Echocardiography ; Electrocardiography ; Female ; Gwangju ; Health Promotion ; Heart Defects, Congenital ; Heart Diseases* ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Hypertrophy, Right Ventricular ; Incidence ; Korea ; Male ; Mass Screening* ; Thoracic Surgery ; Ventricular Premature Complexes

Authors concluded an experimental study in order to find out what the effects of parathyroid hormone on cells derived from human Trabecular bone in vitro are on terms of proliferation of cells, adenylate cyclase activity and production of small substances such as osteocalcin and collagen type I. The results were as follows; 1. 3H-thymidine incorporation into cultured osteoblast was initially low (day 1–2), increased by exponential curve from day 3 till day 11. The uptakes of 3H-thymidine by osteoblasts, when bovine parathyroid hormone was added, increased dose-dependently. Greater increments were seen at concentrations of bovine PTH higher than 5.0 X10-8 mole. 2. Intracellular c-AMP accumulation was stimulated by bovine PTH in a dose-dependent manner and greater production was seen at concentrations of bovine PHT higher than 5.0 X10-8 mole. Maximal stimulation was observed at 1 X10-7 mole of bovine PTH. The concentrations of c-AMP were observed significantly higher in the presence of bovine PTH in a dose-dependent manner when compared to those of bovine PTH-absent culture condition. 3. Treatment with bovine parathyroid hormone of cultured osteoblasts resulted in increase of alkaline phophatase activity and synthesis of osteocalcin in the cultured media in a dose-dependent manner. Greater productions were observed at concentrations of bovine PTH higher than 5.0 X10-8 mole. 4. Synthesis of type I collagen by cultured osteoblasts in bovine PTH-added media was inversely proportional to their concentration, whereas control group showed minimal increments of no significance. These in vitro findings may suggest that PTH has a stimulatory effect on proliferation of osteoblast, c-AMP production and alkaline phosphatase activity in a direct manner.
Adenylyl Cyclases ; Alkaline Phosphatase ; Cell Proliferation ; Collagen Type I ; Humans ; In Vitro Techniques ; Osteoblasts ; Osteocalcin ; Parathyroid Hormone

Free flaps have been widely used in lower leg reconstruction. However, in cases with extensive injury to the vessels as well as to the bone and soft tissues, and having only one intact major vessel in the lower leg(single vessel leg), careful selection of recipient vessels for the free flap transfer is mandatory for preventing further vascular compromise of the distal lower leg. The sural artery and its vena comitantes are frequently protected form externally harmful forces by the bulky surrounding gastrocnemius muscle and can be used as recipient vessles for free flaps without any detrimental influence on the vascularity of the distal lower leg. In our department, three latissimus dorsi muscle free flap were transferred with sural vessels as recipient vessels in the reconstruction of the single vessel legs. Except for one case of flap failure due to serious infection at the microvascular anastomoses site, all the other cases were successfully reconstructed without any necrosis of the gastrocnemius muscle or the distal leg. In addition, the sural vessels were easily accessed in any patient position and their caliber was similar to that of the vascular pedicles of the donor muscle flaps. In conclusion, the sural vessels can be another useful option in selecting recipient vessels for free flap transfer in the reconstruction of the single vessel leg.
Arteries ; Free Tissue Flaps* ; Humans ; Leg* ; Muscle, Skeletal ; Necrosis ; Superficial Back Muscles ; Tissue Donors

