PURPOSE: Nebulizers are commonly used to treat children with asthma. Some pulmonary infections associated with contaminated nebulizer units have been reported. The aims of this study were to determine whether home nebulizers are repositories of bacteria and to ascertain how asthmatic patients use and maintain their nebulizers at home. METHODS: Fifty-five children with asthma aged 2 to 6 years were enrolled in this study. The parents were asked to bring their child's nebulizer units to regular follow-up visits. Bacterial samples which were obtained from the masks(or mouthpieces), nebulizer chambers and throat swabs were inoculated to blood agar, chocolate agar, and McConkey agar. Cultures were incubated at 5 percent CO2 incubator and observed after 24 hours. Parents completed a questionnaire regarding nebulizer usage and care in their child. RESULTS: Bacterial contamination was found in samples from 27(49.1%) of the 55 masks(or mouthpieces) and 24(43.6%) of the 55 chambers. The predominant microorganisms isolated were Acinetobacter baumannii, Bacillus subtilis, Klebsiella pneumoniae, Staphylococcus aureus, and Candida albicans. The questionnaire revealed that 40 parents cleaned the nebulizer units with tap water(and soap) and dried then, as they had received cleaning and drying instructions from a medical staff member. Seven organisms from nebulizer units were indistinguishable from the patient's throat isolates. CONCLUSION: We have demonstrated that home nebulizers in these asthmatic children were frequently contaminated with aerobic bacteria. Aerosolization might transmit these bacteria to their upper respiratory tracts. The education and training of home caregivers should include the principles of cleaning and maintenance of their child's nebulizer units.
Acinetobacter baumannii ; Agar ; Asthma ; Bacillus subtilis ; Bacteria ; Bacteria, Aerobic ; Cacao ; Candida albicans ; Caregivers ; Child* ; Education ; Follow-Up Studies ; Humans ; Incubators ; Inhalation ; Klebsiella pneumoniae ; Medical Staff ; Nebulizers and Vaporizers* ; Parents ; Pharynx ; Surveys and Questionnaires ; Respiratory System ; Staphylococcus aureus

BACKGROUND AND OBJECTIVES: Left ventricle burdened by longstanding volume-overload, undergoes various structural and functional alterations. Accordingly, the expressions of multiple classes of genes are likely to be altered. However, the profile of gene expressions, specifically in a volume-overloaded left ventricle in humans, has not been explored. SUBJECTS AND METHODS: The pattern of gene expression was studied, using a cDNA microarray, in myocardium from 4 normal subjects and 5 patients with chronic regurgitant valvular heart disease whose end-diastolic left ventricular dimension measures 65 mm or more, but whose systolic function remained preserved. RESULTS: We identified 58 differentially expressed genes that were functionally classifiable in the volume-overloaded myocardium. Those genes involved in cell cycle/growth (up/down-regulation: 9/1), signal transduction (4/1) were mostly overexpressed in the volume-overloaded myocardium. The distributions of the gene expressions were variable for those involved in transcription/translation (up/down-regulation: 6/7) and apoptosis (2/2). The genes related to the myocyte structure (troponin T3, tropomyosin, etc)(up/down-regulation: 1/10), as well as those related to metabolism (2/5), were underexpressed. The gene expression patterns from RT-PCR and Western blot, with randomly selected genes, were similar to those from the cDNA microarray. CONCLUSION: Altered expression was identified in multiple genes in the volume-overloaded human left ventricle prior to the development of heart failure. The genes related to cell growth and signal transduction were mostly overexpressed, while those related to cellular structure and metabolism appeared to be underexpressed. These results might help in the elucidation of cellular mechanisms for the remodeling process associated with chronic volume-overloading.
Apoptosis ; Blotting, Western ; Cellular Structures ; Gene Expression* ; Heart Failure* ; Heart Valve Diseases ; Heart Ventricles ; Heart* ; Humans* ; Metabolism ; Muscle Cells ; Myocardium* ; Oligonucleotide Array Sequence Analysis ; Signal Transduction ; Transcriptome* ; Tropomyosin

