M-mode, pulsed Doppler and Doppler color flow mapping, in addition to two-dimensional echocardiography, have greatly improved imaging of the fetal heart through identification of abnormal cardiac anatomy and rhythm in utero. The early detection of cardiac disturbance in utero permits alteration in obstetric management such as delivery in a high-risk center for optimal neonatal care and/or decision in optimal delivery time. We report two cases of the neonatal arrhy-thmia which were observed by fetal echocardiography. In the first case, female baby showed neonatal arrhythmias including tachycardia and brady-cardia until 3 days after birth, and then turned to bradyarrhythmia due to non-conducted atrial bigeminy. These events lead us to review the fetal echocardiographs of the patient carefully. Premature atrial contractions were observed in her fetal echocardiography. At 2 months after birth, the patient's electrocardiogram showed normal sinus rhythm. Severe neonatal bradycardia of the second case was due to congenital complete heart block, identified clearly by electrocardiogram after birth. This case also showed complete heart block in her fetal echocardiography. After insertion of the temporary pacemaker, cardiomegaly was improved. Both the neonate and the mother had positive anti-SSA/Ro autoantibody. But any other symptoms and signs of neonatal lupus did not appear in the neonate. Patient's mother also did not show any symptoms and signs of systemic lupus erythematosus. Since the prognosis depends upon the cause of bradyarrhythmia in fetus and neonates, differential diagnosis is important in obstetric management and optimal neonatal treatment.
Arrhythmias, Cardiac* ; Atrial Premature Complexes ; Bradycardia ; Cardiomegaly ; Diagnosis, Differential ; Echocardiography* ; Electrocardiography ; Female ; Fetal Heart ; Fetus ; Heart Block ; Humans ; Infant, Newborn ; Lupus Erythematosus, Systemic ; Mothers ; Parturition ; Prognosis ; Tachycardia

High frequency ventilation considerably reduces the risk of barotrauma due to low peak airway pressure compared to conventional mechanical ventilation. This risk, however, is also preaent with high frequency jet ventilation (HFJV) if excessive driving preasure are used and, above all if expiration is impeded. We investigated the effects of outflow resistance, which was varied by connecting different size of tube (ID 8.0, 7.5, 7.0, 6.5, 5.5, 5.0, 4.5, 4.0 mm), which was cut in 10 cm length, to the proximal site of endotracheal tube (ID 8.0 mm), which was inserted into the trachea of anesthetized dogs with a attached airway pressure monitoring catheter externally, in different driving pressure (2 kg/cm2, 1 kg/cm2) and frequency (100beats/min, 200beats/min) on the intra-airway preesure during HFJV. HFJV was performed with a catheter (diameter 2.5 mm) which was inaerted through endotracheal tube and located 1 cm proximal to the tip of endotracheal tube. Intra-airway pressure was acutely increased with the tube size of smaller than 5.5 mm in driving pressure 2 kg/cm2 and 5.0 mm in driving pressure 1 kg/cm2 compared to previous size of tube. 2 kg/cm2 of driving pressure showed significant higher airway pressure compared to 1 kg/cm in any size of tube. There was no difference in airway pressure by varing of frequency with same driving preasure. In summary, pulmonary barotrauma due to higher airway pressure may be occur if HFJV catheter occupied more than 25% of outflow tract area especially in higher driving pressure.
Airway Resistance ; Animals ; Barotrauma ; Catheters ; Dogs ; High-Frequency Jet Ventilation* ; High-Frequency Ventilation ; Respiration, Artificial ; Trachea ; Ventilation

