No abstract available.
Carcinoma, Squamous Cell* ; Prognosis*

Broncho-gastric fistula caused by benign gastric ulcer perforation after esophagectomy is very rare. In general anesthesia of a patient with broncho-gastric fistula, in spite of hyperventilation, leakage of the anesthetic gases through fistula may make the patient hypercapneic, and positive pressure ventilation may increase the risk of the pulmanary aspiration by the regurgitation of gastric fluid by stomach distension. For that reason, in this patient, denitrogenation was performed during patient's voluntary respiration with 100% oxygen for 5 minutes, and induction was performed without positive pressure ventilation, and one lung ventilation was carried out. Hypoxemia was followed by one lung ventilation because his pulmonary function was moderate obstructive type and his lung was damaged by aspiration of gastric fluid via broncho-gastric fistula. A low level of continuous positive airway pressure (CPAP) has no significant hemodynamic effect and can maintain the patency of nonventilated lung, so hypoxemia induced by one lung ventilation may be reduced. Thus we carried out one lung ventilation with CPAP (10 cmH2O) in nonventilated lung and blocked broncho-gastric fistula with a bronchial blocker for prevention of both regurgitation of gastric fluid and leakage of anesthetic gases. One lung anesthesia was performed without any problem in this case.
Anesthesia ; Anesthesia, General* ; Anesthetics, Inhalation ; Anoxia ; Continuous Positive Airway Pressure ; Esophagectomy ; Fistula* ; Hemodynamics ; Humans ; Hyperventilation ; Lung ; One-Lung Ventilation ; Oxygen ; Positive-Pressure Respiration ; Respiration ; Stomach ; Stomach Ulcer

Gelastic Seizure(Ictal laughter) is frequently associated with hypothalamic hamartoma that is congenital tumor composed of heterotrophic and hyperplastic tissue located in the hypothalamus near the interpeduncular cistern, tuber cinereum, and mamillary body. The seizure usually begins in infancy or childhood and may be accompanied with precocious puberty and cognitive decline. A 14 year-old boy visited to our hospital because of paroxysmal frequent involuntary laughing regardless of emotional change. Brain MRI showed nonenhancing hypothalamic mass that had isointensity with gray matter on T1W1 and hyperintensity on T2Wl. So it was suspected that he had a gelastic seizure accompanied with hypothalamic hamartoma.
Adolescent ; Brain ; Hamartoma* ; Humans ; Hypothalamus ; Magnetic Resonance Imaging ; Male ; Mamillary Bodies ; Puberty, Precocious ; Seizures* ; Tuber Cinereum

OBJECTIVES: Avascular necrosis of bone has been frequently documented in association with systemic lupus erythematosus and it has been suggested by many investigators that systemic factors may be implicated in its pathogenesis. In order to define the incidence, clinical feature and related risk factors of avascular necrosis in corticosteroid- treated rheumatic disease patients, we conducted this retrospective study. METHODS: Medical records of 278 patients with diagnoses of systemic lupus erythematosus (SLE), polymyositis/dermatomyositis, overlap syndrome comprising either of SLE, polymyositis, or dermatomyositis, and mixed connective tissue disease were reviewed with regards to the following: 1) duration of disease, risk factors of avascular necrosis, such as the presence of Raynaud phenomenon, small vessel vasculitis, alcoholism. 2) history of steroid treatment, including duration, initial dose, cumulative dose and mean daily dose during follow-up, cumulative dose and mean daily dose during the first year of disease, history of steroid pulse therapy, and history of cytotoxic drug therapy. 3) laboratory findings including false positive VDRL, lupus anticoagulant, anti-phospholipid antibody, and activated partial thromboplastin time. 4) Development of avascular necrosis, duration of disease, activity of disease at the time of diagnosis of avascular necrosis, and the site. RESULTS: Nineteen patients developed avascular necrosis leading to the incidence rate of 18.5/1,000 patient-year. Sites of involvement were hip in 16 cases(84.2%), talus in 2 cases(10.5% ), and phalanx, scaphoid, and humerus in 1 case(5.3% ), respectively. Fifty-eight percent of patients had involvement in more than one site. Presence of Raynaud phenomenon, small vessel vasculitis, history of cytotoxic therapy, history of steroid pulse therapy, cumulative dose and mean daily dose of steroid during follow-up and 1st year of diagnosis were not significantly different between the 2 groups. CONCLUSIONS: The incidence of avascular necrosis in our patient population was similar to that reported in SLE patients previously, but other risk factor including steroid dosage could not be identified.
Alcoholism ; Dermatomyositis ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Hip ; Humans ; Humerus ; Incidence ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic ; Medical Records ; Mixed Connective Tissue Disease ; Necrosis* ; Osteonecrosis ; Partial Thromboplastin Time ; Polymyositis ; Raynaud Disease ; Research Personnel ; Retrospective Studies ; Rheumatic Diseases* ; Risk Factors ; Talus ; Vasculitis

