No abstract available.
Pregnancy* ; Pyelonephritis*

OBJECTIVE: Excelsior XT-27 (Stryker Neurovascular, Fremont, CA, USA) or Rebar 27 (eV3 Covidien, Irvine, CA, USA) microcatheters have recently been used to overcome the limitations of the Renegade Hi-Flo microcatheter such as interference between two microcatheters (one for stent delivery and the other for cerebral aneurysm coiling) during the jailing technique. We evaluated differences and influential factors related to the interference phenomenon according to these two microcatheters group. MATERIALS AND METHODS: Between June 2011 and September 2013, the jailing technique was applied to 94 internal cerebral artery (ICA) aneurysms. The jailing technique with the Neuroform EZ stent system was performed using Renegade (n = 22), Rebar (n = 35), and XT-27 microcatheters (n = 37). In the Renegade Hi-Flo microcatheter group, the jailing technique was successful in 19/22 patients (86.4%) and interference between the two microcatheters occurred in 6/21 patients (28.6%). In the Rebar and XT-27 microcatheter group, the jailing technique was successful in 71/72 patients (98.6%) and interference between the two microcatheters occurred in 1/72 patients (1.4%). RESULTS: There was a significant difference in the interference between the two delivered microcatheters group (p-value < 0.000) and the carotid siphon angle (p-value: 0.004) in the univariate analysis. In the multiple logistic regression analysis, the Rebar and XT-27 microcatheter group (odds ratio [OD] [95% confidence interval (CI)]; 31.277 [3.138-311.729], p-value: 0.003) and the carotid siphon angle (OD [95%CI]; 0.959 [0.922-0.997], p-value: 0.035) were found to be influential factors in the interference phenomenon. CONCLUSION: The Rebar 27 and XT-27 microcatheters were more successful and exhibited less interference between the two microcatheters than the Renegade Hi-Flo microcatheter.
Aneurysm* ; Carotid Artery, Internal* ; Cerebral Arteries ; Humans ; Intracranial Aneurysm ; Logistic Models ; Stents*

OBJECTIVE: Treatment of spontaneous intracerebral hemorrhage (ICH) remains controversial. However, an extensive hemorrhage with a poor mental status is suitable for surgical evacuation. Our experience with the transsylvian-transinsular (TS-TI) microsurgical approach for deep-seated basal ganglia (BG) ICH was investigated. MATERIAL AND METHODS: A retrospective review was conducted on 86 patients with BG ICH who underwent an operation at the Department of Neurosurgery of our Hospital from September 2011 to October 2014. Thirteen patients underwent craniotomy and the TS-TI microsurgical approach for hematoma evacuation. Twenty-seven patients underwent conventional craniotomy with the trans-cortical transtemporal (TC-TT) approach, and 46 patients underwent a burrhole operation and hematoma drainage using a frameless stereotaxic device (ST). RESULTS: The average age distribution was similar. The preoperative Glasgow coma scale (GCS) was similar for the TC-TT and TS-TI groups. The pre-operative hematoma levels were higher in the TC-TT (109.4 +/- 48.6 mL) and TS-TI (96.0 +/- 39.0 mL) groups than in the ST group (46.5 +/- 23.5 mL). The hematoma removal rate was 77% in the TC-TT group, 88% in the TS-TI group, and 34% in the ST group. The mean maintenance period of a hematoma catheter was 3.6 days in the ST group. The clinical outcome showed correlation with the preoperative neurological symptoms. CONCLUSION: The TS-TI group was superior to the TC-TT group for evacuation of an intracerebral hematoma.
Age Distribution ; Basal Ganglia ; Basal Ganglia Hemorrhage* ; Catheters ; Cerebral Hemorrhage ; Craniotomy ; Drainage ; Glasgow Coma Scale ; Hematoma ; Hemorrhage ; Humans ; Neurosurgery ; Retrospective Studies

Dieulafoy lesion is an uncommon cause of gastrointestinal bleeding, reported to be only 2% of acute or chronic upper gastrointestinal bleeding episodes. Bleeding occurs from a small mucosal erosion involving an unusually large submucosal artery in an otherwise normal mucosa. It is associated with massive, life threatening hemorrhage and is difficult to diagnosis. In most cases the lesion is encountered in the proximal stomach, antrum, duodenum, colon and rectum. In particular, extragastric Dieulafoy lesion is an extremely rare source of intestinal bleeding. In Korea, no case of bleeding from a Dieulafoy lesion of the small intestine has been previously reported. We experienced one case of bleeding from a jejunal Dieulafoy lesion, which was confirmed by the pathologic examination of the resected specimen, and report here.
Adult ; Arteries/abnormalities* ; Case Report ; Female ; Gastric Mucosa/blood supply* ; Gastrointestinal Hemorrhage/etiology* ; Human ; Intestinal Mucosa/blood supply*

The purpose of this study was to introduce the methodology of intervention analysis with time series data and to investigate the influence of the patient referral system on medical care utilization in Kangwha county. The data were obtained at the Kangwha Medical Insurance Society and we analysed the material based on the outpatient care fee. The results were as follows: 1. The average outpatient care utilization in the hospital decreased by 41.7% due to the patient referral system. 2. The utilization of the health institution increased by 278.8 persons per month due to the patient referral system. 3. The patient referral system did not influence the total outpatient care utilization. The methodology of intervention analysis, which detected the effect of intervention, will be helpful to the study of public health area.
Ambulatory Care ; Fees and Charges ; Humans ; Insurance ; Public Health ; Referral and Consultation*

