BACKGROUND/AIMS: Complete endotracheal tube obstruction is a medical emergency, and partial occlusion causes increased breathing rates and failure to wean off mechanical ventilation. Partial occlusion may be underestimated due to the lack of proper detection methods. We tested whether the sound of an endotracheal tube could be used to detect an endotracheal tube obstruction using an in vitro model. METHODS: An endotracheal tube was connected to a ventilator on one end and a test lung on the other. Sounds were recorded with a microphone located inside the endotracheal tube via a connector. During mechanical ventilation, we changed the endotracheal tube internal diameter from 5.0 to 8.0 mm and different grades of obstruction at different sites were used along the tube. Sound energy was compared among the different conditions. RESULTS: The energy of endotracheal tube sounds was positively correlated with the internal diameter and negatively correlated with the degree of obstruction. The rate of decline in energy differed with obstruction location. When the obstruction was more distal, the rate of decline in endotracheal sound energy was more rapid. CONCLUSIONS: Changes in the sound of an endotracheal tube can be used to detect an obstruction. Further studies are needed for clinical application.
*Airway Obstruction ; Confidence Intervals ; Exhalation ; Humans ; *Intubation, Intratracheal ; Models, Theoretical ; Positive-Pressure Respiration ; Statistics as Topic

Pulmonary cryptococcosis is rare in immunocompetent subjects. Here, we present the case of a 16-year-old boy who was referred to our pediatric department for the management of multiple consolidations detected on chest radiography, which was routinely performed when the patient was being evaluated for an ankle fracture. Fine needle aspiration biopsy was performed, and the definitive diagnosis was established as cryptococcal pneumonia. After 8 weeks of antifungal treatment, the pulmonary nodules on the chest radiographs disappeared.
Adolescent ; Animals ; Ankle ; Biopsy ; Biopsy, Fine-Needle ; Child ; Cryptococcosis ; Humans ; Multiple Pulmonary Nodules ; Pneumonia ; Thorax

PURPOSE: This study compared the postoperative outcomes and complications between laparoscopic totally extraperitoneal (TEP) hernia repair and open Lichtenstein hernia repair. METHODS: A total of 64 cases (30 cases by the TEP method and 34 cases by Lichtenstein repair) were enrolled in this study. The operative time, the hospital stay, the VAS score, the amount of analgesic used, the postoperative complications and recurrence were compared between the 2 methods. RESULTS: The mean operative time was 71 min for the TEP group, which was not significantly longer than that for the Lichtenstein group (66 min). The mean postoperative hospital stay was 3.7 days for the TEP group, which was significantly shorter than that for the Lichtenstein group (4.2) (p=0.035). The mean postoperative analgesic dose was 0.9+/-0.7 and 1.1+/-1.0 within 24 hours and 0.2+/-0.5 and 0.7+/-0.8 after 24 hours, respectively. The dose of analgesic after 24 hours was significantly lower for the TEP group (p=0.011), but the dose within 24 hours and the total dose was not significantly different. The VAS score was 2.3+/-1.0 and 2.6+/-0.9 at 12 hrs and 1.2+/-0.8 and 1.7+/-0.8 at 48 hrs, respectively. The VAS score was significantly lower for TEP group than that for the Lichtenstein group at 48 hrs (p=0.011), but there was no significant difference between the groups at 12 hrs. There was one recurrence in the TEP group. CONCLUSION: For the TEP group, the hospital stay was significantly shorter than that for the Lichtenstein group and this is maybe because the postoperative pain after 24 hours from the operation was less for the TEP group. Laparoscopic TEP repair may be performed efficiently with an acceptable operating time and a shorter hospital stay, as compared to open Lichtenstein hernia repair.
Hernia ; Herniorrhaphy ; Length of Stay ; Operative Time ; Pain, Postoperative ; Postoperative Complications ; Pyrazines ; Recurrence

Since the tuberculosis (TB) in adolescents has unique clinical characteristics, special attention should be paid to this age group. Adolescents are more susceptible to developing TB disease and more likely to have cavitary pulmonary disease. Also, adolescent patients with TB more frequently present with extrapulmonary disease. We report three adolescents with active pulmonary and/or intestinal TB: one had pulmonary and intestinal TB, another had a pulmonary TB, and the third exclusively had an intestinal TB. Diagnosis was confirmed by pathologic examination of the lung and/or intestines. All three patients were treated successfully without complication. A brief review of the literature has been included.
Adolescent* ; Diagnosis ; Humans ; Intestines ; Lung ; Lung Diseases ; Tuberculosis* ; Tuberculosis, Pulmonary

BACKGROUND AND OBJECTIVES: We performed this study to evaluate the common carotid artery intima-media thickness (CCA IMT), and its correlation with several clinical variables, including the 10 year coronary heart disease (10 Yr CHD) risk in both healthy and hyperlipidemic hypertensive (HH) Koreans. SUBJECTS AND METHODS: This was a multi-centered prospective epidemiological study. The study population consisted of 227 healthy subjects without risk factors, with the exception of age (mean 49 years old, 114 males), and 243 HH subjects (mean 51 years old, 120 males). The carotid IMT and presence of plaques were semi automatically measured in both carotid arteries at a central reading facility. RESULTS: Linear regression analysis of all the subjects revealed that the independent factors of both CCA IMT were age, pulse pressure (PP) and HDL-cholesterol, and that of the right CCA IMT were sex and 10 Yr CHD risk. In healthy subjects, the independent factor of both CCA IMTs was age, and that of the right CCA IMT was body weight. In the HH subjects, age, sex, total cholesterol, HDL-cholesterol and PP were independent factors of both CCA IMTs, but 10 Yr CHD risk was an independent factor of only the right CCA IMT. Carotid plaques were seen in 17% of the healthy subjects and 35% of the HH subjects. An ROC curve analysis showed a right CCA IMT of 0.646 mm and left CCA IMT of 0.656 mm demonstrated 60% sensitivity and specificity in differentiating healthy from HH subjects. CONCLUSION: This result reliably demonstrates the Korean CCA IMT, as well as several other significant pieces of information.
Blood Pressure ; Body Weight ; Carotid Arteries ; Carotid Artery, Common ; Carotid Intima-Media Thickness* ; Cholesterol ; Coronary Disease ; Epidemiologic Studies* ; Humans ; Korea* ; Linear Models ; Middle Aged ; Prospective Studies ; Risk Factors* ; ROC Curve ; Sensitivity and Specificity

PURPOSE: Wilms tumor is the most common malignant renal tumor in children. We investigated the epidemiology, clinical features and treatment outcome of the children with Wilms tumor in Korea during the recent 10 years. METHODS: Two hundred forty six patients were enrolled between January 1991 and December 2000 from 26 major hospitals in Korea. The data regarding the clinical features including sex, age, pathologic type, prognostic factor and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed, The differences between groups were analyzed by log-rank test. RESULTS: There were 130 males and 116 females. The incidence between the age of 1~4 years was the highest with 66.2%. The annual incidence rate per 1, 000, 000 population varied from 1.9 to 2.1. The 10 years overall survival rate according to sex, clinical stage, pathologic type and relapse were as follows: 88.6% in male, 90.9% in female, 100% in stage I, 94.7% in stage II, 92.1% in stage III, 63.4% in stage IV, 85.7% in stage V, 95.3% in favorable histology, 64.1% in unfavorable histology, 94.8% in non-relapse, and 40.9% in relapse. The relapse rate was 12%. The 10 years overall survival rate of 246 patients were 89.1%. CONCLUSION: Our results could provide the most recent and important clinical information on Wilms tumor of children in Korea.
Child ; Epidemiology* ; Female ; Humans ; Incidence ; Kaplan-Meier Estimate ; Korea* ; Male ; Medical Records ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Wilms Tumor*

Pneumoperitoneum usually indicates rupture of a hollow viscus and considered a surgical emergency. But air may also enter the peritoneum from the lung or the genital organs in female without visceral perforation. While scuba diving, the rapid ascent is usually controlled by placing in a decompression chamber and the excess gas volume is exhaled. Failure to allow this excess gas to escape will result in overdistension of air passage, which may rupture resulting in pulmonary interstitial emphysema or, if air enters the circulation, air embolus can occur. Pneumo-peritoneum is a rare complication of diving accidents. While the majority of cases are not related to an intraabdominal catastrophy, more than 20% have been the result of gastric rupture. We report a 42-yr-old male patient with massive pneumoperitoneum after scuba diving, who presented himself with dyspnea and abdominal distension. Knowledge of this rare condition and its benign course may allow the emergency physician and surgeon to order appropriate studies to help avoid unnecessary surgical treatment. It is important to determine promptly whether the air emanated from a ruptured viscus or was introduced from an extraperitoneal source. Free air in the abdomen does not always indicate a ruptured intra-abdominal viscus.
Adult ; Diving/adverse effects* ; Female ; Human ; Male ; Pneumoperitoneum/diagnosis* ; Pneumoperitoneum/etiology* ; Radiography, Abdominal ; Radiography, Thoracic