BACKGROUND: Infantile Hypertrophic Pyloric Stenosis (IHPS) is one of the most common surgical problems of early infancy and one for which an eminently successful surgical treatment has been available since the work of Ramstedt in 1912. A clinical study was begun to access further the accuracy of ultrasonography in identifying hypertrophic pylorus. METHODS: This study is a retrospective clinical analysis of 31 cases of IHPS treated at the Department of Surgery of Pohang St. Mary's Hospital from Jan. 1990 to Dec. 1997. RESULTS: (1) The most prevalent age group was between 3 weeks and 8 weeks in 24 cases (77.4%), and the ratio of males to females was 5.2:1. (2) Among the 31 cases, new born babies were 21 cases (67.7%). (3) In 30 cases (96.8%), the gestational age was between 37 weeks and 42 weeks, and the birth weight was more than 3.5 kg in 21 cases (67.7%). The body weight percentile at admission was lower than the 50 percentile in 31 cases. (4) Among the 31 cases, breast-fed infants were 15 cases (48.4%), milk-fed 13 cases (41.9%), and mixed-fed 3 cases (9.7%). B type blood group was 23 cases (74.2%), and O type was 4 cases (12.9%). (5) In 4 cases (12.9%), an inguinal hernia was noted as an associated anomaly. (6) The onset of symptoms was neonatal (1 week-12 weeks) in all 31 cases, and the duration of the symptoms was between 1 week and 2 weeks in 18 cases (58.1%). (7) Non-bile stained, projectile vomiting was noted in all 31 cases (100.0%), an olive-shaped mass in right upper quadrant of the abdomen was felt in 27 cases (87.1%), and visible peristalsis on the epigastrium was noted in 25 cases (80.6%). (8) On laboratory tests, 17 patients had leukocytosis, and anemia was observed in 2 cases. Hypokalemia was observed in 9 cases (29.0%), hypochloremia in 4 cases (12.9%), and moderate to severe alkalosis (CO2 content > 25 mEq) in 7 cases. (9) Among the 25 cases, for which an the ultrasonographic evaluation was performed, the length of the stenotic canal was from 16 mm to 20 mm in 23 cases (92.0%), and the thickness of the stenotic portion was from 5 mm to 6 mm in 21 cases (84.0%). (10) All 31 cases were surgically treated by using a Fredet-Ramstedt pyloromyotomy, and the mortality was nil. The average hospitalization was 9.4 days. (11) There was 1 case of duodenal perforation and 1 case of intermittent non-projectile vomiting after the operation. CONCLUSIONS: We conclude that early accurate diagnosis, adequate preoperative preparation of the fluid & electrolyte imbalance, immediate surgical correction, and scheduled careful oral feeding are important in treatment of IHPS. Ultrasonographic determination of pyloric muscle length and thickness is the most accurate of the currently available techniques. A Fredet-Ramstedt pyloromyotomy is a safe and successful surgical procedure.
Abdomen ; Alkalosis ; Anemia ; Birth Weight ; Body Weight ; Diagnosis ; Female ; Gestational Age ; Gyeongsangbuk-do ; Hernia, Inguinal ; Hospitalization ; Humans ; Hypokalemia ; Infant ; Leukocytosis ; Male ; Mortality ; Peristalsis ; Pyloric Stenosis, Hypertrophic* ; Pylorus ; Retrospective Studies ; Ultrasonography ; Vomiting

