PURPOSE: The purpose of this study is to evaluate the clinical effect of antithrombin lll concentrates in disseminated intravascular coagulation (DIC) of neonates. METHODS: We reviewed the clinical records of 11 newborn patients who had been admitted and diagnosed as DIC at the neonatal intensive care unit of Sanggye Paik Hospital from November, 1995 to September, 1996. RESULTS: There were 6 males and 5 females. In 9 cases (81.8%), gestational age was less than 37 weeks and birth weight was less than 2,500g. Sepsis was the most common underlying disease in 9 cases (81.8%), followed by respiratory distress syndrome, necrotizing enterocolitis, and fulminant hepatitis. The etiologic organisms of sepsis, were gram negative organisms, fungus, and gram positive organisms in decreasing order. There were signs of gastrointestinal tract hemorrhage, pulmonary hemorrhage, and intracranial hemorrhage as a result of DIC. In the clinical outcome of DIC patients, 6 out of 11 patients survived (54.5%). CONCLUSION: Administration of antithrombin lll concentrates in DIC of neonates produces improvement of clinical course and survival.
Birth Weight ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Enterocolitis, Necrotizing ; Female ; Fungi ; Gastrointestinal Tract ; Gestational Age ; Hemorrhage ; Hepatitis ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Intracranial Hemorrhages ; Male ; Sepsis

Anal incontinence following pelvic trauma, surgery or neurologic disorder has significant medical and social implications. When no known functioning sphincter muscles are present, surgical correction of this distressing condition other than by stomal fecal diversion is aimed at recreating a sphincter mechanism under voluntary control. The use of the gluteus maximus encircling the neorectum with a contractile muscualr ring provides an active control of continence and reserves the anorectal angulation. The sacrifice of the entire gluteus maximum muscle in an ambulatory patient will cause difficulty in climbing stairs; however, the use of the anatomically dissected lower half will preserve its function. With careful dissection, the lower half of the g1uteus maximus muscle together with its neurovascular supply can be developed for anal sphincter reconstruction. Three Patient, (two men and one woman) underwent g1uteus maximus transposition for complete anal incontinence. The indication for operation were sphincter destruction secondary to extensive soft tissue necrosis on perianal, perineal and buttock area due to necrotizing fascitis(n=2), and soft tissue defect on perianal, buttock area due to trauma(n=1). The procedure is performed with the use of a diverting colostomy. The inferior portion of the origin of each gluteus maximus is detached from the sacrum and coccyx, bifurcated,and tunneled subcutaneously to encircle the anus. The ends were sutured together to form two opposing slings of voluntary muscles. Postoperatively two patient regained continence to solid stool, one to liquid stool as well. The technique of constructing sphincter is simple and utilizes principles of muscle tendon transfer without jeopardizing function of gait. Furthermore the gluteus maximus muscle, being an accessory muscle of anal continence, is an ideal structure for this reconstruction.
Anal Canal ; Buttocks ; Coccyx ; Colostomy ; Fecal Incontinence ; Gait ; Humans ; Male ; Muscle, Skeletal ; Muscles ; Necrosis ; Nervous System Diseases ; Sacrum ; Tendon Transfer

No abstract available.
Pregnancy*

Hydrofluoric acid is one of the strongest irritating, corrosive and poisonous inorganic chemicals. Hydrofluoric acid burns are occurring with ever-increasing frequency due to the wide use of this acid in industries. Hydrofluoric acid burns are characterized by severe progressive tissue destruction and excruciating pain due to the unique properties of the freely dissolvable fluoride ion. The authors reviewed medical records of 32 cases(36 spells) of hydrofluoric acid burns which occurred in a hydrofluoric acid manufacturing factory from Sep. 1, 1990 to June 30, 1993. The results are as follows; 1. Eleven measurements of air concentrations of hydrofluoric acid by detection tube method from 1990 to 1992 were all below TLV(Department of Labor, R. O. K). 2. There were 19 cases(22 spells) of hydrofluoric acid burns which occurred during the study period among regular employees. The overall incidence density of hydrofluoric acid was 17.8 cases(20.6 spells) per 100 person-year. Incidence density was 19.0 cases(22.0 spells) per 100 person-year among male workers and there were no female cases. Incidence density was 32.9 cases(38.3 spells) per 100 person-year among production workers and 1.9 cases(1.9 spells) per 100 person-years among management workers with the difference being statistically significant(P<0.01). 3. Of 32 cases(36 spells) of hydrofluoric acid burns among workers who were regularly employed or temporarily employed, 26 spells(81.2%) were between age 20 to 39. In 15 spells(41.7%) burns occurred between 12 : 00 and 17 : 59 with 16 spells(44.3%) having arrived at hospital within 2 hours after the accident. 4. Of 36 spells, the main cause of hydrofluoric acid burns were by splashes(8 spells, 22.2 %). The most frequent site of burns were fingers and pain was the most frequent symptom. Thirty spells(83.3%) of the hydrofluoric acid burns were treated with local injection of antidote(calcium gluconate). Complete recovery without scarring were observed in most of the cases(34 out of 36 cases, 94.4%). The study results suggest that to prevent hydrofluoric acid burns, environmental control and the wearing of hydrofluoric acid resistant protective clothes and gloves are important. It is also stressed that establishment of an emergency management and a transfer system for hydrofluoric acid burn victims is necessary.
Burns* ; Burns, Chemical ; Cicatrix ; Emergencies ; Female ; Fingers ; Fluorides ; Humans ; Hydrofluoric Acid* ; Incidence ; Inorganic Chemicals ; Male ; Medical Records

