BACKGROUND: Information on the long-term fate of patients with prosthetic valve is limited. Cerebral embolism is a major cause of late morbidity and mortality in patients with prosthetic valves even though recent prostheses are less thrombogenic and anticoagulants are administered. We investigated the long-term risk of the first ischemic and hemorrhagic stroke and effect of presumed risk factors on the development of stroke in patients with prosthetic valves. METHODS: In a retrospective study, 554 patients who survived the 30-days after cardiac valve replacement between June, 1985 and May, 1995 were included. End points were attacks of ischemic and hemorrhagic stroke. Risk of stroke at end points was calculated according to Kaplan-Meier method. The influence of several clinical variables on these stroke events was analyzed by univariate and mutivariate analyses. RESULTS: Thirty seven of 554 patients had 42 stroke events(34 ischemic stroke, 8 hemorrhagic stroke) during follow-up periods(mean: 52.9months). Six of these patients died from stroke. The cumulative stroke-free probability was 92.4% at 5years and 87.7% at 10years. The cumulative ischemic stroke-free probability was 93.7% at 5years and 89.4% at 10years. No or irregular use of anticoagulants was the only significant independent predictor(RR:4.99, 95%CI:2.01-12.41, p<0.01) of ischemic stroke. The cumulative hemorrhagic stroke-free probability was 98.7% at 5years and 98.1% at 10years. CONCLUSION: Regardless of the type of prostheses, patients with prosthetic valves, notably those without anticoagulants, are at high risk for ischemic stroke.
Anticoagulants ; Follow-Up Studies ; Heart Valves ; Humans ; Intracranial Embolism ; Mortality ; Prostheses and Implants ; Retrospective Studies ; Risk Factors ; Stroke* ; Thromboembolism

We reported a case of nontraumatic cerebrospinal fluid fistula who had concomittantly CSF rhinorrhea, pneumocephalus and bacterial meningitis. By metrizamide CT cisternography, we found her CSF fistula was likely to be on the right lateral wall of sphenoidal sinus. She was recovered from her symptoms by medical treatment and has been free of CSF rhinorrhea or meningitis without surgical repair of CSF fistula during recent 1 year follow up.
Cerebrospinal Fluid* ; Fistula* ; Follow-Up Studies ; Meningitis ; Meningitis, Bacterial ; Metrizamide ; Pneumocephalus

No abstract available.
Fractures, Compression* ; Vertebroplasty*

An anomalous systemic arterial supply to the normal basal segments of the left lower lobe without sequestration is a rare congenital anomaly. It differs from classical bronchopulmonary sequestration in that the involver lung retains a normal connection to the bronchial tree, although some place this entity exists within the broad framework of pulmonary sequestration. We experienced a case of a woman who presented with a nodular lesion on a chest X-ray. Contrast-enhanced CT diagnosed her as having an anomalous systemic arterial supply to the normal basal segments of the left lower lobe. This case is reported with a brief literature review.
Bronchopulmonary Sequestration ; Female ; Humans ; Lung* ; Thorax ; Tomography, X-Ray Computed ; Trees

A Case of pigmented choroid plexus carcinoma is reported. The patient was a 35-year-old woman who had headache of 3-month duration, followed by ataxia for 1month before admission. Brain CT revealed a well enhanced mass at the left cerebello-pontine angle area as well as hydrocephalus. Subtotal removal of the tumor was performed via suboccipital craniectomy under the impression of meningioma because there was a mass only in the extraventricular area. The tumor was diagnosed by light microscopic examination. Pigmented choroid plexus carcinoma, which has been reported as low grade malignancy, is very rare and located always in the ventricles. In the case the tumor was subtotally removed and ventriculo-peritoneal shunt surgery and radiation therapy underwent later. The patient has been followed-up without recurrence for 1 year postoperatively.
Adult ; Ataxia ; Brain ; Choroid Plexus Neoplasms* ; Choroid Plexus* ; Choroid* ; Female ; Headache ; Humans ; Hydrocephalus ; Meningioma ; Recurrence ; Ventriculoperitoneal Shunt

