Broncho-gastric fistula caused by benign gastric ulcer perforation after esophagectomy is very rare. In general anesthesia of a patient with broncho-gastric fistula, in spite of hyperventilation, leakage of the anesthetic gases through fistula may make the patient hypercapneic, and positive pressure ventilation may increase the risk of the pulmanary aspiration by the regurgitation of gastric fluid by stomach distension. For that reason, in this patient, denitrogenation was performed during patient's voluntary respiration with 100% oxygen for 5 minutes, and induction was performed without positive pressure ventilation, and one lung ventilation was carried out. Hypoxemia was followed by one lung ventilation because his pulmonary function was moderate obstructive type and his lung was damaged by aspiration of gastric fluid via broncho-gastric fistula. A low level of continuous positive airway pressure (CPAP) has no significant hemodynamic effect and can maintain the patency of nonventilated lung, so hypoxemia induced by one lung ventilation may be reduced. Thus we carried out one lung ventilation with CPAP (10 cmH2O) in nonventilated lung and blocked broncho-gastric fistula with a bronchial blocker for prevention of both regurgitation of gastric fluid and leakage of anesthetic gases. One lung anesthesia was performed without any problem in this case.
Anesthesia ; Anesthesia, General* ; Anesthetics, Inhalation ; Anoxia ; Continuous Positive Airway Pressure ; Esophagectomy ; Fistula* ; Hemodynamics ; Humans ; Hyperventilation ; Lung ; One-Lung Ventilation ; Oxygen ; Positive-Pressure Respiration ; Respiration ; Stomach ; Stomach Ulcer

The expression of c-fos and c-jun in the brain of the rat after capsaicin treatment was investigated by in situ hybridization, dot blot hybridization and immunocytochemical methods. Adult male Sprague-Dawley rats[200g] were used for this study. The first set of rats received a single subcutaneous injection of capsaicin[50mg/Kg] dissolved in 10% Tween-80 and 10% ethanol in saline. The rats were decapitated 1, 3, 5, 10, 24, 72 hours and 1 week after capsaicin treatment. The control set of rats were treated with saline instead of capsaicin. In situ hybridization and dot blot hybridization were carried out. O1igonucleotide probe complimentary to c-fos mRNA sequences were used for this study and labeling of oligonucleotides was accomplished using the DNA tailing kit. The expression of c-fos mRNA on the nucleus of neurons in in situ hybridization was observed throughout the brain, and was especially abundant in the olfactory cortex, nucleus of diagonal band of Broca, habenular nuclei, periaqueductal gray, parabrachial nucleus, entopeduncular nucleus, ventral posterolateral nucleus of the thalamus and cerebellum. Compared to the control rats, c-fos mRNA were increased 24 hours after capsaicin injection and gradually decreased after 72 hours, returning to the normal control level 1 week after capsaicin injection. c-fos mRNA was detected only 1 week after capsaicin injection in the various areas of the brain. The fos protein-like immunoreactivity was initially somewhat decreased at 24 hours, but increased at 72 hours and reactions was maximally observed at 1 week after capsaicin treatment. But Jun protein immunoreactivity was not increased, on the contrary, it was even decreased both in numbers of reactive cells and immunoreactivity 1 week after capsaicin injection. From the above results, c-fos gene expression was pronounced in the nucleus concerned with pain, olfaction and taste such as VPL nucleus of the thalamus, olfactory cortex and parabrachial nucleus, in the limbic system concerned with stress and emotion such as nucleus of diagonal band of Broca, periaqueductal gray and habenular nucleus, in the structure concerned with somatic motor function such as entopeduncular nucleus and cerebellum. Also, the c-fos gene was activated by the capsaicin early in the course of effects, then the fos protein increased as a results of c-fos activation. On the other hand, c-jun did not respond to capsaicin treatment early in the course, but Jun protein decreased late in the course of capsaicin effects.
Adult ; Animals ; Brain* ; Capsaicin* ; Cerebellum ; DNA ; Entopeduncular Nucleus ; Ethanol ; Genes, fos ; Habenula ; Hand ; Humans ; In Situ Hybridization ; Injections, Subcutaneous ; Limbic System ; Male ; Neurons ; Olfactory Pathways ; Oligonucleotides ; Periaqueductal Gray ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger ; Septal Nuclei ; Smell ; Thalamus ; Ventral Thalamic Nuclei

