PURPOSE: This study was aimed to evaluate the effect of time of surgery for acute appendicitis on surgical outcomes to optimize the timing of appendectomies. METHODS: Medical records of patients who underwent an appendectomy were reviewed to obtain data on time of symptom onset, time of hospital presentation, and start times of surgery. Surgical findings were used to define appendicitis as either uncomplicated or complicated. The uncomplicated group included patients with simple, focal, or suppurative appendicitis, and the complicated group included patients with gangrenous, perforated appendicitis or periappendiceal abscess formation. The 2 groups were analyzed by age, sex, and time. RESULTS: A total of 192 patients were analyzed. The mean time from symptom onset to start of operation showed a significant difference between both groups (1,652.9 minutes vs. 3,383.8 minutes, P < 0.001). The mean time from hospital visit to start of operation showed no difference between both groups (398.7 minutes vs. 402.0 minutes, P = 0.895). Operating within 24 hours of symptom onset had a relative risk of 1.738 (95% confidence interval, 1.319-2.425) for complications. Operating more than 36 hours after symptom onset was associated with an increased risk of postoperative ileus and a longer hospital stay. CONCLUSION: Complicated appendicitis is associated with a delay in surgery from symptom onset rather than a delay at hospital arrival. Surgeons should take into account the time from symptom onset when deciding on the timing of appendectomy. We recommend that appendectomy be performed within 36 hours from symptom onset.
Abscess ; Appendectomy ; Appendicitis* ; Humans ; Ileus ; Length of Stay ; Medical Records ; Surgeons ; Treatment Outcome

Prader-Willi syndrome(PWS) was first described by Prader et al in 1956. This syndrome is characterized by diminished fetal activity, low birth weight, infantile hypotonia with feeding problem, temperature instability, early onset of childhood hyperphagia with consequent obesity, short stature, hypogonadism and mental retardation. The deletion of chromosome 15(del 15(qll-13)) was reported by Ledbetter in 1981, which was thought to be of paternal origin. Recently, such micro- deletion may be diagnosed by fluorescence in situ hybridization(FISH) that recognizes specific DNA base sequence. We experienced a Prader-Willi syndrome confirmed by FISH in an infant that had hypotonia, growth retardation, feeding difficulty and FUO since 1 month of age. We report this case with a brief review and related literature.
Base Sequence ; DNA ; Fetal Movement ; Fluorescence ; Humans ; Hyperphagia ; Hypogonadism ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intellectual Disability ; Muscle Hypotonia ; Obesity ; Prader-Willi Syndrome*

Fryns syndrome is a lethal syndrome of multiple congenital anomalies first described by Fryns et al in 1979. A recently developed major diagnostic criteria includes abnormal face, small thorax with widely spaced hypoplastic nipples, distal limb and nail hypoplasia, lung hypoplasia with diaphragmatic hernia, central nervous system anomalies and congenital heart disease. The pathogenesis of Fryns syndrome is not clear. Of the major immediate life-threatening abnormalities of this syndrome, lung hypoplasia associated with diaphragmatic hemia has usually proven to be fatal. We report a case of Fryns syndrome, which has the prenatal ultrasonographic findings of Dandy-Walker malformation and renal hypoplasia.
Central Nervous System ; Dandy-Walker Syndrome ; Extremities ; Heart Defects, Congenital ; Hernia, Diaphragmatic ; Lung ; Nipples ; Thorax

No abstract available.
Cervix Uteri* ; Female ; Pregnancy*

No abstract available.
Cystectomy* ; Quality of Life* ; Urinary Diversion*

BACKGROUND: A mixture of local anesthetics such as lidocaine and bupivacaine has frequently been used in clinical practice. The rationale behind this is to take advantage of lidocaine's rapid onset and bupivacaine's perpetuation in anesthesia. The purpose of this study was to examine the changes in the onset and recovery of nerve blocking action exerted by the different combinations of these two in the mixture. METHODS: Isolated sciatic nerve preparations obtained from adult male Sprague-Dawley rats were used in this study. Recordings of A-fiber compound action potentials (A-CAPs) were made at the end of the isolated nerve while single pulse stimuli (0.5 msec, supramaximal intensity, 2 Hz) were applied to the opposite end of the nerve. Seven different composition of lidocaine-bupivacaine mixtures were prepared (0 : 6, 1 : 5, 2 : 4, 3 : 3, 4 : 2, 5 : 1, 6 : 0 vol./vol.), where basal concentrations of lidocaine and bupivacaine were 0.2% and 0.05%, respectively. Amplitudes of A-CAPs were measured before, during and after perfusion of mixture solution. The time needed for A-CAPs amplitude to decrease to 10% of the basal value after starting perfusion (onset time) and that needed to reach to 50% of the basal value after ceasing the perfusion (recovery time) were measured. RESULTS: With increasing concentration ratios of lidocaine to bupivacaine in the mixture as mentioned above, the following onset and recovery times were obtained (6.0 +/- 0.3, 5.6 +/- 0.3, 6.0 +/- 0.5, 8.3 +/- 0.5, 7.3 +/- 0.6, 7.8 +/- 0.3, and 10.8 +/- 0.8, minutes; 38 +/- 4, 63 +/- 12, 87 +/- 19, 100 +/- 13, 104 +/- 18, 137 +/- 27, and 157 +/- 18 minutes, respectively). CONCLUSION: Onset times were, in general, exponentially decreased with the increase in the lidocaine concentration. However, recovery times were lineary increased with the increase in the bupivacaine concentration. So, it should be kept in mind that rapid onset can only be obtained with the expense of substantial reduction in the duration of local anesthetic effect of the mixture, and vice versa.
Action Potentials ; Adult ; Anesthesia ; Anesthetics ; Anesthetics, Local ; Bupivacaine ; Humans ; Lidocaine ; Male ; Nerve Block ; Neural Conduction* ; Perfusion ; Rats, Sprague-Dawley ; Sciatic Nerve

Nocardiosis is a rare infection seen most commonly in immunocompromized patients. Most patients have pulmonary involvement, but some develop disseminated infection. A 52-year-old man, treated with immunosuppressive drugs for 3 months after kidney transplantation, developed pulmonary nocardiosis and disseminated infection involving brain, skin, and both uvea. The diagnosis was made by open lung biopsy specimens showing characteristic weak acid fastness with modified Ziel-Neelsen stainig and histologic examination. Immunosuppressive therapy was continued and combination of surgical drainage of brain abscess and chemotherapy with Minocycline were successful. With the increasing number of allograft recipients and concomitant immunosuppression, the possibility of an increase in Nocardia opportunistic infections exists.
Allografts ; Biopsy ; Brain ; Brain Abscess ; Diagnosis ; Drainage ; Drug Therapy ; Humans ; Immunosuppression ; Kidney Transplantation ; Kidney* ; Lung ; Middle Aged ; Minocycline ; Nocardia ; Nocardia Infections* ; Opportunistic Infections ; Skin ; Transplantation* ; Uvea

Authors have recently experienced a rare case of avulsion of the left eye ball due to ocular injury in 7 years old Korean girl. The eye ball was completely exposed out of the lid margin. In this case authors supposed that the dynamic inertia was played a major role in the mechanism of avulsion of this eye ball. A breief review of other literatures has also been described.
Child ; Female ; Humans

No abstract available.
Cardiac Catheterization* ; Cardiac Catheters* ; Child* ; Cineangiography* ; Heart Diseases* ; Heart* ; Humans ; Statistics as Topic*

The variable clinical responses seen with rnost cancer immunotherapy suggests that there is a large interindividual variation in immunoiogic response to tumors. One of the key functional parameter.s of an immune response is the loca1 production of cytokines. These multifunctional cytokines have been implicated in growth stimulation and cytotoxicity of ovarian tumor celle. To determine the presence and quantities of cytokines in ovarian cancer tissue, the cons-titutive expression of cytokine mRNA in biopsies from epithelial ovarian carcinomas was determined by using a PCR-assisted mRNA amplification asssy(RT-PCR). Using a set of cytokine-specific primers for 14 different cytokines, distinctive patterns of cytokine gene expression between normal and malignant ovarian tissues could be found. Several cytokines were detected even in the norma1 ovarian tissue including IL-1A, IL-8, TGF-A, TGF-B, GM-CSF, and IL,-2R. In case of the ovarian cancer, the signals were more intense than normal and we could detect the expression of some other cytokines, such as IL-1B, IL- 4, IL-6, IL-l0, TNF, and INF-T, which could not be detected in normal tissue. The presence of eytokines in ovarian cancer tissue could be impartant in the growth and development of cancer, more specifically, in relation to host immune responsiveness.
Biopsy ; Cytokines ; Gene Expression* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Growth and Development ; Immunotherapy ; Interleukin-6 ; Interleukin-8 ; Ovarian Neoplasms* ; RNA, Messenger