OBJECTIVE: Interhemispheric subdural hematoma (IHSDH) is uncommon, because of their unusual location. However, it is a distinct lesion with its unique characteristics. We investigated clinical features and outcomes of consecutive 42 patients with IHSDH, retrospectively. METHODS: From 2006 to 2015, we treated 105 patients with IHSDH. All patients were diagnosed by computed tomography (CT) or magnetic resonance imaging. We selected 42 patients with thick (3 mm or more) IHSDH. We retrospectively reviewed the clinical and radiological findings, management and outcomes. RESULTS: The male to female ratio was 2:1. Two thirds of the patients were over 60 years old. Slip or fall was the most common cause of trauma. The level of consciousness on admission was Glasgow Coma Scale (GCS) 13 to 15 in 25 patients. The most common symptom was headache. All IHSDH was hyperdense in CT at the time of diagnosis. IHSDH frequently accompanied convexity subdural hematoma. The outcome was favorable in 27 patients, however, six patients were expired. Twenty-two patients were managed conservatively. Surgery was performed in ten patients to remove the concurrent lesion. The outcome was poor in spontaneous one, patients with low GCS, and patients with conservative treatment. CONCLUSION: IHSDH is rare especially the isolated one. The outcome was dependent to the severity of injury. Surgery may be helpful to remove the concurrent mass lesion, however, conservative treatment is generally preferred.
Consciousness ; Craniocerebral Trauma ; Diagnosis ; Female ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Headache ; Hematoma, Subdural* ; Humans ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Symptom Assessment

OBJECTIVE: From November 30, 2016, the Korean Government carried the revised Medical Dispute Mediation and Arbitration Act into effect. Mediation will start automatically without agreements of the defendant, when the outcome of the patient was death, coma more than a month or severe disability. Cerebral aneurysm has a definite risk of bad outcome, especially in the worst condition. Any surgical intervention to this lesion has its own high risk of complications. Recently, Seoul central district court decided 50% responsibility of the doctors who made a rupture of the aneurysm during coiling (2015Ga-Dan5243104). We reviewed judicial precedents related to cerebral aneurysms in lawsuit using a web search.METHODS: We searched judicial precedents at a web search of the Supreme Court, using the key words, "cerebral aneurysm".RESULTS: There were 15 precedents, six from the Supreme Court, seven from the High Court, and two from district courts. Seven precedents were related to the causation analysis, such as work-relationship. Five precedents were malpractice suits related bad results or complications. Remaining three precedents were related to the insurance payment. In five malpractice precedents, two precedents of the Supreme Court reversed former two precedents of the High Court.CONCLUSION: Judicial precedents on the cerebral aneurysm included not only malpractice suits, but also causation analysis or insurance payment. Attention to these subjects is needed. We also need education of the independent medical examination. To avoid medical disputes, shared decision making seems to be useful, especially in cases of high risk condition or procedures.
Aneurysm ; Coma ; Decision Making ; Dissent and Disputes ; Education ; Expert Testimony ; Humans ; Insurance ; Intracranial Aneurysm ; Malpractice ; Negotiating ; Rupture ; Seoul

We describe moderate hyperbilirubinemia in a 28-year-old man who suffered from gallstones and splenomegaly, with combined disorders of hereditary spherocytosis (HS) and Gilbert's syndrome (GS). Since it is difficult to diagnose HS in the absence of signs of anemia, we evaluated both the genetic mutation in the UGT1A1 gene and abnormalities in the erythrocyte membrane protein; the former was heterozygous for a UGT1A1 allele with three mutations and the latter was partially deficient in ankyrin expression. This is the first report of the concomitance of HS and GS with three heterozygous mutations [T-3279G, A (TA)7TAA, and G211A] in the UGT1A1 gene.
Adult ; Alleles ; Ankyrins/metabolism ; Electrophoresis, Polyacrylamide Gel ; Gallstones/surgery ; Gilbert Disease/complications/*diagnosis/genetics ; Glucuronosyltransferase/chemistry/genetics/metabolism ; Heterozygote ; Humans ; Male ; Mutation ; Protein Structure, Tertiary ; Sequence Analysis, DNA ; Spherocytosis, Hereditary/complications/*diagnosis/genetics ; Splenomegaly/diagnosis

No abstract available.
Oocyte Donation* ; Oocytes*

No abstract available.
Fertilization* ; Oocytes*