Heart failure is a recognized, although uncommon, cause of massive liver cell necrosis, the clinical consequence of which are intermingled with those of cardiac insufficiency in most case. But, hepatic coma is rerely caused by hepatic congestion only. We report the three cases with heart failure resulted in massive liver cell necrosis and fulminant hepatic failure. The manifestations of fulminant hepatic failure were hepatic encephalopathy, jaundice, marked increase of prothrombin time and serum transaminase and there were no evidences of viral hepatitis and toxic hepatitis as a cause of liver failure.
Drug-Induced Liver Injury ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Hepatic Encephalopathy ; Hepatitis ; Jaundice ; Liver ; Liver Failure ; Liver Failure, Acute* ; Necrosis ; Prothrombin Time

BACKGROUND: The pathophysiologies of Failed Back Surgery Syndrome (FBSS) are epidural adhesion& fibrosis; arachnoiditis, neural encroachment, mechanical instability. Epidural adhesiolysis alleviate back pain through blocking the neural activity of scar area and decreasing the inflammation & edema. There are two methods of adhesiolysis, endoscopic & non-endoscopic adhesiolysis. Present study was aimed to compare the pain relief & side effects between two methods. METHODS: We investigated 86 post-laminectomy patients with low back pain and radiculopathy, who do not relieved with any kinds of conservative treatment. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. Group I was consisted with non-endoscopic 41 patients, and Group II was endoscopic 45 patients. Evaluation included assessment of pain relief (visual analogue scale, VAS), rate of reprocedures and duration of pain relief (VAS < 5) at post-epidural adhesiolysis 2 week, and 1, 2, 6 months. We also looked for complication of adhesiolysis. RESULTS: Statistical analysis (t-test, chisquared test) demonstrated VAS & reprocedure rate was significantly low (P < 0.05) in group II at 6 month and duration of pain relief (VAS < 5) was more prolonged in group II. One patient in each groups complained skin eruption and pruritus, and one patient of group II was proved epidural abscess and one patient of group I complained headache. CONCLUSIONS: Endoscopic and non-endoscopic epidural adhesiolysis are effective and safe in patients, who was not relieved the symptoms with conservative treatment, but endoscopic epidural adhesiolysis is more recommendable because its more prolonged effect.
Arachnoid ; Arachnoiditis ; Back Pain ; Cicatrix ; Edema ; Epidural Abscess ; Failed Back Surgery Syndrome ; Fibrosis ; Headache ; Humans ; Inflammation ; Low Back Pain ; Magnetic Resonance Imaging ; Pathology ; Pruritus ; Radiculopathy ; Skin

BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

Pneumomediastinum is a relatively uncommon, infrequently reported entity, In the evaluation of these entity, it is important to exclude pathological causes, including Boerhaave's syndrome which carries a high mortality. Spontaneous pneumomediastinum is related to excessive intraalveolar pressure leading to rupture of perivascular alveoli in the setting of a Valsalva maneuver without communication to gut material. So, it has a benign self-limited course and rarely requires medical intervention. On the contrary, secondary pneumomediastinum caused by instrumental, traumatic, and spontaneous perforation of esophagus. Although the prognosis have been improved since the advent of broad-spectrum antibiotics and nutritional support, pneumomediastinum due to esophageal perforation still has a high morbidity and mortality. The most important prognostic factor is the time interval between perforation and initiation of therapy, and an awareness and a high clinical suspicion is critical in the early diagnosis and treatment. Recently, we have experienced 2 cases of pneumomediastinum, one case was spontaneous pneumomediastinum and the other may be caused by instrumental esophageal perforation. We report the clinical course of the patients with a current literature review.
Anti-Bacterial Agents ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Fibrinogen ; Humans ; Mediastinal Emphysema* ; Mortality ; Nutritional Support ; Prognosis ; Rupture ; Valsalva Maneuver

Purpose: This study aims to investigate the effect of gonadotropin-releasing hormone agonist (GnRHa) on the growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis and to evaluate whether -202 A/C IGF binding protein-3 (IGFBP-3) promoter polymorphism affects growth velocity in females with central precocious puberty (CPP) during treatment. Methods: Data was collected from 97 females younger than 9 years, diagnosed with precocious puberty and treated with GnRHa for at least 1 year at Kangdong Sacred Heart Hospital from 2014 to 2015. Their body height, weight, change in height standard deviation score (∆SDS), serum IGF-1, serum IGFBP-3, bone age, and -202 A/C IGFBP-3 promoter polymorphism were measured before and after GnRHa treatment. The interrelationships between the variables were calculated. Results: During treatment, height SDS, IGF-1 SDS, IGFBP-3 SDS, and IGF-1/IGFBP-3 ratio significantly decreased. A significant correlation was observed between ∆IGF-1 SDS and ∆height SDS (r=0.405, P<0.001). The presence of the C allele was significantly correlated with IGF-1 SDS after treatment (P=0.049) and with IGFBP-3 SDS before and after treatment (P=0.012 and P=0.001), but not with ∆IGF-1 SDS, ∆IGFBP-3 SDS, ∆IGF-1/IGFBP-3 ratio, or ∆height SDS. Conclusion Growth velocity during GnRHa treatment is related to ∆IGF-1 SDS, indicating the apparent impact of GnRHa on the GH-IGF-1 axis. The -202 A/C IGFBP-3 promoter polymorphism does not affect the growth velocity of GnRHa in CPP girls.

No abstract available.

