BACKGROUND: Atrial fibrillation (AF), commonly considered as a cardiac embolic source, can itself be induced by stroke. We therefore tried to find and analyze this 'stroke-induced' AF. METHODS: From the Inha University Stroke Registry of the past 2 years, 143 middle cerebral artery (MCA) territorial infarct patients who had been admitted within 48 hours after stroke onset were recruited to participate in the study. Electrocardiograms (EKG) on admission and follow-up during hospitalization were analyzed. Also, MCA infarct was subdivided according to insular involvement by brain imaging. RESULTS: Among 143 MCA territorial infarcts, 38 patients had AF on admission (Rt:21; Lt:17). Of those, insular involvements of the MCA infarct was noted in 32 patients. All the patients had a follow-up EKG and AF disappeared in 3 patients (Rt:2; Lt:1). In the remaining 105 patients, 10 patients subsequently developed new AF within 1 week after hospitalization. All those 10 patients had right-sided MCA infarcts and insular involvements were present in 9 patients. In summary, among the 48 MCA infarct associated with AF, 13 AF (Rt:12; Lt:1) were presumed to be the consequence and not the cause of stroke. CONCLUSIONS: Though human insular stimulation and inactivation studies have suggested that AF would be more common in left insular destructive lesions, it was not always supported in clinical series. From our study, presumed 'stroke-induced' AF was highly associated with right insular lesions. The mechanism of arrhythmogenesis by ischemic stroke might be more complicated than previously expected and, not merely the simple inactivation of an anatomical substrate, the insular cortex.
Atrial Fibrillation* ; Electrocardiography ; Follow-Up Studies ; Hospitalization ; Humans ; Middle Cerebral Artery* ; Neuroimaging ; Stroke

BACKGROUND: In anesthesia for tonsillectomy in children, deep general anesthesia, rapid recovery to consciousness and the return of protective airway reflexes are desirable. This study was designed to estimate the efficacy of TIVA with propofol and fentanyl compared with isoflurane-N2O. METHODS: Forty pediatric patients in ASA class I for tonsillectomy were allocated randomly to either TIVA with propofol and fentanyl (n=20, T) or isoflurane-N2O (n=20, I) group. Anesthesia was induced with propofol 1 mg/kg, fentanyl 3 microgram/kg IV and was maintained by continuous infusion of propofol 6~10 mg/kg/hr, fentanyl 6~10 microgram/kg/hr in T group and was induced with thiopental 5 mg/kg IV and maintained by inhalation of 1.2~2.5 vol% isoflurane in I group. The changes of hemodynamics, recovery time and complications were evaluated. RESULTS: Systolic and diastolic pressure were increased in I group than T group at 1 min after intubation (p<0.05). Heart rate was increased in I group than T group at 1 min after intubation, 1 min and 5 min after incision, changing tube, end of operation and 5 min after end of operation (p<0.05). The recovery time was shorter in T group than I group (p<0.05). Pain on injection was more frequent in T group than I group (p<0.05), and excitatory effect during emergence was more frequent in I group than T group (p<0.05). CONCLUSIONS: TIVA with fentanyl and propofol is better than isoflurane-N2O for anesthesia of tonsillectomy in children in view of small hemodynamic change, early and gentle recovery pattern and side effects.
Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous* ; Blood Pressure ; Child* ; Consciousness ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Inhalation ; Intubation ; Isoflurane* ; Propofol ; Reflex ; Thiopental ; Tonsillectomy*

BACKGROUND: In anesthesia for cesarean section, there is an increased incidence of maternal awareness because a light plane of general anesthesia is chosen for fetal safety and rapid recovery. Propofol may be the choice if smooth induction and rapid maternal recovery are desired. Authors tried to know that propofol has properties which suggest that it might be useful alternative to thiopental and enflurane. METHODS: Forty patients in ASA class I or II scheduled for cesarean section were allocated randomly to either propofol (n=20) (P) or thiopental-enflurane (n=20) (T-E) group. Anesthesia was induced with propofol 2 mg/kg IV and maintained by continuous infusion of propofol 8 mg/kg/hr in P group and was induced with thiopental 4 mg/kg IV and maintained by inhalation of 1 vol% enflurane in T-E group. All patients received vecuronium 0.1 mg/kg and 50% N2O-O2. Blood pressure, heart rate, Apgar score, umbilical arterial blood gas analysis and the incidence of maternal awareness using the isolated forearm technique (IFT) were evaluated. RESULTS: Diastolic pressure was decreased in P group than T-E group at 10 min after delivery. Heart rate was increased in P group than T-E group at immediate after extubation (p<0.05). For apgar score, umbilical artery gas analysis and maternal awareness there were not significant differences between two groups. CONCLUSIONS: In comparison with thiopental-enflurane, propofol infusion (8 mg/kg/hr) coupled with N2O was proved to be clinically satisfactory anesthesia for cesarean section with no adverse effects on both mother and neonate.
Anesthesia* ; Anesthesia, General ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section* ; Enflurane ; Female ; Forearm ; Heart Rate ; Humans ; Incidence ; Infant, Newborn* ; Inhalation ; Mothers ; Pregnancy ; Propofol ; Thiopental ; Umbilical Arteries ; Vecuronium Bromide

