No abstract available.
Myocardial Infarction*

Moyamoya disease is a rare, progressive, occlusive cerebrovascular disorder characterized by bilateral stenosis of the intracranial portion of the internal carotid artery. Symptoms including transient ischemic attacks, seizures, intracranial hemorrhage and cerebral infarction, are variable. There are few case reports of moyamoya disease in pregnancy. Since hyperventilation-induced cerebral ischemia and hypertension are provoked by active labor, cesarean section has been recommended to avoid neurologic complications for pregnant women with moyamoya disease. The optimal anesthetic management for cesarean section in these patients has not been discussed. We report a case of moyamoya disease in a patient presenting for cesarean section at 40 weeks' gestation. Epidural anesthesia was administered using 0.5% bupivacaine and fentanyl. Intraoperative hemodynamic state was stable. The patient has no significant postoperative complications.
Anesthesia* ; Anesthesia, Epidural ; Brain Ischemia ; Bupivacaine ; Carotid Artery, Internal ; Cerebral Infarction ; Cerebrovascular Disorders ; Cesarean Section* ; Constriction, Pathologic ; Emergencies* ; Female ; Fentanyl ; Hemodynamics ; Humans ; Hypertension ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Moyamoya Disease* ; Postoperative Complications ; Pregnancy ; Pregnant Women ; Seizures

No abstract available.
Lymphadenitis* ; Parotid Gland* ; Tuberculosis, Cutaneous* ; Tuberculosis, Lymph Node

Since 1976, 938 cases of E.R.C.P. were performed at the Kwangju Christian Hospital & since December 1981, 19 cases of Endoscopic papillotomy(E.P.T.) were performed, following Results were obtained: 1) Out of 19 cases which were diagnosed by E.R.C.P.; 17 cases of C.B.D. stones, 1 case of ascaris in bile duct, 1 case of remained C.B.D. stone diagnosed by T-tube cholangiogram after operation, & E.P.T. was done in total 19 casees. 2) During 1st E.P.T., 2 cases were removed by Dormia basket under direct visualization & during 2nd E.P.T., 5 cases were removed by Dormia basket under direct visulization & 12 cases were passed in stool & 3x3.5cm large stone passage was found. 3) Complications of E.P.T. were noted in 2 cases: 1 case of bleeding was treated by blood transfusion & 1 case of Acute pancreatitis was treated by medical care.
Ascaris ; Bile Ducts ; Blood Transfusion ; Common Bile Duct* ; Gwangju ; Hemorrhage ; Pancreatitis ; Sphincterotomy, Endoscopic*

BACKGROUND: Tracheal intubation and skin incision are potent stimuli that can induce increased sympathetic activity, tachycardia and hypertension. The purpose of this study is to evaluate whether the epidural clonidine pretreatment reduce the sympathetic activity and cardiovascular response. We compared the hemodynamic changes and catecholamine concentration before, during and after general anesthesia with epidural clonidine pretreatment. METHODS: Forty patients undergoing lower abdominal surgery were randomly allocated into the two groups. In Group 1, 10 ml of 0.9% normal saline was administered epidurally 15 minutes before induction of anesthesia as control. In Group 2, 3 microgram/kg clonidine diluted in 10 ml normal saline was administered epidurally 15 minutes before induction of anesthesia. We measured the blood pressure, heart rate and plasma catecholamine concentration at preinduction, 1 minute after intubation (T1), 1 (T2) and 30 minutes after skin incision (T3), 1 (T4) and 2 (T5) hours after arrival at recovery room and the results were compared between group 1 and group 2. RESULTS: There was statistically significant difference in systolic pressure at T1 and T2 between the two groups. Heart rate was statistically significant difference at T1 and T4 between the two groups. There was statistically significant difference in epinephrine and norepinephrine concentration at T1 and T2 between the two groups. CONCLUSION: The elevation of blood pressure, heart rate and plasma catecholamine concentration accompanying tracheal intubation and skin incision may be reduced by administration of epidural clonidine.
Anesthesia ; Anesthesia, General* ; Blood Pressure ; Clonidine* ; Epinephrine ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Norepinephrine ; Plasma* ; Recovery Room ; Skin ; Tachycardia

