BACKGROUNDS: Various methods have been devised for choosing the correct internal diameter (ID) of endotracheal tubes and the proper lengths for oral endotracheal tubes at different ages in children. This study was performed to evaluate the appropriate sizes of uncuffed endotracheal tubes and distance from upper incisor to carina in Korean children under 8 years old. METHODS: Five hundred thirty five children under 8 years in ASA class 1 and 2 were evaluated for the study by age groups: 0~3 months, 4~11 months and every each year until 8 years. Appropriate sizes were to permit a gas leak at 15~25 cmH2O with positive pressure ventilation. Distances from incisor to carina were at the point which bilateral lung sounds were noticed during slow extubation from endobroncheal intubation. RESULTS: Appropriate tube sizes were 3.0 mm to 3.5 mm for infants under 3 months, 3.5 mm to 4.0 mm for 4 to 11 months and ""4.15+0.28xage (yr) (mm)"" (R2=0.77, p<0.05) for children between 1 and 8 years old. Distances from upper incisor to carina were 12.0 cm for infants under 3 months, 13.7 cm for 4 to 11 months and ""14.5+0.6xage (yr) (cm)"" (R2=0.62, p<0.05) for children between 1 and 8 years old. CONCLUSIONS: We conclude that the endotracheal tube ID for the Korean children are a little greater than those of previous reports in foreign countries and airway lengths for the Korean children are similar to those of foreigners.
Child* ; Emigrants and Immigrants ; Humans ; Incisor* ; Infant ; Intubation ; Positive-Pressure Respiration ; Respiratory Sounds

The validation study for two STR loci on X-chromosome, DXS7132 and GATA31D10, was done including allelic distribution and frequency of each allele to use these results for individual identification and paternity testing. For 496 unrelated Koreans, above two STR loci were amplified simultaneously using duplex PCR amplification method. The amplified products were analyzed by polyacrylamide gel electrophoresis followed by silver staining. In male DXS7132 locus revealed 7 different alleles ranging from 276bp to 300bp. The largest allele was consisted of 14 repetition of [TCTA] unit and took 0.3417. The allele 15 followed next as 0.3165 and allele 13 as 0.1726. In female general distribution was same except one allele, allele 18 was found additionally. The heterozygosity was 0.7706 and 23 different genotypes were found. Polymorphism information content(PIC) was 0.727. Two cases of mutation were noted in DXS7132 locusIn both male and female 7 different alleles were noted in GATA31D10 locus and the alleles ranged from 195bp to 231bp. The allele 15(199bp) took the majority of all as 0.825. The other alleles showed rather relatively low frequency. The heterozygosity was 0.2385 and 11 different genotypes were found. PIC was 0.2521, and no mutation was noted in GATA31D10 locus. Considering these two loci together, 22 different halpotype were noted.
Alleles ; Electrophoresis, Polyacrylamide Gel ; Female ; Genotype ; Haplotypes ; Humans ; Male ; Paternity ; Polymerase Chain Reaction ; Silver Staining

BACKGROUND: A change in urine output has been recently recognized as a valuable biomarker of acute kidney injury that is associated with mortality in critically ill patients. We investigated the prognostic impact of oliguria for survival outcomes in multiple myeloma (MM) patients presenting with renal impairment (RI). METHODS: Retrospective data on 98 patients with MM and RI, who received initial treatment with novel therapies, were analyzed. Oliguria was defined as a urine output of <0.5 mL/kg/h. RESULTS: The baseline median eGFR was 39.7 mL/min (range, 5.1-59.8). Achievement of renal complete response (CR) was observed in 39.8% of patients. Nine patients (9.2%) presented with oliguria at initial diagnosis, and 4 initially required dialysis. Over a median follow-up period of 17.1 months (range, 1.7-100.0), the median overall survival (OS) was 38.7 months (95% CI 25.0-52.5). Multivariate analyses indicated that oliguria at diagnosis [hazard ratio (HR) 3.628, 95% CI 1.366-9.849, P=0.011], and thrombocytopenia <100x10(9)/L at diagnosis (HR 2.534, 95% CI 1.068-6.015, P=0.035), were significantly associated with overall survival. CONCLUSION: Oliguria was significantly associated with higher mortality in MM patients with RI. Therefore, close monitoring of urine output could be important for these patients.
Acute Kidney Injury ; Critical Illness ; Diagnosis ; Dialysis ; Follow-Up Studies ; Humans ; Mortality* ; Multiple Myeloma* ; Multivariate Analysis ; Oliguria* ; Renal Insufficiency ; Retrospective Studies ; Thrombocytopenia

