Vertigo mimicking labyrinthine lesions may have resulted from ischemic insult to the inner ear or the vestibular nerve and nucleus in the AICA infarction syndrome. A 56-year-old female was admitted to the emergency room with vertigo and hearing loss in right ear. On neurological examination, she had left beating jerky torsional and horizontal nystagmus with falling and past pointing to right side. Brain magnetic resonance images showed high signal intensity in anterolateral portion of inferior pons on T2- weighted images. Severe right facial palsy of peripheral type developed 24 hours after admission. Audiometry and electronystagmography documented absent auditory and vestibular function on the affected side. We argue that vertigo of the acute infarction in AICA territory can be involved the eight and seventh nerve root entry zoon and mimic labyrinthine lesions
Audiometry ; Brain ; Ear ; Ear, Inner ; Electronystagmography ; Emergency Service, Hospital ; Facial Nerve* ; Facial Paralysis ; Female ; Hearing Loss ; Humans ; Infarction* ; Middle Aged ; Neurologic Examination ; Nystagmus, Pathologic ; Pons ; Vertigo* ; Vestibular Nerve

Malignant transformation develops in a little less than 2% of mature cystic teratomas. A wide variety of malignant tumors may arise within benign mature cystic teratomas, and the most common of these is squamous cell carcinoma, which account for 75~85%. In general, the tumors are in an advanced stage and the prognosis is poor as most patients die within a year. However, when the tumor is confined to the ovary, they have a good prognosis and the 5-year survival rate is 63~83%. We experienced three cases of squamous cell carcinoma arising in mature cystic teratoma. Two of the carcinomas occurred in postmenopausal women: 58-(case 1) and 66-(case 2) year-old, and were confined to the ovaries. They were alive 37 months and 18 months after the operation, respectively. The third case was a 45-year-old premenopausal woman who had an extraovarian extension of the tumor and early recurrence within two months. Histologically, cases 1 and 3 were conventional well to moderately differentiated squamous cell carcinomas and case 2 showed a well-differentiated squamous cell carcinoma with exuberant proliferating trichilemmal tumor-like areas.
Carcinoma, Squamous Cell* ; Female ; Humans ; Middle Aged ; Ovary* ; Prognosis ; Recurrence ; Survival Rate ; Teratoma*

OBJECTIVE: The purpose of this study is to identify risk factors for subarachnoid hemorrhage(SAH) in Korea. METHODS: The clinical record and environmental data of 250 patients who had admitted our hospital between September 2001 and May 2003 were reviewed retrospectively by the neurosurgical nursing practitioners. RESULTS: In this study, the peak age for presentation with ruptured intracranial aneurysm was around 5th decade which is most active period of his or her life. The peak time of aneurysm rupture was from 6 to 12 A.M.(34.8%) and the onset of SAH occurred the most frequently at work(30.4%). The prevalence of hypertension in SAH patients was 42.8%, That of cigarette smoking in men and in women were 81.7% and 15.8% respectively. Hypertension was significantly corrected with the amount of hemorrhage based on Fisher Grading system(P<0.05). The consumption of smoking and the amount of hemorrhage was closely correlated also(P<0.05). CONCLUSION: Hypertension and cigarette smoking may be closely related to aneurysmal SAH. Undoubtedly, they are significantly related to massive, fatal SAH with poor neurologic condition. To prevent reduce aneurysmal SAH, cessation of smoking, anti-hypertensive medication and stress control are most important basic step in promotion of public health.
Aneurysm* ; Causality* ; Female ; Hemorrhage ; Humans ; Hypertension* ; Intracranial Aneurysm ; Korea ; Male ; Nursing ; Prevalence ; Public Health ; Retrospective Studies ; Risk Factors ; Rupture* ; Smoke* ; Smoking*

OBJECTIVE: We present a retrospective analysis of clinical characteristics of vertebral artery dissecting aneurysms and efficacy of treatment outcome according to the various treatment modalities. METHODS: From March 2001 to February 2002, seven patients with dissecting aneurysm of vertebral artery were diagnosed by cerebral angiography. Five patients presented with subarchnoid hemorrhage and two patients with mass effect. Five patients were treated endovascularly using Guglielmi detachable coils and a patient with severe brainstem compression underwent direct surgery. Another patient rebled before treatment and subsequently died. RESULTS: We had no endovascular procedure-related complications. Four patients with subarachnoid hemorrhage who underwent endovascular treatment survived with good recovery. One of them rebled after initial treatment and was treated by additional endovascular procedure. Among patients with mass effect, one patient was treated with proximal occlusion of vertebral artery and another underwent complete excision of aneurysm, with anastomosis of the PICA into the dissecting aneurysm proximal portion. We obtained a good treatment results with improvement of myelopathy in both patients, however, the patients who had underwent bypass surgery suffered from transient lower cranial nerve palsy. CONCLUSION: The endovascular treatment for vertebral artery dissecting aneurysm could be the treatment of choice for these lesions to prevent early rebleeding and obtain optimal results. However, the choice for the treatment modality in such lesions should be determined according to the individual lesions considering the status of patients, clinical characteristics, and relation with posterior inferior cerebellar artery.
Aneurysm ; Aneurysm, Dissecting* ; Arteries ; Brain Stem ; Cerebral Angiography ; Cranial Nerve Diseases ; Endovascular Procedures ; Hemorrhage ; Humans ; Pica ; Retrospective Studies ; Spinal Cord Diseases ; Subarachnoid Hemorrhage ; Treatment Outcome ; Vertebral Artery*

BACKGROUND: Pharmacists could dispense medicines without doctors' prescription in Korea before July 2000. The aim of this study was to compare the prescription behaviors of practicing doctors and pharmacists to common cold by the simulated patients. We selected the common cold as a subject of simulation because it was the most frequent health problem to visit doctors and pharmacists and the abuse of antibiotics might be prevalent in management of it. METHODS: Seventy five private clinics and drug stores were selected in Seoul, Korea. The simulated patients were selected and trained standardized symptoms of common cold. The simulated patients recorded the prescription behaviors of doctors and pharmacists. RESULTS: Average number of prescribed medicines were 5.0 and 5.6 in clinic and drug store respectively. 54.7% of the clinics and 61.3% of the drug stores prescribed antibiotics respectively with no significant difference between them. The most frequently prescribed antibiotics were penicillines. About 7% of the doctors and 11% of the pharmacist prescribed glucocorticoid to simulated patients respectively. About 20% of the pharmacists performed some kinds of physical examination to the simulated patients. Both doctors and pharmacist gave little information or advice on use of medicines, possible side effects and past side effects of medicines. CONCLUSION: There were frequent abuse of antibiotics and occasional use of glucocorticoid in private clinics and drug stores. Both doctors and pharmacists did not give enough information on use of medicines to the simulated patients.
Anti-Bacterial Agents ; Common Cold* ; Humans ; Korea ; Patient Simulation ; Penicillins ; Pharmacists* ; Physical Examination ; Prescriptions* ; Seoul

Three dimensional structures of envelope protein from Korean isolates and Nakayama-NIH strain of Japanese encephalitis virus (JEV) were deduced by a computer program (HyperChem 4.0 Chemplus 1.0) based on the data of the three dimentional structure of Tick-borne encephalitis virus. In the three dimensional structure of envelope protein, neutralizing epitope and T-helper cell recognition site of C-terminal region of Korean isolates were structually similar to those of Nakayama-NIH but the N-terminal region was not. Korean JE isolates were compared with Nakayama-NIH strain by using cross-neutralization antibody test. Neutralizing activities of Korean isolates derived from guinea pigs were higher than those of Nakayama-NIH strain against Korean isolates, although the polyclonal antibody titers of Nakayama-NIH showed 1:160 to 1:640 against Korean isolates. According to the results from three dimentional structures and cross-neutralization analyses, the antigenic difference between Korean JE isolates and Nakayama-NIH strain may be dependent on structural difference of envelope protein.
Animals ; Encephalitis Virus, Japanese ; Encephalitis Viruses* ; Encephalitis Viruses, Tick-Borne ; Encephalitis* ; Guinea Pigs ; Korea*

Pulmonary artery aneurysms are extremely rate and are seldom diagnosed during life. In true aneurysms, dilatation tends to be confined to the main trunk of the artery and degenerative changes in the wall are found. In 1971, Williams et al reported the first successful excision and replacement of the main pulmonary artery, including the bifurcation, with a dacron graft. Since then there have been few cases of main pulmonary artery aneurysm treated surgically. However, aneurysm of the main pulmonary artery treated surgically was not reported in our country till now. Recently we have experienced a case of the mainpulmonary artery aneurysm in a 10 years old boy and it was confirmed by echocardiogram, ultrasonogram of the chest, computed tomogram of the chest, radioisotope heart scan, cardiac catheterization and cine-angiogram of main pulmonary artery, aorta & right ventricle etc and patent ductus arteriosus was noted at the indifferent site from aneurysmal sac. Thereafter he underwent surgical correction at our hospital with the aid of total cardiopulmonary by-pass.
Aneurysm* ; Aorta ; Arteries ; Cardiac Catheterization ; Cardiac Catheters ; Child ; Dilatation ; Ductus Arteriosus, Patent ; Heart ; Heart Ventricles ; Humans ; Male ; Polyethylene Terephthalates ; Pulmonary Artery ; Thorax ; Transplants ; Ultrasonography

Purpose: The purpose of this study is to compare the shear bond strength of resin cement for orthodontic brackets without applying an adhesive primer, to the case of applying an adhesive primer. Materials and Methods: The specimens were divided into three experimental groups, Transbond XT, GC Ortho Connect and Orthomite LC, and the enamel surface was divided into two sections, one with 37% phosphoric acid and the other with 37% phosphoric acid and an adhesive primer or universal adhesive. Each of three types of cement was applied to orthodontic bracket, and after bonding, the shear bond strength was measured. Results: Transbond XT and Orthomite LC significantly increased shear bond strength when orthodontic brackets were bonded after applying an adhesive primer and universal adhesive, respectively. Conclusion It is expected that application of an adhesive primer or universal adhesive after acid etching will improve shear bond strength of orthodontic brackets in Transbond XT and Orthomite LC.

Purpose: Recently the incidence of vancomycin resistant enterococcus (VRE) infection and colonization has increased in the hospitalized patients. The purpose of present study is to examine the clinical significance of VRE infection and colonization in liver transplantation (LT) patients and to investigate the outcome. Methods: Among 194 patients who underwent LT from January 2001 to July 2004, 15 patients had at least one report of culture positive of VRE (VRE(+)). We compared the clinical outcome of 15 VRE(+) patients with those of VRE(-) patients. Results: One year mortality was higher in VRE(+) patients than VRE(-) patients (27% vs 4%; P=0.0001). Causes of death were primary graft non-function, infective endocarditis, MRSA sepsis and CMV pneumonitis. Mean duration of hospital stay was 102+/-63 days in VRE(+) patients, which shows significant difference with 51+/-30 days in VRE(-) patients (P=0.008). Cases who underwent gastroscopy (1.00+/-1.51 vs. 0.12+/-0.47; P=0.04) and percutaneous catheter drainage (1.33+/-1.49 vs. 0.40+/-1.05; P=0.03) were significantly more frequent in VRE(+) patients. The findings of gastroscopy were upper gastrointestinal bleeding (n=4), and bile duct obstruction (n=1). The contents of percutaneous catheter drainage were hematoma (n=3), bile juice (n=3) and ascites (n=1). Conclusion: VRE infected patients experienced more frequently gastrointestinal tract complications including bleeding or biliary complication and they showed higher 1-year mortality rate, although these patients died of causes other than VRE infection.
Ascites ; Bile ; Catheters ; Cause of Death ; Cholestasis ; Colon ; Drainage ; Endocarditis ; Enterococcus* ; Gastrointestinal Tract ; Gastroscopy ; Hematoma ; Hemorrhage ; Humans ; Incidence ; Length of Stay ; Liver Transplantation* ; Liver* ; Methicillin-Resistant Staphylococcus aureus ; Mortality ; Pneumonia ; Sepsis ; Transplants ; Vancomycin*

PURPOSE: Cyclosporine (CsA) dosing is traditionally based on trough levels (C0) rather than area under the concentration- time curve (AUC), although AUC correlates better with post- transplantation acute rejection and toxicity. It was reported that C2 (2-hour post-dose blood level) is an accurate single- sample marker for AUC0-4 in patients receiving CsA. No trials of C2 monitoring have been carried out in liver transplant recipients who are immunosuppressed with the combination of CsA and Mycophenolate Mofetil (MMF). The purpose of this study was to evaluate the correlation between C0, 1, 2, 3, 4 levels and AUC0-4 and define recommended target C2 in liver transplant recipients who are treated with CsA and MMF. METHODS: Thirty adult living donor liver transplant recipients were followed up 12 weeks after transplantation. CsA and MMF were administered in all recipients. CsA dose was reduced to the half level of target C0 in recipients treated solely with CsA. C0 and C2 were measured during in-patient period post-transplant. RESULTS: The best correlation between CsA concentration at various time points and the AUC0-4 was found at C2 (r2=0.931) (P<0.05). Mean C2 was 543.2+/-260.1 ng/mL (mean+/-SD). We observed complications associated with the immunosuppressants in six patients (20%). But, only one patient experienced acute rejection proven by biopsy and, there is no the graft loss and nephrotoxicity. CONCLUSION: In early post-transplant days, AUC0-4 was strongly correlated with C2. Reduced CsA dosing can be attempted in recipients who are immunosuppressed with the combination of CsA and MMF. The optimal target C2 probably can be suggested as about 543.2+/-260.1 ng/mL (mean+/-SD). During the in-patient period, C0 matched with target C2 can be decided. Target C0 can be individualized because C0 matched with target C2 differs in each recipients and C2 can't be checked routinely during the out-patient period.
Adult ; Area Under Curve ; Biopsy ; Cyclosporine* ; Humans ; Immunosuppressive Agents ; Liver Transplantation ; Liver* ; Living Donors ; Outpatients ; Transplantation* ; Transplants