As the number of obese patients increases, childhood obesity also increases and it is recognized as a big problem because it increases the incidence of hypertension, hyperlipidemia, diabetes and metabolic syndrome. Although thyroid hormone abnormalities sometimes exist in obese patients without thyroid disease, there is still much controversy on the impact of obesity on thyroid hormone test results. Accordingly, the present study investigated the correlation between obesity and thyroid hormone concentrations in children with normal thyroid function. In the present study, 356 patients aged 6-18 years who visited the Chosun University Hospital were randomly selected, after exclusion of those with thyroid disease, diabetes mellitus, kidney disease, those with a history of smoking and drinking, and those taking steroids or lipid lowering agents. There were no significant differences in levels of thyroid stimulation hormone (TSH) and free thyroxin (fT4) between males and females. The patients were divided into groups based on serum TSH concentration: group A with TSH < 4.0 μIU/mL and group B with TSH ≥ 4.0 μIU/mL (upper level of normal range). BMI z score, ALT, rGTP, and total cholesterol were significantly higher in group B. Multiple regression analysis adjusted for age, gender, birth weight, and pubertal development showed that TSH and BMI z score were positively correlated, while fT4 was not correlated with other factors.

There are reports that inhaling hypertonic saline with bronchodilator is helpful in the treatment of bronchiolitis. However, further studies are needed to determine if it is helpful to inhale hypertonic saline with bronchodilator in children with recurrent wheezing. We aimed to investigate the effect of hypertonic saline inhalation in children with recurrent wheezing. A total of 40 patients under 6 years of age admitted to Kwangju Christian Hospital from December 2014 to May 2016 were enrolled. Patients were randomly assigned to receive salbutamol. In the control group (n=21), salbutamol (2.5-5 mg / 0.5-1 mL) was inhaled four times a day with physiological saline (0.9% normal saline 1-3 mL). In the experimental group (n=19), the same amount of hypertonic saline (5% saline 1-3 mL) was inhaled four times a day instead of physiological saline. We compared the duration of wheezing remission between patients who had recurrent wheezing (n=40). There was no difference in the duration of wheezing remission in patients who had recurrent wheezing. But the hypertonic saline inhalation group had a lower post treatment clinical score on the 2nd-3rd day of admission than the physiological saline inhalation group. In this study, hypertonic saline inhalation therapy was not significantly effective in the treatment of recurrent wheezing. More additional research is needed to determine whether inhaled hypertonic saline is effective in the treatment of recurrent wheezing.

Hartmann’s procedure is most often used if immediate anastomosis is not feasible and considered very high risk of anastomotic leakage. The reversal of Hartmann operation has a significant benefit in patient's quality of life, but there are disadvantages because it is procedure of a high degree of complexity. For reversal of Hartmann operation to be truly beneficial, morbidity rate should be reasonable. The aim of this study is therefore to review clinical outcomes of the conversion of Hartmann procedure and define the complication rate of reversal of Hartmann operation in a contemporary practice. Patients undergoing an elective reversal of Hartmann’s procedure at Chosun University Hospital between January 2011 and December 2016 were included in our analysis, and the medical records were retrospectively reviewed. Total 70 patients underwent Hartmann reversal during this period. There were 33 men (47.1%) and the mean age was 67.7±14.5. The most frequent indications for Hartmann’s procedure were complicated diverticulitis in 37 patients (52.9%). Major morbidity rate was 14.3 % (10 patients), anastomotic leakage rate of 4.3% and mortality rate was 2.9% (2 patients). The most common complication was wound infection (25.7%). Univariate analysis demonstrated that there were no statistically significant variables. This study demonstrates that patients who underwent reversal of their Hartmann’s operation did not have increased postoperative morbidity based on advanced age, higher ASA score, presence of multiple comorbidities, type of operation, and longer operation time.