This study was designed to clarify the dependency of hypoxic coronary vasodilation (HCD) on the endothelium and the role of the K+ channels on HCD in the rabbit coronary artery. HCD was investigated in an isolated left circumflex coronary artery precontracted with prostaglandin F2 alpha. Vascular rings were suspended for isometric tension recording in an organ chamber filled with Krebs-Henseleit (KH) solution. Hypoxia was induced by gassing the chamber with 95% N2 + 5% CO2 and was maintained for 15 approximately 25 min. Hypoxia elicited a vasodilation in the precontracted coronary artery with and without endothelium. There was no difference between the amplitude of the HCD induced by two consecutive hypoxic challenges and the effects of 20% O2 + 5% CO2 + 75% N2 and 95% O2 + 5% CO2 control K-H solution of subsequent responses to hypoxia. Inhibition of the cyclooxygenase pathway by treatment with indomethacin had no effect on HCD. Blockades of the tetraethylammonium chloride-sensitive K+ channel abolished HCD. Apamin, a blocker of the small conductance Ca(2+)-activated K+ (KCa) channel, and iberiotoxin, a blocker of the large conductance KCa channel had no effect on HCD, respectively. Glibenclamide, a blocker of the ATP-sensitive K+ (K+ATP) channel, reduced HCD. Cromakalim, an opener of the K+ATP channel, relaxed the coronary artery precontracted with prostaglandin F2 alpha. The degree of relaxation by cromakalim was similar to that by hypoxia while glibenclamide reduced both hypoxia- and cromakalim-induced vasodilatations. In conclusion, these results suggest that HCD is independent on endothelium and HCD is considered to be induced by activation of K+ATP channel.
Animal ; Anoxia/physiopathology* ; Coronary Vessels/physiopathology* ; Coronary Vessels/drug effects ; Cyclooxygenase Inhibitors/pharmacology ; Enzyme Inhibitors/pharmacology ; Female ; Indomethacin/pharmacology ; Male ; Nitroarginine/pharmacology ; Rabbits ; Tetraethylammonium/pharmacology ; Vasodilation/physiology*

Hallervorden-Spatz disease (HSD) is a rare, progressive, autosomal recessive hereditary disorder characterized by pyramidal and extrapyramidal signs, speech disturbances, mental deterioration and retinal degeneration during childhood or adolescence. In late-onset form after the age of 20, parkinsonian features may be the predominant clinical manifestation. Meanwhile, involuntary tongue movements are rare and poorly understood, which have been reported in tardive dyskinesia, neuroacanthocytosis, chronic epilepsy, and after head trauma. We report a case of a patient with 'fly catcher's tongue' as a major clinical presentation, accompanied with mild parkinsonism, and typical MR findings of HSD.
Adolescent ; Craniocerebral Trauma ; Diptera* ; Epilepsy ; Humans ; Movement Disorders ; Neuroacanthocytosis ; Pantothenate Kinase-Associated Neurodegeneration* ; Parkinsonian Disorders ; Retinal Degeneration ; Tongue*

Cerebral infarcts rarely occur following head injury. Carotid artery dissection is usually proposed mechanism in such cases. We experienced a case of middle cerebral artery (MCA) infarct occurred just after head trauma without evidence of vascular abnormality. A 59-year-old male was transported to the emergency room immediately after traffic accident. He had right zygomatic fracture without neck injury. Left hemiparesis was noticed, and brain CT revealed hyperdense MCA sign in the right side. His neurologic status deteriorated over 2 days, and brain MRI showed total right MCA infarct with midline shift. Cerebral angiography was unremarkable. Two months later he had improved so much, but left hemiparesis with right MCA infarction re-developed. We suggest head trauma immediately can induce cerebral infarct without neck vessel injury, and in differential diagnosis of focal neurologic deficit after trauma, cerebral infarct as well as hemorrhage or contusion must be considered.
Accidents, Traffic ; Brain ; Carotid Arteries ; Cerebral Angiography ; Contusions ; Craniocerebral Trauma* ; Diagnosis, Differential ; Emergency Service, Hospital ; Head* ; Hemorrhage ; Humans ; Infarction, Middle Cerebral Artery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Middle Cerebral Artery* ; Neck ; Neck Injuries ; Neurologic Manifestations ; Paresis ; Zygomatic Fractures

No abstract available.
Acanthosis Nigricans* ; Aluminum* ; Yttrium*

Background: Acne is a chronic inflammatory disease of the pilosebaceous unit and usually affects adolescents when the peak concentrations of growth hormone, insulin-like growth factor 1, and androgen are demonstrated. The activity of alkaline phosphatase (ALP), which increases physiologically in growing children and adolescents, in the pilosebaceous unit has been reported. However, the correlation between the serum level of ALP and the number of acne lesions has not been studied. Objective: The present cross-sectional study was designed to evaluate the correlation between serum level of ALP and the numbers of non-inflammatory and inflammatory acne lesions in children and adolescents. Methods: For this study, 202 pediatric and adolescent patients clinically diagnosed with acne vulgaris were included. Age, sex, serum level of ALP, number of non-inflammatory acne lesions, number of inflammatory acne lesions, and number of total acne lesions were evaluated. Additionally, the serum level of dehydroepiandrosterone sulfate was evaluated in 117 patients. Multiple regression analysis was performed. Multicollinearity was quantified using the variance inflation factor. Results: In the 202 patients, serum level of ALP was the only independent factor that significantly affected both the number of non-inflammatory acne lesions and of total acne lesions (regression coefficient=0.089 and 0.086, respectively, p＜ 0.001). Conclusion There was a significant correlation between serum level of ALP and the extent of acne (non-inflammatory acne lesions and total acne lesions).

Patients who have undergone partial gastric resection are at an increased risk for the development of cancer and polyps in the gastric remnant, and this risk increases with time following gastrectomy. The prevalence of polypoid change at 15~20 years after surgery is approximately 10%, about four or five times higher as compared to nonoperated one. Hyperplastic polyps are encountered more frequently than adenomatous polyps. Surgical treatment for gastric remnant cancer has been regarded as standard method, but it was reported that endoscopic mucosal resection of early gastric remnant cancer could be performed under strict indication, as the incidence of lymph node metastasis was very low. Recently one adenomatous polyp with focally carcinoma in situ in the gastric remnant was removed by endoscopic mucosal resection in male patient who had undergone Billroth II gastrojejunostomy for gastric ulcer disease 12 years earlier.
Adenomatous Polyps ; Carcinoma in Situ ; Gastrectomy ; Gastric Bypass ; Gastric Stump* ; Gastroenterostomy ; Humans ; Incidence ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Polyps ; Prevalence ; Stomach Ulcer

PURPOSE: The aim of this study was to identify the clinical features and natural history of dietary protein induced proctocolitis (DPIPC) and to detect the causative foods of DPIPC, and to evaluate the effect of elimination of the foods on the course of the disease. METHODS: Between March 2003 and July 2004, data from 30 consecutive patients with DPIPC who were followed for over 6 months, was reviewed. The diagnostic criterion used for DPIPC was an increase in the number of eosinophils in the lamina propria (> or =60 per 10 high-power fields). In breast feeding mothers, 5 highly allergenic foods were eliminated from the maternal diet for 7 days, namely, allergenic food groups such as dairy products, eggs, nuts and soybean, fish and shellfish, and wheat and buckwheat. We observed the disappearance or appearance of hematochezia after elimination or challenge with the offending foods. RESULTS: Before diagnosis infants were breast-fed (93.3%) or formula-fed (6.7%). Mean age at symptom onset was 11.5+/-5.1 (5~24) weeks, and mean age at diagnosis was 17.8+/-9.5 (8~56) weeks. Duration from symptom onset to diagnosis was 6.3+/-6.7 (0~36) weeks. Mean peripheral blood eosinophil count was 478+/-320 (40~1,790)/mm3 and eosinophilia (>250/mm3) was observedin 90.0% of patients. None of patients were found to have an increased serum IgE level. Of 15 patients that received sigmoidoscopy, nodular hyperplasia with erosion was observed in 93.3%. Of 27 patients whose mother ate the diet eliminated the 5 food groups, hematochezia diappeared in 74.1% of patients. Offending foods were identified as dairy products (37.5%), wheat and buckwheat (27.5%), fish and shellfish (20.0%), nuts and soybean (7.5%) and eggs (7.5%). A free maternal diet without patient's clinical symptoms was achieved at 29.4+/-8.7 (9~44) weeks of patient's age, and a free baby diet without blood in stools was achieved at 37.5+/-9.7 (12~56) weeks of age. CONCLUSION: DPIPC commonly occurs in exclusively breast-fed babies. Elimination of the above-mentioned 5 hyper-allergenic food groups from the maternal diet for 7days enables the detection of the offending foods. DPIPC is a transient disorder and 96.0% of patients can tolerate the offending foods at 12 months of age.
Breast Feeding ; Dairy Products ; Diagnosis ; Diet* ; Dietary Proteins* ; Eggs ; Eosinophilia ; Eosinophils ; Fagopyrum ; Gastrointestinal Hemorrhage ; Humans ; Hyperplasia ; Immunoglobulin E ; Infant ; Mothers ; Mucous Membrane ; Natural History* ; Nuts ; Ovum ; Proctocolitis* ; Shellfish ; Sigmoidoscopy ; Soybeans ; Triticum