BACKGROUND: We studied the effects of intraperitoneal CO2 insufflation and/or the reversed Trendelenburg position on airway pressure and compliance of the total respiratory system. METHODS: We selected and randomly allocated eighty adults to a control group C or laparoscopy group L. Without premedication, propofol and vecuronium were injected for anesthesia. In the supine position we checked peak and plateau airway pressures, and calculated the dynamic and static compliance of the total respiratory system. We only used 10o reverse Trendelenburg position in group C, and used both 10o reverse Trendelenburg position and abdominal CO2 insufflation in group L. Afterwards, we checked airway pressure and compliance and compared them between groups. RESULTS: In group C, there was no change in airway pressure and compliance. But in group L, peak airway pressure (13.9 +/- 2.4 vs 21.0 +/- 3.3 cmH2O) and plateau airway pressure (11.7 +/- 2.1 vs 18.9 +/- 3.2 cmH2O) were increased and dynamic compliance (47.7 +/- 9.1 vs 30.6 +/- 5.9 ml/cmH2O) and static compliance (58.4 +/- 12.4 vs 13.1 +/- 7.3 ml/cmH2O) of the total respiratory system were decreased. CONCLUSION: In a laparoscopic cholecystectomy, intraabdominal insufflation of CO2 raises airway pressure and reduces compliance of the total respiratory system. Reverse Trendelenburg position itself does not affect airway pressure and compliance.
Adult ; Anesthesia ; Cholecystectomy, Laparoscopic ; Compliance* ; Head-Down Tilt* ; Humans ; Insufflation* ; Laparoscopy ; Premedication ; Propofol ; Respiratory System ; Supine Position ; Vecuronium Bromide

BACKGROUND: This study was planned to evaluate the influence of propranolol and esmolol on cerebral circulation and to estimate clinical implications and usefulness. METHODS: This study was designed to measure vital signs, cerebrospinal fluid pressure, cerebral perfusion pressure and blood flow velocity of common carotid artery. This was measured by Doppler Flowmeter after intravenous administration of propranolol 12.5, 25, 50 microgram/kg (P-12.5, P-25, P-50, respectively), and esmolol 0.5, 1.0, 2.0 mg/kg (E-0.5, E-1.0, E-2.0 group, respectively) at 1 or 2 minute intervals for 14 minutes. RESULTS: In the propranolol group (P-12.5, P-25 and P-50), the systolic blood pressure (SBP) significantly decreased since postinjection 1 minute and this decreased pressure continued throughout the entire experiment. But in esmolol group (E-0.5, E-1.0 and E-2.0), the SBP decreased significantly and rapidly recovered within 4 minutes. Heart rate significantly decreased in the propranolol group and continued throughout the experiment, but in the esmolol group the heart rate decreased and rapidly recovered within 10 minutes. The duration of the decreased heart rate in the esmolol group was shortened by decreasing the dosage. The blood flow velocity of the common carotid artery significantly decreased at 1 to 14 minutes after the injection of propranolol, but in group E-1.0, it was significantly decreased at 1 to 2 minutes, and in group E-2.0 at 1 to 3 minutes. CONCLUSIONS: The esmolol group showed less changes of SBP, heart rate and common carotid artery flow, and shorter duration of effect than the propranolol group. Mean blood pressure, cerebrospinal fluid pressure and cerebral perfusion pressure had no significant differences between propranolol and esmolol groups.
Administration, Intravenous ; Blood Flow Velocity ; Blood Pressure ; Carotid Artery, Common* ; Cerebrospinal Fluid Pressure ; Flowmeters ; Heart Rate ; Perfusion ; Propranolol* ; Rabbits* ; Vital Signs*

