Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective resuscitative modality to temporize noncompressible truncal hemorrhage. Confirming the proper position of the balloon catheter in the target aortic zone is vital. Currently, there is a need for nonradiographical methods. This would overcome the drawbacks of conventional imaging modalities, such as fluoroscopy. Several studies have suggested ultrasound-guided visualization via subxiphoid, transperitoneal, or transesophageal views as an alternative to conventional imaging methods. However, such views are easily obscured in emergency settings. Herein, we report the case of a 70-year-old patient who was successfully resuscitated by REBOA under the guidance of transsplenic ultrasound. REBOA was safely performed using transsplenic visualization without fluoroscopy.

BACKGROUND: Although a history of febrile convulsion (FC) is common in epilepsy patients, the preferential associa-tion of febrile convulsion with temporal lobe epilepsy (TLE) is not clear. METHODS:We obtained the FC data from "Paik and Bongsang hospital" epilepsy clinic. We classified epilepsy syndromes into generalized epilepsy (GE), temporal lobe epilepsy (TLE), extratemporal epilepsy (ETLE), unclassified partial and undetermined epilepsy by standardized criteria. The incidence of antecedent FC was evaluated in relation to the epilepsy classifications. We calculated kappa values for inter and intra observer reliability for the classifications of epilepsy syndromes. RESULTS: The agreement of epilepsy classifications were reliable (intra-observer kappa value=0.78, inter-observer kappa value=0.77). Thirteen percent of the studied patients (72/537) had a history of FC and 38% of FC (27/72) were complex types of FC. TLE was more likely to be preceded by FC 25% (42/166) than ETLE 6% (12/189), p<0.05 or GE 13% (12/93), p<0.05 and 85% of complex FC (23/27) preceded TLE. GE however, was more likely to have non-complex FC 100% (12/12) than partial epilepsy 55% (32/58), p<0.05. CONCLUSIONS We therefore conclude and agree that FC should be preferentially associated with TLE.
Classification ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Generalized ; Epilepsy, Temporal Lobe* ; Humans ; Incidence ; Seizures, Febrile* ; Temporal Lobe*

PURPOSE: Laparoscopic totally extraperitoneal (TEP) hernia repair is known to be relatively difficult in cases with a history of lower abdominal surgery. We assess the feasibility of laparoscopic TEP hernia repair in those patients. METHODS: Thirty five patients with a previous history of radical prostatectomy or lower abdominal surgery who underwent laparoscopic TEP hernia repair for inguinal hernia were reviewed retrospectively. All operations were performed by a single experienced surgeon. RESULTS: Thirty three out of the 35 patients (94%) were men. Laparoscopic TEP hernia repair was performed successfully in 30 out of 35 cases. Twenty five cases (71%) were right inguinal hernia, 6 cases (17%) were left hernias, and 4 cases (11%) had an inguinal hernia on both sides. Five cases were converted to transabdominal preperitoneal (TAPP) (n=3) or open methods (n=2). Mean operation time was 111 minutes. The patient group with previous radical prostatectomy was the largest (n=22, 63%) and required a longer operation time (124 minutes). Blood loss was less than 50 cc in all cases. Average hospital stay was 1.2 days after surgery. Voiding difficulties requiring catheterization were observed in 13 cases (37%). CONCLUSION: Laparoscopic TEP hernia repair for a patient with previous history of radical prostatectomy or lower abdominal surgery except for appendectomy can be safely performed by an experienced surgeon, but is not recommended as a standard choice because of a longer operation time and higher conversion rate.
Appendectomy* ; Catheterization ; Catheters ; Hernia* ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Laparoscopy ; Length of Stay ; Male ; Prostatectomy* ; Retrospective Studies

