Epidermolysis bullosa dystrophica is rare, chronic non-inflammatory disease of hereditary trait, which easily ptoduces bullae spontaneously or by heat and minor trauma such as pressure or friction. We present two cases of epidermolysis bullosa dystrophica that seems to be a dominant type considering the presence of family history with histopathologic and electron microscopic findings. Successful anesthetic management of two patients with epidermolysis bullosa dystrophica was accomplished with general anesthesia.. The special concerns which relate to airway management in this disease are discussed. Early diagnosis and institution of preventive measures can minimize the need for restorative and surgical management in these children. However, when anesthetic management is necessary, the use of appropriate consultants and adjuncts can provide valuable support.
Airway Management ; Anesthesia, General ; Child ; Consultants ; Early Diagnosis ; Epidermolysis Bullosa Dystrophica* ; Epidermolysis Bullosa* ; Friction ; Hot Temperature ; Humans ; Skin

Catheterization of the innominate or superior vena caval vein via the basilic, external jugular and internal jugular veins was attempted in 103 adult and pediatric patients scheduled for cardiovascular and pulmonary surgery. Both basilic veins were used in 43 patients, and malposition of the cathether tips occured in 23% of the cases. The site of malposition was often the ipsilateral internal jugular vein. Both external jugular veins were utilized in 58 cases, and the malposition was 17%. The ipsilateral internal jugular vein was also the most common site of malpogition. Catheter curling was noted in 3 patients. One case of premature ventricular contraction was observed on the E.K.G monitor during catheterization, but disappeared as soon as the catheter was withdrawn. Difficulty was encountered in the passage of the catheter in 9% of the cases using the basilic vein and in 40% using the external jugular vein.
Adult ; Catheterization ; Catheters ; Central Venous Catheters* ; Humans ; Jugular Veins* ; Ocimum basilicum* ; Veins ; Ventricular Premature Complexes

The permanent impairment evaluation for children in developmental stage is very difficult and it is even impossible in some cases. The impairment evaluation for developing children has not yet been included in the guideline of the American Medical Association. Due to frequent medical and social demands in Korea, we developed an impairment evaluation guideline for motor impairment, intellectual disability/mental retardation, developmental speech-language disorder and epilepsy caused by pediatric cerebral injuries, or cerebral lesions other than the developmental disorders such as autism. With the help of various literature and foreign institutions, we developed our in order to develop a scientific guideline for pediatric impairment that is suited to Korean cultural background and social condition.
Brain/physiopathology ; Brain Diseases/*complications ; Brain Injuries/complications ; Child ; Developmental Disabilities/classification/*diagnosis/etiology ; *Disability Evaluation ; *Disabled Children ; Humans ; Korea ; Language Development Disorders/classification/diagnosis/etiology ; Mental Disorders/classification/diagnosis/etiology ; Program Development ; Seizures/classification/diagnosis/etiology ; Severity of Illness Index

The tourniquet is widely used in upper and lower extremity surgery in orthopedic practice. However, safe working guidelines for the application of the tourniquet are not clearly defined. The use of a tourniquet is an important step in performing total knee arthroplasty, and it seems plausible that mechanical damage is directly related to the height and the duration of the pressure of the tourniquet applied. Even the tourniquet pressure which is widely accepted in clinical practice, if it is applied for several hours, would permanently damage not only tissues directly under the tourniquet but also the muscles and the nerves distal to the tourniquet. The resultant ischemia to limb produces local changes including hypoxemia, acidosis and hyperkalemia. Relatively little is known about the systemic effects of tourniquet release when the patient is undergoing total knee replacement surgery under a general anesthesia. Therefore, we studied the systemic effects. The results were as follows: 1) Approximately five minutes after the tourniquet was released there was a statistically significant increase in mean heart rate.: 2) Serum potassium levels tended to increase significantly until five minutes while the serum sodium level rose significantly only one minute, and the lactate level rose significantly for only two minutes after tourniquet released; 3) PaCO2 increased for five minutes after tourniquet release and remained elevated for 30 minutes; 4) PaO2 did not change significantly two minutes after tourniquet release; 5) The mean pH dropped to 7.34 and remained low for over five minutes.
Aged ; Blood Pressure ; Carbon Dioxide/blood ; Electrolytes/*blood ; Female ; Heart Rate ; Human ; *Knee Prosthesis ; Male ; Middle Age ; Oxygen/blood ; *Tourniquets

