A case of the cryptococcal meningitis is reported and the literature reviewed. A cryptococcosis is the most common form of fungal infection of the nervous system. The disease may simulate tuberculous meningitis, tumor of the brain, encephalitis and various psychosis. Our case is no significant symptoms and sings before the head trauma which was accompanied by transient loss of consciousness. The patient's symptoms and signs were aggravated by the head trauma (a mild cerebral concussion only). The patient expired on the 10th hospital day. The cryptococcal meningitis was proved by autopsy.
Autopsy ; Brain ; Brain Concussion ; Craniocerebral Trauma ; Cryptococcosis ; Encephalitis ; Humans ; Meningitis, Cryptococcal* ; Nervous System ; Psychotic Disorders ; Tuberculosis, Meningeal ; Unconsciousness

A case of the cryptococcal meningitis is reported and the literature reviewed. A cryptococcosis is the most common form of fungal infection of the nervous system. The disease may simulate tuberculous meningitis, tumor of the brain, encephalitis and various psychosis. Our case is no significant symptoms and sings before the head trauma which was accompanied by transient loss of consciousness. The patient's symptoms and signs were aggravated by the head trauma (a mild cerebral concussion only). The patient expired on the 10th hospital day. The cryptococcal meningitis was proved by autopsy.
Autopsy ; Brain ; Brain Concussion ; Craniocerebral Trauma ; Cryptococcosis ; Encephalitis ; Humans ; Meningitis, Cryptococcal* ; Nervous System ; Psychotic Disorders ; Tuberculosis, Meningeal ; Unconsciousness

BACKGROUND: Early esophageal cancer has a good prognosis compared with advanced esophageal cancer, so early detection of the cancer is emphasized. Early esophageal cancer is considered as esophageal cancer located within the submucosal layer and without metastasis in the operative specimen. Despite this criterion, evidence has accumulated suggesting that submucosal tumors have a very different prognosis from intra-epithelial and intramucosal lesions. The purpose of this study is to define the characteristics of and the appropriate operative method for esophageal cancer. METHODS: Medical records of 19 patients who had received an esophagectomy and who had been diagnosed as having early esophageal cancer between 1981 and 1996 at this hospital were reviewed. RESULTS: There was 17 cases of submucosal lesions and 2 cases of mucosal lesions. 74% of the patients had alcohol or smoking history. When endoscopic findings were classified according to the endoscopic classification of JSED, there were 5 cases of type 0-I, 4 cases of type 0-III, 4 cases of type 1, and others. Type 0-I and 0-III were common. The accuracy of the endoscopic ultrasonographic finding was 39% compared with the postoperative pathologic finding. The mean duration of follow-up was 21 months, and there were 2 recurrences during follow-up. One recurred 13 months after the operation and the other 23 months after the operation. Both of them were submucosal lesions and received a transhiatal esophagectomy. CONCLUSIONS: Annual endoscopic examination with lugol staining may be needed for early detection of esophageal cancer. Submucosal lesions of early esophageal cancer should be managed with an esophagectomy and lymph node dissection. Also, expertness of the endoscopist is very important in deciding on an of operative method.
Classification ; Esophageal Neoplasms* ; Esophagectomy ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Smoke ; Smoking

PURPOSE: Besides interferencence of esophageal motor function by the nasogastric tube, a decline of the positive gastro-esophageal pressure gradient caused by intermittent positive pressure ventilation seems to have a major role in the pathogenesis of gastroesophageal reflux (GER) in mechanically ventilated preterm infants. The aim of this study was to determine the incidence of GER and associated risk factors in mechanically ventilated preterm infants. METHODS: Twenty four hour esophageal pH monitorings were performed using a antimony electrode on 11 mechanically ventilated preterm infants in Neonatal Intensive Care Unit in Pusan National University Hospital. We evaluated the following reflux parameters; reflux index, reflux episodes/ hour, reflux episodes > or =5 min/hour, duration of longest episode, and percent episodes > or =5 min. Patients were considered to have significant GER if more than 2 among 5 parameters were satisfied. RESULTS: The mean gestational age of the patients was 30.9 weeks, mean birth weight was 1,568 g, and mean age at the time of pH monitoring was 2.8 days. Significant GER was detected in 4 patients (36.4%). There was no relationship between the incidence of GER and gestational age, birth weight, postnatal age, or the ventilator settings. CONCLUSION: The incidence of GER in mechanically ventilated preterm infants was similar, compared with other previous studies. Associated risk factors of GER in these patients were not detected. Therefore, mechanical ventilation in preterm infants does not seem to be the high risk factor of GER.
Antimony ; Birth Weight ; Busan ; Electrodes ; Esophageal pH Monitoring ; Gastroesophageal Reflux* ; Gestational Age ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Intermittent Positive-Pressure Ventilation ; Respiration, Artificial ; Risk Factors ; Ventilators, Mechanical