BACKGROUND AND OBJECTIVES: This study aims to investigate the development of open-set speech perception abilities in children who received cochlear implantation at older age and to examine the preoperative variables contributing to the postoperative speech perception outcomes. SUBJECTS AND METHOD: Open-set speech perception abilities were assessed with the Monosyllabic Word and Common Phrases Tests for 37 prelingually deafened children who received implantation between the ages of 7 and 17 years. Their performance was compared to that of 60 children who received implantation before 7 years of age. To identify the factors contributing to the postoperative open-set speech perception abilities, we analyzed age at hearing aid fitting, age at implantation, duration of implant use, preoperative language and speech perception abilities, and pure tone thresholds in the better ear. RESULTS: The children who received implantation after 7 years of age significantly improved during the first year of implant use, but reached a plateau by 1.5 to 2 years after implantation, reaching scores between 60% and 70%. Children who received implantation after age 7 showed higher speech perception scores than the younger children over the first year of implant use, but showed lower scores than the younger children after 2-3 years of implant use. The variables associated with the postoperative open-set speech perception abilities were speech perception ability, language ability, and hearing levels before implantation. CONCLUSION: Prelingually deafened children who received implantation at older age can obtain substantial open-set speech perception understanding, but tended to reach a plateau between 1.5-2 years after implantation. Speech perception, language abilities, and hearing level before implantation contribute to the outcome.
Child ; Cochlear Implantation ; Cochlear Implants ; Hearing ; Hearing Aids ; Humans ; Language ; Speech Perception

Purpose: This study aimed to determine the correlation between various clinical results, including recurrence in patients with breast cancer, and preoperative blood composition ratio and postoperative pathological results. Methods: A total of 444 patients who underwent surgery were included, and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and postoperative pathological results were classified into postoperative cancer stages to confirm the association with various clinical results, including recurrence. Results: The median age of the patients was 51 years. The stages were divided into 1, 2, 3, and 4. Additionally, stages 1 and 2 comprised one group and stages 3 and 4 comprised another group. The cut-off values of the NLR, PLR, and MLR were confirmed to be 1.43, 158.84, and 0.21, respectively. It was noted that the association with recurrence was higher in the group with hormone receptor negative (p<0.001), higher stage (p<0.001), and underwent neoadjuvant chemotherapy (p<0.001). In the association with blood composition ratio and recurrence, survival was high in the PLR group with a high cut-off value (p=0.004). There was no significant relationship in the NLR and MLR groups. In the disease-free survival and overall-survival curves, only the PLR group showed a significant association of 0.003 and 0.001, respectively. The NLR and MLR groups did not show any significant result. Conclusion No significant association with recurrence and mortality was confirmed in the NLR and MLR groups. However, the preoperative blood test in the high PLR group showed recurrence and mortality rate were high.

Purpose: Breast cancer is the most common cancer in Korean women and the number of cases is increasing. We have found various histopathological differences in breast cancer and are using this knowledge for treatment. Various factors may help determine the progression of cancer in patients. The expression of lymphovascular invasion, a pathologic factor, denotes a poor prognosis. We analyzed the characteristics of patients showing lymphatic invasion. Methods: Data from 606 patients with breast cancer who underwent surgery between 2006 and 2016 were collected. We analyzed various pathologic factors in patients with or without lymphatic invasion expression. Results: Mean age was 52.0±11.2 years (range 29-83 years) and mean follow-up duration was 57.3 months (range 3−125 months). Pathologically, breast cancer types were invasive ductal carcinoma (552, 91.2%), invasive lobular carcinoma (21, 3.4%), and other pathologies (33, 5.4%). Number of patients in stages I, II, III, and IV were 299 (49.3%), 223 (36.8%), 82 (13.7%), and 2 (0.02%), respectively. Immunohistochemistry revealed 396 (65.3%) estrogen receptor (ER)-positive cases, 287 (47.3%) progesterone receptor (PR)-positive cases, and 139 (22.9%) human epidermal growth factor receptor 2 (HER2)-positive cases. Seven patients had local recurrence and 41 patients had distant metastasis, which included 14 bone, 7 lung, 5 liver, and 15 multiple metastases. Seventeen patients showed lymphatic invasion, while 24 patients were without lymphatic invasion. Significant association was observed between T and N stages and lymphatic invasion (p<0.001). No significant correlation was observed between lymphatic invasion and ER (p=0.073), HER2 (p=0.553). However, there was a significant correlation between lymphatic invasion and PR (p=0.044). Overall survival and disease free survival rates were significantly worse in the presence of lymphatic invasion (p<0.01, 0.011, respectively). Conclusion Lymphatic invasion was associated with T and N stages, overall survival and disease free survival. More careful observation and treatment strategy is needed, especially in locally advanced breast cancer.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease in South Korea with clinical features similar to those of scrub typhus. Infected patients with these two diseases usually visited the emergency department (ED) complaining of fever that was not responsive to treatment in a local clinic. Aggressive management of SFTS is required in order to prevent rapid progression and human-to-human transmission, thus rapid and accurate differential diagnosis of the two diseases in the ED is important. We reported three laboratory confirmed cases of SFTS during 2013-2014 in a single center, with fever, skin lesions, and history of outdoor activities in order to help in differential diagnosis between SFTS and scrub typhus in the ED.
Communicable Diseases, Emerging ; Diagnosis, Differential ; Emergency Service, Hospital ; Fever* ; Humans ; Korea ; Scrub Typhus* ; Skin ; Thrombocytopenia*