Genetic factors are increasingly found as potential causes of children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). Representative genes include cationic trypsinogen, serine protease 1 (PRSS1), serine protease inhibitor Kazal type 1 (SPINK1), cystic fibrosis transmembrane conductance regulator (CFTR), chymotrypsin C (CTRC) and calcium sensing receptor (CASR) genes, etc. In Korean children, PRSS1 and SPINK1 genes have been most commonly studied, while CFTR mutations were reported in one patient to date. We report a case of a 13-year-old male adolescent with CP with CFTR mutations. Since he was first diagnosed with idiopathic acute pancreatitis (IAP) based on laboratory and computed tomographic findings, he was admitted with ARP and CP over four times in a year at the secondary and tertiary hospital. No etiology was detected by several examinations including magnetic resonance cholangiopancreatography (MRCP), endosco-pic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS) with fine needle aspiration (FNA) biopsy and genetic test including PRSS1 and SPINK1. Although he had no typical symptoms associated with cystic fibrosis (CF), CFTR mutations were detected with additional gene examination. Testing for CFTR mutations should be concerned in pediatric patients with APR and CP without other identified causes.

The management of acute Achilles tendon rupture has been well established and is often treated with interrupted tenorrhaphy. While surgical site infection, rerupture and ankle contracture has been reported as potential complications, the tendon often heals uneventfully, and reports of complication other than mentioned above are extremely rare. We report a case of a common peroneal nerve injury which occurred after Achilles tendon repair surgery. The injury may have occurred following compartment syndrome from the anteriorly place long leg splint. To our knowledge, this is the first report in the literature.

Ureteroscopic lithotripsy has higher stone free rate compared with extracorporeal shock wave lithotripsy. Ureteroscopyassociated complications are flank pain, transient hematuria, ureteral perforation, ureteral avulsion, and sepsis. Among these, sepsis is most serious complication with the incidence of about 1%. We report a case of sepsis and septic shock that developed immediately after ureteroscopic lithotripsy. It was diagnosed with elevated lactate and procalcitonin values. It was caused by Pseudomonas aeruginosa which was detected in preoperative urine culture and postoperative blood culture.

Acute upper airway obstruction can cause negative pressure pulmonary edema (NPPE). It is a well-known perianesthetic complication, but is uncommon for intubated patients. Radiation injury of lung can easily lead to pulmonary hemorrhage or NPPE caused by changes of transthoracic or transpulmonary pressure. It is due to injury of alveolar-capillary membrane by radiation. We report the case of a 71-year-old man with a history of radiation therapy for lung cancer after surgical resection who developed the abrupt onset of pulmonary hemorrhage and NPPE during general anesthesia for hydrocele and inguinal hernia operation.

The sacrocolpopexy has been the gold standard surgery for POP (pelvic organ prolapse). Though the rates of mesh-related complications after sacrocolpopexy are relatively low, the complications should be considered. This case report describes the clinical cases of removal of mesh eroding following hysterectomy, laparoscopic sacrocolpopexy and posterior vaginal repair. The surgery for complete mesh excision was performed at laparotomy or laparoscopy. Although any complications haven't been yet reported in two cases, careful follow-up management should be needed. Successful sacrocolpopexy without complications requires technically experienced pelvic surgeons, the most suitable surgical methods and the best graft material.

Acute myocardial infarction (AMI) as an acute form and a catastrophic manifestation of coronary artery disease (CAD) is the major cause of morbidity and mortality worldwide. The prevalence and incidence of myocardial infarction can be influenced by demographic, biological and psychosocial factors, and it is rare in childhood and adolescent years. Contrary to the elderly, where cardiac attack is mainly caused by CAD, exercise-induced cardiac attack is relatively more prevalent in a young adult. We report here on a case of ST-segment elevation myocardial infarction (STEMI) in a young adult during vigorous physical activity and we review the relevant literatures.

Percutaneous lumbar epidural adhesiolysis is widely used a treatment for various chronic spinal pain but inadvertent complications of subdural, spinal, or intravascular injection can occur. We report a case of 63-year-old female with unusual pulsatile subdural injection image during attempted lumbar epidural adhesiolysis with fluoroscopy. Pulsatile image confined to the posterior aspect of the spinal canal at L3-4 level was observed. After recognizing subdural injection, we performed epidural adhesiolysis carefully without using steroid and local anesthetics under fluoroscopic guidance. Although unusual, pain physician needed to the understanding of the various subdural fluoroscopic contrast images.