Tracheo-esophageal fistula (TEF) is a well known and a relatively common congenital anomaly (1 in 3,000 4,500 live births). Half of the patients with TEF may have other congenital anomalies, VATER syndrome. However, the presence of subglottic laryngeal stenosis in patients with TEF is uncommon. We report a case of TEF (type C) combined with subglottic laryngeal stenosis. We anesthetized a 2.74 kg neonate for reconstruction surgery. But, it was impossible to pass an uncuffed endotracheal tube (2.5 mm inner diameter and 3.6 mm outer diameter) beyond the vocal cord. A gastrostomy was performed only under mask ventilation, and emergent tracheostomy was done. Endotracheal endoscopy revealed TEF combined with subglottic laryngeal stenosis. In this case, she can be managed successfully by the performance of an early tracheostomy.
Endoscopy ; Fistula* ; Gastrostomy ; Humans ; Infant, Newborn ; Laryngostenosis* ; Masks ; Tracheoesophageal Fistula ; Tracheostomy ; Ventilation ; Vocal Cords

The purpose of this study was to assess the expression of ICAM-1, VCAM-1 and PECAM-1 in allergic and chemical conjunctivitis. The allergic and chemical conjunctivitis were induced in C57BL/6 mouse by compound 48/80(C48/80) and 2% characterized clinically by blepharospasm 100%, chemosis 80%, injection AgNO3, respectively. The allergic conjunctivitis was characterized clinically by blepharospasm 100%, chemosis 80%, injection, 40%, mucous discharge 20%, but the chemical conjunctivitis by blepharospasm 80%, chemosis 60%, infection 40% and no mucous discharge at 30 minute after topical application. On the endothelial cells, ICAM-1 was expressed from 1 to 48 hours, VCAM-1 from 6 to 72 hours and PECAM-1 from 1 to 72 hours in allergic conjunctivitis. In chemical conjuctivitis, the expression of ICAM-1 was observed from 6 to 72 hours. The expression of VCAM-1 was observed from 24 and 72 hours. The expression of PECAM-1 was demonstrated from 6 to 72 hours. The expression of cell adhesion molecules, particulary VCAM-1 and PECAM-1, was slighter in chemical conjunctivitis compared to allergic conjunctivitis. In conclusion, experimental allergic and chemical conjunctivitis demonstrate that cell adhesion molecules play a role in part in ocular inflammation and that there are differences between the adhesion molecule expression of two types of confunctivitis.
Animals ; Antigens, CD31 ; Blepharospasm ; Cell Adhesion Molecules ; Conjunctivitis* ; Conjunctivitis, Allergic ; Endothelial Cells ; Inflammation ; Intercellular Adhesion Molecule-1 ; Mice ; Vascular Cell Adhesion Molecule-1

No abstract available.
Skull Fracture, Depressed*

Traumatic aortic transection after blunt chest injury is highly lethal and has high operative mortality. Recently, the diagnostic and therapeutic method of this injury is advanced, especially in spinal cord protection during aortic cross-clamping. We have experienced two cases of traumatic aortic transection with left hemothorax after blunt chest injury, which was diagnosed in operative field. The transected aorta was primarily repaired with clamp and sew method and postoperative paraplegia had not occured. The patients were dischraged without any significant complications. We report these cases with a review of literature.
Aorta ; Hemothorax ; Humans ; Mortality ; Paraplegia ; Spinal Cord ; Thoracic Injuries

