No abstract available.
Electrocardiography*

A 21-year-old man presented with a 7 days history of fever. Careful clinical examination led to the discovery of left supraclavicular lymphadenopathy without hepatosplenomegaly. Serologic tests for Ebstein-Barr virus, HIV, hepatitis type B & C, syphilis and typhoid fever were negative. Blood, urine, and stool cultures yielded no growth. Histologically, the process mainly involved the connective tissue framework of the lymph node, sharing the features of inflammatory pseudotmor(IPT) of other organs: a storiform growth pattern, increased vascularity with associated vascular lesions, and a polymorphous inflammatory infiltrate in a collagen-rich stroma. Immunohistochemical study for spindle cells showed positive reaction for actin and vimentin but not for desmin, and lymphoid cells revealed polyclonality. Characteristics of mass formation, and the inflammatory nautre of the process enabled us adopt the term IPT which should be differentiated from hematolymphoid proliferative disorder or mesenchymal neoplasia.
Male ; Humans

No abstract available.
Humans

This study was undertaken at the department of Obstetrics and Gynecology, Chonnam University Medical School, to investigate the association between some of the risk factor and the incidence of intrauterine fetal growth restriction(IUGR). The studied population was selected from patients who admitted at Chonnam University Hospital during January, 1992 through May, 1997, with following criteria, Korean, singletone pregnancy with live birth and known gestational weeks with 28 or more. And then, the risk factors were analyzed in terms of maternal factor, placental factor, and fetal factor. The following results were obtained. 1) The incidence of IUGR was 6.1%. 2) The incidence of IUGR was higher at young aged mother and nullipara. 3) Only 39.1% of etiologic factors for IUGR was found to have known causes. According to the risk factors for IUGR, hypertensive disorder during pregnancy, anemia, cardiac disease, leukemia, and pulmonary tuberculosis were associated with increased incidence of IUGR. 4) The relative risk of IUGR was much higher in neonates born with congenital anomalies. 5) According to the placental causes of IUGR, placenta previa and placenta abruption showed some association with IUGR.
Anemia ; Fetal Development* ; Fetal Growth Retardation ; Gynecology ; Heart Diseases ; Humans ; Incidence ; Infant, Newborn ; Jeollanam-do ; Leukemia ; Live Birth ; Mothers ; Obstetrics ; Placenta ; Placenta Previa ; Pregnancy ; Risk Factors ; Schools, Medical ; Tuberculosis, Pulmonary

Purpose: To evaluate the risk factors for the development of osteonecrosis in civilian professional divers by an epidemiologic study and to determine the correlation between osteonecrosis in divers and coagulopathy by analysis of serologic markers that are related to thrombophilia and hypofibrinolysis. Materials and Methods: Forty-two divers, who collected pen shells (Atrina pinnata), and among whom 10 had osteonecrosis (group 1), were compared with 32 divers without osteonecrosis (group 2). Both groups were evaluated based on the number of years of diving experience, number of dives per year, mean number of dives per day, mean diving time and depth, and diving methods. We determined any statistically significant differences among these variables. We measured the levels of serologic markers that were related to hyperlipidemia, thrombophilia, and hypofibrinolysis from the divers and a control group of 20 physicians (group 3). The levels of the serologic markers were compared between groups 1 and 2 and between the divers and the control group, in order to determine the relationship between the serologic markers and the development of dysbaric osteonecrosis. Results: None of the variables demonstrated any statistically significant differences, except for the mean diving time, in which group 1 had a mean diving time of 124 minutes and group 2 had a mean diving time of 62.1 minutes (P<0.05). In the analysis of the serologic markers, there were no statistically significant differences between groups 1 and 2; however, in comparison with the group 3, the divers demonstrated significantly decreased activity levels of proteins C and S (Protein C: P<0.05; Protein S: P<0.05), and an increase in the levels of plasminogen activator inhibitor-1 (PAI-1) (P<0.05). Conclusion: The divers with osteonecrosis had a longer mean diving time than did those divers without osteonecrosis. In the serologic marker analysis, the divers with osteonecrosis demonstrated significantly decreased activity levels of Proteins C, S and a significant increase in the levels of PAI-1, compared with the control group.
Biomarkers* ; Diving ; Epidemiologic Studies* ; Epidemiology ; Hyperlipidemias ; Osteonecrosis* ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Protein S ; Risk Factors ; Thrombophilia