PURPOSE: To report the difficulties in the process of locking head screw removal due to the stripping of the hexagonal recess of the screw head. MATERIALS AND METHODS: We have removed 113 5.0-self tapping locking head screws and 202 3.5-self tapping locking head screws from 34 patients with fracture healing and 5 patients complicated with infection. All of the operations were done by one surgeon. All the screws were placed with the use of torque limiting attachment or driver. RESULTS: All of 113 5.0-self tapping locking head screws were removed without difficulties with an usual manner. 21 out of 202 3.5-self tapping locking head screws were removed with many difficulties due to the stripping of the hexagonal recess. 3 screws were removed successfully with the use of conical extraction screw. 12 screws were taken out by further stripping and destruction of the screw head. In 6 situations where the only one screw was left stripped, the plate was bent around the stripped screw and then it was removed by turning the plate as a handle. One screw was removed with the partial breakage of the near cortex upon lifting the plate after failed attempt of using conical extraction screw. CONCLUSION: Although we have followed the guidelines at the time of insertion we have experienced difficulties in the removal of 3.5 locking head screws due to the stripping of the hexagonal recess. Care should be taken at the time of removal of the locking plate especially for the 3.5 locking screws.
Fracture Healing ; Head ; Humans ; Lifting ; Torque

We report a case of the accidental intravenous administration of a large dose of magnesium sulfate during cesarean section. A 41-year-old woman, at 33 weeks gestation, with pregnancy-aggravated hypertension, headache and generalized edema presented in acute labor and showed fetal bradycardia on a nonstress test. Laboratory tests demonstrated an increased level of magnesium (5.4 mg/dl). A cesarean section was performed under general anesthesia with O2-N2O-enflurane and vecuronium. After delivery 2,000 mg of magnesium sulfate was mixed with the lactated Ringer's solution 1,000 ml and 550 ml administered to the patient. After noticing the accidental infusion of the magnesium sulfate, we replaced the lactated Ringer's solution with normal saline 1,000 ml and performed arterial blood gas analysis, checked serum electrolyte, including Mg2+ and Ca2+, and had monitored depth of muscle relaxation and vital signs. The level of magnesium had increased to 8.9 mg/dl after the accidental magnesium infusion. For about one and half hours after emergence from general anesthesia, she complained of dyspnea and paraparesis of extremities. To treat the hypermagnesemia, 3% calcium gluconate 1,000 mg and furocemide were given intravenously to antagonize magnesium and to increase the urine output. The depth of neuromuscular block was frequently monitored using a nerve stimulator. After conservative treatment, she recovered from the effect of the hypermagnesemia and was discharged on the fifth postoperative day. Anesthesiologists must to keep in mind the preoperative patients' pathophysiologic conditions, check co-administered drugs and the contents of intravenously connected solutions.
Administration, Intravenous* ; Adult ; Anesthesia, General ; Blood Gas Analysis ; Bradycardia ; Calcium Gluconate ; Cesarean Section* ; Dyspnea ; Edema ; Extremities ; Female ; Headache ; Humans ; Hypertension ; Magnesium Sulfate* ; Magnesium* ; Muscle Relaxation ; Neuromuscular Blockade ; Paraparesis ; Pre-Eclampsia ; Pregnancy ; Vecuronium Bromide ; Vital Signs

A sarcomatoid carcinoma of the gastrointestinal tract is a very rare tumor. Only limited cases have been reported in the literature. The tumor is more malignant than the usual adenocarcinoma of the gastrointestinal tract. Typically, when discovered, a sarcomatoid carcinoma of the small intestine is already in a late stage of disease with a rapidly progressive course. The survival rate is markedly lower than for adenocarcinomas. Here, we report the case of a 63-year-old male patient who was referred from the Gastroenterology Department of Chonnam University Hospital. He had been suffering from a sudden onset of painless jaundice, and from weight loss for one month. The operation at our hospital was performed under a diagnosis of periampullary cancer. Whipple's operation was carried out on Dec. 14, 1998. Pathology confirmed the diagnosis of a sarcomatoid carcinoma of the duodenum. This article presents that case of a sarcomatoid carcinoma of the duodenum with a brief review of the literature.
Adenocarcinoma ; Diagnosis ; Duodenum* ; Gastroenterology ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Jaundice ; Jeollanam-do ; Male ; Middle Aged ; Pathology ; Survival Rate ; Weight Loss

