Aspiration can generate postoperative pulmonary morbidity of varing severity, depending on the type and volume of the aspirate. Epidural anesthesia can lead to local anesthetic systemic toxicity with mental change, followed by respiratory depression and abdominal and intercostal muscle weakness depressing the ability of the patient to cough and clear the airway. The authors experienced a case of pulmonary aspiration with systemic toxicity after epidural anesthesia for cesarean section. The chest X-ray showed alveolar consolidation at left lower lung field and arterial blood gases showed that PaO2 decreased. The exact causes of mental change and respiratory depression were unknown, but we suspected it lidocaine induced systemic toxicity due to vascular absorption, When airway reflexes are ineffective during face mask ventilation of the lungs, aspiration of clear oral secretions can generate small airway obstruction.
Absorption ; Airway Obstruction ; Anesthesia, Epidural* ; Cesarean Section ; Cough ; Female ; Gases ; Humans ; Intercostal Muscles ; Lidocaine ; Lung ; Masks ; Pregnancy ; Reflex ; Respiratory Insufficiency ; Thorax ; Ventilation

PURPOSE: Predicting life expectancy of terminally ill cancer patients is very important. In many studies, ferritin is detected at higher levels in the sera of cancer patients, and higher ferritin level correlates with aggressiveness of disease and poor outcomes of patients. This study evaluated a prognostic role of serum ferritin levels in terminally ill cancer patients. METHODS: This study enrolled 65 terminally ill cancer patients from March through June 2012. We assessed routine laboratory findings including serum ferritin levels as well as demographic and clinical characteristics of the patients. To examine the association between serum ferritin levels and patient's characteristics, we used Spearman's correlation analysis, Wilcoxon's rank sum test or Kruskal-Wallis test, as appropriately. For multivariate analysis, Cox's proportional hazard regression model was used to evaluate significance of serum ferritin levels as a prognostic factor. RESULTS: A negative correlation between serum ferritin levels and survival time was found. After adjusting for sex, age, performance status, creatinine levels and white blood cell counts, serum ferritin levels were significantly associated with survival time. CONCLUSION: Even at the very end of life of terminal cancer patients, serum ferritin levels were an independent prognostic factor for survival.
Creatinine ; Ferritins* ; Humans ; Leukocyte Count ; Life Expectancy ; Multivariate Analysis ; Prognosis ; Terminally Ill*

Polyomavirus disease is a re-emerging infectious complication in renal transplantation. It manifests as symptomless renal dysfunction and progresses to graft loss unless the prompt diagnosis and intervention are initiated. A gold standard for diagnosis is the renal biopsy. Recently, the molecular diagnosis can be made using plasma PCR technique before histologic confirmation. Reduction of immunosuppression is a mainstay of treatment. Leflunomide and other antiviral agents could be used successfully in selected cases. The screening using urine decoy cell and subsequent plasma PCR may detect the BK viral replication, and preemptive intervention will prevent development of overt nephropathy without risk of rejection. This review will cover the recent advances and clinical issues in diagnosis and management of polyomavirus disease, mainly BK virus associated nephropathy.
Antiviral Agents ; Biopsy ; BK Virus ; Immunosuppression ; Isoxazoles ; Kidney ; Kidney Transplantation ; Mass Screening ; Plasma ; Polymerase Chain Reaction ; Polyomavirus ; Polyomavirus Infections ; Rejection (Psychology) ; Transplants

Purpose: To identify the incidence and characteristics of immediate substitutions of injured players that occurred during Korean professional football league matches. Methods: This study included injuries that resulted in immediate substitutions of injured players during Korean professional football league matches. The match broadcasting records were used to check the date of the match, home-away matches, the team to which players belong, the position on the field of play, and the time of injury.The match recording videos were used to evaluate the injury mechanism and the injured area. Results: In 228 matches, 66 immediate substitutions of injured players occurred, with an incidence rate of 0.3 per match. Total number of substitutions due to injuries most frequently occurred in May, with 15 substitutions in 30 matches; however, after considering the number of substitutions per match in each month, November was the most severe month with 0.53 substitutions after injuries per match. Most frequently injured players were defenders (36.4%), followed by midfielders, forwards, and goalkeepers. Immediate substitutions of injured players took place 32 times in the first half and 34 times in the second half. 51.5% of all injuries were related to collisions, and injuries to the knee and thigh accounted for 45.5% of all injuries. Conclusion There were 66 immediate substitutions of injured players during a single season of the Korean professional football league, with 0.3 substitutions after injuries per match. To prevent and manage serious injuries that can occur during a football match, a thorough analysis of risk factors of injuries that lead to immediate substitution is required.

