BACKGROUND: In both infants and children, increased hormonal and metabolic responses to open heart surgery may be directly related to postoperative complications. Anesthestic management including regional anesthesia can substantially attenuate a perioperative stress response and targeted therapy may improve the outcome. In this study, our objectives were to quantify the extent of pain control, and to evaluate the safety and efficacy of caudal morphine or meperidine. METHODS: Seventy-five pediatric patients undergoing a open heart surgery were randomly assigned to three groups according to receiving morphine (group M, n = 25), or meperidine (group D, n = 25) caudally, and a control group (group C). Caudal morphine 30ng/kg with 0.15% bupivacaine 1 ml/kg or meperidine 2 mg/kg with 0.15% bupivacaine 1 ml/kg was injected after anesthetic induction. Pain score and side effects were evaluated immediate postoperatively, 12, 24, and 48 hr postoperatively in the intensive care unit and consciousness recovery and extubation time were checked. RESULTS: Patients in the groups M and D had significantly lower pain scores than the group C. Recovery and extubation time were shorter in the groups M and D. Incidence of nausea and vomiting was significantly higher in the group M than in the groups D and C. CONCLUSIONS: Caudal morphine and meperidine reduced postoperative pain and facilitated extubation.
Anesthesia, Conduction ; Bupivacaine* ; Child ; Consciousness ; Heart* ; Humans ; Incidence ; Infant ; Intensive Care Units ; Meperidine* ; Morphine* ; Nausea ; Pain, Postoperative ; Postoperative Complications ; Thoracic Surgery* ; Vomiting

Diffuse myalgia is common in transient systemic viral infections but overt myositis, with weakness and signs of muscle inflammation, rarely accompanies viral infection in chidren. We describe a 8-year-old boy with severe myalgia and tenderness in both lower extremities, whose unusual skeletal muscle uptake on Technetium-methylene diphosphate bone scan helped to diagnosis of myositis. Clinical course, muscle-derived enzyme studies(AST, ALT, LD, CK), electromyogram findings, histopathologic findings obtained from left gastrocnemius muscle biopsy and serologic studies for enteroviral antibodies (enterovirus type 71 and Coxsackie B4 neutralization antibody titer 1:128 respectively) were all compatible with acute viral myositis.
Antibodies ; Biopsy ; Child ; Diagnosis ; Humans ; Inflammation ; Lower Extremity ; Male ; Muscle, Skeletal ; Myalgia ; Myositis*

Brugada syndrome is characterized by an ECG pattern of right bundle branch block and ST segment elevation in right precordial leads (V1 to V3), without structural heart disease. However, these ECG manifestations transiently normalize in up to 40% of cases. Brugada syndrome is responsible for up to one half of all sudden cardiac deaths in young adults and they may be worsened by beta blockers. We present the anesthetic management of a patient with Brugada syndrome without the characteristic ECG pattern.
Anesthesia* ; Brugada Syndrome* ; Bundle-Branch Block ; Death, Sudden ; Death, Sudden, Cardiac ; Electrocardiography* ; Heart Diseases ; Humans ; Young Adult

Antipsychotic medications are often continued throughout the perioperative period and may have significant interactions with anesthetics. Risperidone is an atypical agent used to treat both positive and negative symptoms of psychosis while producing fewer extrapyramidal symptoms. It's mode of action is related to dopaminergic and serotonergic antagonism. However, it also possesses a potent alpha-1 adrenergic antagonistic property. Here, we report a case of a 46-year-old man with major depressive disorder, controlled with paroxetine, clonazepam and risperidone, undergoing spinal anesthesia for open reduction of femur fracture. Eight minutes after induction of anesthesia, the patient developed exaggerated hypotension, unresponsive to ephedrine and rapid intravenous fluid administration. Eventually, hypotension was corrected after using large doses of phenylephrine. When planning spinal anesthesia to a patient taking risperidone, an alpha-1 agonist, such as phenylephrine, may be useful in treating possible exaggerated hypotension.
Adrenergic Antagonists ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Clonazepam ; Depressive Disorder, Major ; Ephedrine ; Femur ; Humans ; Hypotension* ; Middle Aged ; Paroxetine ; Perioperative Period ; Phenylephrine ; Psychotic Disorders ; Risperidone*

