BACKGROUND: Portable cardiopulmonary bypass (CPB) technique has been used increasingly as a potent and effective option for emergency cardiopulmonary resuscitation (CPR) because it can maintain more stable hemodynamics and provide better survival than conventional CPR techniques. This study was designed to develop a prototype of Korean portable CPB system and, by applying it to CPR, to discriminate whether it would be superior to standard open-chest CPR. MATERIAL AND METHOD: By using adult mongrel dogs, open-chest CPR (OCPR group, n=4) and portable-CPB CPR (CPB group, n=4) were compared with respects to restoration of spontaneous circulation (ROSC), hemodynamics, effects on blood cells, blood gas patterns, biochemical markers, and survivals. Ventricular fibrillation-cardiac arrest (VF-CA) of arrest (VF-CA) of 4 minutes followed by basic life support (BLS) of 15 minutes was applied in either group, which was standardized by the protocol of American Heart Association. Then, advanced life support (ALS) was applied to either group under the support of internal cardiac massage or CPB. ALS was maintained until ROSC was achieved but not longer than 30 minutes regardless of the presence of ROSC. All of the measured values were expressed as means+/-SD percent change from baseline. RESULT: During the early ALS, higher mean arterial pressure was maintained in CPB group than in OCPR group (90+/-19 vs. 71+/-32 %; p<.05) and lower mean pulmonary arterial pressure was also maintained in CPB group than in OCPR group (105+/-24 vs. 146+/-6%; p<.05). ROSC was achieved in all dogs. Post-ROSC levels of hematocrit, RBC, and platelet were decreased and plasma free hemoglobin was increased significantly in CPB group compared to OCPR group (p<.05). Changes in blood gas patterns, lactate, and CK-MB levels were not different between groups. Early mortality was seen in 3 dogs in OCPR group (survival time 31+/-36 hours) and 2 in CPB group (228+/-153 hours, p=ns). The remainders in both groups showed prolonged survival. CONCLUSION: These findings indicate that portable CPB can be effective to maintain stable hemodynamics during cardiac arrest, to achieve ROSC and to prolong survival. Further study is needed to refine the portable CPB system and to meet clinical challenges.
Adult ; American Heart Association ; Animals ; Arterial Pressure ; Biomarkers ; Blood Cells ; Blood Platelets ; Cardiopulmonary Bypass* ; Cardiopulmonary Resuscitation* ; Dogs* ; Emergencies* ; Heart Arrest* ; Heart Massage ; Hematocrit ; Hemodynamics ; Humans ; Lactic Acid ; Mortality ; Plasma

An 11-year-old girl was diagnosed with encephalitis due to Epstein-Barr virus(EBV). She was admitted to our hospital due to convulsion and decreased consciousness after several days of fever, sore throat and headache. Cerebrospinal fluid analysis showed lymphocyte-dominant pleocytosis and markedly elevated levels of protein. Magnetic resonance imaging(MRI) finding was normal, except for marked leptomeningeal enhancement. Even though she had signs and symptoms of infectious mononucleosis, EBV infection could not be considered as the underlying cause of the encephalitis until IgM for the viral capsid antigen of EBV had been detected in her blood. After treatment with acyclovir, a high dose of methylprednisolone and intravenous immunoglobulin, the neurological symptoms improved rapidly. She has not suffered from any neurological complications in the four months since being discharged. EBV infection should be considered as the main etiology in cases of childhood encephalitis, although there is no evidence of infectious mononucleosis existed.
Acyclovir ; Capsid ; Child ; Consciousness ; Encephalitis ; Epstein-Barr Virus Infections ; Fever ; Headache ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Immunoglobulins ; Infectious Mononucleosis ; Leukocytosis ; Magnetic Resonance Spectroscopy ; Methylprednisolone ; Pharyngitis ; Seizures

Cellular schwannoma is a very rare benign tumor involving peripheral nerves, mimicking malignant nerve sheath tumor in histological appearance. It is a clinico-pathological variant of benign schwannoma characterized by a high cellularity, increased mitotic figures and occasional presence of bone destruction. A 6-month-old female patient was admitted with progressive quadriparesis. Magnetic resonance imaging of the cervical spine showed a well-enhancing extramedullary mass on the C4 to C6 area. Total laminectomy was performed on C4-7, and intradural extramedullary tumor was removed. Histologically, the tumor was composed of proliferated spindle cells. Most of the tumor was composed of Antoni A area with hypercellular spindle cells arranged in fascicular pattern. The tumor cells showed mild atypism with mitotic figure upto 4/10HPF and diffuse, strong S-100 protein immunostaining. The patient was improved postoperatively.
Female ; Humans ; Infant* ; Laminectomy ; Magnetic Resonance Imaging ; Neurilemmoma* ; Peripheral Nerves ; Quadriplegia ; S100 Proteins ; Spinal Cord Neoplasms ; Spine*