BACKGROUND: Most febrile neutropenic patients are treated in an aggressive manner. However, identification of low-risk patients may enable clinicians to administer risk-based treatment. The object of this study is to certify the factors associated with increased risk at the time of visiting the emergency department. METHODS: This is a retrospective study. We reviewed the medical records of 101 febrile neutropenic patients who had visited the emergency department of Seoul National University Hospital from January 1998 to August 1999. We assumed 22 risk prediction factors that could be assessed at admission to the emergency department and 5 factors that could be assessed during treatment course. To find independent risk-prediction factors, we analyzed these factors respectively by using multiple regression analysis. RESULTS: Tachycardia(aOR=136.5), altered mentality(aOR=28.8), decreased renal function(aOR=20.1), and significant comorbidity(aOR=17.2) are the independent factors associated with higher mortality. Altered mentality(aOR=31.6) and decreased renal function(CCr<75ml/min, aOR=5.4) are those associated with a higher incidence of septic shock. Independent factors associated with persistent(more than 3 days) fever are the early(within 10 days) onset of fever after last chemotherapy(aOR=8.8) and the existence of new pulmonary infiltrates on a simple chest X-ray(aOR=4.3). CONCLUSION: The stability of vital signs, the change of mentality, the renal function, the existence of significant comorbidity, the existence of new pulmonary infiltrates, and the rate of neutropenia are clinically useful risk-predication factors in febrile neutropenia at the time of visiting the emergency department.
Comorbidity ; Emergency Service, Hospital ; Febrile Neutropenia ; Fever ; Humans ; Incidence ; Medical Records ; Mortality ; Neutropenia ; Retrospective Studies ; Seoul ; Shock, Septic ; Thorax ; Vital Signs

BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.
Death Certificates* ; Education ; Emergencies ; Mortality ; Retrospective Studies ; Seoul

BACKGROUND: In the authors clinical experience, delirium during recovery from sevoflurane anesthesia is more common in younger children than in older children. The aim of the present study was to assess the recovery quality after sevoflurane anesthesia in school and preschool children. METHODS: Thirty children, ASA 1, scheduled for elective surgery were assigned into two groups of preschool (n = 15) or school (n = 15). All children were premedicated with midazolam (0.05 mg/kg) and glycopyrrolate (0.04 mg/kg) an hour before anesthesia induction. Thiopenthal sodium (5 mg/kg) and vecuronium bromide (0.1 mg/kg) were used for the induction of anesthesia, and it was maintained by inhalation of sevoflurane in N2O/O2 50/50 via an endotracheal tube. Recovery characteristics and agitation characteristics on emergence were also compared between the two groups. RESULTS: Emergence delirium occurred more frequently in preschool children (P < 0.01). Duration of emergence delirium was also longer in preschool children (P < 0.01). CONCLUSIONS: Emergence delirium after sevoflurane anesthesia was more common and longer in preschool children.
Anesthesia* ; Child ; Child, Preschool* ; Delirium* ; Dihydroergotamine ; Glycopyrrolate ; Humans ; Incidence* ; Inhalation ; Midazolam ; Sodium ; Vecuronium Bromide

Bisphosphonate, a potent anti-resorptive agent, is generally accepted as a safe, effective, well tolerated treatment for postmenopausal osteoporosis. Atypical femoral fracture (AFF) and bisphosphonate related osteonecrosis of jaw (BRONJ) are the increasing morbidities in patients treated with long term bisphosphonate. Pathogenic mechanisms of AFF and BRONJ are not fully identified and not identical. We report a case of BRONJ followed by AFF and its nonunion in a 67-year-old woman patient receiving an oral bisphosphonate during 7 years for the treatment of osteoporosis.
Aged ; Female ; Femoral Fractures* ; Humans ; Jaw* ; Osteonecrosis* ; Osteoporosis* ; Osteoporosis, Postmenopausal

BACKGROUND: Rapid culture and identification of mycobacteria is important to effective treatment and management of patient. We made in-house biphasic media and designed identification system by multiplex PCR/PCR-RFLP. We tried to compare the report time of new system with that of conventional one. METHODS: A total of seven hundred and forty specimens sent for tuberculosis culture in a tertiary care hospital were inoculated into biphasic media which was composed of Ogawa media and Middlebrook 7H9 broth. When growth was detected, Mycobacterium tuberculosis and nontuberculous mycobacteria were identified by cord formation in AFB stain and multiplex PCR using IS6110 and hsp65 gene. Diagnostic algorithm for mycobacteria was established by PCR-RFLP with 13 species, 58 mycobacteria. We tried to identify 14 M. tuberculosis and 18 nontuberculous mycobacteria by that system. RESULTS: Eighty-four mycobacteria (11.4%) out of 740 specimens isolated. The mean report time of new system was 21+/-8.2 day, while that of conventional one was 31+/-8.3 day (P<0.005). Algorithm capable of identification 13 mycobacteria species was made. It showed 19 RFLP patterns and 7 of them were new ones which have not been described. The result of identification for 32 mycobacteria by PCR-RFLP was identical with that of biochemical method. CONCLUSIONS: Culture and identification of mycobacteria by biphasic media and Multiplex PCR/PCR- RFLP was a easy, rapid and cost-effective method in the area with the high prevalence rate of tuberculosis.
Humans ; Multiplex Polymerase Chain Reaction ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Polymorphism, Restriction Fragment Length ; Prevalence ; Tertiary Healthcare ; Tuberculosis