Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.
Acute Lung Injury ; Anesthesia* ; Anesthesia, General ; Anoxia ; Blood Gas Analysis ; Extracorporeal Membrane Oxygenation* ; Female ; Gastrointestinal Tract ; Humans ; Incidence ; Intubation, Intratracheal ; Laparoscopy ; Middle Aged ; Mortality ; Pneumonia, Aspiration ; Respiration, Artificial ; Stomach Neoplasms

This study was aimed at investigation of the stimulatory innervations on the rat urinary bladder. Detrusor muscle strips of 15 mm long were suspended in isolated muscle chambers containing 1 ml of PSS maintained at 37℃ and aerated with 95% O²/5% Co². Isometric myography was performed, and the results were as followings: Muscle strips showed “on-contraction” by electric field stimulation (EFS) frequency-dependently. The EFS-induced contraction was not affected by hexamethonium, a ganglion blocker, but abolished by tetrodotoxin, a nerve conduction blocker. Physostigmine, a cholinesterase inhibitor enhanced the EFS-induced contraction which was inhibited by hemicholinium, an inhibitor of choline uptake at the cholinergic nerve ending. Such an EFS-induced contraction was antagonized by atropine only partially, and the atropine-resistant portion was completely abolished by the desensitization of purinergic receptors by prolonged incubating of the strips in the presence of high concentration of ATP. Bethanechol, a cholinergic agonist, elicited concentration-dependent contraction. Adenosine triphosphate (ATP), a purinergic agonist, induced a weak but concentration-dependent contraction of short duration. Bethanechol-induced contraction was not affected by ATP-desensitization, and ATP-induced contraction was not affected by tetrodotoxin. These results suggest that there are at least two main stimulatory components of innervations in the detrusor muscle, cholinergic muscarinic and purinergic; and those receptors are independent each other.
Adenosine Triphosphate ; Animals ; Atropine ; Bethanechol ; Choline ; Cholinergic Agonists ; Cholinesterases ; Ganglion Cysts ; Hemicholinium 3 ; Hexamethonium ; Myography ; Nerve Endings ; Neural Conduction ; Physostigmine ; Rats* ; Receptors, Purinergic ; Tetrodotoxin ; Urinary Bladder*

PURPOSE: The aim of this study was to determine the rate of lymph node (LN) micrometastasis in patients with stage I and II rectal cancer.METHODS: One hundred eighty patients with either stage I or II rectal carcinoma who underwent curative resection between 1995 and 2010 were included. Forty-eight patients received neoadjuvant chemoradiotherapy. Two sections from each LN were stained with hematoxylin and eosin (H&E) and with CK20 by immunohistochemistry (IHC), respectively.RESULTS: A total of 2,257 LNs with a median of 12.5 LNs per patient were examined. For IHC staining, CK20-positive neoplastic cells were found in 4 of the 2,257 LNs (0.2%) from 3 of the 180 patients (1.7%), and all corresponding H&E re-stained sections confirmed that these neoplastic cells were present. Three of four neoplastic cells were micrometastasis, and one was macrometastasis. All occult neoplastic cells were found in 3 of the 85 patients (3.5%) with stage II disease.CONCLUSION: We observed a 3.5% rate of occult neoplastic cells in stage II rectal cancer. Interestingly, the results of IHC staining corresponded with those of H&E re-stained sections, suggesting that the examination of H&E stained section by a competent pathologist may replace IHC staining.
Chemoradiotherapy ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Immunohistochemistry ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Micrometastasis ; Rectal Neoplasms

PURPOSE: To report the results of surgical repairing of inferomedial orbital wall fractures accompanied with loss of bony strut by an overlapping method using Resorb X(R) plates (poly(D,L)-lactic acid). METHODS: To repair inferomedial orbital wall fractures with loss of bony strut, we bent the medial aspect of the plate for floor fracture according to the anatomical structure and then inserted the floor implant, which was supported by anterior, posterior and lateral margins of the floor fracture. Then, the medial implant, which was supported by the bent medial edge of the floor implant, was inserted. Postoperatively, we analyzed the outcomes of 21 patients regarding postoperative enophthalmos, limitation of eye movement (LOM) and diplopia. The diagonal lengths of the orbit in the operated side were compared with the non-traumatized side based on the coronal view of the postoperative CT scans to determine the success or failure of the reconstruction. RESULTS: The average postoperative enophthalmic value was 0.5 mm, and no significant differences between the orbital diagonal lengths of the operated and non-operated eyes were observed. The LOM shown in 7 out of 8 patients was completely resolved during the postoperative follow-up period. All patients with diplopia, including one patient who showed partial remission of LOM, experienced complete symptom resolution. No other complications related to the implant were recorded. CONCLUSIONS: Inferomedial orbital wall fractures with the loss of bony strut can be successfully repaired by the overlapping method using Resorb X(R) implants.
Diplopia ; Enophthalmos ; Eye ; Eye Movements ; Floors and Floorcoverings ; Follow-Up Studies ; Humans ; Orbit ; Orbital Implants

