One hundred patients with hyperventilation syndrome presenting to emergency department(ED) were studied. Those were diagnosed on clinical basis by emergency medical physician. The male to female ratio was 15 : 85. In monthly distribution, the numbers of patients were increased during the two months, June and July. The 41% of patients visited the emergency center from 9:00 p.m. to 3:00 a.m.. The most common predisposing factors were the domestic problems, especially those between husband and wife(37%). Presenting complaints were dyspnea(34), paresthesia(30), muscle spasm(24), dizziness(6) and palpitation(6 patients). The initial examination of the patients in the ED were as follows, systolic blood pressure(134+/-7.15mmHg), heart rate(87.67+/-14.34/minute), respiratory rate(22.21+/-3.34/minute) and body temperature(36.61+/-0.31 degrees C, n=98). Arterial blood gas analysis showed alkalemia(pH 7.51+/-0.09) and hypocapnia(PCO2 26.67+/-8.30mmHg). After emergency cares, including carbone dioxide re-breathing and antianxietics, most of the symptoms were disappeared. The mean duration of stay in ED was 3.27+/-0.23 hours. The most important considerations in diagnosis of hyperventilation syndrome was the patients's history and the effective management was carbon dioxide rebreathing for a few minutes and antianxietics.
Blood Gas Analysis ; Carbon ; Carbon Dioxide ; Causality ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Female ; Heart ; Humans ; Hyperventilation* ; Male ; Spouses

BACKGROUND: Moyamoya disease is a chronic cerebrovascular disorders in which stenosis of the major arteries of the circle of Willis at the base of the skull progresses to occlusion. We observed two kinds of collateral pathways from the extracranial to the intracranial arteries. Also we evaluated clinlcal and neuroimaging features of moyamoya disease to give on aid in diagnosis. METHODS: We analysed 17 patients with moyamoya disease through the medical record and neuroimaging (conventional angiography and/or MR angiography) review. Six out of 17 patients were children(< OR =15 years) and the other 11 patients were adults(15 years). There were 8 males and 9 females. RESULTS: In our result, moyamoya disease was more common in the adult. There was bimodal age distribution, so average age of onset in children was 8-year-old and in adult 37-year-old. Common clinical features are seizure (66%), TIA (17%), and psychotic behavior (17%) in childrens and hemorrhages (73%), infarction (18%), seizures (9%) in adults. According to angiographic staging classification of Suzuki et al. (1967), our cases showed distribution of stage I (13%), stage II (8.8%), stage III (65.3%), stage IV (4.3%), stage V (4.3%), stage VI (4.3%). In collateral vessels of moyamoya disease, there were 7 cases of ethmoidal moyamoya, 3 of vault moyamoya and 1 of mixed form. It is interesting that there were five cases of unilateral moyamoya disease and one case had pseudoaneurysm. CONCLUSION: According to our results, we may say that seizures are common in the children and hemorrhages are in the adult. Unilateral moyamoya were mainly occurred in the adult. Ethmoidal collaterals were common among collaterals and stage III had a more cases than others in our neuroimaging data. These clinical and neuroimaging data may help interpretation and diagnosis of moyamoya disease.
Adult ; Age Distribution ; Age of Onset ; Aneurysm, False ; Angiography ; Arteries ; Cerebrovascular Disorders ; Child ; Circle of Willis ; Classification ; Constriction, Pathologic ; Diagnosis ; Female ; Hemorrhage ; Humans ; Infarction ; Male ; Medical Records ; Moyamoya Disease* ; Neuroimaging* ; Seizures ; Skull

