BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

Congenital absence of nails usually occur as a rare isolated anomaly or combined with other ectodermal defects. This anomaly is regarded as an inherited disorder either dominantly or recessively but quite a few cases were reported as sporadically developed. The patient was a 2-month-old girl who had no nails on both her 2nd, 3rd toes but had rudimentary nails on her left big toe and both 4th toes at birth. We could not find any other congenital deformity, any family history of inherited diseases related to anonychia. Radiological findings revealed no visualization of both 4th distal phalanges, only. We report this case as congenital anonychia of a sporadic type which may have developed independently from an underlying bone abnormality. We also review other reported cases in the literature.
Congenital Abnormalities ; Ectoderm ; Female ; Hallux ; Humans ; Infant ; Parturition ; Toes*

We performed a retrospective study of 12,307 patients who visited the emergency room of St. Paul's Hospital, secondary medical center, from January 1 to December 31,1996. The results were as follows : 1. Of 12,307 total patients, male to female ratio was 1.16:1 but after 7th decade, there were more female than male. And 3rd decade was the peak age group. 2. The majority o(patients visited our emergency room from noon to midnight (65% of total patients). 3. On average,33.7 patients visited our emergency room per day. Most patients visited on Sundays and other holidays(average 43.3 per day). 4. By monthly distribution, the patients Increased slightly during May, June, July, August and September. 5. Disease to injury ratio was 2.6:1. In disease, male to female ratio was 1 :1 and in injury, the male prominence had a the ratio 1.8:1 In 2nd decade, disease to injury ratio was higher (1.4:1) than that of other decade. And there were mostly disease patients in the group under 1 year old (19.2: 1). 6. Of 12,307 total patients,5,458 patients received only Intern's treatment (44.3%). In 3rd decade, the ratio of Intern's treatment was higher (54.4%). 7, The patients were categorized as follows, Infernal medicine 28.1%, Pediatrics 18.2fo, Orthopedic surgery 13.2%, Plastic surgery 7.4% etc. 8. Averaged admission rate was 25.3% and the rate of general surgery was the highest (49.5%). The rate of admission to intensive care unit (ICU) was 5.5% of total visiting patients and 21.8% of total admission patients. 9. The total patients transferred from other hospitals were 1152 (9.4%), 3.16 per day. The majority used non-emergency vehicles and only 8.5% of patients used the rescue service or ambulances. 10. The average transit time spent in the emergency room was 182 minutes. The longest was 246 minutes in March and the shortest 127 minutes in January.
Ambulances ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Intensive Care Units ; Male ; Orthopedics ; Pediatrics ; Retrospective Studies ; Surgery, Plastic

The frequency of stab wounds is gradually increasing and patients with stab wounds visit the hospital through the emergency room. Management options for patients with stab wound include mandatory exploration and selective observation, but recently many authors have emphasized the importance of selective conservation with development of diagnostic procedure and controversy still exists concerning the management of patients with stab wounds. We retrospectively analysed the clinical data of 78 patients with stab wounds who visited the emergency room of St. Paul's Hospital over 5 years from January 1 1992 to December 31 1996. The following results were obtained. 1) The most prevalent age group were the twenties & the thirties(58.9% of patient) and then most patients were of young age. The male to female ratio was 2.9: 1. 2) Most injuries occurred at night between 8p.m. and 4a.m.(61.5%) and during September injuries were most frequent. 3) The most common causes of stab wound were fighting(55.1%) followed by suicide (21.8%), then accidents including traffic accidents(16.7%) and robbery(6.4%). 4) The instruments most commonly used were knives(53.8%) and broken glass(28.2%). 5) Half of patients were drunk from alcohol and in 3 cases from an antipsychotic drug. 6) In 11 cases(14.1%), there were multiple wound sites and in 8 cases(10.3%) superficial wounds into subcutaneous fatty tissue. 7) According to stab wound sites, the extremities were wounded in 36 cases(46.2%), chest in 21 cases(26.9%), abdomen in 15 cases(19.2%) and neck in 7 cases(9.0%). 8) Emergency explorations were performed in 43 cases(55.1%) under general or regional anesthesia, which included neck in 4 cases(9.3%), chest in 3 cases(7.0%), abdomen in 11 cases(25.6%) and extremity in 25 cases(58.1%). In exploratory laparotomy, negative exploration rate was 18.2%. 9) Death occurred in 2 cases(2.6%). One died due to sepsis with multiple colon perforation and the other due to hypovolemic shock with Superior Vena Cava injury.
Abdomen ; Adipose Tissue ; Anesthesia, Conduction ; Colon ; Emergencies ; Emergency Service, Hospital ; Extremities ; Female ; Humans ; Laparotomy ; Male ; Multiple Trauma ; Neck ; Retrospective Studies ; Sepsis ; Shock ; Suicide ; Thorax ; Vena Cava, Superior ; Wounds and Injuries ; Wounds, Stab*

