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

A 49-year-old man was admitted to Baptist Hospital on September 1, 1990. For mitral valve replacement due to mitral regurgitation. He has been treated by implantation of artificial pacemaker due to complete heart block for 1 year ago. We have experienced anesthetic management above patient who was scheduled of MVR. The patient with a cardiac pacemaker (VVI type) could give anesthesiologist many associated problems during the operation and anesthesia. During anesthesia an anesthesiologist should be able to manage the problems which might occur because of a cardiac pacemaker by various origins. Authors report this case with evaluation of references.
Anesthesia ; Heart Block ; Heart* ; Humans ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; Pacemaker, Artificial ; Protestantism ; Thoracic Surgery*

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

PURPOSE: The aim of this study was to observe clinical course including remission rate during antithyroid medication for Graves' disease in children and adolescents, and to evaluate factors related to remission. METHODS: This is a retrospective study of 42 patients (8 males), who were diagnosed at pediatric endocrine clinic in Chungbuk National University Hospital from January 1994 to December 2009. They were treated with antithyroid drugs only and were followed for at least 2 years. Their average age at diagnosis was 11.5 +/- 3.4 years, and average follow-up period was 4.5 +/- 2.2 years. RESULTS: At diagnosis, 64.3% of the subjects were in puberty, 87.8% showed goiter which was significantly prevalent in females (P < 0.05), and 38.9% manifested exophthalmos. Thyrotropin receptor antibody was positive in all the patients, whereas anti-microsomal antibody was positive in 88.1% and anti-thyroglobulin antibody in 81.0%. Twenty two (52.4%) patients remitted with 4.3 +/- 2.5 years' medication, and the others were continuously medicated at the last follow-up of 4.8 +/- 1.8 years. By quartile estimate for the remission time, 25 percentile was remitted at 3.7 years, 50 percentile at 7.1 years, and 75 percentile at 9.2 years. Among the factors for the remission, initial thyroid stimulating hormone level was significantly lower in non-remission group compared to remission group (P < 0.05). CONCLUSION: In pediatric Graves' disease treated only antithyroid drugs, the time required for remission is so long that it is necessary to establish fixed medication period and to choose definitive treatment modality as in adult Graves' disease through multicenter clinical study.
Adolescent ; Adult ; Antithyroid Agents ; Autoantibodies ; Child ; Exophthalmos ; Female ; Follow-Up Studies ; Goiter ; Graves Disease ; Humans ; Puberty ; Receptors, Thyrotropin ; Retrospective Studies ; Risk Factors ; Thyrotropin

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

Intravenous anesthesia of propofol was compared with ketamine on 20 gynecological patients undergoing dilatation and currettage. The patients were randomly assigned to study in two treatment groups so that l0 patients was administered ketamine anesthesia and 10 patients was administered propofol anesthesia. The hemodynamic responses and recovery characteristics of the two group were compared with control group. Arterial blood pressure(systolie, .mean, diastolic) and heart rate after induction were significantly increased in ketamine group, but showed significantly decrease in propofol group(table 5). Time to full recovery(mean+/-SD) was significantly less in the propofol group(14.3+/-2.9 min vs 40.2+/-4.l min, p<0.01)(table 4). The authors conclude that intravenos anesthesia of propofol is a pratical alternative technique for gynecological patients undergoing dilatation and currettage and may be preferable to ketamine because of the significantly shorter recovery time.
Anesthesia ; Anesthesia, Intravenous* ; Dilatation* ; Heart Rate ; Hemodynamics ; Humans ; Ketamine* ; Propofol*

Pre-surgical and post-surgical change in adult clef lip and palate patient following Le Fort I advancement osteotomy combined with bone graft was evaluated clinically and cephalometically. We obtained a successful function and esthetic improvement. The bone graft of alveolo-palatal clefts provides a stable bone support to the adjacent teeth of the cleft area, and well union of adjacent bone tissue, the closure of oronasal fistula and improvement of speech problem. Le Fort I osteotomy following the ostectomy of nasal septum for advancement of the maxilla was obtained relative improvement of esthetics and functional occlusion. 1. The orthodontic correction was required before and after surgery. 2. In this case, there was a limited range of anterior advancement of the Premaxillary-segment due to the scar tissue. 3. After 8 months of operation, we could show the new bone deposition on the cleft sites in dental radiograph and then the prosthetic treatment to the missing teeth was done.
Adult ; Bone and Bones ; Cicatrix ; Esthetics ; Fistula ; Humans ; Lip ; Maxilla ; Nasal Septum ; Osteotomy ; Palate ; Tooth ; Transplants