PURPOSE: To identify the inter-fractional shift pattern and to assess an adequate treatment margin in the radiotherapy of a liver tumor using mega-voltage computed tomography (MVCT) of a tomotherapy unit. MATERIALS AND METHODS: Twenty-six patients were treated for liver tumors by tomotherapy from April 2006 to August 2007. The MVCT images of each patient were analyzed from the 1st to the 10th fraction for the assessment of the daily liver shift by four groups based on Couinard's proposal. Daily setup errors were corrected by bony landmarks as a prerequisite. Subsequently, the anterior-, posterior-, right-, and left shifts of the liver edges were measured by maximum linear discrepancies between the kilo-voltage computed tomography (KVCT) image and MVCT image. All data were set in the 2-dimensional right angle coordinate system of the transverse section of each patient's body. RESULTS: The liver boundary shift had different patterns for each group. In group II (segment 2, 3, and 4), the anterior mean shift was 2.80+/-1.73 mm outwards, while the left mean shift was 2.23+/-1.37 mm inwards. In group IV (segment 7 and 8), the anterior-, posterior-, right-, and left mean shifts were 0.15+/-3.93 mm inwards, 3.15+/-6.58 mm inwards, 0.60+/-3.58 mm inwards, and 4.50+/-5.35 mm inwards, respectively. The reduced volume in group II after MVCT reassessment might be a consequence of stomach toxicity. CONCLUSION: Inter-fractional liver shifts of each group based on Couinard's proposal were somewhat systematic despite certain variations observed in each patient. The geometrical deformation of the liver by respiratory movement can cause shrinkage in the left margins of liver. We recommend a more sophisticated approach in free-breathing mode when irradiating the left lobe of liver in order to avoid stomach toxicity.

Spinal epidural lipomatosis(SEL) is characteristic by abnormal accumulation of unencapsulated fat in the epidural space, which usually occurred as a complication of longterm steroid therapy or Cushing's syndrome and occasionally in obese patients with no other known etiology. This condition, which may result in devastating neurologic complications has also been reported without exogenous steroid intake. Magnetic resonance imaging is the meet helpful diagnostic means and should be used initially. We describe a case of nonsteroid induced symptomatic SEL associated with phenytoin-induced hypothyroidism and obesity. A 27-year-old woman was hospitalized with inability to walk for 2 months ago. She has back pain in her legs associated with radiating pain. She had a history of myoclonic seizure and treated with phenytoin 300 mg for 8 years. On admission, she shows mild hypothyroidism on thyroid function test. Serum phenytoin level was elevated as to 22.1 ug/ml. On cross sectional MRI, the thecal sac has a striking stellate appearance with three rays emanating from a central core. It produces a trifid shape resembling the letter "Y". Correction of underlying endocrine abnormality with weight reduction instead of decompressive laminectomy can reverse the process. In a obese patient with radicular pain or progressive paralysis, SEL may be the etiologic factor involved.
Adult ; Back Pain ; Cushing Syndrome ; Epidural Space ; Female ; Humans ; Hypothyroidism* ; Laminectomy ; Leg ; Lipomatosis* ; Magnetic Resonance Imaging ; Obesity* ; Paralysis ; Phenytoin* ; Seizures ; Strikes, Employee ; Thyroid Function Tests ; Weight Loss

We report a case of rare cervical isthmic spondylolisthesis of C6-7 combined occult spinal bifida at C6, and review the radiologic finding, different diagnosis and treatment. A 23-year old female presented nuchal, back pain after traffic accident. Radiologic finding showed the 6th cervical isthmic defect, spondylolisthesis and dysplasia. The patient was conservatively treated about 8 weeks, and 10 months after injury, she was symptom free with full range of motion of cervical spine and she was followed up. Cervical spondylolysis is a very rare condition. This clinical importance is vulnerable to trauma. For whatever reasons, symptomatic patients need to be treated by conservative or surgical option.
Accidents, Traffic ; Back Pain ; Cervical Vertebrae ; Female ; Humans ; Range of Motion, Articular ; Spine ; Spondylolisthesis ; Spondylolysis

