No abstract available.
Female ; Germ Cells* ; Neoplasms, Germ Cell and Embryonal* ; Ovary*

We report an autopsy case of the brain stem glioma that extended extensively in the brain stem itself and cephalad. This 18-year-old boy first presented with dizziness, vomiting and left side weakness with left facial palsy. Brain MRI revealed a diffusely infiltrative tumor involving whole medulla, pons and lower midbrain. A total of 4000 R was given with some alleviation of respiratory difficulty. He died one year after the onset. Autopsy revealed the tumor involving pons, a portion of medulla oblongata, and cerebellum. The tumor showed diffusely infiltrative pattern and extended along the periventricular area to the thalamus and corpus callosum. The cut surface was grayish white and solid. It also showed areas of myxoid degeneration and necrosis probably related to radiation therapy. Microscopically the tumor was a cellular and pleomorphic glioma that showed some astrocytic differentiation. It was diffuse without geographic necrosis.

Gestational trophoblastic tumor is one of the curable disease, but metastatic trophoblastic tumor still shows high mortality rate because of resistance to the chemotherapy. Choriocarcinoma may occur after an any type of human pregnancy. The incidence of choriocarcinoma following term pregnancy is very uncommon, and such tumor appears to follow a more aggressive course with more extensive metastatic spread and is less responsive to chemotherapy resulting in a poorer prognosis. Choriocarcinoma presenting as postpartum hemorrhage, and spontaneous tumor perforation with intra-abdominal hemorrhage is even rarer, requiring emergency laparotomy. We had experienced one case of metastatic choriocarcinoma following term pregnancy that required emergency total abdominal hysterectomy due to uterine perforation and hemorrhage. So, we report this case with brief review of literatures.
Choriocarcinoma* ; Drug Therapy ; Emergencies ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Laparotomy ; Mortality ; Postpartum Hemorrhage ; Pregnancy ; Pregnancy* ; Prognosis ; Trophoblastic Neoplasms ; Uterine Perforation*

No abstract available.
Legg-Calve-Perthes Disease*

PURPOSE: Polymerase chain reaction (PCR) assay, introduced as a fast and sensitive diagnostic method, is useful in detecting Mycobacterium tuberculosis. The purpose of this study was to evaluate the usefulness of in-house PCR assay in the detection of Mycobacterium tuberculosis by comparing PCR results with conventional diagnostic techniques and Cobas Amplicor M. tuberculosis(TM) kit. MATERIALS and METHODS: We retrospectively assessed the diagnostic yield of in-house PCR method employed for the amplification IS6110 sequences in 2,973 specimens. We also compared in-house PCR with Cobas Amplicor M. tuberculosis(TM) kit in 120 specimens collected from June to July 2006. Routine acid-fast stain (AFS) and culture assay were also performed and analyzed. RESULTS: Of 2,973 cases, 2,832 cases (95.3%) showed consistent results between in house PCR, AFS and culture methods, whereas 141 (4.7%) displayed inconsistent results. The sensitivities, specificities, and positive and negative predictive values of each method were as follows: 77.5%, 99.7%, 95.5%, and 98.0%, respectively for PCR; 49.2%, 100%, 100%, and 95.7%, respectively, for AFS method; and 80.7%, 100%, 100%, and 98.3%, respectively, for culture assay. Consistent results between PCR and Cobas Amplicor M. tuberculosis(TM) kit were shown in 109 cases (90.8%). The sensitivities, specificities, and positive and negative predictive values of each method were as follows: 81.3%, 98.9%, 96.3%, and 93.5% respectively for PCR and 71.9%, 100%, 100%, and 90.7%, respectively, for Cobas Amplicor(TM) kit. CONCLUSION: In-house PCR and Cobas Amplicor(TM) kit show high sensitivity and specificity, and are reliable tests in the diagnosis of tuberculosis.
Humans ; Mycobacterium tuberculosis/*genetics/*isolation & purification ; Polymerase Chain Reaction/*methods ; Sensitivity and Specificity

