The authors reported the cases of 23 patients with aneurysms measuring 2.5 cm or greater in diameter found during 7 years period in which we performed 596 operations for aneurysm of the 23 patients, 14 were treated by direct operation, 3 by internal carotid ligation with or without bypass surgery, 2 by trapping, 1 by wrapping and the other 3 by conservative therapy. The overall incidence of giant aneurysms was 3.9% but varied according to location; 9 cases were located on the internal carotid artery; 8 were on the anterior communicating artery; 5 were on the middle cerebral artery. 14 patients had hemorrhagic attacks, 7 had mass effects from the aneurysm, and 2 had ischemic events. Overall favorable outcome was 65% and the mortality was 13%. Based on the review of the literature, the appropriateness of surgery and surgical methods are discussed.
Aneurysm ; Arteries ; Carotid Artery, Internal ; Humans ; Incidence ; Intracranial Aneurysm* ; Ligation ; Middle Cerebral Artery ; Mortality

No abstract available.
Cartilage* ; Fascia* ; Transplants* ; Tympanoplasty*

By using (99m)Tc-Pertechnetate, we evaluated the thyroid function of 136 persons with uptake slopeindex(U.S.I.) which was calculated by computerized dynamic flow study. Also, we compared our results of U.S.I.with those of established ¹³¹I-24 hr uptake % in given materials by comparative analysis of their correlation with the hormonal values of T3, T4, Free T4. The results wre as follows: 1. The U.S.I. of euthyroidismal group and hyperthyrodismal group were 4.87±2.26, 27.67±9.56 respectively. The ¹³¹I-24 hr uptake % of above groups were29.22±10.23, and 71.45±15.51. So the differentiation of the two groups could be done more easily by using (99m)Tc-Pertenchnetate U.S.I. than by using ¹³¹I-24 hr uptake %. 2. The correlation rates between (99m)Tc-Pertechnetate U.S.I. and other laboratory hormon levels, T3, T4, Free T4, ar almost parallel with thosebetweeen ¹³¹I-24 hr uptake % and the values of T3, T4, Free T4. Also the direct correlation rate between (99m)Tc-Pertechnetate U.S.I. and ¹³¹I-24 hr uptake % was 0.898. So, the method of thyroidal function evaluation by (99m)Tc-Pettechnetate U.S.I. is very reliable. 3. The (99m)Tc-Pertechnetate U.S.I. is very helpful to evaulate thefunctions of each lobe respectively incases of having obviously different radioactivity between both lobes. 4. (99m)Tc-Pertechnetate used dynamic thyroid function study and scan can be performed during the short time without preparation and especially helpful in debilitating patient and patients under antithyroid drug therapy, who need repetitive follow-up examination.
Drug Therapy ; Follow-Up Studies ; Humans ; Methods ; Radioactivity ; Thyroid Gland

The nerve conduction study with the inching method has been performed to characterize the nature of lesion (focal of diffuse) within the carpal tunnel and to increase the diagnostic sensibility of the carpal tunnel syndrome (CTS). The sensory nerve conduction velocity of finger-to-palm (F-P) segment of median never or the ratio of sensory nerve conduction velocity of palm-to-wrist (PW) segment to F-P segment of the median nerve (P-W/F-P ratio) was also measured to differentiate the CTS from the early peripheral polyneuropathy, which may only involve the median nerve. Conduction times of the sensory median nerve between the midpalm and the distal forearm in 2cm increments were measured orthodromically in controls (n=32) and CTS patients. The P-W/F-P ratio in control, CTS without diabetes mellitus (DM) (n=23), CTS with DM (n=9), and diabetic peripheral polyneuropathy (DP) groups was compared. The criteria for focal lesion within the carpal tunnel were defined as follows 1) If the maximal conduction time is located at 4-2cm segment distal(designated as '-') to distal wrist crease, it must be prolonged more than 4 times that of the adjoining distal segment or 6 times that of adjoining proximal segment. 2) If the maximal conduction time is located at -6--4cm segment, it must be beprolonged more than 4 times that of the adjoining proximal segment. According to above criteria, the incidened of focal lesion within the carpal tunnel was 84.4%(27/32) and the most common segment of focal lesion was -4--2cm segment(85.2%, 23/27). The P-W/F-P ratio was more decreased in CTS without DM (0. 55 + 0. 11) and CTS with DM(O.68+0.07) groups than control(0382+0.09) and DP(O.81+0.09) groups(P<0.01). In CTS groups, it was more decreased in CTS without DM group than CTS with DM group(p<0.05). So the measurement of sensory nerve conduction velocity of F-P segment of median nerve or the P-W/F-P ratio is helpful not only to evalucate the early distal involvement of peripheral neuropathy but also to establish the subclinical involvement of the segment distal to transverse carpal ligament in CTS with DM group.
Carpal Tunnel Syndrome* ; Diabetes Mellitus ; Forearm ; Humans ; Ligaments ; Median Nerve ; Neural Conduction ; Peripheral Nervous System Diseases ; Polyneuropathies ; Wrist