PURPOSE: The sole available treatment for the majority of epilepsy patients is antiepileptic drug therapy. Drug compliance is an important factor for adequate treatment. This study is for investigating pediatric epilepsy patients' compliance to antiepileptic drug treatment at Gil hospital, in South Korea. METHODS: From February 1997 to July 2005, retrospective studies were made on 327 patients with epilepsy in Gil hospital of Gachon medical school. The patients who were taking medication prescribed at other hospitals, were admitted to the hospital for over 30 days, had seizures due to meningitis, encephalitis or trauma were excluded. The participants included patients followed for two years or until the seizures were no longer present. RESULTS: Of the total 327 patients, the mean drug compliance was 80.8%; over 80% for 203 patients(62.1%), 80-50% for 97, under 50% for 28(8.6%). Gender, the age of patients, dose frequency, results of the EEG, MRI abnormalities, etiology of epilepsy, and the duration of the first seizure did not significantly influence drug compliance. However, the patients taking tablets or capsules showed higher compliance than those treated with powder medication. In addition, the patients who started to take drugs after the year 2000 had higher compliance than those before 2000. CONCLUSION: The patients taking tablets or capsules and those who started after 2000 had higher compliance. Although most patients had satisfactory drug compliance, 8.6% had poor compliance(under 50% of compliance); this group requires further attention to improve their compliance.
Capsules ; Child ; Compliance ; Electroencephalography ; Encephalitis ; Epilepsy ; Humans ; Meningitis ; Patient Compliance ; Retrospective Studies ; Schools, Medical ; Seizures ; Tablets

PURPOSE: Electroencephalography(EEG) is an essential method carried out for classifying seizures and taking appropriate treatment. The aim of this study is to investigate the concordance between clinical findings of epileptic seizures and EEG in children. METHODS: We enrolled 461 patients from those who visited Gil hospital from January 1, 2000 to September 30, 2008 with the chief complaint of epileptic seizure more than once and checked their first EEG at the same hospital. The clinical findings of seizure were based on the charts and interictal waking and sleep EEGs were done. RESULTS: The mean age of the patients was 6.7 years old. 497 epileptic seizures occurred and its clinical finding included 310 of partial seizures and 187 of generalized seizures. In 315 waking EEG 158 were abnormal including 118 of partial seizures, 59 of generalized seizures and 19 of both seizures, in 431 sleep EEG 239 were abnormal including 196 of partial seizures, 77 of generalized seizures and 34 of both seizures, and in waking and/or sleep EEG 273 were abnormal including 216 of partial seizures, 97 of generalized seizures and 40 of both seizures. Epileptic syndromes were observed in 90 patients. 146(41.5%) of partial seizures, 44(23.4%) of generalized seizures, and 79(87.8%) of epileptic syndromes accorded with EEG. CONCLUSION: When diagnosing seizures in children, we must consider not only clinical findings but also accurate EEG findings.
Child ; Electroencephalography ; Epilepsy ; Humans ; Seizures

BACKGROUND: Anti-tuberculosis drugs used in combination cause adverse drug reactions, but the prevalence of the reactions and risk factors have not been determined. This study aims to identify the prevalence and risk factors of adverse drug reactions (ADR) to the use of first line anti-tuberculosis drugs. METHODS: A total of 435 newly diagnosed patients with tuberculosis (44.1 years+/-19.0 years) were eligible for this study. All patients received daily oral isoniazid (300 or 400 mg), rifampicin (450 or 600 mg) and ethambutol (800 mg) for 6 months, and pyrazinamide (20 mg/kg) for 2 months. Blood tests were performed regularly (before treatment, 2 weeks after treatment, and bimonthly there after). Patients were interviewed 2 months and 6 months after treatment. A serious ADR was defined as any ADR that resulted in the discontinuation of one or more of the drugs. RESULTS: An ADR was noted in 52.6% of all patients. Gastrointestinal (19.3%), cutaneous (17.7%), hepatic (13.8%), renal (12.6%), and neurological (10.3%) ADRs were frequent and hematological (4.4%), musculoskeletal (3.0%) ADRs were less frequent. A skin ADR was associated with an elevated baseline of liver enzymes (odds ratio, 3.48; 95% CI, 1.2 to 9.9), whereas a hepatic ADR was associated with a history of chronic liver disease (odds ratio, 4.82; 95% CI, 1.7 to 13.2). The prevalence of any serious ADR was 9.7%. Occurrence of any serious ADR was associated with a history of chronic liver disease (odds ratio, 4.29; 95% CI, 1.4 to 13.6). CONCLUSIONS: Anti-tuberculosis drugs given in combination frequently caused a ADR and the findings suggest that a patient receiving anti-tuberculosis treatment should be closely monitored.
Drug-Related Side Effects and Adverse Reactions* ; Ethambutol ; Hematologic Tests ; Hepatitis ; Humans ; Isoniazid ; Liver ; Liver Diseases ; Prevalence* ; Pyrazinamide ; Rifampin ; Risk Factors ; Skin ; Tuberculosis

PURPOSE: This study was aimed to understand the experience and adjustment process of organ transplantation recipients in Korea, using grounded theory method. METHODS: Eight patients after liver transplantation and two patients after heart transplantation were selected for this study, for whom minimum follow-up duration was at least 6 months after transplantation. Data was collected from July to November 2005 through in-depth individual interviews either at home or hospital. The data were analyzed using a constant comparative method in which new data was continuously coded into categories and properties. RESULTS: Data analysis revealed that "safekeeping the graft" was the core category in experience of organ transplantation recipients. In order to safekeep transplanted organ, recipients used seven different strategies to deal with various problems and conflicts which occurred during the recovery process: 1) altering the role function of family, 2) complying the treatment regimen, 3) developing the know-how for self-care, 4) returning to the normal life, 5) keeping the positive thinking, 6) concerning for the donor, and 7) improving the self-fulfillment. CONCLUSION: The results of this study provided deep understanding on the recovery process after organ transplantation and these would help establishing more appropriate intervention to improve quality of life for organ transplantation recipients.
Adaptation, Psychological ; Follow-Up Studies ; Heart Transplantation ; Humans ; Korea* ; Liver Transplantation ; Organ Transplantation* ; Qualitative Research ; Quality of Life ; Self Care ; Social Adjustment ; Statistics as Topic ; Thinking ; Tissue Donors ; Transplants*

PURPOSE: The aim of this study was to investigate the clinical usefulness of upper gastrointestinal (GI) endoscopy in children with Henoch-Schonlein purpura (HSP). METHODS: We retrospectively analyzed the clinical, endoscopic, and histopathologic records of children with HSP who had been admitted to the Department of Pediatrics of Gil Hospital and underwent upper GI endoscopy between January 2002 and June 2009. Patients were classified into the following two groups for statistical analysis: duodenal involvement (+) and duodenal involvement (-). RESULTS: Fifty-one children with HSP underwent upper GI endoscopy; the mean age was 7.2+/-2.9 years. The upper GI endoscopy showed abnormalities of the duodenum in 38 cases (74.5%), 22 of which had duodenal ulcers. Among the biopsy specimens obtained from the duodenum of 37 cases, 13 cases (35.1%) had leukocytoclastic vasculitis, neutrophil debri, and/or extravasation of RBCs. Steroid use was more frequent in the duodenal involvement (+) group (86.8%) than the duodenal involvement (-) group (53.8%; p=0.02). The mean length of hospitalization was 13.9+/-8.43 days in the duodenal involvement (+) group and 8.1+/-4.62 days in the duodenal involvement (-) group (p=0.003). The recurrence rate was significantly higher in the duodenal involvement (-) group than the duodenal involvement (+) group (p=0.027), whereas none of the other study parameters, such as the age of onset, renal involvement, and steroid use, led to significantly higher or lower recurrence rates. CONCLUSION: These results suggest that duodenal involvement can influence the clinical course and prognosis of HSP in children.
Age of Onset ; Biopsy ; Child ; Duodenal Ulcer ; Duodenum ; Endoscopy ; Endoscopy, Gastrointestinal ; Hospitalization ; Humans ; Neutrophils ; Pediatrics ; Prognosis ; Purpura, Schoenlein-Henoch ; Recurrence ; Retrospective Studies ; Vasculitis ; Vasculitis, Leukocytoclastic, Cutaneous

