Tracheobronchial rupture following tracheal intubation with double-lumen endobronchial tube (DLT) is a rare complication, but may result in a massive air leakage with resultant pneumothorax, mediastinal emphysema and extensive subcutaneous emphysema in the postoperative period. We report a case of sustained laceration of the posterior membranous part of the trachea possibly due to overinflation of the double-lumen endobronchial tube. A 76-year-old, 45 kg, female was scheduled for a repair of her bronchopleural fistula. Following induction of anesthesia, intubation was performed with Robertshaw's DLT, and a tracheal cuff was inflated with 6 ml of air, but the sound of an air leak was heard coming from the patient's mouth during controlled ventilation. A further 5 ml of air was added 1 ml at a time into the tracheal cuff but the air leak sound continued. At that point, the sound was considered to originate from the bronchopleural fistula rather than from lack of sufficient air. After a thorough deflation of the tracheal cuff, 6 ml of air was reinjected and the operation was resumed. A 4 cm split was unexpectedly noticed in the posterior wall of the trachea during the operation and was repaired without complication.
Aged ; Anesthesia ; Female ; Fistula ; Humans ; Intubation ; Lacerations ; Mediastinal Emphysema ; Mouth ; Pneumothorax ; Postoperative Period ; Rupture* ; Subcutaneous Emphysema ; Trachea ; Ventilation

BACKGROUND: To evaluate the usefulness of admission and daily acute physiology and chronic health evaluation (APACHE) III score in relation to length of stay in the intensive care unit (ICU) for outcome prediction, 4,554 patients were studied. METHODS: These patients were admitted to the ICU from June 6, 1994 to December 31, 2002. Exclusion criteria included patients being treated for burns, having surgery for coronary artery bypass grafts, having a diagnosis of myocardial infarction, being under 16 years of age and being discharged less than 16 hours after admission. To evaluate the discrimination power of admission and daily APACHE III score, the area under the receiver operating characteristic curve was computed for each of the initial 16 days of ICU care. RESULTS: Admission APACHE III score loses discrimination power over time, from admission day to day 4 in the ICU, the area under the receiver operating characteristic curve was above 0.8 and after day 16, it dropped to below 0.7. However, daily APACHE III score maintained discrimination power at about 0.8 over time. CONCLUSIONS: In the early days after ICU admission, admission and daily APACHE III score are useful. With time daily APACHE III scores are more useful than admission APACHE III score.
APACHE* ; Burns ; Coronary Artery Bypass ; Diagnosis ; Discrimination (Psychology) ; Humans ; Intensive Care Units ; Length of Stay* ; Myocardial Infarction ; ROC Curve ; Transplants

Pulmonary epithelioid hemangioendothelioma (PEH), originally termed an intravacular bronchioloalveolar tumor, is a rare pulmonary neoplasm with a vascular origin and slow rate of malignancy. It affects various organs such as the liver, the central nervous system, lung, etc. Clinically, pulmonary epithelioid hemangioendothelioma has been considered to be a borderline malignancy, a generally indolent and nonaggressive tumor that displaes the pulomonary parenchyma over a number of years by slowly enlarging the tumor nodule. The clinical course of PEH is known to be usually benign. Here we report an unusual case of PEH that was highly malignant and was eventually fatal. The PEH was confirmed by microscopic analysis and hmmunohistochemical staining of CD31+(a membrane receptor and a sensitive and specific marker for vascular lesions) from an open lung biopsy specimen.
Biopsy ; Central Nervous System ; Hemangioendothelioma, Epithelioid* ; Liver ; Lung ; Lung Neoplasms ; Membranes

