Objective: Peripheral arterial disease (PAD) reduces functional activity and increases the rate of cardiovascular death in the elderly. Our study aimed to determine whether the presence of PAD in stroke patients affected the progression of disability or death one year after discharge. Methods: From April 2012 to March 2013, consecutive first stroke patients above 50 years of age without known PAD were enrolled. PAD was defined as a low ankle-brachial index (less than 0.9) measured by an automatic device. Clinical data associated with the stroke were collected from medical records. Disability in stroke patients was evaluated with the modified Rankin scale (mRS) on discharge day and one year after the index stroke. Progression of disability was defined as an increase in mRS more than one level at one year. Results: Among the 526 patients, 238 had ischemic strokes and underwent ankle-brachial index (ABI) measurement. Of them, 192 patients were included. In univariate analysis, age, dyslipidemia, discharge mRS, low-density lipoprotein cholesterol, D-dimer, homocysteine, internal carotid artery stenosis, posterior cerebral artery stenosis, and PAD were factors associated with worsening mRS. After adjustment for these factors in the logistic regression analysis, PAD was an independent factor associated with worsening mRS. In the analysis of one-year mortality, patients with PAD had a higher death rate, but PAD was not an independent factor after adjusting for other variables. Conclusions: The presence of PAD in stroke patients suggests a chance of disability progression, but may not be a predictor of death after one year.
Atherosclerosis ; Peripheral arterial disease ; Stroke

Thoracic disc herniation is an uncommon cause of thoracic cord compression. Herniation in this region is of particular importance because of the serious disorders of nervous function which result from anterior compresstion of the spinal cord. Early diagnosis and prompt surgical treatment are imperative because of the progressive and serious neurological deficit which results from delay. Numerous problems remain as to the safest surgical approach to the prolapsed thoracic intervertebral disc. We treated a case of herniated intervertebral disc occuring at Tll–T12 using the anterior approach. The result was favourable.
Early Diagnosis ; Intervertebral Disc ; Spinal Cord

The aims of treatment of children with CDH untreated until walking age should be to reestablish the mechanics of the hip joint and avoid complications, especially avascular necosis, thus delaying the devlopment of osteoarthritis. In the child who is first seen between the ages of one and three years, considerable controversy still exists as to the merit of closed versus operative management. The average 29.3 months follow-up results in fifty congenitally dislocated hips in forty-five children with were between six and thirty-six months old when treatment was begun have been reviewed at the Department of Orthopaedic Surgery, In Je University, College of Medicine, Paik Hospital from June, 1979 to Aug, 1989. The results of this study were as follows: 1. Factors affecting method of treatment were age, degree of dislocation and acetabular index; A. Age 1) The children below ages of 18 months were treatment by closed reduction. 2) The children below ages of 18 months were treatment by open reduction with concomittant procedures. B. Degree of dislocation: Open reduction was more frequently reguired in higher degree of dislocation. C. Acetabular index: It was little influenced on method of treatment. 2. The complications were persisten subuxation (3 cases), temporary irregular ossification (16 cases) and avascular necrosis (1 cases).
Acetabulum ; Child ; Dislocations ; Follow-Up Studies ; Hip ; Hip Joint ; Humans ; Mechanics ; Methods ; Necrosis ; Osteoarthritis ; Walking

The methanol extract from the leaves of Petasites japonicus Maxim (PJ) was studied for its (anti-)mutagenic effect with the SOS chromotest and reverse mutation assay. The (anti-)carcinogenic effects were evaluated by the cytotoxicity on human cancer line cells and by the function and the expression of gap junctions in rat liver epithelial cell. PJ extracts significantly decreased spontaneous beta-galactosidase activity and beta-galactosidase activity induced by a mutagen, ICR, in Salmonella (S.) typhimurium TA 1535/pSK 1002. All doses of the extract (0.08-100 mg/plate) decreased the reversion frequency induced by benzo (alpha)pyrene (BaP) in S. typhimurium TA 98. It decreased not only the spontaneous reversion frequency but also that induced by BaP in S. typhimurium TA 100. PJ extract showed greater cytotoxic effects on human stomach, colon and uterus cancer cells than on other cancer cell types and normal rat liver epithelial cells. Dye transfers though gap junctions were significantly increased by PJ extracts at concentrations greater than 200 microg/mL and the inhibition of dye transfer by 12-O-tetradecanoylphorobol-13-acetate (TPA) was obstructed in all concentrations of PJ. PJ significantly increased the numbers of gap junction protein connexin 43, and increased the protein expression decreased by TPA in a dose-dependent manner. Based on these findings, PJ is suggested to contain antimutagenic and anticarcionogenic compounds.
Animals ; Cell Line, Tumor ; Cell Survival/*drug effects ; Formazans/chemistry ; Gap Junctions/*metabolism ; Humans ; Mutagenicity Tests ; Petasites/*metabolism ; Plant Extracts/*pharmacology ; Plant Leaves/metabolism ; Rats ; Tetrazolium Salts/chemistry