PURPOSE: The sunken chest deformity without breast asymmetry is not a rare condition encountered in augmentation mammaplasty. Therefore, failure to recognize the deformity and improper surgical plan will lead to a suboptimal result. The authors review the experience of breast augmentation in simple sunken chest patient based on retrospectively collected data. METHODS: From January, 2008 to January, 2009, patients with simple sunken chest underwent endoscopic submuscular augmentation mammaplasty through axilla, using silicone implants. Patient demographics were queried and outcomes were assessed. RESULTS: Eleven patients (22 breasts) were followed up for 8.2 months after surgery. Sunken chests were augmented with implant size of approximately 248.9 cc (range: 213~286 cc) and contralateral chest with 211.4 cc (range: 180~235 cc). Simultaneous camouflaging the chest wall depression with breast augmentation resulted in good aesthetic outcome. All of the patients were satisfied with the surgery. There were no complications among all patients. CONCLUSION: We have demonstrated proper surgical planning with precise implant selection to optimize results in patients with small breast and simple sunken chest. Even though asymmetry still remains after the operation, it is still considered as acceptable.
Axilla ; Breast ; Congenital Abnormalities ; Demography ; Depression ; Female ; Humans ; Mammaplasty ; Retrospective Studies ; Silicones ; Thoracic Wall ; Thorax

OBJECTIVE: To assess the effect of recombinant human leukemia inhibitory factor on in vitro development of 1-cell ICR mouse embryo. MATERIALS AND METHOD: ICR mice were superovulated with PMSG/hCG and 1-cell stage mouse embryos were recruited. 1-cell mouse embryo were cocultured on human oviductal cells in a CO2 incubator (coculture group) and were cultured on 0.4% BSA+HTF media (control group). And anti-hLIF Ab was added the cocultured group in a different concentration (1pg, 10pg, 100pg, 1ng) and developmental rate was compaired to the control group, and rhLIF was added to the preincubated 0.4% BSA+HTF media in a different concentration (2000U, 1000U, 100U, 10U) and its developmental rate was compaired to group which was cultured on 0.4% BSA+HTF media only. RESULT: 1. The cleavage rate of 2-cell mouse embryo co-cultured with human tubal epithelial cell was significantly higher than that of cultured with media alone (HTF with 0.4% BSA) (p<0.05). 2. When LIF antibody was added to the medium with human tubal epitherlial cell, the mouse embryo could not cleave more than 2-cell in 1 ng of LIF antibody, and less than 1 ng, the cleavage rate was lower than cultured without LIF antibody group(p<0.05). 3. Two cell blocked ICR mouse embryos were developed into four cells under LIF(p<0.05), but no further development was observed. CONCLUSIONS: These results shows that LIF enhances the development of preimplantation embryo, and when rhLIF is applicated in vitro, it has positive effects on the development of early mouse embryo and can help overcoming the two-cell block.
Animals ; Blastocyst* ; Coculture Techniques* ; Embryonic Structures ; Epithelial Cells ; Humans ; Incubators ; Leukemia Inhibitory Factor* ; Leukemia* ; Mice ; Mice, Inbred ICR ; Oviducts

BACKGROUND: This study aims to determine whether significant associations exist between the parents' country of birth and adolescent depressive symptoms in the early stages of a multicultural society. METHODS: We used data from the 2012–2016 Korea Youth Risk Behavior Web-based Survey, which included responses from 327,357 individuals. Participants were classified into groups according to their parent's country of birth. Logistic regression analysis was used to examine the significance of the associations. RESULTS: Adolescents whose parents were born abroad are more likely to have depressive symptoms (odds ratio [OR] = 1.68; 95% confidence interval [CI], 1.33–2.12) than adolescents whose parents were native Koreans. Respondents whose father was born in North Korea or Japan or Taiwan show greater odds of depressive symptoms than respondents whose parents were native Korean. CONCLUSION: Adolescents whose parents were born abroad are more likely to have depressive symptoms. Multicultural family support policies should be implemented in consideration of the characteristics of the parents' country of birth.

Glomerulonephritis associated with malignancy is deemed to be paraneoplastic glomerulonephritis. Myelodysplastic syndrome (MDS) is a group of heterogeneous clonal hematopoietic stem cell disorders characterized by impaired hematopoietic cell differentiation and cytopenia. The pathophysiology of MDS is thought to be immune-mediated in part. A few reports have documented various forms of glomerulonephritis in patients with MDS and suggested that immune dysregulation is important in the development of paraneoplastic glomerulonephritis. Here, we report a patient with MDS and refractory anemia with excess blast-2 accompanied by minimal change nephrotic syndrome. The patient was treated with prednisolone, and the nephrotic-range proteinuria and pancytopenia improved markedly.
Anemia, Refractory ; Cell Differentiation ; Glomerulonephritis ; Hematopoietic Stem Cells ; Humans ; Myelodysplastic Syndromes* ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Pancytopenia ; Prednisolone ; Proteinuria ; Steroids

Small bowel variceal bleeding is a rare cause of gastrointestinal hemorrhage, with clinical manifestations ranging from asymptomatic incidental findings to life-threatening conditions. The diagnosis and management of small bowel bleeding are challenging because of the localization of the lesion and the difficulty of the procedure. Trans-arterial embolization (TAE) is a secure and straightforward method for treating ectopic varices. On the other hand, there have been limited local studies on the outcomes of TAE for patients with small bowel variceal hemorrhage. This paper reports patients diagnosed with small bowel variceal bleeding and treated with TAE.