No abstract available.
Dexamethasone* ; Humans ; Membranes* ; Rupture*

OBJECTIVE: The aim of this study was to determine whether fetuses delivered prematurely because of pregnancy complications had a different neonatal outcomes than that of those bom after either spontaneous preterm labor or after premature rupture of membrane. METHODS: The study design was a retrospective analysis of 150 very low birthweight(<1500 grams) infants and their mothers who delivered preterm neonates at Samsung Medical Center. Only singleton infants without major congenital anomalies were included. The primary reason for delivery was categorized as preterm delivery because of pregnancy complications(indicated preterm delivery) or spontaneous preterm delivery. Selected neonatal outcomes were compared between infants born to women in each of these groups. RESULTS: There were some survival benefits in infants born to women who underwent indicated preterm delivery from univariate analyses. In the multiple logistic regression analysis, however, selected neonatal outcomes did not differ between the groups. CONCLUSION: We concluded that a "stressed" pregnancies confer negligible survival advantage to the very low birthweight infants.
Female ; Fetus ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Membranes ; Mothers ; Obstetric Labor, Premature ; Pregnancy Complications ; Pregnancy* ; Retrospective Studies ; Rupture

OBJECTIVE: To analyse neonatal outcomes of the very low birthweight infants born to women who underwent an indicated preterm delivery and spontaneous preterm delivery. METHODS: We performed an observational study of 150 very low birthweight(<1500 grams) infants delivered at Samsung Medical Center. The study population was limited to singleton infants without major congenital anomalies. The primary reason for delivery was categorized as indicated preterm delivery or spontaneous preterm delivery. Selected neonatal outcomes were compared between infants born to women in each of these groups. RESULTS: Univariate analyses showed some survival benefits in infants born to women who underwent indicated preterm delivery. Selected neonatal outcomes, however, did not differ between the groups in the multiple logistic regression analysis. CONCLUSION: There was no survival advantage to the very low birthweight infants born to women who underwent an indicated preterm delivery compared to those born to women with spontaneous preterm delivery.
Female ; Humans ; Infant* ; Logistic Models ; Observational Study

No abstract available.
Cisplatin*

PURPOSE: Seasonal variations in asthma-related hospitalizations and emergency department visits have long been recognized. This study aimed to investigate the seasonal patterns of asthma in children and adolescents who presented at emergency departments in Korea. METHODS: We analyzed the National Emergency Department Information System records from 117 emergency departments in Korea that comprised all of the patients with asthma who were aged 3-18 years and who presented at the emergency departments from 2007 to 2012. The children and adolescents were divided into 3 groups based on their ages, namely, 3-6 years, 7-12 years, and 13-18 years. The data were tabulated, and graphs were created to show the seasonal trends in the monthly numbers of emergency department visits as a consequence of asthma. RESULTS: A total of 41,128 subjects were identified, and the male-to-female ratio was 1:0.5. General ward admissions comprised 42.6% (n=17,524 patients) of the emergency department visits, and intensive care unit admissions comprised 0.8% (n=335 patients) of the emergency department visits. The monthly numbers of emergency department visits for asthma varied according to the season, with high peaks during fall, which was from September to November, and low levels in summer, which was from June to August. CONCLUSIONS: Important differences in the seasonal patterns of emergency department visits for asthma were evident in children and adolescents. Identifying seasonal trends in asthma-related emergency department visits may help determine the causes and reduce the likelihood of asthma exacerbation.
Adolescent* ; Asthma* ; Child* ; Emergencies* ; Emergency Service, Hospital* ; Epidemiology ; Hospitalization ; Humans ; Information Systems ; Intensive Care Units ; Korea* ; Patients' Rooms ; Seasons*