The final degrees of education for the third and fourth authors were mutually misplaced.

We report a case of cardiac arrest in a 71 year old male during the Valsalva maneuver that had been performed immediately after completing a pneumonectomy. The patient had a subclinical atrial septal defect (1.08 cm sized) and he previously undergone a left upper lobectomy of the lung without complications 11 months earlier. He underwent a left completion pneumonectomy due to recurrent lung cancer. After surgery a Valsalva maneuver was performed with 35 cmH2O to relocate the mediastinum. During this procedure, the patient experienced a cardiac arrest and was resuscitated with difficulty. It is believed that the cardiac arrest was due to pulmonary hypertension, right ventricular failure and right to left shunt caused by several factors, such as the pneumonectomy, subclinical atrial septal defect (1.08 cm sized), and Valsalva maneuver. In addition, the hypovolemia caused by fluid restriction and the epidural injection of local anesthetics might have contributed to this incident. Although it is a rare complication, it is suggested that subclinical ASD can cause severe hypoxemia, dyspnea even cardiac arrest after pneumonectomy. In order to avoid these complications, ASD should be treated with percutaneous closure or surgical intervention. If these are not possible, care must be taken when anesthetizing the patient, and anything that can increase the pulmonary vascular resistance and right to left shunt should be avoided.
Anesthetics, Local ; Anoxia ; Dyspnea ; Heart Arrest ; Heart Septal Defects, Atrial ; Humans ; Hypertension, Pulmonary ; Hypovolemia ; Injections, Epidural ; Lung ; Lung Neoplasms ; Male ; Mediastinum ; Pneumonectomy ; Valsalva Maneuver ; Vascular Resistance

PURPOSE: We compared the clinical efficacy of Therasonic LTS (piezoelectric type) with that of SDS-5000 (spark gap type) for the management of urinary stones. MATERIALS AND METHODS: We evaluated 516 patients treated with Therasonic LTS, between June 1996 and April 2001, and 314 treated with SDS-5000 between September 2001 and January 2003. We compared the average success rates and shock wave sessions according to the stone sizes and locations, and also verified the complications related to the therapies. RESULTS: The total success rates of Therasonic LTS and SDS-5000 were similar (92.6 and 94.6%, respectively), with no difference according to stone location and size. However, the average shock wave sessions were significantly lower in the group treated with SDS-5000 (2.5 1.8 sessions) compared to the group treated with Therasonic LTS (3.1 1.9 sessions) (p<0.05). The cumulative success rates were 64.3 and 77.1%, respectively, at the completion of session 3, and 82.2 and 88.2%, respectively, at the completion of session 5. The complication rates associated with the therapies were 8.9 and 6.9%, respectively, consisting of pain, gross hematuria, steinstrasse and acute pyelonephritis, most of which were successfully controlled by conservative treatment. CONCLUSIONS: SDS-5000 lithotripsy is more efficient than Therasonic LTS in terms of shock wave sessions.
Calculi ; Hematuria ; Humans ; Lithotripsy ; Pyelonephritis ; Shock ; Urinary Calculi* ; Urinary Tract

PURPOSE: We assessed the usefulness of manual reduction in patients with an acute scrotum. MATERIALS AND METHODS: We retrospectively analyzed the data of 61 consecutive males who had undergone surgical exploration for an impression of testicular torsion, focusing on the incidence, duration of symptoms, direction of testicular torsion and results of manual reduction. Of the 61 explorations, there were 46 (75.4%) and 15 (24.6%) cases of testicular torsion and torsion of a testicular appendage, respectively. RESULTS: Of the 46 testicular torsions, the symptoms were localized to the left side in 37 and to the right side in 9. While the mean symptom duration of the 31 in the orchiectomy group (89 hours) was significantly longer than that in the 15 salvaged testes (10 hours, p=0.003), the mean degree of rotation between the two groups was not significant (p=0.196). Information on the direction of testicular rotation was available in 44 cases, with medial rotation having occurred in 31 (70.5%) and lateral rotation in 13 cases. The clinical symptoms were improved in 4 of the 20 patients in who manual reduction was attempted; residual torsion was identified in 2 patients. CONCLUSIONS: Manual detorsion, the fastest way to relieve testicular ischemia, should be performed at an early offstage following presentation. However, in attempting the manual reduction, the urologist should consider the possibility that a quarter of patients with an acute scrotum do not have testicular torsion, with 30% of testicular torsions occurring in the lateral direction. Surgical exploration remains necessary to confirm the causes of an acute scrotum and to correct any residual torsion.
Humans ; Incidence ; Ischemia ; Male ; Orchiectomy ; Retrospective Studies ; Scrotum* ; Spermatic Cord Torsion ; Testis

