Ticlopidine, a widely used antiplatelet agent, has been rarely reported to cause thrombotic thrombocytopenic purpura (TTP). To the best of our knowledge, its occurrence has never before been reported in Korea. A 69 years old female patient suffered from an acute ischemic stroke. Ticlopidine 250mg bid was started and she followed an uneventful clin-ical course. The platelet count was normal on the 1st and the 12th day of ticlopidine administration. Around the 31st day, at home, she developed purpura, dyspnea and a stuporous mental status. Under the diagnosis of TTP, a plasma exchange was performed and her condition eventually returned to the baseline status. Ticlopidine induced TTP can developed abruptly despite close monitoring of platelet count, as illustrated by this case. Physicians prescribing ticlopi-dine should be aware of this potentially dangerous complication.
Aged ; Diagnosis ; Dyspnea ; Female ; Humans ; Korea ; Plasma Exchange ; Platelet Count ; Purpura ; Purpura, Thrombotic Thrombocytopenic* ; Stroke ; Stupor ; Ticlopidine*

No abstract available.

Although ventricular pacing alone initially had deemed adequate for most clinical situations, some patients did not do well after ventricular pacing was initiated, and developed various symptoms attributed to this mode of pacing. The pacemaker syndrome is complex of clinical signs and symptoms related to the adverse hemodynamic and electrophysiologic consequences of ventricular pacing in the absence of other causes. Neurologic symptoms or those congestive heart failure predominated. We recently experienced a case of pacemaker syndrome in a 44-year-old female who had suffered sick sinus syndrome and was implanted with dual chamber pacing system being programmed to VVI pacing. She complained of chest discomfort, dyspnea, and near-fainting in a day after being programmed to VVI. Blood pressure was decreased to 9/60mmHg. Electrocardiography showed toPwave onT wave, representing retrograde ventriculoatrial conduction. The symptoms and signs were disappeared immediately after the pacing system was programmed to DDD pacing.
Adult ; Blood Pressure ; Dichlorodiphenyldichloroethane ; Dyspnea ; Electrocardiography ; Female ; Heart Failure ; Hemodynamics ; Humans ; Neurologic Manifestations ; Sick Sinus Syndrome ; Thorax

Broncho-gastric fistula caused by benign gastric ulcer perforation after esophagectomy is very rare. In general anesthesia of a patient with broncho-gastric fistula, in spite of hyperventilation, leakage of the anesthetic gases through fistula may make the patient hypercapneic, and positive pressure ventilation may increase the risk of the pulmanary aspiration by the regurgitation of gastric fluid by stomach distension. For that reason, in this patient, denitrogenation was performed during patient's voluntary respiration with 100% oxygen for 5 minutes, and induction was performed without positive pressure ventilation, and one lung ventilation was carried out. Hypoxemia was followed by one lung ventilation because his pulmonary function was moderate obstructive type and his lung was damaged by aspiration of gastric fluid via broncho-gastric fistula. A low level of continuous positive airway pressure (CPAP) has no significant hemodynamic effect and can maintain the patency of nonventilated lung, so hypoxemia induced by one lung ventilation may be reduced. Thus we carried out one lung ventilation with CPAP (10 cmH2O) in nonventilated lung and blocked broncho-gastric fistula with a bronchial blocker for prevention of both regurgitation of gastric fluid and leakage of anesthetic gases. One lung anesthesia was performed without any problem in this case.
Anesthesia ; Anesthesia, General* ; Anesthetics, Inhalation ; Anoxia ; Continuous Positive Airway Pressure ; Esophagectomy ; Fistula* ; Hemodynamics ; Humans ; Hyperventilation ; Lung ; One-Lung Ventilation ; Oxygen ; Positive-Pressure Respiration ; Respiration ; Stomach ; Stomach Ulcer

BACKGROUND: Acromioclavicular (AC) stability is maintained through a complex combination of soft-tissue restraints that include coracoclavicular (CC), AC ligament and overlying muscles. Among these structures, the role of the CC ligament has continued to be studied because of its importance on shoulder kinematics, especially after AC injury. This study was designed to determine the geometric change of conoid and trapezoid ligaments and resulting stresses on these ligaments according to various scapular motions. METHODS: The scapuloclavicular (SC) complex was isolated from a fresh-frozen cadaver by removing all soft tissues except the AC and CC ligaments. The anatomically aligned SC complex was then scanned with a high-resolution computed tomography scanner into 0.6-mm slices. The Finite element model of the SC complex was obtained and used for calculating the stress on different parts of the CC ligaments with simulated movements of the scapula. RESULTS: Average stress on the conoid ligament during anterior tilt, internal rotation, and scapular protraction was higher, whereas the stress on the trapezoid ligament was more prominent during posterior tilt, external rotation, and retraction. CONCLUSIONS: We conclude that CC ligament plays an integral role in regulating horizontal SC motion as well as complex motions indicated by increased stress over the ligament with an incremental scapular position change. The conoid ligament is the key structure restraining scapular protraction that might occur in high-grade AC dislocation. Hence in CC ligament reconstructions involving only single bundle, every attempt must be made to reconstruct conoid part of CC ligament as anatomically as possible.
Biomechanical Phenomena ; Cadaver* ; Dislocations ; Ligaments* ; Muscles ; Scapula ; Shoulder