In Korea, there are four types of snakes, Glyoidius brevicaudus, G. intermedius (formerly named, saxatilis), G. ussuriensis, Rhabdophis tigrinus. The case-fatality rate in snake bite envenomation is very low. Snake venom is a heterogeneous mixture of pharmacologically active enzymatic, non-enzymatic protein, peptide toxins, other organic and inorganic substances. The pathophysiology evokes a complex series of events that depend on the combined and synergistic action of toxic and non-toxic components. The manifestation includes local and systemic effects. Local tissue effects includes of tissue pain, redness, swelling, tenderness, bullae formation, and necrosis. The major systemic manifestations of snake bite include neurotoxicity, myotoxicity, cytotoxicity, hemolytic, procoagulant, hemorrhagic, and hypotensive effects and interfere in platelet function. General care includes parenteral analgesia, antivenom administration, and serial assessments of limb swelling and laboratory tests. Despite the presence of soft tissue inflammation, prophylactic antibiotics are rarely required, and most patients achieve good outcomes with supportive care and antivenom alone. In the case of mild poisoning do not need to be treated with antivenom. In moderate to severe envenomation, antivenom should be administered. When administered antivenom, adverse reactions are monitored closely and treated early with epinephrine and anti-histamine. In future, we should establish algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy.
Analgesia ; Anti-Bacterial Agents ; Blood Platelets ; Epinephrine ; Extremities ; Humans ; Inflammation ; Korea* ; Necrosis ; Nociceptive Pain ; Poisoning ; Snake Bites* ; Snake Venoms ; Snakes* ; Venoms

Four cases of intracerebral hemorrhage remote from the site of initial supratentorial craniotomy are presented. Traumatic cases are excluded in this report and all cases developed after uneventful elective craniotomy. Two patients had ruptured aneurysm and the other two had giant supratentorial tumors, one craniophayrngioma and one ependymoma. All patients were operated on supine position and no patient had preoperative hypertension. Two had hematoma in the sucortical white matter, one in the cerebellar hemisphere and the other one showed hematoma both in the cerebellar hemisphere and the supratentorial subcortical area. The size of hematoma ranged from 8-20cc in volume. No definite cause could be found except one in which the blood pressure was transiently elevated during induction of anesthesia. A possible cause might be the sudden changes of blood pressure during induction and recovery from anesthesia, overdrainage of CSF, continuous CSF drainage and sudden changes in intracranial dynamics by removal of a huge intracranial mass. One patient with intracerebellar hemorrhage needed emergency suboccipital craniectomy for removal of the hematoma. One patient shows no improvement due to aspiration pneumonia and subsequent lung abscess. Although rare, these conditions may occur after any craniotomy and surgeons should always be alert to the possibilities of such comlication, especially when intracranial pressure(ICP) was elevated.
Anesthesia ; Aneurysm, Ruptured ; Blood Pressure ; Cerebral Hemorrhage ; Craniotomy ; Drainage ; Emergencies ; Ependymoma ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Lung Abscess ; Pneumonia, Aspiration ; Supine Position ; Supratentorial Neoplasms

PURPOSE: The aim of this study was to clarify the clinicopathological differences between T1N1M0 and T2N0M0, particularly the survival rates, and the role of chemotherapy in the stage Ib gastric cancer. METHODS: From January 1992 to December 1999, 118 cases were confirmed as having stage Ib gastric cancer in the Korea University Medical Center. Among them 31 patients were classified as being T1N1M0 and the other 87 cases were T2N0M0. The clinicopathological features and the prognosis were evaluated retrospectively. RESULTS: The overall 5-year survival rate of the stage Ib gastric cancer patients was 94%. Overall 5-year survival rates in T1N1M0 and T2N0M0 were 100% and 91%, respectively. Though T1N1M0 group showed better prognosis, there was no significant difference between two groups (P=0.14). D1, D2, and D2+alpha resections were performed in 28 cases (23.7%), 81 (68.6%), and 9 (7.6%), respectively, and there was no difference in the survival rate (P>0.05). The 5-year survival rates were analyzed according to whether or not they had received chemotherapy. There was a 98% 5-year survival rate with those who had chemotherapy and a 90% 5-year survival rate with those who had not had chemotherapy, but there was no significant difference between them (P=0.18). In the T2N0M0 group, the 5 year survival rates of patients with or without chemotherapy were 97% and 86%, respectively, but there was no significant difference (P=0.16). CONCLUSION: Though T1N1M0 group showed a better prognosis than the T2N0M0 group, there was no significant difference between the two groups (P=0.14). There was no significant survival difference between D1, D2, or D2+alpha procedures. It appears that post operative intravenous chemotherapy does not affect the prognosis of stage Ib gastric cancer, and the role of the chemotherapy in patients with T2N0M0 diseases is minimal.
Academic Medical Centers ; Drug Therapy ; Humans ; Korea ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

