The purpose of this study was to evaluate the histologic difference that occured after trichloroacetic acid(TCA) chemical peel in an animal model that was pretreated with Tretinoin alone or Tretinoin-based combined pretreatment kit. Eight Hartley white guinea pigs were used in our study. The dorsal skin of the guinea pigs was divided into six equal squares(2x2 cm). Upper two areas of these six were not pretreated, middle two areas were pretreated for 4 weeks with Tretinoin alone and lower two areas were pretreated for 4 weeks with Tretinoin-based combined kit. Each guinea pig underwent chemical peel with 50% TCA. The wounded areas were biopsied at post-peeling 3 weeks and 6 weeks. The histology revealed that those animals pretreated with combined kit healed quicker than the animals pretreated with Tretinoin alone. This study implies that if patients are treated with Tretinoin-based-combined pretreatment kit before undergoing chemical peel, the pretreatment time will be shortened.
Animals ; Guinea Pigs* ; Guinea* ; Humans ; Models, Animal ; Skin ; Tretinoin* ; Wounds and Injuries

No abstract available.
Fetal Blood* ; Umbilical Cord*

BACKGROUND: The changes of cerebral hemodynamics during syncope have not been fully evaluated. We investigated the changes in the cerebral blood flow velocity during head-up tilt test (HUT) using transcranial Doppler ultrasonogra-phy (TCD) in patients with neurocardiogenic syncope or presyncope. METHODS: Thirty-three patients with a history of recurrent syncope or presyncope of unknown origin were evaluated using HUT for 30 minutes (baseline tilt test), fol-lowed by an infusion of intravenous isoproterenol if needed. Systolic (SV) and diastolic velocities (DV) of middle cere-bral artery were continuously monitored by TCD. Positive responses were defined as presyncope or syncope with hypotension, bradycardia, or both. RESULTS: Five patients had positive responses during baseline tilt and 14 patients dur-ing the isoproterenol infusion. During the baseline tilt test, there was a 86 +/- 23% drop in DV and a 41 +/- 34% drop in SV in patients with positive responses, and mean changes in those were less than 10% in patients with negative responses (p=.00, p=.00). During the HUT with an isoproterenol infusion, the TCD showed an 80 +/- 18% drop in diastolic velocity in patients with positive responses, and a 47 +/- 10% drop in patients with negative responses (p=.00), However, the change in systolic velocity did not differ. TCD showed three patterns during positive responses: loss of all flow, loss of end-diastolic flow, and a decrease in diastolic velocity. Loss of consciousness occurred in patients with loss of all flow or end-diastolic flow during positive responses. CONCLUSIONS: TCD shows different patterns of changes in cerebral hemody-namics during HUT. TCD can be used to investigate the pathophysiology of neurocardiogenic syncope.
Arteries ; Blood Flow Velocity ; Bradycardia ; Hemodynamics ; Humans ; Hypotension ; Isoproterenol ; Syncope* ; Syncope, Vasovagal ; Ultrasonography, Doppler, Transcranial ; Unconsciousness

