Focal brainstem encephalitis due to Herpes simplex virus if a very rare infectious disease, occurs with a frequent of 1-2 million population per year. A 3 years old girl is described with infection due to Herpes simplex virus causing brainstem encephalitis. The diagnosis was established by enzyme immunosorbent assays of the cerebrospinal fluid and serum which demonstrated antibody responsed to Herpes simplex virus. The clinicopathological features, radiological findings, laboratories and brainstem biopsies are discussed in the context of the literature.
Biopsy ; Brain Stem* ; Cerebrospinal Fluid ; Child, Preschool ; Communicable Diseases ; Diagnosis ; Encephalitis* ; Female ; Herpes Simplex* ; Humans ; Simplexvirus*

No abstract available.
Drug Therapy, Combination* ; Multiple Myeloma*

PURPOSE: Assess the appropriate level of electrocardiography (EKG) education that should be incorporated into the curriculum of emergency medical technician (EMT) students. METHODS: Consensus by EMT professors and emergency medicine specialists was obtained using two rounds of the Delphi survey. The questionnaire consisted of 70 items; 12 related to demographic information, 8 related to general interpretation of EKG, 26 related to interpretation of arrhythmia, 20 related interpretations of structural anomaly, infarction and systemic disease, and 4 related to interpretation of EKG findings used for advanced cardiac life support. We considered consensus to be agreement of greater than 7 of 9 (66.7%). RESULTS: 59 and 24 subjects were included in the first and second rounds of the Delphi survey, respectively. The response rate was 59% for the first round and 40.7% for the second round. Of 70 items, 40 items came to a consensus by the panel. All items related to interpretation of EKG and advanced cardiac life support and most (10 of 12) items related to basic content were felt to be important by both EMT professors and emergency medicine specialists. However, for items related to arrhythmia and related to structural anomaly, infarction and systemic disease, less than half of the items examined were felt to be necessary in the curriculum of EMT students (12 of 26 and 6 of 20). CONCLUSION: We identified 40 items that should be included into the EKG curriculum of EMT students. These findings should be used to create more effective educational programs for EMT students.
Advanced Cardiac Life Support ; Arrhythmias, Cardiac ; Consensus ; Curriculum ; Delphi Technique ; Electrocardiography ; Emergencies ; Emergency Medical Technicians ; Emergency Medicine ; Humans ; Infarction ; Porphyrins ; Surveys and Questionnaires ; Specialization

Internal carotid-posterior communicating artery aneurysms are frequently related to third nerve palsy which is reversible after the clipping of aneurysm. The authors had analyzed 61 cases in 52 patients who have posterior communicating artery aneurysm and evaluated the factors affecting the development of third nerve palsy and its recovery after clipping of the aneurysm. The results are followings 1) Oculomotor nerve palsy was noticed in 10 patients(16.4%) among 61 cases of posterior communicating artery aneurysm, of which 6 had complete and 4 had partial palsies. 2) Posteriolateral inferior direction of the aneurysm seemed to be closely related to the development of ophthalmoplegia. 3) Development of ophthalmoplegia was not related to the clinical status of the patient on admission, but to the amount of subarachnoid hemorrhage on initial CT scan and size of the aneurysm. 4) Preoperative degree of third nerve palsy and the timing of operation are not definitely related to the recovery of ophthalmoplegia. 5) The recovery of third nerve palsy are normalization of ptosis, normalization of EOM limitation and normalization of papillary change in order.
Aneurysm* ; Arteries* ; Humans ; Intracranial Aneurysm ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Ophthalmoplegia ; Paralysis ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

It is known that the prognosis of spontaneous SAH(subarachnoid hemorrhage) of undetermined cause is generally favorable. Yet, the natural history and pathogenesis of SAH of undetermined cause remain controversial and patients management is largely empirical. 42 cases of non-traumatic SAH of undetermined cause of a total of 415 cases of SAH treated during a 5-year period(1991-1996) were available for this study. What should be done when angiography is negative after SAH? This study was undertaken to present a more definitive management in preventing rebleeding after SAH of undetermined cause. This study show that explorative craniotomy for aneurysmal operation is warranted, despite negative cerebral panangiograms, if the patient manifests the classical signs and symptoms of SAH and definite subarachnoid blood in CT(computed tomogram) or direct lumbar puncture and any suspicious lesions in cerebral panangiography, particularly the AcoA(anterior communicating artery) region.
Aneurysm ; Angiography ; Craniotomy ; Humans ; Natural History ; Prognosis ; Spinal Puncture ; Subarachnoid Hemorrhage*

