No abstract available.
Ciprofloxacin* ; Enoxacin* ; Humans* ; Metabolism* ; Theophylline*

Disorders of coagulation and uncontrollable bleeding are major problems during a major surgical operation. The correct diagnosis, appropriate treatment and preparation for abnormal coagulation and bleeding conditions with specific factors and blood products are procedure of utmost importance. Detailed history, physical examination and performance of appropriate laboratory tests including specific factor assay are essential for the diagnosis of an abnormal coagulation and bleeding problem. We have experienced a case of factor ll deficient patient who had surgery for a glioma of the forebrain. He had a past history of two episodes of massive bleeding during operation and showed a bleeding tendency after angiography for this last admission, but he didn't show any abnormal blood coagulation tests except for a factor ll deficiency. He had received Vitamine K 20 mg/day for 7days preoperatively. All laboratory coagulstion tests became normal and he had a surgical removal of a forebrain glioma uneventfully under general anesthesia. He received only 1 unit of fresh frozen plasma during operation and had an uneventful postoperative course.
Anesthesia, General ; Angiography ; Blood Coagulation Tests ; Diagnosis ; Glioma ; Hemorrhage ; Humans ; Hypoprothrombinemias* ; Physical Examination ; Plasma ; Prosencephalon ; Vitamins

Many kinds of lumbar diseases cause lumbar segmental instability and/or limitation of motion. But, there is no reliable method for measuring accurate trunk motion. In order to measure relative trunk motion respect to the pelvis in vitro, external linkage type of spine motion analyzer was developed. Special programs for calculation of the relative angular motion and graphical display were also developed. The developed device was tested to compare spine motion pattern between 15 normal volunteers and 18 lumbar fusion patients in flexion, extension, lateral bending and axial rotation. It was rather simple and reliable method for spine motion analysis. And it was possible to measure not only angular displacement but also angular velocity and angular acceleration. There were more coupling motions in lateral bending and axial rotation than in flexion and extension. Compared to the normal subjects, patients showed different angular motion, especially in the angular acceleration. Optimal trajectory of the trunk motion derived from mathematical model in flexion and extension matched well with measurement for normal subjects.
Acceleration ; Healthy Volunteers ; Humans ; Models, Theoretical ; Pelvis ; Spine*

No abstract available.
Cardiomyopathies* ; Peripartum Period*

Cervical pregnancy is a rare and dangerous form of ectopic pregnancy in which the blastocyst implants within the cervical canal below the internal os of the uterine cervix. The characteristic clinical sign is a severe asymptomatic uterine bleeding in early pregnancy or during curettage. Most cervical pregnancies result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervical tissue. Because of uncontrolled profuse vaginal bleeding, total hysterectomy has been the mostly necessitated to control life-threatening bleeding. Transvaginal sonography allows early diagnosis, and conservative treatment (two-time treatment : first treatement with systemic or intraamnionic methotrexate, secondly with curettage or ligature of the uterine arteries) improves the patient's fertility. Successful treatment is defined as elimination of the cervical pregnancy with preservation of the uterus. We report two cases of cervical pregnancy managed, successfully with methotrexate, leucovorin and curettage.
Abortion, Spontaneous ; Blastocyst ; Blood Vessels ; Cervix Uteri ; Curettage ; Cytochrome P-450 CYP1A1 ; Early Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Leucovorin ; Ligation ; Methotrexate ; Pregnancy* ; Pregnancy, Ectopic ; Uterine Hemorrhage ; Uterus

For young children with scoliosis before growth spurt, suhcutaneous lengthening without fusion was designed by Harrington and modified by Moe and Luque. However, many problems including spontaneous fusion, rod breakage, and hook disloclgement have been ohserved. CotrelDubousset(CD) instrumentation was sometimes used, but it usually resulted in failure due to soft tissue adhesion around the rough surface of ordinary CD rod. We tried to use the smooth CD rod, transvcrse-pedicle clawing on the upper part, and pedicle screw inscrtion on upper and lower part of the curve to reduce the hardware failures. Among 8 patients in whom suhcutaneous lengthening with smooth CD rod was carried out hetween October l992 and Suly 1996. 4 cases perfomed with final spinal fusion were analysed. There were I central core disease, 1 multicore disease and 2 idiopathic scoliosis(infantile and juvenile type). Mean age at the first operation was l0.0(8.8-11.8) years, and the Risser sign was all grade 0 except one with grade 1. Suhcutaneous lengthening was performed every 5 or 6 months Mean lengthening duration was 22(9-39) months and mean age at spinal fusion was 11.7(9.6-13.8) years. Mean Cobb angle decreased from 7ldegrees (55degrees-88degrees) at preoperative stage to 32 (10degrees-59degrees) at the last follow-up. There were 5 complications during 21 operations, and three hardware failures comprised 2 hook dislodgcment and 1 screw pull-out. Crankshaft phenomenon happened in I case who had had a posterior fusion in young age(9.6 years) due to laminar fracture. The suhcutaneous lengthening with smooth CD rod can he another option of treatment for young children with severe scoliosis. prescrving the powth potential of involved vertebrae with few complications.
Animals ; Child* ; Follow-Up Studies ; Hoof and Claw ; Humans ; Myopathy, Central Core ; Scoliosis* ; Spinal Fusion ; Spine ; Tissue Adhesions

The diagnosis of Hodgkin's disease is based on the morphologic identification of Reed-Sternberg (RS) cells and its variants in paraffin-embedded sections. The origin of RS cells remains a subject of controversy, and cells resembling RS cells are observed in some non-Hodgkin's lymphoma of T-cell lineage. In this study, eighteen cases of Hodgkin's disease (3 nodular sclerosis, 6 diffuse lymphocyte predominance, and 9 mixed cellularity) were studied with peanut agglutinin(PNA), anti-Leu-M1(CD15), LN2(CD74), Ber-H2(CD30) and bauhinia purpurea (BPA) by the avidin-biotin-peroxidase complex(ABC) method in paraffin-embedded sections. RS cells and their variants revealed positive reactions with one or more of the reagents in all examined cases. BPA staining was positive in 17 of 18 cases (94.4%), PNA staining was positive in 9 of 18 cases (50.0%), Leu MI was positive in 7 of 18 cases(38.9%), Ber-H2 was positive in 11 of 18 cases (61.1%), and LN2 was positive in 8 of 18 cases(44.4%). The staining properties of examined markers were recognized as paranuclear, diffuse cytoplasmic and cellular membranous patterns, but LN2 disclosed diffuse cytoplasmic staining in the positive cells. BPA also showed dense cytoplasmic staining reaction with macrophage-histiocytes. BPA reactivity was not affected by fortnalin fixation or paraffm embedding. Thirty six cases of non-Hodgkin's lymphomas(IO T-cell and 26 B-cell type) were also examined. The neoplastic cells of those cases did not stain positive with BPA, PNA, and Leu-Mi, but stained positively with LN2 in 3 cases of T-cell lymphomas and 14 cases of B-cell lymphomas, and BeT-H2 in T-cell lymphomas. In conclusion, to facilitate the detection of RS cells and related variants in paraffm sectionse of Hodgkin's disease, BPA can be used as a useful marker because of its high-detection rate, reproducible staining pattem, and resistance to fixative.

Hyperemesis gravidarum is characterized by severe nausea, vomiting followed by weight loss, dehydration, electrolyte imbalance and acid-base derangements. Its treatment was composed of adequate fluid therapy, electrolyte replacement and nutrient supply. In severe case, it also leads to a variety of neurological symptoms including confusion, gait disturbance and nystagmus, possibly due to thiamine deficiency and may result in so called Wernicke's disease. We have experienced a case of Wernicke's encephalopathy associated with severe hyperemesis gravidarum and this case is presented with a brief review of literature.
Dehydration ; Female ; Fluid Therapy ; Gait ; Hyperemesis Gravidarum* ; Nausea ; Pregnancy ; Thiamine Deficiency ; Vomiting ; Weight Loss ; Wernicke Encephalopathy*

Background: Multidrug-resistant tuberculosis(MDR-Tb) has been increased not only in Asia but also in Western society, which may cause public health problems and reduce the efficacy of treatment of tuberculosis. In Western society HIV infection is believed to do a central role in increasing incidence of MDR tuberculosis, but MDR-Tb in Korea may be somewhat different about clinical features, underlying disorders, and prognosis. Goble et al reported that overall treatment failure rate in MDR-Tb including resistance to isoniazid(INH) and rifampin(RFP) was 44%. The aim of this study is to find the treatment result in Korea and the factors determining the prognosis. Methods: A retrospective study of pulmonary tuberculosis cultured M. tuberculosis from sputum or bronchial washing fluid between 1986 through 1992 was conducted in the Seoul Paik Hospital, Inje University. We reviewed clinical courses of 141 patients, who had a tuberculosis with resistance to 2 or more drugs including isoniazid(INH) and rifampin(RFP). One hundred and 4 patients of 141 patients had completed treatment and followed up for more than one year. Results: Of 104 (mean age 43.6+/-16.7, M: F=63: 41) patients with sufficient follow-up data, 73(84.6%) patients responded which is defined as negative sputum cultures for at least 3 consecutive months. Seven patients(6.7%) had a failure in negative conversion and 9(8.7%) of the patients who initially responded relapsed. Overall treatment failure rate was 15.4%. Patients who were treated for less than 12 months had a higher relapse rate(12.3%) than 18 months(4.9%). And there was a statistically significant correlation between the relapse rate and the number of drugs to which isolates wera resistant(p<0.05). Conclusion: The treatment failure rate of MDR-Tb in Korea was lower than previous studies in western country and the major determining factor of prognosis was the number of resistant drugs to M. tuberculosis at drug sensitivity test. For reducing the relapse rate, we recommend more than 12 months of treatment for MDR tuberculosis.
Asia ; Follow-Up Studies ; HIV Infections ; Humans ; Incidence ; Korea* ; Prognosis ; Public Health ; Recurrence ; Retrospective Studies ; Seoul ; Sputum ; Treatment Failure ; Tuberculosis* ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary

BACKGROUND: In case of tuberculous pneumonia, differentiation from bacterial lobar pneumonia is sometimes very difficult because clinical symptoms, signs and radiological images are very similar. So we investigated the usefulness of CA125, which is known to increase in tuberculous diseases, in differential diagnosis between tuberculous pneumonia (TBPN) and community acquired bacterial lobar pneumonia (LP). METHODS: Serum CA125 level was measured in 20 patients with TBPN (female 12 male 8: mean age 36.1 years) and 14 patients with LP (female 5 male 9: mean age 45.1 years) by radioimmunoassay (Centocor(R) CA125 RIA kit). RESULTS: 1) The serum CA125 level in TBPN (333.7 283.5 u/ml) was higher than in LP (60.9 66.2 u/ml). (P < 0.05) 2) If we took cut-off value as 195 u/ml in differential diagnosis between TBPN and LP, the sensitivity and specificity of CA125 level in the diagnosis of TBPN were 70% and 93%, respectively. 3) There was no significant difference in serum CA125 level between noncavitary TBPN (242.1 +/- 16.6 u/ml,n=10) and cavitary TBPN (399.6 +/- 318.4 u/ml,n=10). (P > 0.05) 4) Following up of serum CA125 level after initiation of antituberculosis treatment showed rapid decline and approach to near normal range in 6 months. CONCLUSION: High serum CA125 level (> 195 u/ml) was useful in differential diagnosis of TBPN from LP.
Diagnosis ; Diagnosis, Differential ; Humans ; Male ; Pneumonia* ; Radioimmunoassay ; Reference Values ; Sensitivity and Specificity