In a series of 289 patients who underwent stereotactic evacuation of spontaneous intracerebral hematoma(ICH) located in the supratentorial hemisphere from January 1990 through December 1994, the 30th day postoperative outcomes were analysed between small ICH group and large ICH group according to the initial Glasgow Coma Scale(GCS) scores. There were no significant differences found in the postoperative outcome between both groups(p=0.26), except for the finding that the small ICH group showed a better GCS score of less than 8(p=0.04) than large ICH group. In conclusion, it is suggested from these findings that stereotactic evacuation should be more readily employed for large ICH group as well as for small ICH group.
Coma ; Hematoma* ; Humans

The authors analyzed 53 cases with spontaneous intracerebellar hemorrhage diagnosed by brain CT scan and assessed the correlation between the mental status at admission, the outcome and the CT findings. The location of hematoma, volume of hematoma, quadrigeminal cistern obliteration, intraventricular hemorrhage and hydrocephalus were correlated to the mental status assessed by GCS at admission. The GCS score at admission, location of hematoma, volume of hematoma, quadrigeminal cistern obliteration, intraventricular hemorrhage and hydrocephalus were correlated to the outcome. We conclude that decreased GCS score at admission, large volume of hematoma, quadrigeminal cistern obliteration, presence of intraventricular hemorrhage and hydrocephalus could be considered as surgical indications and contributing factors for poor prognosis in the patients with spontaneous intracerebellar hemorrhage.
Brain ; Hematoma ; Hemorrhage* ; Humans ; Hydrocephalus ; Prognosis* ; Tomography, X-Ray Computed

BACKGROUND: General anesthesia alters autonomic nervous system activity. Evaluation of the autonomic nervous system activity using heart rate variability and so, evaluating the anesthetic depth was tried. METHODS: In thirty patients undergoing gynecological surgery under general inhalational anesthesia with enflurane, a 10-minute EKG was perioperatively acquired during main incidents. The heart rate variability was analyzed and expressed as 5-minute signals. RESULTS: In an analysis of the frequency area adopting the heart rate variability, both low and high frequencies represented the effects of the autonomic nervous system, but the low and high frequencies, their ratio and 1/f noise were not valuable in estimating the depth of anesthesia before, during and after the operation. The detrended fluctuation analysis also proved unsuitable for the estimation of the anesthetic depth during an operation. CONCLUSIONS: The signal using heart rate variability reflects the parameter of the autonomic nervous system during operations.
Anesthesia* ; Anesthesia, General ; Autonomic Nervous System ; Electrocardiography ; Enflurane ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Humans ; Noise

PURPOSE: Atypical femoral fracture (AFF), periprosthetic femoral fracture (PPFF) and femoral nonunion (FNU) are recalcitrant challenges for orthopedic surgeons. Teriparatide (TPTD) had been demonstrated to have anabolic effects on bone in various studies. We postulated that adjuvant TPTD after operation would enhance biologic stimulation for bone formation. We investigated (1) whether the adjuvant TPTD could achieve satisfactory union rate of surgically challenging cases such as displaced AFF, PPFF and FNU; (2) whether the adjuvant TPTD could promote development of abundant callus after surgical fixation; (3) whether the adjuvant TPTD had medically serious adverse effects. MATERIALS AND METHODS: Thirteen patients who agreed to off label use of TPTD in combination of operation were included in this retrospective case series. Median patients' age was 68.7 years, and there were three male and ten female patients. Their diagnoses were nonunion in six patients and acute fracture in seven. Medical records and radiographic images were reviewed. RESULTS: Twelve of thirteen fractures were united both clinically and radiologically within a year after adjuvant TPTD. Union completed radiologically median 5.4 months and clinically 5.7 months after the medication, respectively. Callus appeared abundantly showing median 1.4 of fracture healing response postoperatively. There was no serious adverse reaction of medication other than itching, muscle cramp, or nausea. CONCLUSION: Even appropriate surgical treatment is a mainstay of treatment for AFF, PPFF, and FNU, the current report suggested that adjuvant TPTD combined with stable fixation results in satisfactory outcome for the challenging fractures of femur.
Anabolic Agents ; Bony Callus ; Diagnosis ; Female ; Femoral Fractures* ; Femur ; Fracture Healing ; Humans ; Male ; Medical Records ; Muscle Cramp ; Nausea ; Off-Label Use ; Orthopedics ; Osteogenesis ; Periprosthetic Fractures ; Pruritus ; Retrospective Studies ; Surgeons ; Teriparatide*

