Tracheal bronchus is an aberrant bronchus that arises most often from the right tracheal wall above the carina and is the result of an additional tracheal outgrowth early in embryonic life. It; incidence ranges between 0.1 and 5%. This anomaly is usually diagnosed incidentally during bronchoscopy, bronchography or computed tomography. Occasionally, it represents the underlying etiology for chronic pulmonary disease, especially if it involves the right upper lobe and reflects an abnorrnal pulmonary clearing mechanism. The tracheal bronchus may be associated with other bronchopulmonary anomalies, tracheal stenosis, or Down's syndrome. Asymptornatic tracheal bronchus does not require any treatment. In case of tracheal bronchus associated recurrent right upper lobe diseases, tracheal bronchus therapy should include resection of the aberrant bronchus as well as the lob it supplies. (J Korgan Pediatr Soc 2000;43:1501-1504)
Bronchi* ; Bronchography ; Bronchoscopy* ; Down Syndrome ; Equipment and Supplies ; Incidence ; Lung Diseases ; Tracheal Diseases ; Tracheal Stenosis

The extracardiac conduit Fontan procedure is the last surgical step in the treatment of patients with a functional single ventricle. An acquired pulmonary arteriovenous malformation may appear perioperatively or postoperatively due to an uneven hepatic flow distribution. Here we report a case of a bifurcated Y-graft Fontan operation in a 15-year-old male patient with a unilateral pulmonary arteriovenous malformation after an extracardiac conduit Fontan operation.
Adolescent ; Arteriovenous Malformations* ; Fontan Procedure ; Heart Defects, Congenital ; Humans ; Male ; Vascular Diseases

BACKGROUND: Preemptive treatment with ketamine, a noncompetitive NMDA antagonist, may prevent establishment of postoperative hypersensitivity by blocking the sensory input that induces the central sensitization. The aim of this study was to determine if continuous preemptive administration of intravenous (IV) ketamine decreases postoperative pain. METHODS: Sixty healthy informed patients scheduled for elective abdominal hysterectomy were randomly divided into two groups of equal size and studied in a double-blind manner. Before surgical incision, patients were given 1 mg/kg of ketamine or equal volume of saline followed by IV infusion of 0.01 mg/kg/min, which was discontinued at peritoneal closure. IV morphine patient-controlled analgesia (PCA) was started in all patients at peritoneal closure. Visual analogue scale (VAS) pain scores and total morphine consumption were recorded at 1, 3, 6, 9, 12, 24, 36, and 48 hours postoperatively. RESULTS: VAS pain scores at rest were significantly less in the ketamine group than in the saline group at 1, 3, 24, 36, and 48 hr postoperatively. VAS at moving status were less in the ketamine group at 1, 3, 12, 24, 36, 48 hr postoperatively. Patients in the ketamine group had significantly lower morphine consumption throughout the study period, about 20-50% reduction in postoperative total morphine was observed. Only ketamine group experienced severe headache (10 cases), while there were no intergroup differences in other side effects such as pruritus, bad dream, and backache. CONCLUSION: These results suggest that preemptive continuous IV ketamine decreases postoperative pain intensity and IV morphine requirement, and its action lasts longer than the normal expected duration of action of ketamine.
Analgesia, Patient-Controlled ; Back Pain ; Central Nervous System Sensitization ; Dreams ; Headache ; Humans ; Hypersensitivity ; Hysterectomy ; Ketamine* ; Morphine ; N-Methylaspartate ; Pain, Postoperative ; Pruritus

Visceral fat has been reported to be associated with nonalcoholic fatty liver disease (NAFLD) and the metabolic syndrome (MetS). We assessed the prevalence of both NAFLD and the MetS, measured visceral fat thickness VFT), and estimated the physical activity indexes of 224 relatively healthy hospital workers. We also investigated the associations between both VFT and physical activity index and each of NAFLD and the MetS. The MetS was diagnosed according to the guidelines outlined by the Adult Treatment Panel III, and NAFLD was diagnosed by ultrasonography. Subjects with hepatitis B and C infections and those reporting moderate alcohol consumption were excluded from the study. The prevalence of the MetS was 11.6% and that of NAFLD was 41.5%. Many subjects with the MetS had NAFLD (73.1%), and some subjects with NAFLD (20.4%) also had several components of the MetS (p=0.001). VFT was significantly increased by both the addition of components of the MetS and the severity of NAFLD (p<0.001). In addition, VFT was independently associated with NAFLD (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.02-1.19) in subjects with more than 2 components of the MetS. In contrast, habitual physical activity was reversely associated with NAFLD (OR, 0.29; 95% CI, 0.10-0.87). In conclusion, an increased visceral fat content and reduced physical activity could be not only biological markers but also therapeutic targets in the treatment of NAFLD and the MetS.
Adult ; Alcohol Drinking ; Blood Pressure ; Comorbidity ; Fatty Liver/*physiopathology ; Female ; Humans ; Hyperinsulinism/complications ; *Intra-Abdominal Fat ; Male ; Metabolic Syndrome X/*physiopathology ; Middle Aged ; Multivariate Analysis ; Odds Ratio

DCRV is a rare cause of right ventricular outflow obstruction by anomalous muscle bundle at the level of sinus portion. The symptoms due to DCRV itself were mild inspite of significant pressure gradient over 90mmHg between proximal and distal chamber, and became severe by associated complication of bacterial endocarditis or aortic regurgitation in ventricular septal defect. In 12 cases(40%), right ventricular hypertrophy configuration in electrocardiogram was characteristic. Although R wave in V1 was tall, S wave in V6 and R wave in aVR were indistinctive. Those were very useful findings for diagnosis of DCRV which was thought to be possible only invasively. With operation prior to overt right ventricular faliure, the prognosis was good with only minor complication.
Adolescent* ; Adult* ; Aortic Valve Insufficiency ; Diagnosis ; Electrocardiography ; Endocarditis, Bacterial ; Heart Septal Defects, Ventricular ; Humans ; Hypertrophy, Right Ventricular ; Prognosis ; Ventricular Outflow Obstruction

The continuous epidural anesthesia is an effective method for postoperative pain control and improvement of pulmonary function. A 39-year-old man was scheduled for postoperative intestinal obstruction. After adhesiolysis under the general anesthesia, epidural anesthesia was done for postoperative pain control. Because an accidental dural puncture was noticed, the adjacent interspace of epidural anesthesia was tried and catheter was inserted. Respiratory depression, hypotension, loss of consciousness and cardiac arrest were developed about 20 minutes after the first injection of 1% lidocain 10ml. Endotracheal intubation was performed and the respiration was controlled using 100% oxygen. Self respiration and alert mentality returned after 180 minutes. No CSF leakage, delayed onset time, severe hypotension, complete recovery may be the result of subdural anesthesia and postoperative hypoxia. But radiological examination was not performed.
Adult ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anoxia ; Catheters ; Heart Arrest* ; Humans ; Hypotension ; Intestinal Obstruction ; Intubation, Intratracheal ; Oxygen ; Pain, Postoperative* ; Punctures ; Respiration ; Respiratory Insufficiency ; Unconsciousness

BACKGROUND: Pneumonia is a common medical complication after acute stroke, and makes a considerable influence on the prognosis. It is potentially preventable or treatable if early recognized. Thus, the identification of which patients are at risk for the development of pneumonia is clinically significant. METHODS: A total of 240 patients with an acute stroke who were consecutively admitted to a Seoul National University Hospital were studied. The following prognostic factors were accounted for in the statistical analyses: age, sex, hypertension, diabetes, cardiac disease, smoking, recurrent stroke, NIHSS, modified Rankin scale (mRS), the presence of dysphagia, blood pressure, body temperature, white blood cell count, blood sugar, fibrinogen, Levin tube insertion, Foley catheter insertion, and subtype of stroke. RESULTS: Pneumonia was diagnosed in 36 (17.0%) patients during the acute stage of stroke, particularly within 2 weeks. Average admission stay of patients with pneumonia was 38.7 days, whereas it was 19.3 days for those without pneumonia. By multivariate analysis, Levin tube insertion, body temperature, recurrent stroke, and mRS were significant predictor of pneumonia development. Forty percent of patients with four or five points of mRS developed pneumonia, compared to 6% in less than four points. CONCLUSIONS: Our results show that the patients who have Levin tube, high mRS, or recurrent stroke tend to develop pneumonia after acute stroke. It is important for early detection and prevention of pneumonia in patients with high mRS.
Blood Glucose ; Blood Pressure ; Body Temperature ; Catheters ; Deglutition Disorders ; Fibrinogen ; Heart Diseases ; Humans ; Hypertension ; Leukocyte Count ; Multivariate Analysis ; Pneumonia* ; Prognosis ; Seoul ; Smoke ; Smoking ; Stroke*