OBJECTIVES: Seoul-Activities of Daily Living(S-ADL) was developed to assess elderly person's basic activities of daily living. This study aims to develop standardized ADL assessment scale and confirm the reliability and validity of the S-ADL. METHODS: It was participated in 336 controls and 145 patients diagnosed Alzheimer's disease. RESULTS: In controls, it was statistically significant to age, but not sex, education, region and presence of spouse. Also, reliability and validity were statistically significant. Principal axis factoring analysis revealed three factors that accounted for 66.67% of the total variance(1.self-care/hygiene, 2.ambulation, 3.toileting). According to each CDR stage, there were significant difference, except for CDR 0.5 and CDR 1 suggesting early dementia. Particularly, it was remarkable for functional impairment in CDR 2 and CDR 3 suggesting moderate to severe dementia. The order of the loss of function was (1) self-care/hygiene, (2) toileting, and (3) ambulation. CONCLUSIONS: Our study showed that the S-ADL could be a very reliable and valid tool for the assessment of functional disabilities of Korean dementia patients. Particularly, S-ADL would be useful in assessing daily function of moderate to severe AD.
Activities of Daily Living ; Aged ; Alzheimer Disease ; Axis, Cervical Vertebra ; Dementia ; Education ; Humans ; Reproducibility of Results* ; Spouses ; Walking

No abstract available.
Trichotillomania*

Aplastic anemia following acute hepatitis or acute hepatic failure is an uncommon disease and has a poor prognosis. We experienced a case of aplastic anemia following acute hepatic failure in a 10- year-old girl. She was admitted because of jaundice and lethargy for 8 days. Laboratory findings revealed marked elevated serum transaminases and bilirubin levels, prolonged prothrombin time and partial thromboplastin time, and massive hepatic necrosis on the pathological study. There was no evidence of metabolic, toxic or autoimmune hepatitis. During the treatment of acute hepatic failure, pancytopenia developed and marked hypocellularity of all hematopoietic elements in bone marrow was revealed. She recovered partially from aplastic anemia after treatment with anti-thymocyte globulin, corticosteroid and cyclosporine.
Anemia, Aplastic* ; Antilymphocyte Serum ; Bilirubin ; Bone Marrow ; Cyclosporine ; Female ; Hepatitis* ; Hepatitis, Autoimmune ; Humans ; Jaundice ; Lethargy ; Liver Failure* ; Liver Failure, Acute ; Massive Hepatic Necrosis ; Pancytopenia ; Partial Thromboplastin Time ; Prognosis ; Prothrombin Time ; Transaminases

No abstract available.
Dislocations* ; Knee*

Thrombotic thrombocytopenic purpura(TTP) is an uncommon fatal disorder of young adults characterized by thrombocytopenia, microangiopathic hemolytic anemia, fluctuating neurologic dysfunction, fever, and renal dysfunction. The fluctuating neurologic dysfunction, which is mainly due to small arteriolar or capillary ischemic vasculopathy, suggests impending stroke. We report a 72-year-old woman who has had recurrent and progressive transient ischemic attacks and confusion after a large amount of bloodletting. She recovered completely after intensive plasmapheresis and immunosuppressant treatment. This case illustrates that aggressive treatment, even in old age, may prevent permanent neurologic deficits when stroke is impending and complicated by TTP.
Aged ; Anemia, Hemolytic ; Bloodletting ; Capillaries ; Female ; Fever ; Humans ; Ischemic Attack, Transient ; Neurologic Manifestations ; Plasmapheresis ; Purpura, Thrombotic Thrombocytopenic ; Stroke ; Thrombocytopenia ; Young Adult

The H19 gene, located at human chromosome 11p15.5, is imprinted in most normal human tissues. However, imprinting is often lost in tumors suggesting H19 is a putative tumor suppressor. We analyzed the single nucleotide polymorphisms (SNPs) of a 16 kb region that includes the H19 gene and its imprinting control region (ICR) in the Korean population. To identify SNPs, we directly sequenced this region in 18 Korean subjects. We identified 64 SNPs, of which 7 were in the exons of H19, 2 were in the introns, 14 were in the 3' intergenic region and 41 were in the 5' intergenic region. Of the 64 SNPs, 21 had not previously been reported and thus appear to be unique to the Korean population. The identified SNPs of H19 in the Korean population may eventually be useful as genetic markers associated with various diseases. In this study, 7 of the 64 identified SNPs were at CTCF binding sites in the ICR and may affect regulation of H19 gene imprinting. Thus, several genetic variations of the H19 gene may be important markers in human diseases that involve genomic imprinting, including cancer.
Binding Sites ; Chromosomes, Human* ; DNA, Intergenic ; Exons ; Genetic Markers ; Genetic Variation ; Genomic Imprinting ; Haplotypes ; Humans ; Humans* ; Introns ; Polymorphism, Single Nucleotide*