In Uremic condition, Secondary Hyperparathyroidism ensues due to phosphate retention, low level of calcitriol, decreased calcium absorption from intestine, skeletal resistance to the Parathyroid Hormone (PTH), hypocalcemia and eventually parathyroid hyperplasia. Theoretically, Reversal of hyperparathyroidism can be expected after successful kidney transplantation. However, Some patients show continuous increase of parathyroid function due to autonomous excretion of PTH, in which case, we could assume a tertiary hyperparathyroidism. There were sporadic reports for the treatment of tertiary hyperparathyroidism after successful kidney transplantation. And in some aspects, there remains a controvesrsy about the timing of parathyroidectomy. The occurrence of a single parathyroid adenoma after kidney transplantation is ever unusual finding. In our hospital, we have experienced a case of parathyroid adenoma who had taken successful kidney transplantation. The patient was 62 year old man who had a long duration of hemodialysis for 10 years. His hypercalcemic findings were managed medically for 1 year. As the patient's hypercalcemic symptom aggrevated, he was admitted and parathyroid adenoma was diagnosed by a CT scan and parathyroid scan. After excsion of the parathyroid adenoma, his general condition and kidney function improved. In our conclusion, there may be a debate for the timing of subtotal parathyroidectomy in the patient with tertiary hyperparathyroidism after kidney transplantation. But when the patient shows a hypercalcemic profile, the parathyroid scan, CT scan, Neck Ultrasonography must be considered to detect single parathyroid adenoma which is so simple to remove surgically.
Absorption ; Calcitriol ; Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Hyperplasia ; Hypocalcemia ; Intestines ; Kidney Transplantation* ; Kidney* ; Middle Aged ; Neck ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Parathyroidectomy ; Renal Dialysis ; Tomography, X-Ray Computed ; Ultrasonography

Giant fusiform aneurysms at the basilar trunk tend to have a poor natural history and surgical management for these aneurysms remains controversial. For these aneurysms, basilar trunk occlusion with endovascular coiling is difficult when the collateral supply from the carotid circulation is relatively poor. Interestingly, we herein present a successfully treated case of a partially thrombosed giant fusiform aneurysm at the basilar trunk with relatively poor collateral supply using endovascular coil occlusion following bypass surgery (superficial temporal artery-radial artery-superior cerebellar artery anastomosis).
Aneurysm ; Arteries ; Natural History

Meralgia paresthetica is commonly caused by a focal entrapment of lateral femoral cuteneous nerve while it passes the inguinal ligament. Common symptoms are paresthesias and numbness of the upper lateral thigh area. Pregnancy, tight cloths, obesity, position of surgery and the tumor in the retroperitoneal space could be causes of meralgia paresthetica. A 29-year-old female patient underwent an emergency cesarean section under spinal anesthesia without any problems. But two days after surgery, the patient complained numbness and paresthesia in anterolateral thigh area. Various neurological examinations and L-spine MRI images were all normal, but the symptoms persisted for a few days. Then, electromyogram and nerve conduction velocity test of the trunk and both legs were performed. Test results showed left lateral cutaneous nerve injury and meralgia paresthetica was diagnosed. Conservative treatment was implemented and the patient was free of symptoms after 1 month follow-up.
Adult ; Anesthesia, Spinal ; Cesarean Section ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Hypesthesia ; Leg ; Ligaments ; Nerve Compression Syndromes ; Neural Conduction ; Neurologic Examination ; Obesity ; Paresthesia ; Pregnancy ; Retroperitoneal Space ; Thigh

The ischemic preconditioning was initially identified as a protective maneuver induced by brief periods of ischemia followed by reperfusion. Although ischemic preconditioning can reduce ischemic injury of heart, skeletal muscle and neuronal tissue, it's protective mechanism remains elusive. Recently, several investigations suggest the associations of nitric oxide with protection from ischemic injury. Nitric oxide synthesized by a member of nitric oxide synthase (NOS) family has been known to increase or decrease the ischemic injury. The purpose of this study was to observe the expression patterns of NOS 1, NOS 2 and NOS 3 in the rat skeletal muscle after cyclic episodes of short ischemia and reperfusion. Nine and thirty-five weeks-old male Sprague-Dawley rats were divided into control and cyclic short ischemia and reperfusion groups. The experimental group was further divided into 3 groups based on cycles of short ischemia and reperfusion. For cyclic short ischemia and reperfusion, left commom iliac artery was occluded 3, 6 and 10 times for 5 minutes ischemia followed by 5 minutes reperfusion using rodent vascular clamps. The animals were sacrificed at hours 0, 3, 6, 24 and 72 after reperfusion and the left rectus femoris muscles were removed. The expression profiles and distribution of NOS 1, NOS 2 and NOS 3 were examined with immunohistochemical staining. The results were as follows; In the cyclic of short ischemia and reperfusion groups, the mortality was increased with increasing of cyclic episodes at 72 hours after reperfusion, and aging. In the control group, NOS 1, NOS 2 and NOS 3 immunoreactivities showed no differenes with aging. In the 9 weeks-old rats, NOS 1 immunoreactivities were observed moderate at 24 hours after 6 times of short ischemia and reperfusion, and moderate and strong at 24 hours after 10 times of short ischemia and reperfusion. In the 35 weeks-old rats, NOS 1 immunoreactivities were observed trace or mild at 24 hours after 6 and 10 times of short ischemia and reperfusion. At 3 hours after 3 times of short ischemia and reperfusion, NOS 2 immunoreactivities were observed moderate or strong, and trace in the 9 and 35 weeks-old rats, respectively. At 3 hours after 10 times of short ischemia and reperfusion, NOS 3 immunoreactivities were observed mild or moderate, and trace or negative in the 9 and 35 weeks-old rats, respectively. In summary, the expression profile of NOS 1, NOS 2 and NOS 3 were observed differently with increasing episodes of short ischemia and reperfusion. The alteration was the most prominent in NOS 3 than in NOS 1 and NOS 2. These results suggest that the alteration of NOS 3 known to protect tissue against ischemic injury may be associated with increasing mortality after multiple episodes of short ischemia and reperfusion.
Aging ; Animals ; Heart ; Humans ; Iliac Artery ; Ischemia* ; Ischemic Preconditioning ; Male ; Mortality ; Muscle, Skeletal* ; Muscles ; Neurons ; Nitric Oxide Synthase ; Nitric Oxide* ; Quadriceps Muscle ; Rats* ; Rats, Sprague-Dawley ; Reperfusion* ; Rodentia

Spontaneous rupture of the kidney, Wonderlich syndrome, is a rare event but potentially life-threatening condition. The most comman causes are clear cell carcinoma, benign angiomyolipoma and vascular disease. Among this event, acute pyelonephritis is a very unusual cause. A 67-year-old diabetic woman was admitted with high fever and left flank pain due to acute pyelonephritis. She had uterine prolapse for 10 years with both renal hydronephrosis before this event. Abdominal ultrasonography and CT scan showed fluid collection around left kidney with a rupture of renal parenchyme at lower pole. The renal angiography showed displaced capsular artery due to subcapsular hematoma and decreased blood flow at lower pole. The percutaneous needle aspiration revealed blood collection around left kidney, which confirmed spontaneous rupture of the kidney. We report this case with a review of the relevant literature.
Aged ; Angiography ; Angiomyolipoma ; Arteries ; Female ; Fever ; Flank Pain ; Hematoma ; Humans ; Hydronephrosis ; Kidney* ; Needles ; Pyelonephritis* ; Rupture ; Rupture, Spontaneous* ; Tomography, X-Ray Computed ; Ultrasonography ; Uterine Prolapse ; Vascular Diseases

OBJECTIVES: To identify the risk factors of cerebrovascular disorders(CVD) in Koreans using a nested case-control study. METHODS: The cohort consisted of beneficiaries who had taken health examinations of the Korea Medical Insurance Corporation (KMIC cohort: 115,600 persons) in 1990 and 1992 consecutively. Four hundred and twenty five (425) cases were selected following the validation of diagnosis among 2,026 reported CVD (I60-I68) inpatients during the year from 1993 to 1997. Controls were matched (1:1) with age and gender of the cases among inpatients without CVD during the same period. The source of data in this study were the files of the 1990 health examinations and the 1992 health questionnaires, as well as an additional telephone survey undertaken from March to November 1999. RESULTS: In a bivariate analysis and multiple logistic regression analysis, risk factors for total CVD were hyperglycemia and hypertension. Unrespectively, the odds ratio of ex-smoker was significantly lower than that of those who had never smoked. The risk factors for ischemic CVD also were hyperglycemia and hypertension. However, only blood pressure was found to be a risk factor for hemorrhagic CVD. Hypercholesterolemia was not a risk factor for total CVD, ischemic CVD, and hemorrhagic CVD. CONCLUSION: We concluded that the most important risk factor for CVD (including subtype) in Koreans was hypertension.
Blood Pressure ; Case-Control Studies ; Cerebrovascular Disorders* ; Cohort Studies ; Diagnosis ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Hypertension ; Inpatients ; Insurance ; Insurance Benefits ; Korea ; Logistic Models ; Odds Ratio ; Questionnaires ; Risk Factors* ; Smoke ; Telephone

