Anoxia ; Oxygen* ; Recovery Room*

Dyke-Davidoff syndorme is a rare congenital disorder which developed hemiatropy of brain, enlargement of ventricles and prominent pneumatization of petrous pyramid of the temporal bone. It mainfests unilateral invountary movement such as seizure, athetosis, chorea and mental retardation. This disorder have strong evidence of significance to differential diagnosis of cerebral palsy because of different therapeutic approach and outcome. Recently we examined 10 years old girl who developed seizure at 2 years old and gradually progressed with hemiparesis, hypoplaisa of right side of the body. The brain CT scan showed marked dilatation of lateral ventricle, prominent sylvian fissure and cortical sulci with somewhat thickened skull vault and pneumatization of petrous pyramid of the temporal bone on left side. EEG showed high voltage slow wave and spikes. So we report a case of Dyke-Davidoff syndrome with review of literature.
Athetosis ; Brain ; Cerebral Palsy ; Child ; Child, Preschool ; Chorea ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Diagnosis, Differential ; Dilatation ; Electroencephalography ; Female ; Humans ; Intellectual Disability ; Lateral Ventricles ; Paresis ; Petrous Bone ; Seizures ; Skull ; Temporal Bone ; Tomography, X-Ray Computed

Anesthetic managment of bronchial asthmatic patient requires understanding of the patho- physiology of the disease and the drug interaction with anesthetics and the drugs related to the treatment. A 53-year old male patient with hemorrhagic pancreatitis had been operated for exploratory laparotomy. He had history of the bronchial asthma. After the operation was completed, patient was transfered to recovery room after extubation. Sudden airway obstruction signs and patients agitation were noted 5 minutes after arrival in the recovery room. Asthmatic attack was relieved with salbutamol, corticosteroid, aminophylline, and isoproterenol intravenously. We have experienced one case of severe asthmatic attack in the postoperative recovery room. We report this case and review the anesthetic managements and drug interactions.
Airway Obstruction ; Albuterol ; Aminophylline ; Anesthetics ; Asthma ; Dihydroergotamine ; Drug Interactions ; Humans ; Isoproterenol ; Laparotomy ; Male ; Middle Aged ; Pancreatitis ; Physiology ; Recovery Room*

Lively discussion has been underway regarding primary care in South Korea as an alternative medical policy in the face of rising medical costs and health care disparities. However, the lack of research about primary care in South Korea makes it difficult to move policymakers, so it is time to enhance primary care research in South Korea. Primary care research can be defined as research directed toward the better understanding and practice of the primary care function. Primary care research traditionally has included basic research, clinical research, health services research related to primary care, health systems research, and research on primary care training; and each field is complementary. In primary care research, participation of primary care physicians is essential because primary care research is different from other conventional studies of disease prevalence, patient characteristics, diagnostic methods, and the treatment environment. Primary care research findings in other countries cannot be applied to South Korea as the characteristics of the health system and medical practice are different. To enhance the research on primary care in South Korea, financial assistance, promoting the research capacity of primary care physicians, and more attention from primary care physicians to research are needed.
Health Services Research ; Healthcare Disparities ; Humans ; Physicians, Primary Care ; Prevalence ; Primary Health Care ; Republic of Korea

Candida was found in the oral cavity, jejunum, and ileum of the healthy population. In case of alimentary tract, the factors of favorable to candida colonization include old age, malnutrition, diabetes, burns, trauma, surgical operations, parenteral nutrition, intravascular or bladder catheterization, H2-blocker therapy, steroid therapy, immunosuppresive treatment and the use of wide spectrum antibiotics: however, gastrointestinal candida colonization is rarely found in the healthy adult. No case of duodenal ulcer with candidiasis has been reported in healthy people. Recently we experienced a case of asymptomatic duodenal ulcer with candidiasis in a healthy male, who had taken H2-blocker and proton pump inhibitor for 3 months after primary closure of duodenal ulcer perforation. Therefore we report this case with review of several literatures.
Adult ; Anti-Bacterial Agents ; Burns ; Candida ; Candidiasis* ; Catheterization ; Catheters ; Colon ; Duodenal Ulcer* ; Humans ; Ileum ; Jejunum ; Male ; Malnutrition ; Mouth ; Parenteral Nutrition ; Proton Pumps ; Urinary Bladder

PURPOSE: Complications are quite common in surgery to correct spinal deformities due to the long duration under anesthesia and massive blood loss. The aim of this study was to evaluate and compare the effectiveness of Aprotinin in spinal deformity surgery. MATERIALS AND METHODS: Fifty-nine patients who underwent spinal deformity surgery were analyzed. Thirty-two patients were administered Aprotinin, and 27 control patients were not. The Pre- and Post- operative hemoglobin and hematocrit, blood loss, transfusion requirements, operative time, postoperative blood loss through suction drains and duration of suction drains were measured in both groups. RESULTS: There were no differences in age, gender, height, weight, hemodynamic indices, postoperative blood loss through the suction drains and the duration of the suction drains between the two groups. Intraoperative blood loss, transfusion and operative time were 1,345+/-425 cc, 1,008+/-721 cc, and 247 minutes in the Aprotinin (+) group and 2,070+/-1,276 cc, 2,552+/-2,791 cc, and 279 minutes in the Aprotinin (-) group, respectively. The postoperative hemoglobin and hematocrit levels were also significantly different (12.9+/-1 cc and 38.3+/-3.1% in the Aprotinin (+) group, and 11.9+/-1.8 cc and 35+/-5.5% in the Aprotinin (-) group, respectively). CONCLUSION: There was significantly less intraoperative blood loss, transfusion and surgery time in the group administered Aprotinin. Therefore, Aprotinin can be used in spinal deformity surgery that has a high risk of massive blood loss.
Anesthesia ; Aprotinin* ; Congenital Abnormalities* ; Hematocrit ; Hemodynamics ; Humans ; Operative Time ; Postoperative Hemorrhage ; Suction

Objective: Urgent upper endoscopy is performed to achieve acute hemostasis in patients with high-risk bleeding sources. Emergency physicians must identify patients who require urgent endoscopic treatments. This study assessed the performance of blood urea nitrogen (BUN) for predicting severe bleeding that necessitates urgent endoscopic hemostasis compared to the risk assessment scores in patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB). Methods: The presumed ANVUGIB patients were classified into endoscopic and non-endoscopic hemostasis groups. Data including historical features, symptoms, signs, and routine laboratory tests were collected and compared. Results: Three hundred and ninety-one patients were analyzed, including 116 patients in the endoscopic hemostasis and 275 patients in the non-endoscopic hemostasis group. In the area under curve (AUC) of the receiver operator characteristic curve, BUN (AUC 0.733; 95% confidence interval [CI], 0.681-0.785) and BUN/creatinine (AUC, 0.727; 95% CI, 0.672-0.783) were superior to total protein, Glasgow-Blatchford score (GBS), modified GBS (AUC, 0.649, 0.623 and 0.646, respectively) for predicting endoscopic hemostasis. Pre-endoscopy Rockall score and AIMS65 were statistically insignificant. The same results were obtained when the patients with liver and chronic kidney diseases were excluded. Conclusion The current results suggest that BUN was an independent predictor of endoscopic hemostasis in patients with ANVUGIB. Further studies will be needed to determine if BUN can be used in clinical practice.

