Complications related to a broken stylet during endotracheal intubation have been infrequently reported. In most cases, broken stylets have been recognized by chest radiography. We report a case of unrecognized iatrogenic aspiration of a broken stylet. A 37-year-old man, who underwent explo-laparotomy two days previously, was reintubated with an uncoated stylet in the intensive care unit because of dyspnea and pulmonary congestion. He was on artificial ventilation for one day and was extubated one week later. We could not find the broken stylet on serial chest x-ray films until a metallic substance was expectorated while the patient was coughing 28 days after extubation. During the intervening period the patient did not complain of any chest discomfort and we did not realize that the broken stylet remained. The use of a plastic coated stylet and its careful observation after intubation are recommended to avoid this complication.
Adult ; Cough* ; Dyspnea ; Estrogens, Conjugated (USP) ; Humans ; Intensive Care Units ; Intubation ; Intubation, Intratracheal ; Plastics ; Radiography ; Thorax ; Ventilation ; X-Ray Film

PURPOSE: To compare chest radiographic findings of pulmonary tuberculosis in non-AIDS immunocom- promised adult patients with those in immunocompetent patients. MATERIAL AND METHOD: Eighty six patients who had pulmonary tuberculosis were included in the study. Of these, 41 were non-AIDS immunocompromised adult patients and 45 were immunocompetent adult patients. Chest radiographs obtained from 86 patients were retrospectively evaluated with regard to the followings ;the anatomic distribution and extent of tuberculous lesions, typical or atypical patterns of radiographic findings. We then compared the results in non-AIDS immunocompromised adult patients with those in immunocompetent adult patients. RESULTS: The characteristic manifestation of pulmonary tuberculosis was a tendency of pulmonary lesions to localize in the apico-posterior segments of the upper lobe and the superior segment of the lower lobe in both groups but more wide distribution such as the anterior segment and the lingular segment of the upper lobe and the basal segments of the lower lobe was frequently identified in non-AIDS immunocompromised adult patients, and also bilateral, multisegmental and multilobular extents were common findings. in immunocompetent adult patients, more common findings were in local exudative and productive lesions and several cavities in preferential sites. Atypical plain radiographic findings were more common in non-AIDS immunocompromised adult patients, and which were multiple cavitary lesions, wide extent of bronchogenic spread and tuberculous pneumonia, and .miliary disseminations and mass like lesions. CONCLUSIONS: Pulmonary tuberculosis in non-AIDS immunocompromised adult patients is characterized by frequent bilateral distribution, wide pulmonary extent, and atypical radiographic findings.
Adult* ; Humans ; Pneumonia ; Radiography, Thoracic ; Retrospective Studies ; Tuberculosis, Pulmonary*

PURPOSE: To compare the efficacy of selective laser trabeculoplasty (SLT) in patients treated with either latanoprost or dorzolamide/timolol fixed combination (DTFC) for primary open-angle glaucoma. METHODS: This retrospective study included 92 consecutive patients who underwent a 180-degree SLT for the first time. The subjects divided into two groups:patients who received latanoprost (n = 63) or DTFC (n = 29) before and after SLT. The main outcome measure was intraocular pressure (IOP) decrease over five years after SLT. The mean IOP change, mean percentage of IOP reduction, and success rates were compared between the patients treated with latanoprost and the patients treated with DTFC. Success was defined as an IOP decrease ≥ 3 mm Hg or IOP reduction ≥ 20% without additional medications, laser surgery, or glaucoma surgery. RESULTS: At the postoperative one-year follow-up, the mean IOP was 15.7 ± 2.2 mm Hg in the latanoprost group and, 16.2 ± 2.4 mm Hg in the DTFC group. At the postoperative five-year follow-up, the mean IOP was 15.1 ± 2.5 mm Hg in the latanoprost group and, 14.6 ± 1.7 mm Hg in the DTFC group. There were no statistically significant differences in IOP change, percentage IOP reduction, or success rate between the groups at each time point after the SLT (p > 0.05). CONCLUSIONS: Selective laser trabeculoplasty showed a reasonable efficacy in lowering the IOP over a five-year follow-up period. There were no significant differences in IOP lowering effect or success rate between the patients treated with latanoprost or DTFC.
Follow-Up Studies ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Laser Therapy ; Outcome Assessment (Health Care) ; Retrospective Studies ; Trabeculectomy*

