BACKGROUND: Vascular dementia is common cause of dementia, second to the dementia of Alzheimer desease. However in Asia and many developing countries, the incidence of vascular dementia exceeds that of Alzheimer's disease. Though many stroke-related factors related the nature of vascular injury, e.g. infarction and hemorrhage, have not assessed yet. Clarifying the difference of electroencephalograpy and clinical prognosis between infarction and hemorrhage, the aim of this study was to elucidate the role of nature of vascular injury. METHODS: to reduce confounding factors, the study population was restricted to the patients of single hemispheric striatocapsular infarction and hemorrhage saving cortex. On admission, we checked the KMMSE and FIM scores and using quantified EEG, we analyzed occipital peak frequency and the relative background alpha, theta and delta spectra power taken from 16 derivations by averaging twenty-2 -sec epoch in infarction, hemorrhage patients and elderly controls. After 6 months follow up, we compare the MMSE, FIM score between infarction and hemorrhage group. RESULTS: 1) Compared with infarction group, hemorrhage groups had a significantly bilateral lower occipital peak freqauency and background bilateral alpha spectra power. 2) In hemorrhage group, there is lower tendency in K-MMSE after 6 month follow up compared to infarction group. CONCLUSION: This study suggests that hemorrhage show more bilateral electrophysiological dysfunction than infarction group and possible grave prognosis for vascular dementia compared to infarction group.
Aged ; Alzheimer Disease ; Asia ; Dementia ; Dementia, Vascular ; Developing Countries ; Electroencephalography* ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Infarction* ; Prognosis* ; Vascular System Injuries

We measured the height and length of palpebral fissure, intercanthal distance and upward deviation of lateral canthus, and ovserved presence of double lid and epicanthal fold of 316 children who had no ocular disease except refractive anomaly by the use of standardized photographic method. We also analyzed the results according to the age, sex and the degree of refractive anomaly. The mean of central height of palpebral fissure was 8.0mm and the mean of maximal height was 8.1mm. In most of cases, the point where the height became maximal was at the center of the palpebral fissure and there was no difference accorging to laterality, sex, age and the degree of refractive anomaly. The length of palpebral fissure was 20.0mm in average and there was no difference according to laterality, sex and the degree of refractive anomaly, but it increased with the increasing age. The intercanthal distance was 33.8mm in average and increased with the increasing age but was not influenced by sex and refractive anomaly. The lateral canthus was deviated upward in relation to medial canthus by 5.90 in average and it was more deviated in female than in male. There was no difference according to laterality, age and refractive anomly, The double lid was present in 28.2% of total subject and it was equally frequent in male and female, and more frequent in the older age group. The epicanthal fold was present in 54.7% of total subject and there was no difference accrding to age and sex. Most of them were epicanthus tarsalis(56.1 %) and epicanthus palpebral is type.
Child* ; Female ; Humans ; Male

BACKGROUND: Alzhiemeranjx disease (AD) and vascular dementia (VD) are common types of dementia. As a result of the development of new specific agents for AD, and because vascular dementia is a potentially preventable dementia, differentiating these diseases is of great importance. The role of EEG spectral analysis in the differential diagnosis between Alzheimer type and vascular dementia is still controversial. Since there have been few studies concerning the differential diagnosis of dementia by EEG, the present study has focused on this aspect. Usefulness of EEG in differen-tial diagnosis of dementia will be elucidated by clarifying relationship between type of dementia and spectral profile of EEG. METHODS: We analyzed the power spectra taken from 16 derivations and spectral profile was constructed by averaging twenty 2 sec epochs in three study groups (normal controls, AD and VD). Spectral profile was divided into three groups; (I) type A, showing a dominant 6.5-12 Hz peak (ii) type B, lacking a dominant peak in the 6.5-12 Hz (iii) type C, corresponding to a flat, low voltage, spectrum. To elucidate the relationship between spectral profile and other factors including diagnosis, statistical test was done. RESULTS: (1) In AD, type C profile was statistically more prevalent than in VD and type A profile was reversed. (2) In AD, Mini-Mental State Examination (MMSE) score was statistically lower in type C profile. (3) Spectral profile was not associated with age, age of symptom onset, and symptom duration. CONCLUSIONS: This study suggested that spectral profile is a useful tool for the differential diagnosis of dementia (AD and VD) and correlated with the severity of disease in AD.
Dementia ; Dementia, Vascular* ; Diagnosis ; Diagnosis, Differential* ; Electroencephalography*

