No abstract available.
Carcinoma, Basal Cell* ; Nevus*

Purpose: : This study aimed to systematically review the preventive interventions for delirium in Korean intensive care unit (ICU) patients and evaluate their efficacy. Methods: : For this systematic review and meta-analysis, we searched the literature and selected studies from data sources that included the RISS, KISS, National Central Library, National Assembly Library, DBpia, Science on, MEDLINE, and Cochrane Library. We used Cochrane’s revised tool for risk of bias in randomized trials and non-randomized studies of intervention tools to assess the quality of the selected studies. The effect size of the intervention was calculated as odds ratio (OR) and standardized mean difference (SMD). Results: : Preventive interventions reported in 23 studies with a total of 4,799 ICU patients were effective in reducing the occurrence of delirium (OR=0.64, 95% CI : 0.49~0.91, p=.011), but not the duration (SMD=–0.22, 95% CI : -0.51∼0.08, p=.148). As a result of a subgroup analysis, non-pharmacological interventions were effective in reducing the occurrence of delirium (OR=0.66, 95% CI : 0.47~0.94, p=.020), while pharmacological interventions had no effect (OR=0.68, 95% CI : 0.33∼1.40, p=.295). Among the non-pharmacological interventions, multi-component intervention had the largest effect size (OR=0.38, 95% CI : 0.26~0.55, p<.001). Conclusion : Non-pharmacological interventions were effective in reducing the occurrence of delirium. We recommend the development and application of multi-component interventions to prevent delirium in the Korean ICU patients.

No abstract available.
Beckwith-Wiedemann Syndrome*

Kaposi's sarcoma was first descrided by Kaposi in 1872 as an idiopathic multiple hemorrhagic sarcoma. Its clinical features revealed to be erythematous red or purple macule started out, and developing into palpable dome-shaped nodules. Etiology is not defined to detail at present. Kaposi's sarcoma is classified to 4 categories; Classical, African, Epidemic and Transplant type. Epidemic or AIDS categories is found approximately 20 % of all AIDS and has strong predilection for head and neck region. The first case of Kaposi's sarcoma observed in patients with kidney transplants was reported in 1969. Kaposi's sarcoma now accounts for 5% of all tumors associated with transplanted patients and alteration of the immunosuppression may have played a key role in these recipients. The most common site of Kaposi's sarcoma in transplanted patients are extremities but rare in head and neck area. We report a case of Kaposi's sarcoma on the hard palate in the kidney transplantation patient.
Extremities ; Head ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation ; Mouth* ; Neck ; Palate, Hard ; Sarcoma ; Sarcoma, Kaposi*

PURPOSE: There are few reports about the natural history of patients with pseudoprecocious puberty due to autonomous ovarian cyst. We reviewed the clinical course of 7 patients who had autonomous ovarian cysts and signs of precocious puberty. METHODS: We retrospectively evaluated 7 children, aged 2.8 to 7.9 years, who were diagnosed with pseudoprecocious puberty due to autonomous ovarian cysts from November 2005 to May 2011. The follow-up durations ranged from 0.5 to 6.3 years. RESULTS: Four out of 7 patients showed elevated serum estrogen levels and all revealed prepubertal response of gonadotropin to GnRH stimulation at diagnosis. The size of the cysts was from 1.7 to 4.6 cm on pelvic ultrasound examination. After 1 to 3 months, the ovarian cysts disappeared in all patients. Three of the girls developed relapsing signs of precocious puberty (vaginal bleeding and breast budding). Two of them showed an increase in growth velocity and bone age due to recurrent ovarian cysts, and one of them was converted to true precocious puberty. CONCLUSION: In our cases, all patients with autonomous ovarian cysts resolved spontaneously. However, some showed frequent recurrence of ovarian cysts, and needed a longer follow up because of the possibility of conversion to true precocious puberty and signs of McCune-Albright syndrome.
Aged ; Breast ; Child ; Estrogens ; Female ; Fibrous Dysplasia, Polyostotic ; Follow-Up Studies ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Hemorrhage ; Humans ; Natural History ; Ovarian Cysts ; Puberty ; Puberty, Precocious ; Recurrence ; Retrospective Studies

Retroperitoneal hemorrhage is a potentially lethal complication in patients on anticoagulant therapy and can be caused by ovarian artery bleeding, regardless of the patients’ age and obstetric history. This case illustrates the clinical presentation of ovarian artery bleeding in a postmenopausal female on anticoagulant therapy, the diagnostic utility of transcatheter angiography, and successful embolization.

The case reported here, concerns a spontaneous low-flow fistula between the carotid arterial network and the cavernous sinus, with ophthalmological symptoms such as conjunctival congestion and diplopia in a 41-year-old woman. The patient has suffered from diabetes without trauma history. Patient's ocular symptoms and signs were only present in the left eye with best-corrected visual acuity 0.04 at the time of presentation. Other ophthalmic findings were exophthalmos, elevated intraocular pressure, and visual field defects. Enlarged extraocular muscles and proptosis were found on orbital computed tomography leading to the misdiagnosis of orbial pseudotumor or thyroid rbitopathy. Carotid angiography showed dural carotid-cavernous sinus fistula, which involved left-side internal and external carotid arterial network and right-side internal carotid arterial network. Orbital color Doppler imaging showed a flow reversal with a systolic component in the enlarged superior ophthalmic vein. We were able to diagnose dural carotid-cavernous sinus fistula. Dural carotid-cavernous sinus fistula was closed successfully by embolization via the vein without omplication. The visual acuity, proptosis, and dilated and tortuous vessels of the conjunctiva improved.
Adult ; Angiography ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Conjunctiva ; Diagnostic Errors ; Diplopia ; Estrogens, Conjugated (USP) ; Exophthalmos ; Female ; Fistula* ; Humans ; Intraocular Pressure ; Muscles ; Orbit ; Thyroid Gland ; Veins ; Visual Acuity ; Visual Fields

Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.
Acute Lung Injury ; Anesthesia* ; Anesthesia, General ; Anoxia ; Blood Gas Analysis ; Extracorporeal Membrane Oxygenation* ; Female ; Gastrointestinal Tract ; Humans ; Incidence ; Intubation, Intratracheal ; Laparoscopy ; Middle Aged ; Mortality ; Pneumonia, Aspiration ; Respiration, Artificial ; Stomach Neoplasms

Duplex ultrasonography (USG) is an accepted method to assess noninvasively arterial inflow to the penis. Optimal pharmacological agents as well as timing of the scan and stimulation during the scan continue to be debated. Between August 1994 and May 1996, 24 normal males (control group) and 45 impotent patients (impotence group) underwent penile doppler sonography, and their records were reviewed. Scans were performed at 1, 3, 5, 10, 15, 20 and 30 minutes after intracavernous injection of PGE1 (10 pg) in all subjects. Any subject not having a full erection at 15 minutes performed private self-stimulation for at least 5 minutes before the 30 minute scan. If we define normal arterial inflow as a peak systolic velocity (PSV) of 30 cm. per second or greater in the best artery, 46% of control group and 55% of impotence group achieved this velocity until 5 minutes. One (4%) of control group and three (6%) of impotence group achieved maximum velocity at 1 or 3 minutes but continually PSV of 30 cm. per second or greater after 5 minutes, so any subject may not have had an incorrect diagnosis. When we calculated maximum velocity in the best artery in relation to percentage tumescence, maximum velocity were recorded most often at 10% tumescence (46% of control group and 51% of impotence group). If we define normal arterial inflow as PSV of 30 cm. per second or greater in best artery, the cumulative percentage of patients who achieved this velocity at 1, 3, 5, 10, 15, 20 and 30 minutes were 4, 34, 46, 88, 96, 96 and 100% in control group and 6, 28, 55, 90, 92, 94 and 96% in impotence group. In conclusion, we support delaying the initial scan until 5 minutes, performing the additional scans until 30 minutes and self-stimulation when necessary. We believe all efforts should be made to have studies performed in the setting of least anxiety to the patient.
Alprostadil* ; Anxiety ; Arteries ; Diagnosis ; Erectile Dysfunction ; Humans ; Male ; Penis ; Ultrasonography*

This study was designed to assess the antihypertensive efficacy and overall tolerance of doxazosin in patients with mild-to-moderate essential hypertension. Doxazosin was administered in once-daily dose from 1 to 3mg to 97 patients both in a general hospital and a local clinic in rural area. These patients are composed of three groups. One group has 49 Patients treated with doxazosin monotherapy, another group with 31 patients treated with doxazosin as well as other antihypertensive drugs combined and a third group is composed of 17 patients with renal insufficiency n addition to hypertension. The patients in the third group with renal insufficiency had 2.5mg/dl-5.0mg/dl in serum creatinine. Results are as follows : 1) The study sample is composed of 37 males (38.1%) and 60 females (61.9%) with mean age 51.4 years. Among three subasmples no statistically significant difference is observed in age, sex, mean body weight and heigh at 0.05 error level. 2) A total of 47 patients (48.5%) of the 97 patients have completed twelve-week doxazosin antihypertensive treatment. At a mean dose of 4.4+/-0.4mg at twelfth week, 37 patients (78.7%) responded to doxazosin therapy. Twenty-nine(61.7% patients achieved "excellent" blood pressure control(mean sitting DBP of < or =90mmHg), and 8 patients (17.0%) showed "good respone" (10mmHg or more DBP reduction from baseline). Whereas remaining 10 patients (21.3%) showed only "fair response" (5-9mmHg DBP reduction) or "failed"(0-4mmHg DBP reduction). In doxazosin monotherapy group thirteen(68.4%) of nineteen patients showed "excellent" or "good response" at a mean dose of 4.8mg/day. Combination therapy group with eighteen patients showed 100% therapeutic success. This group had fourteen(77.8%) "excellent" and four(22.2%) "good respinse" at a mean daily dose of doxazosin 3.9mg. Renal insufficiency group with ten patients showed six(60.0%) "excellent" and four (40.0%) "failure"cases at a mean daily dose of 4.6mg. 3) The mean baseline sitting blood pressures of doxazosin monotherapy group were 175/109 whose blood pressure at twelfth week were 150/94 at a mean daily dose of 4.8mg. The baseline blood pressure of combined therapy group 180/111 were reduced to 145/91 at twelfth week at a mean daily dose of 3.9mg. Those of renal insufficiency group were 177/112 and 156/98 respectively at a mean doxazosin daily dose of 4.6mg. 4) Of the 97 study cases, adverse effect were reported in 19.6%. The most prevalent adverse effects were dizziness(11.3%), blurred vision(9.3%), headache(5.2%), most of which were mild or moderate and disappeared with or were tolerated on continued therapy. But three cases(3.1%) had to refrain from doxazosin administration due to blurred vision, dizzines, and headache. 5) The change of lipid analysis between before and after treatment in the monotherapy group with doxazosin showed 3.8% decrease of total cholesterol and 4.6% increase of HDL cholesterol and 11% increase of triglycerides, which were not statistically significant. In the combination therapy group 0.4% decrease of total cholesterol, 24.1% decrease of HDL cholesterol and 44.3% increase of triglycerides were observed. In the renal insufficiency group 4.9% decrease of total cholesterol, 22.1% decrease of HDL cholesterol, 0.1% decrease of triglycerides were observed. But all these findings have limitation in generalization due to small number of sample and a short period of observation. 6) Laboratory chemistry test results revealed no apparent treatment-related abnormalities.
Antihypertensive Agents ; Blood Pressure* ; Body Weight ; Chemistry ; Cholesterol ; Cholesterol, HDL ; Creatinine ; Doxazosin* ; Female ; Generalization (Psychology) ; Headache ; Hospitals, General ; Humans ; Hypertension ; Male ; Renal Insufficiency ; Triglycerides