We report on the application of a venovenous type extracorporeal membrane oxygenator (ECMO) in high-risk tracheal procedures in six cases consisting of five patients with tracheal stenosis. An ECMO should be helpful for preventing respiratory emergency during a tracheal procedure.
Emergencies ; Extracorporeal Circulation ; Extracorporeal Membrane Oxygenation ; Humans ; Membranes ; Oxygenators, Membrane ; Tracheal Stenosis

PURPOSE: Measles is one of the most highly communicable infectious disease, but has become a rare disease with the widespread use of vaccine. Recently, however, resurgence of the disease in school aged or adolescents who had received the vaccine before or at the 15 month warrants reappraisal of the efficacy of the vaccination. The purpose of this study was to investigate positive prevalence of antibody and its quantitative titers in different age groups in order to determine necessity and appropriate time of booster vaccine. METHODS: We measured measles antibody in the sera of 192 children from different age groups(61 cases from 4-6 years of age, 40 cases from 8-9 years of age, 47 cases from 12-13 years of age, 44 cases from 15-16 years of age). Eight to ten children from each group were selected and quantitative antibody titers were measured by EIA(measles Ig G EIA SEIKEN) method. RESULTS: 1) The positive prevalence of measles antibody in four to six year age group(72%) was significantly lower than the expected positive prevalence of measles antibody(95%) (p<0.001). 2) Median antibody titer in twelve to thirteen year age group tended to be relatively lower than the other age groups. 3) There was no significant differences in the positive prevalence of measles antibody and median titers between sex. CONCLUSIONS: This data supported that the booster vaccination be needed at four to six years of age.
Adolescent ; Child ; Communicable Diseases ; Humans ; Measles* ; Prevalence ; Rare Diseases ; Vaccination*

No abstract available.
Pheochromocytoma* ; Renal Artery*

Microcopic polyangiitis (MPA) is a systemic disorder affecting small vessels. In MPA, the central nervous system involvements have rarely been reported. We experienced a case of MPA with subdural effusion and pachymeningitis in a 50-year-old woman. The diagnosis of MPA was made by the presence of mononeuritis multiplex, hematuria, pachymeningitis, and p-ANCA seropositivity in this patient. Subdural effusion was of exudates and an active suppurative inflammation was observed on the dural biopsy.
Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Central Nervous System ; Diagnosis ; Exudates and Transudates ; Female ; Hematuria ; Humans ; Inflammation* ; Meningitis ; Microscopic Polyangiitis* ; Middle Aged ; Mononeuropathies ; Subdural Effusion*

BACKGROUND: To evaluate the role of emergency debridement performed in conjunction with an empirical antibiotic therapy in clinically diagnosed, full-blown Vibrio vulnificus sepsis. METHODS: Immediate surgical debridement was performed on 13 out of 15 patients who were clinically diagnosed as having Vibrio vulnificus sepsis. RESULTS: Among 15 patients Vibrio vulnificus was isolated in 8 patients. Underlying diseases were liver cirrhosis (2), chronic alcohol ingestion or chronic liver disease (10), diabetes mellitus (3), gastrectomy (1) and in 4 cases no underlying condition was identified. All patients had skin lesions such as erythema, bulla, vesicle and gangrene. All but one initially showed variable degree of hypotension, thrombocytopenia, hepatic dysfunction, renal failure and mental confusion. Their mean APACHE III score was 84. Immediate survival (within 48hrs) in clinically diagnosed Vibrio sepsis was 80% (12/15) and long term survival rate among them was 66.6%. Forty-eight hour survival rate in bacteriologically confirmed cases of Vibrio vulnificus sepsis was 75%, where their long-term survival was 62.5%. CONCLUSION: In treating full-blown Vibrio vulnificus sepsis, immediate emergency surgical debridement performed in conjunction with the empirical antibiotics gives a possibility to improve both immediate and long term prognosis of the disease.
Anti-Bacterial Agents* ; APACHE ; Debridement* ; Diabetes Mellitus ; Eating ; Emergencies* ; Erythema ; Gangrene ; Gastrectomy ; Humans ; Hypotension ; Liver Cirrhosis ; Liver Diseases ; Prognosis ; Renal Insufficiency ; Sepsis* ; Skin ; Survival Rate ; Thrombocytopenia ; Vibrio vulnificus ; Vibrio*