BACKGROUND: Although a magnetic resonance imaging (MRI) is highly sensitive for changes associated with ischemic stroke, the detection of an acute ischemic lesion is usually impossible within 6 hours of the stroke onset on a conventional MRI. The perfusion MRI is a new imaging technique for diagnosing acute ischemic stroke. We evaluate the clinical usefulness of the perfusion MRI in predicting the final infarct extent in 18 patients with acute middle cerebral artery (MCA) territory ischemic stroke. METHOD: The perfusion MRI was performed within 6 hours after the stroke onset in all patients with a single-section dynamic contrast-enhanced T2*-weighted imaging in conjunction with a conventional routine MRI and MR angiography. Time-concentration curves and cerebral blood volume (CBV) maps were calculated from the dynamic MR imaging data by using numerical integration techniques. We compared findings of CBV maps with infarction on a follow-up CT or MRI. RESULTS: In 14 of 18 patients, the CBV in the occluded MCA territory were decreased. In the remaining 4 patients with a reversible ischemic neurologic deficit (RIND) or transient ischemic attack (TIA), the CBV were increased in 3 and normal in 1. Out of 14 patients with a decreased CBV, two had focal regions of increased CBV within the affected territory, indicating reperfusion hyperemia. The regions of increased or decreased CBV were eventually converted to infarction on follow-up images in all 14 patients. Out of 4 patients with RIND or TIA, one showed focal infarction in centrum semiovale on a follow-up image. CONCLUSIONS: The perfusion MRI was useful for the assessment of hemodynamic change about cerebral perfusion and may predict the extent of final infarction in acute MCA territory ischemic stroke. These results suggest that the perfusion MRI may play an important role in the diagnosis and management of acute ischemic stroke.
Angiography ; Blood Volume ; Diagnosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Hyperemia ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; Neurologic Manifestations ; Perfusion* ; Reperfusion ; Stroke*

PURPOSE: Carcinoembryonic antigen (CEA) is an important prognostic marker in colorectal cancer (CRC). However, in some stages, it does not work. We performed this study to find a way in which preoperative CEA could be used as a constant prognostic marker in harmony with the TNM staging system. METHODS: Preoperative CEA levels and recurrences in CRC were surveyed. The distribution of CEA levels and the recurrences in each TNM stage of CRC were analyzed. An optimal cutoff value for each TNM stage was calculated and tested for validity as a prognostic marker within the TNM staging system. RESULTS: The conventional cutoff value of CEA (5 ng/mL) was an independent prognostic factor on the whole. However, when evaluated in subgroups, it was not a prognostic factor in stage I or stage III of N2. A subgroup analysis according to TNM stage revealed different CEA distributions and recurrence rates corresponding to different CEA ranges. The mean CEA levels were higher in advanced stages. In addition, the recurrence rates of corresponding CEA ranges were higher in advanced stages. Optimal cutoff values from the receiver operating characteristic curves were 7.4, 5.5, and 4.5 ng/mL for TNM stage I, II, and III, respectively. Those for N0, N1, and N2 stages were 5.5, 4.8, and 3.5 ng/mL, respectively. The 5-year disease-free survivals were significantly different according to these cutoff values for each TNM and N stage. The multivariate analysis confirmed the new cutoff values to be more efficient in discriminating the prognosis in the subgroups of the TNM stages. CONCLUSION: Individualized cutoff values of the preoperative CEA level are a more practical prognostic marker following and in harmony with the TNM staging system.
Carcinoembryonic Antigen ; Colorectal Neoplasms ; Disease-Free Survival ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Recurrence ; ROC Curve

