No abstract available.
Acidosis, Renal Tubular* ; Captopril*

Traumatic intracranial lesion has been one of the most frequent and serous problem in neurosurgical pathology. CT made it possible to get prompt diagnosis and surgical intervention of intracranial lesions by its safety, fastiness and accuracy. Computed tomographic scan was carried out on 1309 cases at Soonchunhyang Chunan Hospitalfor 15 months from Oct. 1983 to Dec. 1984. We have reviewed the computed tomographic scans of 264 patients whichshowed traumatic intracranial lesion. The results were as follows: 1. Head trauma was the most frequentlydiagnosed disase using computed tomographic scans(57.8%), and among 264 cases the most frequent mode of injury wastraffic accident (73.9%). 2. Skull fracture was accompained in frequency of 69.7% and it was detected in CT in38.6%: depression fractue was more easily detected in 81%. 3. Countercoup lesion(9.5%) was usually accompained with temporal and occipital fracture, and it appeared in lower incidence among pediatric group. 4. Intracranial lesions of all 264 cases were generalized cerebral swelling(24.6%), subdural hematoma(22.3%), epiduralhematoma(20.8%), intracerebral hematoma(6.1%), and subarachnoid hemorrhage(3.0%). 5. The shape of hematoma wasusually biconvex(92.7%) in acute epidural hematoma and cresentic(100%) in acute subdural hematoma, but the morechronic the cases became, they showed planoconvex and biconvex shapes. 6. Extra-axial hematoma was getting decreased in density as time gone by. 7. Hematoma density was not in direct proportion to serum hemoglobin levelas single factor.
Chungcheongnam-do ; Craniocerebral Trauma ; Depression ; Diagnosis ; Hematoma ; Hematoma, Subdural, Acute ; Humans ; Incidence ; Pathology ; Skull Fractures

Pneumoperitoneum is usually the result of a perforated gastrointestinal (GI) tract associated with peritonitis. However, on rare occasions, spontaneous pneumoperitoneum not associated with a perforated GI tract has been described in the literature. A ruptured liver abscess is one of these occasions, and herein a case that resulted in pneumoperitoneum is reported. A 61-year-old woman was referred to the ER with acute onset of abdominal pain. The patient had been diagnosed as having diabetes mellitus and hypertension. The abdominal examination was not remarkable for tenderness, but her vital signs were unstable. Laboratory investigations revealed a WBC count of 4, 000/mm3, Na+ of 129 mEq/L, and K+ of 3.2 mEq/L. A plain radiography disclosed a minute amount of free air in the left subphrenic space, and a computed tomography (CT) scan visualized a low-density cystic mass suspected to be a gas forming pyogenic liver abscess. A laparoscopic exploration was performed for diagnosis and peritoneal drainage. Under the laparoscopy, a ruptured liver abscess and large amount purulent plaque were observed scattered in the entire peritoneal cavity. Evacuation of the abscess, cholecystectomy, liver biopsies, and peritoneal lavage were carried out after conversion to an open laparotomy. An abscess culture was obtained from the liver, with Klebsiella pneumoniae revealed as the pathogen. The administration of appropriate antibiotics followed the surgery, and she recovered without complications. A ruptured pyogenic liver abscess is an extremely rare and threatening condition despite the advances in diagnostic technology and new strategies for their treatment. However, the appropriate surgical management, followed by effective antibiotic therapy, will recover the patient without serious complications.
Abdominal Pain ; Abscess ; Anti-Bacterial Agents ; Biopsy ; Cholecystectomy ; Diabetes Mellitus ; Diagnosis ; Drainage ; Female ; Gastrointestinal Tract ; Humans ; Hypertension ; Klebsiella pneumoniae ; Laparoscopy ; Laparotomy ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic* ; Middle Aged ; Peritoneal Cavity ; Peritoneal Lavage ; Peritonitis ; Pneumoperitoneum ; Radiography ; Rupture, Spontaneous* ; Vital Signs

The fat adherence syndrome(FAS) is a severe form of the restrictive strabismus resulting from the adherence of orbital tissues to the globe of extraocular muscles and their attachments, for which no successful treatment currently exists. we developed anexperimental model for the FAS in the rabbit eyes and then evaluated the effects of polyurethane film with sustained release dexamethasone on the prevention of experimental FAS. Thirty eyes of fifteen white rabbits had a fat autograft placed between the inferior rectus and the periosteum of the inferior orbital rim and then, the inferior rectus, the fat and the periosteum were sutured to create an experimental FAS. In Group I the experimental FAS was only induced as a control group. The polyurethane film with no released substance and the polyurethane film with sustained release of dexamethasone were inserted between the inferior rectus and the fat in Group II and Group III, respectively. The force required to move the eyeball superiorly 4mm, 6mm, and 8mm was measured preoperatively and 4 weeks ostoperatively. At postoperative 4 weeks the surgical dissection to evaluate the degree of the adhesion and the histologic examination were performed. A significant increase in forced duction(postop-preop) was found at all levels of ocular rotation in Group I and it means that the induction of experimental FAS was successful. Histology revealed a moderate inflammatory response with partial loss of normal adipose tissue replaced by fibrovascular tissue. Group III had significantly less restriction than Group I and Group II. Group II had less restriction than Group I, but statistically not significant. In conclusion, the use of the polyurethane film with sustained release of dexamethasone may have a role in the prevention of experimental FAS.
Adipose Tissue ; Autografts ; Dexamethasone ; Muscles ; Orbit ; Periosteum ; Polyurethanes* ; Rabbits* ; Strabismus