BACKGROUND: Despite improved managements for acute respiratory distress syndrome (ARDS), its mortality remains high. Extracorporeal membrane oxygenation (ECMO) has emerged as the final option for the treatment of ARDS unresponsive to conventional measures. This study describes our experiences of venovenous ECMO support for the treatment of ARDS. MATERIALS AND METHODS: Between 2007 and 2010, 56 patients (aged 56.6+/-13.4 years, 43 males) received venovenous ECMO for the treatment of ARDS. The detailed clinical records were retrospectively reviewed. RESULTS: Before the institution of ECMO support, 35 patients (55.4%) required nitric oxide inhalation, 35 patients (55.4%) received continuous renal replacement therapy, and 20 patients (35.7%) were in shock status. The median duration of ECMO support was 164 hours (range, 5 to 1,413 hours). 27 (48%) patients could be successfully weaned from ECMO. Of them, 7 (13%) survived to discharge. On logistic regression analysis, a requirement for higher inspiratory pressure before ECMO support was the only significant factor that could predict ECMO weaning failure. CONCLUSION: The outcome of venovenous ECMO support for the treatment of ARDS was suboptimal. Further improvements in outcomes should be made through the accumulation of experience and establishment of a standardized protocol for the management of ECMO.
Adult ; Extracorporeal Membrane Oxygenation ; Humans ; Inhalation ; Logistic Models ; Nitric Oxide ; Renal Replacement Therapy ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Shock ; Weaning

BACKGROUND: Intravenous recombinant tissue plasminogen activator (r-tPA) infusion is the only established treatment for acute ischemic stroke so far. We explored whether the demonstrated efficacy of r-tPA could be applied to communi-ty-based hospitals in Korea and whether the immediate improvements after r-tPA infusion had any predicting value for long-term outcomes. METHODS:Twenty-six patients (mean age, 69; 46% female) with acute ischemic stroke were treated with r-tPA, abiding by the National Institute of Neurological Disorders and Stroke (NINDS) protocol. The Neurological status was measured with the National Institutes of Health Stroke Scale (NIHSS) at baseline, at 1 hour after r-tPA , at 24 hours, and at 7 days and the functional outcome was evaluated with the modified Rankin scale (mRS) and Barthel Index at 90 days after stroke. RESULTS: Of 26 patients, 16 (62%) made full recovery or became independent, 4 (15%) had severe physical disability, and 6 (23%) patients died. Three patients (11.5%) had intracranial hemorrhage (asymptomatic, 2; symptomatic, 1). There were no significant differences in age, sex, risk factors, baseline NIHSS scores, hemorrhagic complication, initial brain CT abnormalities, and onset to needle time between good (full recovery or mRS 0-2) and poor groups (mRS 3-5 or death) at day 90, except for the improvement of NIHSS examined at 1 hour after r-tPA (repeated measured ANOVA test, p<0.01). CONCLUSIONS The NINDS r-tPA protocol is feasible in the community-based hospitals in Korea with the safety and efficacy comparable to the results of NINDS r-tPA trials. In addition, we suggest that the immediate neurological improvement after r-tPA be a predictor for favorable long-term outcomes. (J Korean Neurol Assoc 19(4):364~369, 2001)
Brain ; Cerebral Infarction ; Humans ; Intracranial Hemorrhages ; Korea ; National Institute of Neurological Disorders and Stroke ; National Institutes of Health (U.S.) ; Needles ; Risk Factors ; Stroke* ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; Treatment Outcome