OBJECTIVE: The goal of this study was to review the etiologies, phathophysiology, clinical presentations and to compare the results of the surgical methods of subdural empyema especially in infants. PATIENTS AND METHODS: We reviewed the clinical data of five infantile subdural empyemas experienced in our hospital from 1993 to 1998 which were all surgically treated by craniotomy or burr hole trephination. We experienced five cases of infantile subdural empyema: two males and three females. The ages ranged from 40 days to 11 months. RESULTS: The etiologies of all five cases were unproven but all five cases had meningitis before the subdural empyemas were diagnosed. The causative organism in one was streptococcus pneumoniae, and the other were unknown. Two were treated with craniotomy(one with a good outcome and the other died) and three were treated with burr hole trephination(all three had a good outcome). CONCLUSION: Subdural empyema is a rapid progressing disease and it is important to detect and treat in the early stages of disease. The choice of surgical method must be based on the stage of the disease and its location in the cranial cavity.
Craniotomy ; Empyema, Subdural* ; Female ; Humans ; Infant* ; Male ; Meningitis ; Streptococcus pneumoniae ; Trephining

Monitoring of the central venous pressure is a simple, relatively inexpensive method of assessing a patient's cardiac status, circulating blood volume, and vasomotor tone. The simplest way of checking the intrathoraeic location of the catheter tip is by observing oscillation of 2~4cmH2O in the manometer column, synchronous with respiratory cycle. Inaccurate measurements are often obtained by the misplacement of the central venous catheter tip, in addition to the other well-known complications. Radiographic identification of the catheter tip is essential to eliminate these problems. We experienced a case of arrhythmia which appeared upon misplacement of the central venous catheter tip, and confirmed its misplacement by radiographic study.
Arrhythmias, Cardiac ; Blood Volume ; Catheters ; Central Venous Catheters* ; Central Venous Pressure ; Methods

Electron microscopic examination of proliferative membranes in retinopathy of prematurity (ROP) was performed in order to evaluate the components of the membranes. The proliferative membranes were obtained from nine patients with ROP stage 5 during pars plicata lensectomy, vitrectomy, and delamination of membrane. Fibrous astrocytes, myofibroblasts, lymphocytes, macrophages, and calcification were found respectively in two cases, and fibroblast-like cells were found in one case. Varying amounts of collagen tissues were found in eight cases and vascular tissues in four cases. Most of membranes were hypocellular and composed mainly of collagen matrix. It is considered that fibrous astrocytes, myofibroblasts, fibroblasts, and vascular structures are involved in the formation of proliferative membranes of ROP, and that later these cells degenerate and disappear, and that finally only collagen matrix remains in the membranes.
Cataract Extraction ; Child, Preschool ; Gestational Age ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Microscopy, Electron ; Retina/*ultrastructure ; Retinopathy of Prematurity/*pathology

The extrahepatic bile duct cancers(EBDC) are rare and are found late stage in their course. Because of their location in close proximity to the liver, hepatic artery, and portal vein, they are often unresectable. However, high survival rates after an aggressive surgical resection has been reported lately. This report presents the results of 62 cases with EBDC operated at the Department of Surgery, Pusan National University Hospital, from 1988 to 1997. EBDC usually occurs in older age group. especially between 60~70 years of age, and the mean age was 56.6 years. Sex ratio(male:female) was 5.2:1 with male predominance. Frequent clinical manifestations in order of frequency were jaundice(82.3%), abdominal pain(69.4%), pruritus(35.5%), anorexia(33.9%), fever and chill(32.3%), weight loss(22.6%). The laboratory findings were increased alkaline phosphatase(93.5%), bilirubin(77.4%), SGOT(77.4%), SGPT(69.4%). Elevated CEA(>5ng/dl) was 28.6%. The preoperative diagnostic accuracy was 100.0% in ERCP and PTC, 96.4% in abdominal CT, and 95.3% in ultrasonogram. The most common site of the cancer was lower third of the bile duct(61.3%), followed by upper third(27.4%) and middle third(11.3%). Curative resection was possible in 33 cases(53.2%) and the other 29 cases were received palliative biliary decompression. Postoperative complications were bile leakage(30.6%), wound infection( 25.8%), intraabdominal hematoma(19.4%), cholangitis(17.7%), and UGI bleeding(11.3%). The dead cases were 5 cases(8.0%) of all 62 cases and the causes of death were sepsis in 3 cases(4.8%) and UGI bleeding 2 cases(3.2%). By TNM classification(AJCC, 1992) stage IV(64.5%) was most common and stage II(25.9%) was next in order. Among the 62 adenocarcinoma, 25 cases were poorly-differentiated lesion(40.3%), 19 cases were moderately-differentiated lesion(30.6%), and 18 cases were well-differentiated lesion(29.0%). In conclusion, the survival rates of EBDC were higher low staged, curative resected, well differentiated and lower third located groups than high staged, palliative resected, poorly differentiated and upper third located groups.
Adenocarcinoma ; Bile ; Bile Ducts, Extrahepatic* ; Busan ; Cause of Death ; Cholangiopancreatography, Endoscopic Retrograde ; Decompression ; Fever ; Hemorrhage ; Hepatic Artery ; Humans ; Liver ; Male ; Portal Vein ; Postoperative Complications ; Sepsis ; Survival Rate* ; Tomography, X-Ray Computed ; Ultrasonography ; Wounds and Injuries