OBJECTIVE: There are various posterior fusion techniques in managing C1-2 instability. The aim of this study is to evaluate surgical techniques and clinical results including complications of the C1 lateral mass and C2 pedicle screw fixation (C1-2 LMPSF) in atlantoaxial disorders. METHODS: From February 1997 to July 2008, 24 patients were performed C1-2 LMPSF due to C1-2 instability. Pathway of vertebral artery was classified into three groups by 3D-angiogram. Diameter of C1 lateral mass and C2 isthmus on the plain X-ray and CT was measured before operation. Surgical method was divided into four groups according to fixation site (bilateral or unilateral) and bone graft (with or without graft). Stability of C1-2 fixation was postoperatively evaluated by flexion and extension cervical lateral films. We reviewed clinical data, imaging studies and old chart retrospectively as sources for analysis. RESULTS: Among 24 patients, os odontoideum was the most common cause (16 out of 24). Four patients had anomalous vertebral artery. Mean diameters of C1 lateral mass was 9.9(range 4.2~16.4) mm at right side, 10.3 (range 3.4~14.2) mm at left side. Mean diameter of C2 isthmus was 5.8 (range 1.0~10.1) mm at right side and 5.8(range 2.1~8.2) mm at left side. Two patients showed very narrow C2 isthmus. As a result, unilateral C1-2 LMPSF was performed on 6 patients (4 for anomalous vertebral arteries and 2 for narrow C2 isthmus). 12 of 18 patients were with C1-2 interlaminar bone graft and 6 patients without bone graft. All patients showed stable C1-2 fixation by flexion and extension cervical lateral X-ray films taken at least 6 months after surgery. Five out of 8 patients who had preoperative radiculopathy only showed improved symptoms. However, Seven out of 8 patients who had myelopathy showed little neurological improvement . CONCLUSION: For C1-2 LMPSF, preoperative 3D CT-angiogram study is mandatory to identify abnormal vertebral artery and narrow C2 isthmus. Bilateral C1-2 LMPSF without bone graft is enough to obtain stable C1-2 fixation. If there is an abnormal vertebral artery or narrow C2 isthmus, unilateral C1-2 LMPSF with bone graft and wiring is alternative successful method.
Humans ; Radiculopathy ; Retrospective Studies ; Spinal Cord Diseases ; Transplants ; Vertebral Artery ; X-Ray Film

BACKGROUND/AIMS: The development of effective, accurate, and rapid diagnostic methods for Mycobacterium infection and mycobacterial species identification is required. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) is an easy, rapid and inexpensive technique for identifying Mycobacterium spp. METHODS: We performed PCR-RFLP to detect and identify Mycobacterium spp. from 10 sterile body fluids, including ascites, cerebrospinal fluid, pleural fluid, synovial fluid, and peritoneal dialysis fluid. Clinical samples were collected from patients with diagnoses of definite, probable or suspected mycobacterial infection. The conserved RNA polymerase genes of Mycobacterium spp. were amplified by PCR. RESULTS: The amplified 360-bp region of rpoB was digested with the restriction enzyme MspI or HaeIII. The PCRRFLP results for the clinical samples were identical to those for M. tuberculosis, M. fortuitum, M. intracellulare, and M. avium. In addition, the results of the PCR-RFLP were identical to those obtained by DNA sequencing. CONCLUSIONS: PCR-RFLP analysis of sterile body fluids may be a useful method for the diagnosis of mycobacterial infections and for the differentiation of mycobacterial species.
*Amplified Fragment Length Polymorphism Analysis ; Bacterial Proteins/*genetics ; *Bacterial Typing Techniques ; Body Fluids/*microbiology ; DNA, Bacterial/*analysis ; DNA-Directed RNA Polymerases/*genetics ; Humans ; Mycobacterium/*classification/genetics ; Mycobacterium Infections/*diagnosis/microbiology ; *Polymorphism, Restriction Fragment Length

OBJECTIVE: Jumping from high place for the purpose of suicide results in various damages to body area. A burst fracture of vertebrae is representative of them and we reviewed eight patients who were diagnosed with spinal burst fracture following suicide falling-down. The demographics, characteristics, performed operation, combined injuries, psychological past histories of the patients were analyzed. METHODS: A retrospective study was made of patients who are diagnosed with vertebral burst fracture from falling-down with the purpose of suicide admitted to department of neurosurgery of the author's hospital, covering the period between 2003 and 2012. RESULTS: Total eight patients were suicidal jumper. There were eleven vertebral burst fractures in eight patients and mean age was 26.5 years old. Seven patients already had psychological past history and there were various combined injuries except vertebrae burst fracture. The ankle fracture such as calcaneus, talus, navicular and malleolus was the most common injury and there were also various combined injury. CONCLUSION: Suicidal jumper is different from incidental faller in some aspects because of different injury mechanism. For managing suicidal jumper, physician had to consider patients' age, affected site, psychiatric problem and combined injuries. Each department related to the injuries of patient have to cooperate each other with departments of psychiatry and rehabilitation from beginning to end.
Ankle Fractures ; Calcaneus ; Demography ; Humans ; Neurosurgery ; Rehabilitation ; Retrospective Studies ; Spinal Fractures ; Spine ; Suicide ; Suicide, Attempted* ; Talus