PURPOSE:Attention deficit hyperactivity disorder(ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, impulsivity and/or hyperactivity with an onset during childhood. There are no specific diagnostic and evaluated tools. The aim of this study was to determine clinical availability of adjunctive tests for diagnosis and measure of the efficacy of treatment in ADHD patients. METHODS:The study group consisted of 41 patients under 15 years of age who visited Kangnam Sacred Heart Hospital and Kangdong Sacred Heart Hospital between January 2007 and June 2008 for evaluation of ADHD. Diagnosis was made according to the diagnostic and statistical manual for mental disorder-IV(DSM-IV) with history, physical examination, ADHD rating scale, and attention deficit hyperactivity disorder diagnostic system(ADS). After psychostimulant treatment, patients were reevaluated by previous diagnostic tools and their results were analysed by SPSS version 16.0. RESULTS:The mean age was 8.44+/-2.49 years old, male to female ratio 4.13:1(33:8). Forty one ADHD patients were subdivided into predominantly inattentive type 17(41.5%), predominantly hyperactive-impulsive type 3(7.3%) and combined type 21(51.2%). In patients, concordance rates of adjunctive tests with DSM-IV diagnostic criteria were 74.29% in Korean ADHD Rating scale(K-ARS), 59.09% in abbreviated Conners' rating scale(ACRS) and 92.68 % in ADS with DSM-IV diagnostic criteria. There were significant differences in the ADS results between before and after psychostimulant treatment. CONCLUSION:Because the concordance rates and efficacy of ADS were higher than K- ARS and ACRS in ADHD patients, it suggests that ADS is a useful method to ADHD diagnosis and treatment.
Attention Deficit Disorder with Hyperactivity ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Heart ; Humans ; Male ; Physical Examination

PURPOSE: This study examined the effect of a varus positioned femoral stem after cementless proximal fitting total hip arthroplasty. MATERIALS AND METHODS: A total of 144 hips in 136 patients who underwent cementless total hip arthroplasty, were followed-up. Twenty-one varus positioned hips were compared with 123 neutral positioned hips. The clinical results were analyzed according to the level of thigh pain and the Harris Hip score. The radiological outcome was assessed according to osteolysis, loosening and stem failure. RESULTS: In the varus positioned hips, thigh pain was present in 1 hip, and the average Harris Hip Score was 96 points. None of the implants showed radiological evidence of loosening or impending failure. Localized osteolysis was identified in 1 hip, non-progressive radiolucencies in 2 hips, and cortical hypertrophy in 1 hip. In the neutral positioned hips, thigh pain was present in 6 hips, and the average Harris Hip Score was 97 points. Localized osteolysis was identified in 8 hips, non-progressive radiolucencies in 7 hips, cortical hypertrophy in 9 hips. CONCLUSION: Patients with varus alignment of the stem did not present poorer clinical outcomes than those with neutral alignment of the stem.
Arthroplasty, Replacement, Hip* ; Hip ; Humans ; Hypertrophy ; Osteolysis ; Thigh

A 25-year-old woman presented with effort-induced chest pain. Physical examination revealed different blood pressures, 180/100 mmHg in right arm and 100/60 mmHg in left arm. Resting electrocardiogram was normal, but down-slope depression of ST segment more than 3 mm in V3-6, II, III, aVF developed at the stage 1 of treadmill exercise test. Stress Thallium-201 scan showed severe ischemia in the anteroseptal and lateral wall of left ventricle. Diagnostic coronary angiogram showed critical stenosis in the ostium of left main coronary artery. The left subclavian artery was occluded totally with well-developed collateral circulation. The patient underwent ostioplasty of left coronary ostium using pericardial patch, and her symptom improved after surgery. Follow-up coronary angiogram one year after surgery showed patent coronary artery ostium with good flow and myocardial perfusion improved on follow-up Thallium-201 SPECT. She has no major cardiac events during 7-year clinical follow-up.
Adult ; Arm ; Chest Pain ; Collateral Circulation ; Constriction, Pathologic ; Coronary Vessels* ; Depression ; Electrocardiography ; Exercise Test ; Female ; Follow-Up Studies* ; Heart Ventricles ; Humans ; Ischemia ; Perfusion ; Physical Examination ; Subclavian Artery ; Takayasu Arteritis* ; Tomography, Emission-Computed, Single-Photon