We report the implantation of a balloon-expandable intravascular stent at proximal left anterior decending artery in a patients suffered from Canakian functional class III angina for 8 years. The patient received 3 times percutaneous transluminal coronary angioplasty at proximal left anterior descending and circumflex artery without benefits. Repeated angiography revealed restenosis at proximal left anterior descending artery. Atherectomy was tried with transluminal extraction catheter(TEC) with luminal dissection and coronary bypass graft followed. occluded vein grafts were defined by follow-up angiography and chest pain recurred. No residual stenosis or thrombosis was documented in 24 hour follow-up angiography and the patient was discharged without symptom at 10 days after stenting.
Angiography ; Angioplasty, Balloon, Coronary ; Arteries ; Atherectomy ; Chest Pain ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Phenobarbital ; Stents* ; Thrombosis ; Transplants ; Veins

OBJECTIVE: The vertebral artery dissecting aneurysms have been increaslingly reported with recent advent of diagnostic tools. The authors analyzed the various therapeutic modalities according to the patient's clinical presentation. METHODS: The clinical characteristics of vertebral artery dissecting aneurysm including clinical presentation, therapeutic modalities and outcomes were reviewed in eleven patients between March 2001 and August 2005. RESULTS: Six patients were presented with subarachnoid hemorrhage and five patients with ischemia. Four patients were treated with endovascular coils or stent and one patient was treated with craniotomy and aneurysmal wrapping. The other six patients were treated conservatively. Clinical outcomes were relatively good (Glawsgow outcome scale > or = 4) except one patient (Glawsgow oucome scale = 3). CONCLUSIONS: The treatment of a vertebral artery dissecting aneurysm must be choosed by characteristics of an aneurysm and the patient's clinical presentations. The patients with hemorrhage must be candidates for aggressive attempts to prevent rebleeding. On the other hand, the patients with ischemia may be good candidates for conservative treatment, and follow-up angiography is mandatory within three weeks after the symptom onset.
Aneurysm ; Aneurysm, Dissecting* ; Angiography ; Craniotomy ; Follow-Up Studies ; Hand ; Hemorrhage ; Humans ; Ischemia ; Stents ; Subarachnoid Hemorrhage ; Vertebral Artery*

PURPOSE: This study aimed to determine whether the standard clinical pathway based on evidence is applicable to pediatric asthma patients in the emergency room, and whether it is better for treatment effectiveness. METHODS: The clinical pathway was applied to children who visited our emergency room due to acute asthma between January 1 and December 31, 2009. Medical records of the emergency room were reviewed to see if the clinical pathway was correctly applied. The patients were divided into 2 groups: those who the pathway was correctly applied and those who the pathway was incorrectly applied to (group B, n=41). RESULTS: Acute asthma exacerbation occurred in 24 children (47%) in group A, while it occurred in 27 children (53%) in group B. The majority of patients in group B had moderate asthma exacerbation. The incorrect application of the clinical pathway and no use or insufficient use of inhaled anticholinergics was most frequently noted. The most common cause for the incorrect application of the clinical pathway was its misunderstanding of residents. The hospitalization rate was higher in group B than in group A. CONCLUSION: The application of the clinical pathway to pediatric asthma patients in the emergency room increased treatment effectiveness. However, training for the residents and intensive care for the patient with moderate asthma exacerbation are necessary for correct application of the clinical pathway.
Asthma ; Child ; Cholinergic Antagonists ; Critical Pathways ; Emergencies ; Hospitalization ; Humans ; Critical Care ; Medical Records ; Treatment Outcome

PURPOSE: The management of sinusitis in children is controversial. Antibiotic is known as the most essential management. Despite nasal irrigation and nasal decongestant have been used as adjunctive treatments of sinusitis, it is still unclear whether these are effective on sinusitis. Therefore, we used antibiotics with either nasal irrigation and an oral nasal decongestant and tried to estimate the outcome of each case. METHODS: This study was conducted with sinusitis patients who visited our pediatric respiratory disease clinic. They were randomized into 4 groups: Group 1 were treated with a high dose of amoxicillin only; Group 2 were treated with nasal irrigation and a high dose of amoxicillin; Group 3 were treated with a nasal decongestant and a high dose of amoxicillin; and Group 4 were treated with nasal irrigation, a oral nasal decongestant, and a high dose of amoxicillin. Responses to treatment were estimated more than 4 days after the beginning of the therapy in acute or subacute sinusitis, and more than 7 days chronic sinusitis. RESULTS: The responses to the treatments the 4 groups were not comparable. A favorable therapy was not found, regardless of whether a patient had suppurative rhinorrhea, nasal stuffness, typical findings of PNS plain radiograph, or adenoid hypertrophy. CONCLUSION: The use of nasal irrigation or a oral nasal decongestant as an additional therapy to antibiotics for the symptoms of pediatric sinusitis showed no additional effects on sinusitis.
Adenoids ; Amoxicillin ; Anti-Bacterial Agents ; Child ; Humans ; Nasal Lavage ; Prospective Studies ; Sinusitis

PURPOSE: Acute lower respiratory infection (ALRI), which is frequently encountered in pediatric patients, is the leading cause of hospitalization. We aimed to identify particular cytokines that correlated with ALRI clinical characteristics. We also aimed to identify any differences in cytokines between respiratory syncytial virus (RSV)-related ALRI and non-RSV-related ALRI. METHODS: Cytokine levels were measured in the sera sampled from 103 pediatric patients diagnosed with ALRI and admitted to Seoul St. Mary's Hospital between May 2012 and April 2013. The correlations between cytokine levels and the length of hospitalization, the number of days with fever, body temperature, pulse rate, respiration rate, oxygen saturation upon admission, and duration of oxygen supplementation were analyzed. RESULTS: In children with ALRI, the level of interleukin (IL)-6, granulocyte-colony stimulating factor (G-CSF), and IL-10 were correlated with a higher body temperature on admission. In addition, the IL-8 level was correlated with pulse rate and respiration rate, and IL-1β level was related with oxygen saturation on admission. In children with RSV-related ALRI, the IL-6 was correlated the with duration of fever, and the IL-1β, IL-2, and IL-8 levels were related to pulse rate and respiration rate. In addition, the increase in interferon-gamma-inducible protein-10 (IP-10) level was correlated with a higher body temperature on admission and a longer duration of hospitalization in children with RSV-related ALRI. CONCLUSION: In children with ALRI, the levels of IL-6, IL-8, IL-1β, G-CSF, and IP-10 were correlated with its clinical features. In children with RSV-related ALRI, the IL-1β, IL-2, IL-6, IL-8, and IP-10 level was correlated with the severity of the disease.
Body Temperature ; Child* ; Cytokines* ; Fever ; Granulocyte Colony-Stimulating Factor ; Heart Rate ; Hospitalization ; Humans ; Interleukin-10 ; Interleukin-2 ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Oxygen ; Respiratory Rate ; Respiratory Syncytial Viruses ; Seoul

INTRODUCTION: Several different methods of enhancing pelvic floor functions have been developed and modified. The aim of this investigation was to compare the usage of a new vaginal cone (double cone) with conventional FES-Biofeedback therapy for female urinary incontinence cases with respect to the effects on pelvic floor rehabilitation. MATERIALS AND METHODS: It was performed on a multi-center based study. One hundred patients, who desired a non-surgical treatment for their urinary incontinence, were divided into two groups randomly. They were: (1) the FES-Biofeedback group (or BFB group); and (2) the new vaginal cone group (or cone group). For a period of six weeks, two sessions each week were carried out for the BFB group. The new 150-gram dumbbell- shaped vaginal cone, made up of fine ceramics material, was developed domestically. A therapist instructed these patients in the cone group for using the new cone for pelvic floor exercises and directed them to repeat the exercises at home daily, as these patients had follow-up visits every week. RESULTS: Objective improvements were obvious in both of these groups. 88% of the cone group and 92% of the BFB group showed an improvement after treatment. There was no significant difference in the improvement of dissatisfaction scores between the two groups. CONCLUSION: The new vaginal cone is relatively easy to use at home and aids in pelvic floor muscle exercises. Consequently, the new vaginal cone could be another treatment modality in non-surgical approaches to female stress urinary incontinence.
Ceramics ; Exercise ; Female ; Follow-Up Studies ; Humans ; Pelvic Floor ; Prospective Studies* ; Rehabilitation ; Urinary Incontinence*

PURPOSE: This study was to evaluate the effect of flexible bronchoscopy for the treatment of secondary atelectasis of children following respiratory infection. METHODS: The medical records for a total of 19 cases of flexible bronchoscopy were reviewed retrospectively, which were performed for the treatment of secondary atelectasis at the Department of Pediatrics of the Catholic University of Korea Seoul St. Mary's Hospital from April 2007 to January 2013. RESULTS: A total of 18 patients (11 males and 7 females) were involved in the study. The range of age was 4 months to 15 years old. The causative underlying diseases were 17 cases of pneumonia, 1 case of bronchiolitis and 1 case of bronchial asthma. The most common location of atelectasis was right middle lobe and right middle lobe with left lower lobe was next. Bronchoscopy revealed inflammatory changes in 12 cases (63.2%) such as mucus plug (n=4), profuse secretion (n=4), mucosal edema (n=3), and bronchial narrowing (n=1), although 7 cases (36.8%) showed normal airway. Other additional findings were bronchomalacia, tracheomalacia, and bronchial tree abnormality. Seven out of 19 cases who received therapeutic intervention had complete or partial reexpansion of their atelectasis. Cases who occurred atelectasis within 6 weeks showed significantly higher improvement than cases occurred after 6 weeks (70% vs. 11.1%, P=0.019). Complications including seizure, fever, hypoxia, mucous bleeding, and hypotension were observed in 6 cases. CONCLUSION: Flexible bronchoscopy revealed to be effective and safe treatment modality in treatment of secondary atelectasis of children. Timely therapeutic intervention in pediatric patients should be considered.
Anoxia ; Asthma ; Bronchiolitis ; Bronchomalacia ; Bronchoscopy ; Child ; Edema ; Hemorrhage ; Humans ; Hypotension ; Korea ; Male ; Medical Records ; Mucus ; Pediatrics ; Pneumonia ; Pulmonary Atelectasis ; Retrospective Studies ; Seizures, Febrile ; Tracheomalacia

PURPOSE: This study aimed to have a deeper insight into the clinical spectrum of foreign body aspiration in children and to prospect the further clinical implications of early diagnosis. METHODS: We conducted a retrospective medical chart review of 48 children with foreign bodies at The Catholic University of Korea, Seoul St. Mary's Hospital, between January 2009 and December 2013 in terms of age, sex, symptoms and signs, radiologic findings, and clinical courses. Patients were divided into 2 groups according to the time from aspiration to a definite diagnosis. The 2 groups were compared for clinical courses, radiologic findings, and the length of hospitalization. RESULTS: Approximately 85% of patients were 3 years of age or younger. About one-fifth of patients had no history of foreign body aspiration. Cough and coarse breathing sounds were the most common symptoms and signs. The most frequent radiologic finding was pulmonary air trapping (33.3%). The mostly commonly aspirated foreign body was peanut and detected in left main bronchus. Cough, sputum, and absence of aspiration history were more common in the delayed diagnosed group than in the early diagnosed group. CONCLUSION: Our results suggest that the number of accidents associated with foreign body aspiration can be reduced by keeping infants with nut formula under close observation and by conducting assertive bronchoscopic examination on children with delayed recovery from respiratory infections. After removal of foreign bodies, close monitoring and expectation of possible complications can prevent patients from a long hospital stay.
Bronchi ; Bronchoscopy ; Child* ; Cough ; Diagnosis ; Early Diagnosis ; Foreign Bodies* ; Hospitalization ; Humans ; Infant ; Korea ; Length of Stay ; Nuts ; Respiratory Sounds ; Respiratory Tract Infections ; Retrospective Studies ; Seoul ; Sputum

OBJECTIVE: The purpose of this study was to evaluate the complications of Transobturator tape (TOT) in the surgical treatment for stress urinary incontinence and their management. METHODS: From March 2005 to October 2007, 206 patients diagnosed with stress urinary incontinence were operated using TOT at Chonnam National University Hospital. We reviewed medical records and analyzed the data according to age, parity, menopausal state, concomitant operations and complications. RESULTS: Mean age of the patients was 52.6+/-10.5 years and mean parity was 2.9+/-1.4. 91 patients (44.2%) were in postmenopausal state and 201 patients (97.6%) had other concomitant gynecologic operations. There were no intraoperative complications such as vaginal injury or bladder perforation. Postoperatively, there were 2 cases (1.0%) of vulva hematoma, 6 cases (2.9%) of urinary retention, 4 cases (1.9%) of de novo urgency and 4 cases (1.9%) of vaginal erosion. CONCLUSION: The surgical treatment using TOT is thought to be safe and effective means for the management of stress urinary incontinence. Although rare, complications may occur, therefore surgeons must be aware of the management of each complications.
Female ; Hematoma ; Humans ; Intraoperative Complications ; Medical Records ; Parity ; Suburethral Slings ; Urinary Bladder ; Urinary Incontinence ; Urinary Retention ; Vulva

PURPOSE: This study was performed to investigate the indications, yield, and complications of flexible bronchoscopy for respiratory disease in children compared to earlier domestic studies and to examine if any differences existed in comparison to international studies. METHODS: The medical records of 100 cases of flexible bronchoscopy that were performed in 76 patients at the Department of Pediatrics of The Catholic University of Korea, Seoul St. Mary's Hospital from June 16, 2010 to August 6, 2013 were reviewed. RESULTS: A total of 76 patients (50 males and 26 females) were included in the study. The most common indication of flexible bronchoscopy was persistent pneumonia or pneumonia in immunocompromised patients (53 cases). The object of flexible bronchoscopy was accomplished in 65 of 100 cases, and, the treatment was changed in 24 of 65 cases. The most common abnormal finding was tracheomalacia that was found in 18 cases. In 67 cases where bronchoalveolar lavage was performed, bacteria were identified in 47 cases, fungi in 9 cases, and viruses in 22 cases. Complications occurred in 8 cases. CONCLUSION: Compared to earlier domestic studies, there was no significant change in diagnostic approaches and therapeutic improvement. However, this study showed that flexible bronchoscopy appears to be safe in patients with hemato-oncologic disease. Compared to international studies, the occurrence of complications due to flexible bronchoscopy was relatively low.
Bacteria ; Bronchoalveolar Lavage ; Bronchoscopy* ; Child* ; Fungi ; Humans ; Immunocompromised Host ; Korea ; Male ; Medical Records ; Pediatrics ; Pneumonia ; Seoul ; Tracheomalacia