PURPOSE: The primary objective of this study was to examine the changes of basal cortisol and DHEA levels present in saliva and serum with age, and to determine the correlation coefficients of steroid concentrations between saliva and serum. The secondary objective was to obtain a standard diurnal rhythm of salivary cortisol and DHEA in the Korean population. MATERIALS AND METHODS: For the first objective, saliva and blood samples were collected between 10 and 11 AM from 359 volunteers ranging from 21 to 69 years old (167 men and 192 women). For the second objective, four saliva samples (post-awakening, 11AM, 4PM, and bedtime) were collected throughout a day from 78 volunteers (42 women and 36 men) ranging from 20 to 40 years old. Cortisol and DHEA levels were measured using a radioimmunoassay (RIA). RESULTS: The morning cortisol and DHEA levels, and the age-related steroid decline patterns were similar in both genders. Serum cortisol levels significantly decreased around forty years of age (p < 0.001, when compared with people in their 20s), and linear regression analysis with age showed a significant declining pattern (slope= -2.29, t= -4.297, p < 0.001). However, salivary cortisol levels did not change significantly with age, but showed a tendency towards decline (slope= -0.0078, t= -0.389, p=0.697). The relative cortisol ratio of serum to saliva was 3.4 - 4.5% and the ratio increased with age (slope=0.051, t=3.61, p < 0.001). DHEA levels also declined with age in saliva (slope= -0.007, t= -3.76, p < 0.001) and serum (slope= -0.197 t= -4.88, p < 0.001). In particular, DHEA levels in saliva and serum did not start to significantly decrease until ages in the 40s, but then decreased significantly further at ages in the 50s (p < 0.001, when compared with the 40s age group) and 60s (p < 0.001, when compared with the 50 age group). The relative DHEA ratio of serum to saliva was similar throughout the ages examined (slop = 0.0016, t = 0.344, p = 0.73). On the other hand, cortisol and DHEA levels in saliva reflected well those in serum (r = 0.59 and 0.86, respectively, p < 0.001). The highest salivary cortisol levels appeared just after awakening (about two fold higher than the 11 AM level), decreased throughout the day, and reached the lowest levels at bedtime (p < 0.001, when compared with PM cortisol levels). The highest salivary DHEA levels also appeared after awakening (about 1.5 fold higher than the 11 AM level) and decreased by 11AM (p < 0.001). DHEA levels did not decrease further until bedtime (p=0.11, when compared with PM DHEA levels). CONCLUSION: This study showed that cortisol and DHEA levels change with age and that the negative slope of DHEA was steeper than that of cortisol in saliva and serum. As the cortisol and DHEA levels in saliva reflected those in serum, the measurement of steroid levels in saliva provide a useful and practical tool to evaluate adrenal functions, which are essential for clinical diagnosis.
Adult ; Age Factors ; Aged ; Analysis of Variance ; *Circadian Rhythm ; Dehydroepiandrosterone/blood/*metabolism ; Female ; Humans ; Hydrocortisone/blood/*metabolism ; Male ; Middle Aged ; Saliva/*metabolism

