Prediction of individual outcome after cardiopulmonary resuscitation is of major medical, ethical, and socioeconomic interest but uncertain. We experienced the case thats the patient got complete neurologic recovery after the 123th day firm cardiac arrest, who had been suspected to go with poor prognosis because she got the findings of Glasgow Coma Scale 4, severe diffuse encephalopathy on encephalogram and generalized tonic-clonic seizure at the 4th day. Recently, a 29 year-old women who sustained from respiratory arrest induced presumably by sedative and anticonvulsant therapy for control of seizure that happened during local lidocaine anesthesia far mamoplasty was transfered to our emergency medical center from local private plastic office. Arrest time was about 20 minutes. On hospital arrival, she had a pulseless bradyasystole and no respiration, but spontaneous circulation was restored at 10 minutes artier CPR started. We started cerebral oriented resuscitation including mild hypothermia(34degrees C), hemodilution, calcium channel blocker infusion. On hospital day 4, patient's glasgow coma scale(GCS) was 4. On hospital clay 7, Brain Magnetic Resonance Imaging(MRI) showed high signal intensity on T2WI, involving the bilateral basal ganglia. After contrast administraton, marked enhancement can be seen at the lesion site. Patient's glasgow coma scale(GCS) increased step by step to 5 on 8th day, 7 on 14th day, 10 on 15th day, 13 on 17th day, 15 on 20th day. 40 days later the patient was discharged with minor neurologic abnormality including hand tremor, dysphonia, amenorrhea and Mini Mental State Examination(MMSE) score(26). Long-term Follow up revealed that all neurologic functional abnormality inducting hand tremor, dysphonia, amenorrhea and MMSE score(26) is completely recovered on 123th day after episode of cardiopulmonary arrest.
Adult ; Amenorrhea ; Anesthesia ; Basal Ganglia ; Brain ; Calcium Channels ; Cardiopulmonary Resuscitation ; Coma ; Dysphonia ; Emergencies ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Hand ; Heart Arrest* ; Hemodilution ; Humans ; Hypoxia-Ischemia, Brain* ; Lidocaine ; Plastics ; Prognosis ; Respiration ; Resuscitation ; Seizures ; Tremor

PURPOSE: The TNM classification for carcinoma of the colon and the rectum provides more detail than other staging systems. This study was performed to evaluate the effectiveness of AJCC staging system (5th ed., 1997) for the colorectal cancer in predicting prognosis. METHODS: We analyzed a data base of 1,233 colorectal cancer patients (M:F=673:560) who underwent surgery in Asan Medical Center during July 1989-December 1996. Survival analysis was performed between the stages and the subgroups in same stage by using Kaplan-Meier method and log rank test. Borderline subgroup comparison between the stages was performed, also. Significance was assigned to a P value of <0.05. RESULTS: Mean age of the patients was 57 (19-90) years old. Median follow-up period was 42 (6-129) months. The number of patients in each stage were 0: 15, I: 152, II: 390, III: 465, IV: 199. The 5 year overall & disease free survival rates of each stage were 100%, 100% (in stage 0), 96.4%, 93.6% (in stage I), 82.7%, 82.2% (in stage II), 59.9%, 55.3% (in stage III), and 7.3%, 24.9% (in stage IV), respectively (P=0.000). Subgroup analysis in stage I (T1N0 vs. T2N0) and II (T3N0 vs. T4N0) revealed no differences. However, in stage III, N1 (n=246) group showed better survival than N2 (n=219) group (70.3%, 65.5% vs. 49.2%, 44.6%: P=0.000). Borderline survival analysis between stage I and II (T2N0 vs. T3N0) was significantly different (96.6%, 95.7% vs 82.7%, 82.3%: P=0.006). However, between stage II and III (T4N0 vs. T1N1), appropriate analysis was impossible due to small number of cases. CONCLUSIONS: AJCC staging system for colorectal cancer was reliable and effective in predicting prognosis. However, substages are needed in stage III.
Chungcheongnam-do ; Classification ; Colon ; Colorectal Neoplasms* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Prognosis ; Rectum

PURPOSE: Oak is the dominant tree species in Korea. Oak pollen has the highest sensitivity rate among all allergenic tree species in Korea. A deep neural network (DNN)-based estimation model was developed to determine the concentration of oak pollen and overcome the shortcomings of conventional regression models. METHODS: The DNN model proposed in this study utilized weather factors as the input and provided pollen concentrations as the output. Weather and pollen concentration data were used from 2007 to 2016 obtained from the Korea Meteorological Administration pollen observation network. Because it is difficult to prevent over-fitting and underestimation by using a DNN model alone, we developed a bootstrap aggregating-type ensemble model. Each of the 30 ensemble members was trained with random sampling at a fixed rate according to the pollen risk grade. To verify the effectiveness of the proposed model, we compared its performance with those of models of regression and support vector regression (SVR) under the same conditions, with respect to the prediction of pollen concentrations, risk levels, and season length. RESULTS: The mean absolute percentage error in the estimated pollen concentrations was 11.18%, 10.37%, and 5.04% for the regression, SVR and DNN models, respectively. The start of the pollen season was estimated to be 20, 22, and 6 days earlier than that predicted by the regression, SVR and DNN models, respectively. Similarly, the end of the pollen season was estimated to be 33, 20, and 9 days later that predicted by the regression, SVR and DNN models, respectively. CONCLUSIONS: Overall, the DNN model performed better than the other models. However, the prediction of peak pollen concentrations needs improvement. Improved observation quality with optimization of the DNN model will resolve this issue.
Korea ; Pollen ; Quercus ; Rhinitis, Allergic ; Rhinitis, Allergic, Seasonal ; Seasons ; Trees ; Weather