Artificial airways have been widely used to keep patency of airway and apply respiratiory care, however those airways may cause frequent and severe complications. Many etiologic factors have been implicated in the development of these problems with the exact reasons being as yet unknown. The purpose of this study was to assess the incidence, evolution and long-thrm effects of complications following artificial airways and to evaluate the effect of complications following artificial airways and to evaluate the effect of factors in the genesis of those complications. 332 consecutive patients admitted to Intensive Care Unit in Shinchon Severance Hospital over a 6-month period from March to August, 1990 were studied who had been intubated or tracheostomied. 1) Complications following artificial airways occurred in 58 patients among 332 patients and the rate of complication was 17.5% and the total number of complication was 63 cases. 2) There was no significant relationship between the rate of complications and patient's demographic factors, such as age and sex. 3) There was statistic significance between the rate of complications and factors such as frequencies of intubation and drugs used for intubation such as sedatives and muscle relaxants. 4) As frequency of intubation increased once, the rate of complication increased about twice. 5) The rate of complications in the patients without sedatives and muscle relaxants at intubation was 2.34 times greater than in those administered either medications.
Demography ; Humans ; Hypnotics and Sedatives ; Incidence ; Intensive Care Units ; Intubation

Cerebrovascular disease and coronary heart disease are the first and the fourth common causes of death among adults in Korea. Reported risk factors of one of these diseases may prevent other diseases. Therefore, we tried to compare and discriminate the risk factors of these diseases. We recruited four case groups and four control groups among the inpatients who were admitted to Wonju Christian Hospital from March, 1994 to November, 1995. Four control groups were matched with each of four case groups by age and sex. The number of patients in each of four case and control groups were 106 and 168 for acute myocardial infarction(AMI), 84 and 133 for subarachnoid hemorrhage(SAH), 102 and 148 for intracerebral hemorrhage(ICH), and 91 and 182 for ischemic stroke(IS) respectively. Factors whose levels were significantly higher in AMI and IS than in responding control group(RCG) were education, economic status, and triglyceride. Factors whose levels were significantly lower in hemorrhagic stroke than in RCG were age of menarch, and prothrombin time. The factor whose level was higher in AMI than in RCG was uric acid. The factor whose level was higher in AMI, ICH, and SAH than in RCG was blood sugar. Factors whose levels were significantly higher in all the case groups than in RCG were earlobe crease, Quetelet index, white blood cell count, hemoglobin, hematocrit, and total cholesterol. The list of risk factors were somewhat different among the four diseases, though none of the risk factors to the one disease except prothrombin time acted as a preventive factor to the other diseases. The percent of grouped cases correctly classified was higher in the discrimination of ischemic diseases(AMI and IS) from hemorrhagic diseases(SAH and ICH) than in the discrimination of cerebrovascular disease from AMI. The factors concerned in the discrimination of ischemic diseases from hemorrhagic diseases were prothrombin time, earlobe crease, gender, age uric aci, education, albumin, hemoglobin, the history of taking steroid, total cholesterol, and hematocrit according to the selection order through forward selection.
Adult ; Blood Glucose ; Body Mass Index ; Case-Control Studies* ; Cause of Death ; Cholesterol ; Coronary Disease* ; Discrimination (Psychology) ; Education ; Gangwon-do ; Hematocrit ; Humans ; Inpatients ; Korea ; Leukocyte Count ; Prothrombin Time ; Risk Factors* ; Stroke ; Triglycerides ; Uric Acid

PURPOSE: The aims of the current study were to evaluate the effects of superficial cold and heat after spine surgery on pain, satisfaction with pain control and comfort level, and to identify subjective responses and adverse effects. METHODS: A prospective, single-blind, randomized controlled trial was utilized. The intervention group (n=36) received superficial cooling until the wound drain was removed and thereafter followed by superficial heating until discharge, while the control group (n=34) received only superficial cooling until wound drain was removed. Data were collected from August 4 to November 11 2014. RESULTS: There was significant difference in pain according to time within groups (F=71.87, p<.001). However, we found no difference in pain between groups. The intervention group reported higher patient satisfaction with pain control (4 vs 3, z=-2.83, p=.005) and higher comfort level (5 vs 4, z=-4.12, p<.001) than the control group. CONCLUSION: Results indicate that sequential application of superficial cold and heat is a useful method in clinical practice for management of pain after spine surgery.
Cryotherapy ; Heating ; Hot Temperature* ; Humans ; Methods ; Pain, Postoperative ; Patient Satisfaction* ; Personal Satisfaction ; Prospective Studies ; Spine* ; Wounds and Injuries