OBJECTIVE: To compare the clinical results between total laparoscopic Hysterectomy (TLH) and total abdominal hysterectomy (TAH). METHODS: 100 cases of TLH and 95 cases of TAH, which were performed at Pocheon CHA university from January 2001 to September 2004. We analyzed the results with regard to patient's characteristics (age, parity), uterine weight, operative time, blood loss, hospital stay and complications. RESULTS: There were no differences in terms of patient's age, parity, main operative indication and total operating time between the 2 groups. The mean uterine weight of TAH group was larger than TLH (291 +/- 239 gm for TLH, 404 +/- 174 gm for TAH, p<.05) group. The estimated blood loss was significantly lower for TLH (239.00 +/- 155.63 mL) than for TAH (333.68 +/- 228.4 mL) (p<.05). The length of hospital day was significantly shorter for TLH (6.78 +/- 1.70 day) than for TAH (7.39 +/- 1.49 day) (p<.05). Post-operative complications in the TLH group were dysuria in 2 cases, major hemorrhage requiring transfusion in 4 cases, trocar site hematoma in 1 case and bowel injury in 1 case. Post-operative complications In the TAH group were major hemorrhage requiring transfusion in 7 cases, wound infection in 3 cases and bowel injury in one case. CONCLUSION: The present study demonstrates that, given adequate training in laparoscopic surgery, TLH may replace TAH in most patients who require a hysterectomy, showing clear advantages of shorter hospitalization and the acceptable complication rate.
Dysuria ; Female ; Hematoma ; Hemorrhage ; Hospitalization ; Humans ; Hysterectomy* ; Laparoscopy ; Length of Stay ; Operative Time ; Parity ; Surgical Instruments ; Wound Infection

Twin Pregnancies are increasing these days due to recent development of the technology in treating infertility. twin pregnancies tend to cause more congenital anomalies than singleton pregnancies do. Especially when twin pregnancies are affected with one anomalous fetus combined to a normal one, the proper management and counseling are difficult. We experienced a twin pregnancy in which one anencephalic fetus was combined to a normal one, after close counseling we decided to continue the pregnancy. At 35 weeks 6 days of gestation, an anencephalic fetus was dead, so we delivered by cesarean section due to breech-cephalic presentation. The birth weight of the normal and anencephalic fetuses were 2160 gm and 600 gm, respectively. The anencephalic fetus was combined with scoliosis, absent left upper limb, and nuchal skin defect, but the healthy one showed good crying and movement and its Apgar score was 8 in 1 minute and 9 in 5 minute. Although the infant needed intensive care for 21days in the nursery room, she was finally discharged in good condition. We present this case with a brief review of the literature.
Anencephaly ; Apgar Score ; Birth Weight ; Cesarean Section ; Counseling ; Crying ; Female ; Fetus* ; Humans ; Infant ; Infertility ; Critical Care ; Nurseries ; Pregnancy ; Pregnancy, Twin* ; Scoliosis ; Skin ; Twins* ; Upper Extremity

BACKGROUND: This study assessed the efficacy of pulmonary metastasectomy for synovial sarcoma in adult patients. METHODS: Fifty patients, diagnosed with pulmonary metastasis from June 1990 to August 2010, were reviewed retrospectively. Twenty-eight patients underwent complete pulmonary metastasectomy, and their survival was evaluated. Age, sex, time to metastatic progression, laterality, number of tumors, size of largest nodule, and number of metastasectomies were analyzed as potential prognostic factors. RESULTS: In all, 29 patients underwent at least one pulmonary metastasectomy, and 51 resections were performed. One intraoperative mortality occurred, and the 5-year survival rate was 58.4%. Bilateral metastases and early metastatic progression were associated with poor survival in multivariate analyses. CONCLUSION: Surgical resection can be a good option for treating pulmonary metastasis in patients with synovial sarcoma. Repeated resection was feasible with low mortality and morbidity.
Adult* ; Humans ; Metastasectomy* ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Retrospective Studies ; Sarcoma ; Sarcoma, Synovial* ; Survival Rate

Aspiration of foreign bodies into tracheobronchial tree is more common in children than in adults. Foreign bodies in airway commonly occur by accident, and in most cases they get removed without delay. Small foreign bodies that lodge in the peripheral airway are often asymptomatic initially and can result in respiratory symptoms several years later. Although foreign body aspiration is frequently suspected in children with acute or recurrent pulmonary symptoms, it is rarely considered in adults, unless a clear history of an aspiration event can be obtained. We have experienced and studied a case of occult aspiration of a shrimp which had been lodged for a long period.
Adult ; Bronchi* ; Bronchoscopy* ; Child ; Foreign Bodies* ; Humans

