No abstract available.
Hyperthyroidism*

No abstract available.
Rho(D) Immune Globulin*

OBJECTIVE: The informed consent, in literal sense, is a medicolegal process that requires full explanation and clear disclosure about the illness, and thorough comprehension and autonomous consent to the respective medical services of the competent recipient. The authors review the theoretical background of the informed consent and investigate pertinent problems encountered in medical practice. METHODS: We gathered 153 consecutive cases of written form of the informed consent regarding diagnosis and treatment from Mar 2001 to Jun 2002. The authors evaluate the completeness of the process by looking into the possible omitted components in whole cases and degree of recall for the explained risk by telephone questionnaire in 128 available cases. RESULTS: In a total 153 cohort, 21 emergency operation cases invariably showed structural deficiencies of free-ended discussion due to short of time. Thorough past history taking and physical examination was necessary to perform reoperation for the postoperative hematoma in 3 cases and solid intimate relationship was necessary to treat previously disclosed complication in 7 cases of invasive diagnostic and minimum operative procedures, respectively. Among the available 128 patients, only 33(25%) ones could recall the given risks addressed at the consent approximately 6 weeks later. CONCLUSION: The informed consent is a process that dictates the free dialogue between the patient and the physician, not a simple paper expressed in published characters. However, to enhance the effectiveness of the consent process, both free discussion and writing down contents are prerequisite.
Cohort Studies ; Comprehension ; Diagnosis ; Disclosure ; Emergencies ; Hematoma ; Humans ; Informed Consent ; Physical Examination ; Surveys and Questionnaires ; Reoperation ; Surgical Procedures, Operative ; Telephone ; Writing

Seizure induced transient brain CT or MRI abnormalities following status epilepticus have previously been reported. However, focal transient imaging abnormalities involving hippocampus or mesial temporal lobe as a consequence of seizure are rare findings. We report 2 patients with transient mesial temporal abnormalities on MRI associated with partial seizure of temporal lobe origin. A 59-year-old man with a 4-month history of occasional epigastric rising sensation had developed frequent olfactory hallucination 7 days prior to presentation. On brain MRI, T2 signal was increased in the right mesial temporal region, and the lesion showed mild mass effects and partial enhancement after gadolinium injection. Interictal spikes were noted from right nasopharyngeal electrode, but there was no clinical or electrical evidence of status epilepticus during prolonged scalp/sphenoidal EEG monitoring. His seizures were successfully controlled by phenytoin. T2 high signal was markedly decreased and prior enhancement was no longer seen on brain MRI done 5 weeks later. A 33-year old woman with a 6 month history of occasional vacant staring and oral automatism with amnesia complained progressive memory impairment. Right amygdala and hippocampal head was enlarged and showed T2 high signal without contrast enhancement. EEG with sphenoidal electrodes showed right sphenoidal spikes. Her seizures were controlled by carbamazepine and brain MRI became unremarkable 6 weeks later. Suggested mechanisms and significance of the transient imaging abnormalities following seizures will be briefly reviewed.
Adult ; Amnesia ; Amygdala ; Automatism ; Brain ; Carbamazepine ; Electrodes ; Electroencephalography ; Female ; Gadolinium ; Hallucinations ; Head ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Memory ; Middle Aged ; Phenytoin ; Seizures* ; Sensation ; Status Epilepticus ; Temporal Lobe*

Pulsating exophthalmos, bruit, episcleral venous distention, conjunctival and (eye)lid edema, ophthalmoplegia, and ocular pain have long been regarded as the classic symptoms and signs of idiopathic dural carotid cavernous sinus fistula(CCF). We experienced a 39-year-old woman who presented with headache and cyclovertical diplopia. On neurologic examination, we found isolated left trochlear nerve palsy only. The past medical history was not remarkable. Intracranial magnetic resonance angiography revealed abnormal signals around the carotid siphon on both sides. Conventional angiography confirmed bilateral dural CCFs, leaking predominantly from the left side. Diplopia and headache had improved spontaneously over 3 weeks after the onset. Occasionally, isolated oculomotor or abducens nerve palsy has been reported as the sole clinical finding of symptomatic dural CCF. But isolated trochlear nerve palsy with dural CCF is extremely rare. Although the exact mechanisms of isolated trochlear nerve palsy by dural CCF is unclear, various mechanisms have been proposed, including compression of trochlear nerve by venous congestion or direct shunted flow in cavernous sinus, vascular steel phenomenon, and venous thrombosis.
Abducens Nerve Diseases ; Adult ; Angiography ; Carotid-Cavernous Sinus Fistula* ; Cavernous Sinus ; Diplopia ; Edema ; Exophthalmos ; Female ; Headache ; Humans ; Hyperemia ; Magnetic Resonance Angiography ; Neurologic Examination ; Ophthalmoplegia ; Steel ; Trochlear Nerve Diseases* ; Trochlear Nerve* ; Venous Thrombosis

No abstract available.
Lutein* ; Lymphangioma, Cystic*

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) for decortication or debridement in the management of empyema thoracis has increased the available treatment options but requires validation. We present and evaluate our technique and experience with thoracoscopic management of pleural empyema, irrespective of chronicity. MATERIAL AND METHOD: VATS debridement or decortication was performed with endoscopic shaver system in 40 consecutive patients presented with pleural space infections. A retrospective review was performed and the effect of this technique on perioperative outcome was assessed. RESULT: VATS evacuation of infected pleural fluid and decortication was successfully performed in 35 of 40 patients. The mean duration of preoperative symptoms before referral was 23 +/- 1.8 days. The mean duration of hospitalization before transfer was 13.5 +/- 1.5 days. Blood loss was 250 to 200 mL. Intercostal drainage was required for 5 +/- 3 days. The postoperative hospital stay was 5 +/- 0.7 days. There were no operative mortalities. CONCLUSION: Video-assisted evacuation of infected pleural fluid and decortication is an effective modality in the management of the fibropurulent stage of empyema. An organized empyema should be approached thoracoscopically, but may require open decortication.
Debridement ; Drainage ; Empyema* ; Empyema, Pleural ; Hospitalization ; Humans ; Length of Stay ; Mortality ; Referral and Consultation ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Thoracoscopy

BACKGROUND: Increasing incidences of epilepsy in the elderly are well-known. However, the causes of newly onset seizures in the elderly have rarely been described in Korea. METHODS: We selected 160 cases of individuals who had their first seizure at over the age of 60 (male : female = 1.5 : 1 ; mean age : 69.1 years), who were admitted to Hallym University Hospital from July 1, 1994 to June 31, 1998. We analyzed the etiology, type of seizures, EEG, neuro-imag-ing, morbidity and mortality of the patients. RESULTS: The etiologies of seizures were remote symptomatic in 87 (54.3%), acute symptomatic in 38 (23.8%), progressive encephalopathy in 21 (13.1%), and idiopathic in 14 (8.8%). Status epilepticus occurred in 34 cases, including 8 cases of multifocal myoclonic status after hypoxic brain damage. The most common single cause of seizure was old stroke (35%, infarction in 41 and hemorrhage in 15 cases). Partial seizure was more common in patients with remote symptomatic than with other causes. Newly developed neurological deficits were present in 30 of the 151 who survived, including 15 acute symptomatic, 9 remote symptomatic, and 6 pro-gressive encephalopathy cases. Morbidity and mortality were highest in the acute symptomatic group (P<0.05) and tend to be low in the idiopathic group. CONCLUSIONS: We conclude that newly onset seizures in the elderly requiring hospitalization occur mainly with acute and remote symptomatic neurological insults. Acute symptomatic neurological insults are associated with a significant morbidity and mortality, while the morbidity is low in the absence of any asso-ciated neurological insults.
Aged* ; Electroencephalography ; Epilepsy ; Female ; Hemorrhage ; Hospitalization ; Humans ; Hypoxia, Brain ; Incidence ; Infarction ; Korea ; Mortality ; Seizures* ; Status Epilepticus ; Stroke

PURPOSE: To evaluate the postoperative changes occurring in the patellar tendon after reconstruction of the anterior cruciate ligament (ACL) using the central one-third of the patellar tendon together with patellar and tibial bony plugs. MATERIALS AND METHODS: Ten patients with ACL injury underwent sagittal and coronal T1-weighted MR imaging of both postoperative and normal knee joints. In all cases, reconstruction of the ACL was performed using the central one-third of the patellar tendon, together with patellar and tibial bony plugs. During the follow-up period of 6-27 months, patient were clinically stable. We compared the length, signal intensity and contour of both patellar tendons, as seen on MR images. RESULTS: No defects was found in harvested patellar tendons, and MR images showed high signal intensity within harvested tendons in six of the ten patients. In seven of ten, patellar tendons had irregular margins and were poorly delineated from adjacent tissue. The mean length of patellar tendons was 44.2+/-2.9 mm in normal knee and 43.9+/-3.1mm in postoperative knee, while their mean thickness in postoperative knee, measured at mid-portion, averaged 4.3+/-1.2 mm. There were no statistically significant differences (p>0.05). The greatest mean thickness of patellar tendon was 6.9+/-1.2 mm and 4.3+/-0.5mm in normal and postoperative knee, respectively. Thus, on average, postoperative patellar tendon was 161% thicker than normal tendon (p<0.05). CONCLUSION: In clinically stable patients, patellar tendons after graft harvesting had a higher signal intensity, worse-defined margins and a greater thickness than normal. We suggest that these are the normal postoperative findings.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Autografts* ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Magnetic Resonance Imaging* ; Patellar Ligament* ; Tendons ; Transplants

OBJECTIVES: This study analyzes the effect of electroconvulsive therapy (ECT) by predicting the factors contributing to the effectiveness of ECT and evaluating the persistency of ECT effect in patients with treatment-resistant schizophrenia. METHODS: Using retrospective review of the charts of 24 schizophrenic inpatients who were admitted to Busan Paik Hospital between March 1, 2005 and December 31, 2009. We compared the pre-ECT Clinical Global Impression (CGI) scores and post-ECT CGI scores among these patients. We evaluated the differences in the ECT responses by sex, age, duration of illness and dose of antipsychotic agents, and investigated the rate of continuation of out-patient treatment and readmission, and the change of the CGI score for 12 months after the ECT. RESULTS: ECT resulted in an overall clinical improvement as measured on the CGI scale. 15 (62.50%) patients were good responders, while 9 (37.50%) were poor responders. There was no significant difference between sex, age, duration of the illness, and dose of antipsychotics taken by the patient before the ECT. 21 (87.50%) patients continuously visited the outpatient department for 12 month, and 14 (66.67%) of them maintained the ECT effect with medical treatment only and without readmission. CONCLUSION: This study showed that the ECT could be a useful treatment option for schizophrenic patients who are resistant to antipsychotics.
Antipsychotic Agents ; Electroconvulsive Therapy ; Humans ; Inpatients ; Outpatients ; Retrospective Studies ; Schizophrenia