OBJECT: In order to compare several Obstetric characteristics and outmmes of teenage pregnancy. METHODS: The 10 year clinical records of 11,583 women undergoing Cesarean section and delivery were reviewed in the department of Obstetrics and Gynecology, Incheon Christian Hospital from July 1, 1989 to June 30, 1999. There were seventy-eight pregnancies under age 20 and we compared them with two hundred pregnancies aged 20-29 who were randomly chosen during the same periods as the control group. RESULT: The following results were obtained. The proportion of birth by teenagers increased from 0.5% of all birth in 1989 to 2.61% in 1999. The most of cases were in high teen group, age 14- 19.The majority(50.5%) were in the age of 19. Seventy two cases(92.3%) had no previous pregnant history. Six cases had one previous pregnant history. The frequencies of prenatal care were significantly lower than that of the control group(p<0.05). The mean gestational period was 36+4weeks, and showed significant difference between the study group and the control group(39+3 weeks). The incidence of preterm labor was significantly different between the two proups(p<0.05). But the incidence of postterm delivery were not significantly different between the two groups. The mean weight gain of pregnant teenagers revealed 10.64kg, significantly less profound than the control group. The matemal weight gain of control group revealed 12.95kg, respectively. The mean birth weight(2.54kg) of infant was significantly less profound than the control group. The incidence of birth of small for gestational age(birth weight 1,500-2,499gm ; 14.5%) was significantly increased among study group than the control group(1%). The rate of abdominal delivery(21.8%) were not significantly decreased than the control group(47%). The incidence of cephalopelvic disproportion and malpresentation for cesarean section were somewhat higher than the control group, and were statistically significant(p<0.05). During the antepartun period, anemia, pyelonephritis, and preterm labor occurred more frequently in the teenage pregnancy than the control group, but not statistically significant. Among postpartum complications, incidence of anemia(51.3%) increased significantly. The perinatal mortality, intrauterine growth retardation, congenital anomaly occurred more frequently than the control group. CONCLUSION: These results show that pregnancy of teenage will be comeout high risk and complications. And then we will be more concern and study about teenage pregnancy.
Adolescent ; Anemia ; Cephalopelvic Disproportion ; Cesarean Section ; Female ; Fetal Growth Retardation ; Gynecology ; Humans ; Incheon ; Incidence ; Infant ; Obstetric Labor, Premature ; Obstetrics ; Parturition ; Perinatal Mortality ; Postpartum Period ; Pregnancy ; Pregnancy in Adolescence* ; Prenatal Care ; Pyelonephritis ; Weight Gain

Marjolin's ulcer is a malignant degeneration of cicatrical tissue, especially in chronic burn scar. Since the first description by Jean Nicholas Marjolin(1828), many studies for Marjolin's ulcer have been performed and reported. From 1985 to 1997, we experienced 20 cases in 14 patients diagnosed as Marjolin's ulcer clinically, and we analysed malignant transformation rate, induction period of Marjolin's ulcer and prevention of Marjolin's ulcer, etc. The results are summarized as follows. 1) The sex distribution was predominant in male(64.3%). 2) The most common cause of injury was flame burn(78.6%). 3) The mean age at the time of diagnosis was 45.6 years and the average lag period was 20.6 years. 4) The pathologic types of Marjolin's ulcer were squamous cell carcinoma(57.2%), followed by dyspasia(28.6%), acnthosis and hyperkeratosis(14.2%). 5) The locations of ulcers were frequently on the lower extremity(42.9%), followed by upper extremity(35.7%) and trunk (21.4%). 6) The lymph node involvements were 3 patients out of the 8 patients who were confirmed as squamous cell carcinoma. 7) The modalities of treatment were skin graft (18 cases, 12 patients), myocutaneous flap(1 case, 1 patient), fasciocutaneous flap(1 case, 1 patient).
Burns ; Carcinoma, Squamous Cell ; Cicatrix ; Diagnosis ; Humans ; Lymph Nodes ; Sex Distribution ; Skin ; Transplants ; Ulcer*