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.
Aged* ; Analgesia ; Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Meperidine ; Morphine ; Passive Cutaneous Anaphylaxis

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.
Aged* ; Analgesia ; Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Meperidine ; Morphine ; Passive Cutaneous Anaphylaxis

Biliary atresia is a surgical disease of infancy with a very poor prognosis usually attributed to the rarity of surgically correctable case. This paper presents a case of incorrectable type of biliary atresia 50 days old Direan female infant who were subjected to the Modified Kasai Operation She had shown good bile excretion after surgery but developed recurrent fever, severe hypocalcemia and roentgenographically prover rickets during the follow up periods. She died 7 months after the operation.
Bile ; Biliary Atresia* ; Female ; Fever ; Follow-Up Studies ; Humans ; Hypocalcemia ; Infant ; Prognosis ; Rickets

The authors describe a case of intracranial epidermoid cyst with fourth ventricle involvement. A 43-year-old woman presented with progressive aggravating headache and cerebellar syndrome due to a large tumor in the fourth ventricle, that extended into the left side of foramen of Luschka. The histopathological workup following gross total removal of tumor had revealed the typical features of an epidermoid cyst. Four months after surgery, the cerebellar sings recovered to normal with a remarkable improvement of headache. Epidermoid cysts involving the fourth ventricle have been known to be one of the most rare diseases in the central nervous system. This rare case is discussed and a review of the relevant literature is presented.
Adult ; Central Nervous System ; Cerebellar Diseases ; Epidermal Cyst* ; Female ; Fourth Ventricle* ; Headache ; Humans ; Rare Diseases

PURPOSE: To evaluate the clinical characteristics of vitamin D deficiency and its association with iron deficiency anemia (IDA). METHODS: A total of 171 children aged less than two years underwent 25-hydroxyvitamin D3 tests between January 2007 and July 2009. The study was classified into two groups: normal and vitamin D insufficiency, by their vitamin 25-hydroxyvitamin D3 levels. RESULTS: In total, 120 children were in the normal group (mean age, body weight and heights 12.5+/-7.0, 9.3+/-0.9 kg and 76.8+/-1.1 cm), and 51 children in the vitamin D insufficiency group (9.9+/-5.4 months, 9.0+/-0.9 kg and 75.1+/-0.9 cm). Vitamin D insufficiency was most commonly diagnosed in the spring (44%). The proportion of complete breast-feeding was higher in the insufficiency (92%), and 25.5% of the children in the deficient group also experienced IDA compared that 12% of normal group. Ten children in the insufficiency group experienced bony changes. Six children received calcitriol medication in the normal group, in whom the mean vitamin 25-hydroxyvitamin D3 level increased from 39.6+/-14.6 ng/mL (pre-medication) to 41.8+/-17.2 ng/mL (post-medication), and 13 in the insufficiency group, in whom the mean vitamin 25-hydroxyvitamin D3 increased from 20.7+/-7.0 ng/mL to a mean post-treatment level of 43.7+/-23.8 ng/mL. CONCLUSION: This study demonstrated that approximately 30% of children aged < or =2 years experienced vitamin D insufficiency associated with subclinical rickets. Many children also experienced concurrent IDA. Guidelines for vitamin D supplement in such children must therefore be established.
Aged ; Anemia ; Anemia, Iron-Deficiency ; Body Weight ; Calcifediol ; Calcitriol ; Child ; Humans ; Iron ; Prevalence ; Rickets ; Vitamin D ; Vitamin D Deficiency ; Vitamins

STUDY DESIGN: Research using radiographic findings. OBJECTIVES: To compare spinopelvic parameters in detail between normal subjects and those who had bilateral gonarthrosis with or without spondylosis. SUMMARY OF LITERATURE REVIEW: The relationship between knee joint flexion contracture and hypolordosis in the lumbar spine has been well established. However, spinopelvic parameters in subjects with gonarthrosis without flexion contracture have not been well described in the literature. MATERIALS AND METHODS: Fifty-seven male subjects in their 60s with bilateral gonarthrosis over Kellgren-Lawrence grade III were included. They were subdivided into the KS group (with spinal osteoarthritis, n=32) and the KN group (without spinal osteoarthritis, n=25). Normal asymptomatic subjects without disease in their back or leg were analyzed as the control group (NN; n=84). The following spinopelvic parameters were measured and compared; C7 plumbline (C7PL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). RESULTS: In the KS group, the C7PL was significantly anteriorly displaced compared to the KN group (1.7±4.5 cm vs. −0.6±2.9 cm, p=0.031) and the NN group (1.7±4.5 cm vs. −0.5±2.9 cm, p=0.014). TK in the KN group was significantly smaller than in the NN group (25.4±8.8° vs. 30.1±8.3°, p=0.041). The KS group had the smallest value of LL, while the NN group had the largest value of LL (−23.2±48.7° vs. −44.9±33.8° vs. −57.3±8.5°, p<0.001). No significant difference was observed in PI, SS, or PT among the 3 groups. A strong correlation was found between LL and SS in the NN group (R=−0.776, p<0.01), while this correlation was moderate in the KN group (R=−0.355, p<0.01). CONCLUSIONS: Overall balance was maintained in the subjects who had gonarthrosis without spinal osteoarthritis. Subjects with gonarthrosis showed less LL, especially if they had spinal osteoarthritis. Further studies are needed to characterize the differences in these pelvic parameters, and to evaluate changes in individuals with knee joint flexion contracture.
Animals ; Contracture ; Humans ; Incidence ; Knee ; Knee Joint ; Kyphosis ; Leg ; Lordosis ; Male ; Osteoarthritis ; Osteoarthritis, Spine ; Spine ; Spondylosis