Presumed risk factors including hypertension, hyperlipidemia, high hematocrit and high hemoglobin was retrospectively studied in 260 strokes (125 cerebral infarction, 79 Intracerebral hemorrhage, 56 subarachnoid hemorrhage) and 266 age and sex matched neurological inpatients controls from 1985 Mar. to 1988 Feb. in Keiymung University Dongsan Hospital. The frequency of hypertension is significantly higher in patients of intracerebral hemorrhage and subarachnoid hemorrhage but not significantly higher in patients of cerebral infarction. The level of serum total lipids, beta-lipoproteins and total cholesterols is significantly higher in patients of cerebral infarction but the level of serum triglyceride, HDL-cholesterol and the ratio of total cholesterol and HDL-cholesterol is not correlated with cerebral infarction. The level of hematocrit and hemogiobin is significantly higher in patients of cerebral infarction and subarachnoid hemorrhage. These results suggest hypertension, hyperlipidemia, high hematocrit and high hemoglobin may be risk factors of stroke in Korea as well as in Western countries.
Cerebral Hemorrhage ; Cerebral Infarction ; Cholesterol ; Hematocrit ; Humans ; Hyperlipidemias ; Hypertension ; Inpatients ; Korea ; Lipoproteins, LDL ; Retrospective Studies ; Risk Factors* ; Stroke* ; Subarachnoid Hemorrhage ; Triglycerides

We report a rare case of adenoid basal carcinoma in uterine cervix. The patient was a 43-year-old Korean female. She received neoadjuvant chemotherapy with Quick Cis-VP16 (cisplatin and VP16 with 7-10 days interval), three times and radical hysterectomy with pelvic lymph nodes dissection under the diagnosis of cervical cancer stage IIa. After the neoadjuvant chemotherapy, the mass size was 3 x 2.5 Cm and which was protruded in exocervical region. Microscopically, scattered small nests of uniformed small cells with dark nuclei and scant cytoplasm were observed. Peripheral palisading as well as the formation of gland-like or acinar structures were noted. There were also foci of squamous differentiation in same portion of the small nests. The epithelial surface in other portions showed squamous cell carcinoma, large cell non-keratinizing cell type. Distribution between adenoid basal carcinoma of the cervix and other disease, such as adenoid cystic carcinoma and squamous cell carcinoma with basaloid features, is important for clinical management because the clinical behavior of adenoid basal carcinoma is less malignant than adenoid cystic carcinoma.
Adenoids* ; Adult ; Carcinoma, Adenoid Cystic ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Cytoplasm ; Diagnosis ; Drug Therapy ; Etoposide ; Female ; Humans ; Hysterectomy ; Lymph Nodes ; Uterine Cervical Neoplasms

BACKGROUND: Minimum effective anesthetic concentration (MEAC) of local anesthetics for spinal anesthesia, defined as the concentration at which a spinal anesthetic agent produces surgical anesthesia within 20 minutes of administration in 50% of patients. This concept is similar to the concept of minimum alveolar concentration (MAC) for inhalation anesthetic. Furthermore, as MEAC may vary with the administered dose, it will be determined using 10 mg of hyperbaric tetracaine. METHODS: 10 mg hyperbaric tetracaine containing dextrose 10 % was administered intrathecally to 12 patients (ASA I-II, age 20~40 yr), who were undergoing lower limb or urological procedures within 90 minutes, at concentrations ranging from 0.07~0.1%. The choice of tetracaine concentration was determined by Dixon's up-and-down method. Complete anesthesia was defined as: (1) pinprick anesthesia at or higher than T10 and (2) complete leg paralysis; all occurring in both lower extremities within 20 min. General anesthesia was initiated if spinal anesthesia was incomplete. RESULTS: MEAC of 10 mg hyperbaric tetracaine was 0.083 %. Mean anesthetic duration was 75.2 minutes (range: 40~100 min). The maximum sensory block level ranged from T3~T8. CONCLUSION: The aim of this study was to establish new concept of minimum effective anesthetic concentration of hyperbaric tetracaine for spinal anesthesia. We recognized that spinal anesthesia can be accomplished with very dilute solution. As fixed dose, no correlation was found between concentration of the spinal tetracaine solution with the highest sensory level, anesthetic duration and the degree of mean arterial pressure decreased.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal* ; Anesthetics, Local ; Arterial Pressure ; Glucose ; Humans ; Inhalation ; Leg ; Lower Extremity ; Paralysis ; Tetracaine*