Purpose: A laparoscopic radical nephrectomy is known to cause less morbidity than a traditional open radical nephrectomy. In our institution, the laparoscopic approach, with intact specimen removal, has become the standard technique for radical nephrectomies. Herein, we report the results and oncological outcome of the experience of a single center. Materials and Methods: We reviewed 68 transperitoneal laparoscopic radical nephrectomies, performed for suspected renal cell carcinoma between December 1999 and June 2006. All data were collected from the patient's medical records. Results: The mean tumor size, surgical time and estimated blood loss were 4.82cm (1.7-14), 228.5 min (120-480) and 409.1cc (32-1,312), respectively. Conversion to open surgery was required in one case due to Endo-GIA malfunction, and conversion to hand-assisted surgery was performed in one case. The histological findings were pT1, pT2 and pT3 in 40 (59.7%), 9 (13.4%) and 18 patients (26.9%), respectively. In one case, the histology confirmed a non-malignant disease. The follow-up period was from 3 to 80 months (median 18). Distant metastasis was observed in 2 cases, but there was no local recurrence or port metastasis. Conclusions: A laparoscopic radical nephrectomy is a safe and feasible treatment for localized renal cell carcinomas. Longer follow-up and large scale studies are necessary to evaluate the long-term survival and disease- free rates, and confirm the effectiveness of performing a radical laparoscopic nephrectomy.
Carcinoma, Renal Cell ; Conversion to Open Surgery ; Follow-Up Studies ; Humans ; Laparoscopy ; Medical Records ; Neoplasm Metastasis ; Nephrectomy* ; Operative Time ; Recurrence

Caliceal diverticula containing calculi had been managed conventionally by deroofing of the diverticulum, closure of the communication with the collecting system, or partial nephrectomy. To minimize the loss of the renal parenchyme and to treat caliceal diverticulum containing calculi, endoscopic procedure was performed successfully in 6 cases. but failed in 1. Repeated endoscopic procedure was performed in failed case 6 months after first operation and succeeded also. The diverticular neck was dilated with the Amplatz dilator upto 24-30Fr. A 20Fr. nephrostomy catheter was placed for 10-14days, and there was no complications. We evaluated the result of diverticular obliteration with excretory urography 6 months after the operation. In conclusion, endourologic management of caliceal diverticulum containing calculi is a safe. less invasive. successful and parenchyme preserving procedure.
Calculi* ; Catheters ; Diverticulum* ; Neck ; Nephrectomy ; Urography

PURPOSE: We report a case of band keratopathy caused by hyperparathyroidism which was treated using EDTA (disodium ethylenediaminetetraacetic acid). METHODS: A 33-year-old woman with band keratopathy caused by hyperparathyroidism with elevated serum calcium, without any eye abnormalities was seen at Korea university hospital. Her corneal epithelium was removed after topical anesthesia, and the lesion was exposed by chemical chelating agent of 0.02M EDTA for 10 minutes, then, dropped topically every 30 seconds, the grayish white opacity which presents the calcium deposits was removed by chemical chelation of 0.02M EDTA in cornea. RESULTS: Most of the opacity was disappeared by chemical chelation with improvement of vision by 4 lines from 10/100 to 10/20. Cosmeticity was improved dramatically as well. No recurrence of corneal opacity was observed at 14 months after the operation. CONCLUSIONS: We experienced one case of band keratopathy caused by only hyperparathyroidism with hypercalcemia, without chronic uveitis, glaucoma, corneal edema, recurrent trauma any eye abnormalities. The primary band keratopathy was successfully treated by chemical chelation of EDTA : visual acuity was improved, foreign body sensation was relieved, and good cosmetic results were achieved. To our best knowledge, this is the first case of primary band keratopathy with hyperparathyroidism with hypercalcemia without any eye abnormalities, and we successfully treated by chemical chelation of EDTA.
Adult ; Anesthesia ; Calcium ; Cornea ; Corneal Edema ; Corneal Opacity ; Edetic Acid* ; Epithelium, Corneal ; Eye Abnormalities ; Female ; Foreign Bodies ; Glaucoma ; Humans ; Hypercalcemia ; Hyperparathyroidism* ; Korea ; Recurrence ; Sensation ; Uveitis ; Visual Acuity

PURPOSE: To compare the results of the ice test with other diagnostic tests for the diagnosis of myasthenia gravis in patients with ptosis. METHODS: The patients included in this study presented with suspicious myasthenic blepharoptosis and visited the Department of Ophthalmology, Guro Hospital, Korea University between March 2003 and February 2004 for diagnosis. All patients received "myasthenic ptosis workup" including the ice test, edrophonium test, RNS EMG, and anti-acetylcholine receptor antibody (anti-AchR) titer test. The tests were compared for specificity, sensitivity, ease of performance, economic benefits and observed complications. RESULTS: The patients included six men and nine women with an average age of 36.9+/-2.4 yrs. Positive test results were obtained as follows: Ice test 80%, edrophonium test 66.7%, RNS EMG 53.3%, and anti-AchR titer test 86.7%. Adverse effects of edrophonium test were encountered in two patients who had nausea, vomiting, and dizziness. CONCLUSIONS: The authors found that the ice test was simpler, faster, more economic, and safer than the others for diagnosing blepharoptosis caused by myasthenia gravis. Considering its relative high sensitivity and specificity, the ice test should be the first screening test given to patients with suspicious myasthenic ptosis.
Blepharoptosis ; Diagnosis* ; Diagnostic Tests, Routine ; Dizziness ; Edrophonium ; Female ; Humans ; Ice* ; Korea ; Male ; Mass Screening ; Myasthenia Gravis* ; Nausea ; Ophthalmology ; Sensitivity and Specificity ; Vomiting