The HACEK group of bacteria (Haemophilus parainfluenzae, H. aphrophilus, H. paraphrophilus, Actinobacilus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corodens, and Kingella kingae) are the normal flora of the upper respiratory tract and oropharynx. The organisms infect abnormal cardiac valves, causing subacute native endocarditis or prosthetic valve endocarditis more than one year after valve surgery. Haemophilus species are responsible for only 0.5~1% of all infective endocarditis cases. Embolization occurs in 60% and the mortality rate ranges from 16~45% of cases of infective endocarditis caused by H. parainfluenzae. We experienced a case of infective endocarditis due to H. parainfluenzae in a 37-year-old male admitted with high fever, chills, nausea & vomiting, chest discomfort, and blurred vision. The organism was isolated from a blood culture and was identified as H. parainfluenzae by factor V requirement, negativity at urea, positivity at ornithine decarboxylase, and acid production from glucose and maltose. The patient was treated with antibiotics and symptoms and signs were improved
Adult ; Anti-Bacterial Agents ; Bacteria ; Cardiobacterium ; Chills ; Eikenella ; Endocarditis ; Factor V ; Fever ; Glucose ; Haemophilus ; Haemophilus parainfluenzae ; Heart Valves ; Humans ; Kingella ; Male ; Maltose ; Nausea ; Ornithine Decarboxylase ; Oropharynx ; Paramyxoviridae Infections ; Respiratory System ; Thorax ; Urea ; Vision, Ocular ; Vomiting

A Pancoast tumor is a rare form of lung cancer that occurs mainly in the apex of the lung as the main symptom of upper extremity pain. Oropharyngeal dysphagia is not a common symptom. This case report describes a 57-year-old male patient with a Pancoast tumor who presented with oropharyngeal dysphagia. The patient's symptoms included left shoulder and arm pain. The chest computed tomography revealed a mass in the apex of the left lung, invading the mediastinum and compressing the left brachial vein and brachial plexus. He was discharged after receiving palliative chemotherapy. The patient returned to the hospital with dyspnea and was diagnosed with aspiration pneumonia. The cranial nerve exam confirmed hoarseness and an absent gag reflex. In addition, the laryngeal elevation decreased, and the bedside water test was positive. A video fluoroscopic swallow study confirmed the presence of oropharyngeal dysphagia, which was attributed to left glossopharyngeal and vagus nerve damage associated with the Pancoast tumor. This case highlights the need to be aware that a Pancoast tumor can cause oropharyngeal dysphagia. If oropharyngeal dysphagia is suspected, VFSS should be performed to prevent complications leading to mortality from lung cancer.

PURPOSE: The purpose of this study was to identify factors influencing premature infants who are small for their gestational ago. METHODS: The medical records of 1,010 premature infants of 26 to 35 weeks of gestational age born at Il-Sin Christian Hospital, Busan from January 2000 to August 2006 were reviewed. We collected data on gestational age, birth weight, infant gender, birth order, maternal age and previous abortion history and analyzed the factors influencing premature infants who were small for their gestational ago at birth. RESULTS: In our study more female than male (P=0.042) in premature infants who were small for their gestational ago were born from mothers aged younger than 20 or older than 35 (P=0.041). But association between smallness for gestational age and birth order or maternal previous abortion history was statistically insignificant (P=0.228, P=0.129). CONCLUSION: Considering the association of birth weight and the survival rate of premature infants, it is thought that maternal age had an influence on the survival rate of premature infants. Social and political support to lower the teenager pregnancy and older pregnancy is expected to increase the survival rate of premature infants and the birth of healthy normal neonates.
Abortion, Induced ; Adolescent ; Birth Order ; Birth Weight* ; Busan ; Female ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Male ; Maternal Age ; Medical Records ; Mothers ; Parturition* ; Pregnancy ; Survival Rate

