If in the aneurysmal rupture patients the brain metabolic parameters obtained from blood chemistry were significant and useful in clinical practice, it cannot be overstimated. Hansdorfer er al.(1973) reported that lactate, pyruvate, uric acid and alpha-HBDH of central venous blood obtained form the patients with brain contusion in basal metabolic state were significantly increased and they were useful in evaluating the prognosis of the patients. Zooping(1970) and Broderson(1974) also had tried to evaluate the prognosis and brain metabolic status of the comatous patients with blood gas analysis and CSF biochemistry. They encouraged us to estimate lactate and lactate/pyruvate ratios of canine jugular venous blood combined with gas analysis. Complete cerebral bloody-ischemia similar with initial stage of aneurysmal rupture was induced by the instanteneous elevation of intracranial pressure 30 mmHg above systemic arterial pressure by infusion of blood and mock CSF mixture into the cisterna arrest or pulmonary hypertension were discarded. At the end of the 5 minutes ischemic period, the needle tip which was inserted in to cisterna magna was removed without decreasing intracranial pressure. At 3 hours, 24 hours, 48 hours and 72 hours after ischemic period jugular venous and arterial blood were sampled for determination of lactate and pyruvate, and blood gas analysis. The following results were obtained. ie ; 1. Both lactate and pyruvate of canine jugular venous blood were increased from 3 hours and reached peak level at 24 hours after insult. Standard value of lactate and pyruvate were 1.416mM and 0.075mM and peak values were 2.429 and 0.165mM(P<0.05). 2. The more severe the neurological deficits of the animals, the highest levels of lactate and pyruvate were observed. 3. The lactate concentrations in 48 hours and 72 hours sample slopped down from 24 hours peak level but were significantly higher than those of standard. 4. Pyruvate returned to the normal range within 48 hours after insult. 5. L/P ratios were not changed significantly until 48 hours after insult but steeply elevated in 72 hours sample. 6. In gas analysis all the animals show respiratory alkalosis after insult. 7. In arterial boundary zones multiple focal ischemia were found in necropsy which was thought as reflecting no-reflow phenomenon. We concluded that elevation of lactate and pyruvate in early stage must be due to the hyperventilation after insult and lactate of late stage reflected CSF lactic acidosis.
Acidosis, Lactic ; Alkalosis, Respiratory ; Aneurysm ; Animals ; Arterial Pressure ; Biochemistry ; Blood Gas Analysis ; Brain ; Brain Injuries ; Chemistry ; Cisterna Magna ; Humans ; Hypertension, Pulmonary ; Hyperventilation ; Intracranial Pressure ; Ischemia ; Lactic Acid* ; Needles ; No-Reflow Phenomenon ; Prognosis ; Pyruvic Acid ; Reference Values ; Rupture ; Uric Acid

PURPOSE: We compared the results of implanting an implantable contact lens (ICL) and an iris claw lens (Artisan(R) lens) in patients' wtih myopia and sought to determine a basis for choosing between the two lenses. METHODS: ICLs were implanted in 32 eyes of 18 patients, and Artisan(R) lenses were implanted in 40 eyes of 23 patients. Uncorrected visual acuity, refraction, endothelial cell density, intraocular pressure, and slit lamp measurements were taken for 12 months. RESULTS: All the patients had improved UCVA from the day after the operation until the 12th month. The mean spherical equivalent refraction at postoperative month 12 was -0.78+/-0.54D in the ICL group and -0.78+/-0.59D in the Artisan(R) lens group. In the same period, endothelial cell density loss was 5.34% in the ICL group but was not significant in the Artisan(R) lens group. There were no significant complications in either group. CONCLUSIONS: Both ICL and Artisan(R) lens implantation resulted in immediate visual improvement and stability of vision during the follow-up period. There was no significant difference in post-operative results. Further study will be needed to decide which lens is the better choice for delicate conditions in myopic patients.
Animals ; Endothelial Cells ; Eye ; Follow-Up Studies ; Hoof and Claw ; Humans ; Intraocular Pressure ; Iris ; Lenses, Intraocular ; Myopia ; Vision, Ocular ; Visual Acuity

BACKGROUND: Psoas abscess is a rare condition with vague clinical presentations, therefore misdiagnosis or delayed diagnosis is often made. We have reviewed the characteristics of the clinical presentation, microbiology, and treatment of 24 patients with psoas abscess. METHODS: The records of all patients treated with psoas abscess at Ajou University Hospital between March, 1996 and May, 2001 were retrospectively reviewed. RESULTS: A total of 24 cases of psoas abscess were reviewed: among these 17 cases were due to secondary cases and seven cases were diagnosed as primary psoas abscess. The right side was affected in 11 cases, the left side in nine, and both sides in four. Methicillin-susceptible Staphylococcus aureus was the most frequent (7/24 cases) pathogen, which were detected in cultures from five of seven patients with primary abscesses, whereas Mycobacterium tuberculosis (6/17 cases) and mixed enteric flora were detected in secondary abscesses. Three of the patients with primary psoas abscess expired from septic shock. The mortality rate was 12.5%. CONCLUSION: A psoas abscess should be considered when any patient presents with nonspecific abdominal pain, back pain and fever. This condition may be diagnosed promptly with computed tomography. Treatment involves use of appropriate antibiotics, as well as drainage of the abscess. Antibiotic coverage must include S. aureus and enteric bacteria. However, in endemic areas (such as Korea), tuberculous infection should be also considered.
Abdominal Pain ; Abscess ; Anti-Bacterial Agents ; Back Pain ; Delayed Diagnosis ; Diagnostic Errors ; Drainage ; Enterobacteriaceae ; Fever ; Humans ; Mortality ; Mycobacterium tuberculosis ; Psoas Abscess* ; Retrospective Studies ; Shock, Septic ; Staphylococcal Infections ; Staphylococcus aureus ; Tuberculosis

Actinomycosis is a chronic suppurative and granulomatous disease caused by a Gram-negative anaerobic bacterium, Actinomyces israelii, which is among the normal flora of the oral cavity and gastrointestinal tract of humans and animals. It is characterized by sulfur granule formation and can involve the cervicofacial area, chest, abdomen, and pelvis. The most common predisposing factors are the presence of an intrauterine contraceptive device, previous trauma, appendectomy, colon diverticulum, and gastrointestinal perforation. Primary gastric actinomycosis is an extremely rare disease. Three cases of gastric actinomycosis have been reported in people who had a subtotal gastrectomy for stomach cancer in Korea. We report a case of primary gastric actinomycosis in a 59-year-old man with untreatable hepatocelluar carcinoma. His actinomycosis was cured with penicillin therapy.
Abdomen ; Actinomyces ; Actinomycosis ; Animals ; Appendectomy ; Carcinoma, Hepatocellular ; Diverticulum, Colon ; Gastrectomy ; Gastrointestinal Tract ; Humans ; Intrauterine Devices ; Korea ; Middle Aged ; Mouth ; Pelvis ; Penicillins ; Rare Diseases ; Stomach Neoplasms ; Stomach Ulcer ; Sulfur ; Thorax

Hypertriglyceridemia-induced pancreatitis is a rare, but serious, complication of pregnancy. We report a case of acute pancreatitis associated with type V hyperlipoproteinemia in pregnancy. A 36-year-old primigravida was admitted at 16 weeks of gestation with severe abdominal pain. Chemical analysis showed high serum pancreatic enzymes and very high serum triglyceride. Abdominal magnetic resonance imaging (MRI) showed diffuse swelling of the pancreas and a peripancreatic fluid collection. A diagnosis of acute pancreatitis with type V hyperlipoproteinemia was made. She recovered from the acute pancreatitis with conservative management and the serum triglyceride decreased rapidly with dietary restriction of fat, insulin/glucose, fenofibrate, and omega-3. We review the management of hypertriglyceridemia-induced acute pancreatitis in pregnancy.
Abdominal Pain ; Adult ; Fenofibrate ; Humans ; Hyperlipoproteinemia Type V ; Hypertriglyceridemia ; Magnetic Resonance Imaging ; Pancreas ; Pancreatitis ; Pregnancy

BACKGROUND: Surgical site infection (SSI) is prominent among the total incidence of healthcare-associated infections, and is a major contributing factor in the trend of increasing medical costs. There have been numerous efforts to analyze the conditions and causes of SSI for the purpose of prevention. In this study of SSI development after gastric surgery, we evaluated the prevalence of specific pathogens and compared the clinical characteristics observed between gram-positive (GPB) and gram-negative bacteria (GNB). MATERIALS AND METHODS: We conducted a retrospective study of patients who developed SSI within 30 days after gastric surgery at 13 clinics in Korea, between January 2007 and December 2008. Only those cases of SSI which included confirmed pathogen were included in this study. RESULTS: Among the 121 patients who developed SSI, GPB were observed in 32 patients and 36 cases, and GNB were isolated in 32 patients and 36 cases. Methicillin resistant Staphylococcus aureus (MRSA) was the most frequently isolated pathogen in this analysis. There were no differences observed between the GPB and GNB group in terms of baseline characteristics, patient or procedure related risk factors, or factors associated with prophylactic antibiotics. CONCLUSIONS: In the previous studies of the occurrence of SSI after gastric surgery, it was reported that the majority of observed pathogens were enteric GNB. Further studies of the incidence of SSI after gastric surgery, particularly those related to MRSA infection, are necessary.
Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Incidence ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Prevalence ; Retrospective Studies ; Risk Factors ; Staphylococcus aureus