Severe bradycardia has been associated with a number of medications used for induction of anesthesia. Fentanyl and other potent opioids are well known for their central vagotonic effect, particularly when given rapidly in high doses. Propofol administration has also been associated with bradycardia, and may even exert a central vagotonic or sympatholytic ef- fect, or both. The anesthetic induction with propofol fentanyl may be followed by severe bradycardia in patients who have not received atropine. The bradyeardia may be prevented by premedication with atropine. We report a case in which anesthesia was induced with fentanyl 3 ug/kg and propofol 2. 5mg/kg in 43 year old female patient undergoing oophorectomy. Twenty or thirty seconds after injection of propofol and fentanyl the reduction of blood pressure and severe bradycardia appeared along with premature ventricular contraction and Mobitz type I A-V block. Immediate therapy was initiated with injection of atropine 0.5mg and hyperventilation with 100% oxygen. After about one minute the vital sign of the patient returned to normal. We emphasize that anticholinergic and oxygen before induction with fentanyl propofol should be administered to prevent possible bradycardia and hypoxia.
Adult ; Analgesics, Opioid ; Anesthesia ; Anoxia ; Atropine ; Blood Pressure ; Bradycardia* ; Female ; Fentanyl ; Humans ; Hyperventilation ; Ovariectomy ; Oxygen ; Premedication ; Propofol ; Ventricular Premature Complexes ; Vital Signs

PURPOSE: This research was conducted to explore the experiences of graduate student women with children fulfilling multiple roles and to generate a substantive theory. METHODS: This study uses the grounded theory method based on Strauss and Corbin(1988)'s method. Interviews were conducted with 11 graduate student women who had children aged three of older. RESULTS: The core category of this research is 'Role balancing for self-generativity'. Based on the core category, three types of married women graduate students' experiences were found. They are 'concentrating on graduate-work' 'postponing graduate-work' and 'adjustment between two roles' CONCLUSIONS: Through understanding the married women's multiple roles experience process, there can be a basis for making a women's health system and social support system for the married women graduate student. Also, this research is to generate a substantive theory which can helps to change social perspectives on the quality of life for the women who will contribute in Korean society as professionals.
Aged ; Child ; Female ; Humans ; Quality of Life ; Women's Health

PURPOSE: This experimental study hypothesize that rapid degeneration of the intervertebral disc over the ability of auto-stabilization by osteophytes bridging to adjacent segments might be the pathomechanism of degenerative lumbar scoliosis (DLS).'' An effort to prove this hypothesis was attempted by confirming the differences in the expression of matrix metalloproteinase-3 (MMP-3) in DLS and pure spinal stenosis. MATERIALS AND METHODS: The intervertebral disc materials obtained during a discectomy through a posterior approach, were included in this experimental study. Two protruded herniated nucleus pulposus were included for the control group. Eight spinal stenosis and seven DLS were included as experimental groups 1 and 2, respectively. The expression of MMP-3 was evaluated by immunohistochemical staining and western blotting using anti human MMP-3 antibody. RESULTS: In the immunohistochemical stains, sparse staining was noted in the control group. More staining, however, mainly extracelluar, was noted in the discs of DLS compared with those of the spinal stenosis group. In western blotting, greater MMP-3 expression was noted in the discs of DLS (mean optical density: 20.68) than in those of the spinal stenosis group (mean optical density: 6.24) which was statistically significant (p<0.05). CONCLUSION: Rapid degeneration of the intervertebral disc might be an important factor for the pathogenesis of DLS. MMP-3 could be one of the key enzymes for the rapid degeneration of the intervertebral discs especially in DLS.
Blotting, Western ; Coloring Agents ; Diskectomy ; Humans ; Intervertebral Disc ; Osteophyte ; Scoliosis* ; Spinal Stenosis*

