Background: Post-dural puncture headache (PDPH) is one of the well-known complication of spinal anesthesia. Epidural blood patch is the treatment of choice for PDPH but is rarely used for the prevention of PDPH after spinal anesthesia. The purpose of this study is to observe the effectiveness of epidural blood patch for prevention of PDPH and to evaluate the complications after epidural blood injection. Methods: Three hundred patients (ASA I or II) receiving spinal anesthesia were studied. They were randomly devided into two groups. Patients in Group I, the control group, were maintained in a supine position for 24 hour after spinal anesthesia. Patients in Group II, the study group, received 3 ml of autologous blood in the epidural space after spinal anesthesia. PDPH was evaluated for 5 days. The incidence, location, onset, and duration of headache in the patients presenting with PDPH were measured for 5 days, and the complications following epidural blood patch in Group II were observed for 2 weeks. Results: The incidence of PDPH in group I was 11%, but 0% in group II. There were no specific complications following epidural blood patch in Group II. Conclusions: This study suggest that the 3 ml epidural autologous blood patch is an useful method for the prevention of PDPH in patients with spinal anesthesia.
Anesthesia, Spinal* ; Blood Patch, Epidural ; Epidural Space ; Headache ; Humans ; Incidence ; Post-Dural Puncture Headache ; Punctures* ; Supine Position

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major cause of nosocomial infection and a molecular typing is necessary for proper epidemiologic investigations of sources and moles of spread in an outbreak. An nosocomial outbreak of MRSA in a neonatal intensive care unit at Ewha Womans University Mokdong Hospital was suspected. To investigate the clonality of isolates and control the spread of nosocomial outbreak, we performed plasmid restriction analysis of MRSA isolates from patients and medical staffs. METHODS: We studied 7 MRSA strains (umbilicus 4, blood 1, urine 1 and pus 1) from patients in a neonatal intensive care unit and the MRSA strains from nares and hands surveillance cultures of 26 medical staffs (4 medical doctors and 22 nurses). All MRSA strains were tested for antimicrobial susceptibility and plasmic analysis after EcoRI restriction. We analyzed the plasmid patterns of MRSA isolated from patients and compared with those from medical staffs. RESULTS: Ten MRSA strains (from 7 nares and 3 hands) were isolated from surveillance cultures of 26 medical staffs. Seven out of 10 MRSA strains from medical staffs revealed identical pattern of antibiogram which was the same pattern in all 7 MRSA strains from seven patients. Plasmid restriction patterns were classified 6 groups from A to F showing 2-10 bands. Six out of 7 MRSA strains from the patients showed group A(A1 5, A31) and 5 out of 10 MRSA strains from the medical staffs showed group A(A1 1, A21, A32, A41) and remainders showed different plasmid restriction analysis patterns. CONCLUSIONS: These results suggest that plasmid restriction analysis is a rapid, inexpensive, and good discriminating molecular typing of MRSA outbreak and is useful for the epidemiologic investigation of MRSA outbreaks in the clinical laboratory.
Cross Infection ; Disease Outbreaks ; Female ; Hand ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Staff ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Microbial Sensitivity Tests ; Molecular Epidemiology* ; Molecular Typing ; Plasmids* ; Suppuration

PURPOSE: The purpose of this study is to examine how well patients who had hip arthroplasty comply with medical regimens given to them after the operation. METHOD: The subjects of the study were patients who had arthroplasty at P Hospital between April 1. 2001 and August 30, 2002. 20 patients of the subjects experienced complications after the operation and the other 20 did not. Data from a survey using the qustionnaire were statistically analyzed in terms of real number, percentage point, mean and standard deviation by using chi2test. t-test and ANOVA. RESULT: 1) the surveyed patients were significantly different in the compliance of medical regimen among them according to their education background as one of the subjects general characteristics. 2) It was found that the group of complication was higher in the compliance of medical regimen than that of non-complication. The two groups showed statistically significant difference with each other in the degree of compliance with therapeutic instructions than the experimental group in terms of the maintenance of abduction after the operation, training instructions on step-by-step basis, urination cotrol on bed, accurate use of crutch, compliance with medication, balance among medical treatment, training, leisure, rest and nutrition. instructions by physicians, nurses and physical therapists, use of low armchairs and toilet bowels and no bending of the body forward, and use of a non-operated leg in case of go upstairs or downstairs. CONCLUSION: It seems necessary to develop systematic and sessional education programs for improving the compliance of medical regimen. ultimately reducing complications following hip arthroplasty.
Arthroplasty* ; Compliance ; Education ; Hip* ; Humans ; Leg ; Leisure Activities ; Patient Compliance* ; Physical Therapists ; Urination

No abstract available.
Neuroblastoma*

A 35 years old female patient was admitted to our neuro-pain clinic with symptoms of low back pain(L4, L5 level) radiated to both lower(L3, L4, L5 level) extremities that developed 6 years prior to admission. Upon initial physical examination, motor weakness or sensory deficit was absent. But on straight leg raising test, it was restricted to 60 degree in both lower extremities. Low back pain and radiating pain improved significantly after we performed epidural steroid injection. However on the next day of procedure the patient complaints more pain and started to experience severe pain during overnight for 3 days. On computer tomography(CT, L3-S1 level), we find suspicious lesion of herniated nucleus pulposus at L5-S1. Otherwise were within normal limits. Based on these symptoms, to find the other lesions, subsequently magnetic resonance imaging(MRI) was performed. Spinal tumor was seen at L2-3 level(2 2 4 cm). Neurosurgical surgery was recommended, and operation was performed. The patient was diagnosed to ependymoma after excision and cytologic studies. Even if one lesion was diagnosed, it must be put off until any other diseases or underlying cancer are ruled out. We report a patient with spinal cord tumor missed on CT, but revealed on MRI in the evaluation and management of herniated nucleus pulposus related(L5-S1) low back pain.
Adult ; Ependymoma ; Extremities ; Female ; Humans ; Leg ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Imaging ; Physical Examination ; Spinal Cord Neoplasms* ; Spinal Cord*

BACKGROUND: It is clinically important to know the distance of upper airway for airway management and respiratory care. The knowledge is useful for avoiding many possible complications due to endotracheal intubation by appropriate choice of endotracheal tube depth. METHODS: We investigated the distance from nose to carina according to the patient,s age, weight, height, sex with computed Tomography in 100 adults who had no anatomical abnormality of the upper airway, neck and head. RESULT: The length between upper incisor and vocal cord was 15.0+/-0.8 cm in male and 13.9+/-0.6 cm in female. The length between vocal cord and carina was 13.2+/-0.8 cm in male and 11.9+/-0.9 cm in female. The length between upper incisor and carina was 28.3 0.9 cm in male and 25.9+/-1.2 cm in female. The length between nose and vocal cord was 17.7+/-0.9 cm in male and 15.9+/-0.8 cm in female. The length between nose and carina was 30.9+/-1.2 cm in male and 27.9+/-1.3 cm in female. The distance of upper airway increased according to patient, s (n=100) height, weight and age(p<0.05). The distance of upper airway not increased according to female patient, s (n=36) age(p>0.05). CONCLUSION: The length between vocal cord and carina, nose and carina, incisor and carina increased according to patient, s (n=100) height, weight and age.
Adult ; Airway Management ; Female ; Head ; Humans ; Incisor ; Intubation, Intratracheal ; Male ; Neck ; Nose ; Vocal Cords

Retrograde intubation has been often used in the patient who reveal difficulty intubation. But, it is time consuming procedure and the patient may be fall into hypoxemia. We have experienced a successful retrograde nasotracheal intubation without hypoxemia by using the Laryngeal Mask Airway. After induction of inhalation anesthesia, ordinary endotracheal intubation was failed in this 45-year-old male patient who was planned to clip the cerebral aneurysm, because the epiglottis could not be seen under direct laryngoscopy. We decided to perform retrograde nasotracheal intubation. Face mask was replaced with Laryngeal Mask Airway and ventilation was continued during procedure. A 18-gauge Tuohy needle was introduced through the cricothyroid membrane and then the epidural catheter was passed cephalad to larynx, distal hole of Laryngeal Mask Airway, and the end of Laryngeal Mask Airway. A 16-F Levin tube was introduced through right nasal cavity and Laryngeal Mask Airway was removed, the Levin tube was tied with epidural catheter in the oral cavity. The epidural catheter was placed from cricothyroid membrane to right nares. The endotracheal intubation was performed successfully by sliding over the catheter. In the postoperative evaluation, significant complications were not detected. The procedure was performed in about 2 minutes and the apneic time was less than 30 seconds. We believe that this procedure may be useful in the patients who may suffer from hypoxemia.
Anesthesia, Inhalation ; Anoxia ; Catheters ; Epiglottis ; Humans ; Intracranial Aneurysm ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopy ; Larynx ; Male ; Masks ; Membranes ; Middle Aged ; Mouth ; Nasal Cavity ; Needles ; Ventilation

PURPOSE: The purpose of this study was to develop a home care nursing network system for operating home care effectively and efficiently by utilizing a wire-wireless network and mobile computing in order to record and send patients' data in real time, and by combining the headquarter office and the local offices with home care nurses over the Internet. It complements the preceding research from1999 by adding home care nursing standard guidelines and upgrading the PDA program. METHOD: Method/1 and Prototyping were adopted to develop the main network system. RESULT: The detailed research process is as follows : 1)home care nursing standard guidelines for Diabetes, cancer and peritoneal-dialysis were added in 12 domains of nursing problem fields with nursing assessment/intervention algorithms. 2) complementing the PDA program was done by omitting and integrating the home care nursing algorhythm path which is unnecessary and duplicated. Also, upgrading the PDA system was done by utilizing the machinery and tools where the PDA and the data transmission modem are integrated, CDMX-1X base construction, in order to reduce a transmission error or transmission failure.
*Computer Communication Networks ; *Home Care Services ; Humans ; *Information Systems ; *Nursing Care

Objective: The primary objective of this study was to predict subgroups of autism spectrum disorder (ASD) based on the Diagnostic Statistical Manual for Mental Disorders-IV Text Revision (DSM-IV-TR) by machine learning (ML). The secondary objective was to set up a ranking of Autism Diagnostic Interview-Revised (ADI-R) diagnostic algorithm items based on ML, and to confirm whether ML can sufficiently predict the diagnosis with these minimum items. Methods: In the first experiment, a multiclass decision forest algorithm was applied, and the diagnostic algorithm score value of 1,269 Korean ADI-R test data was used for prediction. In the second experiment, we used 539 Korean ADI-R case data (over 48 months with verbal language) to apply mutual information to rank items used in the ADI diagnostic algorithm. Results: In the first experiment, the results of predicting in the case of pervasive developmental disorder not otherwise specified as “ASD” were almost three times higher than predicting it as “No diagnosis.” In the second experiment, the top 10 ranking items of ADI-R were mainly related to the quality abnormality of communication. Conclusion In conclusion, we verified the applicability of ML in diagnosis and found that the application of artificial intelligence for rapid diagnosis or screening of ASD patients may be useful.

Cor triatriatum is a rare cardiac malformation in which the left atrium is subdivided into two chambers by a fibromuscular septum, one locates posterosuperiorly, which is connects with the pulmonary veins, and the other locates anteroinferiorly connecting with the mitral valves and left ventricie. It is often lethal in children with cor triatriatum due to congestive heart faliure which develops abruptly and rapidly. So, the most important thing is early detection of the disease. We experienced a case of cor triatriatum in 20 month-old female. She had severe symptoms related to congestive heart faliure, and the conditions showed dangerous. Echocardiography was used for correct diagnosis. The patients was improved dramatically after proper surgery. So, We reported this case and review literatures briefly.
Child ; Cor Triatriatum* ; Diagnosis ; Echocardiography ; Estrogens, Conjugated (USP) ; Female ; Heart ; Heart Atria ; Heart Septal Defects, Atrial* ; Humans ; Infant ; Mitral Valve ; Pulmonary Veins