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Antral web is a rare cause of gastric outlet obstruction in neonate. It is a 2-4 mm thin mucous membrane that can be found anywhere from 1 to 7 cm proximal to the pylorus. The baby was born at gestational age of 32(+1) weeks with 1,880 g as 2nd baby of dizygotic twin. After birth, the baby had constant non-bilious vomiting without feeding while he didn't show abdominal distension or discoloration. The infantogram showed distended stomach with distal small bowel gas. Upper gastrointestinal series revealed that the antrum was abruptly narrowed at 1 cm proximal to pylorus. We performed laparotomy at the 10th day after birth and excised the 2 mm-thick web circumferentially. He began milk feeding after 6 days and discharged uneventfully at postoperative 35 days with corrected age of 38(+4) weeks with body weight 2,420 g. The antral web should be considered in the case of non-bilious vomiting in neonate.
Body Weight ; Carbamates ; Gastric Outlet Obstruction ; Gestational Age ; Humans ; Infant, Newborn ; Laparotomy ; Milk ; Mucous Membrane ; Organometallic Compounds ; Parturition ; Pylorus ; Stomach ; Twins, Dizygotic ; Vomiting

Antiphospholipid syndrome (APS) is a noninflammatory autoimmune disorder characterized by the association of arterial and/or venous thrombosis, recurrent fetal loss and elevated titres of antiphospholipid antibodies, namely lupus anticoagulant (LAC) and/or anticardiolipin antibodies (aCL). It can either occur as a free-standing condition (primary APS) or be associated with another autoimmune disease (secondary APS), mainly systemic lupus erythematosus. The precise pathogenesis of thrombosis in APS in unknown. For children with unexplainable venous or arterial thrombosis, APS should be considered. The diagnosis of APS in children requires a clinical event including venous or arterial thrombosis or immune thrombocytopenia and a laboratory abnormality including positive LAC test or positive aCL antibody test, moderate or high titer IgG. The laboratory abnormality should persist for at least 2 months. We report a 7-year-old girl who had pulmonary embolism and multiple arterial thrombosis caused by primary APS. The laboratory abnormality was positive LAC and beta2-glycoprotein I. She was treated successfully with low molecualr weight heparin (LMWH). After recovery, she was continuously treated with subcutaneous LMWH for another 3 months and switched to oral warfarin. She was symptom-free through 3 years of follow-up.
Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Autoimmune Diseases ; beta 2-Glycoprotein I ; Child ; Diagnosis ; Female ; Follow-Up Studies ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Immunoglobulin G ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic ; Pulmonary Embolism ; Pulmonary Infarction* ; Thrombocytopenia ; Thromboembolism* ; Thrombosis ; Venous Thrombosis ; Warfarin

Congenital duodenal obstruction is a one of the emergent surgical conditions in neonates. Almost of them were diagnosed with double-bubble sign in prenatal ultrasonography. However, partial obstruction caused from duodenal web could be overlooked. We reported a duodenal web in early childhood. A three-year-old girl visited at our pediatric clinic for constipation. She had been showed non-bilious vomiting after weaning meal since 6 months old of her age, but her weight was relevant for 50-75 percentile of growth curve. Barium enema was initially checked, but any abnormal finding was not found. We noticed the severely distended stomach and 1st portion of duodenum. Upper gastrointestinal series revealed partial obstruction in 2nd portion of duodenum. After laparotomy, we found the transitional zone of duodenum and identified a duodenal web via duodenotomy. We performed duodeno-duodenostomy without any injury of ampulla of Vater. She was recovered uneventfully. During 6 months after operation, she does well without any gastrointestinal symptoms or signs, such as vomiting or constipation.
Ampulla of Vater ; Barium ; Child ; Constipation ; Duodenal Obstruction* ; Duodenum ; Enema ; Female ; Humans ; Infant, Newborn ; Laparotomy ; Meals ; Stomach ; Ultrasonography, Prenatal ; Vomiting ; Weaning

