BACKGROUND & OBJECTIVE: Recent studies suggest that anticoagulation, or antiplatelet therapy is safe and effective for the prevention of cardiogenic embolic stroke. However it has not been studied in Korea how the patients with cardioembolic source were managed in practice for the prevention of stroke. This study was done to assess the current status of primary and secondary prevention of cardioembolic stroke. METHODS: Retrospective study was undertaken in 124 patients with cardiogenic embolic stroke, following items were examined, previous anticoagulation or antiplatelet therapy, previous stroke, Insight of the heart disease, and International Normalize Ratio(INR) value on arrival at the hospital. RESULTS: In 124 patients cardioembolic sources were constituted of non-valvular atrial fibrillation (NVAF) in 54, rheumatic heart disease In 40, prosthetic cardiac valve In 14, dilated cardiomyopathy(D-CMP) in 6, left ventricular akinetic segment in 7(including 3 cases of LV thrombi), recent myocardial infarction in 3. In 93 patients with no previous stroke, 44 patients had regular medical follow-up because of his/her cardiac problems and primary prevention of stroke was made only in 12 (27%) patients (8 on anticoagulation and 4 on antiplatelet therapy). The rate of primary prevention varied according to the type of cardioembolic source; 100% with mechanical prosthetic valve, 33.3% with valvular atrial fibrillation, 6.7% with NVAF, and none with D-CMP and bioprosthetic valve. Previous stroke was found in 31 patients, among whom 24 had been followed regularly. Twenty patients(83%) were under secondary prevention of cardioembolic stroke (anticoagulation in 11 and antiplatelet agents in 9). Among 19 patients who developed stroke in spite of anticoagulation, INR values were lower than 1.5 in 12(63%), between 1.5 and 2.0 in 5(26%), and above 2.0 in 2(11%). CONCLUSION: Our results suggest that cardioembolic strokes have not been prevented properly. Many physicians seem to be reluctant to anticoagulate their patients with cardioembolic source, and even with anticoaguation the dosage is frequently insufficient to prevent stroke.
Atrial Fibrillation ; Follow-Up Studies ; Heart Diseases ; Heart Valves ; Humans ; International Normalized Ratio ; Korea ; Myocardial Infarction ; Platelet Aggregation Inhibitors ; Primary Prevention ; Retrospective Studies ; Rheumatic Heart Disease ; Secondary Prevention ; Stroke*

Listeria monocytogenes is a gram-positive rod which can be isolated from soil, vegetation, and many animal reservoirs. Human disease due to Listeria monocytogenes is uncommon but occurs most frequently in the neonatal period, during pregnancy and in elderly or immuno-suppressed patients. Listeriosis in pregnant women may cause spontaneous abortion, fetal distress, preterm labor, fetal death, or neonatal septicemia/meningitis. Maternal infection alone may occur without infection of the infant, especially at the end of pregnancy. One case of septicemia with Listeria monocytogenes in pregnant women at the 35th weeks of pregnancy with fetal distress is presented.
Abortion, Spontaneous ; Aged ; Animals ; Female ; Fetal Death ; Fetal Distress* ; Humans ; Infant ; Listeria monocytogenes ; Listeriosis ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnant Women ; Sepsis ; Soil

The Mainz classification for renal cell tumors was introduced in 1986 and it's utility has been reported in several histogenetic and genetic studies of renal cell tumors. We present a study of 127 cases of renal cell tumors with clinicopathologic correlation, DNA content analysis, and histogenesis studied by histochemical and immunohistochemical staining. The 127 renal cell tumors classified by the Mainz classification were 87 clear cell, 17 chromophilic, 13 chromophobe and 3 sarcomatoid renal cell carcinomas, 5 oncocytomas and 2 adenomas. These subtypes showed significant correlation not with age, sex, Robson's stage, DNA ploidy or tumor recurrence but with nuclear grade (p=0.001) and tumor size (p=0.001). Hall's colloidal iron (p=0.002) and carbonic anhydrase II (p=0.013) stains, representing the origin of distal nephron especially of collecting duct, were significantly correlated with specific subtypes of renal cell tumors, especially chromophobe cell renal carcinoma. This study demonstrates that the Mainz classification suggests several morphologically different subtypes and variants of renal cell tumors and that some of them may have originated from the distal nephron, particularly from the collecting duct.
Adenoma ; Adenoma, Oxyphilic ; Carbonic Anhydrase II ; Carcinoma, Renal Cell ; Classification* ; Colloids ; Coloring Agents ; DNA* ; Iron ; Nephrons ; Ploidies ; Recurrence

PURPOSE: The definition of continence after radical prostatectomy has not been established. We examined the continence rate and changes in voiding and storage symptoms after laparoscopic radical prostatectomy(LRP). MATERIALS AND METHODS: Fifty-seven patients were enrolled and followed for more than 12 months after a LRP. Postoperative evaluation of urinary incontinence was performed by interview, and was classified as completely dry, intermittent(occasional dribbling only), using only 1 pad/day, using more than 1 pad/day, and no control. Pre- and post-operative International Prostate Symptom Scores(IPSS) were compared(Total, each criterion, and quality of life, voiding, and storage symptom subscores). RESULTS: Sixty seven percent of patients were completely dry and 17% of patients were classified as intermittent. Those using 1 pad/day, more than 1 pad/day, or no control accounted for 2%, 9%, and 5%, respectively. Pre- and post-operative total IPSS and quality of life scores were not different, but urgency and nocturia scores increased(p<0.05). The voiding subscore decreased and the storage subscore increased after LRP(p<0.05), suggesting aggravation of storage symptoms after LRP. CONCLUSIONS: We need to determine which definition of continence is most clinically useful. It is important to assess lower urinary tract symptoms, especially storage symptoms, as well as urinary incontinence after LRP.
Humans ; Lower Urinary Tract Symptoms ; Nocturia ; Prostate ; Prostatectomy ; Quality of Life ; Urinary Incontinence ; Urinary Tract

It is. commonly assumed that nasorespiratory function can exert a dramatic effect upon the development of the dentofacial complex. Specially, it has been stated that chronic nasal obstruction leads to mouth breathing, which causes altered tongue and mandibular positions. If this occurs during a period of active growth, :the .outcome is development of the "adenoid facies". Such patients characteristically: manifest a vertically long lower third facial height, narrow alar bases, lip incompetence, a long and narrow maxillary arch and a greater than normal mandibular plane angle. But several authors have reported that so-called adenoid facies is not always associated with adenoids and mouth breathing, and that a particular type of dentition is not alwarys found in mouth breathers with or without adenoids. Some authors have believed adenoids lead to mouth breathing in cases with particular facial characteristics and types of dentition. We assumed that the ability to adapt to individual's neuromuscular complex is various. So, we compared the difference of influence of mouth breathing between childrens who have different facial types. This study included 60 patients and they were divided into three groups by Rickett's facial type. Their dentition and tongue position were compared. The results are as follows. 1. There is a significant difference in arch width of upper molars between different facial types. Especially dolichofacial type patients have narrowest arch width. 2. There is a significant difference in tongue position between different facial types. Especially dolichofacial type patients have lowest positioned tongue.
Adenoids ; Child ; Dentition* ; Facies ; Humans ; Lip ; Molar ; Mouth ; Mouth Breathing ; Nasal Obstruction ; Respiration* ; Tongue

Hypoxemia remains one of the most common postoperative problems. It is difficult to detect but potentially lethal, especially in combination with other complications. A case is presented of persistent hypoxemia resulting from pneumothorax in a 44-year-old male patient having surgery for the pancreatic head cancer under general anesthesia. He was catheterized in the right subclavian vein by the infraclavicular approach for the measurement of CVP on the first preoperative day and developed pneumothorax subsequently. This complication was thought to have been aggravated due to inattentive positive pressure ventilation and diffusion on N2O during anesthesia. This patient recovered from postoperative hypoxemia after needle aspiration of air from the pleural cavity without any other problem in the recovery room.
Adult ; Anesthesia ; Anesthesia, General ; Anoxia* ; Catheters ; Diffusion ; Head and Neck Neoplasms ; Humans ; Male ; Needles ; Pleural Cavity ; Pneumothorax* ; Positive-Pressure Respiration ; Recovery Room ; Subclavian Vein

No abstract available.
Humans ; Transplants*

This is a case report and review of literature that deals with hemifacial microsomia corrected by costochondral graft, Lefort I osteotomy and bilateral intraoral sagittal split ramus osteotomy. Patient, 23 years old female, had visited to treat the esthetic problem due to a deviation of jaw. On the basis of clinical and radiographic examinations, she was diagnosed as hemifacial microsomia. First, costochondral graft was performed to bridge the defect between glenoid fossa and body of mandible. After 11 months,. Patient was performed a Lefort I osteotomy and bilateral intraoral sagittal split ramus osteotomy to create a symmetric jaw. Patient was satiesfied with final esthetics and there have been no evidence of infection ill now.
Esthetics ; Female ; Goldenhar Syndrome* ; Humans ; Jaw ; Mandible ; Osteotomy ; Osteotomy, Sagittal Split Ramus ; Transplants

A 41-year-old female was admitted to our hospital for self-audible wheezing sound and dyspnea. On past history, she has been suffered from chest discomfort, and treated recurrently by other hospitals. But, there was no symptomatic improvement. A stridor and mixed wheezing sound was auscultated on whole lung field. PFT revealed fixed type or variable intra- & extra-thoracic air way obstructive pattern. By bronchoscopy & bronchogram, we found web-like structure on the distal trachea. A bronchoplasty was performed and the post-operative PFT showed slight improvement & she had no more complaints.
Adult ; Bronchoscopy ; Dyspnea ; Female ; Hemoptysis* ; Humans ; Lung ; Respiratory Sounds ; Thorax ; Trachea

We report 13 chromophobe renal cell carcinomas (10.8%) observed among 120 renal cell carcinomas in adults. The average age was 53 (range: 34-72) years old, and 6 were males and 7 females. The mean tumor size was 10 (range: 5-17) cm, mean nuclear grade 2.4, and mean Robson's stage was 1.9. There were two distinct histologic variants; typical variant (n=9) and eosinophilic variant (n=4). Both of them showed typical light microscopic features and positive reaction with Hale's colloidal iron and carbonic anhydrase II, a marker protein of intercalated cells of renal collecting ducts. A strong positive immunoreactivity for epithelial membrane antigen was noted in the cytoplasm in 12 of 13 tumors. Numerous microvesicles, 180~440 nm in diameter, were identified ultrastructurally. DNA aneuploidy was found in 3 out of 10 cases. Neither local recurrence nor metastasis have been identified during the following period of 4~144 (mean 48) months.
Adult ; Aneuploidy ; Carbonic Anhydrase II ; Carcinoma, Renal Cell* ; Colloids ; Cytoplasm ; DNA ; Eosinophils ; Female ; Humans ; Iron ; Male ; Mucin-1 ; Neoplasm Metastasis ; Recurrence