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) with acquired metallo β-lactamase (MBL) resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP)-1 MBL in a medical intensive care unit (MICU) in Korea is reported. METHODS: Since isolating carbapenem-resistant K. pneumoniae (CRKP) at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). In addition, a surveillance study of environmental cultures and health-care workers (HCWs) was conducted in the MICU during the same time frame. RESULTS: During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions. CONCLUSIONS: This study shows that rapid and systemic detection of CRE and strict infection controls are important steps in preventing nosocomial transmission.
Aged ; Clinical Coding ; Critical Care* ; Diffusion ; Disease Outbreaks ; Drug Resistance, Bacterial ; Electrophoresis, Gel, Pulsed-Field ; Enterobacteriaceae ; Hand ; Humans ; Infection Control ; Intensive Care Units* ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Male ; Methods ; Mortality ; Pneumonia ; Polymerase Chain Reaction ; Sputum

BACKGROUND AND PURPOSE: Chronic simulated snoring was induced in rabbits to determine the impact of snoring on the development of atherosclerosis. METHODS: The pressure wave of induced snoring at the carotid bifurcation of rabbits was acquired by gently pressing the airway. This wave was then simulated using custom-made mechanical devices. Twelve rabbits were used in this study, seven of which were assigned to the experimental group and the remaining five formed the control group. All of the rabbits were raised on a 1% high-cholesterol diet. Either working or sham devices were positioned at the ventral center of the neck in each rabbit. At the end of a 2-month observation period, all of the rabbits were sacrificed by perfusion fixation, the carotid arteries harvested, and the carotid atherosclerosis histology reviewed. RESULTS: All of the rabbits survived to the end of the experimental period. Blood sampling revealed the presence of hypercholesterolemia in both groups, with no significant difference between them. The presence and degree of atherosclerosis did not differ significantly between the groups. CONCLUSIONS: The findings of this study show the feasibility of making a chronic simulated snoring rabbit model. However, the causative role of snoring in carotid atherosclerosis was not detected in this animal study.
Animals ; Atherosclerosis ; Carotid Arteries ; Carotid Artery Diseases* ; Diet ; Hypercholesterolemia ; Neck ; Perfusion ; Rabbits* ; Snoring*

BACKGROUND: Atracurium is a benzylisoquinolium nondepolarizing neuromuscular blocking drug. It releases histamine upon the rapid administration of more than 2 x ED95. Cisatracurium is about three to four times more potent than atracurium, less likely to release histamine, and has weaker cardiovascular or autonomic effects. Mivacurium releases histamine to about the same degree as atracurium at the same dose. This study was undertaken to reevaluate the experimental model for the evaluation of effects on the autonomic nervous system, and to determine the neuromuscular blocking profiles and the vagolytic effects of atracurium, cisatracurium and mivacurium in cats. METHODS: Cats, either sex, anesthetized with pentobarbital, were used. Neuromuscular blocking effects were assessed using the effects on the anterior tibialis muscle twitch evoked with supramaximal stimuli (0.2 ms-duration, 0.1 Hz). Inhibition of the parasympathetic nervous system was assessed in response to bradycardia to vagal nerve stimulation with ten-second trains of square-waves (0.5 ms-duration, 20 Hz). The dose-response curves for both neuromuscular blocking and vagolytic actions were determined for each animal. The dose-response curves were constructed in cumulative fashion. The response for vagal stimuli was measured two minute after each dosing. Vagal ID50 (The doses that produced 50% inhibition of the response to vagus nerve stimulation) were determined. RESULTS: NMB ED95 and NMB ED50, respectively, were 102.0 +/- 28.3 and 143.7 +/- 40.5 microgram/kg for atracurium, 81.4 +/- 13.3 and 110.7 +/- 18.8 microgram/kg for cisatracurium, and 56.8 +/- 17.4 and 74.2 +/- 25.0 microgram/kg for mivacurium. Vagal ID50 was 2,654 +/- 1,651 microgram/kg for atracurium, 655 +/- 389 microgram/kg for cisatracurium, and 606 +/- 182 microgram/kg for mivacurium. The vagal ID50/NMB ED95 and vagal ID50/NMB ED50 were 18.5 and 26.0 for atracurium, 5.9 and 8.1 for cisatracurium, and 8.2 and 10.7 for mivacurium. CONCLUSIONS: Atracurium has a wider margin of safety only for vagal stimulation as compared with cisatracurium and mivacurium. However, we couldn't exclude that either sympathetic stimulation or histamine release might contribute to heart rate.
Animals ; Atracurium* ; Autonomic Agents ; Autonomic Nervous System ; Bradycardia ; Cats* ; Heart Rate ; Histamine ; Histamine Release ; Models, Theoretical ; Neuromuscular Blockade* ; Parasympathetic Nervous System ; Pentobarbital ; Vagus Nerve ; Vagus Nerve Stimulation

