The recent discovery of plasmid derived beta-lactamase production by N. gonorrhoeae has changed the outlook of treatment of gonococcal infections and may well become the single most important factor in gonorrhoea control. Penicillinase is a beta-lactamase that splits the beta-lactam ring of penicillin hetween the C and N atoms to form penicilloic acids. We have been trying to assess the prevalence of PPNG in Korea since May 1980. We report here 7 strains of beta-lactamase producing N. gonorrhoae detected by chrornogenic cephalosporin method from Jan. 1981 to Mar. 1981 at the Joong Ku puhlic health center in Seoul. In January, I strain (l.3%); February, 2 strains (5.0%); and March, 4 strains .(6 4%) have been isolated. All restrains were confirmed by sugar feriventation test. Previously only one strain of PPNG had been reported among Korean laymen. The sudden appearance of PPNG among Korean laymen in 1981 may mean the barruer between U.S. Army enc1aves and Korean public has been broken recently and/or direct irnport of PPNG frorn abroad especially from South East Asia.

Neurogenic pulmonary edema (NPE) leading to cardiopulmonary dysfunction is a potentially life-threatening complication in patients with central nervous system lesions. This case report describes a 28-yr woman with life-threatening fulminant NPE, which was refractory to conventional respiratory treatment, following the rupture of an aneurysm. She was treated successfully with extracorporeal membrane oxygenation (ECMO), although ECMO therapy is generally contraindicated in neurological injuries such as brain trauma and diseases that are likely to require surgical intervention. The success of this treatment suggests that ECMO therapy should not be withheld from patients with life-threatening fulminant NPE after subarachnoid hemorrhage.
Adult ; Brain/radiography ; Decompressive Craniectomy ; Extracorporeal Membrane Oxygenation ; Female ; Humans ; Intracranial Aneurysm/complications/*diagnosis ; Pulmonary Edema/*diagnosis/etiology/therapy ; Subarachnoid Hemorrhage/etiology ; Tomography, X-Ray Computed

OBJECTIVE: To analyze the clinical data and surgical results from symptomatic chronic subdural hematoma (CSDH) patients who underwent burr-hole drainage (BHD) at the maximal thickness area and twist-drill craniostomy (TDC) at the precoronal point. METHODS: We analyzed data from 65 symptomatic CSDH patients who underwent TDC at the pre-coronal point or BHD at the maximal thickness area. For TDC, we defined the pre-coronal point to be 1 cm anterior to the coronal suture at the level of the superior temporal line. TDC was performed in patients with CSDH that extended beyond the coronal suture, as confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed and analyzed. RESULTS: Of the 65 CSDH patients, 13/17 (76.4%) with BHD and 42/48 (87.5%) with TDC showed improved clinical performance and radiological findings after surgery. Catheter failure was seen in 1/48 (2.4%) cases of TDC. Five patients (29.4%) in the BHD group and four patients (8.33%) in the TDC group underwent reoperations due to remaining hematomas, and they improved with a second operation, BHD or TDC. CONCLUSION: Both BHD at the maximal thickness area and TDC at the pre-coronal point are safe and effective drainage methods for symptomatic CSDHs with reasonable indications.
Catheters ; Drainage* ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Medical Records ; Sutures ; Tomography, X-Ray Computed

Background: Post operative nausea, vomiting and pain are the most common distressing symptoms following surgery. Recently much interest has been shown in the influence of auditory stimuli during anesthesia, and studies suggest that thinking may occur while under adequate general anesthesia. The aim of my study was to investigate the effect of intraoperative positive suggestion on the incidence of post operative pain, nausea, vomiting, general well being and gas output time. METHODS: Following ethics committee approval of our hospital, informed written consent was obtained from 60 ASA 1 or 2 patients scheduled for major gynecological surgery. Patients were allocated randomly to study or control groups. Those in the study group were played tapes containing positive suggestions ; those in control group were played a blank tape. Anesthesia was induced with propofol, succinycholine, vecuronium, and was maintained with enflurane 1.5 vol% in a 50% mixture of oxygen in nitrous oxide. Head phones were applied and patients in study group were played a tape suggesting that there would be no pain, nausea or vomiting and that they would be comfortable after the operation. The tape was played repeatedly throughout surgery until skin closure. The severity of postoperative nausea, vomiting, pain, postpoerative well being state and gas output were assessed using a four-point 0-3 verbal rating score (VRS) and scores were collected in the recovery room, at a postoperative 3 hr, 6 hr, 12 hr, 24 hr and 5 days. RESULTS: There was no significant difference between groups for any VRS parameter, i.e., postoperative pain, nausea, vomiting, general state of being or gas output time. CONCLUSIONS: Despite hearing positive suggestion in patients undergoing total hysterectomy surgery during general anesthesia, we were unable to demonstrate any reduction in the incidence of postoperative pain, nausea, vomiting, general well being state scores and gas output time.
Anesthesia ; Anesthesia, General ; Enflurane ; Ethics Committees ; Female ; Gynecologic Surgical Procedures ; Head ; Hearing ; Humans ; Hysterectomy ; Incidence ; Nausea ; Nitrous Oxide ; Oxygen ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Propofol ; Recovery Room ; Skin ; Thinking ; Vecuronium Bromide ; Vomiting

