Posterior Reversible Encephalopathy Syndrome(PRES) mainly develops in patients under immunosuppressive therapy after transplantation, or patients who suffer hemato-oncologic diseases, eclampsia, acute hypertensive encephalopathy related with nephrotic disease. Sudden headache, nausea, mental derangement, convulsion, vision problems are the main symptoms shown in PRES. It typically shows edema of occipito-parietal area of cortex or subcortex in Magnetic Resonance Imaging(MRI). A 10-year-old male was hospitalized with the chief complaint of headache, vomiting and dizziness for 3 days. He was treated for upper respiratory infection for 1 week before the hospitalization. Initial blood pressure was 145/95 mmHg, which was high for his age. Uninalysis showed microscopic hematuria(3+). The hypertension persisted even after the hospitalization, and re-checked blood pressure was 175/115 mmHg. The patient complained of headache, and after that, he suffered from alteration of mental status with dysarthria and generalized type of seizure events. The MRI showed lesions suggestive of PRES. He recovered to alertmental status after the blood pressure was controlled. Antistreptolysin-O(ASO) titer was increased and complement 3(C3) titer was decreased. The follow up MRI taken 1 month after the event became normal. We report a case of PRES related with contemporary hypertensive event in Acute Post-Streptococcal Glomerulonephritis(APSGN).
Blood Pressure ; Child ; Complement System Proteins ; Dizziness ; Dysarthria ; Eclampsia ; Edema ; Female ; Follow-Up Studies ; Glomerulonephritis ; Headache ; Hospitalization ; Humans ; Hypertension ; Hypertensive Encephalopathy ; Magnetic Resonance Spectroscopy ; Male ; Nausea ; Posterior Leukoencephalopathy Syndrome ; Pregnancy ; Seizures ; Transplants ; Vision, Ocular ; Vomiting

PURPOSE: Liver cell damage after ischemia and reperfusion injury has been a major cause of death after liver surgery. Yet there have been no exact and practical guidelines for assessing liver cell damage after ischemia and reperfusion injury. The aim of this study was to estimate the liver cell viability after ischemia and reperfusion injury. METHODS: A 70% partial liver occlusion model with employing Spraque Dawley Rats was used. The ATP content of the liver tissue, the palmitic acid metabolic rate and the histologic change (H/E, TUNEL stain) were all measured at 30 minute intervals to assess liver cell viability during 120 minutes of ischemia. At 24 hours reperfusion after 30, 60 and 120 minutes ischemia, the same parameters and the AST/ALT level in the blood were measured. RESULTS: The ATP content was decreased below 20% compared to normal liver after ischemia, but there were no significant changes in the histology and the palmitic acid metabolic rate during 120 minutes ischemia. At 24 hours reperfusion after 30, 60 and 120 minutes ischemia, the ATP content was decreased to around 50% in all the groups and the palmitic acid metabolic rate was decreased 90.9+/-2.4%, 80.0+/-5.3% and 79.1+/-7.7%, respectively, compared to the control liver. But histologic change was not as great as the change in the ATP content and the palmitic acid metabolic rate. CONCLUSION: Judging by these results, liver has relatively good tolerance during ischemia, but after reperfusion, the liver showed damage depending on the duration of ischemia. This study might be very helpful as a guide line of liver damage after ischemia and reperfusion in both clinical practice and basic research.
Adenosine Triphosphate ; Animals ; Cause of Death ; Cell Survival* ; In Situ Nick-End Labeling ; Ischemia* ; Liver* ; Palmitic Acid ; Rats* ; Reperfusion Injury* ; Reperfusion*