Motor impairment due to stroke limits patients’ mobility, activities of daily living, and negatively affects their return to the workplace. It also reduces patients’ quality of life and increases the socioeconomic burden of stroke. Therefore, optimizing the recovery of motor impairment after stroke is a very important goal for both individuals and society as a whole. The emergence and improvement of various technologies in the Fourth Industrial Revolution have exerted a major influence on the development of new rehabilitation methods and efficiency enhancements for existing methods. This review categorizes rehabilitation methods that promote the recovery of motor function into upper limb function and lower limb function and summarizes recent advances in stroke rehabilitation. Although debate continues regarding the effects of some rehabilitation therapies, it is hoped that the evidence will be improved through ongoing research so that clinicians can treat patients with a higher level of evidence.

Background and Objectives: Many patients experience hypothyroidism after lobectomy. The purpose of this study was to investigate the effects of the extent of surgery (isthmus-saving lobectomy vs. isthmus-removing lobectomy) on postoperative hypothyroidism after lobectomy. Materials and Methods: In total, 144 consecutive benign or low-risk papillary thyroid cancer patients with euthyroid status were retrospectively enrolled from January 2016 to June 2018; 100 patients underwent isthmus-saving lobectomy (IS group), and 44 patients underwent isthmus-removing lobectomy (IR group). Thyroid function tests (TSH) were performed at 3, 6, 12, and 24 months after surgery. Levothyroxine was administered to patients with overt hypothyroidism and those with subclinical hypothyroidism who complained of obvious symptoms of hypothyroidism. Results: The TSH level was significantly lower in the IS group at 3 and 6 months after surgery (p=0.049 and 0.026, respectively). Among patients with TSH ＜2 μIU/mL preoperatively, 17 patients (17/66=25.8%) in the IS group had significantly maintained TSH levels at ＜2 μIU/mL compared with 2 patients (2/21=9.5%) in the IR group even after surgery (p=0.039). Postoperative overt hypothyroidism was found in 5 patients (5.0%) in the IS group and 6 patients (13.6%) in the IR group (p=0.048), and the numbers of patients who took medication after the surgery, 10 (10%) and 14 (31.8%), were significantly lower in the IS group (p=0.001). Conclusion Isthmus-saving lobectomy in patients with euthyroid status reduced the incidence of postoperative hypothyroidism and thyroid hormone replacement and helped in maintaining a low TSH level when compared with isthmus-removing lobectomy.

The cardiac function of the patients with chronic renal failure, who have had routine hemodialysis for long period is influenced by many factors including hypertension, anemia, artherosclerosis, interdialytic fluid collection and acidosis. Also the fluid shifts that occur during dialysis can alter left ventricular loading conditions. Hemodialysis may also influence left ventricular contractility by virture of its ability to correct electrolyte imbalances, BUN, hematocrit and concentration of inotrophics. Ten patients with chronic renal failure, who have hemodialysis during more than 6 months were studied for the effect of hemodialysis on left ventricular function through echocardiography. 1) Body weight and systolic blood pressure were decreased(P<0.05) and diastolic blood pressure mean arterial blood pressure and heart rate did not increased significantly. 2) Serum calcium increased and BUN and serum potassium decreased significantly(P<0.05). 3) The prolonged preejection period, decreased left ventricular ejection time, stroke volume, endsystolic wall stress and increased rate corrected velocity of circumferential fiber shortening, shortening fraction had statistical significance. In conclusion, hemodialysis can improve cardiac function as decreased preload and increased left ventricular contractility from the patients with chronic renal failure.
Acidosis ; Anemia ; Arterial Pressure ; Blood Pressure ; Body Weight ; Calcium ; Dialysis ; Echocardiography ; Fluid Shifts ; Heart Rate ; Hematocrit ; Humans ; Hypertension ; Kidney Failure, Chronic* ; Potassium ; Renal Dialysis* ; Stroke Volume ; Ventricular Function, Left*

