Even though the incidence of traumatic anterior dislocation of the hip is approximately 15% of all traumatic dislocation, the incidence of bilateral traumatic anterior dislocation is extremely rare. In a review of literature, the authors could find only one case report of bilateral traumatic anterior dislocation of the hip and no case in Korea. The mechanism of traumatic anterior dislocation of the hip is forced abduction. This paper is a case report of a traumatic bilateral anterior dislocation of the hips in a 36 year old labor who injured by fall down from about 5 meter in height. The case was treated by means of closed reduction, traction and physical therapy. Follow up study was performed for one year and obtained good result.
Dislocations ; Follow-Up Studies ; Hip Dislocation ; Hip ; Incidence ; Korea ; Traction

PURPOSE: Gastric epithelial dysplasia (GED) was defined as "unequivocally neoplastic epithelium that may be associated with or give rise to invasive adenocarcinoma" and GED also represents a direct precursor of intestinal type adenocarcinoma of the stomach. The recommended treatment guidelines for GED in the medical literature are endoscopic mucosal resection (EMR) or surgery for high grade dysplasia (HGD) and annual endoscopic surveillance with biopsy for low grade dysplasia (LGD) The aim of this study was to determine the treatment plan for GED that is diagnosed by endoscopic biopsy. MATERIALS AND METHODS: We enrolled 148 patients who were treated by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for GED: there were 63 patients with HGD and 85 patients with LGD and all of them were diagnosed by endoscopic biopsy from January 2006 to December 2008. The results of the final histopathologic reports after EMR or ESD were compared with the results of the endoscopic biopsies. RESULTS: The final histopathologic results of the 148 patients with GED showed 49 (33.1%) patients with adenocarcinoma, 40 (27.0%) patients with HGD and 59 (39.9%) patients with LGD. Among the 63 patients with HGD, 34 (54.0%) patients had adenocarcinoma, 20 (31.7%) patients had HGD and 9 (14.3%) patients had LGD. For the 85 patients with LGD, 15 (17.6%) patients had adenocarcinoma, 20 (23.5%) patients had HGD and 50 (58.8%) patients had LGD. CONCLUSION: Complete resection, including EMR or ESD, is needed for patients with GED diagnosed by endoscopic biopsy and they have HGD. For patients with LGD, EMR or ESD may be needed in addition to endoscopic surveillance with biopsy for making the correct diagnosis and proper treatment because of the possibility of adenocarcinoma.
Adenocarcinoma ; Biopsy ; Epithelium ; Humans ; Stomach

Actinomycosis is a chronic, granulomatous suppurative disease caused by Actinomyces species. Actinomyces is an anaerobic, gram positive organism that requires special techniques for culture and isolation. Actinomycosis is characterized by formation of multiple abscesses, draining sinuses, abundant granulations (sulfur granule) and dense fibrous tissue. The three major clinical presentations include the cervicofacial, thoracic, and abdominal regions. Since A. israelii is a normal inhabitant of the oral cavity, to make a definitive diagnosis it must be recovered from closed tissue spaces, draining sinuses, or abscesses, or it must be shown to be invasive in histopathologic sections. The drug of choice is penicillin. Because of the dense fibrous tissue surrounding the colonies of organisms and the concentration of organisms in clusters, high doses of pharmacologic agents must be used for long periods, and radical surgical excision should accompany antibiotic therapy if possible. We report three cases of abdominal actinomycosis, preoperatively impressed as appendicitis and pelvic abscess, which was diagnosed by a histological study of operative specimens. The possible pathogenic mechanisms causing clinical symptoms are discussed.
Abscess ; Actinomyces ; Actinomycosis* ; Appendicitis ; Diagnosis ; Mouth ; Penicillins

Lithium remains the most widely used therapeutic agent for bipolar affective disorder, particularly mania. Although many investigators have studied the effects of lithium on abnormalities in monoamine neurotransmitter as a pathophysiological basis of affective disorder, the action mechanism of lithium ion remains still unknown. To explore the action mechanism of lithium in the brain, we examined the effects of lithium on the extrasynaptosomal concentrations of catecholamines and their metabolites. Synaptosomes were prepared from the rat forebrains and assays of catecholamines and metabolites were made using HPLC with an electrochemical detector. Lithium of 1mM decreased the extrasynaptosomal concentrations of NE from the control group of 3.07+/-1.19 to the treated group of 0.00+/-0.00 (ng/ml of synaptosomal suspension) but not that of DHPG. It can be suggested that lithium increases synaptosomal uptake of NE. Increased intraneuronal uptake of NE would decrease neurotransmission and extraneuronal metabolism of NE. Because increased brain NE metabolism and neurotransmission have been suggested as important components in the pathophysiology of bipolar affective disorder, especially mania, lithium-induced increase of intraneuronal NE uptake can be suspected as an action mechanism of therapeutic effect of lithium in manic patient, possibly in bipolar affective disorder.
Animals ; Bipolar Disorder ; Brain* ; Catecholamines ; Chromatography, High Pressure Liquid ; Humans ; Lithium ; Metabolism ; Mood Disorders ; Neurotransmitter Agents ; Norepinephrine* ; Prosencephalon ; Rats* ; Research Personnel ; Synaptic Transmission ; Synaptosomes