PURPOSE: Vancomycin-resistant enterococci (VRE) are now nosocomial pathogens in Korea. But little is known about the prevalence of stool colonization with VRE in neonates in Korea. So we studied the prevalence and risk factors of VRE colonization in the Neonatal Intensive Care Unit (NICU). METHODS: From January 2000 to December 2004, the medical records of 294 neonates (127 cases of VRE group and 167 cases of non-VRE group, according to the results of stool culture) were reviewed retrospectively. We studied the annual prevalence of VRE and risk factors of VRE colonization in neonates. RESULTS: From 2000 to 2003, the prevalence rate of VRE in NICU increased. After preventing VRE transmission, the prevalence rate of VRE has decreased. CONCLUSION: VRE colonization increased recently. Risk factors of VRE colonization were prematurity, lower birth weight, longer hospitalization and use of vancomycin or 3rd generation cephalosporin, compared with the non-VRE group. To prevent VRE transmission among newborns, aggressive infection control strategies by NICU staffs must be implemented immediately for all babies.
Birth Weight ; Colon* ; Hospitalization ; Humans ; Infant, Newborn* ; Infection Control ; Intensive Care, Neonatal ; Korea ; Medical Records ; Prevalence* ; Retrospective Studies ; Risk Factors* ; Vancomycin

Background/Aims: Constipation is a common gastrointestinal disorder. Prucalopride is a dihydrobenzofurancarboxamide derivative with gastrointestinal prokinetic activities and is recommended as an appropriate choice in patients unresponsive to laxatives. This study assessed the safety and efficacy of prucalopride in Korean patients with chronic constipation, in whom laxatives were ineffective. Methods: This prospective, non-interventional post-marketing surveillance of prucalopride was conducted from 2012 to 2018 at 28 hospitals in Korea. Adults who received prucalopride for the symptomatic treatment of chronic constipation were included. The patients received 2 mg of prucalopride once daily or 1 mg once daily in patients older than 65 years. The baseline characteristics, adverse events (AEs), and seven-point scale of Clinical Global Impression-Improvement were collected. Results: Of 601 patients, 67.7% were female, and the mean age was 62.3 years. Three hundred patients (49.9%) were older than 65 years. At the baseline, 70.0% of patients reported less than two instances of spontaneous complete bowel movements per week. AEs were reported in 107 patients (17.7%), including headache (3.2%) and diarrhea (2.8%). Seven serious AEs (SAEs) were reported in five patients (0.8%). The SAEs were resolved without complications; there were no cases of death. All SAEs were assessed as ‘unlikely’ causality with prucalopride. In 72.7% of patients, chronic constipation was improved by the prucalopride treatment during the study period. Conclusions This study demonstrated the promising safety and efficacy profile of prucalopride in clinical practice. Thus, prucalopride should be considered in patients with chronic constipation when bowel symptoms are refractory to simple laxatives.

One of the most important adverse effects of a tumor necrosis factor (TNF)-alpha inhibitor is the reactivation of tuberculosis. Most of them occur in the lung, but sometimes they can be found in other organs. Moreover, the proper management of active rheumatoid arthritis (RA) in patients with anti-TNF-alpha associated tuberculosis is still in debate. We present the case of a seropositive RA patient who showed good response with rituximab, an anti-CD20 monoclonal antibody, after developing splenic tuberuculosis, following treatment with TNF-alpha inhibitor. Confirming a diagnosis of splenic tuberculosis is difficult and can be delayed due to its nonspecific symptoms and rare occurrence. This case suggests that splenic tuberculosis should be doubted in RA patients treated with TNF-alpha inhibitor, and that rituximab may be considered as an alternative treatment option in RA patients with anti-TNF-alpha associated tuberculosis.
Antibodies, Monoclonal, Murine-Derived ; Arthritis, Rheumatoid ; Humans ; Lung ; Tuberculosis ; Tuberculosis, Splenic ; Tumor Necrosis Factor-alpha ; Rituximab

A healthy 34-year-old man was admitted to the intensive care unit through the emergency room with a drowsy mentality and severe chilling. Following a diagnosis of septic shock of unknown origin, the patient was treated with broad spectrum antibiotics and massive hydration. After recovery of consciousness, he complained of a severe toothache that originated from the right lower teeth. Under dental consultation, he was diagnosed as having an acute periapical abscess of the right mandibular first molar. The patient underwent extraction and cyst enucleation. Gram negative bacilli isolated from blood culture on day 5 after admission were identified as Prevotella species. After receiving antibiotic treatment and undergoing dental procedures, the patient made a full recovery. We report on a case of septic shock due to infection by Prevotella species in association with an acute periapical abscess.
Adult ; Anti-Bacterial Agents ; Consciousness ; Emergencies ; Humans ; Intensive Care Units ; Molar ; Periapical Abscess ; Prevotella ; Shock, Septic ; Tooth ; Toothache

PURPOSE: The aim of this study was to identify the predictive factors in the early laboratory findings for cardiac sequelae in Kawasaki disease(KD). METHODES: A retrospective review of the records was conducted of all children with KD who were admitted to the Ulsan Dongkang General Hospital, Masan Samsung Hospital, and Gyeongsang National University Hospital between January 1995 and December 1999. We analyzed and compared the early laboratory findings between the patients with and without coronary artery dilatation. RESULTS: A total of 981 patients were divided into two groups : 826 patients(84.3%) with normal coronary artery and 155 patients(15.7%) with coronary artery dilatation. Age and sex were not significantly different between the two groups. The mean serum C-reactive protein(CRP) in the coronary artery dilatation group and in the normal coronary artery group were 5.0 mg/dl(+/-5.3) and 4.1 mg/dl(+/-5.0), respectively, with a significant difference(P<0.05), whereas the other early laboratory findings had no difference between the groups. CONCLUSION: This study shows that the early serum CRP was higher in patients with KD who had coronary artery dilatation than in those with normal coronary artery. There may be a strong possibility of cardiac sequelae at a high level of serum CRP. However, the cut-off value of serum CRP could not be determined for the prediction of cardiac sequelae in patients with KD.
Child ; Coronary Vessels ; Dilatation ; Hospitals, General ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies ; Staphylococcal Protein A* ; Ulsan

OBJECTIVE: The purpose of this study is to see whether the incidence of RDS (respiratory distress syndrome) in premature twin is higher than in premature singleton, and to see the clinical difference between the groups. METHODS: Seventy seven premature twins with respiratory distress syndrome who admitted to the department of Pediatrics, Catholic University Medical Center and Chonnam University Hospital for 5 years from Jan. 1998 to Dec. 2002 were enrolled. They were classified with group A in which both of twins have RDS (A1=25, A2=25), group B1 (B1=14) in which first twin has the RDS and group B2 (B2=13) in which second twin has the RDS. Incidence rate of RDS, birth order, gender, delivery mode, gestational week, birth weight, Apgar score, use of surfactant, and mortality rate between groups were also compared. RESULTS: Premature twins have higher incidence of RDS than premature singletons. The RDS is more often than in female. The average gestational week was 30.5 in A, 32.6 in B1, 32.1 in B2, and the average birth weight (gm) was 1,470 (A1), 1,464 (A2), 1,803 (B1), 1,687 (B2). Gender, delivery mode, Apgar score at 1 minute and 5 minute, use of surfactant, and mortality rate and morbidity showed no significant difference. CONCLUSION: Premature twins are more prevalent to RDS than premature singletons. The second twin don't likely to have the RDS than the first baby, but the special care is required because their mortality rate and morbidity were more or less higher.
Academic Medical Centers ; Apgar Score ; Birth Order ; Birth Weight ; Female ; Humans ; Incidence ; Jeollanam-do ; Mortality ; Pediatrics ; Twins*