It is well known that the reactivation of hepatitis B virus (HBV) may occur as an acute hepatitis after chemotherapy or immunosuppressive therapy. Although most of these cases have been reported in HBsAg-positive patients, there have been a few reports of HBV reactivation in HBsAg-negative patients. There have been concerns for the need to screen the reactivation as well as anti-viral prophylaxis in HBsAg-negative patients with possible HBV occult infection who are planning to undergo chemotherapy or immunosuppressive therapy. Rituximab, an anti-CD20 monoclonal antibody, is effective in the treatment of non-Hodgkin's lymphoma. However, rituximab can affect the immunity against HBV, consequently increasing viral replication. In fact, there have been reports of HBV reactivation after treatment with rituximab. Here, we report a case of HBV reactivation following rituximab plus systemic chemotherapy in diffuse large B cell lymphoma patient who was HBsAg negative, anti-HBs positive, and anti-HBc positive, ultimately leading to treatment-unresponsive fulminant hepatic failure.
Aged ; Antibodies, Monoclonal/*therapeutic use ; Antineoplastic Agents/*therapeutic use ; Antiviral Agents/therapeutic use ; DNA, Viral/analysis ; Female ; Guanine/analogs &derivatives/therapeutic use ; Hepatitis B/*diagnosis/drug therapy ; Hepatitis B virus/isolation &purification ; Humans ; Liver Failure, Acute/*diagnosis ; Lymphoma, Large B-Cell, Diffuse/*drug therapy ; Recurrence

PURPOSE: Protein C and S deficiencies are frequently described as causes of the hypercoagulable states. The aim of this study was to evaluate the clinical features and prognosis of deep venous thrombosis associated with protein C and/or S deficiencies and to determine an adequate treatment modality for such cases. METHOD: A total of consecutive 42 patients with deep venous thrombosis of the lower extremity were seen in our hospital between September 2000 and August 2002. Hypercoagulability studies were done before systemic anticoagulation therapy, and the diagnosis of protein C and/or S deficiencies was confirmed if antigenic protein C and/or S levels were less than 60%. RESULT: Seven patients (16.7%) were diagnosed with deep venous thrombosis associated with protein C and/or S deficiencies. Of these, 5 patients with acute iliofemoral deep venous thrombosis were treated with catheter-directed thrombolysis therapy, and 2 with systemic anticoagulation therapy. There were no major complications or clinically detectable pulmonary emboli. CONCLUSION: Protein C and/or S deficiencies are one of the common causes of deep venous thrombosis. Considering that patients with deep venous thrombosis and protein C and/or S deficiencies should be treated with life-long anticoagulation for the prevention of recurrence, patients presenting with deep venous thrombosis without evidence of other risk factors should be evaluated for hypercoagulable states.
Diagnosis ; Humans ; Lower Extremity* ; Prognosis ; Protein C* ; Protein S ; Recurrence ; Risk Factors ; Thrombophilia ; Thrombosis ; Veins ; Venous Thrombosis*

Dermatomyositis is a clinical syndrome of unknown etiology characterized by a nonpurulent inflammatory myopathy involving striated skeletal muscle associated with rheumatoid arthritis, or systemic lupus erythematosus, sometimes underlying malignancy. A few cases of acute renal failure due to rhabdomyolysis in dermatomyositis has been reported. But, no case combined with breast cancer have been reported. We experienced a case of acute renal failure due to rhabdomyolysis associated with dermatomyositis. The patient was admitted to the our hospital due to breast cancer. After breast cancer operation, she complained of progressive muscle weakness. The heliotrope rash involved the eyelid, bridge of nose and forehead. And eczematoid dermatitis involved the lower abdomen and both forearm and hands. The laboratory findings revealed LDH 2,944IU/L, CPK 2,244IU/L and SGOT 214IU/L. Serum myoglobin and aldolase were increased, and antinuclear antibody was 1:40(positive, homogenous pattern). Electromyogram revealed myopathic findings compatible with dermatomyositis. Then, the patient developed acute renal failure requring hemodialysis. After acute hemodialysis, acute renal failure resolved. But, the patient died on the 113th hospital day due to sepsis. Here, we report a case of acute renal failure due to nontraumatic rhabdomyolysis associated with dermatomyositis in breast cancer.
Abdomen ; Acute Kidney Injury* ; Antibodies, Antinuclear ; Arthritis, Rheumatoid ; Aspartate Aminotransferases ; Breast Neoplasms* ; Breast* ; Dermatitis ; Dermatomyositis* ; Exanthema ; Eyelids ; Forearm ; Forehead ; Fructose-Bisphosphate Aldolase ; Hand ; Humans ; Lupus Erythematosus, Systemic ; Muscle Weakness ; Muscle, Skeletal ; Myoglobin ; Myositis ; Nose ; Renal Dialysis ; Rhabdomyolysis* ; Sepsis

Dental Occlusion ; Follow-Up Studies ; Humans ; Malocclusion ; Orthognathic Surgery ; Osteotomy ; Osteotomy, Sagittal Split Ramus ; Recurrence

