An 8-year-old girl visited the emergency room with perioral cyanosis and dyspnea, which had developed 20 hrs prior to the hospital visit. She had taken a Chinese herbal medication for 3 days prior to the onset of the symptoms. A co-oximeter examination revealed a methemoglobin level of 23.7%. An intravenous infusion of methylene blue was administered. Chemical analysis of the herbal medication revealed an ammonia (NH3) level of 239.41 mg/ L. More studies are needed on the correlation between methemoglobinemia and the components of Chinese herbal medicines.
Ammonia ; Asian Continental Ancestry Group ; Child ; Cyanosis ; Dyspnea ; Eating ; Emergencies ; Humans ; Infusions, Intravenous ; Methemoglobin ; Methemoglobinemia ; Methylene Blue

PURPOSE: The purpose of this study is to find out the changing pattern of drug or foreign body ingestion between 1990s and 2000s in Wonju Christian Hospital, which is located in one of the most rapidly urbanizing cities in Korea. METHODS: We retrospectively reviewed the medical records of patients with acute drug intoxication and foreign body ingestion from January 1991 to December 1994 and from January 2001 to December 2004. We performed clinical analysis and compared the results of the 1990s and 2000s. RESULTS: There were 43 cases of acute drug intoxication in the 1990s, and 35 cases in the 2000s. Foreign body ingestion was 47 cases in the 1990s and 22 cases in the 2000s. The ingested foreign bodies were chiefly coins (46.8 percent), Weiqi chips (14.9 percent), plastic toys (6.4 percent) and others (31.9 percent) in the 1990s. In the 2000s, others (58.2 percent) were the most commonly ingested foreign body with mercury batteries (23.8 percent), nails (9 percent), pins (9 percent) following. The most common cause of drug intoxication was medical drugs (37.2 percent) others (23.2 percent), agricultural agents (13.9 percent), carbon monoxide (11.6 percent), rodenticide (9.3 percent), insecticide (9.3 percent) in the 1990s. In the 2000s the most common causes were others (34.3 percent), medical drug (31.4 percent), agriculture agents (20 percent), detergent (11.4 percent), insecticide (2.9 percent) and carbon monoxide (2.9 percent). The highest incidence age group was the 1-3 year old group, both in acute drug intoxication and foreign body ingestion. There were no changes in the incidence age group between the 1990s and the 2000s. CONCLUSION: There were some significant changes in the cause of acute drug intoxication and foreign body ingestion between the 1990s and 2000s. New education programs for preventing acute drug intoxication and foreign body ingestion are important and necessary.
Agriculture ; Carbon Monoxide ; Child ; Detergents ; Eating* ; Education ; Foreign Bodies* ; Gangwon-do* ; Humans ; Incidence ; Korea ; Medical Records ; Numismatics ; Plastics ; Play and Playthings ; Retrospective Studies

PURPOSE: Our aim was to describe the clinical features of noroviral gastroenteritis in children. METHODS: This study included 22 children with noroviral gastroenteritis, as confirmed by stool RT-PCR, who were admitted to Bundang CHA Hospital between July 2006 and June 2008. Their medical records were reviewed and compared with those of 45 children with rotaviral gastroenteritis. RESULTS: In the norovirus group, 19 (86.4%) children showed vomiting and 21 (95.5%) children showed diarrhea, while all children in the rotaviral group showed both vomiting and diarrhea. The duration of vomiting was not different in the two groups, but mean episodes of vomiting/24 h were higher in the norovirus group than in the rotavirus group. The duration of diarrhea was longer and mean episodes of diarrhea/24 h were higher in the rotavirus group. The Vesikari Scale was not different in the two groups. Frequency and duration of fever did not show a significant difference. Most children in both groups were below 2 years of age. CONCLUSION: Clinical features of noroviral gastroenteritis were largely similar to those of rotaviral gastroenteritis, but vomiting was more severe in noroviral infection, and diarrhea was more severe and prolonged in rotaviral infection. With regard to noroviral infection, further epidemiologic investigations and preventive efforts are essential.
Child ; Diarrhea ; Fever ; Gastroenteritis ; Humans ; Medical Records ; Norovirus ; Rotavirus ; Vomiting

PURPOSE: To analyze the clinical outcomes of surgical treatment of distal humerus intercondylar fractures through the transolecranon approach combined with anterior transposition of the ulnar nerve. MATERIALS AND METHODS: Eight patients who had distal humerus intercondylar fractures were included in this study and underwent operative treatment through the transolecranon approach for sufficient operative field with anterior transposition of the ulnar nerve and fixed with reconstruction plate. RESULTS: The results were evaluated using Riseborough and Radin rating criteria. Seven cases of eight cases were achieved good results with flexion contracture less than 30 degrees and forward flexion more than 115 degrees. However, one case was acheived poor result with 40 degrees of flexion contractue and 70 degrees of forward flexion. There were no the compressive ulnar neuropathy. CONCLUSION: We found the transolecranon approach and anterior transposition of the ulnar nerve a viable option for surgical treatment of the distal humerus intercondylar fractures
Contracture ; Humans ; Humerus* ; Ulnar Nerve* ; Ulnar Neuropathies

No abstract available.
Catheters* ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Fetal Therapies* ; Lung*

BACKGROUND AND OBJECTIVES: The purpose of this study was to figure out the correlation of hypertension and atherogenic dyslipidemia in postmenopausal women. MATERIALS AND METHODS: The study population consisted of consecutive 380 postmenopausal women (age> or =50, FSH>40IU/L and triglyceride[TG]<400 mg/dl) visiting health promotion center at Samsung Cheil Hospital from March 1997 to July 1998. We measured blood pressure by automatic sphygmomanometer (A & Dco.LTD.TM-2654) and divided them into four groups by blood pressure (Group I:systolic blood pressure[SBP]< 120 mmHg and diastolic blood pressure[DBP]<80 mmHg, n=87. Group II:SBP 120-139 mmHg or DBP 80-89 mmHg, n=109. Group III: SBP 140-159 mmHg or DBP 90-99 mmHg, n=127. Group IV: SBP> or =160 mmHg or DBP> or =100 mmHg, n=57). We measured thier body mass index (BMI) and waist-hip ratio (WHR). We also measured their levels of glucose, total cholesterol and TG by automatic biochemical analyzer (Hitachi 7150) and HDL cholesterol by direct method using AutoDAIICHI reagent. We calculated LDL cholesterol levels by Friedewald formula. RESULTS: MI, WHR and glucose level of group IV were significantly higher than those of group I. But there were no significant differences among the groups in the levels of total cholesterol, LDL cholesterol and apolipoprotein B. HDL cholesterol level of group I was statistically higher than that of group IV. TG level and LDL cholesterol/apo B ratio of group IV were significantly higher and lower than those of other groups respectively. CONCLUSION: Postmenopausal women who had moderate or severe hypertension show the trend toward abdominal obesity and atherogenic dyslipidemia. We might have to pay attention to these metabolic abnormalities in postmenopausal women with hypertension.
Apolipoproteins ; Blood Pressure ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Dyslipidemias* ; Female ; Glucose ; Health Promotion ; Humans ; Hypertension* ; Menopause ; Obesity, Abdominal ; Sphygmomanometers ; Waist-Hip Ratio

BACKGROUND: Cutaneous squamous cell carcinoma (SCC), which occurs in keratinocytes of the epidermis and is the second most common skin cancer, has a more invasive growth pattern and higher potential to metastasize than basal cell carcinoma. Total excision of the primary tumor is the treatment of choice. For clear excision of the tumor, invasion depth is one of the most important factors. This study was conducted to clarify the relationship between the size and the invasion depth of cutaneous SCC. METHODS: Twenty-six cases were collected for this prospective study. Frozen biopsies were examined after complete resection of the tumor, followed by histological confirmation by pathological examination. The major and minor axis lengths of the tumor, the invasion depth, and the level of invasion were measured. Recurrence or metastasis was recorded through regular follow-up. RESULTS: The Pearson correlation coefficient was used for statistical analysis. Significant results were observed for the relationship between the major and minor axis lengths and the invasion depth of the tumor (0.747, 0.773). No cases of recurrence or metastasis were observed. CONCLUSIONS: In head and neck cutaneous SCC, the invasion depth of the tumor is closely related to the major and minor axis lengths of the tumor. Therefore, the invasion depth of the tumor can be estimated by measuring the size of the tumor, and a standard vertical safety margin for head and neck cutaneous SCC can be established, which could be helpful in the development of a preoperative reconstruction plan.
Biopsy ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell* ; Epidermis ; Epithelial Cells* ; Follow-Up Studies ; Head* ; Keratinocytes ; Neck* ; Neoplasm Metastasis ; Prospective Studies ; Recurrence ; Skin Neoplasms

Angiodysplasia (AD) is increasingly being recognized as a major cause of gastrointestinal bleeding. Morphologically flat lesions are common types of AD, whereas the polypoid types are rare. We report a case of multiple polypoid AD in the small bowel causing severe anemia and requiring surgical treatment. A 60-year-old male patient visited our hospital with dyspnea and hematochezia. He had a history of myocardial infarction and was taking both aspirin and clopidogrel. Capsule endoscopy, enteroscopy, computed tomography, and angiography revealed multifocal vascular lesions with a polypoid shape in the jejunum. Surgical resection was performed because endoscopic treatment was considered impossible with the number and the location of lesions. The risk of recurrent bleeding related to the use of antiplatelet agents also contributed to the decision to perform surgery. AD was histologically diagnosed from the surgical specimen. He resumed taking both aspirin and clopidogrel after surgery. He fully recovered and has been doing well during the several months of follow-up.
Anemia ; Angiodysplasia* ; Angiography ; Aspirin ; Capsule Endoscopy ; Dyspnea ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Jejunum ; Male ; Middle Aged ; Myocardial Infarction ; Platelet Aggregation Inhibitors

Background/Aims: Owing to the low prevalence of small-bowel adenocarcinoma (SBA), data on the impact of Crohn’s disease (CD) on the survival of patients with SBA are lacking. Therefore, we investigated this issue in this study. Methods: In this bicenter cohort study, patients with histologically confirmed SBA were retrospectively enrolled and classified into two groups: sporadic SBA and CD-associated SBA. Patients with duodenal SBA were excluded. Overall survival, disease-free survival, and factors associated with survival were analyzed. Results: Of 128 patients with SBA, 115 had sporadic SBA and 13 had CD-associated SBA. Ileal involvement and poorly differentiated tumors were more common in the CD-associated SBA group than in the sporadic SBA group (ileal involvement, 53.8% vs 22.6%; poor differentiation, 46.2% vs 14.8%; both p<0.05). In survival analysis, overall survival showed no statistical difference between the sporadic SBA and CD-associated SBA groups (p=0.370). However, when stratified by stage, the adjusted overall survival of the CD-associated SBA group was lower in patients with an advanced disease stage (p=0.029). Disease-free survival showed the same tendency, albeit without clinical significance (p=0.097). CD (hazard ratio [HR], 2.308; p=0.047), older age (≥65 yr) at SBA diagnosis (HR, 2.766; p=0.001), and stage III/IV disease (HR, 3.151; p<0.001) were factors associated with mortality. Conclusions The overall survival of patients with CD-associated SBA did not differ from that of patients with sporadic SBA. However, as CD is an independent risk factor for mortality, vigilant surveillance in high-risk patients may be crucial.

Adenoma of the ampulla of Vater is a rare disease, and there is no universal consensus on the management of this entity due to its rarity and unpredictable behavior. Because many of these tumors recur after local excision and because it is difficult to obtain a definitive diagnosis or to exclude malignancy before operation, local excision of ampullary tumors still remains controversial despite being a standard operation for nearly a century. Many surgeons resort to more radical resection, such as pancreatoduodenectomy for treatment of this troublesome disease. The author's report on the evaluation and treatment of 10 patients who underwent pancreatoduodenectomy for ampullatry tumors, diagnosed as benign adenoma on preoperative endoscopic biopsy. Endoscopic retrograde cholangiopancreaticography (ERCP) and computed tomography (CT) was performed in all cases. There were 6 men and 4 women, with a median age of 53 years (22-72 years). Postoperative histopathologic examination revealed that five of the ten patients had had cancerous change within adenoma. Four of the five ampullary adenocarninomas were confined to mucosa, but one had invaded the pancreatic parenchyma. No case was accompanied with lymphatic involvement. Reoperative pancreatoduodenectomy was perfomed in one patient with recurrent villotubular adenoma after local excision of ampulla. All patients are still alive and without any evidence of tumor recurrence after pancreatoduodenectomy (median follow up period 35 months, range 17-77 months). There was no postoperative death. Diagnosis of malignancy could not be ruled out based on a preoperative endoscopic biopsy in ampullary tumors. We conclude that pancreatoduodenectomy with regional lymph node dissection should be the standard treatment in circumstances without any contraindication to extensive surgery.
Adenoma ; Ampulla of Vater ; Biopsy* ; Consensus ; Diagnosis ; Female ; Follow-Up Studies ; Health Resorts ; Humans ; Lymph Node Excision ; Male ; Mucous Membrane ; Pancreaticoduodenectomy ; Rare Diseases ; Recurrence