BACKGROUND: Benign prostatic hyperplasia (BPH) is a common condition in males over 40 years old, and the incidence of BPH has a tendency to increase with age. Obesity is state of excessive accumulation of fat in the body that leads to changes in the body's metabolism and endocrine function. Therefore, progression of BPH occurs in the obese state according to many articles. The purpose of this study was to compare the efficacy of obesity indices which correlate with prostate volume. METHODS: The study was carried out in 285 males, who visited a health promotion center and underwent transrectal ultrasonography and abdominal fat computed tomography from April, 2010 to June, 2013. Anthropometric parameters were measured directly and blood samples were obtained in the morning after over eight hours of fasting. The correlation between obesity indices and prostate volume was analyzed. RESULTS: After adjusting for age, prostate volume was positively correlated with BMI (r=0.227, P<0.001), waist circumference (WC) (r=0.151, P=0.011), waist to height ratio (WHtR) (r=0.149, P=0.012), and visceral fat area (VFA) (r=0.157, P=0.008). However prostate volume showed no correlation with subcutaneous fat area (SFA) and visceral to subcutaneous ratio (VSR). WHtR had the largest area under the curve (AUC) for the identification of prostate volume more than 30 mL (AUC=0.595, P=0.017) followed by VFA and BMI in order. CONCLUSION: Prostate volume was positively correlated with BMI, WC, WHtR, and VFA among the obesity indices and WHtR had the largest AUC followed by VFA and BMI in order.
Abdominal Fat ; Area Under Curve ; Fasting ; Health Promotion ; Humans ; Incidence ; Intra-Abdominal Fat ; Male ; Metabolism ; Obesity ; Prostate ; Prostatic Hyperplasia ; Subcutaneous Fat ; Ultrasonography ; Waist Circumference

OBJECTIVES: The aim of this study was to examine the effect of depression, impulsivity, and resilience on smartphone addiction in university students. METHODS: A total of 322 students from two universities in Seoul were enrolled in this study. Participants were divided into a risk user group and normal user group according to results using the Korean smartphone addiction scale. We additionally surveyed smartphone use patterns of the participants. The Beck Depression Inventory (BDI), Barratt Impulsiveness Scale (BIS), and Conner-Davidson Resilience Scale (CD-RS) were also used for measurement of the participants' severity of depression, impulsivity, and resilience. RESULTS: The risk user group spent more time using a smartphone on weekdays than the normal user group. The risk user group showed significantly higher scores on BDI, BIS than the normal user group. The risk user group showed significantly lower scores on CD-RS than the normal user group. Results of multiple regression analysis showed that impulsivity was a significant factor affecting smartphone addiction in university students. CONCLUSION: These results suggest that smartphone addiction is influenced by impulsivity. Students with high impulsivity may be vulnerable to smartphone addiction. Further research regarding the underlying mechanisms of these associations is needed.
Depression* ; Humans ; Impulsive Behavior* ; Seoul

Posttransplant lymphoproliferative disorder (PTLD) is documented as one of the serious complications leading to mortality particularly in organ transplant recipients receiving immunosuppressive therapy. Extant literature confirms beyond doubt that the most common site of involvement of PTLD is lymph nodes, and rarely involved is the gastrointestinal tract. It is a well-known fact that Epstein-Barr virus (EBV) is a risk factor for PTLD development. In this study, we report a case of PTLD presented as small bowel perforation without EBV infection after long-term immunosuppressive therapy in a renal transplant recipient.
Epstein-Barr Virus Infections ; Gastrointestinal Tract ; Herpesvirus 4, Human ; Kidney Transplantation ; Lymph Nodes ; Lymphoproliferative Disorders ; Risk Factors ; Transplants