Palpable inguinal mass in children should be differentiated from inguinal hernia, hydrocele, lymph node, and tumor. Though using ultrasonography, fatty tumor would be misdiagnosed as incarcerated inguinal hernia containing fatty component. We experienced the huge inguinal lipoblastoma in 5-year-old girl mimicking recurrent incarcerated hernia. Laparoscopic exploration revealed it was not incarcerated hernia but well demarcated bulging mass from abdominal wall. Mass was about 10x4x3 cm and extended from internal inguinal ring to saphenous opening. It was near total excised because of right external iliac vein injury. Pathologically, it was proven as lipoblastoma containing mature adipocyte with lipoblast and fibrous septa. Postoperatively, we noticed a segmental thrombotic occlusion of external iliac vein. After 1 year, she has no symptom related to occluded vessel. The remained lipoblastoma showed no interval change. Even lipoblastoma has a good prognosis with low recurrence rate, we need careful follow-up.
Abdominal Wall ; Adipocytes ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Hernia ; Hernia, Inguinal* ; Humans ; Iliac Vein ; Inguinal Canal ; Lipoblastoma* ; Lipoma ; Lymph Nodes ; Prognosis ; Recurrence ; Ultrasonography

OBJECTIVES: The aim of this study was to investigate the characteristics of occupational lung cancer. METHODS: We analyzed the characteristics of 53 occupational lung cancer cases among 128 lung cancer cases applied for industrial accident compensation insurance benefits and referred for the decision of work-relatedness between 1999 and 2005. Statistical analysis was conducted using the Chi-square test on 128 lung cancer cases. RESULTS: The age of diagnosis, smoking history, and cell type of lung cancer cases were not significantly different between 53 cases of occupational lung cancer and 75 cases of non-occupational lung cancer (p>.05). Here is a list of occupational lung cancer case numbers associated with certain carcinogens were: 33(62.3%) cases with asbestos, 23(43.4%) cases with polycyclic aromatic hydro carbon (PAH), 17 cases(32.1%) with chromium VI (Oxidation state), 14 cases(26.4%) with crystalline silica, 12 cases (22.6%) with nickel compounds, 2 cases(3.8%) with radon daughters, and 1 case(1.9%) with arsenic. Eighteen cases(34.0%) of occupational lung cancer had exposures to a single carcinogen, and 35 cases (66.0%) had exposures to more than 2 carcinogens. Job types associated with occupational lung cancer cases were: 16 cases(30.2%) with maintenance, 13 cases(24.5%) with welding; 6 cases(11.3%) with grinding; 4 cases(7.5%) with foundry; 3 cases(5.7%) with driving, casting, and painting' and 14 cases (26.4%) with 'other'. CONCLUSIONS: This study identified the characteristics of occupational lung cancer through the analysis of the age of diagnosis, smoking history, cell type, job, and carcinogen. There is no difference between occupational lung cancer and non-occupational lung cancer except exposure to the carcinogens. these results indicate that past exposure to occupational carcinogens remains an important determinant of occupational lung cancer occurrence.
Accidents, Occupational ; Arsenic ; Asbestos ; Carbon ; Carcinogens ; Chromium ; Compensation and Redress ; Crystallins ; Insurance Benefits ; Lung ; Lung Neoplasms ; Nickel ; Occupational Health ; Radon Daughters ; Silicon Dioxide ; Smoke ; Smoking

PURPOSE: Convulsive status epilepticus(SE) is a serious, life-threatening neurological condition that requires immediate treatment to avoid significant morbidity and mortality. Despite improvements in the diagnosis and treatment of SE in the last two decades, SE in young infancy is still associated with high morbidity and mortality. Thus, understanding the varied etiology and clinical presentation and prognosis of SE is very important for improving the methods of evaluation and treatment of this major neurological condition. METHODS: Eighty-eight cases with 53 who have been admitted to the Department of Pediatrics, Fatima Hospital during the period of July, 1992 to June, 1997 were included. We described age distribution, etiologic classification according to age, seizure type, neurologic outcome, recurrence of SE and epileptic seizure. RESULTS: SE was frequent in young infant less than 3 years of age. Major etiology of SE was acute symptomatic(34.1%) and febrile(31.8%). In the seizure type, the majority(92.1%) was generalized convulsive, many cases(69.3%) of SE were first seizures. The neurologic sequelae were found in 15.9% and mortality rate in 5.7%. The neurologic sequelae and mortality were higher in acute symptomatic. In sixty-three follow-up cases, eleven cases were epileptic seizure, eight cases were recurred SE and two cases were recurred febrile SE. CONCLUSION: SE is a life-threatening neurological condition and occurrs mostly in young infants less than 3 years of age. It requires immediate detection of etiology in SE and aggressive treatment for reducing mortality and morbidity rates.
Age Distribution ; Child* ; Classification ; Diagnosis ; Epilepsy ; Follow-Up Studies ; Humans ; Infant ; Mortality ; Pediatrics ; Prognosis ; Recurrence ; Seizures ; Status Epilepticus*