Objective: : To evaluate and compare the clinical and radiographic features of 25 patients with infectious spondylitis treated with anterior debridement and reconstruction using autogenous bone grafts vs. a metal cage with allogenic bone grafts. Methods: : The study analyzed 25 patients diagnosed with infectious thoracolumbar spondylitis who underwent anterior radical debridement and reconstruction. Autogenous bone grafts were used in 13 patients (group 1), and a metal cage with allogenic bone grafts was used in 12 patients (group 2). Clinical outcomes were assessed by the visual analogue scale (VAS) scores and neurological status. Additionally, the serological results and the radiographic results using the sagittal Cobb angle were compared. Fusion was evaluated by computed tomography (CT) imaging at 24 months postoperatively. Results: : Both groups showed a significant decrease in the postoperative mean VAS scores; however, only, group 1 patients showed a significantly higher VAS score than group 2 patients, 1 month postoperatively (p=0.002). The postoperative neurological status significantly improved. Elevated C-reactive protein levels and erythrocyte sedimentation rate values returned to normal limits at the 2-year follow-up without recurrent infection. No significant intergroup difference was observed in Cobb angle. Bony fusion was confirmed in all patients at CT 24 months postoperatively. Conclusion : Although the use of a metal cage with allogenic bone grafts for anterior column reconstruction remains controversial, our results suggest that it can be considered as an effective treatment of option for anterior column reconstruction in patients with infectious spondylitis.

BACKGROUND: ADPKD is one of the most common hereditary renal disease in adult and is a systemic disorder with a variety of cardiovascular manifestations. To elucidate the clinical characteristics of cerebrovascular complications in Korean ADPKD patients, we reviewed the medical records of ADPKD patients who was registered in ADPKD clinic of Seoul National University Hospital. METHODS: A total of 18 adult patients were included and their sex ratio was 8:10. The median age of ADPKD diagnosis was 45.5 year (range 19-85), and age at cerebrovascular accident(CVA) was 52 years(22-82). The median duration from hypertension to CVA was 8 years(0-30). RESULTS: There were 5 cases of infarction, 4 cases of intracerebral hemorrhage, 4 cases of subarachnoid hemorrhage, and 4 cases of transient ischemic attack. Other clinical parameters of ADPKD were not different from patients who were not complicated with CVA. Intracranial aneurysms were detected in 6 patients and their median age at diagnosis was 47.5 years(33-66). Four cases were manifested as subarachnoid hemorrhage. Five cases were diagnosed through TFCA, and two of them were revealed as multiple aneurysms. Five cases received surgical treatment and five of six cases improved without any neurologic sequeale. MR angiography(MRA) were taken in 16 asymptomatic patients, and multiple aneurysms were newly detected in one of them. CONCLUSION: Cerebrovascular complications in Korean ADPKD patients were not significantly different from western patients. Intracranial aneurysms must be included in differential diagnosis in ADPKD patients who manifest an acute neurologic symptoms, and high-risk group need to be screened selectively with MRA.
Adult ; Aneurysm ; Cerebral Hemorrhage ; Diagnosis ; Diagnosis, Differential ; Humans ; Hypertension ; Infarction ; Intracranial Aneurysm ; Ischemic Attack, Transient ; Medical Records ; Neurologic Manifestations ; Polycystic Kidney, Autosomal Dominant* ; Seoul ; Sex Ratio ; Subarachnoid Hemorrhage