OBJECTIVE: The aim of this study was to evaluate the prognostic value of squamous cell carcinoma antigen (SCC-Ag) and the optimal cut-off value for predicting recurrence in cervical squamous cell carcinoma patients with complete remission after primary treatment. METHODS: We reviewed the records of 783 cervical squamous cell cancer patients who underwent primary therapy and showed complete remission at our institution between January 2000 and April 2014. A receiver operating characteristic curve was used to determine the optimal SCC-Ag threshold to predict recurrence. Cox regression model for disease free survival was used to assess differences in outcome. RESULTS: The median follow-up period was 41.2 months, and 154 patients (19.7%) had recurrent disease. The median pretreatment and posttreatment SCC-Ag level was 2.6 ng/mL (range, 0.1 to 532.0 ng/mL) and 0.7 ng/mL (range, 0.0 to 46.8 ng/mL), respectively. Both pretreatment and posttreatment SCC-Ag levels were higher in the recurrence group (P=0.017 and P=0.039). Optimal cut-off value of pretreatment and posttreatment SCC-Ag for predicting recurrence was 1.86 ng/mL (area under the curve, 0.663; P=0.000), and 0.9 ng/mL (area under the curve, 0.581; P=0.002), respectively. In the multivariate Cox regression model, pretreatment SCC-Ag >1.86 ng/mL (odds ratio, 2.11; 95% confidence interval, 1.38 to 3.22; P=0.001) and posttreatment SCC-Ag >0.9 ng/mL (odds ratio, 1.64; 95% confidence interval, 1.18 to 2.28; P=0.003) were significantly associated with poor disease free survival. CONCLUSION: Patients with pretreatment SCC-Ag >1.86 ng/mL or posttreatment SCC-Ag >0.9 ng/mL should be considered at high risk for cancer recurrence after complete remission, and therefore, closer surveillance is needed.
Carcinoma, Squamous Cell* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoplasms, Squamous Cell ; Recurrence* ; ROC Curve

BACKGROUND/AIMS: This study was performed to investigate the clinical and serological characteristics of toxocariasis in the Pohang region. METHODS: A total of 145 patients with peripheral eosinophilia (> 450 cells/microL) were enrolled and divided into two groups based on Toxocara excretory-secretory IgG enzyme-linked immunosorbent assay (ELISA) positivity, and the clinical features and serologic markers were compared between the two groups. RESULTS: The seropositive rate of Toxocara was 62.1%. The serum total eosinophils (p = 0.038), total IgE level (p < 0.01), Dermatophagoides farinae (Df) seropositivity rate (p < 0.01), frequency of eosinophilic tissue infiltration in the lung or liver (p < 0.01), and ingestion of raw cow meat or liver (p < 0.01) were higher in seropositive patients than in seronegative patients. However, the presence of asthma and rhinitis (p < 0.01) were more frequent in seronegative patients. Among seropositive patients, positive correlations were observed between serum total IgE, total eosinophils, and the optical density value of the Toxocara IgG ELISA (p < 0.01; p = 0.015, respectively). The specific IgE to Df was significantly higher (p < 0.01) than that to Dermatophagoides pteronyssinus (Dp), suggesting a cross reaction between the Df antigen and the Toxocara antigen. CONCLUSIONS: Patients who have elevated serum total IgE and have eosinophilia without allergic disease might have toxocariasis. The lower frequency of asthma or rhinitis and a tendency for higher specific IgE to Df than that to Dp could be useful findings for the diagnosis of toxocariasis in patients with eosinophilia.
Asthma ; Cross Reactions ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Eating ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Liver ; Lung ; Meat ; Pyroglyphidae ; Rhinitis ; Toxocara ; Toxocara canis ; Toxocariasis

