This treatise summarizes the medical facts about the persistent vegetative state(PVS) and the associated issues. In August 1998, the opinions of the 380 neurologists and the 1007 neurosurgeons are inquired about the diagnostic criteria of PVS, the degree and the withdrawal of treatment on PVS patients. The response rate is 18.8%. The diagnostic criteria of PVS is determined by the items approved above 5007o of responses. (1) no evidence of cerebral function and an inability to interact with visual, auditory stimuli and follow commands. (2) maintaining the respiratory function with spontaneous respiration and normal respiratory pattern. (3) spontaneous eye opening and eye ball movements without sustained tracking. (4) variably preserved brain stem reflexes. (5) presence of sleep-wake cycles. (6) (1)-(5) symptoms should be persist for 6 months after the development of vegetative state. (7) the diagnostic criteria of PVS should be applied more than 3 times during the minimum observation period. (8) this diagnostic criteria of PVS could be applied to adults over 7 ages. As to the degree of treatment, nasogastric tube feeding and air-way keeping through the tracheostomy are approved over 9007b. Also antibiotics can be used in infection. As to the withdrawal of treatment, do not resuscitate order of patient s family is accepted by 46.1% in an emergency condition like cardiac arrest. But discharge against medical advice by the patient s family is accepted by 73.107o in non-emergency condition. In the case of neonates, parents decision is more determinative than any other thing.
Adult ; Anti-Bacterial Agents ; Brain Stem ; Emergencies ; Enteral Nutrition ; Heart Arrest ; Humans ; Infant, Newborn ; Korea* ; Parents ; Persistent Vegetative State* ; Reflex ; Respiration ; Tracheostomy

Acetabular fractures are usually caused by violent external force such as car clash and commonly accompany injuries of the other parts of the body. And there has been long controversy between conservative and operative treatments. A clinical analysis was performed on the 29 patients with acetabular fractures, who had been treated at seoul National University Hospital from 1973 to 1982, mainly focussed on the result of treatment. Followings are the summary of the result. 1. Conservative treatment was done in 52% and operative treatment in 48%. 2. Mean follow-up period was 1 year and 8 months. 3. The result of treatment was good or fair in 53% of conservative treatment group comparedto 71 in operative treatment group. 4. Primary total hip replacement was done in one case of bursting fracture combined with fracture of femur neck and the result was good. 5. Superior and bursting fractures showed the worst result(poor in 83%). 6. Degenerative arthritis with or without avascular necrosis was the most common complication (45 %) and it was more common in conservative treatment group (60 vs. 29%). 7. From above results it could be said that operative treatment in acetabular fractures, if carefully done with reasonable indications, would improve the result and decrease the rate of degenerative arthritis.
Acetabulum ; Arthroplasty, Replacement, Hip ; Femur Neck ; Follow-Up Studies ; Humans ; Necrosis ; Osteoarthritis ; Seoul

No abstract available.
Krukenberg Tumor*

The authors present 31 patient with acute epidural hematoma who had been admitted from January, 1987 to June. 1989 managed by consevative treatment. The results were as follows ; 1) The age of patients was distributed evenly, most patients were male (26 cases) and the most common mechanism of injury was traffic accidents(14 cases). 2) Sites of hematoma were mostly the temporal and parietal area and the maximum thickness of hematoma was not different from each site. 3) On admission, all patients presented GCS score above 13 except 2 cases. 4) All patients did not undergo delayed up, due to the enlargement of the hematoma or neurological deterioration. 5) The maximum thickness of hematoma was under 20 mm in all patients. 6) The hematoma was resolved within 30 days in all cases. This was confirmed with brain CT scan.
Brain ; Hematoma* ; Humans ; Male ; Rabeprazole ; Tomography, X-Ray Computed

This study was carried out to understand the relationship between specific chromosome changes and their phenotypic consequences at the tissue level of human lung cancers. Then paraffin-embedded human lung squamous cell carcinoma samples were investigated for in evidence of genetic alterations, using chromosome 7 and 17-specific repetitive alpha-satellite DNA probes. In situ hybridization procedure with chromosome-specific DNA probes was optimized for use on formalin-fixed paraffin-embedded lung tissue sections. The chromosome index ranged from 1.10 to 1.88(median, 1.49) for chromosome 7 and 1.20 to 1.98(median, 1.69) for chromosome 17. Normal lymphocytes and stromal cells showed one or two chromosome signals per cell in most cases. All tumors showed three or more chromosome signals per cell with range of 16.0% to 80.6% of cancer cells(median, 50.9%) for chromosome 7 and 32.7% to 84.7%(median, 69.9%) for chromosome 17. The chromosome index did not correlate with the DNA content in most cases. Chromosomes 7 and 17 were either overrepresented or underrepresented when they were compared with corresponding DNA index determined by FCM. An increase in copy number, particularly of chromosome 7 was associated with a less favorable phenotype, including high nuclear grade. In addition, chromosome alterations were differentially expressed in the different areas of the same tissue section, correlating with histologic heterogeneity. These results suggest that chromosome polysomy can be reliably detected in tissue sections using in situ hybridization. There is a strong correlation between genotypic abnormalities and tumor phenotype in human lung cancer. This capability will prove to be an important tool for determining the underlying genetic basis for tumor development, tissue phenotype heterogeneity and progression by allowing genetic determination to be made on paraffin-embedded tissue sections where tumor histologic architecture is preserved.
Humans ; Lung Neoplasms

No abstract available.
Lung Neoplasms* ; Lung* ; Pneumothorax, Artificial*

Abdominal actinomycosis is very rare infectious disease and seldom reported as a cause of abdominal mass. This disease is diagnosed by pathologic findings and culture result but it is very difficult to differentiate with other granulomatous illammatory disease, diverticular disease, malignancy, etc. The radiologic findings were non-specific and CT scan revealed the inflammatory mass with multiple small abscesses and fibrous change. The treatment of choice for actinomycosis is medical treatment with penicillin but surgical intervention may be needed when complication such as obstruction, fistula formation, abscess formation develop. We report a patient with abdominal actinomycosis that presented with transverse colonic obstruction and severe abdominal wall inflammation. This patient had no past operative history but got intrauterine contraceptive devices during last 10 years. We treated this patient by surgical resection and antibiotic therapy.
Abdominal Wall ; Abscess ; Actinomycosis* ; Colon* ; Colon, Transverse ; Communicable Diseases ; Fistula ; Humans ; Inflammation ; Intrauterine Devices ; Penicillins ; Tomography, X-Ray Computed

The authors compared the changes of morphology, blood brain barrier alteration, pathology, arterial blood lactate content and cerebrospinal fluid lactate content between an intermittent brain retraction group and a continuous brain retraction group in 56 mongrel cats. The results were as follows ; 1) Microscopically, hemorrhages were punctate in 15 cases among 25 cases in the intermittent retraction group. However, there were multiple or large hemorrhages in 13 cases among the 25 cases in the continuous brain retraction group. 2) All cases of the intermittent retraction group showed 0~25% Evans blue staining of the coronal section crossing the retraction site. However, 8 cases among the 25 cases of the continuous retraction group showed 51~75% Evans blue staining and 4 cases of this group showed 76~100% staining. 3) With photomicroscopy, the authors noted small hemorrhage and cellular swelling in the intermittent retraction group instead of pyknosis, hemorrhagic necrosis, vacuolation in the continuous retraction group. 4) The change of arterial blood lactate content was from 1.22+/-0.24mmol/L at preretraction time to 1.42+/-0.26mmol/L at 90 minutes after release of retractor in the intermittent retraction group(p<0.01). In the continuous retraction group, the authors noted a change in the lactate content from 1.20+/-0.38mmol/L to 3.15+/-0.97mmol/L for the same time as above(p<0.001). 5) The change of CSF lactate content in the intermittent retraction group was from 1.39+/-0.29mmol/L at preretraction time to 1.43+/-0.23mmol/L at 90 minutes after release of retractor(p>0.05). In the continuous retraction group, this author noted change in the lactate content from 1.37+/-0.28mmol/L to 2.11+/-0.52mmol/L for the same time as described above(p<0.01). From the above results, the superiority of the intermittent brain retraction was demonstrated as compared with the continuous brain retraction. Also the possible utilization of this experimental method was discussed for other wxperimental studies on ischemia.
Animals ; Blood-Brain Barrier ; Brain* ; Cats* ; Cerebrospinal Fluid ; Evans Blue ; Hemorrhage ; Ischemia ; Lactic Acid ; Necrosis ; Pathology

No abstract available.
Humans ; Tibial Nerve*

Spinal stenosis is a localized narrowing of spinal canal due to strurctural abnormalities. Its symptoms are obscure, and characterized by chronic, poorly localized, bilateral nerve root compression signs. Computerized tomography(CT) has been accepted as almost an absolute diagnostic method for spinal stenosis after its application in the orthopedic field. During the period of 2 years, from March 1982 to March 1984, 26 cases of spinal stenosis were treated surgically after botlt CT scanning and myelography. We obtained following results about advantage of CT scanning in spinal stenosis. 1. Myelography showed following findings: Hourglass defect 9, Complete block 8, Unilateral focal defect 4, Uniform narrowing 1, Mixed 2, Negative finding 2. Myelographic finding was not specific for spinal stenosis and diagnostic accuracy was inferior to CT. 2. The type of spinal stenosis was identified by CT scan finding. Of 26 cases, 21 cases were degenerative spinal stenosis, of which central stenosis was present in 7 cases, and lateral stenosis was present in all cases. The remaining 5 cases were combined type, and both central and lateral stenosis were present in all cases. 3. The diagnostic accuracy,in localizing the level of stenosis was 61.5% by myelography, and 96.2% by CT scan. CT was especially superior to myelography in the localization of the multi-segmental stenosis. 4. CT gives valuable information about extent and degree of stenosis, especially lateral recess stenosis, thus helping the surgeon to decide on the extent of decompressive lamininectomy preoperatively.
Clothing ; Constriction, Pathologic ; Methods ; Myelography ; Orthopedics ; Radiculopathy ; Spinal Canal ; Spinal Stenosis ; Tomography, X-Ray Computed