PURPOSE: To evaluate the effectiveness of intravitreous injection of Vancomycin and Amikacin in exogenous endophthalmitis (before culture results are obtained), and the relationship between such empirical therapy and results of culture, susceptibilities of cultured organism to antibiotics, and visual prognosis. METHODS: The authors conducted a retrospective study of 23 patients (23 eyes) who had been treated for endophthalmitis between May 1996 and November 2000. RESULTS: The final vision was 0.15 and better in 18 eyes out of 23 eyes, and 5 eyes reported vision worse than 0.1. Endophthalmitis was associated with cataract surgery in 15 eyes, ocular traumja in 7 eyes, filtration surgery in 1 eye. Eyes with posttraumatic endophthalmitis had worse visual prognosis. When smear and culture was performed, 14 out of 23 eyes were tested positive, and all the obtained microorganisms showed sensitivity to vancomycin and amikacin. The results were similar between Gram positive and negative bacteria. When the onset of symptoms was within 1 week after intraocular operation, and when the patients with ocular trauma reported to the hospital within two days, the prognosis was relatively better. The use of intravitreous antibiotics alone yielded similar results compared to the use of combined systemic antibiotics. Two out of 5 eyes which underwent vitrectomy and 16 out of 18 eyes which did not undergo vitrectomy reported final vision of 0.15 or better. CONCLUSIONS: When endophthalmitis is suspected, one should immediately perform diagnostic workup and the patient is immediately given intravitreous injection of vancomycin and amikacin. When smear and culture results are obtained later on, one can modify and improve the treatment modalities in an attempt to improve visual prognosis.
Amikacin ; Anti-Bacterial Agents ; Bacteria ; Cataract ; Endophthalmitis* ; Filtering Surgery ; Humans ; Prognosis ; Retrospective Studies ; Vancomycin ; Vitrectomy

The incidence of traumatic rupture of the tracheobronchial tree has been increased considerably with advent of widespread mechanization and high speed era. Rupture of the bronchus is an unusual result of nonpenetrating trauma to chest. Early diagnosis and primary repair not only restore normal lung function but also avoid difficulties and complications associated with delayed diagnosis and repair. These complications are pneumonia, atelectasis and lung abscess secondary to the bronchial obtruction. We experienced a case of partial rupture on left main bronchus caused by nonpenetrating blunt chest trauma with rib fractures 1 year ago. He was suffered from progressively developing dyspnea on exercise and treated as bronchial asthma at other hospital. Bronchoscopic finding was the narrowed lumen of left main bronchus at 1cm from carina by web-like membrane. We confirmed by bronchogram and repaired by end to end anastomosis, which is rare delayed finding in bronchial rupture without pulmonary complications. We report a case of nonpenetrating traumatic bronchial rupture, manifested by bronchial web in bronchoscopy.
Asthma ; Bronchi ; Bronchoscopy* ; Delayed Diagnosis ; Dyspnea ; Early Diagnosis ; Incidence ; Lung ; Lung Abscess ; Membranes ; Pneumonia ; Pulmonary Atelectasis ; Rib Fractures ; Rupture* ; Thorax* ; Trees

BACKGROUND: Using hypobaric local anesthetics, patients undergoing total hip replacement surgery (THR) can be anesthetized in the lateral decubitus position with operative side up, and do not need to be repositioned for operation. This can save preparation time and inadvertent change of anesthetic level due to position change. Number of studies have examined the use of hypobaric local anesthetics for THR, but the main focus of the studies was to compare the effect of various drugs or baricities, rather than adequate dosages. Therefore, we aimed to determine adequate dosages of hypobaric tetracaine for THR. METHODS: Sixty patients were randomly allocated into three groups. Spinal anesthesia was performed in the lateral decubitus position with the operated side uppermost using 0.2% tetracaine diluted with distilled water, 10, 12, or 14 mg was administered into the subarachnoid space. RESULTS: Time to T10 block, the level of maximal sensory and motor block, and the incidence of hypotension were no different in the three dosage groups. The number of patients who showed adequate anesthesia (more than T10 and modified Bromage scale 2) were no different. Duration of sensory block and the time to complete motor recovery increased with dosage. The number of patients with less than a 2 hour sensory block was higher in the 10 mg group (50%) than in the two other groups (10% in 12 microgram, 0% in 14 microgram). CONCLUSIONS: 10 mg of hyperbaric tetracaine was not enough, and 14 mg adequate for a hip surgery of 2 hour duration. The two doses were similar in terms of the sensory and motor block level and the incidence of hypotension.
Anesthesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Arthroplasty, Replacement, Hip* ; Hip ; Humans ; Hypotension ; Incidence ; Subarachnoid Space ; Tetracaine* ; Water