A study was made on 50 cases of epileptic children who had been observed at the pediatric department of Chungnam National University Hospital Taejeon Eul Ji Hospital during the period from July, 1986 to June, 1991. The result are as follows: 1) Epilepsy was most frequent in children from 1 year to 10 year of age (80%). Epilepsy was commoner in female children compare to male representing male to female ratio, 1:1.2. 2) Intractable cases with VPA were 40%, and male to female ratio was 1.2:1. Intractable cases were most common between 1 and 5 years (65%). 3) The most common epileptic type was generalized tonic clonic seizure (38%). 4) The clinical effect of valproic acid was the worst in severely abnormal EEG finding. 5) The mean plasma VPA level was significantly lower for the polytherapy (57.7microgram/ml) than for the monotherapy (69.5microgram/ml). The VPA dose of steady-state was significantly higher for polytherapy (27.9mg/kg/d) than for the monotherapy (20.9mg/kg/d). VPA level: dose ratio was reduced in the polytherapy (2.1) as compared to monotherapy (3.3). 6) The plasma VPA level increased according to dosage. In the same dose, plasma level of monotherapy was significantly higher than polytherapy. 7) The VPA dose of stead-state was highest under 1 year (monotherapy: 24.8mg/kg/day, polytherapy: 33.4mg/kg/day). The VPA dose decreased in accordance with an increase of the age. 8) There was no correlation between EEG change and plasma concentration of VPA. 9) There was linear correlation between clinical affect and plasma VPA level, and plasma concentration of VPA reached 51 to 100microgram/ml at that time. 10) The clinical effect was good in abscence seizure, simple partial seizure, myoclonic seizure, and generalized tonic clonic seizure in decreasing order. 11) The incidence of side effect were gastrointestinal disturbance, behavior disorder, laboratory abnormality, neurologic abnormality in order of frequency. The frequency of overall side effects observed was 40% but toxic effects were generally mild.
Child* ; Chungcheongnam-do ; Daejeon ; Electroencephalography ; Epilepsy ; Female ; Humans ; Incidence ; Male ; Plasma ; Seizures ; Valproic Acid*

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Female ; Pregnancy ; Pregnancy, Ectopic*

PURPOSE: Occupational stress can have a negative effect on the worker such as physical, emotional, and psychological health. Although it is well reported that health service staff tend to have a high level of minor psychiatric disorder, only a few studies have been reported in Korea. Intern and Residency (residents) are very vulnerable periods of stress and other psychiatric disorders. In this study, we describe occupational stress of interns and residents and relationship between occupational stress and depression. METHODS: The participants of this study were interns and residents trained in a tertiary hospital in Korea. The occupational stress scale was used for measurement of occupational stress. In addition, the Korean version of the Beck depression scale was used to evaluate the prevalence of depression. Statistical analyses were performed using SPSS v. 18.0; p-value less than 0.05 was considered statistically significant. RESULTS: Female doctors showed higher occupational stress than male. Interns and chief residents demonstrated higher occupational stress than other grades. Astonishingly, most participants showed depressive mood. Compared with the general population, job demand and culture of the workplace are in the first upper quartile. It is indicated that compared with general populations, physicians have a higher workload and patience is required in order to cope with the harsh culture of the workplace. Depressive mood was evaluated with various factors and only occupational stress was statistically significant. CONCLUSION: Overwhelming occupational stress of residents could result in both medical and social problems. Therefore, recognition of occupational stress is essential and aggressive interventions are required.
Burnout, Professional ; Depression ; Female ; Health Services ; Humans ; Internship and Residency ; Korea* ; Male ; Prevalence ; Seoul* ; Social Problems ; Tertiary Care Centers*

The incidence of myocardial ischemia and silent myocardial infarction are higer in diabetic than in nondiabetic patients. We had a case of a disbetic, myocardial ischemic female patient, 54years old, who had cardiac arrest during an emergency surgery. The patient was admitted via emergency room with the diagnosis of rupture of basilar artery aneurysm. During the dissection for the exposure of the artery. The aneurysm ruptured. causing massive hemorrhage. At this time, cardiac arrest was revealed at the monitoring EKG, cardiopulmonary resuscitation with DC shock were performed to reverse venticular fibriliation but the EKG monitor showed T wave inversion and sinus tachycardia in several leads. And the blood pressure was hardly audible with systolic of about 50mmHg. So nitroglycerin 0.05mg, intravenous bolus injection was given twice and the systolic went up to 110mmHg with a diastolic of 80mmHg. So the operation proceeded and finished. The patient was sent to the ICU. On the third postoperative day, the patient again had cardiac arrest but this time could not be resuscitated. We experienced the dramatic effect of nitroglycerin on this ischemic patient during cardio pulmonary resuscitation and we would like to share this experience with our colleagues.
Aneurysm ; Arteries ; Blood Pressure ; Cardiopulmonary Resuscitation* ; Diagnosis ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Heart Arrest ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin* ; Rupture ; Shock ; Tachycardia, Sinus

OBJECTIVE: To compare the clinical results between laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH). METHOD: 60 of LAVH cases and 60 of TAH cases, which were performed at Dankook university hospital from April 1998 to December 2000. We analyzed the results with regard to patient's characteristics, indication of hysterectomy, weight of uterus, operation time, blood loss, hospital stay and complications. RESULTS: Total 120 of hysterectomy cases (60 LAVH, 60 TAH) were enrolled in this study. All operations, LAVH and TAH, were performed by same surgeon. There were no significant differences in patient's characteristics (age, height, weight, parity) between the two groups. The main preoperative indication was myoma uteri, followed by adenomyosis, CIN III, for both LAVH and TAH. The mean uterine weight of TAH cases was larger than LAVH (214.8+/-88.1 gm for LAVH, 377.1+/-269.0 gm for TAH, p<0.05) cases. The operation time was longer in LAVH operation (114.3+/-31.4 min for LAVH, 93.7+/-30.2 min for TAH, p<0.05). The blood loss was not significantly different between the two groups (185.5+/-53.3 ml for LAVH, 205.8+/-65.8 ml for TAH, p>0.05). The hospital stay of LAVH was significantly shorter than TAH (4.9+/-0.6day for LAVH, 7.5+/-1.9day for TAH, p<0.05). CONCLUSION: In the comparison of LAVH and TAH operation, we conclude that LAVH can be considered as the first choice when determining hysterectomy method, unless contraindication prevents it. LAVH has advantages of shorter hospitalization and the acceptable complication rate.
Adenomyosis ; Female ; Hospitalization ; Hysterectomy* ; Hysterectomy, Vaginal* ; Length of Stay ; Myoma ; Uterus

A case of recurrent fibrosarcoma arising from the distal portion of the left spermatic cord in a twenty-two-year-old male is presented, and is discussed on its incidence, differential diagnosis, treatment and prognosis with brief literature review.
Diagnosis, Differential ; Fibrosarcoma* ; Humans ; Incidence ; Male ; Prognosis ; Spermatic Cord*

An autopsy case of spontaneous rupture of urinary bladder followed by longstanding chronic and acute hemorrhagic cystitis associated with anomalous course of the right ureter and pyo-hydronephrosis, and acutely disseminated tuberculous pneumonia in a twenty-two-year-old Korean Army soldier is presented. Pathogenesis of spontaneous rupture of urinary bladder is briefly discussed.
Autopsy ; Cystitis* ; Humans ; Military Personnel ; Pneumonia ; Rupture, Spontaneous* ; Ureter* ; Urinary Bladder*

BACKGROUND: The potential adverse effects of ketamine in neurosurgical anesthesia have been well established. However, the effects of ketamine on intracranial pressure (ICP) and hemodynamics during general anesthesia remain unclear. The purpose of this study was to assess the effects of ketamine on hemodynamics and ICP in anesthetized, ventilated rabbits. METHODS: Thirty rabbits were divided into three groups: Group 1 (n=10) received 1 ml/kg normal saline iv; Group 2 (n=10) received 0.5 mg/kg ketamine iv; Group 3 (n=10) received 1.0 mg/kg ketamine iv. After induction with thiopental, anesthesia was maintained with isoflurane and nitrous oxide in oxygen. During controlled ventilation, ICP, mean arterial pressure (MAP), cerebral perfusion pressure (CPP) and heart rate (HR) were measured. The ICP was measured using Ladd ICP monitoring system. All variables were evaluated at baseline and for 30 min following ketamine. RESULTS: In group 1, ICP, MAP, CPP and HR were unchanged over the course of the study. In group 2, ICP, MAP and CPP were unchanged. HR increased at 1, 3 and 5 min (p<0.01), 10 and 20 min (p<0.05) after injection. In group 3, ICP, MAP and CPP increased at 1 and 3 min (p<0.01) after injection. HR increased at 1, 3 and 10 min (p<0.01), 5 min (p<0.05) after injection. CONCLUSIONS: These results suggest that 0.5 and 1.0 mg/kg of ketamine don't significantly affect the hemodynamics and ICP in anesthetized, mechanically ventilated rabbits.
Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Intracranial Pressure* ; Isoflurane ; Ketamine* ; Nitrous Oxide ; Oxygen ; Perfusion ; Rabbits* ; Thiopental ; Ventilation