Oculocerebrorenal syndrome of Lowe(OCRL) is a rare X-linked disorder characterized by congenital cataract(oculo-), hypotonia, developmental delay, cognitive impairment(cerebro-), renal tubular dysfunction(renal), and growth retardation. Recently, the defective gene, OCRL-1 gene encoding [PtdIns(4,5)P2] 5-phosphatase, was cloned with mutations identified in patients. Although there have been about 200 cases of OCRL reported in English literature, only three reports have been published in our country including two from an ophthalmologic point of view. This is a case report of two patients diagnosed with OCRL at our hospital. The diagnosis was based on characteristic clinical manifestations involving three major systems(eyes, central nervous system and kidneys) and MRI findings of the brain. There are no specific therapy for this disorder yet, and we provided ophthalologic treatment for congenital cataract, rehabilitation therapy for neurologic symptoms, and supportive therapy for renal Fanconi syndrome. We expect that a molecular genetic diagnosis and gene therapy will be available in the near future.
Brain ; Cataract ; Central Nervous System ; Clone Cells ; Diagnosis ; Fanconi Syndrome ; Genetic Therapy ; Humans ; Magnetic Resonance Imaging ; Molecular Biology ; Muscle Hypotonia ; Neurologic Manifestations ; Oculocerebrorenal Syndrome* ; Rehabilitation

Supernumerary derivative (22) syndrome is a rare genomic syndrome. It is characterized by severe mental retardation, microcephaly, failure to thrive, preauricular tag or sinus, ear abnormalities, cleft and/or high-arched palate, micrognathia, kidney abnormalities, congenital heart defects, and genital abnormalities in males. In 99% of the cases, one of the parents is a balanced carrier of a translocation between chromosome 11 and chromosome 22. To date, there have been about 100 case reports of supernumerary derivative (22) syndrome. In most of the cases, supernumerary derivative (22) syndrome was the result of 3:1 meiotic segregation in the maternal 11;22 translocation carrier. We now report a case of 47,XX, + der(22)t(11;22)(q23;q11.2) resulting from 3:1 meiotic segregation of the paternal translocation carrier.
Chromosomes, Human, Pair 11 ; Chromosomes, Human, Pair 22 ; Congenital Abnormalities ; Ear ; Failure to Thrive ; Heart ; Humans ; Intellectual Disability ; Kidney ; Male ; Microcephaly ; Palate ; Parents ; Trisomy

The purpose of this study was to select the manageable diseases which are prevalent in Korea for periodic health examinations and to evaluate the sensitivity and specificity of periodic health examination in detecting these diseases. The data was derived from reimbursement data of the Korea Medical Insurance Corporation over a two year period (April 15, 1986 to April 14, 1988) and interviews with Yonsei Medical School professors. This study demonstrated that: 1. The manageable diseases which were selected for periodic health examinations are pulmonary tuberculosis, viral hepatitis, diabetes mellitus, syphilis groups, essential hypertension, renal disease groups, and iron deficiency anemia. 2. The sensitivity of the health screening for each disease was as follows: pulmonary tuberculosis 51.5%, viral hepatitis 60.3%, diabetes mellitus 64.7%, syphilis groups 63.3%, essential hypertension 49.9%, renal disease groups 44.0%, and iron deficiency anemia 80.9%. We conclude that peiodic health esaminations should focus on the manageable diseases that we have defined. The number of items in periodic health screening tests and hospital quality control should be increased for the diseases with a demonstrated low sensitivity.
Anemia, Iron-Deficiency ; Diabetes Mellitus ; Hepatitis ; Hypertension ; Hypertension, Renal ; Insurance ; Korea ; Mass Screening ; Quality Control ; Schools, Medical ; Sensitivity and Specificity ; Syphilis ; Tuberculosis, Pulmonary

The blood sugar control has been a significant problem after transplantation. Cyclosporine is partly responsible for post-transplantation diabetes mellitus (PTDM), but steroid has been well known to have diabetogenic effect and mainly responsible for glucose intolerance after transplantation. Deflazacort, a new steroid, has been introduced as a substitute of conventional steroid to prevent glucose intolerance after transplantation. We performed prospective study of deflazacort conversion from conventional steroid in kidney transplant patients with pre-transplantation diabetes mellitus(pre-Tx DM) or PTDM. A total of 82 kidney transplant patients was included for this study. Forty two patients were converted to deflazacort as a conversion group and 40 patients were remained on conventional steroid as a control group. In conversion group, the patients were converted from steroid to deflazacort with ratio of 5:6 in dosage. Nine patients developed severe anorexia with nausea/vomiting and three patients among them went back on steroid within 3 months after conversion(conversion failure 7.1%). After minimal 6 months of follow-up, there was neither episodes of graft dysfunction nor rejection. There was a significant improvement of glucose control in conversion group. In 12 patients(30.8%), more than 50% dose reduction of insulin or oral hypoglycemics requirement was possible. In control group, however, only 2 patients showed greater than 50% of insulin or oral hypoglycemics dose reduction. We could find that deflazacort conversion had a significant impact on blood sugar control in PTDM patients(11/26) but not in pre-Tx DM patients(1/13). In conclusion, conversion to deflazacort in PTDM patients with stable graft function was safe and blood sugar control was readily possible without an increment of risks of rejection and infection. We propose to use deflazacort as a substitute for prednisone in PTDM patients with stable graft function.
Anorexia ; Blood Glucose ; Cyclosporine ; Diabetes Mellitus ; Follow-Up Studies ; Glucose ; Glucose Intolerance ; Humans ; Hypoglycemic Agents ; Insulin ; Kidney* ; Prednisone* ; Prospective Studies ; Transplants

No abstract available.
Animals ; Embryonic Structures* ; Mice* ; Quality Control*