No abstract available.
Encephalitis, Arbovirus*

BACKGROUND: We studied the incidence of trauma caused by alcohol related accidents, and the effects that has on the occurrence, the extent, and the outcome to the patient. METHODS: In our study we studied trauma patients excluding pediatric patients(15 years old and under) who came to the Emergency department of Korea University Medical School Anam Hospital from the 1st of january 1996 to 30th of June 1996, looked into their medical records, and studied the records in a retrospective manner. The trauma patients were divided into two groups, a) alcohol-related and b) alcohol-non-related. The two groups were then subdivided according to their sex, age, the time they came in, the anatomical part of the trauma, the mechanism of their injury, the extent of the injury, the length of their hospital stay, the length of their ED stay and were seperately compared and analysed. Statistically, ANOVA and logistic regression analysis using SAS were used in the study and then was assessed in Chi-square analysis methods. RESULTS: The total of the trauma patients, added up to 832 people, 577: male and 255: female. Among this sum, 16 trauma patients were alcohol related(male:127 & female 36). 115 people were in the age group of 21-40. Compared to the non-alcohol related trauma group, the alcohol-related group had more facial & scalp injuries and tended to come in the hours between 0-6 AM. The cause of the injuries were mossy by fast-fighting and suicide, compared to mostly accidental-slipping injuries in the non alcohol-related group. There were no difference in the degree of the injury(ISS) and the length of hospital stay between the two groups, whereas the length of the stay at the ED was longer alcohol-related trauma patients. CONCLUSION: Alcohol related trauma patients were mostly in their 20s and 30s, came to the hospital at a late time it the reason for their visit were mossy because of fist fighting. In the Emergency department, because prompt and correct diagnosis is quite difficult to make in this group, their ED stay tended to be longer. We can conclude that measuring the blood alcohol level of these patients, continuing the psychological therapy and educating people is needed.
Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Incidence ; Korea ; Length of Stay ; Logistic Models ; Male ; Medical Records ; Retrospective Studies ; Scalp ; Schools, Medical ; Suicide

Spasticity is a wide variety of motor problems to connote difficulty with coordinated movements, involuntary spasma, rigidity. Abnormal primitive reflexes and hyperactive reflexes. Electrophysiologically, spasticity is represented as the involuntary firing of motor units on a reflex basis at a polysynaptic spinal cord level, associated with interruption of descending cortical pathways. Although many procedures have been tried over the years to combat this spasticity, and the multitude of procedures indicates that none are entirely satisfactory, the reduction in spasticity produced by dentatotomy has been confirmed in many neurological centers. The F-wave is a late response recorded in the electromyography of a muscle following stimulation of its nerve supply. There is evidence that the size of the F-wave is dependent on motor neuron excitability. If such a relationship exists, procedures which are carried out to relieve motor neuron excitability might be expected to change F-wave size and it might therefore be possible to use the F-wave as an objective monitor during stereotactic dentatotomy. We have investigated this possiblity in 10 cats, weighing 2.8 to 3.7kg each. The size of F-wave Amplitude in experimental animals were devided into 2 groups, normal control group values(10 cats, before dentatotomy) and the dentatotomy group values(10 cats after dentatotomy). The F-wave size and F/M ratio were recorded from right tibialis anterior muscle after application of supramaximal stimulation(250 V. 100 mA. 2 Hz. 10 times) on the right peroneal nerve. The results were as follows: 1) The size of M-wave amplitude did not change significantly in experimental models(before dentatotomy, 2805.5+/-1012.3 microV;dentatotomy group, 2555.5+/-725.9 microV, P>0.05). 2) The individual size of F-wave showed a wide variability from each stimulus, which emphasizes the importance of using 0 stimulating responses. The mean value of F-wave amplitude before dentatotomy was 436.5+/-113.2microV. 3) The size of F-wave amplitude was significantly reduced after dentatotomy(before dentatotomy, 436.5+/-113.2microV;after dantatotomy: 212.5+/-49.3microV, P<0.05). The size of F-wave amplitude decreased about 48.6% after dentatotomy. 4) The F/M ratio also significantly reduced after dentatotomy(before dentatotomy, 17.1+/-6.6%;after dentatotomy, 8.5+/-1.2%, P<0.05) and mean reduction was 49.7%. The results demonstrated that the dentatotomy markedly decreased the size of F-wave amplitude in experimental cats and indicated that the monitoring of F-wave amplitude during dentatotomy might be useful as an objective monitor for the relief of spasticity.
Animals ; Cats* ; Dyskinesias ; Electromyography ; Fires ; Motor Neurons ; Muscle Spasticity ; Peroneal Nerve ; Reflex ; Spinal Cord