PURPOSE: The purpose of this study was to assess the frequency of acute rheumatic fever(ARF) among children in Korea and to describe trends in its clinical characteristics compared to data from a previous study(1978-1987). METHODS: A mailed questionnaire survey sent to the pediatric departments of 13 general hospitals in Korea requested the total number of patients with ARF and its clinical manifestations from Jan. 1988 to Dec. 1997. These data were compared with the data from a previous study (1978-1987) to evaluate the clinical trends in occurrence and clinical manifestations of ARF during the last 20 years in Korea. RESULTS: The average number of patients with ARF for the 10-year period(1988-1997) was 0.74 per 1,000 annual pediatric inward patients. There was a significant decrease in incidence during the study period. There were 115 male and 85 female patients with ARF, and 97.5% of total patients were 6 to 15 years old. 126 out of 200 patients(63.0%) had a history of preceding upper respiratory infection(URI). The percentage of major manifestations were as follows; carditis(66.5%),polyarthritis(54.0%), erythema marginatum(12.0%), chorea(7.5%) and subcutaneous nodule (6.0%). Clinical findings of carditiswere cardiac murmur(91.0%), cardiomegaly in chest PA(34.6%), congestive heart failure(15.8%). The electrocardiographic findings were PR interval prolongation (37.6%), right ventricular hypertrophy (RVH) and left ventricular hypertrophy(LVH)(15.8%), QT interval prolongation(13.5%). Doppler echocardiographic valvular lesions were mitral insufficiency(96.2 %), aortic insufficiency(39.8%). Minor and other clinical manifestations were fever(69.0%), arthralgia (56.5%), sore throat(28.5%). CONCLUSION: There was a steady decrease in the number of patients with ARF during the study period from 1988 to 1997. A sudden decrease in number of patients with ARF between the two study periods is likely due to patients with valvular heart disease, possibility of double registration, and wide spread use of echocardiography for accurate diagnosis.
Adolescent ; Arthralgia ; Cardiomegaly ; Child* ; Diagnosis ; Echocardiography ; Electrocardiography ; Erythema ; Estrogens, Conjugated (USP) ; Female ; Heart ; Heart Valve Diseases ; Hospitals, General ; Humans ; Hypertrophy, Right Ventricular ; Incidence ; Korea ; Male ; Postal Service* ; Surveys and Questionnaires* ; Rheumatic Fever* ; Thorax

No abstract available.
Child* ; Humans ; Korea* ; Myocarditis* ; Rheumatic Fever*

PURPOSE: The aim of this study was to investigate the epidemiologic status of Kawasaki disease (KD) in infants < or =6 months of age. METHODS: For the epidemiologic study of KD in Korea, data from 22,674 KD patients were collected from 1997 to 2005 on a 3 -year basis by a retrospective survey. From this survey, data of 1,739 KD patients < or =6 months of age were analyzed and compared with those of KD patients >6 months of age. RESULTS: A total of 1,739 patients < or =6 months of age, including 1,088 males and 651 females, represented 7.7% of total KD patients. These subjects included 22 patients aged <1 month, 171 patients aged 1-2 months, 304 patients aged 2-3 months, 407 patients aged 3-4 months, 372 patients aged 4-5 months, and 463 patients aged 5-6 months. Their mean age of onset was 4.3 months, and the male-to-female ratio was 1.67 :1 . Incidences of coronary arterial (CA) abnormalities (21.0% versus 18.7%) and CA aneurysms (4.7% versus 3.1%) detected by echocardiography showed differences between patients with KD younger and older than 6 months, respectively. CONCLUSION: Comparison of data from KD patients >6 months old with data from 1,739 KD patients < or =6 months old showed significantly higher incidences of CA abnormalities and CA aneurysms in the younger patients.
Age of Onset ; Aged ; Aneurysm ; Coronary Aneurysm ; Echocardiography ; Epidemiologic Studies ; Female ; Humans ; Incidence ; Infant ; Korea ; Male ; Mucocutaneous Lymph Node Syndrome ; Retrospective Studies