Kniest syndrome (OMIM #156550) is a rare autosomal dominant disorder caused by a dysfunction of type II collagen, which is encoded by the COL2A1 gene (OMIM +120140) mapped to chromosome 12q13.11. Type II collagen, a molecule found mostly in the cartilage and vitreous tissues, is essential for the normal development of bones and other connective tissues. Kniest syndrome is a type II collagenopathy that presents as skeletal abnormality associated with disproportionate dwarfism, kyphoscoliosis, enlarged joints, visual loss, hearing loss, and cleft palate. This report describes a Korean patient with Kniest syndrome who was diagnosed with typical clinical features and radiologic findings. The patient presented with disproportionately short stature and kyphoscoliosis from birth. A skeletal survey revealed fused lamina in the thoracic spine, hemivertebrae, flexion deformities in multiple joints, and plagiocephaly.
Cartilage ; Cleft Palate ; Collagen Type II ; Congenital Abnormalities ; Connective Tissue ; Dwarfism ; Hearing Loss ; Humans ; Joints ; Parturition ; Plagiocephaly ; Spine

Kniest syndrome (OMIM #156550) is a rare autosomal dominant disorder caused by a dysfunction of type II collagen, which is encoded by the COL2A1 gene (OMIM +120140) mapped to chromosome 12q13.11. Type II collagen, a molecule found mostly in the cartilage and vitreous tissues, is essential for the normal development of bones and other connective tissues. Kniest syndrome is a type II collagenopathy that presents as skeletal abnormality associated with disproportionate dwarfism, kyphoscoliosis, enlarged joints, visual loss, hearing loss, and cleft palate. This report describes a Korean patient with Kniest syndrome who was diagnosed with typical clinical features and radiologic findings. The patient presented with disproportionately short stature and kyphoscoliosis from birth. A skeletal survey revealed fused lamina in the thoracic spine, hemivertebrae, flexion deformities in multiple joints, and plagiocephaly.
Cartilage ; Cleft Palate ; Collagen Type II ; Congenital Abnormalities ; Connective Tissue ; Dwarfism ; Hearing Loss ; Humans ; Joints ; Parturition ; Plagiocephaly ; Spine

High selectivity provided by biomolecules such as antibodies and enzymes has been exploited during the last two decades for development of biosensors. Of particular importance are efficient immobilization methods for biomolecules in order to preserve their biological activities. In this study, we have evaluated immobilization strategies for an anti-DNA antibody on a self-assembled monolayer of omega-functionalized thiols. The antibody was immobilized via peptide bond formation between the primary amines in the antibody and the carboxyl groups on the self-assembled monolayer. The peptide bond coupling was achieved by activating COOH groups on the surface through N-Hydroxysuccimide (NHS)-ester formation, followed by acylation of NH2 group in the antibody. DNA binding activity of the immobilized antibody was examined by counting beta emission from 35S-labeled DNA.
Antibodies, Antinuclear* ; DNA/immunology ; DNA/analysis* ; DNA-Binding Proteins/chemistry ; Gold ; Membranes, Artificial ; Polymerase Chain Reaction ; Polyvinyls/chemistry ; Radioimmunoassay/methods* ; Thioctic Acid/chemistry

OBJECTIVE: To investigate the association of genetic background between MTHFR C677T genotype and infertile females with polycystic ovarian syndrome. MATERIALS AND METHODS: We compared 86 infertile females with polycystic ovarian syndrome (PCOS) with 100 healthy fertile females with one or more offspring. Pyrosequencing analysis for MTHFR C677T variation was performed on polymerase chain reaction (PCR) product of study group. To validate pyrosequencing data of C677T variation for randomly selected 50 samples, we compared the pyrosequencing result with the PCR-RFLP (Restriction Fragment Length Polymorphism) result of MTHFR C677T genotype. RESULTS: The prevalence of the C677T mutant homozygous (TT) was significantly lower (p=0.0085) in females with PCOS (8.14%) than in fertile females (21.00%). MTHFR 677 TT genotype had a decreased risk (3.7-fold) of PCOS compared with wild type (MTHFR 677 CC). CONCLUSION: Our data support a role for MTHFR mutant homozygous (677 TT) genotype in reducing risk in Korean infertile females with Polycystic ovarian syndrome.
Female* ; Genotype ; Humans ; Korea* ; Oxidoreductases* ; Polycystic Ovary Syndrome* ; Polymerase Chain Reaction ; Prevalence