Auditory neuropathy is a hearing disorder characterized by an absent or severely abnormal auditory brainstem response, with preservation of the cochlear microphonics and otoacoustic emissions. This suggests that outer hair cell (OHC) function is normal but that auditory function proximal to the OHCs is impaired. These patients demonstrate mild to severe hearing loss for pure tones and impaired word discrimination out of proportion to pure tone loss. Hearing aid alone is of little or no benefit in patients with auditory neuropathy. Visual support via cued speech or signed language can be a fail-safe method for insuring language development. Recently, there are some reports that cochlear implantation is highly successful in patients with auditory neuropathy. We report three cases (two children and one woman) with auditory neuropathy. Each patient was tested with cochlear microphonics, otoacoustic emissions, auditory brainstem response and middle latency response, etc. All three patients had normal cochlear microphonics or otoacoustic emissions with absent auditory brainstem response. Two of them had evidence of a peripheral neuropathy. We should be aware of auditory neuropathy and implications for its management, which differs from treatment of sensorineural hearing loss. Auditory neuropathy also raises a concern about the risk of false-negative findings when newborn hearing screening is restricted to otoacoustic emissions.
Child ; Cochlear Implantation ; Cochlear Implants ; Discrimination (Psychology) ; Evoked Potentials, Auditory, Brain Stem ; Hair ; Hearing ; Hearing Aids ; Hearing Disorders ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Infant, Newborn ; Language Development ; Mass Screening ; Peripheral Nervous System Diseases

BACKGROUND AND OBJECTIVES: The aim of this study was to assess the accuracy of threshold estimates determined by the auditory steady-state response (ASSR) in a group of sedated infants and young children with a range of hearing losses. MATERIALS AND METHOD: Two studies were performed because the behavioral audiometric information was not available from infants and young children. In the first study, a retrospective analysis was performed for 36 children (mean age: 3 years 4 months) who had completed auditory brainstem response (ABR) and pure tone audiometry to verify that ABR threshold is a good predictor for pure tone threshold in our laboratory. The ABR thresholds to 500 Hz, 1000 Hz tone-pip and click were compared with behavioral thresholds. In the second study, a prospective analysis of 23 children (mean age: 12 months), the ABR thresholds to 500 Hz, 1000 Hz tone-pip and click were compared with ASSR thresholds to amplitude and frequency modulated tones. RESULTS: The first study in which strong correlations were found between ABR and pure tone thresholds (r> or =0.92) demonstrated that ABR thresholds could be used to predict the pure tone thresholds. The second study which showed that ASSR thresholds were highly correlated with ABR thresholds (r> or =0.93) indicated that ASSR thresholds provided reliable audiometric information in infants and young children. CONCLUSION: These studies showed that ASSR could be used to estimate hearing thresholds with reliable accuracy in infants and young children.
Audiometry ; Child* ; Evoked Potentials, Auditory, Brain Stem* ; Hearing ; Hearing Loss ; Humans ; Infant* ; Prospective Studies ; Retrospective Studies

Although many imaging modalities can play some roles in the diagnosis of vertebral artery dissection (VAD), digital subtraction angiography (DSA) remains the gold standard method, with the highest detection rate and ability to assist in planning for endovascular treatment. However, this tool is often avoided in children because its invasive nature and it exposes them to radiation. High resolution magnetic resonance imaging (HR-MRI) have been suggested to be a reliable and non-invasive alternative, but it has never been discussed in children in whom vertebral artery dissection is a rare condition. In this report, we evaluate a case of a 2-year-old child who initially presented with cerebellar symptoms, and was early diagnosed with vertebral artery dissection using HR-MRI and was successfully treated.
Angiography, Digital Subtraction ; Child ; Child, Preschool ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Methods ; Vertebral Artery Dissection ; Vertebral Artery