PURPOSE: Carcinoembryonic antigen (CEA) is an important prognostic marker in colorectal cancer (CRC). However, in some stages, it does not work. We performed this study to find a way in which preoperative CEA could be used as a constant prognostic marker in harmony with the TNM staging system. METHODS: Preoperative CEA levels and recurrences in CRC were surveyed. The distribution of CEA levels and the recurrences in each TNM stage of CRC were analyzed. An optimal cutoff value for each TNM stage was calculated and tested for validity as a prognostic marker within the TNM staging system. RESULTS: The conventional cutoff value of CEA (5 ng/mL) was an independent prognostic factor on the whole. However, when evaluated in subgroups, it was not a prognostic factor in stage I or stage III of N2. A subgroup analysis according to TNM stage revealed different CEA distributions and recurrence rates corresponding to different CEA ranges. The mean CEA levels were higher in advanced stages. In addition, the recurrence rates of corresponding CEA ranges were higher in advanced stages. Optimal cutoff values from the receiver operating characteristic curves were 7.4, 5.5, and 4.5 ng/mL for TNM stage I, II, and III, respectively. Those for N0, N1, and N2 stages were 5.5, 4.8, and 3.5 ng/mL, respectively. The 5-year disease-free survivals were significantly different according to these cutoff values for each TNM and N stage. The multivariate analysis confirmed the new cutoff values to be more efficient in discriminating the prognosis in the subgroups of the TNM stages. CONCLUSION: Individualized cutoff values of the preoperative CEA level are a more practical prognostic marker following and in harmony with the TNM staging system.
Carcinoembryonic Antigen ; Colorectal Neoplasms ; Disease-Free Survival ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Recurrence ; ROC Curve

PURPOSE: Patients with work related burns suffer from anxiety, depression, insomnia and suicide ideation etc. Psychiatric symptoms could be reduced by treatment. Almost all patients are referred to psychiatric intervention in our hospital. However, a number of patients show non-adherence. The aim of this study is to figure out the reason of non-adherence and psychiatric symptoms of work related burns patients. METHODS: 123 patients participated in this study. Startle, Physiological arousal, Anger, and Numbness (SPAN), Feeling Suicide, Patient Health Questionnaire-2 (PHQ-2) were administered as screening tool. Questions about psychiatric intervention and reasons to refuse psychiatric intervention were asked. RESULTS: 32% patients were depressed, 34% patients had suicide ideation and 59% had PTSD after work related burns. However, 46% of burn patients had not been treated. Stigma of psychiatric intervention and concerns about dependency were major reasons for non-adherence. CONCLUSION: There are gap between necessity and reality of psychiatric intervention on work related burn patients.
Anger ; Anxiety ; Arousal ; Burns ; Dependency (Psychology) ; Depression ; Humans ; Hypesthesia ; Mass Screening ; Occupational Injuries ; Referral and Consultation ; Sleep Initiation and Maintenance Disorders ; Stress Disorders, Post-Traumatic ; Suicide

BACKGROUND/AIMS: The purpose of this study was to discover the physiologic difference of a postprandial motor response in different segments of the colon between patients with irritable bowel syndrome and healthy subjects. METHODS: Irritable bowel syndrome patients are categorized into three groups according to their main symptoms; loose stool-dominant (A, n=5), abdominal pain-dominant (B, n=5), constipation-dominant (C, n=6) and the normal control group (n=5). The intraluminal pressure activity was measured with a colonoscopically positioned multilumen manometric catheter. The change of the colonic motility index (MI) is presented as a percent change (mean+/-SE%) over the basal period in response to a meal. RESULTS: 1) In the transverse, descending and sigmoid colon of healthy subjects, the percentage changes in the basal MI during the first 30 min after the meal are significantly increased (p < 0.05-0.01). 2) In the sigmoid colon, the percentage changes in the basal MI during the first 30 min after the meal were 62+/-18 in A, 29+/-18 in B, 12+/-8 in C and 306+/-102% in heathy subjects respectively, which shows a significant difference between the MI of control and healthy subjects (p < 0.05). 3) In B and C, the percentage changes in the basal MI during the first 30 min after the meal in the descending colon were 105+/-38, 11+/-7, respectively, which shows a significant difference between the two groups (p < 0.05). In A and C, the percentage changes in the basal MI during the first 30 min after the meal in the sigmoid colon was 62+/-18, 12+/-8, respectively, which shows a significant change between the two groups (p < 0.05). CONCLUSION: This study suggests that postprandial intraluminal pressure differences play a role in the pathophysiology of irritable bowel syndrome.
Catheters ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Humans ; Irritable Bowel Syndrome* ; Meals ; Motor Activity*