Vascular malformations are known by several names, such as angiodysplasia, vascular ectasia, arteriovenous malformation, and telangictasia. Arteriovenous malformations may occur anywhere in the gastrointestinal tract. The large intestine is the most commonly involved location, usually on the right side. Arteriovenous malformations, which consist of enlarged, tortuous and dilated, often thin-walled blood vessels, usually occur in the submucosa or mucosa. Occasionally, they can cause recurrent and even massive hemorrhage. The authors treated a case of angiodysplasia in the upper jejunum, which caused massive bleeding. A 67-year-old female patient was admitted because of massive lower gastrointestinal bleeding. The bleeding point was found by angiography, injection of methylene-blue dye, and intraoperative endoscopy. The bleeding lesion in jejunal segment was resected, and end-to-end anastomosis was performed. The postoperative course was uneventful, and the patient was discharged on the 10th postoperative day.
Aged ; Angiodysplasia ; Angiography ; Arteriovenous Malformations ; Blood Vessels ; Dilatation, Pathologic ; Endoscopy ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Intestine, Large ; Jejunum* ; Mucous Membrane ; Vascular Malformations*

PURPOSE: To compare the results of two different surgical methods (translation vs rod derotation) in a correction of double thoracic adolescent idiopathic scoliosis (AIS) using pedicle screw instrumentation. MATERIALS AND METHODS: Forty-seven patients with double thoracic AIS treated by pedicle screw instrumentation were reviewed retrospectively after a minimum follow-up of 2 years. The patients were divided into two groups; TR group (translation method, n=14) and RD group (rod derotation, n=33). There were no significant differences in the preoperative curve characteristics between the two groups. RESULTS: In the TR group, the preoperative upper thoracic curve of 37+/-4 degrees improved to 24+/-4 degrees (35% correction), and the lower thoracic curve of 52+/-9 degrees improved to 18+/-5 degrees (65% correction). In the RD group, the preoperative upper thoracic curve of 40+/-7 degrees improved to 19+/-7 degrees (51% correction), and the lower thoracic curve of 56+/-12 degrees was improved to 16+/-6 degrees (72% correction). The correction of the upper and lower thoracic curves was significantly better in the RD group (p<0.05). Thoracic sagittal kyphosis was corrected from 21 degrees to 24 degrees in the TR group and from 18 degrees to 26 degrees in the RD group. There was no significant difference in the spinal balance, shoulder height difference, T1 tilt and fusion extent. The operating time and the amount of blood loss was 231 minutes and 2050ml in the TR group and 263 minutes and 3217ml in the RD group, respectively (p<0.05). CONCLUSION: In correcting double thoracic AIS using pedicle screw instrumentation, the rod derotation method showed better correction for the upper and lower thoracic curves. The translation method showed the advantages of easier application, a shorter operation time and less blood loss.
Adolescent* ; Follow-Up Studies ; Humans ; Kyphosis ; Retrospective Studies ; Scoliosis* ; Shoulder

Generally, absolute alcohol embolization has been commonly used for treatment of arteriovenous malformation (AVM) because complete surgical extirpation of AVM can be an extremely hazardous and difficult. Even if absolute alcohol is safe embolic agent, it can result in pain, pulmonary hypertension, pulmonary embolism and post-embolization syndrome such as nausea, vomiting, hemolysis and myoglobinuria. So, general anesthesia is needed for alcohol embolization. In this case, anesthesia was induced with intravenous (IV) propofol 110 mg and succinylcholine 60 mg and maintained with propofol and vecuronium. The pulmonary artery pressure was monitored with a Swan-Ganz catheter. After alcohol injectons, systolic pulmonary artery pressure was increased, ranging 35-40 mmHg. And cola-colored urine was noticed. For treatment of pulmonary hypertension, nitroglycerine was given IV. The IV fluid rate was increased and furocemide was given IV to increase the urine output. After general anesthesia, the patient was awake but appeared to be alcohol-intoxicated. Blood alcohol level was 42 mg/dl. Urinalysis showed large amounts of myoglobin, hemoglobin and albumin. So, anesthesiologists have to keep in mind of such complications when absolute alcohol embolization is done.
Anesthesia ; Anesthesia, General ; Arteriovenous Malformations* ; Catheters ; Ethanol* ; Hemolysis ; Humans ; Hypertension, Pulmonary ; Myoglobin ; Myoglobinuria ; Nausea ; Nitroglycerin ; Propofol ; Pulmonary Artery ; Pulmonary Embolism ; Succinylcholine ; Urinalysis ; Vecuronium Bromide ; Vomiting