Epidural anesthesia for cesarean section requires sensory blockade up to T4 level. 18 to 20 ml of 0.5% bupivacaine, 1.5 to 2.0% lidocaine, or 3.0% chloropmcaine usually produces an adequate sensory blockade to T4 level. However, when we used that amount of local anesthetics, most of the patients often complained of mild to moderate pain or discomfort during delivery of baby, manipulation of peritoneum or the uterus. So we feeled the need of increase in dosage of local anesthetics and we used 26 ml of local anesthetics or local anesthetic-fentanyl mixture. This study was undertaken to measure plasma concentration of lidocaine and observe the possible systemic toxicity of local anesthetics with the total dosage of beyond maximum recom-mended dose. Epidural anesthesia were performed with a 17 gauge Tuohy needle and local anesthetics were injected as follows. Group 1 (n;17): 0.5% bupivacaine 100 mg+2% lidocaine 80 mg+fentanyl 100 ug (50 ug/ml) Group 2 (n; 15): 2% lidocaine 520 mg without epinephrine Group 3 (n; ll): 2% lidocaine 480 mg + fentanyl 100 ug All groups were received 26 ml of local anesthetics or local anesthetic-fentanyl mixture. We checked the level of anesthesia, length of spinal column, cardiovascular changes, plasma concen- tration of lidocaine, toxic systemic reactions and patient's complaints. The plasma concentration of lidocaine were measured by immunofluorescence assay at 2, 5, 7, 10, 12 and 15 minutes after injection of local anesthetics. The results were as follows; 1) The peak plasma concentration of lidocaine were measured 12 minutes after administration of local anesthetics in the group 2 and 3. 2) Sensory blockade up to T4 level could be accomplished within 10 minutes after epidural anesthesia in the group l. 3) In the group 2 and 3, onset of action was more rapid. These groups had a tendency to fall in blood pressure than the group 1, but recovered soon with small dose of ephedrine. 4) In one patient, maximum peak plasma concentration of hdocaine was 6.8 ug/ml, but no adversereaction was observed. Above results suggested that 26 ml of local anesthetics in all groups could be used for appropriate anesthesia for cesarean section with minimal camplications and patient's satisfaction.
Anesthesia ; Anesthesia, Epidural* ; Anesthetics, Local* ; Blood Pressure ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Epinephrine ; Female ; Fentanyl ; Fluorescent Antibody Technique ; Humans ; Lidocaine ; Needles ; Peritoneum ; Plasma* ; Pregnancy ; Spine ; Uterus

Epidural anesthesia for cesarean section requires sensory blockade up to T4 level. 18 to 20 ml of 0.5% bupivacaine, 1.5 to 2.0% lidocaine, or 3.0% chloropmcaine usually produces an adequate sensory blockade to T4 level. However, when we used that amount of local anesthetics, most of the patients often complained of mild to moderate pain or discomfort during delivery of baby, manipulation of peritoneum or the uterus. So we feeled the need of increase in dosage of local anesthetics and we used 26 ml of local anesthetics or local anesthetic-fentanyl mixture. This study was undertaken to measure plasma concentration of lidocaine and observe the possible systemic toxicity of local anesthetics with the total dosage of beyond maximum recom-mended dose. Epidural anesthesia were performed with a 17 gauge Tuohy needle and local anesthetics were injected as follows. Group 1 (n;17): 0.5% bupivacaine 100 mg+2% lidocaine 80 mg+fentanyl 100 ug (50 ug/ml) Group 2 (n; 15): 2% lidocaine 520 mg without epinephrine Group 3 (n; ll): 2% lidocaine 480 mg + fentanyl 100 ug All groups were received 26 ml of local anesthetics or local anesthetic-fentanyl mixture. We checked the level of anesthesia, length of spinal column, cardiovascular changes, plasma concen- tration of lidocaine, toxic systemic reactions and patient's complaints. The plasma concentration of lidocaine were measured by immunofluorescence assay at 2, 5, 7, 10, 12 and 15 minutes after injection of local anesthetics. The results were as follows; 1) The peak plasma concentration of lidocaine were measured 12 minutes after administration of local anesthetics in the group 2 and 3. 2) Sensory blockade up to T4 level could be accomplished within 10 minutes after epidural anesthesia in the group l. 3) In the group 2 and 3, onset of action was more rapid. These groups had a tendency to fall in blood pressure than the group 1, but recovered soon with small dose of ephedrine. 4) In one patient, maximum peak plasma concentration of hdocaine was 6.8 ug/ml, but no adversereaction was observed. Above results suggested that 26 ml of local anesthetics in all groups could be used for appropriate anesthesia for cesarean section with minimal camplications and patient's satisfaction.
Anesthesia ; Anesthesia, Epidural* ; Anesthetics, Local* ; Blood Pressure ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Epinephrine ; Female ; Fentanyl ; Fluorescent Antibody Technique ; Humans ; Lidocaine ; Needles ; Peritoneum ; Plasma* ; Pregnancy ; Spine ; Uterus

Background/Aims: To select appropriate empirical antibiotics, updates on the changes in pathogens are essential. We aimed to investigate the changes in pathogens and their antibiotic susceptibility in acute cholangitis (AC) with bacteremia over a period of 15 years. Furthermore, the efficacy of empirical antibiotic therapies and the risk factors predicting antibiotic-resistant pathogens (ARPs) were analyzed. Methods: A total of 568 patients with AC and bacteremia who were admitted to Daegu Catholic University Medical Center from January 2006 to December 2020 were included. Their medical records were retrospectively reviewed. In addition, the data were grouped and analyzed at 3-year intervals under the criteria of Tokyo Guideline 2018. Results: During the study period, 596 pathogens were isolated from blood cultures of 568 patients. The three most common pathogens were Escherichia coli (50.5%), Klebsiella species (24.5%), and Enterococcus species (8.1%). The proportion of vancomycin-resistant Enterococci (VRE) has increased since the mid-2010 (0.0% to 4.3%, p=0.007). There was emergence of carbapenem-resistant Conclusions The proportion of VRE has increased and CRE has emerged in AC. In addition, healthcare-associated infection, history of previous biliary intervention, and the severity of AC were independent risk factors predicting ARP. For patients with these risk factors, the administration of imipenem or piperacillin-tazobactam should be considered.

Background: /Aim: The aim of this study was to compare clinical features of hypertriglyceridemia-induced acute pancreatitis (HTGAP) with those of biliary acute pancreatitis (BAP) and alcoholic acute pancreatitis (AAP), respectively. Methods: Medical records of patients with acute pancreatitis (AP) who were admitted to our institution from January 2014 to December 2018 were retrospectively reviewed. Disease severity and local complications were evaluated according to the 2012 Revised Atlanta Classification. Systemic complications were evaluated according to the Modified Marshall Scoring System. Results: Of the total 610 patients with AP, those with BAP, AAP, and HTGAP were 310 (50.8%), 144 (23.6%), and 17 (2.8%), respectively. Compared with BAP, HTGAP showed higher proportion of moderately severe acute pancreatitis (MSAP) (64.7% vs. 28.1%, p<0.001) and severe acute pancreatitis (SAP) (17.6% vs. 5.5%, p <0.001). And HTGAP showed more local complications (76.5% vs. 26.8%, p<0.001) and higher recurrence rate (52.9% vs. 6.5%, p <0.001), but there was no significant difference in systemic complications (23.5% vs. 11.6%, p =0.140). Contrarily, there was no significant difference between HTGAP and AAP with respect to disease severity (64.7% vs. 63.9% in MSAP and 17.6% vs. 6.9% in SAP, p =0.181), local complications (76.5% vs. 67.4%, p =0.445), recurrence rate (52.9% vs. 32.6%, p =0.096), and systemic complications (23.5% vs. 11.5%, p =0.233). Conclusions HTGAP showed higher disease severity, more local complications, and higher recurrence rate than BAP. However, there was no significant difference in clinical features between HTGAP and BAP.

Persistent cloaca is a very rare congenital malformation with the incidence of 1/50,000-250,000 births. This malformations have a single common perineal opening for the genital, urinary and gastrointestinal tracts. Because of wide spectrum of abnormal anatomy involving upper urinary tract, gastrointestinal systems, cardiovascular system, central nervous system, and respiratory system, prenatal diagnosis is difficult through ultrasound during pregnancy. It has been reported that if the anomalies are diagnosed early, they can be corrected surgically. We present a case of persistent cloaca with meconium peritonitis and hydrometrocolpos confirmed by neonatal surgery after emergency cesarean section.
Cardiovascular System ; Central Nervous System ; Cesarean Section ; Cloaca* ; Emergencies ; Female ; Gastrointestinal Tract ; Incidence ; Meconium* ; Parturition ; Peritonitis* ; Pregnancy ; Prenatal Diagnosis ; Respiratory System ; Ultrasonography ; Urinary Tract