No abstract available.
Adult* ; Esophageal Atresia* ; Fistula* ; Humans

Successful management of active hemorrhagic shock is directed toward efforts to control bleeding, replenish blood and fluid deficits, restore cardiac output, and enhance oxygen delivery. In patients with low hemoglobin concentration, the use of whole blood or packed red blood cell is indicated. Some patients may refuse blood transfusions on religious grounds, and some patients may not be given blood transfusions for uncommon blood type. We report a case of a 34 years old hemorrhagic shock patient(Hgb 3.7 g/dl) whose blood type was Rh- 0, and who underwent operation successfully with profound hemodilution.
Adult ; Blood Transfusion ; Cardiac Output ; Erythrocytes ; Hemodilution ; Hemorrhage ; Humans ; Oxygen ; Shock ; Shock, Hemorrhagic*

Five cases of traumatic intracranial aneurysm were presented. All of them were located at the cavernous segment of the internal carotid artery. These lesions were associated with basal skull fracture. Four cases were presented with massive epistaxis, and two of them required transfusion. All cases were treated successfully:four by detachable balloon occlusion of the proximal internal carotid artery and one by trapping of the lesion at the internal carotid artery. Because the mortality rate of ruptured traumatic aneurysm if high, clinical suspicion must be focused on prompt diagnostic work-up and early treatment.
Aneurysm ; Aneurysm, False ; Balloon Occlusion ; Carotid Artery, Internal ; Epistaxis ; Intracranial Aneurysm* ; Mortality ; Skull Fractures

BACKGROUND: The HLA system is known to be the most polymorphic gene cluster in the human genome. HLA allele and haplotype distribution varies widely among different ethnic groups. In this study, we examined the frequency of HLA class I alleles and haplotypes in 309 healthy Koreans. METHODS: We typed HLA-A, -B, and -C genes at the allelic level in 109 unrelated Korean individuals using a sequence-based typing. With the additional data of 200 healthy Koreans from dbMHC (http: //www.ncbi.nlm.nih.gov/mhc/), allele and haplotype frequencies were estimated by the maximum likelihood method. Serological typing results of 49 individuals were compared with the results highly resolved. RESULTS: A total of 22 HLA-A, 41 HLA-B, and 21 HLA-C alleles were found in this study. Alleles showing frequencies of more than 10% in each HLA locus were A*2402 (22.5%), A*0201 (15.7%), A*3303 (14.4%), A*1101 (11.0%), B*5101 (12.1%), Cw*0102 (18.8%), and Cw*1402 (10.2%). The most common A-B-C haplotypes at a frequency of more than 3% were A*3303-B*5801-Cw*0302 (5.2%), A*2402-B*5101-Cw*1402 (4.5%), A*1101-B*1501-Cw*0401 (4.3%), A*3303-B*4403-Cw*1403 (4.0%), A*3001-B*1302-Cw*0602 (3.7%), and A*0207-B*4601-Cw*0102 (3.2%). Misassignment of HLA-C antigen by serotyping was detected in 11 (22.4%) of 49 individuals. CONCLUSIONS: Our results will be useful as a basic data for studies on anthropology, disease association, and bone marrow transplantation. Misidentification of HLA-C by serotyping is so high that it would be desirable to perform a DNA typing especially in unrelated bone marrow transplantation.
Alleles* ; Anthropology ; Bone Marrow Transplantation ; DNA Fingerprinting ; Ethnic Groups ; Genome, Human ; Haplotypes* ; Histocompatibility Testing ; HLA-A Antigens* ; HLA-B Antigens ; HLA-C Antigens ; Humans ; Multigene Family ; Serotyping