PURPOSE: Acute appendicitis is the most common cause of an acute abdomen that needs an emergency operation. However, the preoperative diagnosis is difficult. The purpose of this study is to assess the diagnostic efficacy of the Alvarado score by a comparison with CT and to determine the indication of CT evaluation. METHODS: From August 2006 to October 2006, 111 consecutive patients were admitted to Chung-Ang University hospital under the impression of acute appendicitis, and a CT scan was done. The Alvarado score, which consists of migration, anorexia, nausea-vomitig, tenderness, rebound tenderness, fever, leukocytosis, and left shift, was applied to the patients. RESULTS: Of the 111 patients, 85 patients underwent an operation, and 26 were discharged without an operation on the basis of the CT finding. The negative appendectomy rate were 4.7%. CT showed a sensitivity, of 0.90 a specificity of 0.97 and an accuracy rate of 0.92. Tenderness and leukocytosis were confirmed as the most important tests and showed accuracy rates of 0.73 and 0.70, respectively. The sensitivity was 0.90 at score 5 and 0.85 at score 7. Therefore, there was no single cut-off score that satisfied all diagnostic values. CONCLUSIONS: The Alvarado score alone is not a satisfactory diagnostic method acute appendicitis. Of the appendicitis patients, 90% might be included in the diagnosis for Alvarado scores above 5, and the negative appendectomy could be as high as 15% for Alvarado scores above 7, which is the score generally accepted for a diagnosis of appendicitis.
Abdomen, Acute ; Anorexia ; Appendectomy ; Appendicitis ; Emergencies ; Fever ; Humans ; Leukocytosis ; Sensitivity and Specificity

OBJECTIVE: To determine the reproductive outcomes of women undergoing microsurgical reversal of tubal sterilization at age 36 years or older. MATERIALS AND METHODS: A series of 133 patients who received microsurgical reversal of the previously sterilized fallopian tubes at Seoul National University Hospital from July, 1980 to January, 1992 was reviewed and evaluated for clinical characteristics, pregnancy rates, and factors influencing the outcome of tubal reversal. RESULTS: Of 133 patients, 78 (58.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading cause for tubal reversal. The mean interval from tubal sterilization to tubal reversal was 65.0 months. The overall pregnancy rate was 52.6% (70/133), and the mean interval was 9.4 months from tubal reversal to pregnancy. Excluding 7 patients who were lost to follow-up, 76 pregnancies were confirmed in 63 patients with the delivery rate per patient of 66.7% (42/63). There were no significant differences in age, duration of tubal sterilization, postoperative tubal length between pregnant and non-pregnant groups. CONCLUSIONS: Microsurgical reversal of tubal sterilization could be a justifiable method in women 36 years age or older.
Cautery ; Child ; Fallopian Tubes ; Female ; Humans ; Lost to Follow-Up ; Pregnancy ; Pregnancy Rate ; Seoul ; Sterilization, Tubal*

The prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea, and physicians, including surgeons, have been focusing on its treatment. Indeed, in Korea, medical treatment using a proton pump inhibitor is the mainstream treatment for GERD, while awareness of surgical treatment is limited. Accordingly, to promote the understanding of surgical treatment for GERD, the Korean Anti-Reflux Surgery Study Group published the Evidence-Based Practice Guideline for the Surgical Treatment of GERD. The guideline consists of 2 sections: fundamental information such as the definition, symptoms, and diagnostic tools of GERD and a recommendation statement about its surgical treatment. The recommendations presented 5 debates regarding fundoplication: 1) comparison of the effectiveness of medical and surgical treatments, 2) effectiveness of surgical treatment in cases of refractory GERD, 3) effectiveness of surgical treatment of extraesophageal symptoms, 4) comparison of effectiveness between total and partial fundoplication, and 5) effectiveness of fundoplication in cases of hiatal hernia. The present guideline is the first to demonstrate the efficacy of the surgical treatment GERD in Korea.
Evidence-Based Practice* ; Fundoplication ; Gastroesophageal Reflux* ; Hernia, Hiatal ; Korea ; Prevalence ; Proton Pumps ; Surgeons

A 69-year-old male presented with a week of worsening headache, mild dizziness and left side weakness,and the radiological work-up of his brain displayed an enhancing mass on the right frontal lobe.The tumor was totally resected. The patient was initially diagnosed with glioblastoma multiforme. Hisneurologic symptoms recovered after surgery. He underwent adjuvant radiotherapy with concurrent temozolomide.Approximately 7 months after surgery, the patient complained of epigastric pains. AbdominalCT scan showed multiple hepatic metastasis and multiple lymphadenopathy. Chest CT andTorso positron emission tomography-CT scans for additional metastasis study revealed multiple metastaticlesions in the right lung, left pleura, liver, lymph nodes, bones, and muscles. Percutaneous liverbiopsy was performed, and associated pathology was consistent with sarcomatous component. Afterliver biopsy, brain tumor pathology was reviewed, which revealed typical gliomatous and sarcomatouscomponents. The patient was therefore diagnosed with metastatic gliosarcoma. The patient was in aseptic condition with aggravated pleural effusion. The patient died 9 months after the diagnosis of primarygliosarcoma.

