A frequent dilemma facing the anesthesiologist is the patient with respiratory tract symptoms. The risks of anesthesia and surgery in these patients have not been clearly established. We present a case in which a potentially serious respiratory complication had arisen. The patient had symptoms of coughing and mucous production. She was a heavy smoker. However, there was no history of pulmonary disease. This report describes a patient who developed left upper lobar collapse after induction of general anesthesia and tachydysrhythmia resulting in ventricular tachycardia and myocardial ischemia.
Anesthesia* ; Anesthesia, General ; Cough ; Humans ; Lung Diseases ; Myocardial Ischemia ; Pulmonary Atelectasis* ; Respiratory System ; Tachycardia, Ventricular*

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) has recently been found to be a novel component of metabolic syndrome (MS), which is one of the leading causes of chronic liver disease. The serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) levels are suggested to affect liver fat accumulation and insulin resistance. We assessed the associations of serum ALT and GGT concentrations within the reference ranges with MS and NAFLD. METHODS: In total, 1,069 subjects enrolled at the health promotion center of Wonkwang University Hospital were divided into 4 groups according to serum ALT and GGT concentrations levels within the reference ranges. We performed biochemical tests, including liver function tests and lipid profiles, and diagnosed fatty liver by ultrasonography. Associations of ALT and GGT concentrationgrading within the reference range with fatty liver and/or MS were investigated. RESULTS: The presence of MS, its components, and the number of metabolic abnormalities [except for high-density lipoprotein-cholesterol (HDL-C) and fasting blood glucose] increased with the ALT level, while the presence of MS, its components, and the number of metabolic abnormalities (except for HDL-C) increased with the GGT level. The odds ratios for fatty liver and MS increased with the ALT level (P<0.001 and P=0.049, respectively) and the GGT level (P=0.044 and P=0.039, respectively). CONCLUSIONS: Serum ALT and GGT concentrations within the reference ranges correlated with the incidence of NAFLD and MS in a dose-dependent manner. There associations need to be confirmed in large, prospective studies.
Adult ; Alanine Transaminase/*blood ; Cholesterol, HDL/blood ; Fatty Liver/*diagnosis/enzymology/ultrasonography ; Female ; Humans ; Liver Function Tests ; Male ; Metabolic Syndrome X/*diagnosis/enzymology ; Middle Aged ; Odds Ratio ; Reference Values ; Retrospective Studies ; gamma-Glutamyltransferase/*blood

BACKGROUND/AIMS: The aim of this study was to evaluate the clinical features, radiologic findings, treatment modalities, and outcomes based on the origin of infection in patients with pyogenic liver abscesses. METHODS: We retrospectively analysed the medical records of 118 patients who were treated for pyogenic liver abscesses between January 2004 and December 2006. Of the 118 patients, 56 patients had biliary risk factors. RESULTS: The clinical characteristics were similar between the two groups, but the biliary risk group was characterized by an older age and the presence of jaundice. The size of the abscess was smaller in the group with biliary risk factors than in the cryptogenic group (p=0.02). Klebsiella pneumonia was the most common organism overall; however, Escherichia coli was more prevalent in the biliary risk group than in the cryptogenic group (p=0.03). Comparing the treatment modalities between the two groups, antibiotic therapy alone was more frequently used in the biliary group (p<0.01). The death rate was higher in the biliary group than in the non-biliary group (7.1 vs. 0.0%, p=0.04). The higher death rate in the biliary group was associated with multi-organ failure, absence of biliary drainage, and underlying diseases. CONCLUSIONS: There were differences between the two groups with respect to the size of the abscess, patient age, cultured organisms, and treatment modalities. The death rate was higher in the biliary group than the cryptogenic group.
Abscess ; Biliary Tract Diseases ; Drainage ; Escherichia coli ; Humans ; Jaundice ; Klebsiella ; Liver ; Liver Abscess, Pyogenic ; Medical Records ; Pneumonia ; Retrospective Studies ; Risk Factors

BACKGROUND: Uncomplicated myocardial infarction is often the harbinger of future cardiac events such as unstable angina, recurrent myocardial infarction or death. The prognostic utility of exercise test(pre-discharge low level exercise test) in patients recovering from acute myocardial infarction(AMI) has been documented by many studies. However there are few data of the safety and value of a symptom-limited exercise test early after AMI. We performed this study to assess the safety of test and the prevalence of abnormal response to symptom-limited exercise test and to determine the ability to predict future cardiac events. METHODS: The study group comprised 91 patients(male ; 73, Anterior infarction ; 43, Q-wave infarction ; 68, Thrombolysis ; 58, Age ; 57+/- years) with uncomplicated AMI. Symptom-limited exercise tests were performed before discharge(8.7+/-0.5 days after infarction) using modified Bruce protocol. Exercise test was considered positive if there was new > or =1mm horizontal or downsloping ST segment depression at 0.08sec after J point compared with baseline. The patients were followed for the development of new cardiac events. RESULTS: 1) The mean duration of exercise test was 14.2 min(range 4.3 - 21.5)and the mean workload(Metabolic Equivalents : METs) was 6.0 METs(range 2.1 - 17.0). There were no complications during exercise test and post-recovery phase. 2) There were positive test in 31 patients(34%), ST segment elevation in 10(11%), and inadequate blood pressure(BP) response in 10 patients(11%). 3) During the follow-up period(1-50 months, mean 12.5 months), 9 patients experienced post-myocardial infarction angina and revascularization therapy, respectively, and 1 patient had cardiac death and recurrent myocardial infarction, respectively. 4) The patients with cardiac events had a significantly higher degree in stenosis of infarct-related artery(90+/-3 vs 78+/-3, p<0.05) and lower systolic BP on peak exercise(136+/-7 vs 156+/-4, p<0.05). 5) The positive exercise test was associated with cardiac events in the follow-up period but ST-segment elevation, inadequate BP response, the use of thrombolytic agents, and non-Q wave infarction did not predict future cardiac events. CONCLUSIONS: The symptom-limited exercise tests early after acute myocardial infarction appear to be safe and will identify more patients with inducible myocardial ischemia relatively. The posive test can predict cardiac events and the prognosis of patients of this group can be improved with aggressive management and careful follow-up.
Angina, Unstable ; Constriction, Pathologic ; Death ; Depression ; Exercise Test* ; Fibrinolytic Agents ; Follow-Up Studies ; Humans ; Infarction ; Myocardial Infarction* ; Myocardial Ischemia ; Prevalence ; Prognosis

BACKGROUND/AIMS: Active bleeding and non-bleeding visible vessels in patients with bleeding peptic ulcer are associated with a high risk of rebleeding. The aim of our study was to define the risk factors associated with failure of endoscopic hemostasis and rebleeding in patients with active peptic ulcer bleeding. METHODS: We retrospectively reviewed 119 patients (90 men and 29 women; mean age, 60.14+/-14.67 years) with active peptic ulcer bleeding (spurting, oozing and/or non-bleeding visible vessel) and who were treated in Wonkwang Medical Center from January 2002 to January 2007. They were classified to endoscopic hemoclipping alone group (n=75) or endoscopic hemoclipping combined with epinephrine injection group (n=44), according to the therapeutic modality. RESULTS: Initial hemostasis was achieved in the two groups (100%), and permanent hemostasis was achieved 71.4% in all the patients. Operation was done in eight patients (6.7%), and six patients (5%) in the two groups, respectively, died within 1 month after initial hemostasis because of bleeding related complications. Recurrent bleeding, the duration of the hospital stay, blood transfusion requirements, complications and the operation and mortality rates were not statistically different between the hemoclip alone and combination groups. Univariate analysis showed that rebleeding was related to the presence of shock on admission (p=0.01), complication (p=0.00), the pulse rate (<100/min) on admission (p=0.04), single ulcer (p=0.032), the level of hemoglobin (<8 g/dL) (p=0.02) and the volume of transfusion (<3 units) after the procedure (p=0.005) in all the patients. On the multivariate analysis that was adjusted for age and gender, the hemoglobin level (<8 g/dL) (odds ratio = 10.5) was the only significant predictor for early rebleeding. CONCLUSIONS: This result may suggest that the combination method does not provide a substantial advantage over hemoclipping alone for the hemostatic management of active peptic ulcers bleeding. A low hemoglobin level on admission may be useful to predict rebleeding after initial endoscopic hemostasis in patients with active peptic ulcer. However, this study was designed retrospectively, so the comparison between these two groups should be re-evaluated prospectively in a large, multicenter trial.
Blood Transfusion ; Epinephrine ; Heart Rate ; Hemoglobins ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Imidazoles ; Length of Stay ; Male ; Multivariate Analysis ; Nitro Compounds ; Peptic Ulcer ; Retrospective Studies ; Risk Factors ; Shock ; Ulcer