BACKGROUND: Microsatellites are short-tandem repeated uncleotide sequences present throughout the human genome. Alterations of microsatellites have been termed microsatellite instability(MI). It has been generally known that microsatellite instability detected in hereditary non-polyposis colorectal cancer (HNPCC) reflects genetic instability that is caused by impairments of DNA mismatch repair system regarding as a novel tumorigenic mechanism. A number of studies reported that MI occurred at varying frequencies in non-small cell lung carcinoma (NSCLC). However It has been unproven whether MI could be a useful market of genetic instability and have a clinical significance in NSCLC. MATERIAL AND METHOD: We have examined whether MI can be observed in thirty NCSLC using polymerase chain reaction whether such alterations are associated with other molecular changes such as p53, K-ras and c-myc oncoproteins expression detected by immunohistochemical stain,. RESULT: MI(+) was observed in 16.6%(5/30) and MI(-) was 83.3% (25/30) Average age was 50+/-7.5 year-old in MI(+) group and 57+/-6.6 year-old in MI(-) group. Two year survival rate in MI(=) group (20% 1/5) was worse than MI(-) group (64% 16/25) with a statistic difference. (P=0.04) The positive rate of K-ras oncoprotein expression and simultaneous expression of 2 or 3 oncoproteins expression were higher in MI(+) group than MI(-) group with a statistic difference(P=0.05, P=0.01) CONCLUSIONS: From, these results the authors can conclude that MI is found in some NSCLC and it may be a novel tumorigenic mechanism in some NSCLC. We also conclude that MI could be used as another poor prognostic factor in NSCLS.
Colorectal Neoplasms ; DNA Mismatch Repair ; Genome, Human ; Humans ; Lung Neoplasms ; Lung* ; Microsatellite Instability* ; Microsatellite Repeats* ; Oncogene Proteins ; Polymerase Chain Reaction ; Survival Rate

Paragangliomas of the mediastinum are rare neoplasms. We report a case of a unsuspected mediastinal paraganglioma in 55-year-old man. The mediastnal tumor was accidentally discovered on a chest roentgenogram and there was no history of hypertension, sweating, flushing and headache. Surgical resection was difficult with bleeding and fluctuation of arterial blood pressure reaching up to 190/130 mmHg with tachycardia. The blood pressure was controlled with nitroglycerine and tachycardia controlled with beta-blocker. After tumor resection, hypotension was treated with dopamine and blood transfusion. Postoperative recovery was satisfactory and the patient discharged after 20 days. The diagnosis of aorticosympathetic paraganglioma was established by histologic examination.
Arterial Pressure ; Blood Pressure ; Blood Transfusion ; Diagnosis ; Dopamine ; Flushing ; Headache ; Hemorrhage ; Humans ; Hypertension ; Hypotension ; Mediastinum ; Middle Aged ; Nitroglycerin ; Paraganglioma* ; Sweat ; Sweating ; Tachycardia ; Thorax

In lepromatous leprosy, it is generally believed that there is not only defective CMl specific for M. leprae, but also generalized impairment of CMI and in erythema nodosum leprosum, an immune complex-mediated pathogenesis as well cell mediated immune pathogenesis have been proposed. Neopterin is a pyrazinopyrirnidine compound derived from GTP, its raised excretion has been related to activation of T-lymphocyte/macrophage axis. A study was performed to evaluate generalized CMI status in the LL and ENL and to investigate a relationship between levels of urinary neopterin and disease activity. Urinary neopterin was measured by high pressure liquid chromatography in 25 healthy subjects, in 25 patients with LL and in 25 patients with ENL. The results were as follaws 1. Urinary Neopterin levels of patients with LL was 188.9+147.3umol/mol creatinine, which was higher than that of control group(144.8+40.4umol/mol creatinine)(p<0.01). 2. Urinary Neopterin levels of patients with ENL was 884.1+970.5umol/mol creatinine, which was higher than of control group, and patients with LL(p<0.01, p<0.01). 3. Serial measurement of urinary neopterin from 1 week to 13 weeks after treatment of ENL in 4 cases of ENL showed good correlation between urinary neopterin levels and disease activity. In summary, it thus appears that measurement of urine neopterin in leprosy provides generalized CMI status and reliable index for activity of disease.
Axis, Cervical Vertebra ; Chromatography, Liquid ; Creatinine ; Erythema Nodosum* ; Erythema* ; Guanosine Triphosphate ; Humans ; Leprosy ; Leprosy, Lepromatous* ; Neopterin*