PURPOSE: We aimed to investigate the effect of oral Saccharomyces cerevisiae Hansen CBS 5926 therapy (Saccharomyces boulardii) on gastrointestinal symptoms and nutrition in gastrectomized patients. MATERIALS AND METHODS: Ninety patients who underwent a gastrectomy due to early gastric cancer were randomly divided into case and control (placebo) groups and were given medicine or placebos for 12 weeks. The gastrointestinal symptom rating and the nutritional status were evaluated by using double blind methods at 4, 16, and 20 weeks after discharge. RESULTS: The ratio of males to females was 2.3:1, and the mean age was 56.3+/-10.2 years. The numbers of subtotal gastrectomies and total gastrectomies were 69 and 21, respectively. Fourteen (15.6%) patients dropped, of whom 5 belonged to the case group. Of the remaining 76 patients, those in the case group had higher levels of serum albumin (P=0.046). For patients who underwent subtotal gastrectomy (n=57), the case group had higher level of serum albumin (P=0.049). CONCLUSION: This double blind study showed that oral Saccharomyces boulardii therapy could improve the postoperative nutrition of gastrectomized patients because gastrectomized patients with oral Saccharomyces boulardii therapy had higher levels of serum albumin than the control group.
Double-Blind Method ; Female ; Gastrectomy ; Humans ; Male ; Nutritional Status ; Placebos ; Saccharomyces cerevisiae* ; Saccharomyces* ; Serum Albumin ; Stomach Neoplasms

OBJECTIVES AND OMPORTANCE: The present study investigated the levels of basic fibroblast growth factor(bFGF) in the CSF of patients with moyamoya disease and its clinical significance. METHODS: The levels of bFGF in CSF, taken from 26 hemispheres of 14 moyamoya patients and 20 patients without vascular anomaly(control group), were measured by an enzyme-linked immunosorbent assay. We analyzed the correlation between the level of bFGF and the clinical factors such as age, onset pattern, development of neovascularization, and cerebral circulation. RESULTS: The CSF of moyamoya patients contained a high concentration of bFGF to a significant extent. The bFGF level was apparently elevated in the patients in whom neovascularization from indirect revascularization, such as modified encephalo-duro-arterio-synangiosis(EDAS) was well developed. A linear correlation between the values of bFGF and clinical progression was noted. CONCLUSIONS: The elevation of bFGF in moyamoya disease seems to be specific. Clinically, the bFGF level may be considered a useful indicator to predict the efficacy of indirect revascularization.
Enzyme-Linked Immunosorbent Assay ; Fibroblast Growth Factor 2* ; Fibroblasts ; Humans ; Moyamoya Disease*

PURPOSE: To identify factors influencing the ablation center and to evaluate the size of the ablation zone after PRK and LASIK using Technolas 217 C. METHODS: This study examined the results of refractive surgery using Technolas 217 C Excimer laser with eye tracking system in 69 eyes, of which 31 underwent PRK and 38 LASIK. The ablation zone and degree of decentration were determined through corneal topography. We divided the eyes into two groups according to the degree of decentration: less than 0.5 mm as the first group, and from 0.5 to 1.0 mm as the second. The ablation zone diameter in topography was compared with the programmed preoperative optical zone. RESULTS: The only factor influencing the ablation center in the PRK group was preoperative spherical equivalent(p=0.016), and no factor influenced the ablation zone in the LASIK group. In both groups, the long axis of the ablation zone was longer than that of the programmed optical zone(p=0.003), while the short axis was shorter (p=0.001). CONCLUSIONS: After refractive surgery using Technolas 217 C Excimer laser with eye tracking system, there was no clinically significant decentration. With greater preoperative spherical equivalent, more decentered ablation was noted in the PRK group. The topographical long axis of the ablation zone was longer than that of the programmed ablation zone, while the short axis of the ablation zone was shorter. During refractive surgery, we should be aware of the possibility that the short axis of the postoperative ablation zone may be shorter than that of the programmed preoperative optical zone.
Axis ; Corneal Topography ; Keratomileusis, Laser In Situ ; Lasers, Excimer ; Refractive Surgical Procedures*