Idiopathic bronchiolocentric interstitial pneumonia is one of idiopathic interstitial pneumonia, which has a relatively aggressive course and poor prognosis. It is characterized by diffuse centrilobular nodules radiologically with mainly bronchiolocentric inflammation and fibrosis associated with patchy alveolitis lacking interstitial granuloma histologically. This disorder is a recently classified disease category, and to our knowledge, there is no case report in Korea. We present a case of idiopathic bronchiolocentric interstitial pneumonia. A 62-year-old man presented with exertional dyspnea with a 1 month duration. The radiological findings showed extensive centrilobular lesions at both lungs. The surgical lung biopsy specimen demonstrated a centrilobular inflammatory process with small airway fibrosis and inflammation partially radiating into the interstitium. Therefore, the patient was diagnosed with idiopathic bronchiolocentric interstitial pneumonia. He was treated with immunosuppressants including steroids and azathioprine. However, his symptoms did not improve and he expired 7 months later due to an acute exacerbation of the interstitial pneumonia and probable infectious pneumonia.
Azathioprine ; Biopsy ; Bronchiolitis ; Dyspnea ; Fibrosis ; Granuloma ; Humans ; Idiopathic Interstitial Pneumonias ; Immunosuppressive Agents ; Inflammation ; Korea ; Lung ; Lung Diseases, Interstitial ; Middle Aged ; Pneumonia ; Prognosis ; Steroids

BACKGROUND: To aware of postoperative residual neuromuscular block (PRNB) is important in that it can cause apnea, delay of awakening and recovery and dissatisfaction of patient.This study aimed to evaluate the PRNB at recovery room and it's course during postoperative periods. METHODS: A questionnaire designed to provide information concerning PRNB, monitoring and reversal on neuromuscular block was sent to all members of the Korean Society of Anesthesiologists by e-mail.The contents of survey were about the incidence of PRNB, the monitoring methods of the muscle relaxation.We also investigated the usual type of neuromuscular blocker and reversal agents. RESULTS: Most responders (85.9%) concerned about the PRNB of which causing a serious problem.More people answered that clinical evaluation was more reliable (83.3%) than tetanic stimulation (46.2%) and neuromuscular monitoring might reduce PRNB. Some responders (11.5%) sometimes omitted the reversal of neuromuscular block.Quantitative neuromuscular monitoring devices were not enough to use in all patients at all hospitals. CONCLUSIONS: The responders had great interest to PRNB but neuromuscular monitoring and reversal of neuromuscular blockade were underused.
Apnea ; Humans ; Incidence ; Muscle Relaxation ; Muscles ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Recovery Room ; Surveys and Questionnaires

Actinomycosis is a chronic suppurative and granulomatous disease. Actinomyces is a gram positive, anaerobic and non-acid fast bacterium. Many actinomycotic pelvic infection in women used intrauterine device(IUD) with long duration were reported, in contrast, others suggest that actinomycosis develop opportunistic infection irrespective of intrauterine device. One to ten percents of patients with acute pelvic inflammatory disease(PID) develop perihepatic inflammation and adhesion---the Fitz-Hugh-Curtis syndrome. Although in the past Neisseria gonorrhea was thought to be the only etiological agent, recent data indicate that chlamydia trachomatis produces the majority of cases. We have experienced the case of tubo-ovarian actinomycosis(case with IUD(Cu-T)) associated with Fitz-Hugh-Curtis syndrome in a 29years old woman, and reported that with a review of related literatures.
Actinomyces ; Actinomycosis* ; Chlamydia trachomatis ; Female ; Gonorrhea ; Humans ; Inflammation ; Intrauterine Devices ; Neisseria ; Opportunistic Infections ; Pelvic Infection