No abstract available.
Blood-Brain Barrier* ; Brain Concussion*

No abstract available.
Blood-Brain Barrier* ; Brain Concussion*

PURPOSE: The existing triage systems for trauma at prehospital field sites have limitations when applied to various nontraumatic conditions at hospitals and show disagreement in inter- or intra-rater assessments. The purpose of study was to develop a simple and objective triage tool which could be applied to both traumatic and non-traumatic patients and would reduce the rate of disagreement in inter- or intra-rater assessments by using a computerized system. METHODS: A prospective study was designed to evaluate the characteristics and the outcomes of patients who visited Korea University Emergency Medical Center between April 1 and May 31, 2002. The observed parameters were age, sex, AVPU scale, mode of visit, and vital signs including blood pressure, pulse rate, respiratory rate, and body temperature. The patient's outcome, which reflected the severity of condition, was expressed on the basis of progress, including home discharge, admission to general ward, and admission to intensive care unit (ICU) or death. RESULTS: Of the 3,242 patients enrolled in the study, 724 were traumatic patients, and 2518 were non-traumatic patients. The accuracy rate between the actual and the calculated classification of a patient's outcome for all patients was 66.2% for discharge, 64.1% for admission to general ward, 30.6% for admission to ICU or death. The corresponding numbers for non-traumatic patients were 70.3%, 70.6%, 32.1%, and those for traumatic patients were 61.3%, 52.5%, 29.8%. CONCLUSION: The Computerized Triage System provides a useful guideline to classify patients into two groups (discharge vs admission), especially in non-traumatic conditions, but it has limitations for classifying into critically ill patients.
Blood Pressure ; Body Temperature ; Classification ; Critical Illness ; Discriminant Analysis ; Emergencies* ; Emergency Service, Hospital* ; Heart Rate ; Humans ; Intensive Care Units ; Korea ; Patients' Rooms ; Prospective Studies ; Respiratory Rate ; Triage* ; Vital Signs

PURPOSE: End-tidal carbon dioxide (ETCO2) reflects pulmonary perfusion and ventilation of resuscitated cardiac arrest patients. Single use of ETCO2 has some limitations in predicting outcomes of cardiac arrest. We hypothesized the dead space ventilation ratio (Vdt/Vt) using arterial CO2 and ETCO2 difference (Pa-etCO2) can be used as a better prognostic indicator of survival in resuscitated cardiac arrest patients. METHODS: 94 patients were cardiac arrest in emergency department from January 2004 to october 2005. Patients were intubated in the emergency department and treated using the standard advanced cardiac life support protocol. 48 patients were resuscitated following cardiac arrest. Their ETCO2 were evaluated by using mainstream capnography. ETCO2 and simultaneously, blood gas studies were evaluated within 1 hour following return of spontaneous circulation (ROSC). 17 Patients were excluded because they had chronic pulmonary disease or they were cardiac arrest after cerebrovascular accident. RESULTS: There was no difference in mean age, arrest rhythm, systolic blood pressure, and base excess between patients that were discharged alive and patients that died in the hospital. Arterial pH of patients expired within 24 hours was significantly lower than that of survivors. The ETCO2 following ROSC averaged 19.7 +/- 10.73 mmHg in cases of hospital death with ROSC< 24 hours, 31.4 +/- 14.04 mmHg in cases of hospital death with ROSC> 24 hours and 26.2 +/- 5.22 mmHg in survivors (p=0.050). The VdA/Vt averaged 0.20 +/- 0.087 mmHg in alive discharges, 0.59 +/- 0.187 mmHg in hospital death with ROSC<24 hours and 0.36 +/- 0.176 mmHg in hospital deaths with ROSC> 24 hours (p=0.000). CONCLUSION: This study showed that high P(a-et)CO2 and high VdA/Vt suggest poor outcomes in arrest patients with ROSC. If future studies validate this model, the use of VdA/Vt that compare to ETCO2 may be a more useful adjunct in assessing the outcomes of cardiac arrest..
Advanced Cardiac Life Support ; Blood Pressure ; Capnography ; Carbon Dioxide ; Emergency Service, Hospital ; Heart Arrest* ; Humans ; Hydrogen-Ion Concentration ; Lung Diseases ; Perfusion ; Stroke ; Survivors ; Ventilation

Carcinoid tumors of ampulla of Vater are rare and slow growing neoplasms that are composed of variable numbers of cells that contain endocrine secretory granules in their cytoplasm, which can be identified by immunohistochemistry, and electron microscopy. Symptoms of Carcinoid tumors of ampulla of Vater are jaundice, hemorrhage, abdominal discomfort, duodenal obstruction or carcinoid syndrome. The incidence of Carcinoid tumors of ampulla of Vater is 1% of all gastrointestinal carcinoid tumors in Western countries. We report a case of no recurrence for 53 months after pylorus preserving pancreaticoduodenectomy for carcinoid tumor of ampulla of Vater
Ampulla of Vater* ; Carcinoid Tumor* ; Cytoplasm ; Duodenal Obstruction ; Hemorrhage ; Immunohistochemistry ; Incidence ; Jaundice ; Microscopy, Electron ; Pancreaticoduodenectomy ; Pylorus ; Recurrence ; Secretory Vesicles