OBJECTIVE: In the case of internal carotid-posterior communicating (ICPCom) artery aneurysm it is possible to successfully clip the aneurysmal neck without any difficulty. However, if the aneurysmal neck is wide, the aneurysmal sac is giant, the aneurysmal sac is hidden by the anterior clinoid process (ACP), or its dome is located in ventral portion or low-lying ICPCom aneurysm, it is difficult to open the proximal aneurysmal neck and we encounter a barrier in controlling bleeding in case of premature rupture of the aneurysm. They need to be resected the ACP for successful aneurysmal clipping. We propose angiographic criteria for predicting necessity of resection of the ACP before clipping of the ICPCom artery aneurysm. METHODS: Between 1999 and 2003, 16 patients with ICPCom artery aneurysm were treated with the resection of the ACP prior to applying the clip on the neck of the aneurysm. We retrospectively analyzed the preoperative cerebral angiographies, and the clinical and operative findings. We measured various radiometric parameters to reveal the angiographic characteristics. RESULTS: The mean value of the radiographic measurement in case of the cerebral angiography in 16 patients is as follows: angle A (the angle between the midline of the skull and the axis of the C1 segment on A-P view) ranged from 15 to 80 degrees (mean+/-SD, 42+/-5 degrees), angle B (the angle between the axes of the C1 and C2 segments on A-P view) ranged from 70 to 150 degrees (mean+/-SD, 110+/-15 degrees), and distance C (the distance between the tip of the ACP and the most proximal portion of the aneurysmal neck on the lateral view) ranged from 2 to 9 mm (mean+/-SD, 4.5+/-1 mm). CONCLUSION: We have resected the ACP in 16 of the 40 ICPCom aneurysms. The mean values of angle A, angle B, and distance C is 42+/-5 degrees, 110+/-15 degrees, and 4.5+/-1 mm, respectively. We did not encounter any difficulty in clipping in all the cases in which there was no premature rupture of the aneurysm. Most of cases had a good outcome.
Aneurysm* ; Arteries* ; Axis, Cervical Vertebra ; Cerebral Angiography ; Hemorrhage ; Humans ; Neck ; Retrospective Studies ; Rupture ; Skull

This report attempts to explain the (i) implications of comorbidity for research and practice in the fieldo of oncology, (ii) the approach for dosing of anti-cancer drugs in the presence of comorbidity, as an example of its clinical application, and finally (iii) the dosing guidelines for the anticancer drugs clinically active in gastric cancer in the presence of renal or liver dysfunction. This has resulted from the idea of approaching comorbidity in a systematic way and of integrating it with oncologic decisions. Various methods have been used to assess comorbidity. However, significant work remains to be done to analyze how various diseases combine to influence the oncologic outcome. The main end-point explored so far has been mortality, but a largely open challenge remains to correlate comorbidity with treatment tolerance and functional and quality of life, as well as to integrate it in clinical decision-making. Cancer chemotherapy in comorbidity should be considered as an example of the need for dose optimization in individual patients, and it should be determined by considering the basic principles of the pharmacokinetics and the pharmacodynamics of the agents. This review analyzes the available data on the pharmacokinetics and the toxicities of anti-cancer agents in the comorbidity population.
Comorbidity* ; Drug Therapy* ; Humans ; Liver Diseases ; Mortality ; Pharmacokinetics ; Quality of Life ; Stomach Neoplasms

