BACKGROUND AND OBJECTIVES: Stroke onset is known to vary by several factors. Although it has been known that stroke may develop most frequently in the morning, its association with the type of activity has quite rarely been described. METHODS: We prospectively investigated by interview the time of and the activity during or before the onset of stroke in patients with acute cerebral infarction from Aug. 1995 to Mar. 1996. The activities were subdivided into basal metabolic rate state, sedentary, light, moderate, and heavy movements based on the caloric expenditure. RESULTS: One hundred-twenty five patients were enrolled. The time of day when ischemic stroke most frequently occurred was from 8:00 AM to noon. The type of activity was significantly associated with stroke onset in that it developed most commonly during and just after sleep or resting. The relationship between the onset of stroke and such patterns of onset time and the activity was found only in the atherothrombotic infarction, but not in the other stroke types. CONCLUSION: We demonstrated that stroke has clear diurnal variation. Our observations also suggested that the activity may be significantly associated with stroke onset. These findings may be useful for better understanding of the pathogenesis and prevention of ischemic stroke.
Basal Metabolism ; Cerebral Infarction* ; Health Expenditures ; Humans ; Infarction ; Prospective Studies ; Stroke

BACKGROUND: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with communityacquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of .dying of severe community-acquired pneumonia. METHODS: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. RESULTS: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnea, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+)cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Save patients death(70%) occured after admission within the first five days, and a mean duration of hospitalization was 11.2 days. CONCLUSION: As the results show most death occured within the first days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.
Adult ; Anoxia ; Anti-Bacterial Agents ; Azotemia ; Cyanosis ; Enterobacter ; Female ; Hope ; Hospitalization ; Humans ; Hypoalbuminemia ; Hypotension ; Critical Care ; Korea ; Leukocytosis ; Leukopenia ; Male ; Medical Records ; Mortality ; Patients' Rooms ; Pneumonia* ; Prognosis ; Prospective Studies ; Respiratory Insufficiency ; Retrospective Studies ; Sputum ; Tachypnea ; Vancomycin

STATEMENT OF PROBLEM: The high melting temperature and chemical reactivity of titanium necessitates casting machines different from those used in conventional casting. Despite the new developments in Ti casting systems, inadequate mold filling and internal porosity are frequently observed casting defects. Therefore, the study on the fabrication technique including sprue design to solve these casting defects is still necessary. PURPOSE: The purpose of this study was to evaluate the effect of sprue design and cross sectional area of sprue on the internal porosity. MATERIALS AND METHODS: 30 simulated cast three units titanium crowns were prepared. 5 cast crowns for each with different sprue design(sinlge sprue, double sprue and plate sprue) of two cross sectional areas(small and large cross sectional areas) were fabricated. The sections of titanium castings were photographed in a microscope at x100 magnification to record internal porosities. RESULTS AND CONCLUSION: Within the limits of this study, the following conclusions were drawn: 1. There was a significantly lower in internal porosity of titanium castings for large cross sectional area of sprue group than the small group(P>.05). 2. There was no significant difference in internal porosity among sprue designs in similar cross sectional area of sprue(P>.05).
Celiac Disease* ; Crowns ; Freezing ; Fungi ; Porosity* ; Titanium*

Cardiac manifestations of hypereosinophilic syndrome rarely include left ventricular thrombosis leading to peripheral emboli. And the cases of thrombectomy in patients with left ventricular thrombus and hypereosinophilic syndrome are extremely rare. Recently we experienced a 58-years-old woman with hypereosinophilic syndrome, the history of thalamic infarction and a huge thrombi in left ventricle. We report this case with literatures.
Female ; Heart Ventricles ; Humans ; Hypereosinophilic Syndrome* ; Infarction ; Thrombectomy ; Thrombosis*

