BACKGROUND: The differentiation between hemorrhagic(HS) and norhemorrhagic(NHS) stroke is the most important first step in the management of acute stroke because clinical management of the two disorders differs substantially. Neuroimaging studies are useful in diagnosing and distinctioning between HS and NHS. The use of clinical variables, such as Siriraj stroke scores(SSS), has led to good sensitivity, specificity and predictive values. The aim of our study was to evaluate the use of the SSS in the Korean population and assess whether it could aid to expedite treatment decisions. METHODS: We reviewed 111 cases of stroke patients admitted to our hospital via the emergency department over a 6 months period from July to December 1998. Levels of consciousness, vomiting, headache, and atheroma markers used in the SSS were applied to these patients who met the criteria for a stroke. RESULTS: Of the 111 patients, the SSS classified 83 with sensitivities of 81.1%(NHS) and 73.3%(HS) and positive predictive values of 84.3% and 68.8%, respectively. The overall accuracy rate was 78.3%. CONCLUSION: Our results suggest that the SSS is not reliable in distinguishing stroke types in the Korean population. Definite neuroimaging studies are needed prior to thrombolytic therapy.
Consciousness ; Emergency Service, Hospital ; Headache ; Humans ; Neuroimaging ; Plaque, Atherosclerotic ; Sensitivity and Specificity ; Stroke* ; Thrombolytic Therapy ; Vomiting

BACKGROUND: Incidence of traumatic hip dislocation have ween increased with development of transportation. Traumatic hip dislocation demands early recognition as an emergency and prompt reduction. So we designed this study to determine what kinds of factors affect the prognosis of the patient. METHODS: Eighty five patients who admitted emergency department of our hospital with the traumatic hip dislocation were enrolled in this study. Cause of injury, type of dislocation, method of reduction, the time from dislocation to reduction, age, gender and associated patellar injury were evaluated by retrospective chart reviews. RESULTS: Average age of excellent and good group(E&G) is 28+/-17.8 and fair and poor group(F&P) is 39+/-18.6, so the older the age the more poor prognosis(P<0.05). The time to take reduction of E&G group is 18+/-8.2 hours and F&P group is 25+/-12.6 hours, so the faster the better prognosis(P<0.05). We classify the type of hip dislocation by Thompson and Epstein method, type I to type V. The prognosis of type I is better than type V(P<0.05). Fifty five case were associated with patellar injury and they had poor prognosis than the other cases that were not associated with knee joint injury. CONCLUSION: In traumatic dislocated hip patients, the prognosis was poor in old age, delay in reduction, higher type of dislocation and associated with knee joint injury.
Dislocations ; Emergencies ; Emergency Service, Hospital ; Hip Dislocation* ; Hip* ; Humans ; Incidence ; Knee Joint ; Prognosis* ; Retrospective Studies ; Transportation

BACKGROUND: Surgical correction of the full spectrum of esophageal atresia with tracheoesophageal fistula has improved over the years, but the mortality and morbidity assoiated with repair of these anomalies still remains high. MATERIAL AND METHOD: We retrospectively analyzes 27 surgically treated patients with esophageal atresia and tracheoesophageal fistula at Dong-A University Hospital between January 1992 and March 1997. RESULT: There were 21 male and 6 female patients. Mean birth weight was 2.62+/-.385 kg(2.0~3.4 kg). Twenty- four(88.9%) had esophageal atresia with distal tracheoesophageal fistula, and 3(11.1%) had pure esophageal atresia. Four(14.8%) infants were allocated to Waterston risk group A, 18(66.7%) to group B, and 5(18.5%) to group C. In eighteen(66.7%) infants with associated anomalies, cardiovascular anomalies were the most common. Three had a gap length of 3.5 cm or greater(ultra-long gap) between esophageal segments, 7 had 2.0 to 3.5 cm(long gap), 8 had 1.0 to 2.0 cm(medium gap), and 9 had 1 cm or less(short gap) gap length. Among 27 neonates, 3 cases underwent staged operation, late colon interposition was done in 2, and all other 24 cases underwent primary esophageal anastomosis. Oerative mortality was 2/27(7.4%). Causes of death included acute renal failure(n=1), empyema from anastomotic leak(n=1), necrotizing enterocolitis(n=1), sepsis(n=1), insulin-dependent diabetus mellitus(n=1 . There were 4 anastomosis- related complications including stricture in 3, leakage in 1. Mortality was related to the gap length(p<.05). CONCLUSION: Although the complication rate associated with surgical repair of these anomalies is high, this does not always implicate the operative mortality. The overall survival can be improved by effective treatment for combined anomalies and intensive postoperatve care.
Birth Weight ; Cause of Death ; Colon ; Constriction, Pathologic ; Empyema ; Esophageal Atresia* ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Mortality ; Retrospective Studies ; Tracheoesophageal Fistula

