STUDY DESIGN: We report two cases of symptomatic spinal epidural lipomatosis (SEL) associated with long-term use of steroid medication OBJECTIVES: The purpose of this study was to assess the clinical characteristics, diagnosis and treatment of symptomatic spinal epidural lipomatosis. SUMMARY OF LITERATURE REVIEW: Spinal epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It can present neurologic symptoms including back pain, radiculopathy or cauda equina. Magnetic resonance imaging is the most helpful dignostic means and should be used initially if suspected. Treatment is decompressive laminectomy and debulking of fat. MATERIALS AND METHODS: Two cases of lumbar epidural lipomatosis with neurologic symptoms were discussed and evaluated by physical examination, postmyelography CT and MRI. RESULTS: Two cases were treated with decompressive laminectomy and debulking of fat. Increased accumulation of the fatty tissue was seen predominently in posterior and posterolateral epidural space of the spinal canal, displacing and compressing the lumbar spinal cord anteriorly. Both gross and histologic evaluation revealed overgrowth of unencapsulated normal appearing fat consistent with spinal epidural lipomatosis. One case was demonstrated gradual improvement in symtoms after operation but the other was died due to medical problems. CONCLUSION: The authors reviewed the literature and reported the results of operative treatment of patients with lumbago, radicular pain and intermitent claudication caused by epidural lipomatosis of lumbar spine and degenerative spinal stenosis.
Adipose Tissue ; Back Pain ; Cauda Equina ; Diagnosis ; Epidural Space ; Humans ; Laminectomy ; Lipomatosis* ; Low Back Pain ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Physical Examination ; Radiculopathy ; Spinal Canal ; Spinal Cord ; Spinal Stenosis ; Spine

No abstract available.
Acetylcholinesterase* ; Aluminum* ; Animals ; Brain* ; Choline O-Acetyltransferase* ; Choline* ; Rats*

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: During one-lung anesthesia in thoracic surgery, accurate placement of double lumen endobronchial tube(DLT) is essential. We have only a few data regarding adequate depth of DLT, especially after position change. We measured the depth of DLT and the change of depth after position change in 50 adult patients. METHODS: After endotracheal intubation with left-sided Robertshaw type polyvinyl chloride(PVC) endobronchial tube, fiberoptic bronchoscope was inserted through tracheal lumen and we positioned the proximal end of the bronchial cuff just below the carinal bifurcation. The depth of the DLT from the upper incisor was recorded, and was rechecked after position change to lateral position. RESULTS: The depth of the DLT was 29.4 +/-1.3 cm(male: 30.2+/- 0.9, female: 28.2+/- 0.8) and this was related with height. But in female group depth of DLT was not related with height. Within the same height group, the depth of DLT differ up to 3.5 cm. The change of depth more than 0.5 cm after position change ocurred in 21 out of 50 patients. CONCLUSION: The adequate depth of DLT in Korean patients, in total patients and in male group seems to related with their height, but in female group the depth of DLT was not related with their height. Within same height group, the depth of DLT may differ greatly. So, the depth of DLT must be adjusted individually. After position change, the head and neck should be kept in neutral position and the adequacy of the depth of DLT must be rechecked.
Adult* ; Anesthesia ; Bronchoscopes ; Female ; Head ; Humans ; Incisor ; Intubation, Intratracheal ; Male ; Neck ; Polyvinyls ; Thoracic Surgery ; Ventilation

BACKGROUND: The incidence and etiology of facial bone fracture differ widely according to time and geographic setting. Because of this, prevention and management of facial bone fracture requires ongoing research. This study examines the relationship between socioeconomic status and the incidence of facial bone fractures in patients who had been admitted for facial bone fractures. METHODS: A retrospective study was performed for all patients admitted for facial bone fracture at the National Medical Center (Seoul, Korea) from 2010 to 2014. We sought correlations amongst age, gender, fracture type, injury mechanism, alcohol consumption, and type of medical insurance. RESULTS: Out of the 303 patients meeting inclusion criteria, 214 (70.6%) patients were enrolled in National Health Insurance (NHI), 46 (15.2%) patients had Medical Aid, and 43 (14.2%) patients were homeless. The main causes of facial bone fractures were accidental trauma (51.4%), physical altercation (23.1%), and traffic accident (14.2%). On Pearson's chi-square test, alcohol consumption was correlated significantly with accidental trauma (p<0.05). And, the ratio of alcohol consumption leading to facial bone fractures differed significantly in the homeless group compared to the NHI group and the Medical Aid group (p<0.05). CONCLUSION: We found a significant inverse correlation between economic status and the incidence of facial bone fractures caused by alcohol consumption. Our findings indicate that more elaborate guidelines and prevention programs are needed for socioeconomically marginalized populations.
Accidents, Traffic ; Alcohol Drinking ; Facial Bones* ; Humans ; Incidence ; Insurance ; National Health Programs ; Retrospective Studies* ; Social Class*

No abstract available.
Trichotillomania*

BACKGROUND: Mushroom poisonings are infrequent but potentially fatal. Most fatalities are due to the amatoxin containing species, particularly Amanita phalloides, Amanita virosa, Amanita verna which cause fulminant hepatic failure often with encephalopathy. METHODS: We experienced twenty two patients with acute mushroom poisoning admitted to Dong San hospital, Keimyung University through emergency department between January 1990 and September 1997. RESULTS: Mean age of the patients was 40.0 years and the ratio of male to female was 1 : 0.83. Seasonal distribution is 10 patients in July, 3 in August and 9 in September. The mean interval between ingestion and early symptom onset was 9.7 hours. Most of the patients had early gastrointestinal symptoms; abdominal pain, nausea, vomiting and diarrhea. except for a patient with associated mental change. The subsequent symptoms and signs follow up admission were fulminant hepatic failure(72.7%), renal failure(31.8%), mental change(27.3%), acute pancreatitis(9.1%), pericardial effusion(4.5%) and erythematous rash(4.5%). The outcomes of the patients were recovery(72.7%), death(18.2%) and hopeless discharge(9.1%). CONCLUSION: The patients who have mushroom poisoning are misdiagnosed as having viral gastroenteritis and are discharged frequently. The doctors and people should be educated not to overlook the severity of mushroom poisoning.
Abdominal Pain ; Agaricales* ; Amanita ; Diarrhea ; Eating ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Gastroenteritis ; Humans ; Liver Failure, Acute ; Male ; Mushroom Poisoning* ; Nausea ; Seasons ; Vomiting

To evaluate the effectiveness of computed tomography for the differential diagnosis of cervical lymphadenopathy, we reviewed CT scans of 26 patients with cervical lymphadenopathy retrospectively. These included 10 patients with tuberculous lymphadenitis, 11 patients with metastasis and 5 patients with lymphoma, We evaluated the CT scans with a special attention to internal nodal density, feature of contrast enhancement and location of lymphadenopathy. Tuberculous lymphadenitis involved multiple nodes unilaterally and showed central low density with even or uneven rim enhancement, usually occurring in young patients (mean: 31.6 years). Two cases with tuberculous lymphadenitis showed calcifications within the lymph nodes. Lymphoma involved unilateral or bilateral nodes and appeared as conglomerated isodense mass with even rim enhancement. Metastasis involved multiple nodes unilaterally and showed focal, diffuse of mixed pattern of central low density with variable rim enhancement, usually occurring in old patients (mean: 59.4 years). Locations of most frequent lymph node involvements were internal jugular group (76%), spinal accessory group (54%) and retropharyngeal group(12%).
Diagnosis, Differential ; Humans ; Lymph Nodes ; Lymphatic Diseases* ; Lymphoma ; Neoplasm Metastasis ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node

PURPOSE: Liver-directed gene therapy is being actively pursued and developed as a method of treating various liver diseases. A number of aspects, including gene intervention, an efficient gene delivery system, and stable transgene expression are key to the success of the chosen strategy, and to overcome problems in these areas, several tactics can be used. In this study, we assess the utility of transarterial embolization using gelfoam particles soaked in an adenovirus vector as a gene-delivery method. MATERIALS AND METHODS: Using the angiographic approach, three dogs each weighing 9.5-11 kg were superselectively catheterized at the left hepatic artery using a 3-F microcatheter and the coaxial method. Two of the dogs were embolized at the left hepatic artery using 3x2x2-mm and 2x1x1-mm gelfoam particles soaked in 2x1011 particles/kg of recombinant adv.CMV.LacZ (LacZ-adv). The left hepatic artery of the remaining animal, used as a control, was infused with the same dose of lacZ-adv in the same way as before but without embolization of the left hepatic artery. Three days after embolization or the infusion of LacZ-adv, the dogs were sacrificed prior to harvest of the entire liver for the evaluation of gene transduction. RESULTS: X-gal staining of the liver tissue obtained was positive for hepatocytes, but the pattern and degree of gene transduction differed according to gelfoam particle size. Where this was 3x2x2 mm, gene transduction along the liver hilum varied, but where 2x1x1-mm particles were used, transduction was more even. No pathologic hepatic tissue injury or inflammation was apparent, and control liver tissue was not stained by Xgal. Serum SGOT and SGPT levels were slightly higher one day after the procedure, but had normalized by day 3. CONCLUSION: Intrahepatic transarterial embolization using gelfoam particles soaked in LacZ-adv appears to be a good method for effective liver-targed gene therapy.
Adenoviridae ; Alanine Transaminase ; Animals* ; Aspartate Aminotransferases ; Catheters ; Dogs* ; Gelatin Sponge, Absorbable* ; Gene Transfer Techniques ; Genetic Therapy* ; Hepatic Artery ; Hepatocytes ; Inflammation ; Liver ; Liver Diseases ; Particle Size ; Transgenes

BACKGROUND: The dissemination of metallo-beta-lactamase (MBL) producing gram-negative bacilli is of great concern because MBL can hydrolyze carbapenem. We report herein the infection by VIM-2 type MBL producing Achromobacter xylosoxidans subsp. xylosoxidans. MATERIALS AND METHODS: For seven A. xylosoxidans subsp. xylosoxidans with reduced imipenem susceptibility, the detection for MBL was performed using EDTA double disk synergy test (EDTA- DDS) and the PCR for IMP-1, VIM-1 and VIM-2 genes. The minimal inhibitory concentration (MIC) of MBL producers were determined by microbroth dilution methods. The DNA fingerprinting analysis was performed by random amplified polymorphic DNA. RESULTS: All seven isolates were MBL producers when tested with EDTA-DDS test and these isolates were VIM-2 type confirmed by the PCR and DNA sequencing analysis. The MIC against imipenem ranged from 16 to 32 microgram/mL in these isolates. The DNA fingerprints of these isolates were identical. CONCLUSION: A. xylosoxidans subsp. xylosoxidans manifest resistance against imipenem by acquisition of VIM-2 type MBL. To our knowledge, this is the first report on the VIM-2 type MBL producing A. xylosoxidans subsp. xylosoxidans.
Achromobacter denitrificans* ; Achromobacter* ; DNA ; DNA Fingerprinting ; Edetic Acid ; Imipenem ; Polymerase Chain Reaction ; Sequence Analysis, DNA