BACKGROUND: Facial rejuvenation can be achieved using a variety of techniques. Since minimally invasive procedures for face lifting have become popular because of their convenience and short operating time, numerous minimally invasive surgical procedures have been developed. In this study, a nonabsorbable polypropylene mesh is introduced as a new face lifting instrument, with the nasolabial fold as the main target area. In this paper, we report the efficacy and safety of a polypropylene mesh in midface rejuvenation. METHODS: Thirty-three subjects with moderate-to-severe nasolabial folds were enrolled from two medical institutions for a noncomparative single-sample study. A mesh was inserted above the superficial muscular aponeurotic system layer, reaching the nasolabial folds through a temporal scalp incision. After 3 weeks, the temporal end of the mesh was pulled to provide a lifting effect. Then, the mesh was fixed to the deep temporal fascia using nonabsorbable sutures. To evaluate efficacy, we compared the scores on the Wrinkle Severity Rating Scale and a visual analog scale for patient satisfaction between the baseline and 7 weeks postoperatively. In addition, we evaluated safety based on the incidence of adverse events. RESULTS: The treatment was deemed effective at improving wrinkles in 23 of 28 cases, and patient satisfaction improved significantly during the study period. There were seven cases of skin or subcutaneous tissue complications, including edema and erythema, but there were no suspected serious adverse events. CONCLUSIONS: Face lifting using a nonabsorbable mesh can improve nasolabial folds without serious adverse effects. Thus, this technique is safe and effective for midface rejuvenation.
Edema ; Erythema ; Fascia ; Incidence ; Lifting ; Nasolabial Fold ; Patient Satisfaction ; Polypropylenes* ; Rejuvenation* ; Rhytidoplasty ; Scalp ; Skin ; Subcutaneous Tissue ; Surgical Procedures, Minimally Invasive ; Sutures ; Visual Analog Scale

PURPOSE: To evaluate the clinical outcome and other relevant factors in cases where local intra-aterial thrombolysis (LIT) is used for the threatment of hyperacute ischemic stroke. MATERIALS AND METHODS: Forty-eight hyperacute ischemic stroke patients were treated by LIT, using urokinase, within six hours of ictus, and for evaluation of their neurological status, the National Institutes of Health Stroke Scale (NIHSS) score was used. Angiographic recanalization was classified according to Mori recanalization grades. Three months after LIT, the outcome was assessed by clinical examination using the modified Rankin scale (good outcome: RS=0-3; poor outcome: RS=4-6). In all patients, the findings of pre- and post- LIT CT, and angiography, as well as neurological status and hemorrhagic complications, were also analysed. RESULTS: Thirty-three patients had occlusions of the middle cerebral artery (MCA), and 15, of the internal carotid artery (ICA). The NIHSS score averaged 16.9 at the onset of therapy and 13.5 at 24 hours later. Successful recanalization (Mori grade 3,4) was achieved in 28 (58.3%) of 48 patients, but in 20 (41.7%) the attempt failed. Twenty-two (45.8%) of the 48 patients had a good outcome, but in (54.2%) the outcome was poor. Thirteen (40.6%) of 32 patients with MCA occlusions and 13 (81.2%) of 16 with ICA occlusions had a poor outcome. Eight patients (16.7%) died. Overall, hemorrhages occured in 20 (41.7%) of 48 patients, with symptomatic hemorrhage in ten. Five (50%) of these ten died. CONCLUSION: LIT using urokinase for hyperacute ischemic stroke is feasible; patients with MCA occlusions had better outcomes than those with ICA occlusions. Hemorrhagic complications of LIT were frequent, and in cases of symptomatic hemorrhage a fatal outcome may be expected.
Angiography ; Carotid Artery, Internal ; Fatal Outcome ; Hemorrhage ; Humans ; Middle Cerebral Artery ; National Institutes of Health (U.S.) ; Stroke* ; Urokinase-Type Plasminogen Activator*

The acute tumor lysis syndrome is an acute illness caused by massive cell lysis after chemotherapies. This syndrome is characterized by hyperuricemia, hyperphosphatemia with hypocalcemia and hyperkalemia. Among these electrolyte abnormalities, the most serious complication is the severe hyperphosphatemia (greater than 14mg/dL) that could result in sudden cardiac arrest or respiratory failure. In order to correct the severe hyperphosphatemia, hemodialysis has been used commonly as the renal replacement therapy . However the hemodialysis can make posthemodialysis serum phosphate rebounded unless the patient take this treatment for more than 6 hours. Therefore it is not sufficient to use hemodialysis treatment alone. To solve this problem, hemodialysis has been used with or replaced by the uninterrupted dialysis technique such as CRRT (continuous renal replacement therapy). We report a 33-year-old man with Burkitt lymphoma who showed severe hyperphosphatemia (peak phosphate value was 18.6mg/dL) during the course of chemotherapy. used with 5 day CAVH (continuous arteriovenous hemofiltration) his phosphate level could be maintained without any rebound. Therefore we concluded that CAVH in conjunction with hemodialysis would be a successful way to control severe hyperphosphatemia associated with tumor lysis syndrome.
Adult ; Burkitt Lymphoma ; Death, Sudden, Cardiac ; Dialysis ; Drug Therapy ; Hemofiltration* ; Humans ; Hyperkalemia ; Hyperphosphatemia* ; Hyperuricemia ; Hypocalcemia ; Renal Dialysis* ; Renal Replacement Therapy ; Respiratory Insufficiency ; Tumor Lysis Syndrome*

BACKGROUND: IL-1beta and IL-1 receptor antagonist (IL-1RN) genetic polymorphisms have been associated with development of gastric atrophy and increased risk of gastric carcinoma. This study aimed to determine the effects of these polymorphisms in gastroduodenal diseases. METHODS: This study population was comprised of 297 patients and they were grouped into gastritis, gastric ulcer, duodenal ulcer, and gastric cancer. We determined IL-1beta-511/-31/+3954 and IL-1RN genotype by polymerase chain reaction using gastric biopsy specimens. RESULTS: The genotype of IL-1beta-511 C/T, -31 T/C, +3954 C/C, and IL-1RN *1/*1 was predominant in all four groups. Allelic and genotypic frequencies of IL-1beta-511/-31/+3954 and IL-1RN showed no significant difference in four groups. IL-1beta-511 T/T, -31 C/C, +3954 C/T, and IL-1RN *2 carriers did not show increased risk of gastric ulcer, duodenal ulcer and gastric cancer. Classification of gastric cancer into intestinal and diffuse type also showed no significant difference of IL-1beta-511/-31/+3954 and IL-1RN genotypic frequencies. CONCLSUION: There was no significant difference of IL-1beta and IL-1RN polymorphisms between patients with gastritis, gastric ulcer, duodenal ulcer and gastric cancer. Therefore, other endogenous or exogenous factors will play more important role in the development of gastroduodenal diseases in Korean.
Atrophy ; Biopsy ; Classification ; Duodenal Ulcer ; Gastritis ; Genotype ; Humans ; Interleukin-1 ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Stomach Neoplasms ; Stomach Ulcer

In immunocompromised renal transplant patients, aspergillosis can be a life-threatening opportunistic infection. Aspergillus is a ubiquitous organism in our environment, so pulmonary aspergillosis usually results from the ingrowths of the colonized Aspergillus in bronchial trees, pulmonary cysts or cavities. We have experienced a case of endobronchial aspergillosis developed in a renal transplant patient with neutropenia. Bronchoscopic biopsy revealed a necrotizing Aspergillus bronchitis in the orifice of the lateral segmental bronchus of left upper lobe. The patient received total 2,760 mg intravenous liposomal amphotericin B. There was no endobronchial lesion on follow up bronchoscopy and biopsy was also negative. This case serves as a reminder to clinicians that Aspergillus should be kept in mind as a possible infectious organism in renal transplant patients.
Amphotericin B ; Aspergillosis* ; Aspergillus ; Biopsy ; Bronchi ; Bronchitis ; Bronchoscopy ; Colon ; Follow-Up Studies ; Humans ; Kidney Transplantation ; Neutropenia ; Opportunistic Infections ; Pulmonary Aspergillosis

The Streptococcus milleri group, which also includes S. anginosus, S. intermedius and S. constellatus, is found in the oropharynx, upper respiratory tract, gastrointestinal tract, and urogenital tract mucosa. Bacteria in the Streptococcus milleri group are associated with bacteremia and abscess formation. Most of the reports of of Streptococcus milleri group (SMG) infection occur in patients with underlying medical conditions. Predisposing factors that have been associated with S. milleri group empyema include mucosal disturbances (sinusitis, periodontal disease, enteric disease), preceding to pneumonia, thoracic surgery, malignancy, neurological disease, alcohol abuse, and also diabetes mellitus. We report on a 42-year-old man with mental retardation. He who suffered from dyspnea and a fever that he had developed for over 14 days. S. constellatus and anaerobic bacterias (Prevotella buccae and Micromonas micros) were cultured. The patient was treated with the drainage of pleural effusion and clindamycin and levofloxacin.
Abscess ; Adult ; Alcoholism ; Bacteremia ; Bacteria ; Bacteria, Anaerobic ; Cheek ; Clindamycin ; Diabetes Mellitus ; Drainage ; Dyspnea ; Empyema ; Fever ; Gastrointestinal Tract ; Humans ; Intellectual Disability ; Mucous Membrane ; Ofloxacin ; Oropharynx ; Periodontal Diseases ; Pleural Effusion ; Pneumonia ; Respiratory System ; Streptococcus ; Streptococcus constellatus ; Streptococcus milleri Group ; Thoracic Surgery