No abstract available.
Ciliary Motility Disorders*

A 16-month-old boy swallowed accidentally a button type lithium battery with diameter 23 mm. The battery impacted at the upper esophagus was removed by endoscpy in 9 hours. At the time of removal, dark-crust and erythematous mucosal lesion was noted where the battery impacted. At the first hospital day, fever over 38.5 degrees C developed, and NPO, antibiotics and H-2 blocker started. At the third hospital day, he had melena, and endoscopy revealed huge active esophageal ulceration ranging from upper esophagus and lower body of the esophagus. Steroid started. At the 10th hospital day, endoscopy revealed much smaller-sized ulceration, but mucosa where the battery impacted initially showed deep depression which might imply developing diverticulum. At the 17th hospital day, endoscopy revealed complete diverticulum. At the 27th hospital day, endoscopy revealed complete resolution of diverticulum.
Anti-Bacterial Agents ; Child ; Depression ; Diverticulum ; Endoscopy ; Esophagus* ; Fever ; Humans ; Infant ; Lithium* ; Male ; Melena ; Mucous Membrane ; Ulcer*

An obese parturient can pose considerable physiologic and technical chalenges to an anesthesiologist. The combined pulmonary changes of pregnancy and obesity commonly make for hypoventilation & hypoxemia because they have both a reduced functional residual capacity and an increased oxygen consumption. The cardiovascular system is also stressed by obesity and pregnancy; both conditions contribute to increased cardiac work. Hypotension is frequently associated with spinal anesthesia because of aortocaval compression by the enlarged uterus and sympathetic blockade. In general anesthesia, obesity is an important risk factor for difficult intubation. Pulmonary aspiration of gastric contents is another significant risk of general anesthesia. Obese parturients are at high risk for developing hypoxia during the induction of anesthesia. We successfully managed the first Cesarean section of a morbidly obese parturient (25 years old, BMI = 54.19 kg/m2) with pregnancy induced hypertension using spinal anesthesia. Then, 1 year later we also successfully managed the second Cesarean section in the same patient (26 years old, BMI = 54.95 kg/m2) using general anesthesia. We restress the importance of anesthetic management of morbidly obese parturients in this case report.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal ; Anoxia ; Cardiovascular System ; Cesarean Section* ; Female ; Functional Residual Capacity ; Humans ; Hypertension, Pregnancy-Induced ; Hypotension ; Hypoventilation ; Intubation ; Obesity ; Oxygen Consumption ; Pregnancy ; Risk Factors ; Uterus

BACKGROUND: Xpert Flu (Cepheid, USA) allows for fully automated real-time RT-PCR using a single-use disposable cartridge. The aim of this study was to evaluate Xpert Flu for the detection of influenza A virus and subtype A/H1N1/2009 pandemic virus. METHODS: We conducted a prospective comparison study for Xpert Flu with the RealTime ready Influenza A/H1N1 Detection Set (Roche Diagnostics, Germany). Analytical specificities of the assays were determined by testing commonly encountered respiratory viral pathogens, including parainfluenza virus type 1/2/3, rhinovirus A, rhinovirus B, metapneumovirus, adenovirus, and coronavirus. The analytical sensitivities and workflow of both methods were also assessed. RESULTS: A total of 102 consecutive clinical specimens were tested by both methods. Total agreement between the two methods was estimated to be 99.0% (101/102): 11 A/H1N1/2009 and 3 seasonal influenza A by the RealTime ready Influenza A/H1N1 Detection Set; 10 and 3 by Xpert Flu. No cross-reactivity was observed between influenza A/H1N1/2009 and other respiratory viral pathogens in either method. The limits of detection of the RealTime ready Influenza A/H1N1 Detection Set and Xpert Flu were 500 TCID50/mL and 20 TCID50/mL, respectively. Xpert Flu required 85 minutes (10 minutes of hands-on time) for processing, while RealTime ready Influenza A/H1N1 Detection Set took 128 minutes (30 minutes of handson time). CONCLUSION: The results of Xpert Flu were comparable to those of the RealTime ready Influenza A/H1N1 Detection Set. It is of note that the fully automated and closed system of Xpert Flu could be advantageous for reducing hands-on time and for preventing cross-contamination during the testing process.
Adenoviridae ; Coronavirus ; Influenza A virus ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Limit of Detection ; Metapneumovirus ; Pandemics ; Paramyxoviridae Infections ; Prospective Studies ; Rhinovirus ; Seasons ; Sprains and Strains ; Viruses

