PURPOSE: As morbidity and mortality resulting from physical trauma have significantly increased, the importance of trauma concerning medical, legal, and socioeconomic issues has been widely documented. Studies of post-traumatic seizure after head trauma have been reported, but mostly in adults. So this study was performed to analyse clinical findings on head trauma patients under 20 years of age. METHODS: The medical records of 230 patients under 20 years of age, who were admitted as head trauma to Chung Ang University hospital from January 1993 till May 1997, were reviewed. RESULTS: The overall incidence of Post-traumatic seizure was 32 of 230 patients in this study. The incidence per age was 16.7% in less than 5 year, 12.2% in 6-10 year, 11.4% in 11-15 year, and 14.9% in 16-20 year. We found incidences of Post-traumatic seizure in cases with depressed skull fracture(44.4%), subdural hematoma(28.6%), subarachnoid hemorrhage(28.6%) and intracerebral hemorrhage(21.1%). Of the 230 patients with head trauma, 2.2% had an immediate-onset seizure, 2.6% an early-onset seizure and 9.1% a late-onset seizure. Of the patients with post-traumatic seizure, abnormal EEG findings were found in 50%. EEG abnormalities were slowing (46.2%) and spike(3.8%). Recurrence rate of post-traumatic seizure was 21.9% in this study. We found a high incidence of recurrence in cases of depressed skull fracture, subdural hematoma and epidural hematoma. CONCLUSION: Considering the great influence of seizure on a child's development and long-term prognosis, prevention based on post-traumatic seizure risk assessment is important and antiepileptic prophylaxis should be considered as disk factors.
Adolescent* ; Adult ; Craniocerebral Trauma ; Electroencephalography ; Hematoma ; Hematoma, Subdural ; Humans ; Incidence ; Medical Records ; Mortality ; Prognosis ; Recurrence ; Risk Assessment ; Seizures* ; Skull ; Skull Fracture, Depressed

PURPOSE: To analyse clinical outcome and prognostic factors according to treatment modality, this paper report our experience of retrospective study of patients with esophageal cancer. MATERIALS AND METHODS: One hundred and ten patients with primary esophageal cancer who were treated in Presbyterian Medical Center from May 1985 to December 1992. We analysed these patients retrospectively with median follow up time of 28 months, one hundred and four patients(95%) were followed up from 15 to 69 months. In methods, twenty-eight patients were treated with median radiation dose irradiated 54.3Gy only. Fifty-six patients were treated with combined chemoradiotherapy. Sixteen cases of these patients were treated with concurrent chemoradiation and the other patients(forty cases) were treated sequential chemoradiotherapy. In concurrent chemoradiotherapy group, patients received 5-FU continuous IV infusion for 4 days. Cisplatin IV bolus, and concurrent esophageal irradiation to 30 Gy. After that patients received 5-Fu continuous IV, Cisplatin bolus injection and Mitomycin-C bolus IV, Bleomycin continuous IV, and irradiation to 20 Gy. In sequential chemoradiotherapy group, the chemotherapy consisted of 5-FU 1,000 mg/m2 administered as a continuous 24 hour intravenous infusion during five days and Cisplatin 80-100 mg/m2 bolus injected, or Bleomycin, Vinblastine, Cisplatin, Methotrexate were used of 1 or 2 cycles. After preoperative concurrent chemoradiation, twenty-six patients underwent radical esophagectomy. RESULTS: ninety-three patients could be examined for response assessment. By treatment modality, response rates were 85.1% for radiation alone group and 86.3% for combined chemoradiation group. But in operation group, after one cycle of concurrent chemoradiation treatment, response rate was 61.9%. Ther pathologic complete response were 15.4% in operation group. Overall median survival was 11 months and actuarial 5-year survival rate was 8%. The median survival interval was 6 months for radiation alone group, 11 months for combined chemoradiation group and 19 months for operation group. And also median survival was 19 months for complete responder group that 8 months for noncomplete responder group. In univariative analysis, statistically significant prognositc factors were tumor size, clinical stage, tumor response, and operation. In multivariative analysis, siginificantly better survival was associated with clinical stage, tumor response, radiation dose, and peration. CONCLUSION: Compared with radiotherapy alone, combined mulimodlity may improve the median survival in patients with localized carcinoma of the esophagus and toxicity is acceptable.
Bleomycin ; Chemoradiotherapy ; Cisplatin ; Drug Therapy ; Esophageal Neoplasms* ; Esophagectomy ; Esophagus ; Fluorouracil ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Methotrexate ; Mitomycin ; Protestantism ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Vinblastine