PURPOSE: The primary objective of this study was to examine the changes of basal cortisol and DHEA levels present in saliva and serum with age, and to determine the correlation coefficients of steroid concentrations between saliva and serum. The secondary objective was to obtain a standard diurnal rhythm of salivary cortisol and DHEA in the Korean population. MATERIALS AND METHODS: For the first objective, saliva and blood samples were collected between 10 and 11 AM from 359 volunteers ranging from 21 to 69 years old (167 men and 192 women). For the second objective, four saliva samples (post-awakening, 11AM, 4PM, and bedtime) were collected throughout a day from 78 volunteers (42 women and 36 men) ranging from 20 to 40 years old. Cortisol and DHEA levels were measured using a radioimmunoassay (RIA). RESULTS: The morning cortisol and DHEA levels, and the age-related steroid decline patterns were similar in both genders. Serum cortisol levels significantly decreased around forty years of age (p < 0.001, when compared with people in their 20s), and linear regression analysis with age showed a significant declining pattern (slope= -2.29, t= -4.297, p < 0.001). However, salivary cortisol levels did not change significantly with age, but showed a tendency towards decline (slope= -0.0078, t= -0.389, p=0.697). The relative cortisol ratio of serum to saliva was 3.4 - 4.5% and the ratio increased with age (slope=0.051, t=3.61, p < 0.001). DHEA levels also declined with age in saliva (slope= -0.007, t= -3.76, p < 0.001) and serum (slope= -0.197 t= -4.88, p < 0.001). In particular, DHEA levels in saliva and serum did not start to significantly decrease until ages in the 40s, but then decreased significantly further at ages in the 50s (p < 0.001, when compared with the 40s age group) and 60s (p < 0.001, when compared with the 50 age group). The relative DHEA ratio of serum to saliva was similar throughout the ages examined (slop = 0.0016, t = 0.344, p = 0.73). On the other hand, cortisol and DHEA levels in saliva reflected well those in serum (r = 0.59 and 0.86, respectively, p < 0.001). The highest salivary cortisol levels appeared just after awakening (about two fold higher than the 11 AM level), decreased throughout the day, and reached the lowest levels at bedtime (p < 0.001, when compared with PM cortisol levels). The highest salivary DHEA levels also appeared after awakening (about 1.5 fold higher than the 11 AM level) and decreased by 11AM (p < 0.001). DHEA levels did not decrease further until bedtime (p=0.11, when compared with PM DHEA levels). CONCLUSION: This study showed that cortisol and DHEA levels change with age and that the negative slope of DHEA was steeper than that of cortisol in saliva and serum. As the cortisol and DHEA levels in saliva reflected those in serum, the measurement of steroid levels in saliva provide a useful and practical tool to evaluate adrenal functions, which are essential for clinical diagnosis.
Adult ; Age Factors ; Aged ; Analysis of Variance ; *Circadian Rhythm ; Dehydroepiandrosterone/blood/*metabolism ; Female ; Humans ; Hydrocortisone/blood/*metabolism ; Male ; Middle Aged ; Saliva/*metabolism

A vesical diverticulum is an abnormal pouch or sac lined with vesical mucosa protruding through the bladder wall. Most vesical diverticula are seen in elderly men in association with bladder outlet obstruction. Occasionally in children, primary or congenital vesical diverticulum is developed with no underlying disease, which produce many urologic problems. Herein we recently experienced one case of the congenital vesical diverticulum in 8-day-old male infant with hydronephrosis and dysuria.
Aged ; Child ; Diverticulum* ; Dysuria ; Humans ; Hydronephrosis ; Infant* ; Male ; Mucous Membrane ; Urinary Bladder ; Urinary Bladder Neck Obstruction

OBJECTIVE: The aim of this study was to compare the clinical characteristics of placental abruption according to the presence or absence of hypertensive disorders in pregnancy. METHODS: The retrospective analysis was performed in total 363 cases of placental abruption among 25,895 deliveries during 5 years from January, 2003 to December, 2007 in 8 hospitals of Catholic university in Korea. Maternal characteristics and neonatal outcomes were compared with parametric test. RESULTS: The incidence of placental abruption was 1.40% during the study period. The proportion of patients complicated with hypertensive disorders was 33.1%. There was no difference in maternal age and the number of previous pregnancy between two groups with or without hypertensive disorders. As expected, mean gestational age at delivery was lower in placental abruption with hypertensive disorders compared to those without the diseases (237.1 days vs 239.1 days). The incidence of abnormal fetal presentation, multiple gestation, PPROM, and polyhydramnios were more common in patients with placental abruption without hypertensive disorders. On the other hand, the incidence of maternal thrombophilia was significantly higher in patients with placental abruption with hypertensive disorders. The patients with placental abruption with hypertensive disorders had higher incidence of abdominal pain, fetal distress, uterine contraction, and uterine hypertonus (p<0.05). In terms of maternal complication, the patients with placental abruption with hypertensive disorders had more severe complications including shock, coagulopathy and renal failure (p<0.05) and had worse perinatal outcome including FDIU (fetal death in uterus) and neonatal death (10.8% vs 10.3%). CONCLUSION: In patients with placental abruption with hypertensive disorders in pregnancy, maternal complications were more common and prenatal outcome was worse compared to patients with placental abruption without hypertensive disorders.
Abdominal Pain ; Abruptio Placentae ; Female ; Fetal Distress ; Gestational Age ; Hand ; Humans ; Incidence ; Korea ; Labor Presentation ; Maternal Age ; Polyhydramnios ; Pre-Eclampsia ; Pregnancy ; Renal Insufficiency ; Retrospective Studies ; Shock ; Thrombophilia ; Uterine Contraction