A retrospective clinical study was done on 78 cases of acute myocardial infarction admitted to Jeonje Presbyterian Medical Center from Jenuary 1972 to June 1982. The following results had been obtained. 1) The ratio of male to female patients with acute myocardial infarction was 3.9:1. Most patients were in the age group between the 6th and 7th decade(64%). 2) The number of patients admitted annually was about 8, and was increased 2.5 folds in the latter 5 years as compared with the first 5 years. 3) The most common past illnesses of patients with acute myocardial infarction were coronary insufficiency with angina pectoris, hypertension, previous myocardial infarction, diabetes mellitus, valvular heart disease and hyperthyroidism in order named. The patients without significant past illness amount to 41.0%. 4) Among the patients with acute myocardial infarction smokers were 1.9 times as many as non-smokers. 5) The chief complaints of the patients with acute myocardial infarction on admission were chest pain(60.3%), dyspnea(26.9%) and mental change(6.4%). 6) The distribution of the patients withacute myocardial infarction by Killip classification was as follows: Class I, 47.4%, class II, 16.7%, class III, 16.7% and class IV, 19.2%. 7) The most common location of acute myocardial infarction by EKG was anterior wall of the myocardium at 79.5%. 8) The patients with arrhythmia by EKG amount to 53.8% and conduction disturbance 20.5%. 9) The patients with acute myocardial infarction who expired during admission were 23%. The ratio of male to female was 2.6:1. Among the expired patients Killip class IV was 80.8% and anterior wall infarction was 77.8%.
Angina Pectoris ; Arrhythmias, Cardiac ; Classification ; Diabetes Mellitus ; Electrocardiography ; Female ; Heart Valve Diseases ; Humans ; Hypertension ; Hyperthyroidism ; Infarction ; Male ; Myocardial Infarction* ; Myocardium ; Protestantism ; Retrospective Studies ; Thorax

Benzoylureas are chemical compounds best known for their use as insecticides. Diflubenzuron is one of the more commonly used benzoylurea pesticides. Others include chlorfluazuron, flufenoxuron, hexaflumuron, and triflumuron. They act as insect growth regulators by inhibiting synthesis of chitin in the body of the insect. They have low toxicity in mammals because mammals have no chitin. Chlorfluazuron insecticides, which are mixed with solvent naphatha, are commonly used. Thus we assume that in the presented case mental change outcome of poisoning was connected with toxic effects of solvent naphtha rather than with chlorfluazuron action. Components of solvent naphtha, particularly trimethylbenzenes, exert strong irritant action on the gastric mucosa and are very well absorbed from the gastrointestinal tract. We report on a 67-year-old man with stuporous mentality after intentional ingestion of approximately 200 ml of liquid chlorfluazuron in a suicide attempt. He was discharged after conservative treatments including gastric irrigation, charcoal, mechanical ventilation, hydration, and antibiotics for aspiration pneumonia without complications.
Aged ; Anti-Bacterial Agents ; Charcoal ; Chitin ; Diflubenzuron ; Eating ; Gastric Lavage ; Gastric Mucosa ; Gastrointestinal Tract ; Humans ; Insecticides ; Insects ; Juvenile Hormones ; Mammals ; Pesticides ; Pneumonia, Aspiration ; Poisoning* ; Respiration, Artificial ; Stupor ; Suicide