OBJECTIVES: The primary objective of this study is to compare model performance of machine learning methods with that of a previous study in which a nonlinear mixed effects model was created using NONMEM(R) for the pharmacokinetic and pharmacodynamic data for propofol. The secondary objective was to evaluate if a pharmacodynamic model describing the relationship between the dose of propofol and bispectral index (BIS) outperform that describing the relationship between a pharmacokinetic model derived-predicted concentrations of propofol and BIS. METHODS: Data were collected during a study involving the infusion of propofol into healthy volunteers. Pharmacokinetic and pharmacodynamic models were constructed using artificial neural networks (ANNs), support vector machines (SVMs), and multi-method ensembles and were compared with the nonlinear mixed effects method as implemented by NONMEM(R). Model performance was assessed by goodness-of-fit statistics, paired t-tests between predicted and observed values for each model and scatterplots. RESULTS: In pharmacokinetic analysis, ensemble I, the mean of ANN and NONMEM(R) predictions, achieved minimal error and the highest correlation coefficient. SVM produced the highest error and the lowest correlation coefficient. In pharmacodynamic analysis, ANN exhibited the best performance. An ANNModel describing the relationship between the dose of propofol and BIS was not inferior to an ANN model describing the relationship between predicted concentrations of propofol derived from an ANN pharmacokinetic model and BIS. CONCLUSIONS: In pharmacokinetic analysis, ensemble combined with ANN achieved slightly better performance than NONMEM(R). The relationship between the dose of propofol and BIS can be predicted without considering pharmacokinetics of propofol.
Machine Learning ; Propofol ; Support Vector Machine

BACKGROUND: The cerebral blood flow velocity (CBFV) has been known to increase in response to acute hypoxia. However, how CBFV might respond to exercise in hypoxic conditions and be associated with electroencephalogram (EEG) remains unclear. The purpose of this study was to evaluate the effect of exercise in hypoxic conditions corresponding to altitudes of 4,000 m on CBFV and EEG. METHODS: In a randomized, double-blind, balanced crossover study, ten healthy volunteers (19.8±0.4 years) were asked to perform the incremental bicycle ergometer exercise twice in hypoxic and control (sea level) conditions with a 1-week interval, respectively. Exercise intensity was set initially at 50 W and increased by 25 W every 2 minutes to 125 W. Acute normobaric hypoxic condition was maintained for 45 minutes using low oxygen gas mixture. CBFV in the middle cerebral artery (MCA) and EEG were measured at rest 5 minutes, rest 15 minutes, immediately after exercise, and 15 minutes recovery using transcranial-Doppler sonography and EEG signal was recorded from 6 scalp sites leading to analysis of alpha and beta wave relative activities. All data were analyzed using two-way repeated-measures analysis of variance and Pearson's correlation. RESULTS: CBFV in the MCA in the hypoxic condition was significantly higher than that in the control condition at rest 5 minutes (83±9 vs. 69±9 cm/s, P<0.01), rest 15 minutes (87±8 vs. 67±7 cm/s, P<0.001), immediately after exercise (112±9 vs. 97±9 cm/s, P<0.01), and 15 minutes recovery (91±11 vs. 74±7 cm/s, P<0.01). However, no significant correlation was found between the changes of CBFV and EEG wave activities. CONCLUSIONS: These results suggest that the drastic change of CBFV observed during exercise with hypoxia might appear independently with EEG wave activities.
Altitude ; Anoxia ; Cerebrovascular Circulation ; Cross-Over Studies ; Electroencephalography ; Healthy Volunteers ; Middle Cerebral Artery ; Oxygen ; Scalp

BACKGROUND: The cerebral blood flow velocity (CBFV) has been known to increase in response to acute hypoxia. However, how CBFV might respond to exercise in hypoxic conditions and be associated with electroencephalogram (EEG) remains unclear. The purpose of this study was to evaluate the effect of exercise in hypoxic conditions corresponding to altitudes of 4,000 m on CBFV and EEG. METHODS: In a randomized, double-blind, balanced crossover study, ten healthy volunteers (19.8±0.4 years) were asked to perform the incremental bicycle ergometer exercise twice in hypoxic and control (sea level) conditions with a 1-week interval, respectively. Exercise intensity was set initially at 50 W and increased by 25 W every 2 minutes to 125 W. Acute normobaric hypoxic condition was maintained for 45 minutes using low oxygen gas mixture. CBFV in the middle cerebral artery (MCA) and EEG were measured at rest 5 minutes, rest 15 minutes, immediately after exercise, and 15 minutes recovery using transcranial-Doppler sonography and EEG signal was recorded from 6 scalp sites leading to analysis of alpha and beta wave relative activities. All data were analyzed using two-way repeated-measures analysis of variance and Pearson's correlation. RESULTS: CBFV in the MCA in the hypoxic condition was significantly higher than that in the control condition at rest 5 minutes (83±9 vs. 69±9 cm/s, P<0.01), rest 15 minutes (87±8 vs. 67±7 cm/s, P<0.001), immediately after exercise (112±9 vs. 97±9 cm/s, P<0.01), and 15 minutes recovery (91±11 vs. 74±7 cm/s, P<0.01). However, no significant correlation was found between the changes of CBFV and EEG wave activities. CONCLUSIONS These results suggest that the drastic change of CBFV observed during exercise with hypoxia might appear independently with EEG wave activities.

