We have experienced one case of acute cardiac arrest occurred during removal of a foreign body in the esophagus in a 8 month old boy. We consider the cause of acute cardiac arrest in this patient as acute hypoxia and vagal reflex, and stress the importance of prompt diagnosis, extensive knowledge and correct and skillful resuscitation.
Anoxia ; Diagnosis ; Esophagus* ; Foreign Bodies* ; Heart Arrest* ; Humans ; Infant ; Male ; Reflex ; Resuscitation

OBJECTIVE: The implantation failure after embryo-transfer (ET) is a major continuing problem in in vitro fertilization (IVF). This study was undertaken to determine the effectiveness of intravenous immunoglobulin for treatment of individuals experiencing repeated unexplained in vitro fertilization-embryo transfer (IVF-ET) failure. METHODS: A total of nine consecutive infertile patients who failed to become pregnant after previous IVF-ET replacing at least three or more normal developed embryos each were included in our study. During the subsequent new IVF-ET cycle, each women received intravenous immunoglobulin 500mg/kg before the embryo transfer. RESULTS: Only one implantation occurred. There were no remarkable side effects. A specific effect of intravenous immunoglobulin for patients with repeated IVF-ET failure could not be demonstrated. CONCLUSION: High-dose intravenous immunoglobulin may not be useful for patients with repeated failure of embryo transfer.
Embryo Transfer ; Embryonic Structures ; Female ; Fertilization in Vitro ; Humans ; Immunoglobulins*

Transient hyperkalemia is well known to occur in man following intravenous administration of succinylcholine chloride. To study on change of the serum level of K+, Na+ & Cl- after injection of succinylcholine in healthy adults, physical status 1 or 2 adopted by the American society of Anesthesiologists, we studied in two groups: pentothal sodium-succinylcholine injection group (group 1) as control, flaxedil-pentothal sodium-succinylcholine injetion group(group 2) as experimental. The following results were obtained: 1. Serum K+ was slightly increased in both groups, 2mEq/L at 3rd minute in control group, 2mEq/L at 1st minute in experimental group after succinylcholine injection, but no statistical significance was noticed in either group. 2. Serum Na+ was decreased 3 mEq/L immediately after pentothal sodium injection and then sliyhtly increased until 10th minute in control group. In experimental group lower level than control was observed until 15th minute, with the maximum decrease of 7mEq/L at 5th minute. But no statistical significance was noticed in either group. 3. Serum Cl was slightly decreased until 10th minute with the maximum decrease of 4mEq/L at 5th minute in control group. In experimental group, it was slightly increased until 5th minute. But no significance was noticed in either group.
Administration, Intravenous ; Adult ; Humans ; Hyperkalemia ; Sodium ; Succinylcholine ; Thiopental

BACKGROUND: The glomerulonephritis appears in various clinical presentations. Renal biopsy is important diagnostic tool for treatment decision and prognosis prediction of glomerulonephritis. We tried to study on the clinical presentations of glomerulonephritis through histopathological findings and treatment responses in elderly patients. METHODS: We made an retrospective analysis in elderly patients aged over 60 years performed renal biopsy in our medical center from January 1991 to February 2005. RESULTS: Of all the 42 patients, the mean age of the patients was 64.6+/-3.5 years, 24 male and 18 female patients were included(1.3:1). Patients aged 60-64 years (n=26, 62%) were majority. On clinical indications of renal biopsies, 17 patients had nephrotic syndrome, 10 had asymptomatic urinary abnormality, 5 had gross hematuria, and 5 had acute azotemia. The results of renal biopsies presented that 30 patients (71%) had primary glomerulonephritis, 9 patients (22%) had secondary glomerulonephritis. Among primary glomerulonephritis, membranous nephropathy (n=10) was most common, followed by IgA nephropathy (n=7),focal segmental glomerulos-clerosis (n=3), membranoproliferative glomerulonephritis (n=2), and mesangioproliferative glomerulonephritis (n=2). In secondary glomer-ulonephritis, there were diabetic nephropathy (n=2), lupus nephritis (n=2), cancer-related nephritis (n=2), poststreptococcal glomer-ulonephritis (n=1), Henoch-Schonlein nephritis (n=1), amyloidosis (n=1). In the cases of nephrotic syndrome, primary nephrotic syndrome (n=12, 71%) is more prevalent than secondary nephrotic syndrome (n=3, 18%). The most common cause of primary nephrotic syndrome was membranous nephropathy (n=8). The causes of asymptomatic urinary abnormality were IgA nephropathy (n=4), lupus nephritis (n=2), membranous nephropathy (n=1), mesangioproliferative glomerulonephritis (n=1). By the complications of renal biopsy, only a few patients presented new-onset hematuria, hematoma, aggravation of hypertension, but, severe complication including an infection or a death was none. 8 of 12 patients with primary nephrotic syndrome were treated, 5 patients of those were shown complete response (n=3) or partial response (n=2). CONCLUSION: Various clinical presentations of glomerulonephritis were shown to elderly patients. Number of complications after renal biopsies were relatively small, and good responsiveness to treatment could be expected in the elderly patients. Therefore it is reasonable to perform a renal biopsy if indicated.
Aged* ; Amyloidosis ; Azotemia ; Biopsy ; Diabetic Nephropathies ; Female ; Glomerulonephritis* ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hematoma ; Hematuria ; Humans ; Hypertension ; Lupus Nephritis ; Male ; Nephritis ; Nephrotic Syndrome ; Prognosis ; Retrospective Studies