Electrohydraulic lithotripsy (EHL) is a method used to breakup the stone by electric discharge in the presence of liquid medium. Recently we experienced a case of successful common bile duct stone removal after EHL during choledochoscopy via T-tube tract, which was the first case of EHL in biliary tract stone in Korea. A 65-year-old female patient was admitted to our hospital because of generalized pruritus after cholcystectomy with T-tube insertion. Obtained cholangiogram showed retained CBD stone which was implssible to remove by Dormian basket and tto dissolute by monooctanoin. After only one session of EHL, we can disintergrat CBD stone into several small pieces and removal of stone was easily done by Basket. After Small cut endoscopic sphincterotomy (EST) remained distal impacted stone was freely passed and control choledochoscopy and cholangiogram showed no remained stone. We think that EHL may be play a potential role in removal of biliary tract stones as in urinary tract stones.
Aged ; Biliary Tract ; Common Bile Duct ; Female ; Humans ; Korea ; Lithotripsy* ; Pruritus ; Sphincterotomy, Endoscopic ; Urinary Calculi

BACKGROUND: Cardiopulmonary exercise test is a useful test for the evaluation of the cardiovascular and respiratory systems. Obese subjects have an increased resting metabolic rate (VO2) compared to non-obese subjects and the increase is more marked during dynamic exercise, which results in the limitation of maximal exercise in obese subjects. In this study, the influence of the obesity and fat distribution on the maximal exercise capacity were evaluated. METHODS: Maximal exercise capacity was represented by maximam maximum oxygen uptake and VO2 max in the cardiopulmonary test. Obesity, total fat content and abdominal obesity(waist to hip ratio, WHR) were measured by bioelectrical impedence method. Total of 42 volunteers(male 22, female 20) were evaluated. RESULTS: 1) Weight to height ratio(mean±SD) was 110%±14.9% in men and 100±11.1% in women. 2) Fat ratio(mean±SD) was 23.3±5.2% in men and 27.55±3.9% in woman. 3) Waist to hip ratio(mean±SD) was 0.85±0.04 in men and 0.8±0.03 in woman. 4) In men, VO2max/min/Kg was negatively correlate with obesity, fat ratio, and abdominal fat distribution. 5) In woman, VO2max/Kg was negatively correlated with obesity and fat ratio, but did not show significant relationship with abdominal fat distribution. CONCLUSION: Obesity was a limiting factor for maximal exercise in both men and women. Abdominal obesity was a limiting factor for maximal exercise in men but its implication to women needs further evaluation.
Abdominal Fat ; Exercise Test* ; Female ; Hip ; Humans ; Male ; Obesity ; Obesity, Abdominal ; Oxygen ; Respiratory System

PURPOSE: The aim of this study was to evaluate the results of multiplex polymerase chain reaction (PCR) in patients with chronic pelvic pain syndrome (CPPS) and the significance of microorganisms as the causative factor of CPPS. MATERIALS AND METHODS: We evaluated the frequency of 19 possible causative microorganisms of prostatitis in 849 patients who had prostatitis symptoms from April 2007 to March 2009 by using multiplex PCR. All of the enrolled patients were category III by the definition of the NIH Chronic Prostatitis Workshop. RESULTS: Of the 849 patients, 414 (49%) and 435 (51%) were categories IIIa (inflammatory CPPS) and IIIb (noninflammatory CPPS). On multiplex PCR, using the third voided urine specimen (VB3), 369 (89%) of the 414 category IIIa and 367 (84%) of the 435 category IIIb cases were found to have positive PCR results for causative microorganisms. The common microorganisms were Enterococcus, Ureaplasma urealyticum, Lactobacillus, Streptococcus agalactiae, and Chlamydia trachomatis in 173 (18%), 144 (15%), 129 (13%), 78 (8%), and 69 cases (7%), respectively. CONCLUSIONS: There were too many positive PCR results for causative microorganisms in the CPPS patients despite negative urine culture examination. Therefore, it is necessary to rule out contamination of the specimen to achieve reliable results with multiplex PCR. However, multiplex PCR can detect various unknown microorganisms suggestive of the etiology of CPPS, particularly those that are difficult to cultivate. PCR is expected to play an important role in the diagnosis of CPPS, but further studies will be required to define the usefulness of molecular tests.
Chlamydia trachomatis ; Enterococcus ; Humans ; Lactobacillus ; Multiplex Polymerase Chain Reaction ; Pelvic Pain ; Polymerase Chain Reaction ; Prostatitis ; Streptococcus agalactiae ; Ureaplasma urealyticum