No abstract available.
Myasthenia Gravis* ; Thymectomy*

The nail-patella syndrome is a genetically determined autosomal dominant disease with variabIe expression affectiag tissues of both ectodermal and mesodermal origin. The condition in an individual is characterized chiefly by dysplasia of the fingernails, hypoplastic or absent patellae, deformities or luxation af the head of the radius, and the presence of illiac horns. It is now well established that the locus for the nail-patella syndrome and the locus for the ABO blood groups are closely linked. We report 2 cases of nail-patella syndrome affected a brother and a sister in a family. Our 2 cases, with blood group B, showed dystrophic nails and hypoplastir. patellae.
Animals ; Blood Group Antigens ; Congenital Abnormalities ; Ectoderm ; Head ; Horns ; Humans ; Mesoderm ; Nail-Patella Syndrome ; Nails ; Patella* ; Radius ; Siblings

Painful fat hemiation is characterized. by the soft, skin colored painful papules on the heels that appears only when weight is bome and disappears when weight. is taken off the heels. The papules were thought to be caused by hemiation of adipose tissue through connective tissue defect. To our knowledge, such a case or similar one has not been reported previously in Korea. The patient was 30 year-old housewife, who have had soft, skin colored painful papules on the medial aspect of the both heels when weight was placed on the foot. Routine laboratory findings were within normal limit. Skin biopsy revealed nodules of lobulated adipose tissue on the mid-dermis far above the original subcutaneous tissue and large venous channels with thick muscular walls. Hypertrophied peripheral nerve trunks were scattered adjacent to the above vascular structure. Diagnosis was confirmed by clinical and histopathological features. Literatun was briefly reviewed.
Adipose Tissue ; Adult ; Biopsy ; Connective Tissue ; Diagnosis ; Foot ; Heel ; Humans ; Korea ; Peripheral Nerves ; Skin ; Subcutaneous Tissue

Moyamoya disease is a particular disease of the circle of Willis which is characterized by its progressive obstruction and associated with different cerebral vascular malformations and infrequently associated with aneurysms. A 23 year old Korean woman was admitted to the Department of Neurosurgery, Korea University Hospital, because of stuporous mentality and Rt. Sided hemiplegia. She fell down and almost immediately lost consciousness on the day morning of admission. Neurological findings included neck stiffness, moderately bilateral dilated pupils, Rt. Sided hemiplegia, positive bilateral Babinski's sign and positive Kernig's sign. Lumbar angiogram revealed grossly bloody cerebrospinal fluid. Carotid angiogram revealed marked stenosis of supraclinoid portion of intracranial internal carotid arteries with extensive collateral small arterial net work at the base of the brain. Small aneurismal sac was visualized at the distal end of the small arterial nerwork probably distal portion of posterior choroidal artery. Brain computed tomography showed hematoma at the posterior portion of left side thalamic area and in the left lateral ventricle. The patient had operation for removal of hematoma and died on the 2nd day of postoperation. Based on this case, mechanisms of formation of aneurysms in moyamoya disease are discussed.
Aneurysm ; Arteries ; Brain ; Carotid Artery, Internal ; Cerebrospinal Fluid ; Choroid ; Circle of Willis ; Consciousness ; Constriction, Pathologic ; Female ; Hematoma ; Hemiplegia ; Humans ; Intracranial Aneurysm* ; Korea ; Lateral Ventricles ; Moyamoya Disease* ; Neck ; Neurosurgery ; Pupil ; Reflex, Babinski ; Stupor ; Vascular Malformations ; Young Adult

Background & Objective: Although the clinical manifestations and outcomes of neuralgic amyotrophy have been previously described, some controversies remain. Thus, we evaluated clinical manifestations and outcomes of patients with neuralgic amyotrophy. Methods: We evaluated the clinical and electrodiagnostic data, and the outcomes, of 32 patients with neuralgic amyotrophy.Of the 32 patients, 26 were followed-up for one year after onset of the disease.Results:The initial symptoms were pain (50.0%), pain with weakness (21.9%), other sensory symptoms without weakness (6.3%), and painless weakness or atrophy (21.9%). The commonly involved nerves were the median (75.0%), radial (68.8%), suprascapular (50.0%), ulnar (50.0%), axillary (46.9%), and musculocutaneous (40.6%) nerves. The initial symptoms were not associated with nerve involvement. Of all patients, 59% recovered fully, 16% had residual mild weakness without functional disability, and 6% experienced persistent severe weakness and were unable to return to work. Some patients were not evaluated because they were lost to follow-up. Conclusions: Painless weakness as an initial symptom of neuralgic amyotrophy may be more common than previously noted. Of all patients, 75% enjoyed favorable outcomes by one year after disease onset. These results will be useful when planning treatment strategies and will deepen our understanding of prognosis of neuralgic amyotrophy.
Brachial Plexus Neuritis