Severe cough may contribute to serous coplications such as pneumothorax, pneumomediastinum, rib fracture, subconjunctival hemorrhage, subdural hemorrhage and cough syncope. However abdominal wall hematoma is a rare complication. Because it usually presents with abdmoianal pain, abdominal wall hematoma needs to be differentiated from the acute surgical abdomen. A 78-year-old woman was admitted with right lower quadrant abdominal pain and a palpable mass for several days. She experienced abdominal pain after violent coughing associated with an upper respiratory tract in fection. Abdominal computed tomography revealed an approximately 7×4 cm sized, ill-defined, soft tissue density lesion in the right lower posterolateral abdominal wall. An abdominal wall hematoma was diagnosed. After admission, she had persistent right lower abdominal pain and an increasing mass. The mass was surgically removed and she was discharged without complications. In summary, when a patient complains of abdmonial pain after severe coughing, an abdominal wall hematomas as a differential diagnosis must be considered.
Abdomen ; Abdomen, Acute ; Abdominal Pain ; Abdominal Wall* ; Aged ; Cough ; Diagnosis, Differential ; Female ; Hematoma* ; Hematoma, Subdural ; Hemorrhage ; Humans ; Mediastinal Emphysema ; Pneumothorax ; Respiratory System ; Rib Fractures ; Syncope

BACKGOUND: SIMV (synchronized intermittent mandatory ventilation) mode is comprised of a ventilator that intermittently enters the volume assist/control mode in conjunction with circuitry that allows for spontaneous ventilation by a demand flow system. There is additional work of breathing caused by the endotracheal tube and demand valve in SIMV. However, PSV (pressure support ventilation) has the ability to decrease work of breathing and to augment spontaneous breaths with a variable amount of inspiratory positive pressure with a clinician-selected level of inspiratory airway pressure. METHODS: To compare the initial weaning success rates and weaning periods between SIMV and PSV, we reviewed medical records of 103 intensive care unit patients, who had received mechanical ventilatory support and performed weaning. We compared the patients' characteristics, initial weaning success rates and ventilatory periods, weaning periods, weaning periods/ventilatory periods, ICU stays according to the weaning process (SIMV and PSV). And then we compared the same variables as the above between the initial weaning success group and initial weaning failure group. RESULTS: Patients' characteristics, ventilatory periods, weaning periods, ICU stays were similar, but there was significantly shorter weaning periods/ventilatory periods on PSV group. Initial weaning success rates according to the weaning process were similar. Ventilatory periods, weaning periods, weaning periods/ventilatory periods, ICU stays were significantly shorter on initial weaning success group. CONCLUSIONS: PSV could be used effectively as one of the weaning modes, and further studies are required about weaning criteria, weaning start time and weaning methods.
Humans ; Intensive Care Units ; Medical Records ; Ventilation* ; Ventilators, Mechanical ; Weaning* ; Work of Breathing

Purpose: We compared clinical outcomes including recurrence rate between amniotic membrane transplantation (AMT) and conjunctival autograft using fibrin glue and minimal conjunctival sutures for pterygium surgery. Methods: We retrospectively analyzed 217 eyes of 198 patients with pterygia who underwent surgery from May 2016 to December 2019. Pterygium excision was performed with conjunctival autograft or AMT, using fibrin glue with both. Recurrence rates and complications were evaluated between the two groups. Results: Postoperative recurrences were noted in one of 185 eyes (0.5%) in the conjunctival autograft group, and in six of 32 eyes (18.8%) in the AMT group. The recurrence rate was significantly lower in the conjunctival autograft group (p < 0.001). Logistic regression analysis revealed that conjunctival autograft was associated with a significantly lower risk of pterygium recurrence compared to AMT (odds ratio, 0.023; 95% confidence interval, 0.003-0.206; p = 0.001). No ocular complication was noted in both groups during follow-up. Conclusions Pterygium excision with conjunctival autograft using fibrin glue was more effective in preventing recurrence compared to AMT.