We experienced 5 cases of acute rubella encephalitis, a serious complication of rubella. The patients presented with convulsions and a deteriorated mental state, both of which occurred with a vanishing maculopapular rash and a low grade fever. The cerebrospinal fluid analysis showed pleocytosis and increased protein and normal glucose levels. We diagnosed the rubella encephalitis by detection of IgM in the serum. Rubella encephalitis is known to be a serious complication of rubella, and with poor prognosis. The mortality rate may reached as high 20%. Our cases recovered without any sequelae.
Cerebrospinal Fluid ; Encephalitis* ; Exanthema ; Fever ; Glucose ; Humans ; Immunoglobulin M ; Leukocytosis ; Mortality ; Prognosis ; Rubella* ; Seizures

BACKGROUND/AIMS: To review the cases of surgically-treated intrahepatic cholangiocarcinoma, and to evaluate the clinical and pathologic features of intrahepatic cholangiocarcinoma that may affect longterm survival among Korean patients. MATERIALS AND METHODS: From 1990 to 1997, 28 patients with intrahepatic cholangiocarcinoma underwent laparotomy. Among them, resection was performed in 25 patients and wedge resection in only 3 patients. The liver resections included: 5 right lobectomies, 1 right trisegmentectomy, 7 left lobectomies, 3 extended left lobectomies, 2 hepatopancreatoduodenectomies and 7 segmentectomies. Curative resection was performed on 15 patients. The histological sections of all resected specimens were immunohistochemically stained with p53 and Ki-67 monoclonal antibodies to assess biological behavior of the tumor cells. The cumulative survival rate and clinicopathological factors, including biological markers (p53, Ki-67), that may influence prognosis were analyzed stastistically. RESULTS: The patients undergoing curative resection survived significantly longer than the patients undergoing noncurative resection. The median survival time for patients with curative resection was 24 months (mean, 34+/-8 months) with 1-, 2-, and 3-year survival rates of 66.6%, 44.4%, and 35.6%, respectively. The median survival time for patients with noncurative resection was 3 months (mean, 8+/-3 months) with 1- and 2-year survival rates of 26.7% and 13.4%, respectively. Univariate analysis showed that positive regional lymph node significantly correlated with poor prognosis (p=0.004); and that curative resection significantly correlated with better prognosis (p=0.001). Age, sex, tumor size, the degree of cell differentiation, gross type of tumor, and p53 and Ki-67 labeling index had no significant correlation with prognosis. CONCLUSION: Our results support the idea that an aggressive liver resection along with regional lymph node dissection is recommended for long-term survival. The validity of the molecular biologic tumor markers (p53, Ki -67) as a prognostic factor is not yet clearly defined.
Antibodies, Monoclonal ; Biomarkers ; Cell Differentiation ; Cholangiocarcinoma* ; Fibrinogen ; Hepatectomy ; Humans ; Laparotomy ; Liver ; Lymph Node Excision ; Lymph Nodes ; Mastectomy, Segmental ; Prognosis ; Survival Rate ; Biomarkers, Tumor

Objective: Alcohol consumption is associated with an increased risk of injuries. However, its effects on injury severity and mortality remain unclear. Specifically, the effects of alcohol intake on the severity of slip injuries have not been thoroughly investigated. Therefore, our study aimed to investigate the effects of alcohol intake on injury patterns and severity in patients experiencing slip injuries. Methods: Emergency department surveillance data collected from 2011 to 2016 were analyzed for this study. Among patients aged 15 and older who were admitted for slip injuries, we compared the type and severity of injuries between the alcohol-intake group and the no-alcohol-intake group. Injury severity was classified as non-severe and severe based on the excess mortality ratio-adjusted injury severity score. Results: In total, 227,548 (alcohol-intake, n=48,581; no-alcohol-intake, n=178,967) patients were included. After adjusting for age, time of injury, use of public ambulance, and season, multivariate logistic regression analysis showed that injuries were more likely to be severe in the alcohol-intake group than in the no-alcohol-intake group (odds ratio, 1.60; 95% confidence interval, 1.47–1.75). In addition, male gender and alcohol consumption had a greater synergistic effect on injury severity than the mere sum of each effect of these factors (odds ratio, 2.65; 95% confidence interval, 2.53–2.78). Conclusion Assessment of the patients influenced by alcohol was a challenge in the emergency department due to altered mental status. We suggest a considerate approach in testing and assessing male patients who slipped after alcohol-intake in the emergency department.