Candida species inhabit the skin and mucous membranes of healthy individuals with low virulence, and osteomyelitis due to candida is very rare. However, the incidence of invasive candidal infection caused by intravenous drug use, broad-spectrum antibiotics, and indwelling central venous catheter is increasing. A 73-year old man visited the outpatient clinic complaining of right shoulder pain that radiated to the right acromioclavicular joint. He had undergone multiple injection procedures followed by nonsteroidal anti-inflammatory drug therapy for several weeks. The ultrasonographic findings showed a heterogeneous mass around the right acromioclavicular joint, while the right shoulder MRI and the overall findings of the body bone scan were suggestive of osteomyelitis. Pathologic findings of ultrasonographically guided joint aspiration fluid showed acute and chronic nonspecific inflammation, while the tissue culture and staining revealed Candida parapsilosis.
Acromioclavicular Joint ; Ambulatory Care Facilities ; Anti-Bacterial Agents ; Arthritis, Infectious ; Candida ; Central Venous Catheters ; Incidence ; Inflammation ; Joints ; Mucous Membrane ; Osteomyelitis ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Skin

OBJECTIVES: The purpose of this study was to investigate the relationship between restricted activity due to oral diseases and oral health behaviors among adolescents. METHODS: A cross-sectional study design was used. The subjects were 238 middle school students and 231 high school students; a total of 469 students from 15 different schools located in 7 regions of Bucheon in Gyeonggi Province, Daejeon, and others. The adolescents who participated in the survey were chosen by convenience sampling. The association between restricted activities due to oral diseases and oral health behaviors was analyzed using multiple logistic regression analysis. RESULTS: The annual experience rate of oral diseases stood at 1.4 percent, while the number of days absent and early departures from school was 0.15 days per student. The rate of middle school students who were disturbed by oral disease with respect to sleep, eating, speaking, and/or schoolwork was 33.1 percent. In high school students, it was 40.6 percent. Dental pain and gingival bleeding were identified as major factors to the restriction of activities, and being disturbed while eating was related to cariogenic beverages. CONCLUSIONS: It would be of great social interest to support and promote oral health programs among adolescents. Therefore, a national survey of the status of activity restrictions due to oral diseases in adolescents should be implemented in order to make specific future plans.
Adolescent ; Cross-Sectional Studies ; Eating ; Hemorrhage ; Humans ; Logistic Models ; Oral Health

The incidence of endobronchial tumor in the pediatric period is very rare and the symptoms are very close to those of respiratory tract infection. Diagnosis can be delayed because of low clinical suspicion and the many ways in which these tumors can present. We report the first case, in Korea, of a pulmonary carcinoid tumor that presented with recurrent pneumonia at the same location in adolescence. Treatment is surgical and geared towards complete resection while sparing healthy lung parenchyma. Long-term and careful follow up is recommended to detect local and distant metastasis.
Adolescent* ; Carcinoid Tumor* ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lung ; Neoplasm Metastasis ; Pneumonia* ; Respiratory Tract Infections

We report here 2 cases of deep-seated mediastinitis combined with sternal osteomyelitis after tracheal reconstruction which were successfully treated with sternectomy, in-situ or free omental transfer, and pectoralis major myocutaneous flap. In case I, an 8 year-old boy with deep seated mediastinitis and sternal osteomyelitis that developed after anterior tracheoplasty through a standard midline sternotomy. In case II, a 50 year-old female patient with mediastinal abcess and sternal osteomyelitis that developed after resection and end-to-end anastomosis of the trachea through an upper midline sternotomy. Treatments consisted of drainage and irrigation followed by wide resection of the infected sternum, placement of the viable omentum into the anterior mediastinal space, and chest wall reconstruction with a pectoralis major myocutaneous flap. The omentum was transferred as an in-situ pedicled graft in case I and a free graft in case II. Both patients have recovered smoothly wit out any events and have been doing well postoperatively.
Child ; Drainage ; Female ; Humans ; Male ; Mediastinitis* ; Middle Aged ; Myocutaneous Flap* ; Omentum ; Osteomyelitis* ; Sternotomy ; Sternum ; Thoracic Wall ; Trachea ; Transplants