BACKGROUND: Pulmonary atresia with intact ventricular septum(PA/IVS) is an anatomically heterogenous anomaly with a variety of surgical strategies possible. The purpose of the study is to evaluate the influence of right ventricular size on the early and midterm results of surgical repair of PA/IVS. MATERIAL AND METHOD: Medical records of 20 consecutive patients with PA/IVS operated on between January 1993 and August 1999 were retrospectively reviewed. There were 12 boys and 8 girls whose ages ranged from 2 days to 14.5 months (median 6 days). Their body weight ranged from 2.52kg to 9.35 kg(median 3.18kg). The preoperative Z-value of the diameter of the tricuspid valve(T-valve) was less than or -4 in 5 patients, between -4 and -2 in 1, between -2 and 0 in 7, between 0 and 2 in 6, and greater than or 2 in 1. All patients who had z-value of tricuspid valve greater than -2.05 were attempted biventricular repair(n=15) and all patients who had it smaller than -4.4 underwent systemic-pulmonary shunt operation only(n=3) or bidirectinal cavopulmonary shunt with right ventricular reconstruction(n=2). RESULT: Two early deaths(2/20, 10%) occurred. Both were infants who underwent transannular patch with shunt. One of these two had huge right ventricle(Z-value of tricuspid valve = 5). There were 2 late non-cardiac deaths 3 and 7 months after operations respectively. Follow-up was completed in all children at a mean of 35.3 months(range, 5 to 54 months). 10 of 11 survivors who underwent transannular patch or valvotomy with or without shunt procedure were in NYHA functional class I even though some of them had small interatrial communication or patent shunt. All three patients who had shunt procedure only at initial palliation completed Fontan procedures with no death. Two patients who underwent right ventricular outflow reconstruction with bidirectional cavopulmonary shunt were also in good condition. CONCLUSIONS: The transanular RVOT patch or valvotomy with or without systemic-pumonary shunt as an initial palliative procedure to achieve biventricular repair for the patients who had neither too small nor too large right ventricle(-2.05< or =Z-value of T-value of T-valve< or =2) could be performed at low operative risk(1/14 7.1%). Systemic-pulmonary shunt procedure and bidirectional cavopulmonary shunt procedure for the patients who had small right ventricle(Z-value of T-valve< or =4.4) could be also performed with low risk. But a patient with huge right atrium and ventricle(Z-value of t-valve=5) had poor operative result.
Body Weight ; Child ; Female ; Follow-Up Studies ; Fontan Procedure ; Heart Atria ; Heart Bypass, Right ; Humans ; Infant ; Medical Records ; Pulmonary Atresia* ; Retrospective Studies ; Survivors ; Tricuspid Valve ; Ventricular Septum*

BACKGROUND: Total anomalous pulmonary venous connection (TAPVC) is still one of the more challenging congenital heart defects in newborns and young infants. The purpose of the study is to evaluate the early and midterm results of the surgical corrections for patients in early infancy with isolated TAPVC. MATERIAL AND METHOD: Hospital records of 15 consecutive patients in early infancy (January 1993 to August 1998) were retrospectively reviewed. There were 8 boys and 7 girls whose ages ranged from 4 days to 3.5 months (median age 22 days). Their body weight ranged from 1.75 kg to 4.9 kg (mean 3.54 kg). The abnormal anatomical connections were supracardiac in 11, cardiac in 3, and infracardiac in 1. In 6 patients (40%), the pulmonary venous drainage was obstructive. Total circulatory arrest was used in 13 patients. Anastomosis between the common pulmonary vein and the left atrium was performed with a continuous suture technique using a fine nonabsorbable polypropylene suture through a lateral approach behind the right atrium. RESULT: There was one hospital death (6.5%) caused by a sepsis 17 days after the operation in a neonate who had supracardiac drainage and was dependent on a ventilator preoperatively. There were 2 late deaths. One died sudde`nly of an unknown cause at home 2.5 years after the operation and the other died of a recurrent pulmonary hypertension 3 months after the reoperation due to pulmonary venous obstruction (PVO). Two patients required reoperations because of PVO 5 months and 10 months respectively after the initial operation. Of these patients, one patient is alive at the present time with persistent pulmonary hypertension. All survivors without postoperative PVO (78.6%) were in NYHA functional class I at mean follow-up of 25.8 months (0.5~67 months). CONCLUSION: Surgical correction of TAPVC in early infancy can be performed at low risk. However, there were 2 postoperative PVOs (14.3%) which had bad results. The survivors without postoperative PVO had excellent functional status.
Body Weight ; Drainage ; Female ; Follow-Up Studies ; Heart Atria ; Heart Defects, Congenital ; Hospital Records ; Humans ; Hypertension, Pulmonary ; Infant ; Infant, Newborn ; Polypropylenes ; Pulmonary Veins ; Reoperation ; Retrospective Studies ; Sepsis ; Survivors ; Suture Techniques ; Sutures ; Ventilators, Mechanical