Wegener's granulomatosis is characterized by necrotizing granulomatosis lesion of the respiratory tract, glomerulonephritis and frequently vasculitis involving other organs. The basic pathophysiologic mechanism of Wegener's granulomatosis is not defined yet. However, it may be suspected an autoimmune disease. We experienced a case of Wegener's granulomatosis which are associated with acute renal failure and pneumothorax. The patient suffered from hemoptysis, fever and cough. Despite antibiotic therapy, symtoms did not improved and multiple varying sized nodules were aggravated on chest roentogenogram and serum creatinine elevated 3.4mg/dl. After diagnosis using video associated thoracoscopic surgery, the patient was treated with cyclophsphamide, glucocorticoid and sulfamethoxasole-trimethoprime. With the combination therapy, the patient felt completely well and chest roentogenogram showed lungs were improved and serum creatinine was normal. The patient was readmitted because of right pleuritic pain and dyspnea 15 day after discharge. The patient was developed a right pneumothorax. The lung was easily expanded by intercostal tube drainage with a one way valve. The patient has been treated as an out- patient with immunosuppressive agents continously.
Acute Kidney Injury* ; Autoimmune Diseases ; Cough ; Creatinine ; Diagnosis ; Drainage ; Dyspnea ; Fever ; Glomerulonephritis ; Hemoptysis ; Humans ; Immunosuppressive Agents ; Lung ; Pneumothorax* ; Respiratory System ; Thoracoscopy ; Thorax ; Vasculitis ; Wegener Granulomatosis*

BACKGROUND AND OBJECTIVES: It had been well known that Lipoprotein(a) had proatherogenic and thrombogenic action because of structural similarity with plasminogen. However the role of Lipoprotein (a) (Lp(a)) in the development of ischemic cerebrovascular disease had not sufficiently clarified. The aim of this study was to evaluate the effect of diabetes mellitus (DM) and hypertension (HBP) to the role of Lp(a) as a risk factor of ischemic cerebrovascular disease. METHOD: For comparing Lp(a) and the lipid profile of ischemic stroke group (5, N=232) with those of control group (C, N=158), we divided each group into four subgroups according to the existance of DM and HBP: stroke patients and control subjects with DM only(DMS, N=27; DMC, N=44), those with HBP only(HBPS, N=94; HBPC, N=44), those with both of DM and HBP (DMHBPS, N=46; DMHBPC, N=29), and those with none of DM and HBP(NS, N=65; NC, N=41). We evaluated Lp(a) and the lipid profile measured less than 72 hour after onset of stroke and 3 month later in 33 ischemic stroke patients. Also we divided the stroke group into two subgroups according to the type (large artery thrombotic vs small artery perforating) and the age of onset (below 50 year-old vs above 50 year-old), and compared Lp(a) and the lipld profile in each subgroups. RESULT: 1. In control group, the Lp(a) in DMC was significantly higher t that in NC. 2. The Lp(a) compared between HBPC & HBPS and between & NS were statistically significant. 3. The Lp(a) in DMS revealed no significant difference compared with that in DMC. 4, The type of ischemic stroke did not give specific Lp(a) level. 5. The Lp(a) in the young age onset revealed no significant difference compared with that in the old age onset. CONCLUSION: The Lp(a) is likely to contribute to the ischemic stroke at independent risk factor, However it is seemed that the role of Lp(a) as a risk factor of the ischemic stroke is evaluated after being subdivided according existence of DM.
Age of Onset ; Arteries ; Diabetes Mellitus ; Humans ; Hypertension* ; Lipoprotein(a) ; Middle Aged ; Plasminogen ; Risk Factors* ; Stroke