The incidence of uterine prolapse during pregnancy is rare. A 34-year-old G3P1 was initially presented at 16 weeks 5days of gestation with a prolapse of the uterine cervix. The cervix was edematous and protruding beyond introitus. Management included bed rest, and the patient was discharged after several days with a vaginal pessary to help maintain cervical placement. At 35 weeks of gestation, the patient did not experience any further prolapse after the removal of the pessary. Pregnancy progressed to term with no further prolapse. She was readmitted at 38weeks 5days of gestation with spontaneous labor. She delivered a 3.36kg male with an Apgar score at 1 minute and at 5 minutes of 7 and 8 respectively. The patient's cervix remained prolapsed in the early postpartum period; however it was easily reduced prior to discharge. After puerperium, the patient's cervix remained prolapsed. She was fitted with a vaginal pessary for uterine support. We reported this case with related literature.
Adult ; Apgar Score ; Bed Rest ; Cervix Uteri ; Female ; Humans ; Incidence ; Male ; Pessaries ; Postpartum Period ; Pregnancy* ; Prolapse ; Uterine Prolapse*

BACKGROUND: To identify the expression patterns and usefulness of various antibodies in making diagnoses and predicting prognoses, an immunohistochemical study was performed on thymic epithelial tumors (TETs). METHODS: Forty-two cases of TETs were reclassified according to the new World Health Organization (WHO) classifications. CD3, CD5, CD79a, CD99, pan-, high- and low-molecular weight cytokeratins, EMA, vimentin, MIB-1 (Ki67) and p53 immunostaining were carried out. RESULTS: There were two, twelve, eight, two, thirteen and one case for type A, AB, B1, B2, B3 and C, respectively. Combined B1/B2 and B2/B3 were 2 cases each. Fourteen cases (33.3%) had myasthenia gravis. CD99 was immunoreactive mainly in cortically derived lymphocytes, while CD3 and CD5 were immunoreactive in medullary-derived lymphocytes. CD5 immunoreactivity was negative in all thymic epithelial cells, except for one case of type B3. MIB-1 indices were highly expressed in cortical lymphocytes and some thymic epithelial cells, but did not show any correlation with grades. p53 in thymic epithelial cells was expressed in 6 (46%) out of 13 cases of type B3 and one case of type C, and it was negative in all other subtypes. CONCLUSIONS: Only p53 was helpful for predicting high grades (B3 and C) (P<0.05). By MIB-1 indices, we could tell how many cortical immature lymphocytes were occupied in TETs, however, grading could not be achieved.
Antibodies ; Classification ; Diagnosis ; Epithelial Cells ; Immunohistochemistry ; Keratins ; Lymphocytes ; Myasthenia Gravis ; Prognosis ; Thymus Gland ; Vimentin ; World Health Organization* ; World Health*

Mesocolic hernia is a rare congenital anomaly caused by an error of rotation of the midgut. It may be seen as total encapsulation of the small bowel or a single loop within a hernial sac. It may be asymptomatic or cause life-threatening intestinal obstruction. Symptoms, when present, are often chronic vague abdominal pain and intermittent obstructive episodes. We have encountered a 40-year-old woman with a congenital mesocolic hernia. Abdominal CT provided the diagnosis. She successfully underwent operation and discharged with good condition. Now we present a case of congenital mesocolic hernia with a review of some articles.
Abdominal Pain ; Adult ; Diagnosis ; Female ; Hernia* ; Humans ; Intestinal Obstruction ; Tomography, X-Ray Computed

BACKGROUND: Coronary artery diseases (CAD) are increasing in recent years among Korean due to change of socioeconomic status. Even though death rates due to CAD has increased in Korea, few epidemiologic studies have been done about risk factors of CAD. We conducted a case-control study to analyze risk factors for CAD among Korean. METHODS: The case series comprised 166 patients with angiographically confirmed CAD, who were admitted to Division of Cardiology in Asan Medical Center. The controls were 137 persons composed of patients with normal coronary arteriogram or patients with normal myocardial SPECT for chest pain. We surveyed life style habits, measured anthropometric variables, and analyzed biochemical markers among CAD patients and controls. RESULTS: In univariate analysis adjusted for age and body mass index (BMI), age, obesity, abdominal obesity, hypertension, low HDL-cholesterol, low apolipoprotein A1, and high lipoprotein (a) were associated with CAD in men and women. Smoking, diabetes, and hypercholesterolemia were associated with in men only. Exercise and high HDL-cholesterol were inversely associated with CAD both in men and women. In multivariate logistic regression analysis, smoking, abdominal obesity, low apolipoprotein A1, and high lipoprotein (a) were found as independent risk factors of CAD among men. Abdominal obesity, low apolipoprotein A1, and high lipoprotein (a) were found as independent risk factors among women. CONCLUSION: These finding suggest cessation of smoking and weight control for abdominal obesity are important for prevention of CAD among Korean. The detection of low apolipoprotein A1 and high lipoprotein (a) could be useful for prevention of CAD.
Apolipoprotein A-I ; Biomarkers ; Body Mass Index ; Cardiology ; Case-Control Studies* ; Chest Pain ; Chungcheongnam-do ; Coronary Artery Disease* ; Coronary Vessels* ; Epidemiologic Studies ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Korea ; Life Style ; Lipoprotein(a) ; Logistic Models ; Male ; Mortality ; Obesity ; Obesity, Abdominal ; Risk Factors* ; Smoke ; Smoking ; Social Class ; Tomography, Emission-Computed, Single-Photon

No abstract available.

To evaluate the oral glutamine (GLN) on the luminal microbes and bacterial translocation (BT) in short bowel, 45 Wistar rats were utilized in three groups; A (control), and B and C (short bowel, 85% of small bowel resected). The group A was fed with elemental diet (EmD), B with EmD+2% glycine, and C with EmD+2% GLN. The groups B and C were isocaloric and isonitrogenous. Wet weight, DNA, protein, and histomorphometry of the mucosa and parallel microbial culture from cecal contents, caval blood, and tissue blocks of the liver, spleen, and mesenteric lymph nodes were performed on the 5th, 10th, and 15th day. Mucosal growth was higher in group C than B. Colony forming units (CFU) from cecal contents increased more in group B than in C. BTs in A, B, and C were 7/15, 8/15, and 2/15, respectively. Total CFUs in blood and tissues were 5.8X10(4)/g, 5.5X10(6)/g, and 1.8X10(4)/g, respectively. As for BT, the most frequent organism was Klebsiella in A (79.3%), but E. coli in B and C (94.2% and 55.6%). GLN seems to suppress luminal microbes, and reduces BT in short bowel due to enforced barrier function and proliferation of the mucosa.
Animals ; Anti-Infective Agents/therapeutic use ; Body Weight/drug effects ; DNA/metabolism ; Glutamine/*therapeutic use ; Intestine, Small/drug effects/microbiology/*surgery ; Male ; Rats ; Rats, Wistar ; Stem Cells ; Time Factors