BACKGROUND: Periampullary cancer is a relatively common malignancy, and its incidence is increasing. A pancreaticoduodenectomy is the procedure of choice in patients with periampullary cancer. However, leakage of the pancreaticojejunal anastomosis has been a major complication after a pancreaticoduodenectomy, with a frequently reported incidence of 5 percent to 25 percent. The ideal management of the pancreatic stump has not yet been determined. Thus we tried to find a safe and effective pancreatic stump management technique and to monitor the security of the pancreatic stump anastomosis by using the body fluid amylase level. PATIENTS AND METHODS: Forty six (46) consecutive patients who had undergone a pancreaticoduodenectomy, between January 1990 and January 1998, were evaluated retrospectively. Before June 1997, we did 36 pancreaticojejunostomies without long stent insertion into the pancreatic duct (group 2). After that, we did 10 P-Jstomies with long stent insertion (group 1). A long silicone stent was used for intubation of the anastomosis. Also the amount of pancreatic juice drainage from the long pancreatic duct tube was checked daily. We placed two Penrose drains and one Jackson-Pratt drain near the anastomosis. Patients were monitored for clinical evidence of a pancreatic fistula by evaluation of the amylase concentration in serum and the peritoneal drainage at postoperative day 7. The normal range of body fluid amylase was defined to be within five times of the normal serum amylase level. Cholangiography, which was obtained through a T-tube or a percutaneous transhepatic catheter, was performed on postoperative day 7 and was used to assess to leakage from or the obstruction at any of the three reconstructive anastomoses. RESULTS: In group 1, there was no leakage from the P-Jstomy site. The daily mean pancreatic juice amount and body fluid amylase level were 76.6 ml/day (range, 0.4-137.4 ml/day) and 147.4 U/L (range,44-323 U/L). In group 2, there were 4 cases of leakage at the P-Jstomy site (11.1%). CONCLUSION: An external long pancreatic duct stent insertion is an effective and safe method for management of a pancreatic remnant. We could check the amount of the daily pancreatic juice precisely. Effective decompression of the P-Jstomy was achieved by long stent insertion. We could monitor the security of the pancreatic stump anastomosis by the body fluid amylase level. We suggest that our method, which monitors the body fluid amylase level, is effective in early detection and treatment of P-Jstomy site leakage. The effort to find the best method for management of the pancreatic remnant should be continued.
Amylases ; Body Fluids ; Catheters ; Cholangiography ; Decompression ; Drainage ; Humans ; Incidence ; Intubation ; Pancreatic Ducts* ; Pancreatic Fistula ; Pancreatic Juice ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Reference Values ; Retrospective Studies ; Silicones ; Stents*

Pfeiffer syndrome is one of a rare form of craniosynostosis syndrome, showing variable degree of craniosynostosis, midface hypoplasia, broad thumbs and toes and syndactyly. This is transmitted in autosomal dominant pattern and known to be related to mutations in FGFR (Fibroblast Growth Factor Receptor) 1 or FGFR 2. We experience a case of newborn Pfeiffer syndrome type 3 who had multiple facial anomalies, thumbs and great toes anomalies, ankylosis of radius and ulnar and hydrocephalus.
Acrocephalosyndactylia* ; Ankylosis ; Craniosynostoses ; Humans ; Hydrocephalus* ; Infant, Newborn ; Radius ; Syndactyly ; Thumb ; Toes

OBJECTIVE: Anterior cervical fusion is widely used with many kinds of plate systems. The purpose of this study is to evaluate the rate and influencing factor of instrument failure. METHODS: The authors reviewed 101 consecutive patients who underwent anterior interbody fusion used Caspar, PCB(Cervical Plate Cage System), Orion and Atlantis plate system during the period of January 1991 to December 2000. The cases of trauma were 49, tumor 2 and degenerative disorder 50. The average length of follow up was 12.2 months. RESULTS: There were 10 cases of instrument related complications and 18 cases of non-instrument related complications. Among 10 cases of instrument related complication, eight patients showed screw loosening and two patients showed bone graft displacement. The nine cases of hardware failure occurred within 3 months. The rate of instrument failure was higher in trauma, unlocking plate and multi-level than non-trauma, locking plate and one-level. There were no injuries to tracheoesophageal or neurovascular structures as a results of instrument failure. CONCLUSION: We conclude that anterior cervical plating can be carried out with acceptable complication rate. The incidence of prominent instrument failure that endangers tracheoesophageal structures is minimal.
Follow-Up Studies ; Humans ; Incidence ; Transplants

Paravalvular abscess is a serious complication of infective endocarditis. The aortic valve and its adjacent ring are more susceptible to abscess formation and paravalvular extension than the mitral valve. A 15-years old patient with bicuspid aortic valve presented with staphylococcal tricuspid valve endocarditis complicated by para-aortic abscess that ruptured into the aortic sinus. We report the clinical, laboratory and echocardiographic features and treatment of this patient and conduct a literature review on this subject.
Abscess ; Aortic Valve ; Bicuspid ; Endocarditis ; Heart Valve Diseases ; Humans ; Mitral Valve ; Sinus of Valsalva ; Tricuspid Valve