No abstract available.
Sterilization, Tubal*

Descending Necrotizing Mediastinitis (DNM) is a complication of oropharyngeal infections that can spread to the mediastinum. It is difficult to diagnose early because clinical and radiologic findings appear in the late stage of the infection. late diagnosis is the principal reason for the high mortality in DNM. An 18-year-old female admitted with Ludwig's angina from dental caries. Despite of combined antibiotics, dental extraction and drainge of submental abscess, infection spread to the cervical area. Chest computed tomogram revealed extension of the abscess to the pretracheal and periaortic space and development of bilateral pleural empyema. We performed bilateral cervical mediastinotomy and thoracotomy for drainage and debridement. Tracheostomy to secure the airway and postoperative pleural irrigation were performed. Postoperative course was uneventful and patient was discharged on the 40th postoperative day. It is important to perform chest CT scanning for early diagnosis of DNM when oropharyngeal infection spreads to the cervical area. Improved survival of patients with DNM implies early and radical surgical drainage and debridement via a cervical mediastinomy and thoracotomy.
Abscess ; Adolescent ; Anti-Bacterial Agents ; Debridement ; Delayed Diagnosis ; Dental Caries* ; Drainage ; Early Diagnosis ; Empyema, Pleural ; Female ; Humans ; Ludwig's Angina ; Mediastinitis* ; Mediastinum ; Mortality ; Thoracotomy ; Thorax ; Tomography, X-Ray Computed ; Tracheostomy

A case of recanalization of totally thrombosed giant aneurysm is reported. The authors describe a 18 year-old female who developed headache, vomiting, and intermittent diplopia with left side ptosis. The brain CT scan and MRI revealed a totally thrombosed giant aneurysm with acute and subacute hemorrhage, located anterior to the left suprasellar cistern. Angiographic finding was non-visualization of the left posteior cerebral artery distal to the P2 segment, and the neck of the aneurysm was not identified. Follow-up angiography taken one month later showed partial recanalization of the thrombosed aneurysm. A probable mechanism of growth, thrombosis, and recanalization, of the giant aneurysms are discussed.
Adolescent ; Aneurysm* ; Angiography ; Brain ; Cerebral Arteries ; Diplopia ; Female ; Follow-Up Studies ; Headache ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Neck ; Thrombosis ; Tomography, X-Ray Computed ; Vomiting

We report 11 patients who developed dystonia and parkinsonian symptoms and signs. All of them developed the onset of parkinsonian symptoms 1 month to about 50 years(median: 2 yrs) after the onset of dystonia. Six of 11 patients developed dystonia affecting a hand; two affecting a foot; one affecting the neck; one affecting bilateral hands and a foot; one affecting a foot, trunk and neck Their parkinsonian symptoms had progressed very slowly and responded well to the levodopa treatment. Beside, none of them had clinical features suggestive of parkinsonian-plus syndrome. These findings suggest that they may have pathological changes confined to the nigrostriatal dopaminergic system as those with idiopathic Parkinson's disease. However, no change or worsening of dystonia after levodopa treatment suggest that they may have additional lesions out-side of the nigrostriatal dopaminergic system. More pathological studies and functional brain imaging studies are needed to define the exact pathogenesis of clinical syndrome of dystonia-parkinsonism.
Dystonia ; Foot ; Functional Neuroimaging ; Hand ; Humans ; Levodopa ; Neck ; Parkinson Disease

No abstract available.
Hernia, Diaphragmatic*

BACKGROUND: Spontaneous pneumothorax is a common respiratory condition and has been postulated that it develops because of rupture of subpleural blebs. Although the morphology and ultrastructure of causative lesions are well known, the reason for rupture of sbupleural blebs is not absolutely clear. Broad consensus concerning the role of meteorological factors in spontaneous pneumothorax dose not exist. The aim of the study was to examine the influence of change of atmospheric pressure and temperature on the occurrence of spontaneous pneumothorax. MATERIAL AND METHOD: One hundred twenty eight consecutive spontaneous pnemothorax events that occurred between January 2003 and December 2004 were selected. Changes of meteorological factors of particular days from the day before for 5 consecutive days were calculated and compared between the days with pneumothorax occurrence (SP days) and the days without pneumothorax occurrence (Non SP days). The correation between change of pressure and temperature and the occurrence of SP was evaluated. RESULT: SP occurred on 117 days (16.0%) in the 2-year period. Although there was no significant differences in change of pressure factors prior 4 days of SP occurrence compare to the 4 days prior Non SP day, change of mean pressure was higher (+0.934 vs. -0.191hPa, RR 1.042, CI 1.003~1.082, p=0.033), and change of maximum pressure fall was lower (3.280 vs. 4.791 hPa, RR 1.051, CI 1.013~1.090, p=0.009) on the 4 days prior SP day. There were significant differences in change of temperature factors prior 2 days and the day of SP, Changes of mean temperature (-0.576 vs.+0.099 degrees C, RR 0.886, 95% CI 0.817~0.962, p=0.004) and maximum temperature rise (7.231 vs. 8.079 degrees C, RR 0.943 CI 0.896~0.993, p=0.027) were lower on the 2 days prior SP. But changes of mean temperature (0.533 vs. -0.103 degrees C, RR 1.141, CI 1.038~1.255, p=0.006) and maximum temperature rise (9.209 vs. 7.754 degrees C, RR 1.123, CI 1.061~1.190, p=0.000) were higher on the SP days. CONCLUSION: Change of atmospheric pressure and temperature seems to influence the chance of occurrence of SP. Meteorological phenomena that pressure rise 4 day prior to SP and following temperature fall and rise might explain the occurrence of SP. Further studies should be continued in the future.
Atmospheric Pressure* ; Blister ; Consensus ; Meteorological Concepts ; Pneumothorax* ; Rupture

BACKGROUND: Apoptosis plays a crucial role in carcinogenesis, as well as in development and tissue homeostasis. Terminal deoxyribonucleotidyl transferase mediated neck end labelling (TUNEL) and in situ nick end labelling (ISEL) have been used to investigate the apoptosis in tissues. Since the introduction of the M30 monoclonal antibody to overcome drawbacks of TUNEL and ISEL, the apoptosis in various tumors, with the exception of pulmonary carcinomas, has been studied. In this study, attempts were made to examine the correlation of apoptosis in non-small cell carcinomas, using both M30 and the expression of p53 protein, with the clinicopathological factors. MATERIAL AND METHOD: Forty five patients with surgically resected non-small cell carcinomas were included. Immunohistochemical staining with M30 and p53 monoclonal antibody were performed, and their expressions compared with the clinicopathological features. The overall survival time and recurrence-free survival time were calculated, and the factors influencing the survival time analyzed using a univariate analysis. The effects of the expression stati of M30 and p53 on the risks of cancer related to both death and recurrence were evaluated using a multivariate analysis. RESULT: The p53 positive group had many more M30 positive cells than the p53 negative group (p53 positive group; 61.7+/-26.8 cells vs. p53 negative group; 45.6+/-29.6 cells, p=0.005) and significantly more p53 positive patients showing at least 10 positive cells (apoptotic index, AI > or =1) on M30 staining (p53 positive group; 52.4% [11/21] vs. p53 negative group 16.7% [4/24], p=0.025). In the univariate analysis, the survival times in relation to smoking (pack-year), performance status (PS) and AI showed significant differences. The multivariate analysis demonstrated the relative risk (R.R) of cancer death increased almost 7.5-fold (R.R 7.482; 95% CI 1.886~29.678; p=0.004) and the risk of recurrence almost 3.8-fold (R.R 3.795; 95% CI; 1.184~12.158; p=0.025) in the high AI (> or =1) compared to the low AI (<1) group. There was no prognostic effect of p53 expression on the survival time or risk of cancer death and recurrence. CONCLUSION: In non-small cell lung carcinomas, M30 immunohistochemistry was an excellent method for analyzing apoptosis; the high apoptotic index could be an adverse prognostic predictive factor.
Apoptosis* ; Carcinogenesis ; Cell Death ; DNA Nucleotidylexotransferase ; Homeostasis ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Lung Neoplasms ; Lung* ; Multivariate Analysis ; Neck ; Recurrence ; Smoke ; Smoking

Purpose: Netarsudil is a Rho kinase inhibitor and the first new class of clinically useful ocular hypotensive agents. In this study, we conducted a systematic literature review and meta-analysis to summarize and synthesize the available evidence on the efficacy and safety of fixed-dose combination (FDC) therapy with netarsudil/latanoprost in patients with glaucoma. Methods: We identified relevant studies in PubMed, Ovid Medline, Embase, and Cochrane Central until April 2021. The quality of the studies and the level of evidence were assessed using the Risk of Bias tool. Efficacy was measured as the mean difference in reducing intraocular pressure (IOP), and safety was assessed by the risk of conjunctival hyperemia (CH) due to FDC therapy, netarsudil monotherapy, or latanoprost monotherapy. Results: Four studies met the predefined eligibility criteria and were included in the meta-analysis. The mean difference in the reduction in IOP after 2 weeks and 4 to 6 weeks of drug administration was -2.41 mmHg (95% confidence interval [CI], -2.95 to -1.87) and -1.77 mmHg (95% CI, -2.31 to -1.87), respectively, in patients receiving FDC therapy versus those receiving latanoprost monotherapy. On the other hand, latanoprost monotherapy had a greater effect in reducing IOP than netarsudil monotherapy after 4 to 6 weeks of administration (mean difference, 0.95 mmHg; 95% CI, 0.43 to 1.47). The risk of CH was significantly higher with both FDC therapy and netarsudil monotherapy compared to latanoprost monotherapy in week 12, where the relative ratio was 3.01 (95% CI, 1.95 to 4.66) and 2.33 (95% CI, 1.54 to 3.54), each. Conclusions Netarsudil/latanoprost FDC therapy has a significantly greater effect on reducing IOP than latanoprost alone. The symptoms of CH were mostly mild, and only a few glaucoma patients discontinued the medication owing to CH in earlier clinical trials. Therefore, it would be beneficial to consider the administration of netarsudil/latanoprost FDC therapy in patients with glaucoma.

A 45-year-old man was referred from a local clinic with persistent fever, intermittent pain in the left upper abdomen, and weight loss of 7 kg. He quit his animal husbandry 18 months ago when his cows were found to be infected with Brucella. Abdominal computed tomography (CT) scan taken on admission showed splenomegaly with a wedge-shaped hypoattenuating region in the enhanced image, which was consistent with splenic infarction. Serology for Bruculla was strongly positive with the standard tube agglutination test (1/2560). After initiation of doxycycline (100 mg every 12 hrs) and rifampin (600 mg every day), the patient's condition improved, and was discharged with oral antibiotics that were to be continued for 3 months. During the 12 months' follow up at the outpatient department, the patient had no symptoms, and the last agglutination titer for Brucella in serum had decreased to 1/40. To our knowledge, this is the first report on splenic infarction associated with brucellosis in Korea, which was treated successfully with antibiotic therapy.
Abdomen ; Agglutination ; Agglutination Tests ; Animal Husbandry ; Anti-Bacterial Agents ; Brucella ; Brucellosis ; Doxycycline ; Fever ; Follow-Up Studies ; Humans ; Korea ; Middle Aged ; Outpatients ; Rifampin ; Splenic Infarction ; Splenomegaly ; Weight Loss