BACKGROUND: Minimum effective anesthetic concentration (MEAC) of local anesthetics for spinal anesthesia, defined as the concentration at which a spinal anesthetic agent produces surgical anesthesia within 20 minutes of administration in 50% of patients. This concept is similar to the concept of minimum alveolar concentration (MAC) for inhalation anesthetic. Furthermore, as MEAC may vary with the administered dose, it will be determined using 10 mg of hyperbaric tetracaine. METHODS: 10 mg hyperbaric tetracaine containing dextrose 10 % was administered intrathecally to 12 patients (ASA I-II, age 20~40 yr), who were undergoing lower limb or urological procedures within 90 minutes, at concentrations ranging from 0.07~0.1%. The choice of tetracaine concentration was determined by Dixon's up-and-down method. Complete anesthesia was defined as: (1) pinprick anesthesia at or higher than T10 and (2) complete leg paralysis; all occurring in both lower extremities within 20 min. General anesthesia was initiated if spinal anesthesia was incomplete. RESULTS: MEAC of 10 mg hyperbaric tetracaine was 0.083 %. Mean anesthetic duration was 75.2 minutes (range: 40~100 min). The maximum sensory block level ranged from T3~T8. CONCLUSION: The aim of this study was to establish new concept of minimum effective anesthetic concentration of hyperbaric tetracaine for spinal anesthesia. We recognized that spinal anesthesia can be accomplished with very dilute solution. As fixed dose, no correlation was found between concentration of the spinal tetracaine solution with the highest sensory level, anesthetic duration and the degree of mean arterial pressure decreased.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal* ; Anesthetics, Local ; Arterial Pressure ; Glucose ; Humans ; Inhalation ; Leg ; Lower Extremity ; Paralysis ; Tetracaine*

BACKGROUND: Pulmonary Langerhans cell histiocytosis forms part of a spectrum of diseases that are characterized by a monoclonal proliferation and infiltration of organs by Langerhans cells. Several organ systems may be involved in Langerhans cell histiocytosis, including the lungs, bone, skin, pituitary gland, liver, lymph nodes and thyroid. Pulmonary histiocytosis X represents 2.8% of interstitial lung disease. Here we present the clinical, radiological, therapeutic aspects of pulmonary histiocytosis X. METHOD: Fourteen cases of biopsy-proven pulmonary histiocytosis X patients who were diagnosed in Seoul National University Hospital during the period from January 1990 to December 1998 were analyzed retrospectively. RESULT: There were 12 men and 2 women in this study. The initial presenting symptoms were dyspnea, cough, chest pain, which was associated with the pneumothorax, and chest radiography abnormalities. Only 8 patients (57%) were smokers. There were 5 patients with extra-pulmonary histiocytosis (pituitary, bone, skin). Eight patients had received the chemotherapy. There were no mortalities and only one patient experienced an aggravation of symptom during the follow-up period. CONCLUSION: In contrast to previous reports from other countries, the patients with pulmonary histiocytosis X in this study presented with several different clinical characteristics, such as a male predominance, relatively low smoker's rate, and a better prognosis.
Chest Pain ; Cough ; Drug Therapy ; Dyspnea ; Female ; Follow-Up Studies ; Histiocytosis ; Histiocytosis, Langerhans-Cell* ; Humans ; Langerhans Cells ; Liver ; Lung ; Lung Diseases, Interstitial ; Lymph Nodes ; Male ; Mortality ; Pituitary Gland ; Pneumothorax ; Prognosis ; Radiography ; Retrospective Studies ; Seoul ; Skin ; Thorax ; Thyroid Gland