PURPOSE: The purpose of this study was to find out what clinicopathologic or immunohistochemical parameter that may affect FDG uptake of primary tumor in PET/CT scan of the gastric carcinoma patient. MATERIALS AND METHODS: Eighty-nine patients with stomach cancer who underwent pre-operative FDG PET/CT scans were included. In cases with perceptible FDG uptake in primary tumor, the maximum standardized uptake value (SUVmax) was calculated. The clinicopathologic results such as depth of invasion (T stage), tumor size, lymph node metastasis, tumor differentiation and Lauren's classification and immunohistochemical markers such as Ki-67 index, expression of p53, EGFR, Cathepsin D, c-erb-B2 and COX-2 were reviewed. RESULTS: Nineteen out of 89 gastric carcinomas showed imperceptible FDG uptake on PET/CT images. In cases with perceptible FDG uptake in primary tumor, SUVmax was significantly higher in T2, T3 and T4 tumors than T1 tumors (5.8+/-3.1 vs. 3.7+/-2.1, p=0.002). SUVmax of large tumors (above or equal to 3 cm) was also significantly higher than SUVmax of small ones (less than 3 cm) (5.7+/-3.2 vs. 3.7+/-2.0, p=0.002). The intestinal types of gastric carcinomas according to Lauren showed higher FDG uptake compared to the non-intestinal types (5.4+/-2.8 vs. 3.7+/-1.3, p=0.003). SUVmax between p53 positive group and negative group was significantly different (6.0+/-2.8 vs. 4.4+/-3.0, p=0.035). No significant difference was found in presence of LN metastasis, tumor differentiation, Ki-67 index, and expression of EGFR, Cathepsin D, c-erb-B2 and COX-2. CONCLUSION: T stage of gastric carcinoma influenced the detectability of gastric cancer on FDG PET/CT scan. When gastric carcinoma was perceptible on PET/CT scan, T stage, size of primary tumor, Lauren's classification and p53 expression were related to degree of FDG uptake in primary tumor.
Cathepsin D ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms

OBJECTIVES: The purpose of this study is to evaluate the impact of delirium on clinical outcomes in intensive care unit (ICU) patients in a Korean general hospital. METHODS: All patients admitted to ICU from March 1, 2013 to October 31, 2013 were assessed by Confusion Assessment Method adapted for use in the ICU for delirium daily, and consistently comatose patients were excluded for analysis. Differences in clinical outcomes (mortality, length of hospital stay, length of ICU stay) were analyzed between delirious patients and non-delirious patients. Subsequently, the impact of delirium on clinical outcomes was analyzed with adjusting for covariates including surgery, age, emergent admission, presence of surgery, and severity of illness. RESULTS: The analysis included 129 delirious patients and 469 non-delirious patients. As primary outcome, mortality, length of stay (hospital day, ICU-stay) were significantly high in the delirious group. The association remained the same after adjusting for the covariates. CONCLUSION: The results correspond with those of previous research studies conducted in foreign ICU. Based on this observation that delirium also has an impact on clinical outcomes in Korean ICU, integrative and in-depth investigation on ICU delirium will be needed.
Coma ; Delirium* ; Hospitals, General* ; Humans ; Intensive Care Units* ; Length of Stay ; Mortality ; Observational Study*

Cholelithiasis, duodenal ulcer, duodenal perforation and tumor invasion may lead to choledochoduodenal fistula (CDF). CDF often has no specific symptoms and may be incidentally detected in an upper gastrointestinal radiographic study or endoscopy; but in some cases, it may be accompanied by recurrent cholangitis and liver abscess. In this paper, a case of recurrent liver abscess caused by CDF is reported. A 62-year-old female was admitted to the authors' hospital because of right upper quadrant pain and fever. The abdominal computed tomography showed a liver abscess in the right lobe. A duodenal fistulous orifice was detected with endoscopy, and a contrast was injected through the duodenal orifice using a catheter under fluoroscopy. The injection of the contrast revealed a fistulous track between the duodenal bulb and the common hepatic duct. In fistulas complicated by recurrent liver abscess, surgery or medical management may be needed. The CDF in this case study was treated via endoscopic clipping.
Catheters ; Cholangitis ; Cholelithiasis ; Duodenal Ulcer ; Endoscopy ; Female ; Fever ; Fistula ; Fluoroscopy ; Hepatic Duct, Common ; Humans ; Liver ; Liver Abscess ; Track and Field

PURPOSE: This study was to identify the relationship between perceived stress, anger expression, and level of depression in cancer patients. METHOD: A cross-sectional descriptive study design was used. Data was collected by questionnaires from 185 in- and out-patients who were diagnosed with cancer at 3 university hospitals and the National Cancer Center using Spielberger et al.'s Anger Expression Scale, Cohen, Kamarch & Mermelstein's Perceived Stress, and Derogatise's SCL-90. The data was analyzed using descriptive statistics, Pearson correlation coefficient, and stepwise multiple regression with SAS/PC. RESULT: The perceived stress in cancer patients indicated a significant positive correlation to anger-in(r=.288, p=.000), anger-out(r=.232, p=.001), and depression(r=.68, p=.000), but no significant correlation to anger-control. The anger-in of cancer patients showed a significant positive relationship to anger-out(r=.53, p=.000), and depression(r=.383, p=.000), but no significant correlation to anger-control. Anger-out showed a significantly negative correlation to anger-control(r=-.248, p=.001) and a positive correlation to depression(r=.240, p=.001). The most significant predictor which influenced depression in cancer patients was perceived stress, followed by anger-in and hobby, and these factors explained their depression with a variance of 54%. CONCLUSION: These results suggested that cancer patients with a high degree of perceived stress are likely to be high in anger-out and anger-in. Perceived stress and anger-in are major factors which affect depression in cancer patients.
*Stress, Psychological ; Neoplasms/*psychology ; Middle Aged ; Male ; Humans ; Female ; Depression/*etiology/psychology ; *Anger ; Aged, 80 and over ; Aged ; Adult

We studied the best parameter to differentiate preoperatively between malignant ovarian tumors and benign ovarian tumors. From January 1988 to December 1992, 244 patients of ovarian tumor were treated with surgery at Chonnarn University Hospital. Patients diagnosed as malignancy by histopathology were 26.2%(64 patients), As the diagnostic pararnetar, we used age, ultrasonography, tumor markers, CT or MRI. The results were obtained as follows: 1. The predictive value of ultrasonographic examination for ovarian cancer was 73.1%. 2. The predictive value of seren CA-125 level for ovarian cancer was 69.1%. 3. The predictive value of combination af ultrasonographic examination and serum CA 125 level for ovarian cancer was 90%. 4. The predictive value of combination of the age older than 40 years, ultrasonographic examination and serum CA-125 level for warian canrer was 92.3%. 5. The predictive value of comhination of three tumor markers(CA-125, CEA and CA 72-4), ultrasonographic examination, CT and MRI for ovarian cancer was 94.6%. Finally, we could preaperatively most exactly differentiate between malignant ovarian tumors and benign ovarian tumors by use of age, three tumor markers(CA-125, CEA and CA 72-4) and ultrsonography, CT or MRI.
Diagnosis* ; Humans ; Magnetic Resonance Imaging ; Ovarian Neoplasms ; Biomarkers, Tumor ; Ultrasonography

BACKGROUND: Speech production requires accurate coordination of the speech musculature, and is dependent upon cooperation among cortical and subcortical structures. Multiple subcortical structures, including the basal ganglia, thalamus, and cerebellum, are involved in several parallel and segregated cortical-subcortical-cerebellum circuits. These circuits serve critical functions in integrating neural networks that modulate speech motor behaviors. Previous studies on speech disorders linked to subcortical lesions have been limited to perceptual evaluations of speech in patients with lesions. However, more recent studies using neuroimaging have confirmed the results of the lesion studies and provided further evidence of the important contributions of the subcortical structures to speech motor control. METHODS: We reviewed recent research literature on both behavioral and functional neuroimaging to reveal the role of subcortical structures in speech production. A review of this topic was conducted by searching the literature and electronic databases. RESULTS: Based on numerous articles, we found that the basal ganglia, thalamus, and cerebellum make different contributions to the modulation of speech-related variables. The cerebellum is the structure that is most strongly associated with speech rate, complexity, and timing. CONCLUSIONS: We conclude that the subcortical structures may play critical functions in speech production. The function of each structure involves the stimulation of cortical regions through the neural circuits and neurotransmitters. Thus, the function of the subcortical structures should be understood within the paradigm of neural networks.
Basal Ganglia ; Cerebellum ; Electronics ; Electrons ; Functional Neuroimaging ; Humans ; Neuroimaging ; Neurotransmitter Agents ; Speech Disorders ; Thalamus