Formalin-fixed, paraffin-embedded samples of 32 brain tumors(8 meningiomas, 10 astrocytomas(low grade 5, anaplastic 5), 8 glioblastoma multiforme, 6 oligodendrogliomas(low grade 2, anaplastic 3) were investigated by immunocytochemistry with monoclonal antibodies against p53 protein and proliferating cell nuclear antigen(PCNA). Expression of p53 protein was detected in 1 of 5 cases(20%) of low grade astrocytomas, 2 of 5 cases(40%) of anaplastic astrocytoma, 4 of 8 cases(50%) of glioblastoma multiforme and 4 of 4 cases(100%) of malignant oligodendroglioma. All low grade oligodendrogliomas, meningiomas fail to express p53. Expression of PCNA was detected in 3 of 8 cases of meningioma with very low labeling index(0-0.3), 2 of 5 cases of low grade astrocytoma with low labeling index(0-11.3), 3 of 5 cases of anaplastic astrocytoma with middle labeling index(0-28.2), 6 of 8 cases of glioblastoma multiforme and 4 of 4 cases of malignant oligodendroglioma with high labelling index(0-92.3, 7.6-48.1). Expression of PCNA was not detected in low grade oligodendrogliomas. Tumor group with high expression of p53 protein showed increment of PCNA expression. A strong positive correlation between tumor grade and extent of p53 protein and PCNA expression was found(p<0.002) .
Antibodies, Monoclonal ; Astrocytoma ; Brain Neoplasms* ; Brain* ; Glioblastoma ; Immunochemistry ; Immunohistochemistry ; Meningioma ; Oligodendroglioma ; Proliferating Cell Nuclear Antigen*

The author reviewed 294 cases of surgically treated cerebral aneurysms during the period from January, 1987 to December, 1992. The results were as follow: The sex ratio between male and female was 1:1.53 and the mean age was 51.3 years. 2) At admission, 220 patients were in relatively good neurologic condition and functional recovery was obtained in 229 patients(78%). 3) The most common site was anterior communicating artery and the number of posterior circulation aneurysms was 12(4%). 4) The incidence of multiple aneurysms was 4% and clinical vasospasm was observed in 19% of the patients. 5) Operative mortality was 8.8% and the prognostic factors were related with age, sex, history of hypertension, amount of SAH, size and site of aneurysm, preoperative neurologic state, clinical vasospasm, and timing of operation.
Aneurysm ; Arteries ; Female ; Humans ; Hypertension ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Sex Ratio

BACKGROUND: Propofol is used worldwide for its sedative effective; nonetheless, has the serious side effect of respiratory depression. An increased blood concentration of propofol is well known to be associated with increased respiratory depression. However, there are no studies of the effect site concentration inducing respiratory depression. The purpose of this study was to determine the effect site concentration inducing respiratory depression of propofol when sedating a patient after spinal anesthesia. METHODS: This study included thirty seven males who received operations with spinal anesthesia, which was performed on L3-4 and L4-5. All patients were monitored with the bispectral index and were continuously infused with propofol using target controlled infusion. Respiratory depression was diagnosed when one of the following was evident without upper respiratory obstructive signs: a greater than 20% increase of end tidal carbon dioxide from baseline pressure or pulse oximetry oxygen saturation lower than 95%. We obtained the EC5, EC10, and EC50 of the effect site propofol for respiratory depression. RESULTS: The EC5 of propofol for respiratory depression was 3.09 mcg/ml (95% CI, 2.60-3.58). The EC10 of propofol for respiratory depression was 3.18 mcg/ml (95% CI, 2.57-3.80). The EC50 of propofol for respiratory depression was 3.99 mcg/ml (95% CI, 2.36-5.61). CONCLUSIONS: The EC5, EC10, and EC50 of effect site propofol for respiratory depression during spinal anesthesia were 3.09 mcg/ml ,3.18 mcg/ml, and 3.99 mcg/ml, respectively.
Anesthesia, Spinal ; Carbon Dioxide ; Humans ; Male ; Oximetry ; Oxygen ; Propofol ; Respiratory Insufficiency

Melanosis ilei is a condition that's characterized by gross greyish-black or brownish-black pigmentation of the mucosa of the terminal ileum. There were several substances that produce gastrointestinal tract pigmentation such as lipofuscin, iron sulphide (FeS), Hemosiderin and exogenous material such as silicates and titanium. We report here on a case of a 58-year-old female who ingested charcoal for a long time, and she was diagnosed with melanosis ilei by colonoscopy. Her condition improved after she stopped ingesting the charcoal.
Charcoal ; Colonoscopy ; Female ; Gastrointestinal Tract ; Hemosiderin ; Humans ; Ileum ; Iron ; Lipofuscin ; Melanosis* ; Middle Aged ; Mucous Membrane ; Pigmentation ; Silicates ; Titanium