MRI(Magnetic Resonance Imaging) have provided for greater image resolution, detailed tissue contrast without use of contrast media and images acquired in any plane. The purpose of this study was to examine the anatomy and dimension of the epidural space using MRI(Magnetic Resonance Imaging) and to compare the information obtained with that from other investigative technique. The anatomy of the lumbar epidural space was studied retrospectively using lumbar MRI scans of 90 patients. The epidural width(E.W.) is divided into three distance between the anterior surface of the ligamentum flavum and the dura at the caudal end of the lumbar segment(A), at the mid point of the ligamentum flavum(B) and at the cranial end of the lumbar segment(C). The distance from skin to supraspinous ligament(S-L) and from supraspinous ligament to epidural space(L-E) were measured. And then with adding both the distance, We measured the distance from skin to epidural space(S-E). Results were as follows; I) Posterior to the dural sac, epidural fat which is of high signal(white) on Tlw(T1 weighted) image is demonstrated at levels Tl I-T12 to L5-Sl giving 'Saw toothed' pattem to the epidural space. The fat is divided into segments by the interposing laminar, and the epidural space is deeper at cranial end than caudal end. 2) It was the relatively wide epidural space in L2-3 and L3-4 level, and the narrowest epidural space in L5-Sl level. 3) The distance from skin to supraspinous ligament was noted marked variation(2-40mm) according to the individual disparity. And the distance from supraspinous ligament to epidural space is 17-43mm. In distance from skin to epidural space, the most narrow place is Ll-21evel (37.95+/-7.65mm). The most deep place is IA-5 level(46.35+/-7.20mm). As the age increase, epidural width is decreased at L3-4 level (p<0.05).
Contrast Media ; Epidural Space* ; Humans ; Investigative Techniques ; Ligaments ; Ligamentum Flavum ; Magnetic Resonance Imaging* ; Retrospective Studies ; Skin

The transforaminal epidural injection (TFEI) has been preferred in many cases because it can deliver the injected dose of medication closer to the nerve root and better facilitate ventral epidural flow compared to other methods. However, in patients with deformities not demonstrated on fluoroscopic imaging, the needle may enter unwanted locations. We treated two cases of intradiscal injection of contrast dye, during the TFEI, in patients with lumbar disc herniation.
Congenital Abnormalities ; Discitis ; Humans ; Injections, Epidural ; Needles

BACKGROUND: Perfusion scintigraphy with dipyridamole have been reported to be useful for diagnosis of coronary artery disease and the assessment of the presence and extent of myocardium at ischemic risk, especially in patients who can not undergo dynamic exercise testing. Dipyridamole, pharmacologic coronary vasodilator, also induces fall in blood pressure and rise in heart rate. The purpose of this study was to answer the question if dipyridamole induced peripheral hemodynamic responses were related to chest pain, ST changes on EKG, scintigraphic defect or extent of coronary stenosis. METHODS: Dipyridamole 99mTc-MIBI myocardial scintigraphy and coronary angiography on 43 subjects who were suspected to have coronary artery disease. The peripheral hemodynamic response was graded as absent(group 0) if there was a < or =10mm fall in systolic blood pressure (SBP) and/or < or =10 beats/min rise in geart rate(HR) ; moderate(group 1) if there was >10 but < or =20mm fall in SBP and/or >10 but < or =20 beats/min rise in HR ; and marked (group 2) if there was >20mm fall in SBP and/or >20 beats/min rise in HR. RESULTS: The overall diagnostic sensitivity and specificity for coronary artery disease of dipyridamole perfusion scintigraphy were 68%, 83% while per vessel sensitivity and specificity for coronary artery disease were 66%, 97%. The numbers of induced chest pain and ischemic ST changes among hemodynamic subgroups, were 40%, 40% in group 0, 33%, 27% in group 1 and 50%, 40% in group 2 without significant difference in each hemodynamic subgroups. Either the numbers of diseased coronary arteries or the numbers of patients demonstrationg reversible scintigraphic defects were not statically different among each subgroups. CONCLUSION: Although the peripheral hemodynamic response dose not always correlate with its central coronary effect but dipyridamlole 99mTc-MIBI myocardial perfusion scintigraphy is an useful test for diagnosis of coronary artery disease.
Blood Pressure ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis ; Dipyridamole* ; Electrocardiography ; Exercise Test ; Heart Rate ; Hemodynamics* ; Humans ; Myocardial Perfusion Imaging ; Myocardium ; Perfusion Imaging ; Sensitivity and Specificity