BACKGROUND: Argatroban, a direct thrombin inhibitor, has been suggested to be beneficial in acute ischemic stroke by preventing microthrombi formation. The aim of this multicenter, aspirin-controlled, randomized trial is to determine the safety and the efficacy of argatroban compared with aspirin in acute ischemic stroke. METHODS: The patients within 48 hours of noncardioembolic ischemic stroke were recruited from 8 centers. Argatroban was infused continuously at 2.5 mg/hr for the first 48 h, and then 10mg of argatroban was infused over 3 h twice a day on days 3-7. Control group received aspirin 300 mg/day for 7 days. The primary outcome was the NIHSS at 30 days and the secondary outcome was Barthel index (BI) and modified Rankin scale (mRS) at 90 days. The safety was evaluated by the incidence of bleeding complication. RESULTS: A total of 236 patients (123 for argatroban and 113 for aspirin) were included. NIHSS at 30 days, BI at 90 days and mRS at 90 days did not show significant difference between the argatroban and the aspirin group (3.1 +/- 3.1 vs 3.5 +/- 3.0, 88.9 +/- 22.5 vs 86.2 +/- 23.8, 1.4 +/- 1.1 vs 1.6 +/- 1.3, p>0.3, respectively). Post hoc analysis revealed that as for the patients who were treated within 24 hours after onset, numbers of patients with NIHSS=1 at 30 days were larger in the argatroban group (23 of 49) than in the aspirin group (10 of 40) (p=0.03). Bleeding complication was not different between the two groups (2 of 123 vs 0 of 113: p>0.4). CONCLUSIONS: Argatroban treatment is relatively safe in acute ischemic stroke. The efficacy of argatroban is not superior to aspirin. However, argatroban may be more beneficial in some subgroup of stroke patients than aspirin.
Aspirin ; Hemorrhage ; Humans ; Incidence ; Stroke* ; Thrombin

BACKGROUND AND OBJECTIVES: Dual blood supply to the anterior interventricular septum (IVS), derived from the septal branches of the left anterior descending artery (LAD) and the conal branch of the right coronary artery (RCA), may prevent ST segment elevation in lead V1 during an anterior acute myocardial infarction (AMI), and predict a favorable in-hospital clinical course. SUBJECTS AND METHODS: The admission 12-lead electrocardiogram (ECG), and the coronary angiograms performed within 10 days of hospital admission, were evaluated in 67 patients with anterior wall AMI, as defined by a ST segment elevation > or =2mm in at least 2 of the V1 to 4 leads. The patients were divided into two groups according to the magnitude of the ST segment elevation in V1 lead: group 1 (ST <1.5 mm, n=22) and group 2 (ST > or =1.5 mm, n=45). The conal branch types were classified into small (a diameter <0.5 mm), not reaching the IVS, and large (a diameter >0.5 mm), reaching the IVS. RESULTS: A large conal branch was found in 11 patients of each group 50 and 24%, respectively (p=0.04). There was no significant relation between the sites of the LAD lesion, whether proximal or distal to the first septal branch, and the presence of ST segment elevation in lead V1. The serum cardiac enzymes, Killip class and the incidence of in-hospital congestive heart failure, were not significantly different. CONCLUSION: The absence of ST segment elevation in lead V1 during an anterior AMI suggested that the IVS is protected by a large conal branch, in addition to the septal branch of the LAD, but this did not influence the in-hospital clinical course.
Anterior Wall Myocardial Infarction* ; Arteries ; Coronary Vessels* ; Electrocardiography ; Heart Failure ; Humans ; Incidence ; Myocardial Infarction ; Prognosis

Eosinophilic abscess is a rare disease of stomach that consists of many eosinophils in submucosa and muscle layers of stomach. Eosinophilic abscess is usually observed in liver after parasite infestation such as hepatic fascioliasis or in intradermal lesion of pemphigus. A 67-year-old female was admitted due to epigastric pain and indigestion. Endoscopic finding suggested early gastric cancer type IIc with the depth of invasion to mucosal layer at the lesser curvature of lower body. Histologic examination of endoscopic biopsy proved to be signet ring cell type adenocarcinoma. On endoscopic ultrasonography, the tumor was imaged as a slightly elevated mass with 15 mm in diameter. The lesion was localized from the first layer to the fourth layer which correspond to the mucosa and the proper muscle layer, The lesion consisted of low echoic and isoechoic densities. The lower echoic lesion ranging from the third layer to the fourth layer was thought to be necrotic or hemorrhagic portion within the tumor. Subtotal gasterectomy was performed. We compared the endoscopic and endosonographic features with the histologic findings of the resected stomach. Histologic examination showed signet ring cell carcinoma in mucosal layer and eosinophilic abscess in submucosal and proper muscle layer. We concluded that the endosonographic depth of invasion was overestimated because of the eosinophilic abscess.
Abscess* ; Adenocarcinoma ; Aged ; Biopsy ; Carcinoma, Signet Ring Cell ; Dyspepsia ; Endosonography* ; Eosinophils* ; Fascioliasis ; Female ; Humans ; Liver ; Mucous Membrane ; Parasites ; Pemphigus ; Rare Diseases ; Stomach ; Stomach Neoplasms*

BACKGROUND: Effective chest compression may improve the return of spontaneous circulation and neurologic outcome in arrest victims. For fear of rescuer's fatigue, guidelines for cardiopulmonary resuscitation (CPR) recommended that chest compression (CC) should be switched every 2 minutes, but there is little evidence. We investigated whether health personnel could provide consistent quality of CC for 2 minutes. METHODS: We recruited prospectively health personnel working on one university hospital. On the day assigned randomly, CPR performance data was collected with use of CPR recording technology. Quality of CPR was calculated every 30 seconds interval. To identify the quality decay, we used repeated measure analysis of variance with SPSS 17.0 for analysis. RESULTS: We analyzed 8,485 CCs performed by 41 subjects. Total number of CC decayed between 90 to 120 seconds (51.6 +/- 3.3 to 50.8 +/- 3.5, p = 0.020) within recommended range. The ratio of correct depth CC decayed between 90 to 120 seconds, falling from 83.4 +/- 24.9% to 68.3 +/- 38.4% (p = 0.002). The ratio of low depth CC increased significantly over time (10.2 +/- 20.7% to 31.3 +/- 38.5%, p < 0.001). CONCLUSIONS: Health personnel may provide adequate number of CC for 2 minutes. But, the number of correct depth CC may decay between 90 to 120 seconds. Also the number of low depth CC may increase over time.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Humans ; Manikins ; Prospective Studies ; Quality of Health Care ; Thorax

BACKGROUND AND OBJECTIVES: Cardiac myxomas are uncommon. Early diagnosis and treatment are essential to reduce morbidity or mortality. Before 1970, preoperative diagnosis was difficult. With the development of echocardiography, a correct diagnosis is made before operation. We reviewed our clinical experience in diagnosis and management of 52 cases of myxomas seen over a 33-year period, 1966 to 1998. PATIENTS AND METHODS: There were 20 males (38%) and 32 females (62%);age range 7 - 80. All the patient's medical records were reviewed. In twenty-five patients in whom echocardiographic features could be reviewed, clinical fetures were compared according to two distinct echocardiographic features;Round and polypoid type. RESULTS: Eighty-four percents of the presenting symptoms were cardiac origin while systemic embolism (SE) accounted for 15%. Echocardiography was used most often for diagnosis. The myxomas were located in the left atrium in 50 (96%), right atrium in 2 (4%). One patient had multiple myxoma. The incidence of SE was significantly higher in polypoid type than in round type (58% vs 0%, p<0.05). Multivariate regression analysis revealed polypoid type was the only independent predictor of SE (p=0.0029). Follow-up duration was ranged from 1 to 266 months. There was no deaths associated with myxoma. One patient presented with a recurrence 3 years after resection, and reoperation was performed uneventfully. CONCLUSION: Due to the nonspecific presentation of myxoma, a high index of suspicion is needed. Surgical excision of myxoma can be considered curative with excellent long-term result. However, because of high possible occurrence of SE, a close attention should be given to those patients who have myxoma of polypoid type.
Diagnosis ; Early Diagnosis ; Echocardiography ; Embolism ; Female ; Follow-Up Studies ; Heart Atria ; Humans ; Incidence ; Male ; Medical Records ; Mortality ; Myxoma* ; Recurrence ; Reoperation

A seven months old, tiger shovelnose catfish was referred to the veterinary medical teaching hospital of the college of veterinary medicine, Konkuk university because of suspecting a foreign body in the stomach. By physical and radiologic examinations, the catfish revealed abdominal enlargement, vomiting, inactivity and radiopaque foreign bodies in the stomach. Under general anesthesia with dilute isoflurane solution, celiotomy was performed. Stomach was atonic, and three foreign bodies were palpated in the stomach. In this process, three stones came out through mouth. Abdominal muscles were closed with a simple continuous suture pattern, and skin was closed with a simple mattress suture pattern. Sutured site was covered with glue and mucous taken from allogenic skin. On the second day after surgery, the patient recovered to normal condition, showing increased appetite and activity.
Animals ; Catfishes/*surgery ; Foreign Bodies/pathology/*surgery ; Gastroscopy/veterinary ; Stomach/*surgery