BACKGROUND: Under certain conditions, exertional headaches may reflect coronary ischemia. CASE REPORT: A 44-year-old woman developed intermittent exercise-induced headaches with chest tightness over a period of 10 months. Cardiac catheterization followed by acetylcholine provocation demonstrated a right coronary artery spasm with chest tightness, headache, and ischemic effect of continuous electrocardiography changes. The patient's headache disappeared following intra-arterial nitroglycerine injection. CONCLUSIONS: A coronary angiogram with provocation study revealed variant angina and cardiac cephalalgia, as per the International Classification of Headache Disorders (code 10.6). We report herein a patient with cardiac cephalalgia that manifested as reversible coronary vasospasm following an acetylcholine provocation test.
Acetylcholine ; Adult ; Angina Pectoris ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Vasospasm ; Coronary Vessels ; Electrocardiography ; Female ; Headache ; Headache Disorders ; Humans ; Ischemia ; Nitroglycerin ; Spasm ; Thorax

BACKGROUND: T-cell mediated cellular immunity has been suggested as an important mechanism in mycobacterial infection. Also, it is known that there is a imbalance between helper and suppressor T cells in the pathogenesis of tuberculosis in human. This study was designed to evaluate the changes of lymphocyte subsets in patients with pulmonary and extrapulmonary tuberculosis. METHODS: Lymphocyte subset analysis was performed on 53 pulmonary tuberculosis and 21 extrapulmonary tuberculosis patients. The proportion of total T (CD3+), B (CD19+), helper T (H, CD3+CD4+) and suppressor T (S, CD3+CD8+) cells, natural killer (NK, CD16+CD56+) cells and activated T (CD3+HLA-DR+) cells were analyzed using SimultestTM (Becton-Dickinson, California, USA) by FACSortTM (Becton-Dickinson, California, USA) and each absolute cell counts and helper T/suppressor T (H/S) ratio were calculated. RESULTS: In pulmonary and extrapulmonary tuberculosis patients groups, there were no significant changes in percentage and absolute cell counts of lymphocyte subset compared to control group. But H/S ratio was significantly decreased in both groups and the H/S ratio in extapulmonary tuberculosis was lower than that in pulmonary tuberculosis (1.06+/-0.44 vs. 1.64+/-0.97). CONCLUSION: Decreased or reversed H/S ratio reflect the role of cell mediated immune response in patients with tuberculosis, expecially in the spreading of pulmonary tuberculosis. Lymphocyte subset test seems to be helpful for access the different clinical forms of tuberculosis, pulmonary and extapulmonary tuberculosis.
California ; Cell Count ; Humans ; Immunity, Cellular ; Killer Cells, Natural ; Lymphocyte Subsets* ; Lymphocytes* ; T-Lymphocytes ; Tuberculosis* ; Tuberculosis, Pulmonary

PURPOSE: To identify prognostic factors for disease progression and survival of patients with extracranial oligometastatic breast cancer (EOMBC), and to investigate the role of radiation therapy (RT) for metastatic lesions. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 50 patients who had been diagnosed with EOMBC following standard treatment for primary breast cancer initially, and received RT for metastatic lesions, with or without other systemic therapy between January 2004 and December 2008. EOMBC was defined as breast cancer with five or less metastases involving any organs except the brain. All patients had bone metastasis (BM) and seven patients had pulmonary, hepatic, or lymph node metastasis. Median RT dose applied to metastatic lesions was 30 Gy (range, 20 to 60 Gy). RESULTS: The 5-year tumor local control (LC) and 3-year distant progression-free survival (DPFS) rate were 66.1% and 36.8%, respectively. High RT dose (> or =50 Gy10) was significantly associated with improved LC. The 5-year overall survival (OS) rate was 49%. Positive hormone receptor status, pathologic nodal stage of primary cancer, solitary BM, and whole-lesion RT (WLRT), defined as RT whose field encompassed entire extent of disease, were associated with better survival. On analysis for subgroup of solitary BM, high RT dose was significantly associated with improved LC and DPFS, shorter metastasis-to-RT interval (< or =1 month) with improved DPFS, and WLRT with improved DPFS and OS, respectively. CONCLUSION: High-dose RT in solitary BM status and WLRT have the potential to improve the progression-free survival and OS of patients with EOMBC.
Brain ; Breast Neoplasms* ; Breast* ; Disease Progression ; Disease-Free Survival ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Radiotherapy ; Retrospective Studies