Thirty - five cases of coarctation of aorta, diagnosed by cardiac catheterization and angiography during the period of 1980-1984, at the department of Pediatrics of Seoul National University Hospital, were studied on the clinical features and management. The followoing results were obtained : 1) The incidence of coartation of aorta was 1.2% of congenital heart disease and sex ratio of male to female was 2.2 : 1. 2) The anatomical type of coarctation was preductal in 19 cases, juxtaductal in 15 cases and postductal in 1 case. Most of preductal coarctation (89.5%) were associated with aortic arch or isthmus hypoplasia. 3) All of these patients had various type of additional cardiac anomalies and among them, PDA was the most common associated lesion and followed by VSD. 4) Significant BP gradient between upper and lower extremies and weak femoral pulsation were noticed in 15 cases(42.8%). 5) Congestive heart failure was present in all but one patient less than 1 year old, while only 3 cases(15%) had congestive heat failure in patients older than one year. 6) Overall surgical mortality was 31.8%, but significant decrease in surgical mortality was found since 1983.
Angiography ; Aorta ; Aorta, Thoracic ; Aortic Coarctation* ; Cardiac Catheterization ; Cardiac Catheters ; Estrogens, Conjugated (USP) ; Female ; Heart Defects, Congenital ; Heart Failure ; Hot Temperature ; Humans ; Incidence ; Male ; Mortality ; Pediatrics ; Seoul ; Sex Ratio

OBJECTIVE: To evaluate the effect of hyaluronan-rich transfer medium on pregnancy and implantation rates in fresh and frozen-thawed embryo transfers in Korean women with previous implantation failure. METHODS: This retrospective study included 283 blastocyst transfers in patients with previous embryo transfer failure at a private fertility clinic. In the study group (n=88), blastocyst transfers were performed using an hyaluronan-rich transfer medium prior to transfer, whereas blastocyst transfers without any treatment served as controls (n=195). According to the type of transfer (fresh elective or frozen-thawed), all the blastocyst transfers were divided into two study and two control groups. RESULTS: The patient's mean age, serum anti-Müllerian hormone level, causes of infertility, embryo quality, and the number of transferred embryos were comparable between the study and control groups. There were no significant differences in clinical pregnancy rate (45.5% vs. 43.1%), implantation rate (28.9% vs. 28.8%), and clinical abortion rate (10.0% vs. 8.3%) between the two groups, and these findings were not changed after subgroup analysis according to the type of transfer. CONCLUSION: The use of hyaluronan-rich transfer medium in the blastocyst transfer does not appear to have any significant effect on the implantation and pregnancy rates in patients with previous implantation failure.
Abortion, Induced ; Blastocyst* ; Embryo Transfer ; Embryonic Structures ; Female ; Fertility ; Humans ; Hyaluronic Acid ; Infertility ; Pregnancy Rate* ; Pregnancy* ; Retrospective Studies

BACKGROUND: Clostridial bacteremia (CB) is the second most frequent anaerobic bacteremia, and CB patients show high mortality without prompt antimicrobial therapy. We retrospectively reviewed 11 years of CB cases in a tertiary care hospital to describe the clinical and microbiological characteristics of CB and to define the risk factors of fatal CB. METHODS: All patients with CB from January 2002 to December 2012 were included in the study. Age, sex, underlying diseases, antibiotic use, and clinical outcome were reviewed. Antibiotic therapy was classified as either 'appropriate' or 'inappropriate' based on the activity against Clostridium species. RESULTS: A total of 118 Clostridium isolates (0.79% of all blood culture isolates) were recovered from the blood cultures of 114 patients. The underlying conditions of patients with CB were neoplasm in 87 cases (76.3%), gastrointestinal symptoms in 84 cases (73.7%), diabetes in 17 cases (14.9%), and hemodialysis in six cases (5.3%). Of the 118 Clostridium isolates, C. perfringens was the most frequent species (42 isolates, 35.6%). Thirty-two patients (28.1%) showed polymicrobial bacteremia, which was most commonly combined with Escherichia coli. Two patients harbored more than two Clostridium species. 'Appropriate' antibiotics were given to 97 (85.1%) patients. The mortality rate of CB at days 2, 8, and 30 was 7.9% (9/114), 14.0% (16/114), and 26.3% (30/114), respectively. CONCLUSION: Neoplasm, especially in the gastrointestinal tract or of hematologic origin, and hemodialysis were considered to be risk factors of blood stream clostridial infection. Early appropriate antibiotic coverage of CB was not definitely associated with lower mortality in our study.
Anti-Bacterial Agents ; Bacteremia* ; Bacteria, Anaerobic ; Clostridium ; Escherichia coli ; Gastrointestinal Tract ; Humans ; Korea* ; Mortality ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Rivers ; Sepsis ; Tertiary Healthcare*