PURPOSE: The purpose of this study was to develop a computer decision making support system that enables nurses to utilize the computer in selecting the best decision for pain management for patients with dementia institutionalized in nursing homes. METHODS: To formulate the protocol for the management of patients' pain, the researcher analyzed content of interviews with 30 nurses in three nursing homes and an expert group. A decision support computer program was formalized based on existing protocols. To evaluate the effectiveness and applicability of the system, analysis of data on patient pain management and nurse satisfaction with the system were done after the formalized decision support computer program was complete. RESULTS: The decision support computer program for pain management for institutionalized patients with dementia was finalized after adjustments following the evaluation. Nurse satisfaction with the program was moderate. It also provided opportunity to reassess thinking about pain and pain management. CONCLUSIONS: The results indicate that this program provides nurses with useful knowledge for pain management in institutionalized patients with dementia and aids in decision making in nursing practice in nursing home.
Decision Making ; Dementia ; Humans ; Nursing Homes ; Pain Management ; Software ; Thinking

Background: Although the orofacial-function improvement exercise (OFIE; oral exercise) was first introduced in Korea 10 years prior, it is still not covered by medical insurance, and no detailed survey on the dissemination of related programs has been conducted. Therefore, this study investigated the actual status of the education and practice of OFIE among the elderly and at elderly welfare institutions in the Seoul and Gyeonggi Provinces. Methods: Senior citizens aged more than 65 years old, public health centers (total of 69) and elderly welfare institutions (including nursing homes and elderly welfare centers, total of 56) per administrative area in the Seoul and Gyeonggi Provinces were targeted. We analyzed 200 elderly people and 93 institutions who agreed to participate in the survey. For the elderly, general characteristics, experience and route, current practice, and necessity regarding OFIE were investigated. For institutions, the history and plan of education programs on OFIE were investigated. Results: Regardless of the general characteristics, both the rate of experience and practice for OFIE were low overall; moreover, although they felt it was necessary, they had insufficient motivation for its implementation. Moreover, only a few institutions which were operating the education about OFIE regardless of the COVID-19 situation. Conclusion Although OFIE is necessary for the elderly, its distribution remains insufficient. Therefore, further efforts are needed to expand the education and raise the awareness of oral exercise among elderly individuals and senior welfare institutions.

BACKGROUND: Unilateral spinal anesthesia prolongs sensory blockade and provides hemodynamic stability. Intrathecal opioids enhance spinal anesthesia without prolonging motor recovery or hemodynamic side effects. The author evaluated the effect of intrathecal fentanyl on unilateral spinal blockade with hyperbaric bupivacaine for knee arthroscopy. METHODS: Thirty-six healthy patients undergoing unilateral knee arthroscopy randomly received unilateral spinal anesthesia with 0.5% hyperbaric bupivacaine 4 mg (Group I) or 0.5% hyperbaric bupivacaine 4 mg combined with fentanyl 10 microgram (Group II). A lateral decubitus position was maintained for 15 minutes after intrathecal injection. The level and duration of sensory and motor blockade were recorded. RESULTS: The regression time of sensory block by two segments on dependent site was prolonged on Group II more than Group I (P < 0.05). There was no significant difference between two groups in recovery time of sensory and motor block. Unilateral sensory block was observed in 18 patients in Group I (100%) and in 2 patients in Group II (11%). Hemodynamic side effects were minimal in both groups, but pruritus was observed in 6 patients in Group II (33%). CONCLUSIONS: Small dose of intrathecal fentanyl with bupivacaine unilateral spinal anesthesia prolonged the duration of sensory block on operated site, but did not increase side effects and the duration of motor block and recovery. But intrathecal fentanyl with bupivacaine made disturbance of successful unilateral spinal block by the sensory block of nonoperated site.
Analgesics, Opioid ; Anesthesia, Spinal* ; Arthroscopy* ; Bupivacaine* ; Fentanyl* ; Hemodynamics ; Humans ; Injections, Spinal ; Knee* ; Pruritus