PURPOSE: Though caustic injury of the upper digestive tract can lead to severe sequelae, there are few clinical studies on this subject. This study was undertaken to evaluate the clinical characteristics, the endoscopic findings and the risk factors of the upper digestive lesions in patient with caustic ingestion injury. METHODS: We retrospectively reviewed the medical records of 137 patients who ingested caustic materials and who visited to our emergency room from January, 2000 to June, 2009. RESULTS: The most common ingested agent was sodium hypochlorite (44.5%), followed by acetic acid (19.7%), hydrochloric acid (11.7%) and lye (8.0%). Ingestion for suicidal attempt (62.0%) was more frequent than accidental ingestion (30.7%). Grade IIa injury was the most frequent finding on endoscopy of the esophagus and Grade I injury was the most frequent finding on endoscopy of the stomach. For the late sequelae, there were 9 cases (6.6%) of esophageal stricture and 2 cases (1.5%) of gastric outlet obstruction. The initial signs and symptoms did not correlate with the development of stricture, but leukocytosis, and grade III injury were related to the risk of developing stricture. CONCLUSION: Caustic injury of the upper gastrointestinal tract is frequently observed on early endoscopy and it can cause significant late sequelae such as stricture. Therefore, it is necessary to evaluate these patients with regular follow up endoscopic examinations for the management of late sequelae.
Acetic Acid ; Constriction, Pathologic ; Eating ; Emergencies ; Endoscopy ; Esophageal Stenosis ; Esophagus ; Follow-Up Studies ; Gastric Outlet Obstruction ; Gastrointestinal Tract ; Humans ; Hydrochloric Acid ; Leukocytosis ; Lye ; Medical Records ; Retrospective Studies ; Risk Factors ; Sodium Hypochlorite ; Stomach ; Upper Gastrointestinal Tract

After a cholecystoduodenostomy on a 3 year old poor risk girl under local anesthesia, atelectasis developed. On the 8th postoperative day, an endotracheal tube was inserted with the patient eonscious and tenacions secretions were aspirated. Again on the 10th post operative day, after intubatioa under general anesthesia, aspiration of mucus and positive pressure ventilation were applied, the child then recovered.
Anesthesia, General ; Anesthesia, Local ; Child ; Child, Preschool ; Female ; Humans ; Mucus ; Positive-Pressure Respiration ; Pulmonary Atelectasis*

OBJECTIVE: Metabolic syndrome (MS) is associated with increased left ventricular (LV) mass and diastolic dysfunction. This study uses relatively load-independent Doppler tissue echocardiography to examine whether MS is associated with decreased longitudinal contractile reserve during dynamic exercise. METHODS: A total of 112 patients with relatively well-controlled, treated hypertension who complained of exertional dyspnea were enrolled (average age, 56.7+/-10.5 years). Fifty-six were non-diabetic patients with MS (group 1), and 56 were age-sex matched hypertensive patients without MS (group 2). Exercise stress echo was performed using a symptom-limited, multistage, supine bicycle exercise test. Multiple Doppler parameters were obtained at baseline, at each stage of exercise. RESULTS: There was no significant difference between the two groups in terms of age, gender, and hemodynamic variables. E/E', an index of LV filling pressure, was significantly higher in the MS group at rest and during exercise. The longitudinal contractile reserve, the change in S' (longitudinal tissue velocity) from baseline to peak exercise, was significantly lower in the MS group (2.00+/-1.65 vs. 2.90+/-1.66, P=0.015). Multiple regression analysis showed independent association of MS with longitudinal contractile reserve when controlled for confounding factors, such as LV mass index, gender, blood pressure, and age (beta=-0.235, P=0.035). CONCLUSION: Longitudinal contractile reserve was reduced in MS patients compared to others, although both groups demonstrated similar longitudinal contractile function at rest. We present the first demonstration that metabolic syndrome is independently associated with LV systolic dysfunction during exercise in hypertensive patients.
Blood Pressure ; Dyspnea ; Echocardiography ; Exercise Test ; Hemodynamics ; Humans ; Hypertension