No abstract available.
Animals ; Autoradiography ; Carcinogenesis* ; Diethylnitrosamine ; gamma-Glutamyltransferase* ; Liver* ; Rats*

No abstract available.
Animals ; Autoradiography ; Carcinogenesis* ; Diethylnitrosamine ; gamma-Glutamyltransferase* ; Liver* ; Rats*

Epidural administration of opioid and/or local anesthetics during general anesthesia is widespread method for postoperative pain control. Despite of its availability, inadvertent administration of non-epidural medications into epidural space can be associated with serious neurologic sequelae. We report a case of accidental epidural atracurium injection.
Anesthesia, General ; Anesthetics, Local ; Atracurium* ; Epidural Space ; Lidocaine* ; Pain, Postoperative

Two Whooper swan (Cygnus cygnus) died after suffering from pododermatitis, lethargy, and ataxia; necropsy was performed. Grossly, the liver was swollen and firm. The kidney and spleen were also enlarged and a pale tan color. On histopathologic examination with Congo red staining, amyloidosis was noted in liver, spleen, and kidney. In addition, marked osseous metaplasia was present in the liver. Based on these results, systemic amyloidosis involving liver, spleen, and kidney with osseous metaplasia in the liver was diagnosed. Study results indicate that an inflammatory reaction associated with pododermatitis had a role in the amyloidosis in this particular case.
Amyloidosis* ; Ataxia ; Congo Red ; Kidney ; Lethargy ; Liver ; Metaplasia ; Spleen ; Triacetoneamine-N-Oxyl

Herpes simplex virus esophagitis and candidal esophagitis can be found in immunocompromised patients. But it rarely occurs in immunocompetent patients. Diagnosis is usually established with an upper gastrointestinal endoscopy. The lesions of herpes simplex virus esophagitis involves the squamous mucosa, where the earlist manifestation is a vesicle, rarely. We report a case of herpes simplex virus esophagitis who, being immunologically healthy, presented with substernal pain and dysphagia and showed vesicle formation on endoscopy. The patient also showed whitish patch and spot on esophageal mucosae. The patient showed loss of symptom and improvement of endoscopic finding after conservative management and antifungal therapy.
Deglutition Disorders ; Diagnosis ; Endoscopy ; Endoscopy, Gastrointestinal ; Esophagitis* ; Herpes Simplex* ; Humans ; Immunocompromised Host ; Mucous Membrane ; Simplexvirus*

BACKGROUND/AIMS: Tuberculous peritonitis is still a very important cause of exudative ascites in Korea. We analized the clinical features and laparoscopic findings in patients with tuberculous peritonitis diagnosed by laparoscopy. METHODS: We studied 51 patients who had tuberculous peritonitis confirmed by laparoscopic biopsy from 1980 to 2000, in retrospective method. RESULTS: The ratio of male to female was 1:2. The peak incidence was between 21 and 40 years of age. The mean duration of symptoms is 60 days. The most frequent chief complaints and physical findings was abdominal fullness (88.2%) and shifting dullness (94.1 %). Involvement of other organs included pulmonary tuberculosis (27.4%), cervical tuberculous lymphadenitis (3.9%). The mean ascitic fluid protein concentration was 4.9 gm/dL, mean WBC count 1,240/mm3 and lymphocyte dominant exudate 88.2%. AFB smear was positive only one patient (2.0%). Tuberculous nodules on laparoscopy were noted in all of the patients. Histolologic findings were caseating granuloma (72.6%), non-caseating granuloma (19.6%) and nonspecific inflammation (7.8%). Tissue AFB stain was positive 10 patients (19.6%). CONCLUSIONS: Tuberculous peritonitis shows nonspecific clinical features. Therefore, laparoscopic examination with biopsy is the most useful method to make differential diagnosis of patients who are suspected tuberculous peritonitis.
Ascites ; Ascitic Fluid ; Biopsy ; Diagnosis, Differential ; Exudates and Transudates ; Female ; Granuloma ; Humans ; Incidence ; Inflammation ; Korea ; Laparoscopy* ; Lymphocytes ; Male ; Peritonitis, Tuberculous* ; Retrospective Studies ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary