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*

We report here on a case of a recurrent left anterior neck infection and focal left suppurative thyroiditis that were associated with a congenital pyriform sinus fistula (PSF) in an 18-year-old male. Acute suppurative thyroidits is a very rare clinical condition and it is usually caused by infection that's derived from infected perithyroidal tissue or a congenital internal fistula. The PSF can lead to recurrent episodes of neck inflammation and abscess, and it is the most common cause of acute suppurative thyroiditis in young man. In this current case, the CT scan showed an air-containing tract of a PSF from the left pyriform sinus to the left thyroid gland and the perithyroidal soft tissue. The CT scan also showed a neck inflammatory infiltration or abscess along the course of the sinus tract. The focal low density of the thyroid parenchyma was seen and this was suggestive of suppurative thyroiditis. Barium esophagography demonstrated the fistulous tract in the PSF. We performed laryngoscopy, and the internal opening of the pyriform sinus fistula was successfully cauterized with AgNO3 and the post procedure course was fair. When an air-containing tract and a recurrent inflammatory infiltration or abscess are present at the left anterior neck with including the thyroid and perithyroidal soft tissue, a PSF should be strongly suspected.
Abscess ; Adolescent ; Barium ; Fistula* ; Humans ; Inflammation ; Laryngoscopy ; Male ; Neck ; Pyriform Sinus* ; Soft Tissue Infections* ; Thyroid Gland* ; Thyroiditis ; Thyroiditis, Suppurative ; Tomography, X-Ray Computed

BACKGROUND/AIMS: With the development of self-expanding metallic stents, colonic obstruction can be relieved without the need for surgery. The results of preoperative placement of stents for malignant colorectal obstruction might be different according to the obstructing lesion. The objective of this study was to compare clinical improvement rates and operative results after preoperative placement of stents for malignant colorectal obstruction according to the location of the obstructing lesion. METHODS: This is a retrospective study including 57 patients who underwent self-expanding metallic stent insertion for obstructing resectable colorectal cancers. Patients were classified into three groups according to the location of the lesion as follows: proximal to the sigmoid colon (Group A), sigmoid colon (Group B), and rectum (Group C). RESULTS: The number of patients in A, B, and C groups was 13, 22, and 22, respectively. No significant differences in age, gender, stent type, and accompanying diseases among the three groups were observed. There were no significant differences in stent-related complications, clinical improvement rates, and one-stage resection rates among the three groups. The postoperative complications, the requirement rate of ICU care, the period of ICU stay, postoperative hospital stay, and hospital mortality did not significantly differ among the three groups. CONCLUSIONS: Clinical improvement rates and operative results after successful placement of stents for obstructing resectable colorectal cancers are not different according to the location of the obstructing lesion, suggesting that preoperative stenting for one-stage curative resection is useful, irrespective of the location of lesion.
Aged ; Aged, 80 and over ; Colorectal Neoplasms/*diagnosis/surgery ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; Intestinal Obstruction/*surgery ; Length of Stay ; Male ; Middle Aged ; Preoperative Care ; Retrospective Studies ; *Stents

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

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