No abstract available.
Pulmonary Alveolar Proteinosis*

We evaluated DNA protection effect of heat shock protein (HSP) against cytotoxic effects of exogenous nitric oxide (NO) and reactive oxygen intermediate (ROI). Cultured human corneal fibroblasts were divided into 4 groups. Control (Group I) was not exposed to a sub-lethal heat treatment. Other 3 groups were exposed to 43 degrees C for 1 hr, then incubated at 37 degrees C during different duration (1, 6, 24 hr, Group II, III, IV, respectively). Expression pattern of HSP 70 was analyzed by Western blot. Cell viability was measured by MTT assay and the relationship between HSP 70 expression and DNA damage was examined by terminal deoxyribonucleotidyl transferase mediated dUTP-digoxigenin nick and labeling (TUNEL) stain and single cell gel electrophoresis. Expression pattern of HSP 70 was dependent on recovery times. Cell viability following heat treatment was significantly increased and the TUNEL positive cell number was decreased at 6 hr. In single cell gel electrophoresis, tail moments were increased in a dose-dependent manner by SNAP and X/XO. Following heat treatment, tail moments showed decreased significantly at 6 hr. These results suggest that induction of HSP 70 by sub-lethal heat treatment is closely related with cytoprotective effects against oxidative stresses in human corneal fibroblasts.
Cell Survival ; Cells, Cultured ; Cornea/*cytology ; DNA Damage ; Dose-Response Relationship, Drug ; Fibroblasts/cytology/drug effects/*metabolism ; Heat ; Heat-Shock Proteins 70/genetics/*metabolism ; Humans ; In Situ Nick-End Labeling ; Nitric Oxide/metabolism ; Nitric Oxide Donors/pharmacology ; *Oxidative Stress ; Reactive Oxygen Species/metabolism ; Research Support, Non-U.S. Gov't ; S-Nitroso-N-Acetylpenicillamine/pharmacology ; Xanthine/pharmacology ; Xanthine Oxidase/pharmacology

PURPOSE: QTc dispersion is a quantitative measure of myocardial repolarization and is a new important prognostic factor for many diseases. We have analyzed the admission ECGs of 53 patients with spontaneous intracerebral hemorrhage (ICH) for QTc dispersion. This study was performed to investigate the value of QTc dispersion as a prognostic factor in ICH patients. METHODS: ECGs done within 24 hours from attack onset were analyzed for abnormalities and QTc. The QTc dispersion is the QT duration of the longest minus the shortest rate-corrected QT interval. We studied the differences in QTc dispersions on the initial ECGs in the ED between a favorable group and an unfavorable group. RESULTS: We found that patients had less chance for a good recovery if they had a lower Glasgow Coma Scale (GCS) score on admission, a larger volume hematoma, a prolonged QTc dispersion, or a longer maximal QTc interval of the 53 patients with ICH, 16 (30.2%) patients demonstrated ECG abnormalities. The QTc dispersion was extremely prolonged in both groups. The favorable group included patients with a mean QTc dispersion=70.6 ms, whereas the unfavorable group included patients with a QTc dispersion= 117.6 ms. CONCLUSION: A prolonged QTc dispersion and a lower GCS score were significant predictors of a poor prognosis for spontaneous ICH patients. An increased QTc dispersion on the initial ECG is an important prognostic factor for ICH patients. More attention should be given to the disposition and intensive care of such patients.
Cerebral Hemorrhage* ; Electrocardiography ; Glasgow Coma Scale ; Hematoma ; Humans ; Critical Care ; Prognosis