BACKGROUND: Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluated the etiological imprtance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. METHOD: The CAP patient over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age 63.8±15.3) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. RESULT: The average Fine's PORT score was 99.7(±44.9). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pneumophila serogroup 1 were not detected. CONCLUSION: Legionella pneumophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.
Adult ; Americas ; Classification ; Communicable Diseases ; Diagnosis ; Female ; Gangwon-do ; Heart ; Hospitalization ; Humans ; Immunoenzyme Techniques ; Intensive Care Units ; Korea* ; Legionella pneumophila* ; Legionella* ; Legionnaires' Disease ; Mortality ; Pneumonia*

Colonoscopy is a safe and standard procedure for diagnosis and therapy of colonic disorders. Iatrogenic colonic perforation during diagnostic colonoscopy, a rare abdominal emergency, has an 0.3~0.8% incidence rate. The choice of treatment for this complication remains controversial. Prompt operative intervention is preferred to minimize morbidity and mortality. However, operative intervention is invasive and needs a long-term recovery period. Conservative treatment is less invasive but can lead to more extensive surgery in case of treatment failure. Very important point on the treatment of iatrogenic perforation of the colon during diagnostic colonoscopy is to avoid the leaking of intestinal contents into the intraperitoneal cavity. We report here a case in which an iatrogenic perforation of the colon during diagnostic colonoscopy was successfully treated by endoscopic clip therapy.
Colon* ; Colonoscopy* ; Diagnosis ; Emergencies ; Gastrointestinal Contents ; Incidence ; Mortality ; Treatment Failure

BACKGROUND: The most common complication of latissimus dorsi myocutaneous flap in breast reconstruction is seroma formation in the back. Many clinical studies have shown that fibrin sealant reduces seroma formation. We investigated any statistically significant differences in postoperative drainage and seroma formation when utilizing the fibrin sealant on the site of the latissimus dorsi myocutaneous flap harvested for immediate breast reconstruction after skin-sparing partial mastectomy. METHODS: A total of 46 patients underwent immediate breast reconstruction utilizing a latissimus dorsi myocutaneous island flap. Of those, 23 patients underwent the procedure without fibrin sealant and the other 23 were administered the fibrin sealant. All flaps were elevated with manual dissection by the same surgeon and were analyzed to evaluate the potential benefits of the fibrin sealant. The correlation analysis and Mann-Whitney U test were used for analyzing the drainage volume according to age, weight of the breast specimen, and body mass index. RESULTS: Although not statistically significant, the cumulative drainage fluid volume was higher in the control group until postoperative day 2 (530.1 mL compared to 502.3 mL), but the fibrin sealant group showed more drainage beginning on postoperative day 3. The donor site comparisons showed the fibrin sealant group had more drainage beginning on postoperative day 3 and the drain was removed 1 day earlier in the control group. CONCLUSIONS: The use of fibrin sealant resulted in no reduction of seroma formation. Because the benefits of the fibrin sealant are not clear, the use of fibrin sealant must be fully discussed with patients before its use as a part of informed consent.
Breast ; Drainage ; Female ; Fibrin ; Fibrin Tissue Adhesive ; Humans ; Informed Consent ; Mammaplasty ; Mastectomy ; Seroma ; Tissue Donors

Hydranencephaly is a rare condition in which the brain's cerebral hemispheres are absent and replaced by sacs filled with cerebrospinal fluid. The prognosis for children with hydranencephaly is generally poor, so many children with this disorder die before the age of 1 year. We experienced a patient with hydranencephaly who showed prolonged survival until age of 22 years. To our limited knowledge, this case may be the longest survival of a patient with hydranencephaly in the world.
Adult* ; Cerebrospinal Fluid ; Cerebrum ; Child ; Humans ; Hydranencephaly* ; Prognosis