OBJECTIVES: Neurobiological models for obsessive-compulsive disorder(OCD) have consistently implicated prefrontal-striatal circuits in the pathophysiology of this disorder. But, prior studies have inconsistently found alteration in caudate and frontal lobe volumes in patients with OCD. This study was undertaken in the hope that semi-automated linear transformation methods would elucidate the morphometric differences of various parts of brain between OCD and normal control group. METHODS: Thirteen patients meeting the DSM-IV criteria for OCD, and 9 psychiatrically normal comparison subjects participated in the study. 3-D brain MRIs using Spoiled gradient-recalled (SPGR) sequence were acquired for each subjects. After spatially normalized according to Talairach and Tournoux's coordinates, the gray and white matters were segmented by semiautomated methods using fuzzy algorithm. Each lobal volumes was measured according to Talairach and Tournoux's coordinates, and the region of interests of caudate nuclei was manually traced. The frontal lobe was divided into 3 subregions; dorsolateral prefrontal cortex, orbital frontal cortex, mesial frontal cortex accoring to the coordinates and Broadman's cytoarchitectonics. RESULTS: Only the volume of left and right frontal gray matter showed a significant difference between OCD and normal subjects. In OCD, the frontal gray matter volume was increased in tendency. There's no difference in laterality and no coorelation with clinical severities. CONCLUSION: Findings of increased frontal gray matter volumes in patients implicate a structural abnormality of these brain regions in the pathophysiology of OCD. The increased frontal gray matter volumes reflect a epiphenomena due to increased cerebral blood flows and metabolic rates before the structural changes may occur.
Brain* ; Caudate Nucleus ; Diagnostic and Statistical Manual of Mental Disorders ; Frontal Lobe ; Hope ; Humans ; Magnetic Resonance Imaging* ; Obsessive-Compulsive Disorder* ; Orbit ; Prefrontal Cortex

PURPOSE: A pancreatic ductal adenocarcinoma is one of the most fatal cancers, as the majority of the patients present with locally advanced or metastatic tumors in the late stages of the disease. However, there is no simple, sensitive, noninvasive, and inexpensive test for the early detection of pancreatic ductal adenocarcinomas. In recent studies, S100A4 has emerged as an important protein in the tumorgenesis of pancreatic adenocarcinomas. METHODS: The possibility of the expression of S100A4 as a new tumor marker of pancreatic adenocarcinomas was confirmed using immunohistochemistry to 32-pancreatic ductal adenocarcinomas, 20 IPMN (intraductal papillary mucinous neoplasm), 8 serous cystadenomas, 5 chronic pancreatitis and 3 neuroendocrine tumors. RESULTS: Thirty-one (96.9%) ductal adenocarcinoma cases and 11 (55.5%) IPMN expressed S100A4, whereas all normal pancreatic tissues (47 cases), chronic pancreatitis and endocrine tumors did not. The expression of S100A4 was associated with the degree of dysplasia in IPMN, but not with the differentiation of ductal adenocarcinomas. CONCLUSION: The overexpression of S100A4 in adenocarcinomas and early emerging IPMN may suggest its potential as a diagnostic marker for the early detection of pancreatic ductal adenocarcinomas.
Adenocarcinoma* ; Carcinoma, Pancreatic Ductal ; Cystadenoma, Serous ; Humans ; Immunohistochemistry ; Mucins* ; Neuroendocrine Tumors ; Pancreas* ; Pancreatic Ducts ; Pancreatitis, Chronic ; Biomarkers, Tumor

Acute humoral rejection after renal transplantation is associated with a higher frequency of allograft dysfunction and graft loss. We report a case of acute humoral rejection which was treated successfully with plasmapheresis and intravenous immunoglobulin. A 31- year-old man developed azotemia after kidney transplantation. Kidney biopsy finding was compatible with antibody-mediated rejection, demonstrated by the infiltration of monocytes and neutrophils and the deposition of C4d on glomerulus and peritubular capillaries. We performed five plasmapheresis with concomitant treatment of intravenous immunoglobulin after each session. With aggressive treatment, there was improvement of oliguric acute renal failure, accompanied by decrease in the percentage of PRA and the titer of donor specific antibodies. Repeated kidney biopsy revealed persistent C4d staining on peritubular capillaries despite disappearance of donor specific antibodies. In conclusion, plasmapheresis and intravenous immunoglobulin are effective in treating acute humoral rejection.
Male ; Humans ; Biopsy

BACKGROUND: Although several interventional pain management procedures (IPs) for reducing the acute herpes zoster (HZ)-related pain have shown some level of effectiveness on early pain relief and the prevention of postherpetic neuralgia (PHN), no conclusive evidence has been presented to support their effectiveness. OBJECTIVE: We evaluated the effectiveness of IPs during the acute phase of HZ for reducing HZ-related pain. METHODS: Sixty-one patients with acute HZ were assessed using the pain visual analogue scale (VAS) that ranges from 0 to 10 at the initial visit and after 1, 3 and 6 months. Changes in pain VAS and the incidence of PHN (pain after 1 month) were compared between 2 patient groups: those who received standard therapy with oral antivirals and analgesics (ST, n=38) and those who received standard therapy with IPs (STIPs, n=23). PHN was defined as either "pain of 1 or higher in pain VAS" or "clinically meaningful PHN (pain of 3 or higher in pain VAS)." RESULTS: Although the initial pain VAS level of patients treated with STIPs (5.74) was higher than that of patients receiving ST (4.09), no significant difference in pain VAS number was seen between the 2 groups at 3 months (0.13 vs. 0.17) and 6 months (0.09 vs. 0.03) of follow-up. The incidence of PHN also was not statistically significant different between the 2 groups at 3 (9.5% vs. 8.3%) and 6 months (9.5% vs. 4.2%). A similar trend was observed in the analysis of HZ patients whose pain VAS level was 3 or higher at the initial assessment. CONCLUSION: Standard therapy with early IPs is effective for rapidly reducing HZ-related pain.
Analgesics ; Antiviral Agents ; Follow-Up Studies ; Herpes Zoster* ; Humans ; Incidence ; Neuralgia, Postherpetic ; Pain Management*

No abstract available.
Lasers, Solid-State* ; Melanocytes* ; Nevus*

BACKGROUND: This study was conducted to evaluate the significance of serum eosinophil cationic protein (ECP) and high-sensitivity C-reactive protein (hs-CRP) levels in children with allergic diseases and non-allergic inflammatory diseases, and to assess the relationships between serum ECP levels and inflammatory parameters. METHODS: In this study, we included 146 children with allergic diseases, 76 children with non-allergic inflammatory diseases, and 25 control subjects. Serum concentrations of ECP, hs-CRP, total IgE, and allergen-specific IgE were measured. RESULTS: Serum ECP levels (77.5+/-88.2 microg/L) of patients with allergic diseases were significantly higher than those of the patients with non-allergic inflammatory diseases (42.2+/-58.8 microg/L) and control subjects (12.7+/-4.2 microg/L) (P<0.001, respectively). The serum ECP levels in patients with non-allergic inflammatory diseases were also significantly higher than those in the controls (42.2+/-58.8 vs. 12.7+/-4.2 microg/L; P<0.001). The hs-CRP levels were significantly higher in patients with allergic diseases than in the controls (0.4+/-0.9 vs. 0.1+/-0.2 mg/dL; P<0.05). No significant relationship was observed between serum ECP and hs-CRP levels in the allergic patients (r=0.09, P>0.05). CONCLUSIONS: Measurement of serum ECP and hs-CRP concentrations can be helpful in the clinical evaluation and monitoring of patients with allergic diseases. No significant correlation was observed between serum ECP and hs-CRP levels in allergic patients, thereby suggesting that elevated levels of ECP do not necessarily reflect the degree of systemic inflammation in allergic diseases.
C-Reactive Protein ; Child ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Immunoglobulin E ; Inflammation

PURPOSE: This study aimed to investigate the association between skeletal maturation and adrenal androgen levels in obese children and adolescents. METHODS: Fifty-three children and adolescents (aged 7–15 years) diagnosed as obese or overweight were investigated. Anthropometric measurements, bone age (BA) determination, serum biochemical analyses, and hormonal measurements were performed. The difference between BA and chronological age (BA–CA, dBACA) was calculated and used to represent the degree of advanced skeletal maturation. RESULTS: Thirty-one subjects were classified into the obese group and 22 subjects into the overweight group. Insulin resistance as calculated by the homeostasis model assessment of insulin resistance (HOMA-IR) was significantly higher in the obese group than in the overweight group (4.03±2.20 vs. 2.86±1.11, P=0.026). The skeletal maturation of the obese group was advanced, but the dBACA did not differ between the obese and overweight groups statistically (1.43±1.35 vs. 0.91±1.15, P=0.141). Serum dehydroepiandrosterone sulfate (DHEA-S) levels were significantly higher in subjects with dBACA>1 compared to those with dBACA≤1 (104.3±62.2 vs. 59.6±61.0, P=0.014). Correlation analyses demonstrated that dBACA was positively correlated with body mass index standard deviation scores (r=0.35, P=0.010), fasting insulin (r=0.36, P=0.009), HOMA-IR (r=0.30, P=0.031), and insulin-like growth factor-binding protein-3 (r=0.331, P=0.028). In multivariate linear regression analysis, HOMA-IR (P=0.026) and serum DHEA-S (P=0.032) were positively correlated with the degree of advanced skeletal maturation. CONCLUSION: Advanced skeletal maturation is associated with increased insulin resistance and elevated DHEA-S levels in obese children and adolescents.
Adolescent* ; Age Determination by Skeleton ; Androgens ; Body Mass Index ; Child* ; Dehydroepiandrosterone Sulfate ; Fasting ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Linear Models ; Obesity ; Overweight

PURPOSE: The aim of this study is to analyze the clinical results of using the technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff. MATERIAL AND METHODS: Form January 2005 to January 2007, we performed the arthroscopic biceps repair with incorporating suture to the rotator cuff for 21 patients with large or massive rotator cuff tear. The mean follow up period was 23 months (range: 6-48months). The number of males and females was 9 and 13, respectively. The age distribution ranged from 47 to 73 years with a mean age of 60.3 years. We compared the preoperative score with the postoperative scores using the University of California Los Angeles (UCLA) score, the shoulder index of the American Shoulder and Elbow Surgeons (ASES) and a simple shoulder test (SST). RESULTS: The improvement in the VAS, ASES and the UCLA and SST scores was statistically significant at the final follow up (average follow-up 23 months) (p>0.05). Two of nine cases were found to have partial tear with continuity but seven cases were found to have complete tear according to the ultrasonography and MRI. CONCLUSION: The technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff is considered to be recommendable.
Age Distribution ; California ; Elbow ; Female ; Follow-Up Studies ; Head ; Humans ; Los Angeles ; Male ; Rotator Cuff ; Shoulder ; Sutures ; Tendons