BACKGROUND: Recurrent somatic SET-binding protein 1 (SETBP1) and splicing pathway gene mutations have recently been found in atypical chronic myeloid leukemia and other hematologic malignancies. These mutations have been comprehensively analyzed in adult AML, but not in childhood AML. We investigated possible alteration of the SETBP1, splicing factor 3B subunit 1 (SF3B1), U2 small nuclear RNA auxiliary factor 1 (U2AF1), and serine/arginine-rich splicing factor 2 (SRSF2) genes in childhood AML. METHODS: Cytogenetic and molecular analyses were performed to reveal chromosomal and genetic alterations. Sequence alterations in the SETBP1, SF3B1, U2AF1, and SRSF2 genes were examined by using direct sequencing in a cohort of 53 childhood AML patients. RESULTS: Childhood AML patients did not harbor any recurrent SETBP1 gene mutations, although our study did identify a synonymous mutation in one patient. None of the previously reported aberrations in the mutational hotspot of SF3B1, U2AF1, and SRSF2 were identified in any of the 53 patients. CONCLUSIONS: Alterations of the SETBP1 gene or SF3B1, U2AF1, and SRSF2 genes are not common genetic events in childhood AML, implying that the mutations are unlikely to exert a driver effect in myeloid leukemogenesis during childhood.
Adolescent ; Carrier Proteins/*genetics ; Child ; Child, Preschool ; Cohort Studies ; Cytogenetic Analysis ; DNA Mutational Analysis ; Female ; Gene Frequency ; Genotype ; Humans ; Infant ; Leukemia, Myeloid, Acute/*genetics/pathology ; Male ; Nuclear Proteins/*genetics ; Phosphoproteins/*genetics ; Polymorphism, Single Nucleotide ; RNA Splicing ; Ribonucleoprotein, U2 Small Nuclear/*genetics ; Ribonucleoproteins/*genetics

Hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure in children younger than 4 years and is characterized by microangiopathic hemolytic anemia, acute renal failure, and thrombocytopenia. HUS associated with diarrheal prodrome is usually caused by Shiga toxin-producing Escherichia coli O157:H7 or by Shigella dysenteriae, which generally has a better outcome. However, atypical cases show a tendency to relapse with a poorer prognosis. HUS has been reported to be associated with acute lymphoblastic leukemia (ALL) in children. The characteristics and the mechanisms underlying this condition are largely unknown. In this study, we describe the case of an 11-year-old boy in whom the diagnosis of ALL was preceded by the diagnosis of atypical HUS. Thus, patients with atypical HUS should be diagnosed for the possibility of developing ALL.
Acute Kidney Injury ; Anemia, Hemolytic ; Child ; Hemolytic-Uremic Syndrome ; Humans ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis ; Recurrence ; Shiga-Toxigenic Escherichia coli ; Shigella dysenteriae ; Thrombocytopenia

BACKGROUND AND OBJECTIVES: Although the Tei index is a useful predictor of global ventricular function, it has not been investigated at the level of regional myocardial function. We therefore investigated the segmental tissue Doppler image derived-Tei index (TDI-Tei index) in patients with regional wall motion abnormalities. SUBJECTS AND METHODS: We prospectively studied 17 patients (mean age 62+/-9 years, 5 women) with left ventricular (LV) regional wall motion abnormalities. The Tei index, defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET), was measured in the basal and mid segments of the LV walls from standard apical views (4-, 2-, and 5-chamber views). We also obtained TDI velocity data in each segment. LV wall motion was classified as normal, hypokinetic, or akinetic, based on visual analysis. The TDI-Tei index, peak systolic myocardial velocity (Sm), early diastolic myocardial velocity (Em), and late diastolic myocardial velocity (Am) were analyzed in a total of 203 segments. RESULTS: Mean LV ejection fraction was 41.8+/-8.5%. TDI-Tei indices of dysfunctional segments (akinesis or hypokinesis, n=63) were significantly higher than those of normal segments (n=140) (0.714+/-0.169 vs. 0.669+/-0.135, p=0.041, respectively). Average values of TDI-Tei index, Sm, Em, and Am were 0.742+/-0.201, 4.206+/-1.336, 5.258+/-1.867, and 5.578+/-2.354 in akinetic segments; 0.677+/-0.101, 4.908+/-1.615, 5.369+/-2.121, and 5.542+/-2.492 in hypokinetic segments; and 0.669+/-0.135, 5.409+/-1.519, 6.108+/-2.356, and 6.719+/-2.466 in normal segments, respectively. A significant negative correlation was apparent between the TDI-Tei index and Sm (r=-0.302, p<0.001). CONCLUSION: These data suggest that the value of the segmental TDI-Tei index differs significantly according to regional function grade.
Contracts ; Humans ; Myocardial Contraction ; Prospective Studies ; Relaxation ; Ventricular Function