The idiopathic hypereosinophlic syndrome (HES) is a disease defined by three diagnostic criteria, first, sustained blood eosinophilia is greater than 1,500/mm3 present for longer than 6 months, second, other apparent etiologies for eosinophilia must be absent, including parasitic infection and allergic disease, third, patients must have signs and symptoms of organ involvement. It is associated with cytotoxic granule proteins released by mature eosinophils. HES mainly affects cardiovascular, neurologic, pulmonary system, liver and spleen while low incidence of gastrointestinal involvement is found, and the development of severe complications such as intestinal obstruction after peritonitis or intestinal perforation is extremely rare. We have experienced a case of HES involving hepatic and digestive system, 39 year old man patient who was operated due to intestinal obstruction that was followed by HES, so we report this case with a review of the literature.
Adult ; Digestive System ; Eosinophilia ; Eosinophils ; Humans ; Hypereosinophilic Syndrome* ; Incidence ; Intestinal Obstruction* ; Intestinal Perforation ; Liver ; Peritonitis ; Spleen

Isolated anomalous right coronary artery originating from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly that is asymptomatic and discovered incidentally in most cases. ARCAPA is generally not considered a fatal defect in infancy or childhood, although cases of sudden death have been reported. Here, we report a 2-month-old female infant who presented with a prolonged fever that was determined to be caused by rhinovirus infection. Myocardial ischemia of the left ventricular posterior wall was already seen on echocardiography, and ARCAPA was discovered incidentally. The patient underwent successful surgical reimplantation of the right coronary artery to the aortic root to re-establish dual ostial circulation.
Asymptomatic Diseases ; Coronary Vessel Anomalies ; Coronary Vessels* ; Death, Sudden ; Echocardiography ; Female ; Fever ; Humans ; Infant* ; Myocardial Ischemia ; Pulmonary Artery* ; Replantation ; Rhinovirus

Purpose: The threshold levels for symptom development of pollinosis vary among studies and countries. This study aimed to determine currently used threshold levels for it. Methods: Oak, pine, Japanese hop, and ragweed pollen samples were collected daily for 8 years from the Seoul and Guri areas. A total of 792 subjects with allergy to these pollens were recruited. The symptom index (SI) was assessed through telephone interviews and allergy questionnaires, and data were analyzed using decision tree. Results: The risk index for oak pollen allergy was “mild” when the pollen count was 0–2 grains/m3 , “moderate” when it was 3–11 grains/m3 , “severe” when it was 12–28 grains/m3 , and “dangerous” when it was ≥ 29 grains/m3 . The risk level for pine pollen allergy was “mild” when the pollen count was 0–4 grains/m 3 , “moderate” when it was 5–42 grains/m3 , “severe” when it was 43–66 grains/m3 , and “dangerous” when it was ≥ 67 grains/m3 . For Japanese hop pollen allergy, the risk level was “mild” when the pollen count was 0–8 grains/m3 , “moderate” when it was 9–10 grains/m3 , “severe” when it was 11–19 grains/m3 , and “dangerous” when it was ≥ 20 grains/m3 . Finally, for ragweed, the risk level was “mild” when the pollen count was 0–1 grains/m3 , “moderate” when it was 2–6 grains/m3 , “severe” when it was 7–33 grains/m3 , and “dangerous” when it was ≥ 34 grains/m3 . Conclusions Revising the threshold levels for the risk index for pollen allergies may be useful for developing pollen prediction models for patients with pollen allergies in Korea.

Purpose: We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. Materials and Methods: Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. Results: Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. Conclusion TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency sur-gery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

Purpose: We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. Materials and Methods: Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. Results: Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. Conclusion TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency sur-gery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

PURPOSE: The purpose of the study was to evaluate the feasibility of infusion of normal saline onto the surface of the liver capsule for minimizing thermal injury of the adjacent organs during radiofrequency ablation of subcapsular hepatic tumor in an ex-vivo porcine model. MATERIALS AND METHODS: We used porcine small bowel with it's serosal surface spread onto the porcine liver as an experiment model. The puncturing electrode was inserted into a 6 Fr introducer sheath, and the introducer sheath was connected to the infusion pump for creating a saline flow over the liver surface . A total of 15 ablations were divided into the control group (n=5), intermittent saline infusion group (n=5) and continuous saline infusion (n=5) group. The ablations were done during 3 minutes, and the infusion was set at 2 ml/min and stopped every 30 seconds in the intermittent saline infusion group. After the ablation, we measured the size of the ablated lesion on the surface of bowel and liver, and we also measured the depth of hepatic lesion. RESULTS: Ablated areas of bowel and liver surface in the control group, intermittent saline infusion group and continuous infusion group were 210.7+/-89.1 mm2, 74.6+/-27.2 mm2 and 35.8+/-43.4 mm2, respectively, and 312.6+/-73.6 mm2, 228.4+/-110.5 mm2, and 80.9+/-55.1 mm2, respectively. In contrast to the broad base of the ablated area on the surface of the liver in the control group, the shapes of the lesions became narrower approaching to the liver surface in all cases of the continuous saline infusion group, and the shapes of the lesions were broad based in 3 cases and narrow based in 2 cases of the intermittent saline infusion group. CONCLUSION: Continuous infusion of normal saline onto the surface of the liver during radiofrequency ablation of subcapsular hepatic tumor is a feasible method for minimizing thermal injury of the adjacent organs. Further exploration of the optimal parameters or techniques to maximize the hepatic ablation and simultaneously to minimize the thermal injury of adjacent organs is required.
Catheter Ablation* ; Electrodes ; Infusion Pumps ; Liver*