Peripartum cardiomyopathy (PPCM) is defined as the onset of acute heart failure without demonstrable cause during the last trimester of pregnancy or within the first 6 months after delivery, which may have devastating consequences upon maternal and fetal outcome. PPCM is often unrecognized as symptoms of normal pregnancy commonly mimic those of mild heart failure but can rapidly progress to cardiac failure. We experienced a shock patient who had cardiac arrest during surgery for emergency cesarean section and the diagnosis of PPCM was made postoperatively. Her postoperative course was complicated by an embolic stroke four months after delivery. We suggest that close peripartum monitoring is essential in the management of PPCM. Thromboembolic complication as a major risk should be considered.
Anesthesia* ; Cardiomyopathies* ; Cesarean Section* ; Diagnosis ; Emergencies ; Female ; Heart Arrest ; Heart Failure ; Humans ; Peripartum Period* ; Pregnancy ; Pregnancy Trimester, Third ; Shock ; Stroke

Various cytokines and chemokines play a role in carcinogenesis. However, no study has previously been undertaken to investigate comprehensively the expressions of cytokines and chemokines in hepatoma cells. In this study, we determined which cytokines and chemokines are expressed in hepatoma cells. Recently, it was reported that the expressions of several chemokines could be increased by Fas stimulus in many normal and cancer cells. Therefore, we also investigated whether chemokines expression is regulated by Fas ligation. To address this issue, we performed RNase protection assays upon 13 cytokines and 8 chemokines genes in 10 human hepatoma cell lines, comprising 8 hepatitis B virus (HBV)-associated hepatoma cell lines. Transforming growth factor-beta2 (TGF-beta2) was found to be expressed in 8 HBV-associated hepatoma cell lines, and to be potently expressed in 5 cell lines; however, the mRNA expressions of interleukin-10 (IL-10), IL-12, interferon-gamma(IFN-gamma) and tumor necrosis factor-alpha(TNF-alpha) were not detected in any cell lines examined. Among the chemokines investigated in this study, IL-8 was expressed by 8 HBV- associated hepatoma cell lines, and monocyte chemoattractant protein-1 (MCP-1) by 7 HBV-associated hepatoma cell lines. However, the mRNA expressions of macrophage inflammatory protein-1alpha (MIP-1alpha), MIP-beta, interferon-inducible protein-10 (IP-10), RANTES, lymphotactin and I-309 were either very weak or undetectable. Fas ligation did not increase chemokines expression in hepatoma cells. Conclusively, TGF-beta2, IL-8 and MCP-1 were overexpressed in HBV-associated hepatoma cells, and the expressions of chemokines were not increased by Fas ligation in human hepatoma cells.
Antigens, CD95/physiology ; Carcinoma, Hepatocellular/*metabolism ; Chemokines/*genetics ; Cytokines/*genetics ; Gene Expression Profiling ; Human ; Liver Neoplasms/*metabolism ; RNA, Messenger/analysis ; Tumor Cells, Cultured

OBJECTIVE: Detection of intracranial multiple aneurysms, including mirror-image aneurysms, have recently been increasing with the development of diagnostic techniques. However, studies of mirror-image aneurysms have been rare in South Korea. Thus, we intend to report our hospital's experience with mirror-image aneurysms during the past 20 years along with a review of relevant literature. METHODS: We analyzed medical records and image data from patients with cerebral aneurysms who had been admitted to our institution from January 1988 to June 2007. We divided the patients into three groups and investigated the clinical patterns of mirror-image aneurysms (Group 1). We then compared them with patients exhibiting non-mirror multiple aneurysms (Group 2) and the patients with solitary aneurysms (Group 3). We also statistically analyzed the age, sex, smoking habits, medical histories, and prognoses of the patients. RESULTS: Mirror-image aneurysms were found in 62 (5.1%) of the 1,209 patients admitted for cerebral aneurysms over the past 20 years. Of the mirror-image aneurysms, 48% were located in the posterior communicating artery (PcoA), and 40% were in the middle cerebral artery (MCA). Ruptures of aneurysms occurred slightly more frequently on the right side and when the aneurysm was larger and its shape was more irregular. Women, particularly menopausal women aged 50 and older, were shown to be at higher risk. Smoking was also a risk factor. However, there were no significant differences in prognoses among the three groups. CONCLUSION: We should pay attention to the possibility of mirror-image or multiple aneurysms when diagnosing and treating menopausal women and smokers, particularly if the cerebral aneurysm is located in the MCA or PcoA.
Aged ; Aneurysm ; Arteries ; Female ; Humans ; Intracranial Aneurysm ; Medical Records ; Middle Cerebral Artery ; Prognosis ; Republic of Korea ; Risk Factors ; Rupture ; Smoke ; Smoking