A clinical and radiological study was done on 96 cases of spontaneous pneumothorax, encoutered in the Dept. ofRadiology, Busan National University Hospital during last 3 years from March. 1979 to March 1982. The results weresummarized as follows; 1. In the age distribution, the ages between 20 and 39 years were most highest, as 54 cases(56.3%). In the sex distribution, the ratio of male to female was 5:1 in male predominance. 2. The underlyingpathology of the total 96 cases of spontaneous pneumothorax were of tuberculous origin in 33.3% andnon-tuberculous origin in 66.7%. And below 20 years, most were of non-tuberculous origin. 3. In the cases of lungcollapse over 2/3, non-tuberculous origin was more than tuberculous origin and had characteristics of significantmediastinal shifting, in contrast to lower percentage of fluid level by chest radiography. 4. The rupture of blebsor bullae was the main immediate causes of spontaneous pneumothorax, independent of the underlying pathology. 5.In only 27 cases (28.1%) among total 96 cases, bullae or blebs could be detected on the chest radiography. 6. Intreatment of spontaneous pneumothorax, the closed thoracotomy with under water seal drainage is accepted to be thegeneral method of treatment. But open thoracotomy is considered as the best useful therapeutic procedure toprevent the recurrence, whenever bullae of blebs are found on the chest radiography. 7. In the cases of closedthoracotomy, the recurrent rate was 25.0% and most cases were found at the ipsilateral side of the first attack.8. Within a week, the collpased lung were well expanded in most cases of total 96 cases, after closed thoracotomy.
Age Distribution ; Blister ; Busan ; Drainage ; Female ; Humans ; Lung ; Male ; Methods ; Pathology ; Pneumothorax ; Radiography ; Recurrence ; Rupture ; Sex Distribution ; Thoracotomy ; Thorax ; Water

We report a case of a 44 year old femele with unilateral aldosterone-proudcing adrenal adenoma characterized by hypertension, plasma aldosterone excess, and low plasma renin, commonly but not invariably with hypokalemia. She also had asymmetric septal hypertrophy of left ventricle established with two-dimensional echocardiography. The electrocardiogram showed inverted T wave and prominent U wave with high QRS voltage on precordial leads. In the case of this patient, we are not sure whether asymmetric septal hypertrophy was caused by secondary hypertension and chronic aldosterone excess of primary aldosteronism, or hypertrophic cardiomyopathy per se, so further long=term follow-up is required to determine it. Following the successful unilateral adrenalectomy, however, the systemic pressure fell down to the normal level and electrolyte abnormalities were corrected immediaterly within a few days and the modest regression in septal hypertrophy was noted in one year, suggesting that the promary aldosteronism contributes to the development or porgression of asymmetric septal hepertrophy.
Adenoma ; Adrenalectomy ; Adult ; Aldosterone ; Cardiomyopathy, Hypertrophic* ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Heart Ventricles ; Humans ; Hyperaldosteronism* ; Hypertension ; Hypertrophy ; Hypokalemia ; Plasma ; Renin

Serial neurosonographic examinations are routinely performed at frequent intervals during nursery course of all preterm infants of very low-birth-weight who are admitted to the intensive care nursery of Presbyterian Medical Center from November 1, 1990 to July 30, 1992. After discharge, the following survivors who had received periodic, serial scanning by meas of cranial ultrasonography were longitudinally observed in an interdisciplinary neurodevelopmental follow-up program to a mean corrected age of 13 months. Neurodevelopmental outcome was assessed by means of Vojta's postural reaction and other neurological examinations. The results are as follows: 1) The incidence of PV-IVH in the study was 79%. 2) According to Papile's grading system of PV-IVH, gradel was 20%, gradell was 46%, gradelll was 19%, and grade IV was 13%. 3) The risk factors associated with PV-IVH were birth weight, gestational age, apgar score, ventilator care, RDS, and sepsis. 4) The mortality of PV-IVH was 20% for gradel, 19% for gradell, 44% for gradelll, and 67% for grade lV. 5) According to relationship between PV-IVH and neurodevelopmental outcome, in two of the four subjects with grade lll PV-IVH, moderate/severe CCD was developed. 6) According to relationship between PVE with cysts and nuerodevelopmental outcome, moderate/severe PVE with periventricular cysts larger than 3mm in diameter was associated with development of severe CCD.
Apgar Score ; Birth Weight ; Follow-Up Studies ; Gestational Age ; Hemorrhage* ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature* ; Critical Care ; Mortality ; Neurologic Examination ; Nurseries ; Protestantism ; Risk Factors ; Sepsis ; Survivors ; Ultrasonography ; Ventilators, Mechanical