No abstract available.
Mediastinum*

OBJECTIVES: To investigate the effects of Computerized Neuropsychologic Test (CNT) on cognitive function and daily life performance in subacute post-stroke patients with cognitive impairment. METHODS: Korean Mini-Mentals State Examination (K-MMSE), Korean version of Modified Barthel Index (K-MBI) were investigated in 125 subacute post-stroke patients with cognitive impairment. We analyzed K-MMSE and K-MBI which were conducted 63 patients who had received CNT and 62 patient who had not received CNT from baseline to 8 weeks follow-up. In the experimental group, initial K-MMSE and K-MBI were conducted 13.3 ± 6.8 weeks after the onset of stroke and their age was 63.4 ± 13.3. In the control group, initial K-MMSE and K-MBI were conducted 13.2 ± 7.7 weeks after the onset of stroke and their age was 65.1 ± 11.6. RESULTS: The 8 weeks follow-up total K-MMSE score and total K-MBI score of experimental group were significantly higher than control group (P < 0.05). In K-MMSE subsection, orientation, judgement, recall, language & visual reconstruction were significantly higher in experimental group than control group (P < 0.05). In K-MBI subsection, personal hygiene, bathing self, toilet, dressing, ambulation, chair/bed transfer were significantly higher in experimental group than control group (P < 0.05). The change of total K-MMSE score of experimental group was significantly correlated with change of total K-MBI score (P < 0.05), but control group was not (P > 0.05). In K-MMSE subsection, change of orientation, registration, language and visual reconstruction were correlated with total K-MBI s core after CNT. Especially, the experimental group, total K-MBI score of the left hemisphere damage group was significantly higher than the right hemisphere damage group (P < 0.05). CONCLUSIONS: This study shows that CNT is effective on subacute post-stroke patients with cognitive impairment. Improvement of cognitive function can expect a positive outcome on daily life performance, in particular, it can be expected to improve the prognosis of patients with stroke, the left hemisphere lesions.
Bandages ; Baths ; Cognition ; Cognition Disorders* ; Cognitive Therapy ; Follow-Up Studies ; Humans ; Hygiene ; Neuropsychological Tests* ; Prognosis ; Stroke ; Walking

Renal cell carcinoma (RCC) is known for its high propensity for early metastasis and one third of patients diagnosed with RCC present with metastatic disease at the time of diagnosis. RCC commonly metastasizes to the lung, bone, liver, brain, and skin by hematogenous spread, whereas metastasis to the head and neck region is rarer. In cases of head and neck metastasis, the thyroid accounts for a large percent. Parotid metastasis from renal cell carcinoma is an extremely rare finding. We recently encountered a 67-year-old man with left parotid mass and finally diagnosed as metastatic renal cell carcinoma. We report the rare case with a review of literature.
Aged ; Brain ; Carcinoma, Renal Cell* ; Diagnosis ; Head ; Humans ; Liver ; Lung ; Neck ; Neoplasm Metastasis ; Nephrectomy ; Parotid Gland* ; Skin ; Thyroid Gland

The prevalence of aneurysm formation in adults with Moyamoya disease (MMD) is higher than that in the general population. The treatment strategy is often individualized based on the patient’s disease characteristics. A 22-year-old man was diagnosed with MMD after presenting a small thalamic intracerebral and subarachnoid hemorrhage in the quadrigeminal cistern. Cerebral angiography revealed a small aneurysm (2.42 mm) in the left anterior choroidal artery. Since the hemodynamics in the left hemisphere was compromised, an indirect bypass surgery was performed. The patient’s condition deteriorated postoperatively because of poor perfusion of the internal carotid artery, and massive hydration was required. During neurocritical care, the aneurysm increased in size (5.33 mm). An observation strategy was adopted because of the distal aneurysmal location and the high risk involved. Subsequently, the patient recovered, and newly developed collateral flow appeared from the external carotid artery. Additionally, a dramatic size reduction of the aneurysm (1.51 mm) was noticed. Our case suggests that MMD-related dissecting aneurysms on a distal cerebral artery, which present a high risk of embolization, could be managed by indirectly reducing the hemodynamic burden. Massive hydration in such cases should be avoided or balanced to avoid the risk of rapid growth and aneurysm rupture.

No abstract available.
Histiocytosis, Langerhans-Cell*

PURPOSE: Most bile duct injuries can be recognized intraoperatively, or within a few days after a laparoscopic cholecystectomy, with a favorable prognosis following proper management. However, a significant delay in the diagnosis, improper management, or other risk factors can lead to serious intractable biliary complications. Herein, the clinical courses of these serious biliary complications were analyzed to find their optimal treatment methods. METHODS: Between 1998 an 2003, 9 cases of serious biliary complications were encountered following a laparoscopic cholecystectomy. Patients detected early and with uneventful biliary reconstruction were excluded. Their mid- and long-term clinical courses were retrospectively analyzed. RESULTS: Their treatment methods undertaken to them were divided as follows: Primary hepaticojejunostiomy (HJ) to the necrotic proximal bile duct (n=3) : delayed stricture occurred in 1 patient among them; HJ to the delayed-onset proximal bile duct stricture (n=2) : There was no recurrence; Right lobectomy and HJ to the proximal bile duct stricture after right portal vein embolization (n=3) : There was no recurrence; And, induction of parenchymal atrophy applied to the isolated right posterior duct injury through portal vein embolization and sequential bile duct occlusion (n=1). CONCLUSION: Necrosis and stricture of the injured proximal bile duct should be managed by a case-by-case basis because every patient revealed different clinical features. Long- term surveillance over 5 years is recommended to detect late- onset biliary stricture.
Atrophy ; Bile Ducts* ; Bile* ; Cholecystectomy, Laparoscopic* ; Constriction, Pathologic* ; Diagnosis ; Hepatectomy ; Humans ; Necrosis* ; Portal Vein ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors