Lateral medullary syndrome is famous for its unique symptom complex such as crossed sensory change or Homer syndrome, and thus hardly can be misdiagnosed. Though this syndrome has been reported to be able to accompany ipsilateral motor weakness, the sensory change of extremities is known to be almost always contralateral to the lesion. We recently experienced one case presented with weakness and dysmetria on the right associated with ipsilateral sensory change. But few days later, he showed additional neurologic signs compatible with right lateral medullary syndrome. Brain MRI showed rostro-caudally elongated lesion extending from right lateral medulla to the upper cervical cord. Here we suggest the probable neuroanatomical substrate for this symptom and clinico-radiologic relationship with previous literature.
Brain ; Cerebellar Ataxia ; Extremities ; Lateral Medullary Syndrome* ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Stroke*

Pulmonary Embolism, one of the causes of maternal death, is a life threatening disease that needs early and accurate diagnosis. We have exprerienced a case of a fatal pulmonary embolism which was diagnosed by lung perfusion scan on the postoperative 1 day after cesarean delivery and was managed with heparin therapy. We present this case with a brief review of literatures.
Diagnosis ; Heparin ; Lung ; Maternal Death ; Perfusion ; Pulmonary Embolism*

Meningeal irritation signs sometimes develop after myelography due to bacterial infection by contamination during the procedure or chemical irritiation by contrast media itself. CSF profiles of chemical meningitis often mimick those of bacterial meningitis, sometimes causing difficulty in differentiation, but in that case clinical course soon reverse in short time without any complication. Postmyelography chemical meningitis by metrizamide (AmipaqueR) has been well described but iohexol (OmnipaqueR) has rarely been reported to cause chemical meningitis. We experienced a patient of chemical meningitis by iohexol and here descibe the case.
Bacterial Infections ; Contrast Media ; Humans ; Iohexol ; Meningitis* ; Meningitis, Bacterial ; Metrizamide ; Myelography*

A clinical analysis of 249 patients with maxillo-facial trauma, who underwent general anes- thesia from January 1992 to December 1993 at Lee-Rha General Hospital, were made in order to investigate various case characteristics such as sex ratio, age distribution, types of trauma, fracture sites, associated injuries, underlying medical problems, abnormal laboratory findings, intubation, and preoperative physical condition. It was found that males outnumbered females showing the peak age incidence in 20's and 30's. The high velocity motor vehicle accidents was the most common cause of trauma and the mandible was the most frequent fracture sites. Among 96 associated injury cases, 63 cases were neumsurgical problems. Underlying medical problems or abnormal laboratory findings were present in 28.9% of the patients studied and preoperative physical status 1 or 1E (ASA classification) was most common accounting for 54.8% of the patients studied. Of the patients who received endotracheal intubation, 73.5% were done via a nasotracheal route.
Age Distribution ; Anesthesia ; Female ; Hospitals, General ; Humans ; Incidence ; Intubation ; Intubation, Intratracheal ; Male ; Mandible ; Motor Vehicles ; Sex Ratio

Recently, xenograft is being increasingly used in spinal fusion to reduce complications such as pain or bleeding following autograft bone grafting. The purpose of this study was to compare the fusion rate and clinical results between autograft and xenograft in 69 patients who had posterolateral lumbar fusion with instrumentation from March 1989 to April 1997. The xenograft was mixed with autogenous bone chips obtained from decompresion. Fusion and clinical results were evaluated with Furguson's method and Modified Smiley-Webster' scale, respectively. The mean follow-up time was 26 months with a minimum of 12 months and a maximum of 41 months. The results are as follows: fusion rates of autograft were 64.6% in Furguson grade A, 25.8% in grade B, 6.4% in grade C and 3.2% in grade D. Xenograft was 15.7% in grade A, 47.6% in grade B, 23.6% in grade C and 13.1% in grade D. Clinical results of autograft were excellent in 29.0%, good in 61.3%, fair in 6.5% and poor in 3,2%. Xenograft was excellent in 23.8%, good in 57,8%, fair in 15.8% and poor in 2.6%. Autograft showed a higher fusion rate of 90.4% than xenograft of 63.3% in grade A and B (P=0.012). Clinical results were not different between autograft and xenograft groups (P=0.494). However, the xenograft group showed lower fusion rate than the autograft group. The results indicated that xenograft is less useful for posteolateral fusion of the lumbar spine.
Autografts* ; Bone Transplantation ; Follow-Up Studies ; Hemorrhage ; Heterografts* ; Humans ; Spinal Fusion ; Spine

PURPOSE: Mycoplasma pneumoniae is one of the most common causes of pneumonia in children and adolescents. Though cold agglutinin test and specific antibody test are used in the diagnosis of mycoplasma pneumonia, there are some limitations in early diagnosis. In this study, we evaluated the availability and usefulness of polymerase chain reaction (PCR) in the diagnosis of M. pneumoniae pneumonia and compared it with serologic test. METHODS: One hundred twenty four children who were clinically diagnosed with pneumonia and admitted to Kyunghee Hospital from January 1998 to March 2001 were enrolled. Mycoplasma specific antibody test using commercial kit (Serodia-MYCO II, Fusirebio Inc., Tokyo, Japan) and PCR using mycoplasma DNA obtained from throat swabs were done. The sensitivity and specificity of PCR were evaluated. RESULTS: M. pneumoniae pneumonia was diagnosed when the mycoplasma specific antibody titer was over 1: 160 or when the titer increased more than fourfold during follow-up period. The specificity, sensitivity, false-positive rate and false-negative rates of PCR were 93.0%, 58.3%, 33.3%. and 9.7%, respectively. CONCLUSION: PCR has shown high specificity. But, the positive result in PCR don't correlate with the disease activity and PCR does not have high sensitivity. So PCR must be used alongside with serologic test in the diagnosis of pneumonia. But, it seems possible to improve sensitivity by delicate handling of samples and by improving PCR technology, and PCR will possibly be used in the diagnosis of early infections of M. pneumoniae pneumonia and in the evaluation of treatments in the future.
Adolescent ; Child* ; Diagnosis ; DNA ; Early Diagnosis ; Follow-Up Studies ; Humans ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pharynx ; Pneumonia* ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Serologic Tests

Hemichorea after cortical infarction has rarely been reported. We report a female patient in which hemichorea of the right extremities developed following a left temporo-parietal infarction. An acute infarction in the territory of the inferior division of the left middle cerebral artery was evident in diffusion-weighted imaging, but the basal ganglia, thalamus, and brainstem appeared normal. Her choreic movement gradually improved after administering haloperidol, and the hemichorea disappeared after 4 days.
Basal Ganglia ; Brain Stem ; Chorea ; Extremities ; Female ; Haloperidol ; Humans ; Infarction* ; Middle Cerebral Artery ; Thalamus

Children aged 3~5 years old represent the challenge in pulmonary function assessment, since evaluating lung function in preschool age group is important for the appropriate treatment for patient with chronic and recurrent cough and wheeze during this period. The joint American Thoracic Society/European Respiratory Society task force has produced recommendations for the spirometric lung function test currently used in the preschool age group. The reliable scientific evidence, documented references and reviews by the experts were used as a support. Reference data of spirometry lung function in preschool children were available in several countries including USA, Norway, Czech, Israel, Canada, and Taiwan. Spirometric pulmonary function tests are feasible in 3~ to 5~year~old children. However, the existing data are not sufficient to make definitive recommendations. Recommendations will need to be revised periodically until sufficient evidence has been collected to make definitive guidelines in various situations.
Advisory Committees ; Aged ; Canada ; Child ; Child, Preschool ; Cough ; Humans ; Israel ; Joints ; Lung ; Norway ; Respiratory Function Tests ; Spirometry ; Taiwan

PURPOSE: Reported incidence of urinary incontinence after a radical prostatectomy (RP) varies between studies. This may be due not only to the definition of incontinence applied, but also how the information is acquired. We investigated the differences in perception of post robot-assisted laparoscopic RP (RALP) urinary incontinence acquired through doctor interviews and patient-reported questionnaires. MATERIALS AND METHODS: Of 238 consecutive men who underwent RALP by a single surgeon between July 2005 and February 2008, we evaluated 66 men using the International Consultation on Incontinence Questionnaire (ICIQ) at various time points after surgery. Each patient's ICIQ results were considered to be the patient's perceptions of urinary incontinence. The physician at the same time directly interviewed the patients about the number of pads used and considered complete continence to be equivalent to the use of no pads or safety liners. RESULTS: Of the 66 patients, the physician reported that 34 (51.5%) had obtained complete continence. However, analysis of the questionnaires of these 34 patients revealed that only 5 (14.7%) patients reported that they never leaked during the past 4 weeks. Most patients (11 patients, 32.4%) who did not use any pad did in fact reported leakage of a small or moderate amount of urine about once a day. CONCLUSION: Our results indicate that there are discrepancies in the perception of urinary incontinence between doctor and patient after RALP. Non-use of pads is not equivalent to obtaining complete urinary continence. Therefore, the number of pads used is not a good measure to determine the status of complete urinary continence.
Aged ; Aged, 80 and over ; Biopsy ; Humans ; Laparoscopy/methods ; Male ; Middle Aged ; Perception ; Physician-Patient Relations ; Prostatectomy/*adverse effects/methods ; Questionnaires ; Robotics ; Treatment Outcome ; Urinary Incontinence/*etiology

BACKGROUND: Atrial fibrillation (AF) and patent foramen ovale (PFO) are established sources of cardioembolism. We investigated differences in stroke outcome and patterns between PFO and AF. METHODS: We performed a retrospective review of the medical records and brain MR images of patients with AF or PFO from the prospective acute stroke and transient ischemic attack registry. Infarct pattern and volume on diffusion-weighted imaging, and the national institutes of health stroke scale (NIHSS) on admission were compared between patients with AF and PFO. RESULTS: From June 2005 to July 2008, a total of 289 subjects were enrolled (AF group, n=156; PFO group, n=133). Infarct pattern analyzed with MR images revealed that multiple vascular territorial infarction was more prevalent in AF group than in PFO group (26.9% vs. 8.3%, P<0.01). A probable cardiac embolism, radiologically defined as territorial infarction without symptomatic steno-occlusion of the corresponding artery, was more frequently documented in AF group than in PFO group (71.8% vs. 41.4%, P<0.01) The infarct volume of PFO was smaller than that of AF. Compared to AF, PFO was associated with the mild neurologic deficit (NIHSS< or =3) after adjusting age, sex and previous stroke history. CONCLUSION: These results suggested that AF and PFO had different characteristics such as infarct patterns and initial clinical severity although both are classified as cardioembolism.
Arteries ; Atrial Fibrillation ; Brain ; Embolism ; Foramen Ovale, Patent ; Humans ; Infarction ; Ischemic Attack, Transient ; Medical Records ; National Institutes of Health (U.S.) ; Neurologic Manifestations ; Prospective Studies ; Retrospective Studies ; Stroke