We report case of a 14-year-old girl with systemic lupus erythematosus who initially presented with acute lupus pneumonitis. She had a 4-week history of exertion for the past 4 weeks, and was transferred from a regional hospital due to abnormality on chest radiographs. Chest radiographs revealed bilateral infiltration and pleural effusion on both lower lung fields. We assumed her to be infected and prescribed antibiotics. The response to antibiotics was ineffective, and viral, bacterial, and mycobacterial cultures were negative. Antinuclear and anti-dsDNA antibodies in serum were positive. The open lung biopsy revealed diffuse alveolar damage. She was diagnosed as having acute lupus pneumonitis in systemic lupus erythematosus and recovered gradually after receiving corticosteroids. Acute lupus pneumonitis may be considered even though interstitial lung involvement in systemic lupus erythematosus is relatively rare in pediatric practice and its diagnosis is difficult.
Adolescent ; Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Antibodies ; Biopsy ; Humans ; Lung ; Lung Diseases ; Lupus Erythematosus, Systemic ; Pleural Effusion ; Pneumonia ; Thorax

PURPOSE: Chlamydia trachomatis (C. trachomatis) is the most prevalent etiology of sexually transmitted diseases and also a cause of respiratory infections in infants. The purposes of this study were to determine the epidemiology, presentation, and laboratory findings of C. trachomatis respiratory infection, and to investigate its severity and hospital courses. METHODS: Between February 2002 and January 2010, we enrolled infants younger than 6 months admitted to Gil Hospital with a diagnosis of acute bronchiolits and pneumonia. Clinical findings and demographic data were reviewed in all patients. Basic laboratory examinations included white blood cell and eosinophil count. C. trachomatis was detected by enzyme immunoassay for C. trachomatis specific immunoglobulin M. RESULTS: Of 1,708 patients, C. trachomatis was detected in 142 (8.3%). The incidence increased from 2002 to 2009 and was higher in spring. C. trachomatis infection was distinguished by less fever (p<0.01) and more crackle (p<0.05) on auscultation, and strongly correlated with eosinophilia (P=0.01). The severity and clinical course of C. trachomatis infection was similar to those of infections by the other etiologies. CONCLUSION: C. trachomatis is prevalent among infants younger than 6 months with a diagnosis of acute bronchiolits and pneumonia. We must consider C. trachomatis as the etiologic agent in infantile respiratory infections and must make more effort to detect C. trachomatis.
Auscultation ; Chlamydia ; Chlamydia trachomatis ; Eosinophilia ; Eosinophils ; Fever ; Humans ; Immunoenzyme Techniques ; Immunoglobulin M ; Incidence ; Infant ; Leukocytes ; Pneumonia ; Respiratory Sounds ; Respiratory System ; Respiratory Tract Infections ; Sexually Transmitted Diseases

PURPOSE: Hospital associated infection (HAI) caused by multidrug-resistant (MDR) microorganisms has been recognized as an important issue in the world, especially in critically ill patients such as the patients admitted in the intensive care unit. There are fewer papers about MDR-HAI in pediatric patients compared to adult patients. In this study, we investigated the incidence and associated factors of MDR-HAI in children admitted to the intensive care unit (ICU) of a university hospital. METHODS: We retrospectively evaluated 135 children who were admitted in ICU for at least 3 days between January 2009 and December 2010. HAI cases were divided into MDR-HAI group and non-MDR-HAI group. Clinical characteristics and various associated factors were compared between those groups. RESULTS: In 39 patients, 45 cases of ICU-related HAI were developed. ICU-related HAI incidence was 47.7 per 1000 patient-days. Thirty-six cases (80.0%) were MDR-HAI. Acinetobacter baumannii was isolated more commonly in MDR-HAI group. And the followings were found more frequently in MDR-HAI group than non-MDR-HAI group: medical condition as an indication for ICU admission, mechanical ventilation, urinary catheterization and previous use of broad-spectrum antibiotics. Among the risk factors, previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. CONCLUSION: ICU-related HAI incidence was higher than previously reported. Previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. To investigate the characteristics of MDR-HAI in children admitted in ICU, further studies with a larger sample size over a longer period of time are warranted.
Acinetobacter baumannii ; Adult ; Anti-Bacterial Agents ; Child ; Critical Illness ; Humans ; Incidence ; Critical Care ; Intensive Care Units ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Sample Size ; Urinary Catheterization ; Urinary Catheters