BACKGROUND: A postoperative pain management has been considered as an important issue in surgery. However, any systematic information or standard method about it has not been so far provided for clinicians in Korea. This study aims to analyze the current practices of in-hospital postoperative pain controls and suggest clinical implications. METHODS: A descriptive statistical analysis was adopted to review a nationwide distribution of postoperative pain control methods for the types of patients, surgery, hospitals, specialties, and analgesia. The data is based on the medical claims database of Health Insurance Review Agency (HIRA), which covers all reimbursement claims from hospitals in Korea. All inpatient surgery cases implemented during one year were included in the analysis. RESULTS: It was reported that 1,539,662 cases out of total 1,891,596 inpatient surgery cases were associated with one or more types of analgesia in 2005. The most frequent type of inpatient surgery was bone surgery (24.4%). In all cases related with analgesia, bone surgery took the highest percentage of 28.6%. It was also revealed that the most frequently used postoperative pain management was oral or external use of NSAID (non steroidal anti-inflammatory drug), which was 75.0% of all analgesia treatments. An epidural PCA (patient controlled analgesia), IV PCA (intra-venous patient controlled analgesia) and epidural opioid bolus were 0.2%, 0.2% and 0.1%, respectively, of all analgesia treatments. CONCLUSIONS: The results would certainly be useful to develop a clinical practice guideline in postoperative pain management to enhance patient outcomes.
Analgesia ; Analgesia, Patient-Controlled ; Humans ; Inpatients ; Insurance, Health ; Korea ; National Health Programs ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis

BACKGROUND: This study was aimed to elucidate the effect of thiopental anesthesia on circulatory response to hemorrhage in rats by power spectral analysis of heart rate and blood pressure variability. METHODS: Sixteen male Sprague-Dawley rats weighing 350~475 g were divided into thiopental (50 mg/kg, ip)-anesthetized (T, n=10) and conscious (C, n=6) groups. Hemorrhage was induced with a withdrawal pump from the femoral artery at 3 ml/kg/min for 5 min. Arterial pressure was measured with a pressure transducer connected to the contralateral femoral artery for 5 min before, during and after hemorrhage. The blood pressure signal digitized at 500 Hz through a data acquisition system was analyzed with fast Fourier transform algorithm to yield power spectra of sytolic (SP) and diastolic (DP) blood pressure and instantaneous heart rate (HR). Powers of very low frequency (VLF, 0.02~0.26 Hz), low frequency (LF, 0.26~0.75 Hz) and high frequency (HF, 0.75~5.00 Hz) band were expressed as percent of total power. RESULTS: Before Hemorrhage blood pressure was lower in T (113 6/83 6 mmHg) than in C (157 4/101 2) rats, but was not changed by hemorrhage in both groups. Before Hemorrhage HR was lower in T (331 22 beats/min) than in C (378 27) rats. HR was significantly increased to 412 26 beats/min in C, but was not changed in T during hemorrhage. Total powers of Before Hemorrhage blood pressure and HR variability were lower in T than in C. During hemorrhage, total power of blood pressure variability tended to increase in both groups, and that of DP was significantly increased during hemorrhage in T. Total power of HR was significantly increased in C, but was not changed in T. T rats showed lower LF and higher HF power of blood pressure, and lower VLF and LF and higher HF power of HR than C rats. During hemorrhage, both groups showed no significant change in spectral distribution of HR power, except for a significant increase in LF of HR after hemorrhage in C. Spectral distribution of blood pressure power was not changed by hemorrhage in C. In T rats, VLF of DP was significantly increased and HF of DP was decreased during hemorrhage. CONCLUSIONS: It suggests that autonomic activity, especially cardiac sympathetic activity is increased in response to hemorrhage in C. Thiopental anesthesia depresses overall autonomic activity, especially sympathetic activity, and vasomotor tone. Hemorrhage under thiopental anesthesia induces depression of baroreceptor reflex activity, while increased levels of vasoconstrictor hormones help to maintain the blood pressure.
Anesthesia ; Animals ; Arterial Pressure ; Baroreflex ; Blood Pressure* ; Depression ; Femoral Artery ; Fourier Analysis ; Heart Rate* ; Heart* ; Hemorrhage* ; Humans ; Male ; Rats* ; Rats, Sprague-Dawley ; Thiopental ; Transducers, Pressure