We performed this study to assess the correlation of residual pulmonary hypertension in the immediate postoperative period with that in the late follow-up period, to assess the histologic changes of pulmonary arteries (PA) at the time of repair for patients with congenital heart disease consisting of left-to-right shunt, and to clarify the role of lung biopsy in determining the operability and reversibility of pulmonary vascular changes. Lung biopsy was performed during repair in 38 patients, with a wide range of age, who had congenital left to right shunt and pulmonary hypertension. All were Heath-Edward grade III or less. Morphometric study included measurement of medial wall thickness (MWT) and decrease rate of pulmonary arterial concentration (PAC). Mean PA pressure in the immediate postoperative period was measured in all 38 patients. Follow-up cardiac catheterization was performed in 15 patients (average 3.8 years after repair). At operation, 5 patients of this late follow-up group were under 2 years of age and the other 10 were 2 or more. During catheterization, pulmonary hemodynamic reaction was observed both under room air inhalation and after inhalation of hypoxic gas FiO2 0.15. Mean PA pressure and pulmonary vascular resistance (PVR) in the immediate postoperative period had a significant correlation with PA pressure and PVR values before the operation, but not with morphometry, Heath-Edward grade, or with pulmonary hemodynamics in late follow-up. During the late follow-up study, 5 of the 15 patients had pulmonary hypertension (defined as mean PA pressure > or = 15 mmHg) under room air inhalation, and PA hypertension was induced in 4 additional patients after hypoxic gas inhalation. There was no incidence of PA pressure or PVR values registering above the preoperative level. The degree of PA hypertension showed a correlation with the rate of PAC decrease and also with patients' age-at-operation. Multiple regression analysis showed that both the rate of PAC decrease and the age-at-operation contributed significantly to the degree of PA hypertension. Some of the patients over age 2 had a decreased rate of PAC above the regression line, which none of the patients under age 2 experienced. In patients with Heath-Edward grade III or less, residual pulmonary hypertension in the immediate postoperative period was not correlated with histology, but in late follow-up, it was with PAC and the age-at-operation. Therefore, a decrease of PAC is assumed to be a totally or partially irreversible pulmonary vascular change depending on the patient's age-at-operation, while medial hypertrophy is thought to be a reversible pulmonary vascular change. Lung biopsy could play an important role in determining the reversibility of pulmonary vascular obstruction, particularly in patients older than 2 years. Ed- re highlights above: such hyphenation is optional, but if used then it should be applied consistently throughout the paper. As 3 of the 4 entries in the abstract use it, I have maintained it consistently below.
Adolescent ; Adult ; Biopsy ; Child ; Child, Preschool ; Follow-Up Studies ; Heart Defects, Congenital/*pathology/physiopathology/surgery ; Hemodynamics ; Human ; Pulmonary Artery/*pathology/physiopathology

PURPOSE: To examine the prevalence of Clostridium difficile (C. difficile) colonization (CDC) and potential neonatal determinants of CDC in hospitalized preterm infants. METHODS: Fecal samples were serially collected within 72 h after birth and at 1, 2, and 4-6 weeks of age from preterm infants in the neonatal intensive care units (NICUs) of two different university hospitals. Total bacterial DNA was extracted from each fecal sample from 49 infants, and polymerase chain reaction (PCR) was performed with primers for the 16S gene of C. difficile and the toxin A and toxin B genes. The correlation between the results of C. difficile PCR assays and the clinical characteristics of the infants was analyzed. RESULTS: The prevalence rates of CDC were 34.7, 37.2, 41.3, and 53.1% within 72 h after birth and at 1, 2, and 4-6 weeks of age, respectively. The toxin positivity rate was significantly higher in the infants with persistent CDC than in those with transient CDC (8/12 [66.7%] vs. 6/25 [24.5%] (p=0.001). Among the various neonatal factors, only the feeding method during the first week after birth was significantly associated with persistent CDC. Exclusive breast-milk feeding (EBMF) significantly decreased the risk of persistent CDC compared to formula or mixed feeding (adjusted odds ratio: 0.133, 95% confidence interval: 0.02-0.898, p=0.038). CONCLUSION: The prevalence of CDC increased with the duration of hospitalization in preterm infants in the NICU. EBMF during the first week after birth in hospitalized preterm infants may protect against persistent CDC.
Centers for Disease Control and Prevention (U.S.) ; Clostridium ; Clostridium difficile ; Colon ; DNA, Bacterial ; Feeding Methods ; Hospitalization ; Hospitals, University ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Parturition ; Polymerase Chain Reaction ; Prevalence

Paraneoplastic hypercalcemia without bone metastasis occurs rarely in esophageal cancer. A 75-year-old man was admitted for general weakness and lethargy. Laboratory data showed high serum calcium level (corrected calcium 14.6 mg/dL), low parathyroid hormone level (3.3 pg/mL) and high parathyroid hormone-related peptide level (3.5 pmol/L). Esophagogastroscopy showed a malignant tumor in the esophagus. Histology showed moderately differentiated squamous cell carcinoma. Bone scan showed no evidence of bone metastasis. Since the patient's calcium levels remained high and mental state did not show improvement despite intravenous fluid therapy, diuretics and intravenous bisphosphonate, hemodialysis was started. After hemodialysis treatment, the serum calcium level subsequently normalized and his mental status improved. Herein, we report a rare case of paraneoplastic hypercalcemia in a patient with esophageal cancer.
Aged ; Calcium/blood ; Carcinoma, Squamous Cell/*diagnosis/pathology ; Endoscopy, Digestive System ; Esophageal Neoplasms/*diagnosis/pathology ; Humans ; Hypercalcemia/*diagnosis/pathology ; Male ; Parathyroid Hormone-Related Protein/blood ; Renal Dialysis ; Severity of Illness Index ; Tomography, X-Ray Computed