It is controversial whether isolated lesions of mammillothalamic tract (MTT) produce significant amnesia. Since the MTT is small and adjacent to several important structures for memory, amnesia associated with isolated MTT infarction has been rarely reported. We report a patient who developed amnesia following an infarction of the left MTT that spared adjacent memory-related structures including the anterior thalamic nucleus. The patient s memory deficit was characterized by a severe anterograde encoding deficit and retrograde amnesia with a temporal gradient. In contrast, he did not show either frontal executive dysfunction or personality change that is frequently recognized in the anterior or medial thalamic lesion. We postulate that an amnesic syndrome can develop following discrete lesions of the MTT.
Aged ; Amnesia/*etiology ; Cerebral Infarction/*complications ; Humans ; Male ; Mamillary Bodies/*physiopathology ; Neuropsychological Tests ; Thalamus/*physiopathology

BACKGROUND: An assessment of the presence and the degree of reversibility of airflow obstruction is clinically important in patients with asthma or chronic obstructive pulmonary disease. However, the time responses of spirometric parameters in response to bronchodilator have not been well investigated. METHODS: We studied 15 patients with asthma. Spirometric and mini-Wright peak expiratory flow measurements were performed at 15, 30, 45, and 60 minutes after using single dose(200 micro gram) of inhaled bronchodilator, salbutamol. RESULTS: The mean values of forced expiratory volume in one second(FEV1) and forced vital capicaty(FVC) were significantly increased at 60 minutes after using bronchodilator in comparison to 15 minutes. And peak expiratory flow rate measured by either mass flow sensor or mini-Wright peak flow meter were significantly increased at 45 minutes after using bronchodilator in comparison to 15 minutes. CONCLUSIONS: To appropriate evaluation of the bronchodilator response in patients with reversible airflow limitation, it would be useful measuring either FEV1 or PEF at the later time point 60 or 45 minutes in comparison to 15 minutes after using bronchodilator.
Albuterol* ; Asthma ; Forced Expiratory Volume ; Humans ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive

PURPOSE: Kyungpook National University School of Medicine initiated a pilot project to admit small number of qualified students who received BS degree or above in the field of sciences in 1996. This study was conducted to evaluate effectiveness of the pilot project. METHODS: Students' academic grades, outcome of their opinion surveys on adaptability to the school life, difficulties and problems from the classes of 1996 to 2001 were analyzed. RESULTS: A total of 57 students were admitted to this program over the past 7-year period, 54.8% of them from natural science major and 36.8% from engineering. Students admitted with BS degree were performing above average in the class by % rank. There was no significant difference in academic performance between the natural science and the engineering major. Of 20 graduated, only one took career in basic medical science (physiology). The students thought undergraduate education was helpful in maturing personal characters than in knowledge or skill attainment. CONCLUSION: The achievement of medical students admitted after baccalaureate level was comparable to that of students with two years of premedical education.
Education ; Education, Medical ; Education, Premedical ; Gyeongsangbuk-do ; Humans ; Natural Science Disciplines ; Pilot Projects ; Students, Medical*

PURPOSE: Implant stability at the time of surgery is crucial for the long-term success of dental implants. Primary stability is considered of paramount importance to achieve osseointegration. The purpose of the present study was to investigate the correlation between the insertion torque and primary stability of dental implants using artificial bone blocks with different bone densities and compositions to mimic different circumstances that are encountered in routine daily clinical settings. METHODS: In order to validate the objectives, various sized holes were made in bone blocks with different bone densities (#10, #20, #30, #40, and #50) using a surgical drill and insertion torque together with implant stability quotient (ISQ) values that were measured using the Osstell Mentor. The experimental groups under evaluation were subdivided into 5 subgroups according to the circumstances. RESULTS: In group 1, the mean insertion torque and ISQ values increased as the density of the bone blocks increased. For group 2, the mean insertion torque values decreased as the final drill size expanded, but this was not the case for the ISQ values. The mean insertion torque values in group 3 increased with the thickness of the cortical bone, and the same was true for the ISQ values. For group 4, the mean insertion torque values increased as the cancellous bone density increased, but the correlation with the ISQ values was weak. Finally, in group 5, the mean insertion torque decreased as the final drill size increased, but the correlation with the ISQ value was weak. CONCLUSIONS: Within the limitations of the study, it was concluded that primary stability does not simply depend on the insertion torque, but also on the bone quality.
Bone Density ; Dental Implants ; Humans ; Mandrillus ; Mentors ; Osseointegration ; Torque