PURPOSE: This study was performed for the purpose of finding causative organisms and clinical features of septic arthritis or acute osteomyelitis in children. METHODS: The study involved a retrospective review of the medical records of 63 microbiologically confirmed cases of acute pyogenic arthritis and osteomyelitis. All of the cases were brought about by community-associated infections and managed at the Seoul National University Children's Hospital or Seoul National University Bundang Hospital from June 2003 to July 2009. RESULTS: The median age of all cases was 60 months and there were 35 males and 28 females. Major involved joints included the hip joint (15 cases), knee joint (7 cases), shoulder joint (4 cases), and elbow joint (4 cases). Also, major involved bones included the femur (20 cases), tibia (13 cases), humerus (7 cases), and radius (7 cases). Staphylococcus aureus was the most commonly identified causative organism, accounting for 49 cases (77.8%). Of the 49 isolates of S. aureus, methicillin-resistant S. aureus (MRSA) accounted for 8 cases (16.3%). Group B streptococcus spp. (GBS) and Salmonella spp. accounted for 3 cases, respectively. Nafcillin or cefazolin was often prescribed as an initial empirical antibiotic. There were 9 cases that were managed by a regimen that included vancomycin as the first choice. Fifty four cases (85.7%) recovered without any complications. Methicillin-sensitive S. aureus (MSSA), responsible for 41 cases, caused chronic complications in 3 cases. Of 8 cases caused by MRSA, 1 case showed chronic complication. There were no fatal cases. CONCLUSION: S. aureus remains the most common organism causing acute pyogenic arthritis and osteomyelitis of childhood acquired in the community. The high prevalence of methicillin resistance among S. aureus should be considered carefully in the selection of initial empirical antibiotics.
Accounting ; Anti-Bacterial Agents ; Arthritis ; Arthritis, Infectious ; Cefazolin ; Child ; Elbow Joint ; Female ; Femur ; Hip Joint ; Humans ; Humerus ; Joints ; Knee Joint ; Male ; Medical Records ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Nafcillin ; Osteoarthritis ; Osteomyelitis ; Prevalence ; Radius ; Retrospective Studies ; Salmonella ; Shoulder Joint ; Staphylococcus aureus ; Streptococcus ; Tibia ; Vancomycin

BACKGROUND: Pneumocystis carinii pneumonia (PCP) is one of the most common cause of infection in patients with HIV infection. Recently, the incidence of PCP have been increasing in immunocompromised hosts without HIV infection. We compared the clinical characteristics of PCP between HIV infected and non-infected persons. PATIENTS AND METHODS: We retrospectively reviewed the charts of 25 patients diagnosed as PCP from 1996 to 2002. Age, sex, underlying conditions, use of immunosuppressants, clinical courses, laboratory findings, treatment and prognosis were compared between HIV infected and non-infected persons. RESULTS: Twenty-five patients with PCP were identified. 16 were HIV infected, and 9 were HIV non-infected. The mean age of overall patients was 43.4+/-13.2 years. Underlying conditions in HIV non-infected persons were hematologic malignancy (7 cases), solid organ transplant (1 case), and autoimmune disease (1 case). Seven cases (77.8%) of HIV non-infected persons had a history of steroid use. Mean duration of symptoms was longer in HIV infected persons than in HIV non-infected persons, but it was not statistically significant. PaO2 was lower in HIV infected persons (61.2+/-16.9 mmHg vs.65.4+/-15.4), but it was not statistically significant. Chest X ray showed typical ground glass opacity in 12 cases (75%) of HIV infected persons and in 4 cases (44.4%) of HIV non-infected persons. Twelve cases (75%) of HIV infected persons were treated with steroid, as were 6 cases (66.7%) of HIV non-infected persons. Ventilator care was needed in 6 cases (37.5%) of HIV infected persons and in 2 cases (22.2%) of HIV non-infected persons. Mortality of HIV infected persons was 50%, and that of HIV non-infected persons was 11.1%. CONCLUSIONS: PCP showed some different clinical characteristics between HIV infected and non-infected persons. Prospective studies regarding the risk factors of PCP, prophylaxis, treatment and prognosis in HIV infected and non-infected persons are warranted.
Autoimmune Diseases ; Glass ; Hematologic Neoplasms ; HIV Infections ; HIV* ; Humans ; Immunocompromised Host ; Immunosuppressive Agents ; Incidence ; Mortality ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia, Pneumocystis* ; Prognosis ; Retrospective Studies ; Risk Factors ; Thorax ; Transplants ; Ventilators, Mechanical

