No abstract available.
Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Pregnancy*

Authors evaluated the electrocardiographic criteria of Minnesota Code (III-1, III-2) for the diagnosis of left and right ventricular hypertrophy in 93 cases of healthy peoples, 74 cases of left ventricular hypertrophy and 4 cases of right ventricular hypertrophy and following results were obtained. 1. By left ventricular hypertropy criteria (III-1), there were 5.4% of false positive and 14.9% of false negative cases. 2. By right ventricular hypertrophy criteria III-2), there were 24.7% of false positive and 20.0% of false negative cases. 3. Electrocardiographic diagnosis of ventricular hypertrophy by Minnesota Code (III-1, III-2) were more reliable criteria than many other criteria of ventricular hypertrophy.
Diagnosis* ; Electrocardiography ; Hypertrophy* ; Hypertrophy, Left Ventricular ; Hypertrophy, Right Ventricular ; Minnesota*

Infective endocarditis by Hemophilus species is very rare:there are only 22 reported-cases of Hemophilus paraphrophilus endocarditis. We report a case of Hemophilus paraphrophilus endocarditis in a middle-aged woman with cerebral embolism and hemorrhage.
Endocarditis* ; Female ; Haemophilus ; Haemophilus paraphrophilus* ; Hemorrhage* ; Humans ; Intracranial Embolism*

BACKGROUND: Ventilator associated pneumonia (VAP) is the most serious nosocomial infection of intensive care units. Several studies have investigated the relationship between the interval of ventilator circuit changes and the incidence of pneumonia in foreign countries, but there are no reports about it in Korea yet. So we performed this study to compare the clinical and cost impact between 3 days and 7 days interval in ventilator circuit changes. METHODS: Seoul National University Hospital is a 1,500-bed, university affiliated, tertiary and acute care hospital. All patients admitted to medical intensive care unit (MICU) and surgical intensive care unlt (SICU) between April 1, 1998 and October 31, 1998, requiring mechanical ventilation were included. Patients were divided into two groups of a-cay circuit changes and weekly changes. Daily surveillance was conducted using the criteria of VAP of the National Nosocomial Infection Surveillance System. Incidence of VAP and risk factors for VAP were evaluated. Standard microbiologic methods were used for the identification of clinical and environmental isolates. Statistical analysis was done by SAS Program (version 6.12), analysis of difference in variables was performed using chi-square test and t-test. Analysis of odds ratios was done with logistic regression analysis. RESULTS: VAP developed at a rate of 12.2 per 1,000 ventilator-days in the 3 days change group and 15.6 per 1,000 ventilator-days in the weekly change group (P=0.7240). The only statistically significant risk factor of VAP was duration of mechanical ventilation, The risk of VAP in patients with more than 7 days was 2.23 times higher than in patients with 7 days and below (OR; 2.2296). Estimated annual savings of nursing time by extending ventilator circuit change interval from 3 days to 7 days were 26,806 min 48 sec and estimated savings of cost by reduction of nursing times was calculated as 6,701,700 won. CONCLUSIONS: Weekly ventilator circuit changes in patients undergoing ventilation therapy in the ICU do not contribute to increased the rates of VAP and are cost-effective.
Cross Infection ; Humans ; Incidence ; Income ; Critical Care ; Intensive Care Units ; Korea ; Logistic Models ; Nursing ; Odds Ratio ; Pneumonia ; Pneumonia, Ventilator-Associated* ; Prospective Studies* ; Respiration, Artificial ; Risk Factors ; Seoul ; Ventilation ; Ventilators, Mechanical

OBJECTIVE: The sural nerve is a sensory nerve in the lower extremity which is formed by the union of the medial sural cutaneous nerve of tibial nerve and the communicating branch of the common peroneal nerve. The objective of this study is to standardize the electrodiagnostic technique of proximal conduction of sural nerve and to investigate the usefulness of the technique in evaluation for the patients with peripheral neuropathy. METHOD: Fifty eight extremities in 29 normal adults without the clinical signs and symptoms of peripheral neuropathy were evaluated with sural nerve conduction study. The active recording electrode was placed over 14 cm proximal to the lateral malleolus, and the reference electrode was placed over 4cm distal to the active electrode. The antidromic evoked responses were recorded with stimulation at points 7, 14, 21 cm proximal to the recording electrode and directly over the sural nerve. RESULTS: The mean values of proximal conduction study of sural nerve in normal adults were 2.40 1.03 msec for peak latency, 11.55 +/-7.31 microvolt in amplitude with stimulation at 7 cm proximal to the recording electrode; 3.43 +/-0.78 msec for peak latency, 10.87 5.86 microvolt in amplitude with stimulation at 14 cm; 4.51 +/-0.83 msec for peak latency, 8.78+/- 4.10 microvolt in amplitude with stimulation at 21 cm. CONCLUSION: A method of proximal conduction study of sural nerve was introduced which could be used as a valuable technique for the evaluation of peripheral neuropathy.
Adult ; Electrodes ; Extremities ; Humans ; Lower Extremity ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Sural Nerve* ; Tibial Nerve

PURPOSE: Recently, after patent ductus arteriosus (PDA) ligation in preterm infants, unexplained hemodynamic instabilities are reported. To determine the incidence, risk factors and clinical manifestations of hemodynamic instability after PDA ligation in very low birth weight (VLBW) infants. METHODS: This retrospective multicenter study enrolled 18 VLBW infants who underwent PDA ligation from January 2002 to February 2008. Hemodynamic instability defined as unexplained cardiopulmonary dysfunction with increased dependency on mechanical ventilation and decreased blood pressure. RESULTS: The mean gestational age and birth weight (BW) of all infants were 27(+)6+/-1(+6) weeks and 951+/-245 g. Hemodynamic instability group (HI) included seven infants (39%) and hemodynamic stability group (HS) included 11 infants (61%). Compared to HS, HI had lower BW (1,033+/-285 g vs. 821+/-126 g, P=0.048) and weight on operation day (1,195+/-404 g vs. 893+/-151 g, P=0.042), longer hospital days (105+/-29 vs. 141+/-39, P=0.038), more severe bronchopulmonary dysplasia (BPD), (no/mild/moderate/severe, 2/5/2/2 vs. 0/1/2/4, P=0.038) and higher preoperative FiO2 (0.29+/-0.06 vs. 0.38+/-0.09, P=0.02). One case of mortality due to sepsis, which was not associated with ligation, was observed among HS. CONCLUSION: The incidence of hemodynamic instability after PDA ligation in VLBW infants was 39%. Low BW, low weight on operation day and preoperative high FiO2 might be risk factors of hemodynamic instability after PDA ligation in VLBW infants. The hemodynamic instability could increase the severity of BPD and hospital days.
Birth Weight ; Bronchopulmonary Dysplasia ; Dependency (Psychology) ; Ductus Arteriosus, Patent ; Gestational Age ; Hemodynamics ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Ligation ; Premature Birth ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Sepsis

PURPOSE: Recently, after patent ductus arteriosus (PDA) ligation in preterm infants, unexplained hemodynamic instabilities are reported. To determine the incidence, risk factors and clinical manifestations of hemodynamic instability after PDA ligation in very low birth weight (VLBW) infants. METHODS: This retrospective multicenter study enrolled 18 VLBW infants who underwent PDA ligation from January 2002 to February 2008. Hemodynamic instability defined as unexplained cardiopulmonary dysfunction with increased dependency on mechanical ventilation and decreased blood pressure. RESULTS: The mean gestational age and birth weight (BW) of all infants were 27(+)6+/-1(+6) weeks and 951+/-245 g. Hemodynamic instability group (HI) included seven infants (39%) and hemodynamic stability group (HS) included 11 infants (61%). Compared to HS, HI had lower BW (1,033+/-285 g vs. 821+/-126 g, P=0.048) and weight on operation day (1,195+/-404 g vs. 893+/-151 g, P=0.042), longer hospital days (105+/-29 vs. 141+/-39, P=0.038), more severe bronchopulmonary dysplasia (BPD), (no/mild/moderate/severe, 2/5/2/2 vs. 0/1/2/4, P=0.038) and higher preoperative FiO2 (0.29+/-0.06 vs. 0.38+/-0.09, P=0.02). One case of mortality due to sepsis, which was not associated with ligation, was observed among HS. CONCLUSION: The incidence of hemodynamic instability after PDA ligation in VLBW infants was 39%. Low BW, low weight on operation day and preoperative high FiO2 might be risk factors of hemodynamic instability after PDA ligation in VLBW infants. The hemodynamic instability could increase the severity of BPD and hospital days.
Birth Weight ; Bronchopulmonary Dysplasia ; Dependency (Psychology) ; Ductus Arteriosus, Patent ; Gestational Age ; Hemodynamics ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Ligation ; Premature Birth ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Sepsis

PURPOSE: To determine clinical outcome in cases of traumatic intraventricular hemorrhage(TIVH) according to the mechanisms and amount of hemorrhage seen on initial CT. MATERIALS AND METHODS: We retrospectively reviewed the initial CT findings of 61 patients with TIVH. The mechanisms of TIVH were analyzed on the basis of the following CT findings: Type I; large intracerebral hematoma extending to adjacent ventricle; Type II: hemorrhagic and/or non-hemorrhagic diffuse axonal injury in the thalamus and basal ganglia; Type III: multiple small hemorrhagic lesions in the septum pellucidum, fornix, corpus callosum, and periventricular region, which may be due to inner cerebral trauma, Type IV: evidence of hypoxic brain injury, and Type V: TIVH with contusion and small subdural or epidural hematomas. The amount of TIVH was classified according to the Graeb score. We analyzed these mechanisms on the basis of CT findings, and for prognosis, correlated these with clinical outcomes and the Glasgow coma score. RESULTS: Prognosis was good in types V and III and poor in type I and II(p=0.001). In patients with a Graeb score of 4 or less, the clinical outcome was better than in those with a Graeb score above 5(p=0.03). Patients with a lower initial Glasgow coma score had poor outcomes(p=0.001). CONCLUSION: The hemorrhage mechanism in patients with TIVH could be important for estimating clinical outcome, especially during the early phase. In patients with type V or III TIVH, clinical outcome was better than in those with type I or II.
Basal Ganglia ; Brain Injuries ; Classification* ; Coma ; Contusions ; Corpus Callosum ; Diffuse Axonal Injury ; Hematoma ; Hemorrhage* ; Humans ; Prognosis* ; Retrospective Studies ; Septum Pellucidum ; Thalamus

Placenta percreta with bladder invasion is an extremely rare complication causing life-threatening hemorrhage, up to 17 liters.1 Most reported cases have been diagnosed after 30 weeks of pregnancy and few have presented before 20 weeks.2 Only 20 cases of placenta percreta with invasion of the bladder have been reported during last decade. In this condition, chorionic villi attach directly to the myometrium without intervening decidua. The exact etiology of impaired decidualization is unknown; however, a previous endometrial insult, such as previous cesarian section or endometrial curettage may be a contributing factor. To avoid massive bleeding, uterine body incision, hypogastric artery ligation before hysterectomy and uterine cervical removal have been attempted.1 Chorionic villi may attach to the myometrium (accreta), invade the myometrium(increta), or in its severe form (percreta) the trophoblastic tissue penetrates the whole myometrium and invades adjacent structures. We experienced a case of placenta previa percreta with bladder invasion and review the literatures.
Animals ; Arteries ; Chorionic Villi ; Curettage ; Decidua ; Female ; Hemorrhage ; Hysterectomy ; Ligation ; Mice ; Myometrium ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy ; Trophoblasts ; Urinary Bladder* ; Uterine Hemorrhage

We experienced a female neonate with congenital nephrotic syndrome (CNS) associated with congenital diaphragmatic hernia (CDH). Because of the rare combination of two conditions, we report this case with literature review. CDH was found immediately after birth and emergency operation was done for hernia repair. But on the next day, generalized edema and oliguria(0.59 mL/kg/hour) was found and her blood chemistry showed hypoalbuminemia (1.6 g/dL), increased BUN (27.7 mg/dL) and serum creatinine( 1.8 mg/dL) along with heavy proteinuria (4+). We started albumin infusion with a bolus of intravenous furosemide. We suspected the neonate had congenital nephrotic syndrome and her 24hr urine protein was 1,816 mg/day. In spite of immunosuppressive therapy, the nephrotic syndrome and renal failure progressed. We started peritoneal dialysis on the day of life 22 but it was not satisfactory. She was complicated by intracranial hemorrhage and multi-organ failure and expired at 34 days of age. Kidney necropsy was performed which showed diffuse mesangial sclerosis (DMS). Her chromosome study revealed 46, XX and her gene study revealed a heterozygous missense mutation, Arg366His, in Wilms tumor suppressor gene (WT1). This case deserves attention on account of the 4th case of CNS with CDH revealing the Arg366His mutation in the WT1 gene andG the 1st case of early onset renal failure without male pseudohermaphroditism and Wilms tumor with CNS, CDH and the Arg366His mutation in the WT1 gene. So, this report gives support to the hypothesis that Arg366His mutation in the WT1 gene can result in CNS and CDH.
46, XY Disorders of Sex Development ; Edema ; Emergencies ; Female ; Furosemide ; Genes, Suppressor ; Hernia, Diaphragmatic ; Herniorrhaphy ; Humans ; Hypoalbuminemia ; Infant, Newborn ; Intracranial Hemorrhages ; Kidney ; Mutation, Missense ; Nephrotic Syndrome ; Parturition ; Peritoneal Dialysis ; Proteinuria ; Renal Insufficiency ; Sclerosis ; Wilms Tumor