No abstract available.
Chediak-Higashi Syndrome* ; Hyperpigmentation*

Endoscopic sphincterotomy (E.S.T.) has relatively low complications and is the theraphy of choice in patients with common bile duct stones. It is also an useful technique for decompression of biliary tract obstruction. Thirty two cases of patients were selected according to opedrative risks: old age, severe jaundice and recurrent or retained bile duct stones after cholecystecomy from 1986 to 1988. The results were as follows, 1) In thirty two cases nf E.S.T., male to female ratio was 1:1.46. Most frequent age was older than 40 years. (male, 84.6%, female, 84.2%). 2) Out of thirty two cases, 20 cases (62.5% were under post clholecystectomy state, 12 eases (37.5%) were obstructive jaundice. 3) Spontaneous stone passage after E.S.T. was 81.3% (26 cases), and total stone remoral rate was 87.5% (28 cases), 4) Complications of E.S.T. were noted in three cases. In the two cases of bleeding, it was spontaneously improved and a case of acute pancreatitis was treated by medical care.
Bile Ducts ; Biliary Tract ; Common Bile Duct* ; Decompression ; Female ; Hemorrhage ; Humans ; Jaundice ; Jaundice, Obstructive ; Male ; Pancreatitis ; Sphincterotomy, Endoscopic*

PURPOSE: The purpose of this study was to evaluate the morphologic changes of the injured hepatic acini following ligation of common bile duct and to investigate the pathophysiologic process of hepatic failure and biliary liver cirrhosis in the extrahepatic cholestasis. MATERIALS AND METHODS: The common bile ducts of 18 rabbits were ligated partially. The rabbits were killed and selective microangiography was carried out with infusion of barium suspension via portal vein 4 to 24 weeks after ligation. Selective microangiography was also carried out in two normal rabbits. The microangiographic findings were evaluated and correlated with histopathologic features. RESULTS: The sinusolds of the liver acinus showed distortion, varying degrees of luminal widening, and irregularities in architecture. Terminal branches of the portal vein (TPV) showed increased number of branches, luminal narrowing, tortuosity, distortion, and beaded appearance. Peribiliary plexi were found as thin curvilinear, barium-filled structures along the wall of the dilated bile duct. The microangiographic findings were well correlated with histopathologic findings. The grades of microangiographic and histopathologic findings were poorly correlated with the duration of the ligation of CBD. CONCLUSION: Changes in microvasculature of the liver acinus following partial ligation of common bile duct were demonstrated by microangiography. Although the microvascular changes were evoked secondary to the injury, they might have some active roles in the pathophysiologic process in the liver.
Barium ; Bile Ducts ; Cholestasis, Extrahepatic ; Common Bile Duct* ; Ligation* ; Liver Cirrhosis ; Liver Failure ; Liver* ; Microvessels ; Phenobarbital ; Portal Vein ; Rabbits

BACKGROUND: Combined spinal-epidural anesthesia (CSEA) for cesarean section has gained an increasing interest as it combines a reliability of spinal anesthesia and the flexibility of epidural anesthesia. The aim of this study is to compare the surgical analgesia and the frequency of side effects for cesarean section produced by CSEA using subarachnoid fentanyl or placbo. METHODS: The study was performed in a randomized, double-blined fashion in 40 (20 per group) healthy, full-term parturients presenting for elective cesarean section. We compared the effects of intrathecal fentanyl (20 microgram), and placebo when administered together with 0.5% hyperbaric bupivacaine 7 mg in combined spinal-epidural anesthesia (CSEA) for cesarean section. Patients' anesthetic levels, vital signs and intraoperative pain were recorded. If anesthetic level achieved by intrathecal injection was not sufficient for cesarean section (T4), additional 2% lidocaine 2 ml per segment was administered epidurally. Patients were asked to rate their severity of pain on a visual analog scale (VAS) score intraoperatively and intravenous fentanyl was administered if the patient experienced intraoperative discomfort. The quality and side effects of anesthsia and neonatal Apgar scores were compared between two groups. RESULTS: The number (percent) of patients achieved sensory block level above T4 by subarachnoid injection alone was significantly higher in the fentanyl group (17/18, 94.4%) than the control grop (10/16, 62.5%). The dose of epidural lidocaine was significantly less in the fentanyl group (p<0.05). The frequency of intraoperative pain was significantly less in the fentanyl group (17%) than in the control group (50%). CONCLUSION: We conclude that adding fentanyl into subarachnoid injection in CSEA for cesarean section significantly decreases the additional epidural local anesthetics and intraoperative pain.
Analgesia ; Anesthesia* ; Anesthesia, Epidural ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Cesarean Section* ; Female ; Fentanyl* ; Humans ; Injections, Spinal ; Lidocaine ; Pliability ; Pregnancy ; Visual Analog Scale ; Vital Signs

BACKGROUND: Intracranial complications of paranasal sinus infection are rare and may be misdiagnosed during an initial evaluation because they often show subtle symptoms, which include elusive physical and neurological findings and imaging. The late recognition of these conditions and the delayed treatment can increase morbidity and mortality rates. We aimed to characterize the typical clinical features of intracranial complications associated with sinusitis. METHODS: Twelve patients who visited the Eulji Medical Center from 1994 to 2000, with sinogenic suppurative intracranial lesions were reviewed. Medical records and radiological studies were reviewed retrospectively. RESULTS: There were 12 cases with 15 sinogenic intracranial complications. The ratio of males to female was 2 : 1. The ages of patients ranged from 16 to 81 (average: 46.7). Four cases had meningitis, four had focal cerebritis, three had cavernous sinus throm-bophlebitis, two had subdural empyema, and two had epidural abscess or empyema. The primary lesions of paranasal sinusitis were located at the sphenoid in three, ethmoid sinus in two, frontal sinus in one and the multiple sinus in six. The outcome revealed complete recovery in six cases, mild neurologic sequelae in three cases, death in two cases and recurrence in one case. CONCLUSIONS: The type of intracranial complication and origin of paranasal sinusitis may be changing. Cases in which such complications are suspected, in order for an early diagnosis, a MRI should be considered. The successful management of intracranial complications consists of timely antibiotics therapy combined with surgical drainage of the loculated infection. (J Korean Neurol Assoc 19(5):457~463, 2001)
Anti-Bacterial Agents ; Cavernous Sinus ; Drainage ; Early Diagnosis ; Empyema ; Empyema, Subdural ; Epidural Abscess ; Ethmoid Sinus ; Female ; Frontal Sinus ; Humans ; Magnetic Resonance Imaging ; Male ; Medical Records ; Meningitis ; Mortality ; Recurrence ; Retrospective Studies ; Sinusitis

A 59-year-old man was admitted because of progressive proximal muscle weakness over 4 months. Serum creatine kinase was markedly increased and electromyography revealed myopathic pattern. Muscle biopsy showed nonspecific myopathic changes. No inflammatory change was shown. Thyroid function tests revealed very low thyroxine and low triiodo-L-thyronine, whereas thyroid-stimulating hormone was greatly increased as well as serum anti-thyroglobulin and microsome antibodies. The patient had hypothyroid myopathy due to Hashimoto's thyroiditis, which improved with L-thyroxine replacement.
Antibodies ; Biopsy ; Creatine Kinase ; Electromyography ; Humans ; Hypothyroidism ; Microsomes ; Middle Aged ; Muscle Weakness ; Muscular Diseases* ; Thyroid Function Tests ; Thyroid Gland* ; Thyroiditis* ; Thyrotropin ; Thyroxine

Secondary cervical dystonia caused by tuberculous meningitis is extremely rare. Sixteen year-old female and 56 year-old male were admitted with fever, headache and mental change. Several days after admission they presented neck deviation and polygraphic study revealed prolonged muscular contraction of sterocleidomastoid and trapezius muscles without EEG changes. Their MRI revealed bilateral lesions in the basal ganglia. Recognition of dyskinesias associated with meningitis may be helpful in the diagnosis of tuberculous meningitis.
Basal Ganglia ; Diagnosis ; Dyskinesias ; Electroencephalography ; Female ; Fever ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Meningitis ; Middle Aged ; Muscle Contraction ; Neck ; Superficial Back Muscles ; Torticollis* ; Tuberculosis, Meningeal*

PURPOSE: Hippocampal atrophy is one of the characteristic pathologic findings of hippocampal sclerosis, for which MR imaging of the hippocampus is essential in the evaluation of hippocampal sclerosis. The purpose of this study is to present the normal MR volumetric data of the hippocampus in normal adult Korean and to compare those with MR volumetric data of hippocampus in patients with hippocampal sclerosis, providing the diagnostic volume criteria of the hippocampal atrophy. MATERIALS AND METHODS: MR volumetry was performed in 30 normal adults and 28 patients with temporal lobe epilepsy whose final diagnosis was hippocampal sclerosis. The volumetric data were compared between sexes, right and left sides, and normal and abnormal hippocampus, and the volume criteria for the diagnosis of hippocampal atrophy was determined. RESULTS: The mean volumes(+/-standard deviation) of normal Korean adult were 2.20+/- 0.73 cm3 (right) and 2.17+/-0.72 cm3 (left) in male and 2.27+/-0.47 cm3 (right) and 2.23 +/-0.48 cm3 (left) in female. The mean right-left differences were 0.14+/-0.11 cm3 and 0.19+/-0.13 cm3 in male and female, respectively. The MR volumetry showed no significant statistical differences between sexes and between right and left. The mean volume and standard deviation of the hippocampus in hippocampal sclerosis patients was 1.46+/-0.60 cm3, and the right-left difference was 0.51+/-0.41 cm3. In comparison of two volume distributions between normal adult group and hippocampal sclerosis patients group, the reasonable diagnostic volume criteria was 0.4 cm3 as right-left volume difference, in which the sensitivity and specificity are 0.61 ant0.90. In all patients with right-left volume difference more than 0.4 cm3, visual determination of unilateral hippocampal atrophy was possible. CONCLUSION: The MR-based hippocampal volumetry is a useful add-on of visual MR diagnosis, only when visual diagnosis of hippocampal sclerosis is difficult.
Adult* ; Atrophy ; Diagnosis ; Epilepsy* ; Epilepsy, Temporal Lobe ; Female ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Male ; Sclerosis* ; Sensitivity and Specificity

OBJECTIVE: In general, it is known that repetitive regular stimuli induce tolerance and repetitive irregular stimuli induce sensitization. We sought to determine the dopamine response in the rat prefrontal cortex under the repetitive regular and repetitive irregular stimuli. METHODS: After giving irregular and regular electrical stimuli repetitively to rats, we measured the dopamine levels of prefrontal cortex. We compared these results with the dopamine levels of prefrontal cortex of rats which were given just one electrical stimulus. Samples were obtained using in vivo brain microdialysis. Dopamine levels in the samples were measured by high pressure liquid chromatography with electrochemical detection. RESULTS: 1) Dopamine levels of prefrontal cortex of both repetitive regular stimuli group and repetitive irregular stimuli group increased after electrical stimuli. 2) Dopamine levels of prefrontal cortex also significantly increased after just one electrical stimulus. 3) Among the repetitive regular stimuli group, repetitive irregular stimuli group and one stimulus group, the dopamine response was most significant in the repetitive irregular stimuli group. CONCLUSIONS: Repetitive irregular electrical stimuli induce sensitization of prefrontal cortex and repetitive regular electrical stimuli don't induce tolerance of prefrontal cortex.
Animals ; Brain ; Chromatography, Liquid ; Dopamine* ; Microdialysis ; Prefrontal Cortex* ; Rats*

OBJECTIVE: In severe head injury or postoperative patients with increased intracranial pressure(IICP) in spite of indroducing barbiturate coma therapy, mannitol, and diuretics infusion, we try hypertonic saline infusion therapy as a new treatment modality and observe its relating results and complications. METHODS: Eleven patients that were treated using hypertonic saline infusion were analyzed. They showed decreased Glasgow coma scale(GCS) or aggravated brain swelling on brain CT scan in spite of conventional therapy for IICP using barbiturate coma and mannitol infusion. We infused 3% hypertonic saline with the rate of 40~60cc/hour. Our goal in using 3% hypertonic saline is to increase the serum sodium level in the range of 150 to 155mEq/l. Serum electrolyte level were monitored every 6 hours and the rate of infusion was controlled according to the current serum sodium level. The therapy was continued until each patient demonstrated clinical improvement, complication of therapy, or lack of response. RESULTS: Six cases showed improvement of GCS. One case was expired due to lung problem even though GCS was improved. Two cases showed persistent vegetative state and other 2 cases never showed any response. All expired cases were head injury patients whose GCS score were lower than 5. There was no hypertonic saline infusion related complications. CONCLUSION: Hypertonic saline therapy are very easy and effective adjunctive therapeutic modality for the patient with severely IICP that is refractory to conventional method. To establish this method as standard therapeutic regimen for the intracranial hypertension, more cases analysis should be necessary to confirm the safety and effectiveness.
Brain ; Brain Edema ; Coma ; Craniocerebral Trauma ; Diuretics ; Humans ; Intracranial Hypertension ; Intracranial Pressure* ; Lung ; Mannitol ; Persistent Vegetative State ; Sodium ; Tomography, X-Ray Computed