In Korea, as the prevalence of acquired immune deficiency syndrome (AIDS) increases, various opportunistic infections are becoming a problem. Progressive multifocal leukoencephalopathy (PML) is postulated to be associated with impaired cellular immunity and can be more frequently encountered these days primarily due to increasing incidence of AIDS. Neurologic deficits and brain imaging study together strongly suggest PML, but confirmatory diagnosis can be made only by cerebrospinal fluid study or tissue biopsy. In Korea few cases of confirmed PML in AIDS patients have been reported, and herein we offer our experience of a case of PML who underwent brain biopsy for confirmative diagnosis.
Acquired Immunodeficiency Syndrome* ; Biopsy ; Brain ; Cerebrospinal Fluid ; Diagnosis ; HIV ; Humans ; Immunity, Cellular ; Incidence ; Korea ; Leukoencephalopathy, Progressive Multifocal* ; Neuroimaging ; Neurologic Manifestations ; Opportunistic Infections ; Prevalence

BACKGROUND: Brain abscess is a important infectious disease of the central nervous system, although the mortality has been reduced due to new antibiotics therapy and improved imaging techniques. MATERIALS amp; METHODS: Over a period of 17 years, from March 1986 to Feburary 2003, 110 patients were identified as having brain abscess at the Severance Hospital. Based on medical records, we reviewed these cases and investigated retrospectively the epidemiology, clinical findings, therapeutic modalities and prognostic factors of brain abscess. RESULTS: There were 78 males and 32 females, and the mean age was 34.4 years. The most common location of brain abscess was the parietal lobe (24.5%), followed by temporal (20.9%) and frontal lobes (20.0%). Gram positive cocci were most frequently isolated as the causative microorganism. Tuberculous brain abscess were diagnosed in 6 (8.8%) cases. The common predisposing conditions were neurosurgery (21.8%), otitis media (10%) and congenital heart disease (8.2%). Headache (63.6%), fever (55.5%) and focal neurologic deficits (51.8%) were the common symptoms. Aspiration or open drainage was performed in 77 cases (70.0%), and excision was performed in 17 cases(15.5%). Thirty five (31.9%) patients had neurologic sequelae after treatment, and the mortality rate was 11.8%. Factors influencing mortality of brain abscess were mental status and multiple abscesses. CONCLUSION: Brain abscess is still a critical infectious disease of the central nervous system with high mortality and morbidity in Korea. Active surgical procedures including aspiration, open drainage or excision, as well as antibiotic therapy, are needed for the proper management.
Abscess ; Anti-Bacterial Agents ; Brain Abscess* ; Brain* ; Central Nervous System ; Communicable Diseases ; Drainage ; Epidemiology ; Female ; Fever ; Frontal Lobe ; Gram-Positive Cocci ; Headache ; Heart Defects, Congenital ; Humans ; Korea ; Male ; Medical Records ; Mortality ; Neurologic Manifestations ; Neurosurgery ; Otitis Media ; Parietal Lobe ; Retrospective Studies