Endovascular procedures are becoming the standard type of care for the management of hemodialysis vascular access dysfunction. As with any type of medical procedure, these techniques can result in procedure-related complications, although the expected number of complications is low. The clinical extent of these complications varies from case to case. Management of these cases depends on the clinical presentation. Major complications such as vein rupture, arterial embolism, remote site bleeding or hematoma, symptomatic pulmonary embolism and puncture site complications necessitating treatment require major therapy. Minor complications such as non-flow compromising small puncture site hematoma or pseudoaneurysms require little or no therapy. It is essential that the interventionist be prepared to manage these complications appropriately when they arise.
Veins ; Stents ; Rupture, Spontaneous ; Retrospective Studies ; Renal Dialysis/*methods ; Postoperative Complications/therapy ; Middle Aged ; Male ; Humans ; Female ; Extravasation of Diagnostic and Therapeutic Materials/therapy ; Embolism/therapy ; *Arteriovenous Shunt, Surgical ; Aged ; Adult

PURPOSE: A new quantitative tumor marker, based on the combined measurement of urinary fragments of cytokeratin 8 and 18, namely the urinary bladder cancer antigen (UBCTM) test, has been proposed for the detection of bladder cancer. We compared the results of the UBC test, with voided urine cytology, for the diagnosis of bladder cancer to evaluate its diagnostic performance. MATERIALS AND METHODS: The UBC concentrations were measured, using an immunoradiometric assay, in the urine of 15 healthy subjects (group I), 26 patients with other urological disease except bladder cancer (group II), 40 patients with active bladder cancer (group III) and 17 patients free of bladder cancer, as confirmed by cystoscopy at follow-up (group IV). The differences in the UBC test, with regard to stage, grade, tumor size, focality and history of recurrence, were also evaluated. RESULTS: The mean UBC concentrations were 3.52micro gram/l, 45.76micro gram/l, 92.80micro gram/l and 20.51micro gram/l, for group I to IV, respectively, which were statistically different (p<0.05). There were significant differences regarding stage (p=0.044) and tumor size (p=0.036). However, no differences were founded in relation to the grade, shape, focality or history of recurrence. The optimal threshold for the UBC test, and the area under the ROC curve, were 12.8micro gram//l and 0.684, respectively. The sensitivity, specificity, positive and negative predictive values for the UBC test and urine cytology in groups III and IV were 50.0 and 30.0%, 88.2 and 100%, 90.9 and 100%, and 42.9 and 37.0%, respectively. CONCLUSIONS: The UBC test appears to be useful for the detection of bladder cancer in terms of its superior sensitivity and negative predictive value over those of urine cytology. Further studies will be required for the clinical utility of the UBC test in the diagnosis and follow-up of bladder cancer.
Cystoscopy ; Diagnosis* ; Follow-Up Studies ; Humans ; Immunoradiometric Assay ; Keratin-8 ; Recurrence ; ROC Curve ; Sensitivity and Specificity ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urologic Diseases