OBJECTIVE: To examine the incidence of the depressive symptoms during pregnancy and the socio-demographic and obstetric factors associated with depression. METHODS: Two hundred five women who had received antenatal care at Kangnam St. Mary's Hospital from March 2008 to May 2008 completed the questionnaire related to socio-demographic characteristics and Edinburgh Postnatal Depression Scale (EPDS). Statistics were performed using chi-square test and Fisher's extract test (SPSS 12.0). Results were considered statistically significant for P-values<0.05. RESULTS: Of 205 pregnant women, the mean score of EPDS was 7.3+/-4.2.54 of 205 women (26.5%) scored more than 10 point which is the cutoff value to define depressive symptoms. The incidences of depressive symptoms were not significantly different by the trimester (25.7% vs. 29.0% vs. 25.0%, P<0.844). There were no significant socio-geographic factors associated with depressive symptoms. In cases of unexpected pregnancies, the incidence of depressive symptoms was significantly high (34.6% vs. 21.0%, P=0.036), and the women who have problems of previous pregnancies scored significantly higher EPDS (56.3% vs. 23.8%, P=0.014). CONCLUSION: This study was the first report about the depression symptoms during pregnancy. Based on this study, we have to focus on and manage depression symptoms related to pregnancy.
Depression ; Depression, Postpartum ; Female ; Humans ; Incidence ; Pregnancy ; Pregnant Women ; Surveys and Questionnaire

BACKGROUND: Rapid-sequence intubation is a common technique to reduce anesthetic complication. Due to side effects of succinylcholine, nondepolarizing muscle relaxants have been tried. Rocuronium is a new nondepolarizing muscle relaxant with a brief onset of action, but devoid of the adverse reaction associated with succinylcholine. Most local anesthetics decrease neuromuscular transmission and pontentiate neuromuscular blocks of muscle relaxants. The purpose of this study was to examine the effect of lidocaine on the onset time of rocuronium-induced neuromuscular blockade in adults. METHODS: Fourty five patients, ASA physical status I or II, were randomly divided into three groups. Anesthetic induction with thiopental 5 mg/kg was made. Succinylcholine (1.0 mg/kg) was administered intravenously in group 1. Rocuronium (0.6 mg/kg) was given in group 2, additional lidocaine (1.0 mg/kg) was given intravenously 1 minute prior to the administration of rocuronium in group 3. Neuromuscular blockade was assessed by train-of-four at the adductor pollicis muscle with supramaximal stimulation of the ulnar nerve (2 Hz, 0.2 msec) every 10 seconds. The condition of intubation, the appearance of arrhythmias, side effects of drugs, and the changes of mean arterial pressure and heart rate were checked and compared in peri-induction periods. RESULTS: The onset time of group 1 (55.1 14.9 sec) was faster than that of group 2 (137.8 46.0 sec) and group 3 (139.3 41.0 sec), but there was no difference between the onset time of group 2 and that of group 3. Intubating conditions were good or excellent in all groups, but group 1 and 3 were better than group 2. There was no difference between the three groups in hemodynamics. More adverse effects were observed in group 1, that of group 2 and 3 were observed in only one case. CONCLUSIONS: The authors concluded that lidocaine is not effective on the onset time of rocuronium, but improves the intubating condition. Rocuronium is devoid of side effects of succinylcholine, but not a alternative to succinylcholine because its onset time is too slow when compared with succinylcholine.
Adult* ; Anesthetics, Local ; Arrhythmias, Cardiac ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Lidocaine* ; Neuromuscular Blockade* ; Succinylcholine ; Thiopental ; Ulnar Nerve