Duodenal diverticulitis is a rare cause of upper abdominal pain and is usually not considered when evaluating patients with acute upper abdominal pain. Furthermore, the duodenum is located near the pancreas and bile duct, and duodenal diverticulitis can be misdiagnosed as acute pancreatitis, cholangitis, cholecystitis, or other pancreatobiliary disorders such as pancreatic cystic neoplasms. Recently, we experienced a rare case of duodenal diverticulitis in the 3rd portion of the duodenum. The patient presented with deep seated upper abdominal pain aggravated by supine posture and relieved by sitting up. The patient was initially diagnosed with acute pancreatitis. However, serum levels of pancreatic enzymes were normal and abdominal CT scan revealed diverticulitis in the 3rd portion of the duodenum. The patient was successfully managed conservatively. Delayed diagnosis of duodenal diverticulitis can result in substantial morbidity and mortality if duodenal perforation occurs and should be considered as a possible cause of upper abdominal pain.
Abdominal Pain* ; Bile Ducts ; Cholangitis ; Cholecystitis ; Delayed Diagnosis ; Diverticulitis* ; Duodenum* ; Humans ; Mortality ; Pancreas ; Pancreatic Cyst ; Pancreatitis ; Posture ; Tomography, X-Ray Computed

BACKGROUNDS/AIMS: Pneumatosis intestinalis (PI) is a condition in which multiple gas-filled mural cysts develop in the gastrointestinal tract. Although its exact etiology remains obscure, PI is rarely observed in liver transplant (LT) recipients. METHODS: In 317 cases of adult living donor LT (LDLT) performed during 2011, PI developed in three patients during the 3 year follow-up. RESULTS: Of these three patients, the two who demonstrated PI at 6 weeks and 2 months after LT, respectively, were asymptomatic and showed no signs of secondary complications. Diagnosis was made incidentally using abdominal radiographs and computed tomography (CT) scans. PI was identified in the right ascending colon with concomitant pneumoperitoneum. These two patients received supportive care and maintained a regular diet. Follow-up CT scans demonstrated spontaneous resolution of PI with no complications. The third patient was admitted to the emergency room 30 months after LDLT. His symptoms included poor oral intake and intermittent abdominal pain with no passage of gas. Abdominal radiography and CT scans demonstrated PI in the entire small bowel, with small bowel dilatation, pneumoperitoneum, and pneumoretroperitoneum, but no peritonitis. Physical examination revealed abdominal distension but no tenderness or rebound tenderness. After 1 week of conservative treatment, including bowel rest and antibiotics therapy, PI and pneumoperitoneum resolved spontaneously without complications. CONCLUSIONS: We suggest that adult LDLT recipients who develop asymptomatic or symptomatic PI with no signs of secondary complications can be successfully managed with conservative treatment.
Abdominal Pain ; Adult* ; Anti-Bacterial Agents ; Colon, Ascending ; Diagnosis ; Diet ; Dilatation ; Emergency Service, Hospital ; Follow-Up Studies ; Gastrointestinal Tract ; Humans ; Liver ; Liver Transplantation* ; Living Donors* ; Peritonitis ; Physical Examination ; Pneumoperitoneum ; Radiography, Abdominal ; Retropneumoperitoneum ; Tomography, X-Ray Computed

BACKGROUNDS/AIMS: Tumor recurrence is very common after hepatic resection of hepatocellular carcinoma (HCC) > or =10 cm. The purpose of this study was to validate the prognostic significance of the preoperative alkaline phosphatase (ALP) level and early intrahepatic metastasis in HCC patients who underwent resection of large HCC. METHODS: Clinical data of 100 large HCC patients who underwent liver resection were retrospectively reviewed. All of them underwent protocol transarterial chemoinfusion (TACI) at 1 month. RESULTS: Median tumor diameter was 13.8 cm, and 94% were single lesions. Systematic and non-systematic resections were performed in 91% and 9%, respectively, with R0 resection achieved in 84%. Overall 1-, 3- and 5-year survival rates were 76%, 38.5%, and 30.4%, respectively. Univariate analyses on patient survival revealed that intrahepatic metastasis on 1-month protocol TACI was the only significant risk factor (p=0.002). Mean ALP values according to the intrahepatic metastasis on 1-month protocol TACI were 124.6+/-76.9 IU/L and 145.1+/-92.6 IU/L, which did not show a statistical difference (p=0.23). CONCLUSIONS: In patients with large HCC, 1-month protocol TACI combined with hepatic resection may contribute to the early detection and timely treatment of potentially preexisting metastatic lesions.
Alkaline Phosphatase ; Carcinoma, Hepatocellular* ; Humans ; Liver ; Neoplasm Metastasis* ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate