One lung ventilation for thoracic surgery may reduce arterial oxygen saturation by ventilation-perfusion mismatching and by increasing intrapulmonary shunting. We experienced a 52 year old male patient with a lung abscess, who showed arterial desaturation after one-lung ventilation. The authors tried to increase arterial oxygen saturation by applying positive end-expiratory pressure (PEEP) and continuous positive airway pressure (CPAP) to dependent and nondependent lung, respectively. However, arterial oxygen saturation did not increase. So, we applied partial differential lung ventilation using an open-close valve designed by the authors, and arterial oxygen saturation increased rapidly. The advantages of the open-close valve are its straightforward use and ease of manipulation. We report a case involving the use of this open-close valve in a desaturated patient during one lung ventilation.
Continuous Positive Airway Pressure ; Humans ; Lung ; Lung Abscess ; Male ; Middle Aged ; One-Lung Ventilation* ; Oxygen ; Positive-Pressure Respiration ; Thoracic Surgery ; Ventilation

Nutcracker syndrome refers to the compression of the left renal vein between the abdominal aorta and superior mesenteric artery which can lead to renal vein hypertension. Patients can present with hematuria, proteinuria, dysuria or abdominal pain. In diagnosing the nutcracker syndrome, measurement of the peak velocity ratio of aorto-mesenteric border versus renal hilum by Doppler sonography is useful. Currently, there are few reports about the genetic correlation in this syndrome. We report two cases of the nutcracker syndrome found in male siblings with hematuria.
Abdominal Pain ; Aorta, Abdominal ; Child ; Dysuria ; Hematuria ; Humans ; Hypertension ; Male ; Mesenteric Artery, Superior ; Proteinuria ; Renal Veins ; Siblings

PURPOSE: Hydronephrosis is found about 30% of children with urinary tract infection (UTI). It can be caused by various conditions, although most childhood hydronephrosis is congenital. This study was performed to investigate the relationship between febrile UTI and hydronephrosis. METHODS: We retrospectively reviewed the medical charts of 183 patients diagnosed as UTI between January 2007 and May 2009 at Korea University Guro Hospital. Inclusion criteria were as followings; 1) fever more than 37.5degrees C measured in the axilla , 2) positive urine culture, 3) no history of urinary tract anomaly on antenatal sonography and urinary tract infection. We classified the enrolled children into two groups of patients with hydronephrosis (HN) and those without hydronephrosis (NHN). RESULTS: The 80 patients were HN and 103 patients NHN. Hydronephrosis was found in 58 patients with left kidney, 8 right and 14 both kidneys. Most of hydronephrosis were of low grade. Compared with NHN group, initial renal cortical defects on DMSA scan significantly increased in HN group (HN 37.5%, NHN 16.5%, P < 0.05). The incidence of VUR was not different between the two groups (HN 22%, NHN 12.1%). White blood cell counts and C-reactive protein were not different between the two groups. Follow-up DMSA scan (about 6 months later after UTI) showed no difference of renal scarring in both two groups. CONCLUSION: Our data suggests that hydronephrosis in febrile UTI patients is clinically useful for detecting renal cortical defects, but is not associated with follow-up renal scar.
Axilla ; C-Reactive Protein ; Child ; Cicatrix ; Fever ; Follow-Up Studies ; Humans ; Hydronephrosis ; Incidence ; Kidney ; Korea ; Leukocyte Count ; Retrospective Studies ; Succimer ; Urinary Tract ; Urinary Tract Infections

BACKGROUND: Lifetime health maintenance program (LHMP) is designed for individualized disease prevention and health promotion through regular health check-ups and improving risk factors. This study aimed to investigate patients' satisfaction of lifetime health clinic (LHC) in a tertiary hospital and to evaluate associated factors in order to support primary health care strengthening policy. METHODS: We conducted surveys for patients, who visited LHC in a department of family medicine at a tertiary hospital from March 1st 2016 to December 31st 2016. We analyzed proportions and characteristics associated with patients, who were willing to recommend LHC. The relationship between willingness to recommend LHC and associated factors were evaluated by multivariate logistic regression analyses. RESULTS: Among the patients who answered the questionnaires, 83.7% responded that they would recommend LHC to others. Results from multivariate analyses suggested that patients living in provinces (odds ratio [OR] 4.21, 95% confidence interval [CI], 1.36-13.02), patients who were recommend by others to visit LHC (OR 3.99, 95% CI, 1.29-12.35), and those who had a large number of medical service preference items (OR 5.91, 95% CI, 1.48-23.58) were significantly associated with willingness to recommend LHC. CONCLUSIONS: LHC pursues the goal of primary care. Findings highlight the fact that high quality health service should be provided in small and municipal hospitals to improve patients' satisfaction. Furthermore, it is essential to establish family physician networks and health service infrastructure that can reflect various opinions.
Health Promotion ; Health Services ; Hospitals, Municipal ; Humans ; Logistic Models ; Multivariate Analysis ; Patient Satisfaction ; Physicians, Family ; Primary Health Care ; Risk Factors ; Tertiary Care Centers*

A review of the literature on cancer pain revealed that many persons with cancer receive inadequate analgesia for pain control, due in part to a lack of knowledge of the control of cancer pain by both physicians and nurses. This study is composed of two parts : one is to train nurses to change their knowledge of and attitude toward the pain management of patients having cancer and to evaluate the effectiveness of this training in comparison with other non-trained group ; the other is to test the applicability of the pain management method knowledge and attitude in the levels of pain of oncology patients. General characteristics of nurses such as age, education, educational experiences of cancer pain management were not different in both groups except the clinical experience. General characteristics of cancer patients and pain-related variables such as pain, sleep, daily activities, treatment modalities, causes of pain were not different in both groups except the educational levels of patients. After an eight-hour educational program given to the experimental nurse group, the knowledge and attitude about assessment of cancer pain, pain medication, and pharmacological knowledge were significantly higher in the experimental group than in the control group, while knowledge about classification of analgesics was not significantly different. The amount of analgesics, measured by the morphine equivalent doses, used in the experimental group was significantly lower than in the control group in the first and the last days. The experimental group used more systematic ways of drug changes from non-narcotic analgesics to narcotic analgesics than the control group. This indicated that the control group used fentanyl patches more commonly than in the control group. Cancer pain scores of both group of patients were measured on an hourly bases for a week in both groups. The patients' pain scores of the first day of measurement in experimental group were not significantly higher than those of control group of patients, while those of the last day were significantly higher than those of the control group. This study supports the need for educational program for the management of cancer pain to the nurses and the doctors.
Analgesia ; Analgesics ; Analgesics, Non-Narcotic ; Classification ; Education ; Fentanyl ; Humans ; Morphine ; Narcotics ; Pain Management*

BACKGROUND/AIMS: Fragmented care in nephrology can cause treatment delays. Nephrologists are qualified to perform vascular access-related procedures because they understand the pathophysiology of renal disease and perform physical examination for vascular access. We compared treatment delays associated with tunneled hemodialysis catheter (TDC) placement between interventional radiologists and nephrologists. METHODS: We collected data by radiologists from January 1, 2011 through December 31, 2011 and by nephrologists from since July 1, 2012 through June 30, 2013. We compared the duration from the hemodialysis decision to TDC placement (D-P duration) and hemodialysis initiation (D-H duration), catheter success and the complication rate, and the frequency and the usage time of non-tunneled hemodialysis catheters (NDCs) before TDC placement. RESULTS: The study analyzed 483 placed TDCs: 280 TDCs placed by radiologists and 203 by nephrologists. The D-P durations were 319 minutes (interquartile range [IQR], 180 to 1,057) in the radiologist group and 140 minutes (IQR, 0 to 792) in the nephrologist group. Additionally, the D-H durations were 415 minutes (IQR,260 to 1,091) and 275 minutes (IQR, 123 to 598), respectively. These differences were statistically significant (p = 0.00). The TDC success rate (95.3% vs. 94.5%, respectively; p = 0.32) and complication rate (16.2% vs. 11%, respectively; p = 0.11) did not differ between the groups. The frequency (24.5 vs. 26%, respectively; p = 0.72) and the usage time of NDC (8,451 vs. 8,416 minutes, respectively; p = 0.91) before TDC placement were not statistically significant. CONCLUSIONS: Trained interventional nephrologists could perform TDC placement safely, minimizing treatment delays.
Catheters* ; Nephrology ; Physical Examination ; Renal Dialysis* ; Vascular Access Devices