PURPOSE: The aim of this study was to determine whether crossed cerebellar hyperperfusion (CCH) was helpful in discriminating mesial from lateral temporal lobe epilepsy (TLE) and what other factors were related in the development of CCH on ictal brain SPECT. MATERALS AND METHODS: We conducted retrospective analysis in 59 patients with TLE (M:41, F:18; 27.4+/-7.8 years old; mesial TLE: 51, lateral TLE: 8), which was confirmed by invasive EEG and surgical outcome (Engel class I , II). All the patients underwent ictal Tc-99m HMPAO brain SPECT and their injection time from ictal EEG onset on video EEG monitoring ranged from 11 sec to 75 sec (32.6+/-19.5 sec) in 39 patients. Multiple factors including age, TLE subtype (mesial TLE or lateral TLE), propagation pattern (hyperperfusion localized to temporal lobes, spread to adjacent lobes or contralateral hemisphere) and injection time were evaluated for their relationship with CCH using multiple logistic regression analysis RESULTS: CCH was observed in 18 among 59 patients. CCH developed in 29% (15/51) of mesial TLE patients and 38% (3/8) of lateral TLE patients. CCH was associated with propagation pattern; no CCH (0/13) in patients with hyperperfusion localized to temporal lobe, 30% (7/23) in patients with propagation to adjacent lobes, 48% (11/23) to contralateral hemisphere. Multiple logistic regression analysis revealed that propagation pattern (p=0.01) and age (p=0.02) were related to the development of CCH. CONCLUSION: Crossed cerebellar hyperperfusio ictal brain SPECT did not help differentiate mesial from lateral temporal lobe epilepsy. Crossed cerebellar hyperperfusion was associated with propagation pattern of temporal lobe epilepsy and age.
Brain* ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Logistic Models ; Retrospective Studies ; Technetium Tc 99m Exametazime* ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: The purpose of this study was to measure accessibility and to examine distribution of restaurants in the local community. METHODS: The target area of this study was two urban areas and a rural area in a city. We collected location information on all restaurants in target areas and classified all restaurants according to Korean food restaurants and Non-Korean food restaurants. We measured restaurant density per 100 m from the residences of the study population and calculated the distance of the nearest restaurant from the residences of the subjects using the Geographic Information System (GIS) analysis method. We compared the accessibility and distribution of restaurants in urban areas with that of the rural area, and compared the accessibility and distribution of Korean restaurants with that of Non-Korean restaurants. RESULTS: Restaurants in urban areas were more dense than those in the rural area, and, in urban areas, restaurants were intensively distributed around the subjects' residence. Also, there were more Non-Korean food restaurants than Korean food restaurants in urban areas, and it was opposite in the rural area. CONCLUSION: It is important that we understood the current state of the restaurant environment in the local community using GIS analysis for the first time in the field of food environment. Further research is necessary on the association of restaurant environments and the dietary life of the population.
Geographic Information Systems ; Restaurants*

PURPOSE: To retrieve the retracted flexor tendon, additional incision and wide dissection are conventionally required. We introduce minimal-incision tenorrhaphy using 1cm-long incision and minimal dissection. METHODS: Transverse incision about 1cm in length is made over the level of retracted tendon. Nelaton's catheter is advanced into tendon sheath from distal primary laceration wound to emerge proximally through the incisional wound. A catheter is sutured to proximal tendon in end-to- end fashion. By gently pulling the catheter, retracted tendon is delivered to distal wound. Tenorrhaphy with core suture and epitendinous suture is then carried out. RESULTS: This retrieving technique provides minimal incision, minimal dissection, minimal bleeding, minimal injury to tendon end, and shorter operation time with preservation of vincula tendinum and pulley system. CONCLUSION: In case of flexor tendon rupture with retraction, this operative method is believed to allow reliable and effective tenorrhaphy and excellent postoperative outcomes.
Catheters ; Hemorrhage ; Lacerations ; Rupture ; Sutures ; Tendon Injuries ; Tendons