A retroperitoneal Synovial Sarcoma is defined as a tumor arising in the retroperitoneal space, with an origin of mesodermal structures. The majority of synovial sarcomas (85 to 95%) occur in the extremities, located near the large joints. They are uncommon, and usually appear as a non- specific soft tissue mass, with no specific imaging feature. However, in some cases, radiological findings and anatomic location of the tumor may help the diagnosis. On CT examination, these tumors may be shown as hypo-dense masses and have an irregular enhancement in the periphery, with a poor enhancement in the central area, reflecting the necrotic, cystic and hemorrhagic changes. Histologically, there are two types of synovial sarcoma: biphasic and monophasic. Both types have about a 40% mortality rate. The known prognostic factors are; frequent mitotic figures, extensive tumor necrosis, and poor differentiation. Surgical ablation remains the mainstay of their management. Regardless of adequate surgical and adjunctive therapies, the recurrence rate ranges from 28 to 36%. Here, we present a case of a retroperitoneal synovial sarcoma, with a review of the literature.
Diagnosis ; Extremities ; Joints ; Mesoderm ; Mortality ; Necrosis ; Recurrence ; Retroperitoneal Neoplasms ; Retroperitoneal Space ; Sarcoma, Synovial*

PURPOSE: Insulinomas are a rare disease, which can be cured by surgical management if diagnosed early. However, diagnosis and localization are difficult, due to their small size and varied clinical manifestations. We analyzed the clinicopathological features, diagnosis and surgical management of insulinomas. METHODS: We retrospectively analyzed 12 insulinoma patients who had undergone pancreatic surgery, between 1988 and 2001, at the Department of Surgery, College of Medicine, The Catholic University of Korea. RESULTS: The male to female ratio of the insulinoma patients was 1: 1 with a mean age of 37.9 years, ranging from 20 to 65. The clinical manifestations were loss of consciousness, weakness, confusion and dizziness, and all the patients had findings compatible with Whipple's triad. The median duration of symptoms before surgery was 16.8 months, ranging from 1 to 48 months. Hyperinsulinemic hypoglycemia was confirmed, during prolonged fasting, when the concomitant fasting blood sugar level was 42.4mg/dl and insulin level was 25.2 microU/ml (8.1~61.8 microU/ml). The insulinoma can be localized in 11 patients (91.7%) preoperatively. For the preoperative localization, a transhepatic portal vein sample (THPVS), selective angiography and a CT scan were good diagnostic methods. Intraoperative ultrasonography was the most useful localization tool during the operation. For treating the insulinoma, an enucleation, a distal pancreatectomy, and a pylorus preserving pancreaticoduodenectomy were performed in 5, 6 and 1 patients, respectively. An enucleation case was diagnosed as nesidioblastosis after surgery, thus needing a near total pancreatectomy. One patient with a multiple endocrine neoplasia (MEN), subtype I, needed a thyroidectomy and an adrenalectomy. All cases were single, benign tumors within the pancreas. The symptoms of hypoglycemia and the laboratory values were normal in all patients after surgery. CONCLUSION: We experienced 12 insulinoma patients, where preoperative suspicions, proper utilization of diagnostic tools, and prudent intraoperative diagnostic procedures enhanced the diagnostic accuracy of the insulinoma, and led to better treatment strategies.
Insulinoma* ; Pancreas*

PURPOSE: The role of P38 mitogen-activated protein kinase (MAPK) in gastric cancer invasion has not yet been determined. In this study, we examined the effects of SB203580, a specific P38 MAPK inhibitor, on the in vitro invasion of gastric cancer and upon the molecules involved in this process. MATERIALS AND METHODS: Human gastric cancer SNU-638 cells were maintained in RPMI 1640 supplemented with 10% FBS. BIOCOAT matrigel invasion chambers were used to examine in vitro invasiveness, zymography for gelatinase activity, CAT assay for uPA promoter activity and Western and Northern blotting to determine protein and mRNA levels, respectively. RESULTS: Treatment of SNU-638 cells with SB203580, a specific P38 MAPK inhibitor, reduced in vitro invasiveness, dose-dependently. SB203580 treatment was found to decrease both mRNA expression and uPA promoter activity in gastric SNU-638 cells. In vitro invasion of SNU-638 cells was partially abrogated by uPA-neutralizing antibodies. The activities of MMPs were not significantly altered by SB203580. CONCLUSION: Our results suggest that P38 MAPK is a potential therapeutic target for inhibiting uPA-dependent gastric tumor invasiveness and metastasis.
Animals ; Antibodies ; Blotting, Northern ; Cats ; Gelatinases ; Humans* ; Matrix Metalloproteinases ; Neoplasm Metastasis ; p38 Mitogen-Activated Protein Kinases* ; Protein Kinases ; RNA, Messenger ; Stomach Neoplasms