OBJECTIVES: The purpose of this study was to establish normative data for healthy Korean adults by measuring the maximal strength and endurance scores of the tongue, lip, and cheek, and to examine correlations between these measurements. MATERIALS AND METHODS: This study included 120 subjects that were divided into three groups according to age: young (20-39 years), middle-aged (40-59 years), and older (over 60 years); and by gender. Measurements were taken using the Iowa Oral Performance Instrument (IOPI). RESULTS: The mean maximal tongue strengths were as follows: young men (46.7±10.2 kPa) and women (32.1±7.9 kPa), middle-aged men (40.9±9.3 kPa) and women (36.9±8.6 kPa), and older men (35.2±9.0 kPa) and women (34.5±6.9 kPa). The mean tongue endurance scores were: young men (28.8±12.6 seconds) and women (20.8±13.5 seconds), middle-aged men (17.0±8.5 seconds) and women (15.3±5.2 seconds), and older men (15.8±6.7 seconds) and women (17.9±8.1 seconds). The mean maximal lip strengths were: young men (11.6±3.0 kPa) and women (11.4±3.8 kPa), middle-aged men (11.4±4.2 kPa) and women (11.1±5.1 kPa), and older men (14.5±3.9 kPa) and women (11.7±2.6 kPa). The mean lip endurance scores were: young men (41.1±23.9 seconds) and women (22.4±21.7 seconds), middle-aged men (24.3±10.3 seconds) and women (30.5±13.4 seconds), and older men (24.9±11.0 seconds) and women (12.8±7.6 seconds). The mean maximal cheek strengths were: young men (24.5±4.6 kPa) and women (20.5±4.3 kPa), middle-aged men (25.2±6.4 kPa) and women (21.2±5.5 kPa), and older men (22.4±5.3 kPa) and women (18.0±4.8 kPa). The mean cheek endurance scores were: young men (47.8±24.4 seconds) and women (43.9±25.0 seconds), middle-aged men (27.3±11.3 seconds) and women (20.0±14.6 seconds), and older men (21.7±14.5 seconds) and women (17.2±11.4 seconds). CONCLUSION: The data collected in this study will provide an important database of standardized measurements for maximal strength and endurance scores of the tongue, lip and cheek in healthy, normal Koreans.
Adult ; Cheek* ; Female ; Humans ; Iowa ; Lip* ; Male ; Tongue*

BACKGROUND: We studied about the The different features of high-resolution CT (HRCT) findings of active pulmonary tuberculosis(TB) were studied between acid fast bacilli(AFB) smear or culture positive and negative group. METHODS: We prospectively evaluated 36 patients who had been confirmed for active pulmonary tuberculosis by the smear or culture of AFB in sputum(n=25), and changes on serial chest radiographs(n=11). The patient were divided into 3 groups by the results on sputum AFB stain and culture. Group 1(n=11) is negative in both AFB stain and culture ; group 2(n=13) is negative in AFB stain but positive in culture ; and group 3(n=12)is positive in both AFB stain and culture. We evaluated the findings of HRCT in each group randomly. RESULT: On the HRCT scans, acinar nodule(100%), macronodule(75%), and cavity(75%) in group 3 were more frequently found than group 1(63%, 18%, 9%) and group 2(46%, 15%, 23%)(p<0.05). The centrilobular nodule and branching structure in group 3(92%) was more frequently observed were more frequently observed in group 3 (92%) than in group 1(54%)(p<0.05), but not different than were similarly observed in group 2(77%)(p>0.05). AFB positive group was statistically different than the negative group in the HRCT findings such as with respect to acinar nodule(100% vs 54%), macronodule(75% vs 17%), and cavity(75% vs 17%)(p<0.05). TB culture positive group was statistically different than the negative group in the HRCT findings such as with respect to acinar nodule(72% vs 45%) and cavity(48% vs 9%)(p<0.05). CONCLUSIONS: HRCT scans are helpful in determining disease acitivity in sputum AFB stain- negative pulmonary tuberculosis. When HRCT shows centrilobular nodule and branching structure, acinar nodule, macronodule, cavity, we are able to decide more study such further studies as sputum induction and bronchoscopy for determination of can be performed to determine the presence of bacilli in patients of AFB stain-negative tuberculosis.
Bronchoscopy ; Humans ; Prospective Studies ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

No abstract available.

Typhoid fever is a systemic infectious disease which affects many organs. In children, few cases have been reported of acute nephritic syndrome in typhoid fever. We report an immunocompetent 9-year old girl with typhoid fever complicated by acute tubulointerstitial nephritis who presented with prolonged fever and acute renal failure.
Acute Kidney Injury ; Child ; Communicable Diseases ; Fever ; Humans ; Nephritis, Interstitial ; Renal Insufficiency ; Typhoid Fever